1939w
,'410TE:
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: October 21, 1993
LOCATION OF CONSTRUCTION
Subdivision Improvement Permit — Class I II
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Move. Equipment Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION D -8L with Rlade
15' H x 14'6" W. Approximately 150.000 to Haul Routes Washington Street at
15' H lbs bridge north of 111 to 48th and left
on 48th to end.
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
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:
Haul Dates 10/21/93
PILOT, CAR REQUIRED
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.
'AA QX
Signature of ANZcant or Age
Granite Construction P.O. Box 9011 Palm Desert, CA 92255 775-8302
Name of Applicant (please print) Business Address Telephone No.
Same
Name of Contractor and Job Foreman Business Address Telephone No.
On File
Contractor's License No.
On File
On File
City Business License No.
On File
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class 111
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
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
10.00
$ 10.00
Received by Date
i99
PERMIT VALIDATION
PERMIT NO. 1939
DATE APPROVED 10/21/93
EXPIRATION DATE 10/22/93
DATE ISSUED 10/21/93
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
OCT -2 1 —93 THU 1=0 : 33 t Cir mac P . 02
NOTE:
With progfr Validation -
thd form con"Ituua in
enalrMahnWrit perrhlt CITY Of LA {QUINTA
APPLICATION FOR PERMIT
'PUBLIC WORKS CONSTRUCTION (ENCROACIiMEN I
For the wntvuttion of 1AM44 or prwou Corps, dPlyfwfW
and other like ou0lia worse Improvamrnq In Cpnn MOA With'MiNOR IM A�QYEMENTS anIdWswalksp IAPPI�4Vi1D SIJ V 8 "Ins
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LOCATION OF CONSTRUCTION Mlrwr Improvement Permit Clue IV
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PURPOSE OF CONSTRUCTION
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,COMPANY NAME : FAX. NO:
FROM:
PAGE 1 OF
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IF YOU EXPkRIENCE ANY DIFFICULTIES FROM FACSIMILE (619) 342-7504, PLEASE
'CONTACT SENDER AT (619) 775-8302.
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Palm Springs branch
P.O, box 9011
Palm Dctcrt U "95M11
K om 619/3604500
FAX 619/3604570
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