1968tfIOTE:
'JVith proper validation
r ..
• 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: 11/10/93
LOCATION OF CONSTRUCTION
Subdivision Improvement Permit — Class I II
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION MVE HQMP.NM
DESCRIPTION O� ONSTRUCTION 650 1UTSUBISHI MMVA201
12 ,1 60,000 LBS - ALL EGSB LEGAL
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Sketch (attach construction plans if appropriate)
HAUL ROM: Oa WASHIBGM STREET
TRW MY 111 TO EISBNH MM STREET
HAUL DATE: 11/12/93
YILOT CAB REQUIRED
'%
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.
Lin.e4."L- /—& 1--/7 i,,— /
Signature of Applicant or Agent
GRANITE CONSTRUCTION 1011 E STREET, MIO, CA 775--8267
Name of Applicant (please print) Business Address Telephone No.
Sm '
Name of Contractor and Job Foreman Business Address . Telephone No.
ON FILM � � OB 7W
City Business License No.
Contractor's License No.
ON FM t ON FM
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
Recorded by
PERMIT NO
PERMIT VALIDATION
1968
DATE APPROVED 11/10/93
EXPIRATION DATE 11/,1122/93
DATE ISSU 1 4/93
By
A nistrative Authority
TELEPHONE: (619) 564-2246
GRANITE CONSTR. CO. 6199220159
f�YlEt
With OtOW validation
this form corinitutea an
Incrochnnnt parmn CITY OF La QUINTA
APPLICATION FOR PERMIT
I 'PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For the oonauurtion of public or private
and other like ouDlic YI►Orka curoa, drlvttwayt _
Imiar�ovem*r$U in cnnneation with MIN4tt IMPROV EM artpgrd�APPRIOUOVEDD S�J� DMS ONS
.110
P.02
OATS:Suhdlvlaion Improverrwnt Permit - Cleq Ili
LOCATION OF C2
O TRUCTiON Minor Improveyrttent Permit Clan IV
rswrt inwin or Gennpdon or Lgailu"l
PURPOSR'OF CONSTRUCTION
RIPTIOUF CONST
Sl -Ut.0 UtUch con11"Ctlon plaru if opp,rpprj4u)
DIMENSION OF INSTALLATION OR REMOVAL,
SIVE OF "LAVATION. IF NEE0E0 �C
PROXIMATE TIME WHEN WORK WILL BEGIN
PROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST t
(Mduding 16MM&l of ail obstrtit-LIOM, materials, ad
Caction and plating permanent rettlrfacinq Ind/ort pfaClhp Pfrovrrn�onu
In opneld"ItiOn of the granting of thil permit, the
p Ir.aht hereby aEreee to:
ItIOr "ItV. defend arc tette CMe City, ftt o4Oion:r0 We+�ot, off
wAlties, lubilitie! er IDo tMitine from ciairttl tfr court eCt�on�eM ��lsFltatives &N arlolovees. hannlwl front 6 a611nM
hapwIng a 000urrine ai a oroxwo to rpyn of Inv worn u ral out of env eCC�Wat. lost or �aM to � ertd all
Notify, the Artm,nMretr V Au 1W� 41h unar the pvmtt Qrsrtted PUrguent to chit aoolfrti amot or ara";Tv
d+or�ty tt lert cwonq,,four (241 hom ut
Campy Math all &wk"d Gttr Ordinam", the ts" ono C4nditio, of�e permit rhm let the dle froo what w+ert� wNl tw ine.MI .
4 Oulftte and to pay for ww eddltlortal reptaopteewt neat w the 4"Ho we rules kw
rmit of this rdOrtt, _ ru9vNti0rg of be C1h► at
of Applicant (plea^ p
dame of ContraCtor_and Jot► l:ar.m...
OLWrw r;a Addreu
Telephone No.
I -------- 8utirtasa Addreea
Telephone Na.
oontraCWr,j i.icallfA No.
"PPliOnt't Inturanel Corrtoanv
City 6ulirteu Licenm No.
BEB: Su�eiv�ein� POIICy Numtxr
Extended Page 2.1
EES: �up0avasion Imp►.0vement Permit Class III
Publle Improvement:: 3% of estimlted construction coat
Privalte improvements: 3% Of estimated wnttructaon C,,,,
'4$
t Minor Improvement Permit — Class IV: See at'
taaed tCea3ule - •-
P9010" F84 $
mat fee
elty
Oepetat-Suety Sona .
equired
TOTAL: s
'Pt No.
ivy by
mod by
PERMIT VALIDATION
PERMIT NO,
DAVE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Adrrinlatreave Authority
TELEPHONE:QEtE' 61344248
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