TS2015-00014 4 uLftf '
See below for Finance Revenue Codes
Tit,,
ENCROACHMENT
OF
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: 6/8/2015 .
LOCATION OF CONSTRUTION(Street address or Description): ADAMS ST NORTH OF HWY 111
PURPOSE OF CONSTRUCTION: INSTALLING TRAFFIC SIGNAL AND STREET IMPROVEMENTS
DESCRIPTION OF CONSTRUCTION: CIP2012-01 ADAMS ST SIGNAL AND STREET IMPROVEMENTS
DIMENSION OF INSTALLATION OR REMOVAL:SEE APPROVED PLANS
APPROXIMATE TIME WHEN WORK WILL BEGIN:6/15/2015 TIME OF COMPLETION: 9/29/2015
ESTIMATED CONSTRUCTION COST: S676,784.00 (Including removal of all obstruction, materials, and debris, backfilling, compaction and
placing permanent resurfacing and/or replacing improvements)
COMMENTS: SEE PROJECT CONTRACT AND SPECIFICATIONS FOR CIP 2012-01 FOR PERMIT CONDITIONS
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 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 conditionsof the permit and all applicable rules a d regulations of the City of and
to pay for any additional replacement necessary as the result of this work.
Signature of Applicant or Agent
GRANITE CONSTRUCTION CO -TYLER 38000 MONROE ST INDlO, CA 92203 (760)289-8456
Name of Applicant (please print) Business Address Telephone No.
GRANITE CONSTRUCTION COMPANY P 0 BOX 50085 WATSONVILLE CA 95077-5085 (831)724-1011
Name of Contractor and Job Foreman Business Address S Telephone No.
089
Contractors License No.
VALLEY FORGE IS CO
Applicants Insurance Company
Finance Revenue Code
TOTAL: $0.00
02501
City Business License No.
GL 2074978689
Policy Number
PERMIT NO: TS2015-0001
DATE ISSUED:
EXPIRATION DATE:4'O,//l -
BY:
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.
PUBLIC WORKS DEPARTMENT
APPLICATION FOR PERMIT
Date: 106/02/2015
Tract No 1201-01 I Project Name dams St Signal and Street Improvements
Vicinity 00 ft north of the intersection of Highway 111 and Adams St jJ
Purpose of Construction (i.e.: Rough Grading, Offsite Street, etc.)Tnstaflga Signal Ti
[Streetlmprovements.
-
_Description of Construction V.(1 e See Plan $etNo ol234)I The Pr9JetCOflsjSsoj±edJ
signalized intersection with associated asphalt paving, concrete flatwork, slurry seal and striping.
Dimensionof Installation or Removal: ApproximatelylAcre of disturbed land
Approximate Construction Start Date: 106/15/2015 1
Approximate Construction Completion Date: 109/29/2015
Estimated Construction Cost:
Estimated Construction Cost shall include the removal of all obstructions, materials, and debris, back-filling, compaction and
placing permanent resurfacing and or replacing improvements
Contact Name: irOonnor •. - Phone Number:t 76028!4
Name of ApplicantlOwner: Granite Construction - j
Applicant Address: [ Oôionroe St Indio CA 92203 V -
Applicant Telephone Number: 76O-289-8456 -
-
Applicant E-mail Address:'iyler.Connor@gcirc.cop
Name of Contractor Granite Construction
Contractor Address: 138000 Monroe St, Indio CA 92203
Contractor Telephone Number: R831)724:iO11
Contractor State License Number: J89
Contractor City Business License Number: 1öi
Contractor E-mail Address:FN/A- -
-
10- A COPY OF THE CURRENT INSURANCE CERTIFICATE MUST BE PROVIDED 4
Applicant or Contractor GeneralLiabil Z
/4
Insurance Company: V 116', R7v e -
V
kpplicant or Contractor General Liability Insuánce P1icy Number:
GL 2074978689 TV_
( Office Use Only:
V Inspection Fee:
Permit Fee: V
As-Built V
Deposit:__________________
Dust Control
Deposit:
Credit
Amount:
TOTAL FEEDUE:
V •I Irit,7 er1eIIt— 1-nrmq N. flflhICltIOI ication
Office Use-Only; V
Assigned Permit Numbcr:'f'32, 15 .'-OOQ
Approval Date:
Expiration
Date:
Issue V
Date:
Administrative Authority: