14037 (2)�aui See below for Finance Revenue Codes
ENCROACHMENT PERMIT
OF C1�'i� .PUBLIC WORKS CONSTRUCTION
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains ..o t, fl' 'ftlic
works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS.
=(MERV Subdivision Improvement Permit - Class III
Minor Improvement Permit - Class IV
DATE:. 3/21/2014
LOCATION OF CONSTRUCTION: East Side of Washington Street South of Avenue 48
PURPOSE OF CONSTRUCTION: Verizon WO# 0543-9U013HI-012; Access (1) Existing Manhole to Spice Existing Cable for Service
DESCRIPTION OF CONSTRUCTION: Please See TCP for -Specific Details and Locations.
DIMENSION OF INSTALLATION OR REMOVAL:
APPROXIMATE TIME WHEN WORK WILL BEGIN: 3/24/2014
TIME OF COMPLETION: 6/24/2014
ESTIMATED CONSTRUCTION COST: N/A (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 an gulations of City
of La Quinta and to pay for any. additional replacement necessary as the result of this wo
rk.
nature of Ap lica t or Agent
Verizon California, Inc. - David Pena 295 Sunrise Way, Palm Springs, CA 92262 909-798-4400
Name of Applicant Business Address Telephone No
Verizon Forces
Name of Contractor and Job Foreman
488385
Contractor's License Number
National Union Fire Ins. Co. of Pittsburgh
295 Sunrise Way, Palm Springs, CA 92262 488385
Business Address Telephone No.
0004
City Business License No
GL5094690
Applicant's Insurance Company Policy Number
FEES Subdivision Improvement Permit - Class I
Minor Improvement Permit - Class I
Finance Revenue Code
Inspection Fee EE=1
Permit Fee E_1
As -Built Deposit E-A
Cash Deposit -Surety Bond, EE=B
if required
TOTAL
IT NUMBER: 14037
0.00
DATE[ UED: J�
286.00 EXP I RA NDA
0.00 BY:
_
0.00 ,WORKiINSPECTEDaB *:—c
$286,00 ' If the work is covered by a-Su—bFdIvlef6 Improvement Agreement, Subdivider
shall requestfinal acceptance of improvements from the City Council.
costs