12040J"' Q•c See below for Finance Revenue Codes
ENCROACHMENT PERMIT
OF 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: 8/10/2012
LOCATION OF CONSTRUCTION: Verizon; WO# 542-4POAOGX; Avenue 52 and Monroe Street
PURPOSE OF CONSTRUCTION: Traffic Control to Access Existing Manhole to Replace Damaged Cable
DESCRIPTION OF CONSTRUCTION: N/A
DIMENSION OF INSTALLATION OR REMOVAL: Replacing 245' of Cable
APPROXIMATE TIME WHEN WORK WILL BEGIN: 8/15/2012 TIME OF COMPLETION: 9/15/2012
ESTIMATED CONSTRUCTION COST: less than $5,000 (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
and all penalties; liabilities or loss resulting from claims or court action and arising out of any accident, I r 11
property happening or occuring as a proximate result of any work undertaken under the permit granted
Notify the Administrative Authority at least twenty-four (24) hours in advance of the time when work will
7097. To submit an inspection request, leave a message on the Inspection Request Hotline at (760) 77
least twenty-four (24) hours prior to the anticipated inspection. 1-n
Comply with all applicable City Ordinances, the terms and conditions of the permit and all
of La Quinta and to pay'for any additional replacement necessary as the result of this wor
Verizon - Bret'Plaskey 295 N. Sunrise Way, Palm
Name of Applicant Business Address
TBD
Name of Contractor and Job Foreman
Contractor's License Number
National Union Fire Ins Co of Pittsburgh
Applicant's Insurance Company
FEES Subdivision Improvement Permit - Class I
Minor Improvement Permit - Class I
Business Address
r
Finance Revenue Code I
Inspection Fee EE=1 $0.00
Permit Fee EE=1 $100.00
i
As -Built Deposit . E-A $0.00
Cash Deposit -Surety Bond, EE=B 0.00
if required
TOTAL
100.00
ed atf{f/�)
prior. 0 P.M. at
CI'TY OF LA QUA A
nd
of Applicant or Agent
CA 92262 (951)'929-9491.
Telephone No
Telephone No.
City Business License No
GL4406483
Policy Number
Public Improvements: 3% of estimated construction costs
Private Improvements: 3% of estimated construction costs
PERMIT NUMBER: 12040
DATE ISSUED: %Z• y /Z
i. BY: v
WORK INSPECTED BY*: l j
PERMIT COMPLETION DATE*: Z� 3
i
If the work is covered by a Subdivision Improvement Agreement, Subdivider
shall request final acceptance of improvements from the City Council. J
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