2014NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
I 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: 12/15/93
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION MVE EQUIPMEMI
DESCRIPTION OF CONSTRUCTION PAVER — 11'6"W,
88,000 LBS - ALL ELSE LEGAL,
PICK
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Subdivision Improvement Permit — Class I II
Minor Improvement Permit Class IV
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:
Sketch (attach construction plans if appropriate)
HAUL ROUTE: SOUTH ON JEFFERSON
STREET FROM AVE 48, WEST TO
WASHINGTON, NORTH TO EISENHOMM
HAUL DATE: 12/16/93
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.
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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., MIO, CA 775-8337
Name of Applicant (please print) Business Address Telephone No.
SAME
Name of Contractor and Job Foreman Business Address Telephone No.
ON FII.E
Contractor's License No.
ON PILE
ON FILE
City Business License No.
ON FILE
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.
Received by
10.00
$ 10.00
Date
2014
PERMIT VALIDATION
PERMIT NO. 2014
DATE APPROVED 12/15/93
EXPIRATION DATE 12/16/93
DAWTIg'S UD12/15/93
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
GRANITE CONSTR. CO. 6199220159 P.01
GRRIIIT�
COnsrRucnon
cornpnn SUIXI
TO : ;DATE : . ? �7
COMPANY NAME:
FAX NO:
FROM: / ` �
'� i n FAXED BY
PAGE 1 OF
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IF YOU EXPERIENCE ANY DIFFICULTIES FROM FACSIMILE (619) 342-75040 PLEASE
CONTACT SENDER AT (619) 775-8302.
775
Palm Springs Branch
P.O, Box 9011
Palm Descrt, CA 9MS-9011
Phone 619/360.4500
FAX 619/360.1370
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NOPE:
With WOW yilfidauon
this farm connitutes an
encroachment parmrt
GRANITE CONSTR. CO. 6199220159
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION {ENCROACHMENT}
Fot the oonfutj ion of twdllc or prrvltA cvrOt.
And other tike pubfla works im o drlvtveYs, Pavoment�s, sidewalks, parking lots,
provArrttn.a In taonr,attlon with MINOR IMPROVEMENTS and APPROVfeO sawen, mains
.154SUBOIV1810N5
P.02
1r„
DATE: - !��"' ,. Subdivision Improvemant Par nit — Clan 111 _
LOCATION OF CONSTRUCTION -� Minor Improvement pimirt Clan IV
(Street soul" or 046motlon o1 �tuottl
PURPOSE OF CONSTRUCTION
DESCRIPTI 2N OF CONSTRUCTION
Lib.�o_ I e
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST i
.,,`(Attach construCtlon plans 1t approvtiata)
4e�e.4
�"� �' • 7-0
(InCludinp removal of All owtrucstion, pIAmlterials, and QAprls, LA11V1 �TLe l
DACOan aa"Gn� plrmlA*nt resurfacina and/or fepladltq mprO menu
Inf�on>{Iderl►Ilron of th3 grantingof fhlai
Pernit, the Ipplicant hlteby flpras to:
1now"Ity, dill" AMC leve the City, its srtnonlep
OenA1tIM, liabrfit,tn a loss httltl t �� aMlpn, reWUP4 Y1 o aid baji;4 wA. "IM19M from r<nd
heppeA�� 0/ O�oOtM M r0�t► Na1rtM Of COyR aCirOn ane ArIArrM OYt 0} any �ide/tt. !Oo Or �r^at i11y ar+d NI
M M A OrORumm iritis at any vm ywwyitM tr4w ate perst,tt rAhttK! OaTage to penoft or provaRY
Notlry the Adrn,rtmreten AuaWjry At lam 4 ptnuent to bili 6p iftueA.
evtty�ur 12�f HCwt vt
Cet the luvw 1MAn vrorlt wtli kw stareeo.
Campy vv+tn rel) eOPrInOtA Gey O+dtnantal. the tants
La wione o4n0tbr+a of the """n"""nR shd e11 Aq and to pay for WNSwitlOnal � a ll the Mull Or tura ind all WOIi"Wl N11114 &W hgttftW d of tete City at
Ifs of Applicant Ie4N Ifni
Alto of Contractor Ano ob Foreman
�ntract0�s Llcenl• ND,
S1r4tute ppficent or A t
�I 1_10YR51 R ./1
TaleptlpM No.
Businau Addr i
Tale ane No.
I
City Business Llcanta No.
''Oflrant's Insurance Company
Policy Number
oE3t $40o,vision imorovoman► a.....,......,_ .
Extended Page 2.1
i uCV_ lS'on Improvement Permit ■+ class III
Public improvernenUt 3% of estimated construction cosu
Private improvemennt 39i of ut►"40 cOnstruct►on cost$
Minor Improvement Permit — Clew IV; $ee stUthad lChed>11i
PlCilon Pee $
M11 fat
+ettt►
h Deposit -Surety Bond
iqulrst4
TOTAL; s
tips No.
rived by Dan
+'ped by
0
PERMIT VALIDATION
09111-Mly ND,
DATE APPRuVED
EXPIRATION DATE
DATE ISSUGO
ey ,
AdMiNst"tive Authority
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