3276NO' E :
With proper validat'fon
this form constitutes an CITY OF LA QUINTA
,encroachment permit
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:-8/11/00
LOCATION OF CONSTRUCTION C/O Madison St. & .Ave. 58
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Extend conduit before road
improvement
DESCRIPTION OF CONSTRUCTION Place conduit from
existing M.H. across intersection of Madison St:
& Ave. 58
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED 2' x 41 x 2201
APPROXIMATE TIME WHEN WORK WILL BEGIN 8118/00
APPROXIMATE TIME OF COMPLETION 9/30/00
ESTIMATED CONSTRUCTION COST $ 4.000
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
Subdivision Improvement Permit Class III
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
In consideration of the granting of this permit, the applicant` hereby agrees to:
See Special Conditions
IF
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 occurring 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.
Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result of this work.
I �
Signature of Applicant or Agent 1
Verison Communications; 293'N. Sunrise Way Palm Sprinlzs, CA
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. City Business License No.
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class 111
Public improvements: 3%of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor, Improvement Permit — Class IV: See attached schedule
Inspection Fee $ "0-
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
-0- A
$ -0-
Received by Date
27
PERMIT VALIDATION
PERMIT NO. 3276
DATE APPROVED 8/18/00
EXPIRATION DATE 3/30/00
DATE I�S/SUED 8/10/00
By
I Administrative Authority
Recorded by Telephone: (760) 777-7075
NOTE:
With proper validation
this form constitutes an
encroachment permit
------ ---------- f
AUG 1 52000
CITY OF LA OUIN t�
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
O8� 11/00 Subdivision Improvement Permit —Clan III
DATE:- Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION C/O MADISON ST & AVENUE 58
(Street address or Description of Location)
PuRPHUE?AFRlVt CTIIN EXTEND CONDUIT BEFORE .Sketch (attachconstructionplans ifappropriate)
DtESSCR PTI N OF C ST IV I T�QZE�UIT FROM
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED SEE ATTACHED DESIGN
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, badtfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrees to:
Indemnity. -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 clains or court action and arising out of any accident, loss or damage to parsons or property
happening or occurring as a proximate result of any work undertaken under the Permit granted pursuant to this application.
Notify the Administrative Authority at least twanty-four (24) haws in advance of the time when worts will be started.
Comply with all applicable City Ordinances, the arms and conditions of the Permit applir2Dla r*Ward regulations of the City of
Ls Quints and to pay for any additional replacement necessary as the result of rk.,P ��%
Sl§nayffe of Applicant or Agent v
VERIZON COMMUNICATIONS 295 N. SUN SE WAY PALM SPRINGS, CA 92262
Name of Applicant (please print)
Address
Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No.
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
Inspection Fee $ __
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
Date
2774
PERMIT VALIDATION
PERMIT NO. LZL-
%,h/
8"
DATE APPROVED
EXPIRATION DATE
.
DATE ISSUED
'By
5
Administrative Authority
Recorded by
Telephone: (619) 777-7075