1641sr
!NOTE:
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
i1l_1114
December 31, 1992
LOCATION OF CONSTRUCTION
Subdivision Improvement Permit —Class I I I
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Move Equipment Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION 14G Blade, 151 high, Haul Route: 52nd at City Limits to
10'6" wide, 84,000 lbs.
. - Washington Street to Tampico
DIMENSION OF INSTALLATION OR REMOVAL Haul Date: 12/31/92
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.
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 Applicant or A ent
Granite Construction Company P.O. Boat 9011 Palm Desert, CA 92255 7758302
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
On File On File c, 11,
Contractor's License No. City Busi+e's��r�L�eense N, .
On File 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 VALIDATION
Permit Fee a,0.00 PERMIT NO. 1641
Penalty 12/31/92
Cash Deposit -Surety Bond DATE APPROVED .
if required EXPIRATION DATE 12/31/92
TOTAL:. $ �'00 DA 12/31/92
E ISSUED
Receipt No. By
Received by Date S Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
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