2072MOM'
With
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: 2/22/94
LOCATION OF CONSTRUCTION
Subdivision Improvement Permit — Class I I I
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION _Move Equipment Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Paver Haul Route: 48th 6 Washington
11'6" W, 84,000 lbs All Else Leeal South on Washington to 52nd
East to City Limits.
DIMENSION OF INSTALLATION OR REMOVAL
Haul Date: 2/22/94 OR 2/23/94
SIZE OF EXCAVATION, IF NEEDED One Day ONLY.
APPROXIMATE TIME WHEN WORK WI LL BEGIN
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 775-8327
Name of Applicant (please print) Business Address Telephone No.
Same AS Above
Name of Contractor and Job Foreman Business Address Telephone No.
On Filev
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 II 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.
Received by
Recorded by
$ 10.00
Date
2-072' 2
PERMIT VALIDATION
PERMIT NO. 2072
DATE APPROVED 2/21/94
EXPIRATION DATE 2/23/94
t ' 'DATE I SU D 2/22/94
By
Administrative Authority
TELEPHONE: (619) 564-2246
NOTOI
with roper vIltl.<Ion
ehle <pem mnetlt�t•e en OITY OP LA QUINTA
APPLICATION FOR PERMIT
PUMLIC WORK® Qa MSTRUOTION (HNCROOOHMEINT)
Per the mna etlon publle tlrlvsw.ve. P•v.m.nt•, Id.w.lk•. m I^pP leca wan water !
end other Ilk• publle work• I prba-aT.en:e In eo nnae<!on wleh MINOR IMPgOVEM aNTO •ntl PROV OD BIIpD[V IBIONa
OATe: 2/22/94
Heul D¢baa 2/22/94 OR 2/22/94
B
aubtllrblon I m ere..m•n<Perml<- Cleaa Ill
LOOATION OP GOIYHT RUCTION
M/nor Imprev.m.nt P•rmn Ole« IV
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APPROXIM4TH7IMe WHEN WORK will BRa—
APPROXIMATa —10 OP COMPLETION
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Pan•Ity
' - PHRMIT NO. 2072
Gan p•Po•Is-6ureev ebntl OATH gPPgOt/90 2/22!94
Ir maul ree ¢XPIRATION DATE 1/33/94
TOTALI • 10.00
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R.ostr.d by Beta II,etlminbveM. Auaworl<r
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TRANSMISSION REPORT
THIS DOCUMENT
WAS SENT
** COUNT
# 1
*** SEND ***
(REDUCED SAMPLE ABOVE)
NO
REMOTE STATION I.D.
START TIME
DURATION
#PAGES
COMMENT
1
2-22-94 9:04AM
0'59"
1
TOTAL 0:00'59" 1
XEROX TELECOPIER 7020
FEB -,2.1-94 MOIL 7:08 PM P, 1
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TO : -DATE: ! .
COMPANY NAvE :' � � FAX NO:
1/7
FAXED ABY : s 1
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3iACB 1 OF
IF YOU EXPERIENCE ANY DIFFICULTIES FROM FACSIMILE (619) 342-7504, PLEASE
CONTACT SENDER AT (619) 775-9M.
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Prim SWinp Ikamh
P.O. box 9011
palm mtIM CA 9MS-9011
Phone 619/360500
fAX 619/360570
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NOTE:
With Drawn vllidetron
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C11Y OF LA QUINTA
APPLICATION FOR PERMIT
-PUBLIC WORKS CONPRUCTION (ENCROACHMENT)
P. 2
For slot cOnrtrdctian of Public or prnaota curbs, drltrAMlYs, Pavements, 11dMalks, parking lots, srwer9, water Rains
and other Ilk* 04blia worita ImprerortwnU in cannscuoA will MINOR IMPROVEMENT$ and APPROVED SU1IDIVi3IoN5
DATE.. Y Subdivision Imorovenunt Pef7nit . Class III
Mlrtnr tnlProvetnant PiMlit Clea IV
LOCATION OF CONSTRUCTION _ -----_
Is~ x1omv a< 06"npnon of Law&"l
PURPOSE OR CONSTRUCTION
DIMENSION OF INSTALLA
OR REMOVAL
SIZE OF EXCAVATION, IF NEgpEO
VPROXIMAtE TIME WHEN WORK WILL 36GIN
Skw a��;etlach eOnawClon plans It approp�rlatal
U WA5
�o 2
k"ROXIMATE, TIME OF COMPLEYION,.w.rw,.,^„�,,ti,,,�
ESTIMATED CONSTRUCTION COST=
Ilnosudino ftmWal of Ali obatrustaon, materials, and debris. backfilling, osff�.� Dry 2 -/ZS.
W4 on d 01"Af perrr:enent rsswfscin
® a1�0r rePiaunq irltOroyamenq! - - _ -
iaR C0+tsldltition of tht Qnnting of this permit, tho spalisal,t haarelry aprrtes to. •
andortwtIN. dafWW ono Im the City, its ttlbtatato epnq. oNleor;, rloMeantatrm am &npicvm. harmism front inls 001htl am wW all
slartalttal, liailiti" W toll rnstrltirq Irpm sselrna M 4"" Arl"N ort of Any $a.44m' loos or aarha" to o!*mo1►s of proo�lRy
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Ca, my Mtn all ffimic"d City 4roirtlem e. the t;rno ars aanditb6ft e1 the arMll Ind all 'aflpllaws eulas &W nquw tpets of the City of
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Jima of Contrictat and Job Foreman
:ontraimorrs License No.
SIOMtoare of Applicand or Apnt
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Busirwst Addre n TaispeloM No.
Citv Eissinoss Llmnw No,
wlicant*s lnsuranca Company
Policy Numoar
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