1916NOTE:
ITith proper validation v
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) ,
L ,
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 II I
DATE: 10/8/93 /Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 1
(Street address or Description of Location) l
PURPOSE OF CONSTRUCTION'
DESCRIPTION OF CONSTRUCTION GRINDBB 10' WIDE 0
84,000 LES ALL ELSE LEGAL
DIMENSION OF INSTALLATION OR REMOVAL
Sketch (attach construction plans if appropriate)
J �w
SIZE OF EXCAVATION, IF NEEDED `f HAUL DAt'8: 10/11/93
I I . W r,
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ X
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent 'resurfacing and/or replacing improvements) f .a rLLc d fL c")
In consideration of the granting of this permit, the applicant hereby agrees to:
ROUTE: AVENDE 50TH BETWEEN
EISENHOWER AND WASHINGTON
NORTH ON WASHINGTON TO
HIGHWAY 111
APPROXIMATE TIME WHEN WORK WILL BEGIN
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.
h/r7
Signature of Appl icanS or Agent
GRANITE CONSTRUCTION P.O. BOB 9011, PAIA DESERS, CA 92255 775-8302
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
ON FILE
Contractor's License No.
ON FM
City Business License No.
ON Mx 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:
Receipt No.
Received by
Recorded by
$ 10.00
Date
716
PERMIT VALIDATION
PERMIT NO. 1916
DATE APPROVED 10/8/93
EXPIRATION ATE 10/11/93
DAT ISSU D -10/8/93
By
TELEPHONE: (619) 564-2246
0
strative Authority
ww%4Will Wr LpNSTRUCTION ""M ww4vn3vn% rermrt trim IV
N
I>:t►eet his � �MlhMl.� ... A ��.. _ .
•PURPOSt OF CONSTRUCTION
DfSC1I'T[ON OF,CONsTRucTljnlu G.,r. .
DIMENSION OF IN'S-'ALLATION OR REMOVAL
SI2E OF EXCAVATION, IF NEEDED
APPRC1fXIMATE TIMS WHEN WORK WILL BEGIN
APPROXIMATE TIMI OF COMPLETION
ESTIMATED I! Ajuvroi
„,��lettrtob aOhstructlOn plans if eplllrwria w)
'e-0 19
40 t 11.1 .
ION cOsr s
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r"wfeefng and/orp�Gn IpirA���I cam ��i
In cosidefstion of the 4rrintinq of thh 9�
portttli, the tipplicent hltrby Alto$ to:
tAOrn�Aih, defend ann sev� the GtY, itt Mnvlonitgd
plop tas, iti0i{itimp M dyM oRAMItM� !rp/r1 !Jalmt et dun eCt,pn ' ret++tl�sntet+vst eta Otrt{ll4y . haft
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�^M�Y "M all APPA"Us ory Of0j Aw. tlla o+ ate It" WAen tvpttt VAO be
Qwlaw. and to Ow for OWN eddltlo w o and �nd►tiaM of %h4 tonn4 Aft NO 4001 twbl4 rylp � niN��Ot11 of t}n City Of
"OWM01V rut *1 e1orlt of Mfg woftt.
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t-�pl
8u>Iirwra i+
l e Ono No.
fitetfie of CohtrectOr ono Job Forema t
�inei; �ddreq
TefephowNd—
Contrrlt tors LicMa No.
Appljq is Iniull<, ,t" Awn...,...
FEES: SuOOwlslOn lrnprOvWnrtAt Permit � Cfis, I II
Public irnprovmfrwpbc 3% of 60171404 cnnatturtlon 04:UPriv;U improYerrlOraq: 3% of Istirtleted doottruaban cost$
Mtngr Ifiprovilment Permit - Class IV! Sae a
ttllched tChed4le
InslkctroA f:ee
Psrrmlt Fre
pfewty
Cal4 ollpettt-surety BV4
O required
TOTAL;
R�iPt No.
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Received, by Date
Avvorofrq by
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City 6soR;t�e�; Llcenw No.
Polled Nurntwr'
PERMIT VALIDATION
PERMIT NO.
DATE AAPROVEO 0 ' 8 - G --3
EXPIRATION OATI:._ I n 3
DATE ISSUED
ey
Adrninfstriitiv+ Authority
TE�EpMONf:: IB4lI St34.24�8
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CITY Of O..A QUINTA
APPLICATION FOR PERMIT
'PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For the oonmuaioA or "Is or privacg
y e
ioMPYMISUB� �6naM #VW like public via*$mCommon mol lOqRQiNTffiorW Appno go �Itii$iNS
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