1649N(fTET
`V th 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 I II
DATE: January 13, 19943 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
. i
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Move w4ulpment Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION 623 E Scraper Haul Routa: Washington & Tampico to
15'6" hitch, 11'10" Wide, 120,000 lba Highvay 111
Haul Date: 1/13/93
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION r
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.
I
Signature of Ap nt or Agen
Granite Construction Company Poo. Box 9011 Palm Desert, CA 92255 775-8302
Name of Applicant (please print) Business Address Telephone No.
Same as alcove ��M4 -) l -S -'S 3 S 3
Name of Contractor and Job Foreman Business Address Telephone No.
Oa Pile On stile
Contractor's License No. City Business License No.
On Bile On Vile
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 $
„::tW _, . _ 10.00
Permit Fee
a
Penalty
Cash Deposit -Surety Bond
if required
I
TOTAL: $ 10.00
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO. 1649
DATE APPROVED 1/13/93
EXPIRATION DATE 1/13/93
DATE ISSUED 1/13/93
By
Administrative Authority
TELEPHONE: (619) 564-2246
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