4387NOTE:
With proper validation
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
Subdivision Improvement Permit — Class I I I
DATE: 4/25/05 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Jefferson_ and Wes0ward Ho Drive (CIP Forme Move)
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION CATV Relocate Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Trench and Pothole to install'
CATV fo-r new hrldRe amd curbing (annrox 350ft)
DIMENSION OF INSTALLATION OR REMOVAL350 LF
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 412RIO5
APPROXIMATE TIME OF COMPLETION
ESTIMATED, CONSTRUCTION COST$ He Rpm kere.-ll1F
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
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 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.
Signature of Applicant or Agent
Time Warner Cable 41-725 Cook St; Palm Desert, CA 92211 250-2142
Name of Applicant (please print) Business Address Telephone No.
Cne-bran Comt+mication Construction: 36630 Cathedral Cyn Dr., Cat City 92234 760-328-6778
Name of Contractor'and Job Foreman Business Address Telephone No.
478543
Contractor's License No.
Landmark American Insurande Co.
00865
City Business License No.
LHA126303
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
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required .
TOTAL:
$ No F".. i(foxmP tnnttea
Receipt No.
Received by Date
M 4387
PERMIT VALIDATION
PERMIT NO. 4387
DATE APPROVED
EXPIRATION DATE b196/Q6
DATE ISSUED �J `D
Administrative Authority
Recorded by
Telephone: (760) 777-7075