2055NOTE:
With proper validation 2
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: 2/7/94
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Move equipment
DESCRIPTION OF CONSTRUCTION Paver, 11116" W,
84,000 Lbs. All Else Legal
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
Haul Route: South on Jefferson
St.From Ave.49, West on Ave.50
North on Washington St.,
8esthon Ave. 48 to Adams St.
Haul Date: 2/7/94 or 2/8/94
ONE DAY ONLY
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 P.O.Box 9011 Palm Desert, CA 92255
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman
On f ile
Contractor's License No.
On File
Business Address
Telephone No.
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
Recorded by
10.00
$ 10.00
Date
2055
PERMIT VALIDATION
PERMIT NO. 2055
DATE APPROVED 2/7/94
EXPIRATZ:np
DATE 2/8/94
DATE ISR 94
By
Administrative Authority
TELEPHONE: (619) 564-2246
L+GA[ �r
;, r,�, ,'
4
r&B- 6-94 SUN 9:42 PM
NOTE:
With WOW validabom
Ws forte ewnnitutu an
ortwollmlTMnt aarfnn
C11Y OF LA QUINTA
APPLICATION FOR PERMIT
-PUBLIC WORDS CONSTRUCTION (ENCROACHMENT)
For the oonmuction of public of Prrvata curbs, drive* vs. mamann, Ildowslics, parklfq lau, &awed. watm rmltu
cork ostler Ilk* public works impmvernanta In cOnnaCUon with MINOR IMPROV€MENT$ ana APPROVED SURDlvl8lONS
OATS: SNbdivi&ion improvemunt Permit -. Clad Ill
Minor Improvemaht Pamlit Cfau IV
LOCATION OF CONSTRUCTION
(itf•aot owes ew f2■aanpt►en art txaatlanl
el
PVAPOS$ OF CONSTRUCTION WEA
Sk��(Itt:itcat Construction plan& it appnKWiatal
v.
- �
'01MANS10N OF INSTALLATION Oft REMOVAL '
.�'
SIZE OF EXCAVATION, if NEEDED �...._tet` aw
_
APPROXIMATE TIME WH9N WORK WILL, 8EGIN
APPROXIMATE TIME OF COMPL�ON
ES'T'IMATID CONSTRUCTION COST S `o�/� v�Y cwzty.
11haudin0 removeI of all obgVUt.'t14A, fRatariall, and debris, bmakfilli
oa4tion artd P1al:iA4 parenafrent ntllftadrq artdl0r rapueitfq imp10 mmeftul 4 GOwe
FS
in CWa18116tioft of the grmtlnq of This permit, the appli>;aht hargy eprin ta:
lAdwimitv, Ifefend aro SM the City, KI sulhon:ef& pans, oflican, rfumsentaum No "love". harmim frown hrd "llim iwm and all
Oeftartraa, la blit+Ie a $*a fmltirq #roe, Iiatml W taurt wtmn Ind arijurq owt of Inv batmuftt, los or 611ho" to COMM or W9111Wty
NOPruA at aooarrirq a& a tivitwou "NA of Inv scent onowuasn umw the oVmx grantee prreuant to oid 6001Mt+o&
N0011V the AdffUA*tr%jm !►WOm"M M rare tv,rntvfgtpr 124I hftn a WVN%a 01 the tifne caftan wOfti MAIi ba g%*MO .
OIMOrt• Mm all 6mmam elty hm. we tarn" ane cono+two of ateoerma IndAl Ioolioable Is and rewic iom of Ota GN of
Le Older and to M tar sm sa ,al ,",paw M the ?MIS of tt►nar6ltt.
of Applicant of
'►laftu of Applicant (0144N print) 8"Am A tau Ta(ephofN N0.
`flame of Contractor and Job foreman audnau Address Talsphom No.
:ontri�torl �rcanw No. City Butinam Womma No.
�pf=liunt'1 Insur.nca Comlaany Poky Number
,tile.
"6Eis Sutioinsion tmprowtment Permit _ Clsu III
Public Improvementst 3% Of sstimsted coruttuctlon aorta
Prlvaw improvemsr►ts; 3% Of tstimstad Consuutt►on calls
Miner Improvement Permit — Class IV: S0e et4Cht16 schedulil
11poetton Kee ;
ormis Fn /cam
Dspee±t.sursty Bone
requ{ti0
TOTALS
a lot Na.
by Dots
`cted by
Extended Page .._.2. 1
PERMIT VALIDATION
PIIIRMIT NO.
DATEAPPAUV60 ���..Y....—..�.._.�
EXPIRATION DATE
DATEI=U80
AQminlstmt v$ Authority
ELEPWn"c. 7k4Ptt P^♦ --
FEk- 6-94 SUN 9:41 PM P, 1
GRRIM
consmuman
commn9
TO: � -DATE: � � �' O /9�I
t /-ZL/
,COMPANY NAME: ` �^ FAX NO:
i
FROM. �/'C/Z2 FAXED BY.
PAGE 1 OF
IF YOU EXPERIENCE ANY DIFFICULTIES FROM FACSIMILE (619) 342-7504, PLEASE
CONTACT SENDER AT (619) 775-5 .
X327_ -
X C7 77s
to
hhr Swkw Branch
P.O. !ox 9011
ft" DMM. CA "255-4011
Phone 619/960.4500
FAX 619/3W4S70