2095�NOTE:� - -- �
With proper validation
this form constitutes an CITY OF LA QUINTA
permit
encroachment pe t
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
ONE TRIP OVERSM 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: 3-10-94
LOCATION OF CONSTRUCTION
Subdivision Improvement Permit —Class I II
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION MDVS FRUMARIT Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION PAVER 11' 6" vide Haul Route,. Ave 50 west from Madison
84.000 The all else legal to Eisenhower south to Montezuma
vest to Alvarado
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Haul Date 3-1,0-94
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.
d
Signature of Applicant or Agent
Granite Const. 38155 Monroe St. Indio, CA 92201 775-8327
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address
Contractor's License No.
on file
Telephone No.
City Business License No.
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I I 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
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by Date
1095
PERMIT VALIDATION
PERMIT NO. 2095
DATE APPROVED 3-10-94
EXPIRATION DATE
3-10-94
DATE ISSUED 3-4-0-94
By— I
A ministrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
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,MAR -1-j-94 THU 0:04 PM
TO:
COMPANY NAME:
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-DATE: `D4
FAX NO: Z/
OM.- 1FAXED BYs
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PAGE 1 OF
IF YOU EXPERIENCE ANY DIFFICULTIES FROM FACSIMILE (619 ) 342-7504, PLEASE
CONTACT SENDER AT (6:19) 775—SM.
IS2.7
lea
Palm Springs Bruch
V.O. door 4011
Palm Dca M CA 94$59011
PPiona 61913604M
FAX 6119/3604570
MAR -0-94 THU 8:05 PM
NOTE:
With Ptoliat Validation
this form canstitytea an
anaoschmem paimrt
Cti'Y OF LA QUINTA
APPLICATION FOR PERMIT
-PUBLIC WORKS CONSTRUCTION 4EN ROACHIVIENT)
P. 2
Fat the aonmuetion of public or Wtvata Curb&, tlrlvt,HYt. pivementt, sldewalks, putting lots, sev.*", water n»Ins
and ptbor tike public work$ lmpruv+rnentr In 4mnt6tti0n with MINOR IMPROVEMENTS and APPROvrD aUS01V18lONS
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DATE: ��� `"
LOCATION Of CONSTRUCTION _ d
15i11�e1 all mm ear Gownplr0" Qr :.40eLM1
PURPOSE OF CONSTRUCTION
91ME.NSIQN OF INSTALLATION OR REMOVAL --
SIZE OF EXCAVATION, IF NEE0EI2
APPROXIMAT9 TIME WHEN WORK WILL BEGIN - r
APPROXIMATE TIME OF COMPLETION o � -
ESTIMATED CONSTRUMON COST S
(I"udirroq ranwwal of all obit wguon, rnallfW6. and dotrris, twCktIlliAq, i70R�.
R Cbtiff aria 01114ing penttirlent raur9etjAq and/or toplacifig imorOr+mvnul
Subdivision Improvistnant Pamit . Clan III
Minor Improvamont Permit Clue IV
Ski AtCh (aMrh 6ptlasUwtlon plans If ipprWi&ty)
W s
for 4lifition of the jantinq of this permit, the applilsht herebrj iWaos to:
1nQannnafr, defers ark sm we relyltell�+t+tf owmantee Awns, otfkM, rfPMentauves enlz ort+oiaVep, Aarrn:aw front 04 WAIAM ani► WW 4911
peftaitiet, Iiabilitiltl a i M tow► Claltnl or Coors eetwn ant arlelne atrt of env la:+t+dara. roe or
rsati0er►rr+e or ooeuntna r $ sar+aarmm ro wn of env rroni v darra9e to aenons of prowfir
nOW'"a" mote Ile S>WMR prikhUld pursuant to Intl soolmt►Qp,
NOON the AAart.n.ettatae AudmntV At heat r'w mgrt@yr 1241 %&An m e hWwa If tete tune *"@a wort VMI be 1%bmi 8.
eanrsry tants Ali eoaleaole City ordlneneM. the t4rrne arts earwig lame of the peartrs ®rd all applimbie mite ww rswlaum of the City of
LA Orrlfue and t* IsaeY far a" "WftjQf* npoaoerrt m ne &w" &I the tt%lt of
Varfq of Applicant (pltsea print)
Mime of Contractor and Job Foternan
:ort114=1es Ljunm No.
koplitant's Insuraftm Company
SIQMtura of Applicant of
SLWnm Address
Telephone No.
Burrneu Address Talaphorw Na.
CatY Bwsiness Llsarm No.
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