1950NOTE:
.With proper validation
lihis form constitutes an
encroachment permit
CITY OF LA QUINTA
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: 11/1/93
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION ROVE EQ
UIPKW
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
DESCRIPTION OF CONSTRUCTION 623 SCRAPER 151H, 11 10" W
120,000 LBS
DIMENSION OF INSTALLATION OR REMOVAL
Sketch (attach construction plans if appropriate)
HAUL ROUTE= HWY 111 AND
WASHINGTON STREET HEADING
NORTH ON WASHINGTON TO
LA QUTATA CITY CINITS
SIZE OF EXCAVATION, IF NEEDED HAIR. DATE: 11/1/93
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:
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 Applicant or Agent
GRANITE CONSTRUCTION P.O. BOBE9011, PALM DESERT, CA 775-8327
Name of Applicant (please print)
Business Address
Telephone No.
SAM
Name of Contractor and Job Foreman Business Address Telephone No.
ON FII.B
Contractor's License No.
ON PII.E
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.
Received by
Recorded by
$ 10.00
Date
PERMIT NO.
Sou
PERMIT VALIDATION
1950
DATE APPROVED 11/1/93
EXPIRATION DATE
11/1/93
DATE ISS ED 1/1/93
By
6v 2/.-,
Administrative Authority
TELEPHONE: (619) 564-2246
1
GRANITE CONSTR. CO. 6199220159
NOTES
With nova validation
this forth oo:►rtitutst an
endraahment oortnit CITY OF LA QUINTA
APPLICATION FOR PERMIT
P
US`IC WORKS CONSTRUCTION rIENCROACHmaNT!
Fat the aoriMuetion Of public; Or Qrtvate curOs, _
ar+d other Ilko pt+biie works arc,on w � MINER IMPROV MitJ�T'�t and, APPItOV� waw
tmprevententl in eonrti mains
I lo SQ sUBOnrlaloNs
DATE: _ — SubdlvWon Imvrovmnwnt Permit — Clan III
LOCATION OF CONSTRUCTION Mirror Irnprovemont Potmit Clava IV
tfit►set eedreto er Q*M tion a mal
P.02
PURPOSE OF CONSTRUCTION
DESC IPTION OF CONSTRUgIQN
01MENSlON OR I TALLATION OR REMOVAL;
SIZE OF EXCAVATION, IF NEEDED
ANAQXIMATIJ TIME WHEN WORK WILL OEOIN
APPROXIMATE TIiM$ OF COMPLETION
ESTIMATED CONSTRUCTION COST i
(Ifleludirtq jemawai of all Obstruct ons materials, and debris, baobtiili
04fton and piaGnq pefR+eMnt rescam
urfadnq and/Or ropbstnq imorovem/ ents)
In Go"Cofation of the OMntinq at thia Dermas thea t'
w��{attar Oftumetion plans it 800wiatel
L g
-ted err ��
c� ..
01 4,K4
pp IWt horn* aOraft tO:
Inglammh, defend one eew► the oily, its er1hon=
oo N►a Iitiu M IOM tMiurq freer C�1l/!i � 4 � egtMgnqtnee ew !carts olr6
iMf eritine ort ofd eooci fit. Mani 46.M am sow 111
fy o®W1Mey M er�ererwtoe H1tt1t of Inv ueorr r , etw tiOeedOrtt. lace pr aart eke to gapry eP OreOeeq
AlaslfV the AdMAiViNtift Aeether9ry K meet rnger trio eamit ereetw purw 0 to trill oto Do 1M.
+pr wnm ell tae �tvdlwr 1241 hetet 1e •�+o of the tubo when woett watt d g apali,
V Who aw to +w �~ Ondutenoss, the toffftm and saneltbft sf Lha Penn" one all aer for erre eddhlotlM etMtlesrril so the came of that �, 4 MI60 WO ryl« atm nMNWOM of he Cite► of
Nome of Applicant (pfbN pint!
Name of Contractor attd Job For.ntaw
Controetoes L-1cense No.
Appltcant't Insursne. a- A-:.'
FREE:
r -w
tr!j
ApfsliOant Or Afpnt
OWN= Address
Dusinga Addre-q
Telephone No,
%Ary Gutiness Llanse No,
POIICY N t
No.
Extended Page 2.1
�saa, auoaivesion i�+wovement Permit -• Class NI
PubtiQ improvements, 3% Of Istimstod construction costo
Prlwte improvementtt 3% of trtimAW cons"Ction easq
i Mlnor Improvement Permlt — Cleu IV: See attld 4e,edul0
�'Pvcuoa F,. s
'ermit fee b
uh 0e13ot'ItSurety BON
requiro4
TOTAL. 1�
I pt No.
ivy by ®eh
Dossed by
G
PERMIT VALIDATION
PERMIT NO.
DATE APPRUVE®
EXPIRATION DATE _ -' 3
GATE ISSUED,
8�
AdNiWocrative Authority
TELEPHOMR. (918) 684.2248