TC2014-1003_00101' 4 ,
See below for Finance Revenue Codes
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ENCROACHMENT PERMIT FILE COPY
PUBLIC WORKS CONSTRUCTION
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 7/17/2014
LOCATION OF CONSTRUCTION (Street address or Description): ADAMS ST NORTH OF MILES
PURPOSE OF CONSTRUCTION: REPAIR BURIED VERIZON CABLE.
DESCRIPTION OF CONSTRUCTION: VERIZON: ADAMS ST NORTH OF MILES
DIMENSION OF INSTALLATION OR REMOVAL:4X6 SQ FT OF ASPHALT
MATE TIME WHEN WORK WILL BEGIN: 7/21/2014 TIME OF COMPLETION: 7/21/2014
ESTIMATED CONSTRUCTION COST: (Including removal of all obstruction, materials, and debris, backfilling, compaction and placing
permanent resurfacing and/or replacing improvements)
COMMENTS: SAW CUT 4 X 6 SQ FT TO DIG PIT TO REPAIR CABLE.
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 at (760) 777-7097. To
submit an inspection request, leave a message on the Inspection Request Hotline at (760) 777-7097 prior to 1:30 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 and
to pay for any additional replacement necessary as the result of this work.
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Sigture of Applicant or Agent
AGUSTIN SOLORZANO 81529 INDUSTRIAL PLACE #B INDIO, CA 92.201 (760)625-5161
Name of Applicant (please print) Business Address Telephone No.
PAULEY CONSTRUCTION INC 2021 W MELINDA LN PHOENIX, AZ 85027 (623)581-1200
Name of Contractor and Job Foreman Business Address Telephone No.
689723 10025
Contractor's License No. City Business License No.
LIBERTY MUTUAL FIRE INSURANCE COMPANY TB2631004260013
Applicant's Insurance Company Policy Number
Finance Revenue Code
PERMIT INSPECTION
TRAFFIC CONTROL ONLY - ONE DAY $286.001
$286.00 1
IFILE COPy
PERMIT NO: TC2014-1003
DATE ISSUED: 7/17/2014
EXPIRATION DATE:7/17/2015
BY: AMY VU
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.
PUBLIC WORKS DEPARTMENT
APPLICATION FOR PERMIT
10 q 00
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Date:! I
Tract No:! •... IProject Name: [VeXlLO(' -aLza too
Vicinityflt 'e *
Purpose of Construction (i.e.: Rough Grading, Mite Street,
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Description of Construction (j: See Plan Set No. 01234)
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Dimension_of Installation _or_Removal:
Approximate Construction Start Date: [?,-30-/r I
Approximate Construction Completion Date: 1777?
Estimated Construction Cost: $f2b7)
Estimated Construction Cost shall include the removal of all obstructions, materials, and debris, back-filling, compaction and
placing permanent resurfacing and or replacing improvements
Contact Name: iPhone Number
Name of Applicant/Owner: qç co
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Applicant Address: .. .__.
Applicant Telephone Numberko'),25-- 51 t,0 \ I
Applicant E-mail Address: oUYC 1
Name of Contractor:
Contractor Address: I W5 #ctc 04
Contractor Telephone NumbertI3,o)3'(i
Contractor State License Number: I U' g- a
Contractor City Business License Number: flUO2'
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Contractor E-mail Address:I I
A COPY OF THE CURRENT INSURANCE CERTIFICATE MUST BE PROVIDED'
n,licant or Contractor General Liability Insurance Comoanv:
Applicant or Contractor General Liability Insurance Policy Number:
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Office Use Only:
Inspection Fee:
Permit Fee:
As-Built
Deposit:
Dust Control
Deposit:
Credit
Amount:
TOTAL FEE DUE: 1
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Office Use Only:
Assigned Permit Number:
Approval Date:
-
Expiration
Date:
Issue
Date:
Administrative Authority:
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