2128NOTE
*th'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
DATE: G/A/4G
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Move Equipment
DESCRIPTION OF CONSTRUCTION paver 11'6"W, 84,000lbs
All Else Legal
DIMENSION OF INSTALLATION OR REMOVAL
Subdivision Improvement Permit— Class III
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
Haul Route: Washington Street from
North City Limits, Ave 50, Eisenhower
to Hildago
Haul Hate: 4/8/94 or 4/11/94
SIZE OF EXCAVATION, IF NEEDED Only one day
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) l / d lr`
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, 38-155 Monroe Street, Indio, CA 619-775-8327
Name of Applicant (please print) Business Address Telephone No.
Same
Name of Contractor and Job Foreman Business Address Telephone No.
On File
Contractor's License No.
On File
On File
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.
10.00
Received by Date
2128
PERMIT VALIDATION
PERMIT NO. 2128
DATE APPROVED 4/8/94
EXPIRATION DATE 4/11/94
DATE ISS E 44/94
By4 141!
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
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TRANSMISSION REPORT
THIS DOCUMENT (REDUCED'SAMPLE ABOVE)
WAS SENT
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*** SEND ***
NO
REMOTE STATION I.D.
START TIME
DURATION
itPAGES
COMMENT
1
4- 8-94 10:45AM
1111"
1
TOTAL 0 01'11" 1
XEROX TELECOP`IER 7020
APR- 8-94 FRI 9;35 PM
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COMPANY NAME: _ 1/ . iAX NO:
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PAGE I OF
IF YOU EXPERIENCE ANY DIFFICULTIES FROM FACSIMILE (619) 342,7504, PLEASE
CONTACT SENDER AT (619) 775 -SM.
4,n ,
Palm swiw WanCh
P.O. sox 9011
Palm p9WM CA 922WO1.1
Phone 619/360-4500
FAX 619/360-4570
I TP
4
APR- 8-94 FRI 9:36 PM
NOTE.-
With
OTE:With orQW validation
this forth conetltutfu in
endoadlRNnt oarfRrt
For trio eortrtruotion of pubfla or prtvato Nros, jgrlvtwtvt, Rvamann, sidewolktl,
parking
and other (lice oubli4 works it"wavenwA s In eon OMOn with MINOR IMPROVEMENTS xndAPPAOV 520 SUS ADIVl8 ONS
C11Y OF LA GUINTA
APPLICATION FOR PERMIT
'PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
P. 2
.r
OATS; / Subdivision Improvement Po mit a. Class ill
Minor Impronaunt Permit CISU IV
LOCATION OF CgNSTAUI:TION .
tswn a www «ti...,psioo of u=tmw
PURPOSE OF CONSTRUCTION 1C
ION Qfj C-ONST
DIMENSION OF INSTALLATION oR REMOVAL
SIZE OF EXCAVATION, IF NEEz0E0
A?PROXIMAT$ TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLE7IQN
ESTIMATED CONSTRUty119N COST t
(Inguditp r+smovu of all olnuucuon, rnattrials, and Cearll, baokflili
aMDA and piacin �, p0�
9 Pflrrftartant reswtbde►p andlor rtglacinq Qf the i+nOrort�tnon
S7c� a`t h (IMI ti GGAIIVv�lan plan! if !pp'rWiata)
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In �t�04r0tiert ul
9nnuny of this pwmit, tho flppiirrnt hutbv sofas 10,
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lfrrartaa N the SW tMaR woFlt tMttf ba asaet#0.
c&h1mv (Mtn all eDolml&s City Orditmts, the Item" art$ WndilloM of %he O+ttnA wilt alt aoolftWe #phis atvi r*QlitfUW
LA Quints anti to pep for arts► mdkkwm n mwwro rt as the rmis of this am. of the
City Of
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Extended Page 2.1
goal SU9000116n Improvement Permit — clau III
Public Improvements: 391 of Ostimsted construction cosu
FfIV4a 1mproveme101ei 3% of 40miatod eonetruclion colo
Mlnor Improvement Permit — CIM IV: Sep ettydtiad dchedijlQ
1010ion Fee $ 1 ,
I PERMIT VALIQATICIN
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-nater
,w Oepoeit4urety Bono
required
TOTAL; s
lim No.
ived by 04t1
.."Zed by
PIAMIT NO.
CATS APPROVED
EXPIRATION DATE
DATE 168V60
AdmInIstrlvve Authority
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