CIP2017-0004J
See below for Finance Revenue Codes 4
OF.-
ENCROACHMENT PERMIT
PUBLIC WORKS CONSTRUCTION
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: 7/10/2017
LOCATION OF CONSTRUCTION(Street address or Description): MILES AVE BTW SEELEY AND DUNE PALMS
PURPOSE OF CONSTRUCTION: CONSTRUCTING NEW MEDIAN
DESCRIPTION OF CONSTRUCTION: 2015-02 MILES AVE MEDIAN ISLAND IMPROVEMENTS
DIMENSION OF INSTALLATION OR REMOVAL: PER APPROVED PLAN
APPROXIMATE TIME WHEN WORK WILL BEGIN: 7/17/2017 TIME OF COMPLETION: 10/17/2017
ESTIMATED CONSTRUCTION COST: S1.015.520.00 (Including removal of all obstruction, materials, and debris, backfllling, compaction
and placing permanent resurfacing and/or replacing improvements)
SEE PROJECT CONTRACT AND SPECIFICATIONS FOR CIP 2015-02 FOR PERMIT CONDITIONS
In consideration of the granting of this permit, the applicant hereby agrees to:
Indemnify, defend and save the City1 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 at (760) 777-7097. To
submit an inspection request, leave a message on the Inspection Request Hotline at (760) 777-7097 prior to 1:30 P.M. at least twenty-four
(24) hours prior to the anticipated inspection.
Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City of and
to pay for any additional replacement necessary as the result of this work. i
of Applicant or Agent
GRANITE CONSTRUCTION
COMPANY/SIBEL WESTCOT 38000 MONROE ST INDIO, CA 92203
Name of Applicant (please print) Business Address
GRANITE CONSTRUCTION COMPANY 38000 MONROE ST. INDlO, CA 92203
Name of Contractor and Job Foreman Business Address
089 • 02501
(760)775-7500
Telephone No.
(760)775-7500
Telephone No.
Contractor's License No.
VALLEY FORGE INS CO
Applicant's Insurance Company
Finance Revenue Code
TOTAL: $0.00
City Business License No.
GL 2074978689
Policy Number
PERMIT NO: CIP2017-0004
DATE ISSUED:
EXPIRATION DATE:
WORK INSPECTED BY':
PERMIT COMPLETION DATE':
'If the work is covered by a Subdivision Improvement Agreement,
Subdivider shall request final acceptance of improvements from the
City Council.
~0'
Date:
Tract No: ki Project Name:
Purpose of.Construction (i.e.: Rough Grading, .Offsite Street, e __________________
Decription of Construction (i.e.: See Plan Set No. 01234) _' I
f1iIes vejian Island LmprovementFroject no 2015-02 - .j - -
Dimension of Installation or Removal:
r Approximate Construction Start Date 7J,17/2,017 k .4
Approximate Construction Completion Date 10IU21J
Estimated Construction Cost $1i015 i
Estimated Construction Cost shall include the removal of all obstructions, materials, and debris, back-filling, compaction and
placing permanent resurfacing and or replacing improvements S S
Contact Name: Number :P)... j
Name of Applicant/Owner: iG'anite ontructi6h
Applicant Address 8000Vi0ir t lrdlo 92203
Applicant Telephone Number 1(760)47754,500 - ' 1
Applicant E-mail Address:[ com <
Name of Contractor:
Contractor Address ö0lnroe St' oCA,92203
Contractor Telephone Number R760) 775-75O0 - 4 ' I
Contractor State License Number:. -
Contractor City Business License Number 12501 '
Contractor E-mail Address:[ieI Westc cgcin com
110- ACOPY OF THE CURRENT INSURANCE CERTIFICATE MUST BE PROVIDED 1
Applicant or Contractor General Liability Insurance Company:
FA&ord
pplicant or Contractor General Liability Insurance Policy Number:
Office Use Only: . Office Use Only:
Inspection Fee:
.
Assigned Permit Number .
Permit Fee: .. . . Approval Date: . . . S.
As-Built . . . Expiration
Deposit:. . Date:.
Dust Control . . . . Issue
Credit . . . . .. . .. . : . . ... . •. : .
Amount: . .. .
Administrative Authority: . .
TOTAL FEE DUE: . ____________________
i Urlve/(flecK11sts -7 Forms /kpp11cat10n5 Application for ermit postea -Zb-u .