2042NOT:
With 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
1/20/94
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION MOVE EQUIPMENT
DESCRIPTION OF CONSTRUCTION 623 SCRAPER
15 HIGH — 11'10" WIDE, 120,000 LBS
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WI LL BEGIN
Subdivision Improvement Permit— Class III
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: NORTH ON
WASHINGTON STREET FROM
HWY 111 TO CITY LIMITS
HAUL DATE : 1/20/94
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.
GRANITE CONSTRUCTION
Signature of Applicant or A ent
38-155 MONROE ST. 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 111
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
InlRelcffln Fee $ 10.00 II
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No
Received by
Recorded by
T
$ 10.00
Date
R
PERMIT NO
2042
PERMIT VALIDATION
2042
DATE APPROVED 1/20/94
EXPIRATION DATE 1/20/94
DATE IISSUED ,x/20/94
By r
Administrative Authority
TELEPHONE: (619) 564-2246
V 78-495 CALLE TAMPICO --- LA OLlINTA, CALIRC'Fi N:A 922,'-
(6 19)
225:
(619) 777.7000
c ti�
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FAX • NUM$£R t --7� S- S3 53•
FROM.:
OUR FAX NVMSERt 619-777-7101
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0PER3a110R i
TOTAL NUMBER OF PAGES
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(Including covm� sheet)
DATE 6ENTI `20 -g
TIME SENT1
r r r r a w e t r r r r r r w.r r r
............
ADDITZONAL.COMTIENTSi
TRANSMISSION REPORT
THIS DOCUMENT (REDUCED SAMPLE ABOVE)
WAS SENT
** COUNT
# 2
*** SEND ***
NO
REMOTE STATION I.D.
START TIME
DURATION
#PAGES
COMMENT
1
6199220159
1-20-94 9:05AM
1'42"
2
TOTAL 0:01'42" 2
XEROX TELECOPIER 7020
Mort:
With Prom validation
this form oonstitutu an
anaroaahment aertntt
GRANITE CONSTR. CO. 6199220159
C"'y OF LA QUINTA
APPLICATION FOR PERMIT
-PUBIC WORKS CONSTRUCTION (ENCROACHMENT)
FW the apnsuuction of
DuDlia wof*a pupllC or Prtri'vata curs, drlvrMrt
afifd Othar Ilka Irtt eetran wl%h MINOR IMPROV MENTS end APPROVED wan APPROVEDD Sid D V!8 ONS
pro t i In
'DATE; Subdivision Improvsmant Permit . Class Ili
LOCATION OF CON TAUCTION Minor Improvement parnln CJau IV
f=ttaes n'NOacotlan —awm nd-46
P.01
RPOSE OF CONSTRUCTION
CONSTaVgT10ff
MENSION OF INSTALLATION OR REMOVAL
®IZE OF EXCAVATION, IF NEEOEO
MATE TIME WHEN WORK WILL BEGIN
Eke�iattudt 4C4nurvetl0n plans if +
DOropriaul
�.z 071-)
4PPROXIMATE TIME Of COMPLETION
;STJMATED CONSTRUCTION COST !
It -owing rtntoval of ail obs:rul.110A. rnatarlaa, ars Cattrls,
',aaoan twckflllingcorn.
and plal:inq Permanent resurfacing and/or replawn9 orental attal
Ih donatdl(ltion of thl Mnting of 1hif1 patftUto that applicant haralav arg(m to:
it►oM+wt�h, dNend ark up me CIMS a
S KTanw a
Penaltlaa, t�rlitres e+ lea tin* f b"�' eM�' raaMMtat" am "love". harntew Item ars
f+avtteRrM a OttoLrtt M mm osiers a town KIM,, SM arisuq ort of anv as ide tt. lowat aOi9Mt of and ail
M M s artslnteta 1*wn of •nv row undwumism Yrta. tRa f�r+tlllt hats 0 '� to oerto+t► Or OrtaOeRv
N6110y the AdM'A'Vlretwtt Awemn1y at teestwfoff Ornuant to via spplr�tlp,,
Comm► IMaf all smhaeio GlY p rr iZ�l hOwn M aQvareA of vie tune whoa woh will baa starte�4
Lb rolnism te. the 4ntt1 aro oonaltW* or ata permit and ell
t0 WQlisi0ie eylq arxrl yt of ala city of
OYlnta and Wfor s+rttr KVhJDMl r PW*'yM AWN as the rtfrtt of thA
Ifs Of Applicant (ptaasa Print)
me of Contractor and J0 foreman
ntractors L'Unaa No.
Plicant't insuranp Comp#nr
s1r4twe at Applicant of
B"r*u Addrau
Telephone No.
Budnau Address T apthone No.
City 8utinelu Llctanfr No.
Policy N
Extended Page 1.1
• ..•'r.� ��Wlli7of
ess ;.iva4wiflon Improvtment Permit _ CteL$
Publlo improvements: 3% of estemated construction oo:u
Prlv4q imprcvemei:tst A of ostimetod e+�npiruct,on cosq
Mlnor improvement Permit — Clep IV: S0e etUChtd tcheduls
iclion Fos S
in FM Q PERMIT VALID�ION
ily
04polit•Surely Bond
iuirW
TOTAL: s i�
'Pt No.
fved by Data
.a24 by
PIAMIT NO,
DATE A?PROV60
EXPIRATION DATE / —ZO — if
DATE ISSugo
By
AdmiNst"UYS Authority
TELEPwnUe. raq.,t f -mi