1994,r.
I,r
NTE:
W,th 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
DATE: 11/29/93
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION MOVE EQUUPMMT
DESCRIPTION OF CONSTRUCTION PAVER 11'6' ,
,000 LBS — ALL ELSE LEGAL
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Subdivision Improvement Permit —Class I I I
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
HAIR. ROUTE: ON WASHINGTON STREET
FROM AVENUE 48 TO NORTHERN CITY
LIMITS
RML DATE: 11/29/93
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: `
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 38-155 MONROE ST., DWIO, CA 775-8327
Name of Applicant (please print) Business Address Telephone No.
SAME
Name of Contractor and Job Foreman Business Address Telephone No.
ON FILE ON FILE
Contractor's License No. 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
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
�ZYr•vv o�i0�(� � /
PERMIT NO,
PERMIT VALIDATION
1994
&M
DATE APPROVED 11/29/93 '
f
EXPIRATION DATE 11/29/93 '
DATE ISSUED 11/29/93
Received by Date 11 Z AdministLafiVe Authority
Recorded by II TELEPHONE: (619) 564-2246
GRANITE CONSTR. CO. 5199220159 P.02
f
i
WTI.,
Nigh ProNet validation
thil form Constitute$ an
sncrachment parrnrt
CITY OF LA QUIKTA
APPLICATION FOR PERMIT
-PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For the oonlitruction of public or privet& Curti. OtIM«evs. pavements, sidewalk$. parking lots, sawen. water malru
and other tike oublia work$ improvements In connection whit MINOR IMPROVSMENTS and APPROVED SUBDIVISIONS
��'�?Subdivision Improvement Permit — Claa III
ATE" Minor Improvement Parmit Clan IV
OCATION 0 CONSTRUCTION
yet amnu of 04sanovan of i-ooeti"I
RPOSE OF CONSTRUCTION
ION OF CONSTR
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION. IF NEEDED
APPROXIMATE TIME WHEN WORK WILL OEG114
Sk�oAtch fatuch c"onstructlon plana It appropriate)
to
t%PPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COSTS .4__�
11r1Cluditp rtmotral of all opatruc.Klon, metesials, and debris, backfilling. opm.����j���'
WbOn and placing Wmanent resurfacing and/or reptuang improvemental
In 00614 fntiGn of thl Panting of this ptrmlt, thf applicant hortby ltgrota to:
M40110 IN. defend ano Im tl1e City, Its walonte0 b"ma' offkgrt. repret4ntitfree sno em01 ea. harmim from $h0
WAItta4, liapilities or ICU rriuitinq ICOM palms or $Curt oatwn " arising out of env e4t+dertt. lots or $tame to wnottit or ,� all
happ�ir9 or ooaurrtnq at a orbsimet4 r*Ntt of a 9a Pro4vertY
any rMoru urWrgeen wooer tt+a oeres+tt granted purvuant to vtls •00ihr�tbr►.
NotiN the AtsrttiMliretrve Aun►ority At 1uu twenty-four 4241 hour u+ a0vama o1 aid 11" when week Holl ba s,,ertea.
Con+aY'►+►en all aoWicapy CttY Ord4rianae, the term mo tonrtitions of the oamtn and Ali applicade ryles aria new1frtpory of the City at
La Culn>s and tO p4v for ww a0dltkxw r%p4mr*m WOMPY u the emit of MA t+yp k.
Name of Applicant (0)$614 print)
Name of Contractor and Job Foreman
:ontrattor's Licanse No.
Slgrtaturt of Applicant t Agent
Busineu Address r
Telephone Na
Businau AddraM Tel✓✓ephons No.
T�
69>7
City 8usinesa Licanu No.
4APtitant's Insurana Company Policy Number
_ Extended Page 2.1
`EES.- Succivis+on improvement Permit a Ciao III
fa Public improvements: 3% of estimated conttruction casts
Prlvato improvomentst all, of ertim+t#d Construction cosy _Y
Minor improvement Permit — Clau IV; Sao atUChed 6Chadule
"pertcon Fee $ PERMIT VALIDATION
trm,t Fee _.�._.._
N0. .,.._.�.
tneity PERMIT,...,.
tut Oepotlt•Surety Gond DATE APPROVED
required
TOTAL; $
EXPIRATION AAT
OWN—
maim No.
0ATJj I$aUlD
,iColved 6y.r...n.rr�..............r�. Data RV
AdMINStrauve Authority
soraed by TELEPHQNE-. (0111564-2246
GRANITE CONSTR. CO.
it
TO: i L -DATE:
6199220159 P.01
GnnnrnE
consiucTIon
comPflny .M2
COMPANY NAME: oe� PAX N0:
FROM: -- FAXED B
PAGE 1 OF
IF YOU EXPERIENCE ANY DIFFICULTIES FROM FACSIMILE (619) 342-7504, PLEASE
CONTACT SENDER AT (619) 775-8302.
77:��
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2
Palm Springs Branch
P.O. Box 9011
Palm Desert, U 9MS-9011
Phone 619/360.4500
FAX 619 / 360.4570