12076 (2)See below for Finance Revenue Codes I
4
ENCROACHMENT PERMIT
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.
Subdivision Improvement Permit -Class III
Minor Improvement Permit - Class IV
DATE: 11 /8/2012
LOCATION OF CONSTRUCTION: IID; Calle Chihuahua East of Eisenhower Drive
PURPOSE OF CONSTRUCTION: Power Pole Maintenance
DESCRIPTION OF CONSTRUCTION: Replace Power Pole
DIMENSION OF INSTALLATION OR REMOVAL: 40' Pole, Wood
APPROXIMATE TIME WHEN WORK WILL BEGIN:. 11/13/2012 TIME OF COMPLETION: 11/16/2012
ESTIMATED CONSTRUCTION COST: N/A (Including removal of all obstruction, materials, and debris, backfilling, compaction and placing
permanent resurfacing and/or replacing improvements)
COMMENTS City of La Quinta will Invoice the Permittee for Time & Material Expenses To Be Determined on Material Ledger
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 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 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 La Quinta and to pay for any additional replacement necessary as the result of this work. - n
aija
Imperial Irrigation_ Company - Jerry Rowland 81-600 Avenue 58, La Quinta, CA
Name of Applicant Business Address
Irby Construction Company P.O. Box 180819, Richland, MS 39218
Name of Contractor and Job Foreman Business Address
163338
Contractor's License Number
ire of Appl'k3nt or Agent
t (760)455-5938/398-5814
Telephone No
(601)960-.7204
Telephone No.
108351
City Business License No
Old Republic Insurance Company MWZY59816
Applicant's Insurance Company Policy Number
FEES Subdivision Improvement Permit - Class I
Minor Improvement Permit - Class I
Finance Revenue Code
s
Inspection Fee EE=1
$0.00
Permit Fee E_1
$0.00
As -Built Deposit E-A
$0.00
Cash Deposit -Surety Bond, EE=B
$0.00
if required
TOTAL
0.00 1
Public Improvements: 3% of estimated construction costs
Private Improvements: 3% of estimated construction costs
PERMIT N BER: 12076 i
DATE ISSUED: AN& klov,. IS- m 2i j
EXPIR DATE: 13 I
BY:to
WORK INSPECTED BY*: l'
i PERMIT COMPLETION DATE*: 2
i
If the work is covered by a Subdivision Improvement Agreement, Subdivider
i shall request final acceptance of improvements from the City Council. !
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