1945NbTE:
,%Nith proper validation
s 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
Subdivision Improvement Permit— Class III
DATE: 10/27/93 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION MVB EQT
DESCRIPTION OF CONSTRUCTION S 101W
84,000 LBS, ALL ELSE LEGAL
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Sketch (attach construction plans if appropriate)
EAUL ROUTE: STAB? AT AVE = 50
AND EISENHOWER TO CITY LIMITS
ON AVENUE 50
HAUL DATE: 10/27/93
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:
1 Indemnify, defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and all
I j
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 ofthiswork.
Signature of Applicant or Agent
GRMTE CONSTRUCTION P.O. BOB 9011, PALL[ DESERT, CA 92255 (619) 775-8302
Name of Applicant (please print) Business Address Telephone No.
SAME
Name of Contractor and Job Foreman Business Address
ON FM
Contractor's License No.
Telephone No.
ON FM
City Business License No.
ON FILE ON FILE
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I I I
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
f►�i11Li�
Receipt No.
$ 10.00
Received by Date
1,945
PERMIT VALIDATION `
I'
PERMIT NO. 1945
DATE APPROVED 10/27/93
EXPIRATION DATE 10/27/93
DATE IS•UED 10/27/93
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
A f,
d
r—
N9TE:
With proper validation
this form constitutes an CITY OF LA QUINTA 3
i�;�roachment permit APPLICATION FOR PERMIT TI'
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
Subdivision Improvement Permit — Class I I I
DATE: 10 ;L_7 el Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTIO
DIMENSIUN OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Sketch (attach construction plans if appropriate)
0
L) Qom- So
io / ai'9 b- -
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 work.
Signature of Ap licant or Agent 2
qcol
Narue
of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
"k.A— L—
Contractor's License No. City Busine s License No.
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 1936
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: .
Receipt No.
Received by
Recorded by
$ l0
Date
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED 10 q
EXPIRATION DATE O a�
DATE ISSUED O / 0�7 / q B
By
Administrative Authority
TELEPHONE: (619) 564-2246
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