2090- 1
NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment, permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
ONE TRIP - OVERSIZE LOAD PERMIT
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
3/1/94
LOCATION OF CONSTRUCTION
Subdivision Improvement Permit— Class III
Minor Improvement Permit Class IV
(Street address or Description of Location) I
PURPOSE OF CONSTRUCTION Move Equipment Sketch (attach construction plans if appropriate)
DE!j %IPTION OF CONSTRUCTION Paver Route: Ave 48, Washington St,
11 6' W, 84,000 1bnxAll Else Legal Ave 50 East-6,City Limits.
DIMENSION OF INSTALLATION OR REMOVAL
Haul Date: 3/2/94
SIZE OF EXCAVATION, IF NEEDED
f
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $� I
(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. 1
Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulation
stof 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 St, Indio 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 file On file S
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 cost's`
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
10 .00
$ 10.00
Received by Date
Recorded by
2090
PERMIT VALIDATION
PERMIT NO. 2090 '
DATE APPROVED 3/1/94
EXPIRATION DATE 3/2/94
DATE ISSU
3/1/94
By --� .
Administrative Authority
TELEPHONE: (619) 564-2246
MAR- 2494 WED 2:32 AM
1.
P. 1
CRRntT�
cons muc non
MMPAn! .
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TO: ,DATE
COMPANY NAMEs FAX NO:
FROM: FAXED by s
2 44 4.
PAGE 1 OF
IF YOU EXPERIENCE AXY DIFFICULTIES FROM FACSIMILE (619) 342-7509, PLEASE
CONTACT SENDER AT . ( 619) 775—SM.
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PD. ftx 9011
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Fla 619/36045M
FAX 610/3601370
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MAR- '2�94 WED 2:32 AM
J
WIfh proal validation
thk forth consutut$fi an
onCraehmertt ounitt
CITY OF LA QUINTA
APPLICATION FOFt PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
P, 2
For the contttuttion of publla or private Curtss, drivrNlYs, pavements, sidewalks, P"Inp lots, s&ywars, w$tau mains
and other Ilk$ public works Imptoremanu in w 111116 s,,on with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision improvoinunt Permit , Class III
DATE: Mirror If ot6votnefit f amlit Class IV .�..r
LOCATION OF CONSTRUCTION
l:uses assafeu K p.>i•npuon eK t,00et4astl �,.
PURPOSE OR CONSTRUCTION
DESCPT�rI 9�109NSY RU
OIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORX WILL SBGIN
Sk' a�Ietuch conetn+ctton plans If apprpptssul
A�tr-
APPROXIMATE CE TIME C COMPLETION
TION �
EStIMArfi:D CONSTRUCTION COST S --
Ilnfluding ren oval of all Obrtrtlatlon, materials, and 0bris, tmckfilling, MR -r
elrf:tion and placing permanent resurtadng indict t$placing irnptovurianU)
If► WAslderation of the granting of Ihlt permit, the applir:artt h#reby agfaos to:
Inosrttrtlfv, dot" aftfl etre We City, Its R IMOI1100 t4)arrq, Offlo$ra, tortrsenui ra are empioyeea, hannlm from hnd a0eth" snr and all
0"Altlaa, liaties of 1pp ttfultirte frOm aalrm ar sours $f,tron said arlsiry owt of any rCC+Wnt, lora or aarnra. to asrwna of ptpprRy
hospe"tt'e or ++WF4 M a 01MUFAM rastrn of any wort wndergeM unaw the pvmn aryntr4 purouant to aN1 6001WOU04.
n1o41M the Adffishdtnstra Auatonzr at lass awtswfawt 4241 hown In fwvenao N tna 11R* when wottc wttl ba ttiwtaa.
Cafnoly Nndt All apalo04 City drtlutaneea. the ta►rr*s artd oorianiofM of the germn arb all apolioadt rvia end rrqul$ttprr Of he CjN of
4 Guinea and to putt for erm OWN"* nils m m e napW the fslutt of thrs Irl".
r1a
yarn+ of Applicant !please print?
J--% J _- - -�
Nome of ContractZaJabForeman
?orttraetor's Licanse No. J.
/� ,Slgrtatwa of A"Py- dr 7
Busrntu Addteu / Telephone No.
6uunau Address T one No.
City eutifma Lianta No,
kppliunt's lniwrance Camp40y Policy Numbar
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