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1880}. f - NOTE: With proper validation thi jorm.coristitutes an encroachment permit t CITY OF LA QUINTA APPLICATION FOR PERMIT PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) 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 DATE 9-16-93 LOCATION OF CONSTRUCTION 50th 6 Eisei►hower (Street address or Description of Location) PURPOSE OF CONSTRUCTION lower cats conduit, DESCRIPTION OF CONSTRUCTION on Erisennower e/o 3uta DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED 2" wide 30" deep Subdivision Improvement Permit —Class I I I Minor Improvement Permit Class IV Sketch (attach construction plans if appropriate) APPROXIMATE TIME WHEN WORK WILL BEGIN aBap APPROXIMATE TIME OF COMPLETION ESTIMATED CONSTRUCTION COST $ (Including, removal of all obstruction, materials, and debris, backfilling, com- paction and placing permanent resurfacing and/or replacing improvements) Inconsideration of the granting of this permit, the applicant hereby agrees to: see attached conditions I 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 an aaaccident, loss or damage to persons or property happening or occurring as a proximate result of any work undertaken under the per it granted pursuant to this application. Notify the Administrative Authority at least twenty-four (24) hours in advance of a ime when work will be started. Comply with all applicable City Ordinances, the terms and conditions of the per rt d all applicable rules and regulations of the City of La Quinta and to pay for any additional replacement necessary as the resuf ofs ork. .Signature of Applicant or Agent Colony Cable ,r 41-725 Cook 8t. Palm Desert, CA 340-1312 Name of Applicant (please print) Business Address Telephone No. Cochran Communications 36630 Cthedral Canyon Cat City 328-6778 Name of Contractor and Job Foreman Business Address Telephone No. 478543 Contractor's License No. on file 865 City Business License No. Applicant's Insurance Company Policy Number FEES: Subdivision Improvement Permit —Class III Public improvements: 3% of estimated construction costs Private improvements: 3% of estimated construction costs Minor Improvement Permit — Class IV: See attached schedule I Inspection Fee Permit Fee Penalty Cash Deposit -Surety Bond if required TOTAL: J Receipt No. Received by -0- $ -0- Date PERMIT NO e -M PERMIT VALIDATION 1880 ..,DATE APPROVED 9-16--93 EXPIRATION DATE % r� C7 --F DATE ISSIIXF By ellAWA Administrative Authority Recorded by 11 TELEPHONE: (619) 564-2246 NOTE: With proper validation this form constitutes an encroachment permit CITY OF LA QUINTA APPLICATION FOR PERMIT -PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) 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 DATE 1" i4,- 7-3 Subdivision Improvement Permit — Clasa Ill s Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION (Street address or Oesenption of Location) PURPOSE OF CONSTRUCTION Sketch (attach construction plans if a ppropriate ) DESCRIPTION OF CONSTRUCTION ?-CW moo' - 4" • C' DIMENSION OF INSTALLATION OR REMOVAL. SIZE OF EXCAVATION, IF NEEDED 2- -3 o`rWAO APPROXIMATE ME WHEN WORK WILL BEGIN – -17.9e� APPROXIMATE TIME OF COMPLETION Irm ESTIMATED CONSTRUCTION COSTS --_7000- 0-31 (Including removal of all obstruction, materials; and debris, backfilling, corn, paetion• and placing permanent 'resurfacing and/or replacing improvements) _. In consideration of the granting of this permit, the applicant hereby agrees to: Indetnify, defend and have the City, its authorize Penal &"n", offiprs, re"sentatiws and ernployeee. harmless from and against any and all tuf, liabilities or loss rewltinq from dawns or court action and arising out of any accident, loci or happening or ooeumnq as a proxonew result of any vvoft under"kan under the darulis to persons Or property permit granted Dunwant to this aopliestion. Notify the Adminestratne Authority at lass twenty-four 1241 hours in advance of the time wort will be ttavtad. Compal with all applicable City Ordinances. the terms and conditions of the permit and al lidbla rules and La Ouinta and to pay for any additional replacement n�arY as the rMlations of the City of result � th' �p Signature of Applicant or Agent kr'r, KBa�� -�Q�t CEsf�Yi°'adySi? �Bol` �, t Name of Applicarp! (please print) — B/uus7jiln/ess A/d/Jd_r/eess"s 11 KA 11C Name Name of Contractor and Job Foreman Contractor's License No. Business Telephone No. Telephone No. City Business License No. Applicant's Insurance Company Policy Number FEES: Subaivision Improvement Permit'— Class III Public improvements: 3% of estimated construction costs Private improvements: 3% of estimated construction costs Minor Improvement Permit — Class IV: See attached schedule Inspection Fee Permit Fee Penalty Cash Deposit -Surety Bond if required TOTAL: S S Receipt No. Received by Date Recorded by PERMIT VALIDATION PERMIT NO. 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