1585Ntr ,E:
Witty proper validation
this form constitutes an
encroachment permit
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
DATE
October 27. 1992
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION Grinder 10 nide
801000 wt. all else lapl
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
Subdivision Improvement Permit —'Class I I I
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
Naski"ton from Fred Waring to Tampico
Date 10-2842
In consideration of the granting of this permit, the applicant hereby agrees to:
Indemnify, -defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and all
j
penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage to persons or property
happening or occurring as a proximate result of any work undertaken under the permit granted pursuant to this application.
Notify the Administrative Authority at least twenty-four (24) hours in advance of the time when work will be started.
Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result of this work.
Signature of Applicant or Agen� ,
Granite 011111mliatraction 775-8502
Name of Applicant (please print) Business Address Telephone No.
P.O. soot 9011 Pala Desert, California 92755
Name of Contractor and Job Foreman Business Address Telephone No.
O tj �7 11 .,- N�: 1
Contractor's License No. City Business License No.
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I I I
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 10.00
Receipt No.
Received by Date
Recorded by
WN1
PERMIT VALIDATION
1585
PERMIT NO
DATE APPROVED
EXPIRATION DATE
10-27-92
10-28-92
DATE ISSUED 10-27-92
By-�.L
Administrative Authority
TELEPHONE: (619) 564-2246
OCT -27-92 TUE 1 4 - 09 I MR'ER I AI_ BLLG — CAT, - C I TY P . 02
the kmm tmvvWft ar+
CITY of tea t]UINTA
APPLICATION FOR PERMIT
PUBCIC WORKS CONSMUCTIOM IENCRO&CHMENT►
For the a1CrLet�uc-oma Q+1 ort?!re of ptmu gums, gir�vr►A. Wrel+y.rb, A+gsrv9 tt1; PafSsrnq bta. Mr+era.
anp otnor aka "'c t> b+v+nm+ria m dpnf.ocaan arm b11NOR IMPROVEMENTS and APPROVEb ttnuur Wake
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�.IaDIVIvtrIoNs
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PURPOSE Of CONrmLiwrTION
cn
DIMENSION OF INSTALtAT1ON. R REMOVAL
SIZE OF EXCAVATION. OF NEEDED
IIPPROXNrATE TIME JMLN *OAK WILL BEGIN
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APPROXIMATE TJMf GF COMisLUnON
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TOTAL
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PERMIT VALIDATION
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DAT'f ok"ROVED
E.YCPJRATION DATt
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