3636 (2)Arlin proper •aijoat:dr
-tea torm constitutes or CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACtMMEwr,
For the construction of public or private curbs, drivevrays, pavements, adragnts, pateaatg koq 311110011111136 1111111101107 11111Oka
and other like public works improvements in connection with MINOR IMPROVEMENTS and APrg0VM9JI001V2N9N=
DATE: — 02 / 19 / 02 Subdivision Improeessesx ft — C� 111
Minor Imprveasat Pewit ChIss IV
LOCATION OF CONSTRUCTION PLACE UNDERGROUND CABLE ON AVE 40 W/O WASHINGTON ST. PLACE
CABLE IN EXISTING CONDUIT SYSTEM ON WASHINGTON ST & AVE 50.
(Street address of Description of Location)
1�1t6
BIE FI U IIVtW TNJ l PLACE NEW CABLE TO PROVIDE Sketelt (attar, vbas it appropriania
DESCRIPTION OF CONSTRUCTION -TRENCH S/S AVE 50 N NE �% - SEE ATTACHED
TO CHER & GUTTER- PI ACF XT PAD, Go—d.*4.r40, 5
DIMENSION OF INSTALLATION OR REMOVAL 1' WIDE 30' DEEP PLACE C LE IN XIST G DU
SY TEM S G P OV I O IA _-
UT TR C C ROL SYS E .
SIZE OF EXCAVATION, IF NEEDED -12 X30 X1050 REFE T QBIr EA FF C T
APPROXIMATE TIME WHEN WORK WILL BEGIN ASAP H B
WORK ORDER REQUIRES MAINTENANCE
APPROXIMATE TIME OF COMPLETION n7J11/n2 WORK TO BE PERFORMED IN ALL MANHOLES
ESTIMATED CONSTRUCTION COSTS ?0 - 000.00 NORTH OF AVE 50 ON E/S WASHINGTON ST .
(Including removal of all obstruction, materials, and debris, backfilling, com TO HWY 111. (VZ W.O. #0543-7F001 M )
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 saw the City, its authorized agents, officers, representatives and emptovees, bas4s toot and apnea aey one as
penalties, liabilities or loss resulting from claims or court action and arising out of any accident_ fan or deep tie peoces or prpnr=F I
happening or occurring as a proximate result of any work undertaken under the permit granted pr=oal tea !is a�Eioe on. K v w
jt
Notify the Administrative Authority at ism twenty-four (24) hours in advance of the tins wfues snot uN ]s scerid ,' S
Comply with all applicable City Ordinances, the terms and conditions of the permit and all appriobie ruin and ■ems at the Ckv or 'r ��
,Q_.�� 7r M4u
La Quints and to pay for any additional replacement necessary as the result of this work
".. - . oVI etfWtil�
112
Signature of Applicant or Agent
LOMA, CA 91752
909/360/7000
Name of Applicant (please print) Business Address Teep?%one No_
LARRY WILSON THOUSAND PALMS OFFICE 760/343-3334
Name of Contractor and Job Foreman Business Address Teiephone No_
CA 378587
Contractor's License No.
Applicant's Insurance Company
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 S 600
Permit Fee / d
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
$ 70 e)
Date
City Business Liss ha -
Policy Nurnbrr
PEPLWT VALIDATION
PERMIT NO. 3(0 3 to/
DATE APPROVED Z/Z S1 d 2
EXPIRATION DATE �7—
DATE ISS
t
By
Recorded by Telephone: (7E.7) 77,-7'