1613�p
JOTEI:
With proper validation Q'
this form constitutes an
CITY OF LA QUINTA
encroachment permit
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: November 23, 1992
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION �
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
Move Equipment
DESCRIPTION OF CONSTRUCTION Road Widener, 10' wide
80,000 lbs.
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
Sketch (attach construction plans if appropriate)
Haul RBute: Avenue 52 at City Limits
to Washington and to Tampico
H' ul Date:,.11/24/92
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.
�t1 tJ
0:7�_ACE�
Signature of Applicant or Agent
Granite Construction Company P.O. Box 9011 Palm Desert, CA 92255 775-8302
Name of Applicant (please print) Business Address Telephone No.
I -) SS�> ''A x
Name of Contractor and Job Foreman Business Address Telephone No.
On File
Contractor's License No.
On File
City Business License No.
On File On File
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
.i ! $
i
Penalty. M
Cash Deposit -Surety Bond
if required t
TOTAL
10.00
Receipt No.
Received by Date
PERMIT VALIDATION
PERMIT NO. 1613
DATE APPROVED 11/23/92
11/24/98
EXPIRATION DATE
DATE•IS•UE 11'/23/92
By
0 Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
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