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ENCROACHMENT PERMIT --
PUBLIC WORKS CONSTRUCTION
See bell w for Finance Revenue Codes
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 III
Minor Improvement Permit - Class IV
DATE: - 11/6/2008
LOCATION OF CONSTRUCTION:. 52585 Avenida Juarez .
PURPOSE OF CONSTRUCTION: Verizon Project: Provide New Service to Customers W.O. # 0543-3PFAOBF
DESCRIPTION OF CONSTRUCTION: Trench 32' Across Street
DIMENSION OF INSTALLATION OR REMOVAL: 32' x 2' of Asphalt Removal/Replacement
APPROXIMATE TIME WHEN WORK WILL BEGIN: 11/20/2008 TIME OF COMPLETION: 11/22/2008
ESTIMATED CONSTRUCTION COST: $2500.00 (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 fo 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 4:00 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 and regulations of the City
of La Quinta and to pay for any additional replacement necessary as the result of this work.
Bret Plaskey - Verizon
Name of Applicant
Pauley Construction
Name of Contractor and Job Foreman
689723
Contractor's License Number
Signature of Applicant or Agent
295 N. Sunrise Way, Palm Springs, CA 92262. 760-327-8648
Business Address Telephone No
14020 N. Indian Canyon, Palm Springs, CA 92262 760-329-1690
Business Address . Telephone No.
10025
City Business License No
Old Republic Insurance Company MWZY57984
Applicant's Insurance Company Policy Number
FEES Subdivision Improvement Permit - Class I
Minor Improvement Permit - Class I
Finance Revenue Code
Inspection Fee E_1
0.00
Permit Fee E=1
$100.00
As -Built Deposit E=A
$0.00
Cash Deposit -Surety Bond, E_13 `
0.00
if required
i
TOTAL
i
100.00
Public Improvements: 3% of estimated construction costs
Private Improvements: 3% of estimated construction costs
PERMIT NUMBER: 8127
DATE ISSUED:
EXPIRATION DATE:
BY:
WORK INSPECTED BY*:
PERMIT COMPLETION DATE*:
* If the work is covered by a Subdivision Improvement Agreement, Subdivider
shall request final acceptance of improvements from the City Council.
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LOCATION
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EXCHANGE
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ISSUE DATE
APPROVALS
OWG-NO.,
RELATED DWG S
RECEIVED
Nov
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