0177NOTE:
-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
W . #'543-31141-I
Subdivision. Improvement Permit — Class I II
DATE: March 25, 1986 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION E/S/0 Washington St. SIO Eisenhower Dr.
(Street address or Description of Location) `
'PURPOSE OF CONSTRUCTION Additional favi 1 itipc -Sketch (attach construction plans,if appropriate)
DESCRIPTION OF CONSTRUCTION _place 192' of 4-4" conduit. Permit is for installation and maint.
of 200 feet.of 4-4" telephone.ducts
and appurtenant work. Work in dirt
DIMENSION OF INSTALLATION OR REMOVAL 192' area only. See GTE drawings No. 543-
..31141-1. The attached general and
special provisions are included and
SIZE OF EXCAVATION, IF NEEDED 4' x 192' - made a part of this permit.
NOTE: A separate permit must be
APPROXIMATE•TIME WHEN WORK WILL BEGIN 6-1-86 secured by.the contractor, and all City
requirements and fees are to -be paid
APPROXIMATE TIME OF COMPLETION :8-1-86 if workis done: by .other than the
ESTIMATED CONSTRUCTION "COST $ 2,400.09 utility company crews.
(Including removal of all obstruction, materials, and debris, backfilling, com- _ nrpg? no
paction and placing permanent resurfacing and/or replacing improvements) nw 1 4111?111 11
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.
Signature of Applicant or Agent
General Telephone Co. of CA 83=790 Dr. Carreon Blvd. Indio,.CA 347-8776
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone. No.
Contractor's License No. �.y City Business License No.
Applicant's Insurance Company 5" r -Policy Number
FEES: Subdivision Improvement Permit — Class III ,TcR�.®.
G X51986
Public improvements: 3% of estimated construction costsNA� �� `t�vr
Private improvements: 3% of estimated construction costs v 1 f
7.7
Minor Improvement Permit — Class IV: See attached schedule _)N
•lr 1 Y
Inspection Fee $ n/{ t- PERMIT VALIDATION
Permit Fee, PERMIT NO. 177
Penalty March 25, 86
Cash Deposit -Surety Bond DATE APPROVED
if required j
.� ; ' EXPIRATION DATE _se=- 1, 86
,TOTAL: $ n/a DATE ISSUED March 25, 86.
Receipt No. By'
Received, by Date Administrative Authority x,
Recorded by TELEPHONE: (619) 564-2246
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