02411 ILI
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NOTE ••-
W ith, proper. validation
this form constitutes Ian
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 ipublic works improvements "in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit — Class III
DATE: T)PrPTnhP-r I n -F 1286 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION STRUCTION Within the paved and earth sections of various La Quinta
roads witL' the boundaries of GTE operating area.
(Street address or Desciiption of Location)'
PURPOSE OF CONSTRUCTION MAN= PERN!T Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION "'Ulwuu;e ctrnu i-k--yaub
of existing. ujlderground equipment and instal- ion.
DIMENSION OF INSTALLATION OR REMOVAL Not More -than 80
.lin. feet exc%vated_under blanket permit.
This authorization does notinclude
excavations of FAS roads (major roads).
Permitee shall notify City Hall a
minim= of 24 hours prior to start of
SIZE OF EXCAVATION, IF NEEDED 3 x 4 bell holes and construction. .
installation of new services. Separate permits are required for
APPROXIMATE TIME WHEN WORK WILL BEGIN lbtify City FAS roads.
2.4 hours in advance of anv work.
APPROXIMATE TIME OF COMPLETION Permit expires 12-31-87
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. (^�
Signature of Applicant or Agent
G.T.E. 83-793 Avenue 47 Indio, CA 92201 347=2711
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
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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 N® 24
Inspection Fee $ PERMIT VALIDATION
Permit Fee PERMIT NO. 241
Penalty DATE APPROVED 12-10—R6
Cash Deposit -Surety Bond
if required EXPIRATION DATE 12-31-87
TOTAL: $ n/a 12-10-86
DATE "ISS ED
Receipt No. B�
Y - - \ Q t
Received by Date Administrative Authority,
Recorded by TELEPHONE: (619) 564-2246