1614.,� NOTE:
47ith 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: November 30, 1992
LOCATION OF CONSTRUCTION
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
' X
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION NOVe 11012ment Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Grinder, 10' Wide*
84.000 lbs, all also legal
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)
In consideration of the granting of this permit, the applicant hereby agrees to:
Haul Route: 52 at City Limits to
Washington and to Tampico.
Haul Date: 11/30/92
Indemnify, defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and all
4
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 resultofthis %wok..
i { N �"'\ll LA ci
i
Signature of Applicant or Agent
Granite Construction Cotpany P.O. Box 9011 palm Desert, CA 92255 775-8302
Name of Applicant (please print) Business Address Telephone No.
Same
Name of Contractor and Job Foreman Business Address Telephone No.
On File On File
Contractor's License No. City Business License No.
On Vise On File
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
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
10.00
$ 10.00
Received by Date
PERMIT VALIDATION
PERMIT NO. 1614
DATE APPROVED 11/30/92
EXPIRATION DATE 11/30/92
DATE ISSUED 11/30/92
By
1 Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
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