1678OTE:•
With proper validation
this form constitutes an
j:encroachment permit
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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
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DATE: February 26; 1993
LOCATION OF CONSTRUCTION
Subdivision Improvement Permit — Class II I
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Equipment Move Sketch (attach construction plans if appropriate)
DESCF�Ipp:T1QN CONST UCTION Grinder, 10. wide. Haul Route: Avenue 32 from Washington
, W4;vQv bs, al also Legal. to City Limits
,•DIMENSION OF INSTALLATION OR REMOVAL +
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SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL -BEGIN
, 4
Haul Dates 2/26/93
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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 a d 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.
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Notify the Administrative Authority at least twenty-four (24)hoursin 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 A01mAnt or Agent,
Granite Construction P.O. Snx 9011 P^lm Dwawrt:a-CA 97255 228-8302•
Name of Applicant (please print) Business Address Telephone No.
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Sam*
Name of,Contractor and Job Foreman Business Address Telephone No.
On Fixe On File
Contractor's License No. R� ,City Business License No.
On File 4� On File
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I II
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 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 10.00
Receipt No.
Received by Date
Recorded by
M
1
PERMIT VALIDATION
PERMIT NO. 1678
'DATE APPROVED 2/26/93
EXPIRATION DATE 2/26/93
DA E ISSUED 2/26/93
By
Administrative Authority
TELEPHONE: (619) 564-2246
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