1775NOTE:
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
DATE
6/25/93
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Move Equipment
DESCRIPTION OF CONSTRUCTION Excavator 11'10" Wide,
15' High, 80' Lona, 140,000 lbs
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Subdivision Improvement Permit — Class I II
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
Route: Tampico & Washington to
50th out of La Quanta
City Limits
Haul Dates 6/25/93
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 7ork.
T NI A C-jRA(_f,
Signature of Applicant or Agent
Granite Construction PO Box 9011 Palm Desert 775-8302
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
On File On File
Contractor's License No. City Business License No.
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 Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 10.00
Receipt No.
Received by Date
PERMIT VALIDATION
1775
PERMIT NO.
DATE APPROVED 6/25/9$
EXPIRATION DATE 6/25/93
DATE ISSUED 6/25/93
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
With proper validation
this form constitutes an _ CITY OF LA C><UINTA lalk
enaroaohment Permit APPLICATION FC iM PERMIT
PUSL.IC WORKS CONS_rRUCTION (ENCRC)^CHMEN7)
Por the construction of public or private curbe, driveways, pavements, sidewalks, parking lots, sowers, water mains
and other like public works Improvements In conneotlon with MINOR IMPROVEMENTS and APPROVED SUBC(VISIONS
DATE: 6/25./93
LOCATION OF CONSTRUCTION
Subdivision Improvement Permit - Class 111
Minor Improvement Permit Claes IV
(etrest address or Casoriptlon of Leaatlen)
PURPOSE OF CONSTRUCTION ' on - eti'1.nmmt+a - - Skotch (attach construction plans If appropriate)
DESCRIPTION OF CONSTRUCTION "�"^'����' t 1 • t [z•• V+.3.a _ Rout®a Tatav Lca &.9
ca
Hiatt 80 • t 4C _nOtl 7b.a - _ Stich 4u£ oP La• Quint®
City Llmito
o1MENSiON OF INSTALLATION OR RPMOVAL Haul Daltas 6/25/93
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK %NILL BEGIN
APPROXIMATE TIME OF COMPLETION - - -
BSTiMATEO CONSTRUCTION COST S - -- -
(Including removal of all obstructlon, materials, and debris, backfilling, com-
peotlon ant( placing permanent resurfacing and/or replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrees to:
Indsrnnifv..dsfend and sove the Clty, Ito, authorisad aga.nts, offlears; reprosentstivs. and smpley sss, harm1006 frem and against env and ■II
pOnoltlo., Ilabllltlas or los. moulting from clslms er. ours action and &rising out or anv ...idem, loss or darnega to persona or prop."V
heppanlna or occurring as a Primate rosult of any work unoartakan under cho permit granted pursuant to this sppllostlon.
NotlfY the Adminl.trativ0 Authority et IOast —.*nw-four (i,a) h=-" in edvsn0& Of Che time when -k will be started.
Comply with all apP1100bia CItY d"rdina nCo.r the terms and ass nditle ns et the permit end all applloebls rule. end regulstlena of aha CAW of
L.a Gulntm and to paV for any additional roplacsmsnt nsoss.ary as %no result of thlo work.
N A C7�.1°tGtT y
Signature of Applicant or Agent
Gr ttiC� Cones r �t1on_ Po H
On I + IPt r 779—B3D2 — __
Name of Applicant (please print)- Business Addrass Telephone No.
Name of Contractor and Job Foremen sualnoss Address Telephone No.
CrL Fila. _,— rt••
Contractor's License No. r City Business License No.
On Fila On Fy '1 ® --
Applicant's Insurance CompanY Polley Number
Pees/ Subdivision Improvement Permit - Class III
Public Improvements: 3% cf estimated aonetruatlon costo
Private Improvements: 396 of estimated construction costs
Minor Improvement Permit - Class IV_; See attached schedule 177 `D
Inspection Fee 4 i PURMIT VALIOATICAN
Permit Fee _.._��s��C PERMIT NO. 1775
Penalty DATe APPROVLo fizz /03
TRANSMISSION. REPORT
THIS DOCUMENT . (REDUCED
WAS SENT
** COUNT **
><** SEND ***
SAMPLE ABOVE)
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REMOTE STATION I.D.
START TIME.
DURATION
#PAGES
COMMENT
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7143427504
5-25-93 9:54AM
1'12"
1
TOTAL 0.01'12" 1
XEROX TELECOPIER 7020
-TU-.fiA-2S-93 FR I 9: 22 t CL t- mo_c- P. 0 1
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TO* i7i✓ Ile,+ DATE:
COMPANY NAME: / 1 FAX NO:
FROM: �/'!�!// � FAXED BY:
PAGE 1 OF --
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1F YOU EXPERIENCE ANY DIFFICULTIES FROM FACSIMILE (619) 342-7504, PLEASE
CONTACT SENDER AT (619) 775-8302:
Palm SprinSs Branch
P.O. Box 9011
Palm Deurt, U 94455-9011
9twne 619/360.4500
FAX 619 / 360.4570
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