1588'�
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With proper validation 4
this form constitutes an CITY OF LA QUINTA
k encroachment permit
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
Subdivision Improvement Permit —Class I I I
DATE: October 29. 1492 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
Mws
PURPOSE OF CONSTRUCTION i�QUil>'tallt Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Barber Orson Faver Haul .Houtst Sonora to Eisenhower to
108" wide. -84.000 lba.'all alta laical Washington to X 10.
1
r
DIMENSION OF INSTALLATION OR REMOVAL -Hua Datot 10/29/92
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)
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
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.
r 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 Quint; and to pay for any additional replacement necessary as the result of this work.
Signature of �Ap licant or Arpt+
./
Granite Construction Gotmanq P.O. Boa 9011 Pals Deserts CA 42255' 7.75""-8327`',
Name of Applicant (please print)' Business Address Telephone No.
Fax 773-8395
Name of Contractor and Job Foreman. Business Address Telephone No.
On Fila On File '
Contractor's License No. City Business License No.
Ott rile On File t
Applicant's Insurance Company Policy Number
FEES:. Subdivision Improvement Permit — Class III
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
1588
PERMIT VALIDATION
PERMIT NO. 15$8
DATE APPROVED 10/29/92
EXPIRATION DATE 10/29/92
DATE ISSUED \10%29/92
By 'e�4AA1/
r�Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
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