1618NOTE:
.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
� _, DATE: December 29 1992
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Move Ecuioment
DESCRIPTION OF CONSTRUCTION Paver. 111611 wide.
84,000 lbs, all else 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-
action and lacin ermanent resurfacin a d/ re lacin im r vements)
Subdivision Improvement Permit— Class III
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
Haul Route: 'Washington from Tampico
to Eisenhower to Fernando to San
Timoteo Street
Haul Date: 12/3/92
p p g p g n or p g p o
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.
Signature of Appl'i�ant or Agent
Granite Construction Company P.O. Bos 9011 Palm Desert, CA 92255 775-8302
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
On File On File
Contractor's License No. City Business License No.
On File
On File
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
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
10.00
$ 10.00
Received by Date
Recorded by
PERMIT NO.
PERMIT VALIDATION
1618
DATE APPROVED
12/2/92
EXPIRATION DATE 12/3/92
DATE ISSUED , 12/2/92
By
Administrative Authority
TELEPHONE: (619) 564-2246
Art
Ig
fit s .
c
er
z Q
IX
mc
Z Lai
— 996 ; Or 96
D z CC
Ir 0 E C)
N6 0
IL
96
ac
0 =
Lu
ac
co
cl
i ? 4L
s AL
Lr
b us
do
0 tn
41
to I
A aw a s