12080 (2)Y' U.N27tgi,� ,
4
ENCROACHMENT PERMIT
FMoF.° PUBLIC WORKS CONSTRUCTION
See below for Finance Revenue Codes
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
r Minor Improvement Permit - Class IV
DATE: 11/19/2012
LOCATION OF CONSTRUCTION: Verizon; W6#0543-7FOAOAL; W/S/O Jefferson N/0 Ave 54; E/S/O Madison S/O Ave 54; W/S/O Madison SIO Ave 54
PURPOSE OF CONSTRUCTION: Splice Existing Cable and Place New Cable
DESCRIPTION OF CONSTRUCTION: Access Existing Manholes to Splice and Place New Cable
DIMENSION OF INSTALLATION OR REMOVAL:
APPROXIMATE TIME WHEN WORK WILL BEGIN: .11/19/2012 TIME OF COMPLETION: /2-W2-
ESTIMATED
2-W2.--.ESTIMATED CONSTRUCTION COST: less than $5,000 (Including removal of all obstruction, materials, z i i� ebbs b IIiAgTcoMpaeti1
permanent resurfacing and/or replacing improvements)
COMMENTS DEC 0 4 2012
In consideration of the granting of this permit, the applicant hereby agrees to: L CITY OF LA QUINTA
FINANCE DEPT.
Indemnify, defend and save the City, its authorized agents, officers, representatives and employees, harmless trom 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 applicabl u s and regulations of the City
of La Quinta and to pay for any additional replacement necessary as the result of this work.
Verizon - Bret Plaskey 295 N. Sunrise Way, Palm Spri
Name of Applicant Business Address
Verizon
Name of Contractor and Job Foreman
488385
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
re of Applicant or Agent
(951)929-9491
Telephone No
295 N. Sunrise Way; Palm Springs; CA 92262 (951)-929:9491-
Business Address Telephone No.
Finance Revenue Code
Inspection Fee EE=1
$0.00
j 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
0004
City Business License No
GL4406483
Policy Number
placing
Public Improvements: 3% of estimated construction costs
Private Improvements: 3% of estimated construction costs
PERMIT NUMBER: 12080
DATE ISSUED: 12. /, 12
D E
EXPIRA : /L. 6. /3
BY:
WORK INSPECTED BY*: LIA,"Y
PERMIT COMPLETION DATE*: Z -/y• / 3
* If the work is covered by a Subdivision Improvement Agreement, Subdivider
shall request final acceptance of improvements from the City Council. . .
COMPLIETE®