1987J
NOTE:
With proper validation
this 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: 11/19/93
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION ZlkiliS BQOIPKW
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
DESCRIPTION OF CONSTRUCTION PAVER 1115"W, 840000 LES
' ALL ELSE LEGAL
DIMENSION OF INSTALLATION OR REMOVAL
Sketch (attach construction plans if appropriate)
HADL ROM t NO= CI'1T LUM
ON WASHM67=9 TRAVEL SOUTH
OH WASHi/GTOII( STREET .AXD
AVMM 50
SIZE OF EXCAVATION, IF NEEDED HAUL DATER 11/19/93
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ r
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
i
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
GRAUTE COHSTRUCTIOH 38-155 HOW= ST., ILiDIOr CA 773-8327
Name of Applicant (please print) Business Address Telephone No.
SM01
Name of Contractor and Job Foreman Business Address Telephone No.
ON FILE 011 FILE
Contractor's License No. City Business License No.
ON FILE ON FM
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I II
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule 1987
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL
Receipt No.
Received by _
Recorded by —
10.00
$ 10.00
Date
PERMIT VALIDATION
PERMIT NO. 1987
DATE APPROVED
11/19/93
EXPIRATION DATE 11/19/93
DATE &D 11419/93 '
By
Administrative Authority
TELEPHONE: (619) 564-2246
m
'f
NOTV
With WOW validation
this form oonsvtutu an
ertcrachrrient oarmlt
GRANITE CONSTR. CO. 6199220159
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
P.02
For the =natruf tion of publlC or prcvate curbs, drlvrmaye. pavomtn% sidewalk&, parking loci, tawen, water mains
and other like public works improvenvanta in connef:sloh with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
DATE. Subdivision Improvement Permit . Clan III .....,..
Minor Improvement Pernlit Clan& IV ......,..,�_
LOCATIO OF 4CONSTRUCTION
IStreet address or Ceamption of Lecau"I
PURPOSE OF CONSTRUCTION
DE40RIPTION OF 90 STRUCTI N
r
DIMENSION Of INSTALLATION OR REMOVAL
ZE OF fcXCAVATtON, If NEEOED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME Of COMPLETION
ESTIMATED CONSTRUCTION COST S
(trtdtidirtg terttoval of All Obatruc.tlon, materials, and debris, backfilling. pour
O t Gni and Placing permanent resurfacing and/or l`01441`19 ifrt lOvement&)
Sk�_IatUch
�wnstructio Plans it a°°`�fiaul.
/1-2 112y/—/
At STs
•
� A)
Wnaldaration of the granting of thin pgrmlt, tho applicant hereby agrt>lea to:
penalties, l dstend an0 ave tree City, +41 It+tTtotlsad perrol, offbers, rape�elntatnee el+o M1010yeee. harsnllR irt�It1 and IdalAlt erry and all
penalties, IYlbiNtiea er toss fmalRe from teal"" or WYR IitlOn e+►d arlelrle out o4 any aoclaent. los or
appMlte of 000urrirN are orORunala Feria of Int► wet Ynoorc"S ► under the verttltt rante0 t� o�lt�o+te or pr0lslrtY
9 pur9uant to chit eppllnttpe).
Noting the Adntlneltretrva Authohty at least r#00A -four 1241 horn M fdvarra of Ma ten+@ when vs" wfll tea Meet&
LA Qui w►m all eWfore City ordiriwitkia�„, the tends ■nd oer,eit" of the Hermit end all W4liaabfo Fula! ar" rvWLW&o * 01 tate City Of
V Obin>♦ and to Afy for utv ad4ltbfwt m neceo ry M the result of this weft.
Nante of Applicant (Ptea&e print)
Talsphon# No.
Name of Contractor anp Job Foreman
Businau Addrt&t Talaph4Ae No.
oyontrIICW(s 411CAnN
City Sullins Llcanse No.
• 6;1�
k0plicant's Insuranp Campiny
Poilcy Number
Cele. ...__ ..... ..._._---.
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n x
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Extended Page 2.1.
EEB: lumvision Imp►ovemant Permit — Class I II \
Public improvements: 3% of estimated construction cote
Private irnproverneilts: 3% of ariIM-A W Construction costs
Wnor improvement Parmlt — Class IV: Sae atUCtAd eChadult
UPaCtion Pae $
®rnnyt Fee r
PERMIT VALIDATION
malty
ash Deposit -surety Qoncl
requitld
TOTAL
malpt No.
�CaiVsd bY....r..r.rrr.�ir..r......,�, lima
+corded by
PERMIT N0,
DAT9 APPRUVED
EXPIRATION OATS�'l`� �q.3
DATE ISSUED
Ey
Adenlydstraaw Authority
TBLEPHONE: (619156462248
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GRANITE CONSTR. CO.
6199220159 P.01
CRRt1tT�
consi ucmon
compnng .m
TO: % L 1 -DATE
41-
COMPANY
NA'4E : '4 FAX NO:
7� o .
FROM:. 42 FAXED BY. L<.•._,.;,/
PAGE 1 OF d
IF YOU EXPERIENCE ANY DIFFICULTIES FROM FACSIMILE (619) 342 -7504, -PLEASE
CONTACT SENDER AT (619) 775-8302..
\ Palm Sprin3s Branch
P.O. Box 9011
Palm DWFI, CA 9MS•9011
Phonic 619/360-450D
FAX 619/360.4570
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