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With proper validation�
y•
.this form constitutes
an
`.�'CITY OF A QUINTA-it encroachm nt permit
APPLICATION FOR PERMIT-
PUBLIC
ERMITPUBLIC 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 ll I
4 -2G- q3
• DATE:- 4;64M Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Move Equipment
(Street address or Description of Location) "
PURPOSE OF CONSTRUCTION Move Equipment Sketch. (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION MOVE Koryiia17SCk ROUTES 50th from. Jefferson to
11 " q " w I I_lC LE 6AL H I G HI 140, 0 00" LBS Eisenhower to Tampico
DIMENSION OF INSTALLATION OR REMOVAL Date: 4/27/93
SIZE OF'EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION '
ESTIMATED CONSTRUCTION COST $ f
(Including removal of all obstruction, materials; and debris, backfilling, comm ."
paction' and placing permanent resurfacing and/or replacing improvement
In consideration of the granting of this permit, the.applicant hereby agrees to:
Indemnify, -defend and save the Ciiy;'its authorized agents, officers,.representatives and employees, harmless from and against any and all
penalties, liabilities or loss resulting from claims or court action aril arising out of any accident, loss or damage to persons or property
` happening or occurring as a proximate result ofany 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'WA
Signature of Applicant or Agent`•
Granite Construction Co PO Box 9011 Palm Dat�ar.lt, CA 99954 775=8302.
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business. Address Telephone No.
On File Oa�Bils
Contractor's: License NO., " `; ' City Business License No.
Applicant's Insurance Company, Policy Number' La ;
i ;FEES: Subdivision.Improyemeni Permit ` ,Class I I I
t� "J.
Public improvements. 3%' of estimated construction costs''= ,
Private ,improvements: 3% of estimated' construction, costs '
Minor.I1mprovement Permit — Class'IV: See attached schedule `^t ; c ! • ��
Inspection Fee .PERMIT•.VALIDATION
Permit Fee 10.00 1724 } r.
PERMIT NO.
Penalty '~-4/26/93
Cash Deposit -Surety Bond. :DATE APPROVED
;
if required EXPIRATION DATE 4/27./93
TOTAL: ! $ 10.00 4/26/93
'DATE ISSUED
Receipt No. B Y b,
Received by Date' Administrative Authority
�.. Recorded by TELEPHONE: (619) 564-2246
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