10053 (2)U isf.4
��. ENCROACHMENT PERMIT
PUBLIC WORKS. CONSTRUCTION
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 111
Minor Improvement Permit - Class IV
DATE: 8/31/2010
LOCATION OF CONSTRUCTION: Family Heritage Church Site; Adams Street North of Miles Avenue
PURPOSE OF CONSTRUCTION: T -Mobil Monopalm; IE25790A;'Boring for Telco Lines
DESCRIPTION OF CONSTRUCTION: Wireless Facility with CMU Equipment Enclosure
DIMENSION OF INSTALLATION OR REMOVAL: Telco Line- 270ft
APPROXIMATE TIME WHEN WORK WILL BEGIN: 9/1/20.10
ESTIMATED CONSTRUCTION COST: less than $5,000
permanent resurfacing and/or replacing improvements)
COMMENTS
TIME OF COMPLETION: 9/30/2010
(Including removal of all obstruction,. materials, and debris, backfilling; compaction and placing
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 occuring 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 at (760) 777-
7097. To submit an inspection request, leave a message on the Inspection Request Hotline at (760) 777-7097 prior to 1:30 P.M. at
least twenty-four (24) hours prior to the anticipated inspection.
Comply with all applicable City Ordinances, the terms and conditions of the permit and all a
of La Quinta and to pay for any additional replacement necessary as the result of this work.
Maryann Harwood - T -Mobile West Corporation 3257 E. Guasti Rd. Ste 200,
Name of Applicant Business Address
91761
Solex Contracting Inc. - Josh Medina 42146 Remington Ave, Temecula, CA 92590
Name of Contractor and Job Foreman Riminacc Aefeiroce
842107
Contractor's License Number
Peerless Insurance Company IE.P 0 2
Applicant's insurance Company .
FEES Subdivision Improvement Permit - Class 1
Minor Improvement Permit - Class I
Finance Revenue Code
Inspection Fee E_1
0.00
Permit Fee EE=1100:00.
As -Built Deposit E-A
0.00
Cash Deposit -Surety Bond, EE=B0.00
if required
TOTAL. .
100.00
rules and regulations of the City
of Applicant or Agent
847-571-2738
Telephone No
_ 951426-9777
Telephone No.Q�
-min�D ! OO co
City Business License No
CBP8340643
Policy Number
Public Improvements: 3% of estimated construction costs
Private Improvements: 3% of.estimated construction costs
PERMIT NUMBER: 10053
DATE ISSUED:
EXPIRARON DATA: `? z'//
BY:
WORK INSPECTED BY*: `
PERMIT COMPLETION DA . *:
* If the work is covered by a Subdivision Improvement Agreement, Subdivider
shall request final acceptance of improvements from the City Council.