2096a -t.
tRIOTA
With proper validation
this form constitutes an
encroachment permit
CITY OF LA QUINTA
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
Subdivision Improvement Permit —Class I II
DATE:. 3-10-94 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Move Equipment Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION paver 1116" wide Haul Route: Hwy 111 & Washington
84,000lbs all else legal south to 50th west to Eisenhower
south to Montezuma west to Alvarado
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
Haul Date: 3-10-94
APPROXIMATE TIME WHEN WORK WILL 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.
A-11 �-
Signature of Applicant or Agent
Granite Const. 38-155 Monroe St. Indio CA 775-8327
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. 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 2096
Inspection Fee $ PERMIT VALIDATION
10
Permit Fee PERMIT NO. 2096
Penalty 3-10-94
Cash Deposit -Surety Bond DATE APPROVED
if required 10 EXPIRATION DATE 3-10-94
TOTAL: $ DATEIU 3-10-94
Receipt No.
By
Received by Date Administrative Authority
Recorded by TELEPHONE: (619) 564-2246
,* .
MAR -10-94 THU 9:20 PM
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With wooer validation
Alt Porn► conttiNtss an
irwastptfrio tt carmn
CITY OF LA QUINTA
APPLICATION FOR PERMIT
-PUBLIC WORKS CQNSTRUcTION (ENCROACHNIENT)
P. 2
For the caft1vunian of public or prtvats avros. drivrneys. Pavamttnts, sldawalka, parking lou, term, vntm maitu
and other Ilk# public "its itttprgvefnann in +aort"CUOn wigs MINOR IMPROVEMENTS and APPROVED SUBptY18i0NS
.09 3 -JO -;o -z
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DATE: %' �
LOCATION of CONSTRUCTION
"bdiviaion impr ra tknt Permit . Class ill
Minor Improvement Parmrt Class IV
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(titfgt taatrtaa ar Osacnotipn pt �at,10A1
PURPOSE OF CONSTRUCTION
OF
DIMZNSION AF INSTALLATION OR REMOVAL,
S 26 OF EXCAVATION, IF NEEDED
A PfIOX1M^TE TIME WHEN WORK WILL 4EGIN
A"ROXIMATE TIME OF CQMPI.iION —
ESTIMATEC CONSTRUCTION COSTS
ihaudittg removal Of all Obstrul uOn, matsrista, and deprll, bactttiltirtq; Cadf�
sstalon lint Placing patm$neat raswfadng and/or reptagt,g iffisravatnenul
Ski IstUch conamctlon pians its alts!
wAswarsw of the "ntlnq of this ptnrmlt, %no appliant Alreby $grits to:
indeMnntty. #$unit We cave V@ Gn►. ftt aly%cntld bganta, otfwm, raatiaanlatfwe am &reivvan. harnitaa tromn unll �s�t+M afN ar+d all
Aer�attiaa, lWNtitis of tad mawltim ttwn valm v gown Moon &M aribnl ort at and wiaent. ►oaf or
�+M oro irrvb U ofollwou awn of CRYswgri vr'dwt"GR Yrs X e f OM4 IMM44 Ourow&hs Ilj 6WInl" a �!h
F4910V the Aafn�naerettre AfA*WTV at utas Cw"lvfout tt{I AOrn to aavwm N CNa tttne wnsn vrot* mll ba titan L
Cmwy we all am"" Gty orou" aae, sn. 'Arm" Oho candloo to of titsannft and all awliamwo tutee arw RMNWWO 61 1116 CRY •1
V laulatD Ona m Wter ate a4dlllib+�et ett aoaT9rM,� sa the rearlt of mo wont,
4nu at Applicant (pitiN print)
'alai of Contractor Ono Job Foreman
ontrames Liunn No.
*itant's Instsranw Company
Slpnitwal of Applicant of
ewlness Addtim
Telephone No.
SulanaUAddrou Yalapi�onl No„10
City Busman Liarua No.