10063 (2)s uta,• See below for Finance Revenue Codes
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 III
Minor Improvement Permit - Class IV
DATE: 10/11/2010
LOCATION OF CONSTRUCTION: Verizon; Calle Tampico E/O Desert Club Drive
PURPOSE OF CONSTRUCTION: Exposed Buried Telephone Cable in Street (Underneath Asphalt) to Isolate/Repair Trouble on Cable
DESCRIPTION OF CONSTRUCTION: Need to Cut a 4'x8' Pit in Asphalt to Expose Telephone Cable
DIMENSION OF INSTALLATION OR REMOVAL: 4'x8' Cutting Asphalt
APPROXIMATE TIME WHEN WORK WILL BEGIN: 10/14/2010 . TIME OF COMPLETION: 10/22/2010
ESTIMATED CONSTRUCTION COST: $1,200 (Including removal of all obstruction, materials, and debris, backfilling, compaction and placing
permanent resurfacing and/or replacing improvements)
COMMENTS
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 applicable rules and regulations of the City
of La. Quinta and to pay for any additional replacement necessary as the result of this worE.
Verizon - Thomas Flinn
Name of Applicant
Arizona Pipeline - Ivan Matamoros
Name of Contractor and Job Foreman
423545
Contractor's License Number
Travelers Prop Casualty Co.
Applicant's Insurance Company
FEES Subdivision Improvement Permit - Class I
Minor Improvement Permit - Class I
of Applicant or Agent
950 S. Williams Road, Palm Springs, CA 92264 760-327-1576
Business Address Telephone No
Cabazon Road, Indio, CA 92201
nr. T
Finance Revenue Code
Inspection Fee E_10.00
Permit Fee E_1
$100.00
As -Built Deposit E-A
$0.00
Cash Deposit -Surety Bond, E -B
$0.00
if required
TOTAL
$100.00
909-208-6944
Telephone No.
6849
City Business License No
VTJEXGL5643B14ATIL10
Policy Number
Public Improvements: 3% of estimated construction costs
Private Improvements: 3% of estimated construction costs
PERMIT NUMBER: 10063
DATE ISSUED: /3 , -lU / 0
EXPIRATION DATE:
BY: -Ia__Y1—
WORK INSPECTeff'BY*: l
PERMIT COMPLETION DATE*:
*If the work is covered by a Subdivision Improv ent A ement, Subdivider
shall request final acceptance of improvement from th City Council.