0009NOTE:
With proper validation
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
June 29 1983 Subdivision Improvement Permit — Class I I I
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION SS/6 Eisenhower Drive E/0 San Isidro Street
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION - Place balephone Cable.. Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION See Attached TY49, "A"
Work On3ers #543-31406-I and $543-31408-I
DIMENSION OF INSTALLATION OR REMOVAL
See a4L.,-d Dwg. fl51"
SIZE OF EXCAVATION, IF NEEDED See at-tadzed 1X�q" "A
APPROXIMATE TIME WHEN WORK WILL BEGIN 7-1-83
APPROXIMATE TIME OF COMPLETION 1-31-84
ESTIMATED CONSTRUCTION COST $ N/A
(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.
CgMZPJ�L TEU�I'AC Z COIAPANY OF CALIFORNIA
Signature of Applicant or Agent
83-793 Avenue 47, Indio, CA 92201 (619)347-5775
Name of Applicant (please print) Business Address Telephone No.
Chon Ruin. 83-793 Avenue 47, Indio, CA 92201 (619) 347-8775
Name of Contractor and Job Foreman
Contractor's License No.
Business Address
Telephone 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 $ 71.00
Permit Fee 20.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 91.00
Receipt No.
Received by Date
Recorded by
PERMIT NO
It 19
PERMIT VALIDATION
009
DATE APPROVED JUM 29, 1983
EXPIRATION DATE J=e 29n 1984
DATE48SUED June 29, 1983
gy C.rzr.sl�-.tea/ �1r
U11 Administrative Authority+„�y
f"VO'K,14 t.. )P.
TELEPHONE: (619) 564-2246
M
NOTE: -
With proper validation
this:form oonsiitutes an
_encroachment permit,
CITY OF- LA QUINTA y
APPLICATION FOR PERMIT m
PUBLIC WORKS CONSTRUCTION.. (ENCROACHMENT);
`M OF
For: the construction of public oi,private 'curbs, driveways,: pavements, sidewalks, 'parking "lots, sewers,•.water mains
and other like public works improvements in connect'io'n with MINOR 1MPROVEMENTS and APPROVED:SUBDIVISIONS
/ 'Subdivision Improvement Permit - Class -111, 6-21-83.
-Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION SS/O Eisenhower Dr E/0 San Isidro.St
I
(Street address or Description of Location)
PURPOSE OF: CONSTRUCTION Place telephone cable Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION see attached dwg. I
W.0.# 543-31406-I ,and 5437--31-4-0-9--1
DIMENSIO^: CF IN'ST,-,LLATION OR REMOVAL
see attached dwR "A"
SIZE. OF EXCAVATION, IF NEEDED see attached dwg "A"
APPROXIMATE TIME WHEN WORK WILL BEGIN 7-1-83
APPROXIMATE TIME OF COMPLETION 1-31:-83.
ESTIMATED CONSTRUCTION COST.$ N/A
(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 resuliAf this work.
Signature of ApplAy/'t or Agent
GENERAL TELEPHONE CO. OF CA -Al -7q•1 Avg 47, Indjro, Ea 92201 619/347-8775
Name of Applicant (please print) Business Address Telephone No.
CHON RUIZ 83-793 Ave.•47, Indio, CA. 92201 619/347-8775
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 +
i
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspeciion,Fee S 7J . 6.0•
Permit Fee —
Penalty
Cash Deposit-S-rety Bond
if required
t. TOTAL:
ece;pt No.
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Date
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
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