0998i � .•
ary r; a 1'+r. ------.-.----I--7 — — — —
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NOTE
With proper validation 2
this form,constitutes an
encroachment permit CITY. OF LA QUINTA'
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
543-11002.69 0FT[�9�Sw
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers; ,water mains' 1,
` and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit.— Class III
DATE': gkXxx February 4, 1991 Minor Improvement Permit Class IV w "
LOCATION OF CONSTRUCTION —S/W ,Cor Washington Street' and avenue. 50 .
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
place 4'-4.'_' PVC Conduits Sketch (attach construction plans if appropriate) '
for GTE cable r.
DESCRIPTION OF CONSTRUCTION place 4-4" PVC conduits per attached drawings
ref:. W04543-1100269
DIMENSION OF INSTALLATION OR REMOVAL 78'x2' x4' _
SIZE•OF EXCAVATION, IF NEEDED- 78''X2' XA'
APPROXIMATE TIME WHEN WORK WILL BEGIN '.
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ 1500
(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:
a Indemnify, defend and save'the City,,its authorized agents, officers; representatives and e p yees, h mless from and against any and all
penalties; liabilities or 'loss resulting from claims or court action and arising out of an acci nt, to s or damage to persons or property,
happening or occurring as a proximate result of any work undertaken unde a pe it grante u uant to this application.
Notify the Administrative Authority at least twenty-four (24) hours in adv e f the ime e k will be started.
Comply with all'applicable City Ordinances, the terms and conditio f th per it an all applicable rule d re ulations of the City of
La Quinta and to pay. for any additional replacement necessar the resul of t is work.
ignature of Applicant or Agent
GTE California'.Inc. 83-793. r. .0 rreon•Bl'vd,:Indio, CA.92201
Name of•Applicant (please print) usiness 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 I
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedul
Inspection,Fee $ —0-
Permit Fee
Penalty '
Cash Deposit -Surety Bond
if. required
TOTAL: $ —0—
Receipt No,, +
Received by Date
Recorded by,
PERMIT VALIDATION
PERMIT N0. 0998 '
DATE APPROVED' 2/4/91
..
EXPIRATION DATE 1530 j91
DATE ISSUED 2/4/,91
By
Administrative Authority, -
TELEPHONE: (619) 564-2246
.. - u..v -- r c• • � � . } _ j Al, `
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P
NOTE: uAN
With proper validation
this form constitutes an .Cl -(Y OF LA - QUINTA
encroachment permit `
APPLICATION . FOR PERMIT
.' 543-1100269' PUBLIC'WORKS CONSTRUCTION (ENCROACHMENT)-•
For 'the, construction .of public 'or. 'private 'curbs, driveways, pavements, sidewalks,' parking lots, sewers, water mains
and othe-r.like public works improvements in connection with, MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit —;Class III,
DATE: Anggg, Fp--bmuary 4. 199, •'. Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION S/W Cox' Washington Street and' av+'~nue 50
i
(Street address or Description of Location)
puce 4-4. PVC cariduits
PURPOSE OF CONSTRUCTION Sketcl (attach construction plans if appropriate)
for GTE cable' t
�(. DESCRIPTION OF CONSTRUCTION' 'DIace 4--4'” PVC conduits per attached drawings
} ref. WOS543-1100269
DIMENSION OF INSTALLATION OR'REMOVAL 78 9.X21 X4 t
SIZE OF EXCAVATION, IF NEEDED. 78 1 x2 "'X4 1 -
APPROXIMATE TIME•WHEN WORK WILL BEGIN•' • ,
APPROXIMATE TIME OF COMPLETION -
ESTIMATED.,CONSTRUCTION COST$ 15004 ;+
' (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
�•ti' ' • penalties; 'liabilities' or loss resulting -from claims or court action and arising out of any accid nt, loss or damage to persons or property
ry' happening or occurring as a proximate result of any work undertaken under he permit granted pursuant to this application.
Notify the Administrative Authority at least twenty-four (24) hours in advance of'the time/whenwvork will be'started..
J '
Comply with all applicable..City Ordinances, the terms and conditi off thepermit an � all applicable rules,na_d regulations of the.City of
La'Quinta and to pay for any additional replacement necessaryaas the result of this work.
• -Signature of Applicant or Agent '
.,GTE California Inc. 83=79.3' r. Cgrreon Blvd, Indio, CA 92201
Name of Applicant (please print),-,+. jBtsiness Address Telephone No.
Name of Contractor and Job Foreman Business Address ' Telephone No. +
"Contractor's License No. City Business License No.
i”
Applicant's. Insurance Company Policy Number
!' +. FEES: •Subdivision'Improvement Permit —.Class III
j►.- , ". t •s Public improvements: 3% of estimated construction costs
i Private improvements: 3% of estimated construction costs +•
Minor Improvement Permit — Class IV: See attached schedule ;
Inspection,Fee $ '0' PERMIT VALIDATION
'F
.�1+'iPermitFee .� PERMIT NO. 0998
Penalty t y
.Cash Deposit Bond ,
if required
TOTAL: $
Receipt No. >
Received by Date
Recorded by
DATE APPROVED • 2/4/91
EXPIRATION DATE •
DATE ISSUED 2/4/91
By
TELEPHONE: (619) 564-2246
Administrative Authority
:.I
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NOTE:
With proper validation
this form constitutes an CITY OF LA OUINTA
encroachment permit
APPLICATION FOR PERMIT
543-1100269 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
Subdivision Improvement Permit — Class I I I
DATE: Alamma February 4, 1991 Minor Improvement Permit, Class IV
LOCATION OF CONSTRUCTION S/W Cor Washington Street and avenue 50
(Street address or Description of Location)
place 4-41 PVC conduits p appropriate)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if
for.GTE cable
DESCRIPTION OF CONSTRUCTION place 4-4" PVC conduits per attached drawings
f. ref. WO$543-1100269
DIMENSION OF INSTALLATION OR REMOVAL 78'X2 ° X41
SIZE OF EXCAVATION, IF NEEDED 78 ' X2 r X4 v
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ 1500 ,
(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: i
Indemnify,. defend and save the City, its authorized agents, officers, representatives and employees, ha
penalties, liabilities' or loss resulting from claims or court action and arising out of any accidi� yint, los
happening or occurring a§ a'proximate result of any work undertaken under the permit granted)pursi
Notify the Administrative Authority at least twenty-four (24) hours in advance of the time v5hen'vvo
Comply with all applicable City Ordinances, the terms and conditions-'o4hef(permit and all applicable
La Quinta and to pay for any additional replacement necessarysa` is he results of this work.
-GTE California Inc;. 83-793 \Dr C
Name of Applicant (please print):.,
nless from and against any and all
or damage to persons or property
nt to this application.
will be started.
ure of Applicant or.Agent
mn'Blvd, Indio, CA 92201
ness Address
of the City of
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 Permit — Class IV: See attached schedule
Inspection Fee $ —0 11
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ —0—
Receipt No.
Received by Date
Recorded by
p (1 t t1 J
PERMIT VALIDATION
PERMIT NO. 0998
DATE APPROVED 2/4/91
EXPIRATION DATE 6/30/91
DATE ISSUED 2/4/91 -
By
Administrative Authority
TELEPHONE: (619) 564-2246
t1