0181 (2)NOTE:
With proper validation
this forrrf constitutes an
encroachment permit
410
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 16, 1986 Subdivision Improvement Permit — Class III
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION S/S Ave. 50 E10 Adams St. 842' E/O Adams, 1904' E/0 Adams
at proposed Orchard Circle
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Place tunderarnimd facilities
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 7-1-86
APPROXIMATE TIME OF COMPLETION 1-30-87
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
Sketch (attach construction plans if appropriate)
See Attached Drawing "A"
Permit is form installation of
underground telephone ducts, vaults
and appurtenant work. Attached
special provisions are included and
made a part of this permit.
NOTE: A separate permit must be
'secured by the contractor, and all City
requirements and fees are to be paid
if work is done by other than the
utility conpany forces.
In consideration of the granting of this permit, the applicant hereby agrees to:
Indemnify,.deferid 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.
Glen Lockhart for C. Ruiz
Signature of Applicant or Agent
General Telephone Co. of CA 83-793 Dr. Carreon Blvd. Indio, CA 347-8775
Name of Applicant (please print) Business Address Telephone No.
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 I I
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs 1
Minor Improvement Permit — Class IV: See attached schedule •"" 1.81
Inspection Fee $ PERMIT VALIDATION
Permit Fee ,PERMIT NO. 181
Penalty 4-16-86
Cash Deposit -Surety Bond DATE APPROVED
if required EXPIRATION DATE 2-30-87
TOTAL: $ NIA
DATE ISSUED 4-16-86
Receipt No.
By
Received by Date Administrative Authority
Recorded by TELEPHONE: (619) 564-2246