1931_ r
NOTE:
tWith proper validation
form constitutes an
encroachment permit
CITY OF LA QUINTA
APPLICATION FOR PERMIT If
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: 10/15/93
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION MOVE EQ
DESCRIPTION OF CONSTRUCTION 824 DOZER
DIMENSION OF INSTALLATION OR REMOVAL 14' WIDE,
151H, 110,000 LBS
SIZE OF EXCAVATION, IF NEEDED
Subdivision Improvement Permit — Class II I
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
HAUL ROUTE: WASHINGTON AND
EISSMOWER TO NORTH CITY LIISITS
ON WASHINGTON.
NO NDVE BEFORE 9:00 AN.
HAUL DATE: 10/18/93
APPROXIMATE TIME WHEN WORK WILL BEGIN 10/18/93
PILOT CAR UQUIRED.
APPROXIMATE TIME OF COMPLETION 10/18/93
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 work.
C. /6,
Signature of Applican or Agent
GRANITE CONSTRUCTION CO. P.O. BOT 9011, PALM DESERT, CA 775-8302
Name of Applicant (please print) Business Address Telephone No.
SAME
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:
Receipt No.
$ 10.00
Received by Date
431
PERMIT VALIDATION
PERMIT NO. 1931
DATE APPROVED 10/15/93
EXPIRATION DATE 10/18/93
DATE ISSUED 10/15/93
By
Administrate Authority
Recorded by 11 TELEPHONE: (619) 564-2246
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