0005NOTE:
With, 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
April 21, 1983 Subdivision Improvement Permit — Class I I I
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION E/S Washinctm St. From Tanpieo to Avenue 52. N/S Avenue 52 from
Washinatcn oft. to Adams & SIS of Aveme 52 from 3475' W/O Jefferson St. to 1900' W/4
(Street address or Description of Location) Jefferson St.
PURPOSE OF CONSTRUCTION R&infOrM tel6PhOM Sketch (attach construction plans if appropriate)
facilities.
DESCRIPTION OF CONSTRUCTION Diract buried telePhOM
cable. W/O X1543 -71278-I
DIMENSION OF INSTALLATION OR REMOVAL 6284' Linear Ft.
SIZE OF EXCAVATION, IF NEEDED bzg4' or txencn ju- ct"
tW Pavement C) Fy41 J A i:bNDA h P f'� r
APPROXIMATE TIME WHEN WORK'WILL BEGIN 5-1-83
g"Ill
APPROXIMATE TIME OF COMPLETION 11-1-83
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. �
j 9-);&, "6zi,5 ,
Signature of Applicant or Agent
G2Z2AT, T MlWE CCWANY OF CALIFOE IA 83-793 Avem a 47, Indio, CA 92201 (619) 347-8775
Name of Applicant (please print) Business Address Telephone No.
CM F=Z — ENG. (XOORD. JOSE M24DZ — CONW. COORD. 347-8777
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No.
City Business License No.
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 $ 7-" . L�) 0
Permit Fee $ 1,10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
Recorded by
$ 2-0,M 5c r , -`'-=-
Date
PERMIT VALIDATION
PERMIT NO
i
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By—
Administrative Authority
TELEPHONE: (619) 564-2246
I -
Is NOTE: - - —
With proper validation
this form constitutes an
-encroachment permit CITY OF . LA-.QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION `(ENCROACHMENT) '`• ''
PF
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
--------------------
Subdivision Improvement Permit.— Class III
DATE:- April 201 1983..
Minor Improvement Permit Class IV .
E/S Washington St from Tam
LOCATION OF CONSTRUCTION g Pico to Ave 52. NIS Ave 52 from
.Washington.. -St to Adams & 8/S of Ave 52 from 34751 W/0 Jefferson Sr t. to 1900' W/0
(Street address or Description of.Location) Jefferson St.
PURPOSE OF CONSTRUCTION — Reinforce telephone Sketch (attach constructionlans if a I
facilities P appropriate)
DESCRIPTION OF CONSTRUCTION dire t Buri Pd tel ephnne (( ?
_cable. W.O.#543 x_7:1278—Z.
DIMENSIO": CF !NST,-,LLATION OR REMOVAL 6284' linear ft.
of 12 diameter telephone cable 30" deep
SIZEAOFEXC4VATION, I,F NE,f DED 6284' of trench 30" deep
APPROXIMATE TIME WHEN WORK WI4LL BEGIN
APPROXIMATE TIME OF COMPLETION 11-1-83
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris; backfilling, com
action and.placing lacin
P p g 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 theresuf of this work.
c
1 �
Signa r pylica or Agent
UnNMIAL IELI;t'HUNE COMPANY OF CALIFORNIA 8-3-
793 Ave.47 r Indio, CA 92201 619/ 47 R77
Name of Applicant (please pant) Business AddressTelephone. No.
CHON RUIZ — ENG. COORD. JOSE MUNOZ — CONST. COORD.347-8777
Name of Contractor and Job Foreman
Contractor's License No.
Applicant's Insurance Company
Business Address
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 S
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
v�
TOTAL:
Receipt No.
ii;;C:ci�•L�i by
_r ,cid by _
Date
Telephone No.
City Business License No.
Policy Number
PERMIT VALIDATION
PERMIT NO
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
t ^�
77
7-1
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te
i _. .... __..;o_ ._.,=rte —a.�., `��_. _.. •-52: _ ..:-�- .....: •; .:
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. F � ; --�-h• . , ., , r . l �= - --• 575
' 1 1
`ENCROACHMENT_ .' ?BM1T DAG. I
N0 SCALE
ASS. BOU 7 L'S
cm
GEnERAL TELEPHonE OF CAUFORmA
LOCATION l tllt�l��Dl` �. S/OC�Lt�TR[�4PlfD
EXCHANGE
C.O.
l
ISSUE DATE APPROVALS
APPROVIEQ YT -LARM4WWI"
__ __ —L"�� - - _ j �- .. • h -+v
DWG SSIZE
AREA GENERAL MANAGER
DWG. NO.
RELATED DWGS.
WORK ORDE R
A
543
FORM 6D9540
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