0286 (2)NOTE:
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 III
DATE: November 4, 1987 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Miles W/O Adams &- Adams N/0 Miles
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Place communication
cable.
DESCRIPTION OF CONSTRUCTION, Bury communication
cable for approximately 2,877 feet.
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 4-1-88
Sketch (attach construction plans if, appropriate)
See attached drawings
USA NO.
Date Issued:
APPROXIMATE TIME OF COMPLETION 8-30-88
ESTIMATED CONSTRUCTION COST $
(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 andall
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
GENERAL TELEPHONE -CO. 83-793 Dr. Carreon BlvdIndio, CA 92201
Name of Applicant (please print) Business Address Telephone No.
619-342-0535
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 + �O C
Minor Improvement Permit - Class IV: See attached schedule N U
Inspection Fee
Permit Fee
Penalty .
Cash Deposit -Surety Bond
if required
TOTAL:
$ N/A '
$ N/A
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO. 00-6
DATE APPROVED ��%o�� 7
EXPIRATIONDATE
DATE ISSUED he C-7
By
Admir47rative Authority
TELEPHONE: (619) 564-2246