0190 (2)OF 7
this form constitutes an <
CITY. OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION. (ENCROACHMENT)
OF T[iB�wS
For the construction of public or private curbs;' driveways, pavements,, sidewalks, parking lots, sewers, vvater=mains .
,,and other like public works improvements in connection with MINOR IMPROVEMENTS and'APPROVED SUBDIVISIONS.
r Subdivision, Improvement Permit — Class III
DATE: MaY 9, 1986
_ Minor Improvement Permit Class IV '
LOCATION OF CONSTRUCTION Desert Club Dr. and La Fonda
(Street address or Description of Location) z is
PURPOSE OF CONSTRUCTION raise existing telephone Sketch (attach construction plans if appropriate)
conduit to clear VOM proposed storwater 60f RCI
DESCRIPTION OF CONSTRUCTION TrenCh an raise existing
conduit system as shown. -
DIMENSION OF INSTALLATION,OR REMOVAL REARPMGE EXISTING"
conduit system.
SIZEOF EXCAVATION, IF NEEDED 40" + :Length— 9 old SEE ATIVD DRAFTING
4 dept.
APPROXIMATE TIME WHEN WORK WILL BEGIN
�5—Z1-86Y - �.•
work to be datable with proposed'
APPROXIMATE TIME OF.0OMP LETION /-30-86• + 3 -inch ,lowering and reconstruction
ESTIMATED CONSTRUCTION'COST $ ' of Desert. Club. i .r
••
(including- removal of all obstruction materials and debris backfillin com-
paction and placing permanent resurfacing and/or. replacing improvements)'
In consideration of the 'grinting 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 arisin• out of an accident,I r .
g y 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. `r
r"
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 83-793 Dr.•Carreon Blvd.; Tndio,,CA 92201 .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 III
Public improvements: 3% of estimated- construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement PermitClass IV: See attached schedule NO'�®
— ,
Inspection Fee $` ' n/a PERMIT -VALIDATION '
Permit Fee PERMIT, No.
190
Penalty S
Cash Deposit�Surety Bond' DATE APPROVED S—A—RH ;
if required EXPIRATION DATE '8-30=86
S
TOTAL: $ DATE ISSUED 5-9-86. -
Receipt No. ,
By
Received by Date 'Administrative Authority
Recorded by
TELEPHONE -(61,9)564-2246
'NOTE:
C�Ty OF LA
UIN
With;ptoper validation COMMUNITY DEVEL P
M�TAT
DEPT
this jorm,constit7utes�'
-.an
-..,..,,.,.,,-.'eeicroachrhentRermit ..:IbITY. bF. LAnQUINTA
APPLICA IQNFOR. PERMIT
.'PU13LI
C WORKS- CONSTRUCTION. -(ENCROACHMENT)
For
i
theor ,private' . construction- of. public vate"-Curb s,,.,drivo k, -pavements,
sidewalks,
;'
:'.parking. n§ lot
s; -sewers,-w.-ater11, ma. ins,
, '.
an�other like public�works;in�roventnti jn,conneaionwitWMINOR IMPROVEMENTS"nd'APPROVEYSUBDIVISIONSI, .
W.. 0....# 543-31.422—R
,:Ma 1.9�6 Subdivision improvement Permit ,-,Clais I I"
DATE:. ,..., .
'Minor :Improvement Permit Class IV -
LOCATION OF'CO14STRUCTION Desert Club _.Dr & La Fonda ="7
(Street address or Deicription of Location)
PURPOSE OF CONSTRUCTION, raise.. existing telephone conduit
Sketch lattach construction plans, if.appro
to clear CVWD proposed stormwate'r 6011RCP priate)
DESCRIPTION OF'CONSTRUCTION'.Trench. and raise existing conduit
-system as shown
SEE ATTACHED DRAWING
DIMENSIC)"-l'OF.!"'S7,,-,LLATION' REARRANGE S G
;V OR REMOVAL
conduit system..
SIZE OF EXCAVATION, IF NEEDED .40'_ length -41", width
4i Appth
APPROXIMATE TIME WHEN WORK WILL BEGIN 5-21-86
-APPROXIMATE. TIME OF COMPLETION ...7-30-86,.
.ESTIMATED CONSTRUCTION COST $
(including removal of all obstruction, -materials;, anO.-Oebris,. backf illing, c6m=
paction and placing permanent, resurfacing and/or 'replacing i
improvements); -
In"cbrisideration. of Ahe 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
. 1; . or damage to persons or property
happening or occurring as a proximate result of any work und
ertaken 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.
Ccimpl�,��'iih all.applicable City� Orclina'nces'L 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.
GENERAL TELEPHONE CO. OF CA. Signature of Applicant or,Agent
83-793 Dr Carreon Blvd; Indio, CA.- 92201 619/34-7=8775
Name of Applican't. se;pr'jni)*'.' Business,Address
te�liiph6n6L N 0.
Name of Contractoiand-Job Foreman Busine'ss'Address -
Telephone No.
Contractor's License, NO. CityL Business License No
:...Applicant's Insurance Company Po'licy,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 Fees,. 44L
Permit Fee
P&nalty
Cish,,Deposit-sbrety -Bond
if required
.,TOTAL:
Recelp- No.
lived by Date -
by
PERPA'IT NO.
'DATE AP'PRdVED..
EXPIRATIONDATE.
DATI E ISSUED
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