2141With.proper validation
this forms 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
4/18/88
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Move equipment
DESCRIPTION OF CONSTRUCTION Paver 11'6" W,
84,000 lbs. All else legal
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Subdivision Improvement Permit — Class I I I
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
Haul Route: Hildlga - Avenida
Bermudas, Ave. 52, Jefferson St.,
Ave. 54, Madison St., Ave. 58,
Jefferson St.
APPROXIMATE TIME OF COMPLETION Haul date: 4/18/94
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.
LAJr>A
Signature of Applicant or Agent a.
Granite Construction 38-155 Monroe St., Indio, CA 92201 (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
One File
Contractor's License No. City Business License No.
On File On File
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit —Class III
Public improvements: 3% of estimated construction costs,
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ 10.
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
$ 10.
Receipt No.
Received by Date
PERMIT NO.
2141
PERMIT VALIDATION
2141
DATE APPROVED 4/18/94
EXPIRATION DATE 4/18/94
DATE ISSUE 4/18/,94
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
Co
,"P,R:14-94 MON 8:17 PM
NOTE:
Wldt WOW nalidbt,an
this to"" wnattlita an
InoroadhMOM varmit
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
P. 2
Fat the aonttvtrction of pwbsla of prfvat6 rpt. dr1
vr&8Y1, pdvoMents, ildewalkt. pparlclrtl Iota,
and othar 11rt Oub"d Warta )mPMv*"rhz; In CGw4ot,0n wi%h MINOR IMPROVEMENTS and APPROVED SU� p Y18 ONS
,M
DATE; lr Strbdlrltign Improvse ant ✓tomtit . Class lit
LOCATION OF CONSTRUCTION Minor Ifflorovoment Permit Clan IV
is~ some or wKnouon or t,00awlt!
PURPOSE OR CpNSTRUCTION �,��(Ittach eonstrualon plans if •
porvpssita )
D R PTION i CONST TON ' %��
r
DIMENSION OF iNSTAt,tATION OR REMOVAL /I4eleo
SIZE OF EXCAVATION, IF NEEOFO /
APPROXIMATE TIME wmEN WORK WILL $90IN
APPROXIMATE TIME OF COMPLgTjopi
ESTIMATED CONSTRUCTION COST t
(Indc►dtnl rtetr+pv6i of all o4WVixtian, maWwa, ins debrIg. twC10111inq, aomr, .
was m and 9166011 permanent mowf6clnp and/or roptaclrlp isllptovamanu)
In sn Institim of the 9rantlns of this permit, th/ appltrartt hlnbv #won to:
II+tOwonafr. d1tend are wr vu Gtr, Its evolont41 aw"U. offleen, ►Nr*taftwu n atm woloym. har mtew 1►oee bra Wiftt Mt ww all
bwlutiat, lQwJj1at ar too rvt l" Own vows M raurt wtwn " briuM w of any eutwent, tow or 440" to ""WA or Orvot kv
NOW" or t►aotlmrq r I SMalmata re1YR Of IRV t*orll vedom*444 Ifr4M the Permit gn11tse pynwnt to Vf11 opotr.trola
114MIIV i40 AditesotMtrA AudwnTy ae Nes ft"Mty,.foyr 1241 h%n N Wva M the IW4 wfteh arOrR VAII W ltieritlL
eat+naw "in atl et>dr+ahas G1V ar"Wan 1. the tar" or" eonu,ttorx of the permit Ind all woiicame fetes I,rw rtigylslwta o1 silo Gry of
4 Qr10
4 WW to W ter Il" KWN*" roaarr*M r~UW20 V a the rttetist Of 11111 was. r /3
14ftwit of Applicant Joissm print)
lathe of Contractor and
,•ontractorrs Licass No.
BuOrieu Address
•009ant'1 Insurance Comimnr ��- Policy Number
i