2037NOTE: —?
VQC.h propir 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
1/5/94
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Move equipment
DFSCPIPTION 9F CONSTRUCTION i Motorgrader
9 10 W, 15 4' H, 43,000 Lbs
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)
Route: South on Washington
Street from City limits to Hwy 111.
HAUL DATE : 1/6
JAN 0 5 1994
� v P
APPROXIMATE TIME OF COMPLETION By�
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: t
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 124) 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.
Granite Construction
Name of Applicant (please print)
Same
Signature of Applicant or Agent
38-155 Monroe St. Indio
Business Address
775-8327
Telephone No.
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 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 Date
Recorded by
2031
PERMIT VALIDATION
PERMIT NO.�•
DATE APPROVED 'gam" ! "
0
EXPIRATION DATE (0 Q
DATE ISSU 94
By
dministrative Authority
TELEPHONE: (619) 564-2246
t,
44•
Noi�It
With WOt#ef Validation
I" toren WnttttIAM an
emoschfhent riormrt
GRANITE CONSTR. CO. 6199220159
CI1Y OF LA QUINTA
APPLICATION FOR PERMIT
-PUBLIC WORKS CONSTRUCTION (ENCROACHNIENT)
For the oontvuction of pu4tle or Wtvate cuffs, drlvaatvt. t�tvomenp, sldawalk�.
and other tike public works fmprpvemrnta In tanneet,on watt MINOR IMPROVEMENTS andl APPROVED�' p VI r^+1ni
so IOU, sev.*Mwauw
.r •
8tON5
DATE: Subdlvlsion Improvernent Permit — Clan Ill
LOCATION OF CONSTRUCTION MiAOr Improvement Pere:rt CJS ly,�
i,lsVr•t seance a peecnauoe el t.ocsueet
P.01
'PURPOSE OF CONSTRUCTION
Sketch fatuch e4newRJon plan] it epgrw;oto!
DE �il� So F C NSTAPC oN J , �
,j •�lv �J
d�
27
DIMENSION OF INSTALLATION OR REMOVAL � �y
512E OF EXCAVATION. IF NEEDED Tq
r
-71ROXIMATE TIME WHEN WORK WILL SEGIN
'PROXIMATE TIME OF COMPLETION
'STIMATED CONSTRUCTION COSTS
Intludinq ltmoval of Ali o0etr11-tl
dn. rrmatersels, ar4 detws, baeitflllinq, com.
*0211 AM placing permanent rtswfecinq and/or replat;ing imprOretnenta!
r+ CM1114eretion of the 9renting of thir< ptnrtit, the sppliGant hereby egreea to:
I^4111111*hrh, daler►d ar'0 M1� enc Clh, rtl tuft�ortsag
Aenaiu•l, 1"d,Ua Oa lop tmltley bele+ Paauslo M • oMbevs, ►�rtllenteiMt a� erf101py6ez. naAn►eei (reAt atb gt,rW ►fry and all
ho9on,ne a omm""s M e oriaiefou faun of ar►v wet $0,00 V4 ar1uM O,et of Inv aotgwrst. los of �� eo Oerlona or Or*"o T r
Netlly the Adm,n.ttMtrrr Auomnry K tarot ^ M Unoee the DWMR Orsated O,erwant to Mi 1pplte•tIOA.
eetM•I r 1$<1 noun ,rr advenea N the elet+e wheel woet "if lea r4rtoo,
CdfhOY VAFA all &MX66,a cstr ordletarI M. the tam mo Oondltbnt at the permit Ind all
V Oulnq ar+d m p� #&emr edditlorter nlxaeer w the t Mit S1t'ttjre wet. opol+mote N1166 ant ►r9u►etr'ortt of ttta City or
Inn 01 ApplicAnt
mme of Contractor and Job Foreman
rnsnctor's Lloanse No.
rplittrtYsIrlsuranp COMp1ny
Business Addreu
Pollcy Number
e
Extended Page 1.1
gas Suoo��.�i improvemQnt Permit — Chy I I I
PWIC imp/ovem4nq. 3% of &St Q Construction ®Ofta
PtIV4te im rovemer►tt:
P 39i Of •rt,cnatb Cunttovct+oA ootq ": {
Mlncr Improvement Permit — Cl&u IV: See etut ►ed-
tChedglm
gCUon Fee s
nit Fit I D PERMIT VALIDATION
oily Mpe—
'�AIAAI'P NO.
i 0epes • it -surety Bond GATE APPRuVED
�ulrea _
TOTAL: - �.�/Da�
EXPIRATION OATS
,..� _ S: 9
Pt No. DATE i>a�UBD -
ive4 by Dene By 1 44 by py i Admirwitnuve AuthcWIN
_. TELEPNnuc.,odmi
1
m