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1634:f proper.valldatlon t - ' 3 form constitutes an encroachment permit - CITY OF. LA QUINTA K 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 III %DATE: DaCember 1$, 1992 Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION 4 (Street address or Description of Location) i �i0V8 EgUipmleilt PURPOSE OF CONSTRUCTION ` Sketch (attach construction plans if appropriate) DESCRIPTION OF.CONSTRUCTION 623 -Scraper, 151 High, 11aul Route: Tampico at4 waehington N 11'10" wide, 120000 lbs north out of City Limits., f. DIMENSION OF INSTALLATION OR 'REMOVAL Haul Date: 12/21/92 SIZE'OF EXCAVATION, IF NEEDED,4. 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 improverq4nts) Inrconsideration 0f1the granting of this permit, the applicant hereby agrees to: Indemnify, -defend and save the City, its authorized agents, officers, representaties 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, Iosslor damage to persons or property happening or occurring as'a proximate result of any work undertaken under the permit granted pursuant to this application. f` ' Notify'the'Administrative�Authority 'at least twenty four (24) hours in advance of the time when work will be started. ComplyVwith allhapplicable 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. i Signature of Ap'kgajit or Agent Granite Construct4ou Company P.O. Boa 9011 Palm Aeairt, C© 92255 775-8302 Name of Applicant (please print) Business Address Telephone No. SS 3 Name of Contractor and Job -Foreman Business Address Telephone No. = -` 0n File . On. Pile "' y r Contracto'r's. License No. ' ` City Business License No. 'On_File - On File ti 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 t Inspection Fee Permit Fee 10.00 Penalty Cash Deposit -Surety Bond if required TOTAL: $ 10.00 Receipt No Received by Recorded by Date 1`ti4 PERMIT VALIDATION PERMIT NO. 1634 DATE APPROVED 12/18/92 EXPIRATION DATE 12/21/92 DATE ISSUED 12/18/92 By— Adm y Administrative Authority TELEPHONE: (619) 564-2246 i. h +►►rs'►V9 �H�1 'I1r01`4[�'11.1 _. 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