2018`'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: 12/21/93
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION MOVE EQUIPMT AND PICS
IIP MACHINE
DESCRIPTION OF CONSTRUCTION PAVER 1116"11,
90.000 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 II
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
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:
HAUL ROUTE: WASHINGTON STREET
NORTH FROM AVE 48 TO AVE 50,
EAST TO CITYLIMITS
HAUL DATE: /22/93
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.
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 STREET, INDIO, CA 775-8321
Name of Applicant (please print) Business Address Telephone No.
SAME
Name of Contractor and Job Foreman Business Address Telephone No.
p T.
ON FM
Contractor's License No. ._
ON FILE
City Business License No.
ON FILE ON FILE
Applicant's Insurance Company r Policy Number
FEES: Subdivision Improvement Permit — Class I I I
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 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No
$ 10.00
Received by Date
Recorded by
2,018
PERMIT VALIDATION
PERMIT NO. 2018
DATE APPROVED 12/21/93
EXPIRATION DATE 12/22/93
DATESUF,,D 12/21/93
By -
--
Administrative Authority
TELEPHONE: (619) 564-2246
GRANITE CONSTR. CO.
COMPANY NA14E :
6199220159 P.01
GRRnnm
comm i O fnon
copflng sga
-DATE:
FAX NO:
FROM:L/24 /e FAXED BY:
CITY Of LA QUINTA
PAGE 1 OF D E C 2 1 19U
PB�
IF YOU EXPERIENCE ANY DIFFICULTIES FROM FACSIMILE (619; 3W2MV4, PLEASE
CONTACT SENDER AT (519) 775-8342.
/5c, X
d
Palm Springs Branch
P.O. Boz 9011
Palm Desert, U 9MS-9411
Phone 619/360-4500.
FAX 619/360.4570
Palm Springs Branch
P.O. Boz 9011
Palm Desert, U 9MS-9411
Phone 619/360-4500.
FAX 619/360.4570
briRfi ,l MOV M2 .
D' C., s I IBr, a2
0
NOTE:
With proves vsiidatlon
this form constltutas in
•nCro 0hrftnt Oarrrtrt
GRANITE CONSTR. CO. 6199220159 P. 02
CITY OF LA QUINTA
APPLICATION FOR PEANUT
,PUBLIC WORKS CONSTRUCTION (CNCROACHMBRIT)
Fos the conrtruction of puljilc or prlvats curia, drivr-,eYt. pavements, tidwwlkt, parking roto, It**". WSW rnaln>i
and other like pubiia worfu Improvenrnu in connecuon with MINOR IMPROVEMENTS and APPROVF.D SUBDIVISIONS
DATE: Subdlvltion Improwmant Permit — C!•u III
Minor Improvement Parntit Clue IV ------
LOCATION OF CONSTRUCTION
4s;N*Im8 ea 0eunption Of f-OC+•%A Mt1
PURPOSE OF CONSTRUCTION e '
�_ e��letsach wnttructlon t,iint it ogproFtiatal
DESC 1PT10 /pF ON RUCTION
DIMENSION OF INS T LLATION OR REMOVAL'Ta
M41r / � o
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL, BEGIN
APPROXIMATE TIME OF COMPLETION
'ESTIMATED CONSTAUC TION COSTS
(Invudinq renvval of all ob4truLtlon, matflrisrs, ar►d d•brlt, backfilling, port}.
"=gri artd pisung perrttanent reaurta4bnp and/or tlplil ing improvirmrfrtu)
IIn consldlfitian of the orenting of Lhill permit, the applican
t Ranby agree, to.
lft1*~y, datend arm " tna City, :tt MYrnonied a""u, oNiem, rearmAutrm a ampl
peneltles, i�abilit'" W IOq M11WRIA9 IMM ClalrM of t ,An eCtFan and W,&,r, Out ®! am tvlcvoft
. h i � An0 *01A" 64W and &;I
hapgtn��n� a 000vr►il►0 se a Oronlnrte +stint of env nn�t ve�rseaeet Yr10a/ the Deem a" to P"I"P or pro"
Notify the AaminrrirytM Aut!►c�rity •t Nea.�t twPn tt 4r�rttee purwant to trice ov�ollaattort.
twfvut 4241 hown 0 lttrsnc• of the tin* "an Wolk will be rwnc .
Comely Mtn
all &Mks&& 44ty arld!dter". tie tamw " 00nditkwoe of the oermn and all
LA Cwlnta and ca pay for
any e0ditW* nptecem�i. +c>ialie.ae Owes and nstu4euone a) the C.1ty of
^stsMrY to the reline Of thri 3atmrlt.
Nsnu at Appiicant (014914 print)
Name of Contractor an0 J b Foreman
Cont14=f'1 Llunse No.
"Pv114;snt'l Insurance Company
8utlnou Adore
Tslephons No.
ButiMU Addrssl Telsphons No.
City 8utinels Licanm No,
Policy Numbor
i
Extended Page 2. 1
-,.� w�wi olu�liti0r
E{:Et iucalvlslon lmorOvfmsnt Permit — Class IIf
KWIC improvements: 3% of 81timatad construction coils
Private improvements.. 3% Of estlmat#d construction COILS
Minor Improvement Permit — Clrirs IV: Sae atUMed tChadule
SP110on Fro
ermit fey
ona{ty .
6h Deposit -Surety Sond
required
TOTAL: S�
ampt No,
1061v14 by Data
tcom6d by
,
PERMIT VALIDATION
DATE APPROVED
EXPIRATION DATE
DATE 163USo
Sy
Admimistrouve Awth"Ity
TELEPHONE: t6i91 b64224�
0