12082Titit 4 Qum&
ENCROACHMENT PERMIT
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.
nww.,%& Subdivision Improvement Permit - Class III
Minor Improvement Permit - Class IV
DATE: 11/20/2012
LOCATION OF CONSTRUCTION: East Side of Eisenhower Drive between Avenida Fernando and Avenue 50
PURPOSE OF CONSTRUCTION: Verizon WO# 543-3FOAOAN; Access (2) Existing Manholes to Splice Existing
DESCRIPTION OF CONSTRUCTION: Access (2) Existing Manholes to Salice Existing Cable for Cell Site.
DIMENSION.OF INSTALLATION OR REMOVAL: N/A III I nrr
APPROXIMATE TIME WHEN WORK WILL BEGIN: 11/27/2012 TIME OF COMPLETION:
ESTIMATED CONSTRUCTION COST: N/A (Including removal of all obstruction, materials, and debris,
permanent resurfacing and/or replacing improvements)
COMMENTS This Encroachment Permit is Only for Work Within City Right -of -Way. Work on Private Property Needs Property Owner's Permission
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 130 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 appli�bleref les and regulafyarys of the
of La Quinta and to pay for any additional replacement necessary as the result of this work. / /
ignatuye of Applicant or Agent N\
Verizon California Inc. - Bret Plskey 295 N. Sunrise Way, Palm Springs, CA 9202 951-929-9491
Name of Applicant Business Address Telephone No
Verizon California Inc. 295 N. Sunrise Way, Palm Springs, CA 92262 951-929-9491
Name of Contractor and Job Foreman Business Address Telephone No.
488385 _ _ 0004
Contractor's License Number City Business License No
National Union Fire Ins. Co. of Pittsburgh GL4406483
Applicant's Insurance Company Policy Number
FEES Subdivision Improvement Permit - Class I
Minor Improvement Permit - Class I
Finance Revenue Code
Inspection Fee
EE=1
$0.00
Permit Fee
EE=1
$100.00
As -Built Deposit
E-A
0.00
i Cash Deposit -Surety Bond,
E_B
$0.00
if required
TOTAL
I
$100.00 I
J
Public Improvements: 3% of estimated construction costs
Private Improvements: 3% of estimated construction costs
PERMIT NUMBER: 12082COMPLEramo
DATE ISSUED: /2. lv. /2
EXPIRA DATE• /2. U •/ �
BY: 100,
WORK INSPECTED BY`
PERMIT COMPLETION DATE`: 1
If the work is covered by a Subdivision Improvement Agreement, Subdivider
shall request final acceptance of improvements from the City Council.