1990NOTE:,
V ith�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
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Subdivision Improvement Permit —Class I I I
DATE: 11/23/93 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION SVS EQUIPMENT Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION PAVES 1116"W,
84,000 LBS, ALL ELSE LEGAL HAUL ROUTE: NORTH CITY LIMITS
ON WASH]I3WM TO AVE 48
DIMENSION OF INSTALLATION OR REMOVAL
HAUL DATE: 11/24/93
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:
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.
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Signature of Applicant or Agent
GRANITE CONSTRUCTION 38-155 MONROE ST., DWIO, CA 775-8327
Name of Applicant (please print) Business Address Telephone No.
SAM 14,
Name of Contractor and Job Foreman
OH FM
Contractor's License No.
ON FILM
Business Address
Telephone No.
ON FM
City Business License No.
ON FILB
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
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No
10.00
$ 10.00
Received by Date
11990
0
PERMIT VALIDATION
PERMIT NO. 1990
DATE APPROVED 11/23/93
EXPIRATION DATE 11/23/93
DAT SSUE 1 23/93
B,
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
GRANITE CONSTR. CO. 6199220159
NOTE:
With WOW Wlidatlon
this form constltutu an
enaroathRtertt permit CITY OF LA QUINTA
APPLICATION FOR PERMIT
,PUBLIC WORKS CONSTRUCTIW4 (ENCROACHMENT)
P.02
For the corimuction of putIlIc or privets curet, drivrNlys- Pavements, sidewalk$. puking lots, saw+rtl, wst`tr main$
And other ilk• "blia worfu improvertrnte In wnnMon wilts MINOR. IMPROVEMENTS and APPROVED SUBDIVISIONS
�M
DATE: Swbdlvleion improvement Perrnit — Class In
Minor Intlseovernent Porntrt Cuss IV ..,.,
LOCATION OF CONSTRUCTION
tsuy.t wan>w K oe,a,atlon ort t.00ai"I
PURPOSE OF CONSTRUCTION ,
Sk�(attach t.OnttnlCtien plans It eMrWiau:
I
SIZE OF EXCAVATION, IF NEEDED ,,.......,om„on
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST S
(Including ton -oval of Ail otsetwt.•tlon, n+steriale, and debris, backfilling,
Pi"On and platin Cort1-
Placing Permanent rcturtadnp and/or reptaeinq i+t'Rtovemetttsj
In fon$Id#f#tion of the
prantinq of this perfn+t, tit# eppliurit hereby #gtsitea to:
inCwnmfV. daler,d grip two the dtty, ell euolonied egarrq, oNk , rwrwhal y" end wnal eee hertttleat from Yrfi;
Waltlae, liabilities w log t�etuitln# Imm Ciel"{ w UNR actio" e1►q vise � • e#elhet airy and all
"eppan►fq or aarruning ei 0 aroltln+esa ►eeyrt Of any wnttt ynQettsrcM Y:10er tftet opers++rt rt ,►t. roes of �,� to pry of Ptvoenr
NOt{fy the ANniANttetM Authgrlry at Nae[ even t 0 pUrwont t9 trill jpaliMU".
tY• eve 1241 hours A edvoeCa at the tlrr+a wrien rtiork +enli iia V-6Meo.
campty Mth all apeuiciaa City 01ditr4 e, Mil! tisane et+e 60"itksne of the Barrio end all ouplicaws rules erw twS1 u9m of this CttV of
1A ouinoe ane to Pae for env switionel ftwomiftm necousty u the roust of mis k"t.
Namw of Applicant
dame of Contractor aria Job Foreman
'Mfllmei License No.
kPPli4nt's Insurance Company
Sl"tuts of Applicant or
Businau Addros
TalephoM No.
V. i
City Butir-Oss Ianw No.
t rollcy Number
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.
i
:,.t.! ,
Extended Page 2.1
'���: "Su90�vision ImprovimMt P
errn►t � Clan I!I
Public improvenvr►tss 3%Of estimated contttuction colo
Friveti improvenunts,, 3% Of astus►et#d construct+on cost$
Rfllnor.lmprovemant Permit — Cimst IV; Sea atUChsd AChadtlie
�speet►on Fse $ Q
prm►t fes
to iDepal.11•Surety Bond
requited
TOTAL,
►pt No. ,
oom6d by
51
PERMIT 4ALIDATION
PERMIT NO,
DATE APPIauvED
EXPIRATION ®ATE
DATE ISSUED
1p
9�e
AdmiNscmuvo Authorlty
TELEPHONE. (61916044248
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GRANITE CONSTR. CO. 6199220159
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consi union
compnnu w
TO: / -DATE:
COMPANY NAME: �'+�� A/ ; FAX NO:41
FROM: �/��' !� f FAXED BY: '' �,� l •:'�.•�.-
PAGE 1 OF� �
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IF YOU EXPERIENCE ANY.,<VIFFICULTIES FROM FACSIMILE (619) 342-7504, PLEASE
CONTACT SENDER''AT (6i4Y 77156-8302'
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Palm Springs Branch
PD. Box 9011
Palm Dtscn, U 9MS-9011
Phone 619/360-1500
FAX 419/360-4570
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