1667NOTE:
With proper -validation
this form constitutes an
F"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
2/5/93
LOCATION OF CONSTRUCTION
Subdivision Improvement Permit — Class II I
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION 1AG BLADE Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
1,
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:
ROUTE TAWICO S WASHINGTON
MVE TO N. WASHINGTON OUT—
SIDE CITY LT!'lITS
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 propeety
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.
OF
1 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.
t
Signature of Applicant or Agent
GRANITE CONST CO PO BOX 9011 PAIR DESERT, CA 92255 775-,8302
Name of Applicant (please print) Business Address Telephone No.
0 Fo X
Name of Contractor and Job Foreman Business Address Telephone No.
6,%A PLC 0A1 F16C
Contractor's License No. City Business License No.
Fkf
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 VALIDATION
PERMIT N0. 1667
DATE APPROVED
2/5/93
EXPIRATION DATE2/8/93
DATE ISSUED 2/5/93
By
A ministrative Authority
TELEPHONE: (619) 564-2246