1603N-01,if:
With proper validation .
this form constitutes an CITY OF LA QUINTA
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 II I
DATE: November' 16;. 1992 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTJQN OF COt�ST'RUCTION 14 G Blade Route Tampico and Washington to
15 High, 10 6 wide X#j 40,UUOWeight 52nd and east out of City limits
Legal -
DIMENSION OF`INSTALLATION OR REMOVAL
SIZE OF EXCAVATION,'1F NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(Including removal of'all'obstruction,•materials, and debris, backfilling, com- Date November 17, 1992
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.
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.
' VLa- A
Signature of Applicant or Agent
Granite Cdnstruction 1-55-0-202
Name of Applicant (please print)' Business Address Telephone No.
P.O. Box. 9011 Plam Desert, CA 92255
Name of Contractor and Job Foreman Business Address Telephone No.
on File,, _ On File
- Contractor's License No..
City Business License No.
on V4 1,a
Applicant's. Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class 111'
Publi6lmprovements: 3% of estimated construction costs
�. Private improvements: 3% of estimated construction costs
Minor ImprovementPermit — Class IV: See attached schedule [i3
Inspection Fee $
Permit Fee 10.00
.,- Penalty
Cash Deposit -Surety Bond
'if required
TOTAL:
Receipt No.
�. Received by
$ 10.00
Date
: Recorded by
PERMIT VALIDATION
PERMIT NO. 1603
-
DATE APPROVED 11/16/92
11/17/92
EXPIRATION DATE
1.1/16/92
DATE ISSUED
��...�By
Administrative Authority.
TELEPHONE: (619) 564-2246
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