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With proper valitlatiorr
this form constitutes an. CITY OF 'L;'QUINTA e
encroachment permit
APPLICATION .FOR PERMIT
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PUBLIC WORKS CME
ONSTRUCTION (ENCROACHNT
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SOF TIS
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For the : construction of j.Pyyic or ;private ,curbs, ; driveways;' paye�mePts;1 sidewalks, ,parking, lots, -sewers, water "mains
-and_ other-like public works improvements! in connection with MINOR IMPROVEMENTS and APPROVED SUBDI ISION ,
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;v4'4 , rte_ a 41431 LittB�i.7�i, 1 37f:� r"tRa t t cy:. ,*..,�j 1C3. 4 :r •I'T,
c.,', 14�. V^' f, :.r +�:;r �,w,.z ext ti ;•''_fir `a��it<< ;q: `t 3ubdiyi;io[�:Inlprovemeni Permit 'Class ]IN" X:X-'.�.
DATE: Aril 20, 1987'
i, Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION S21 '. Pr c
corner Calle -Tampbico at D®sett Clu4'
6'., teeaddress1orocatlgnl:~
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"PURPOSE'OF•CONSTRUCTIONOff—Site const. -Water,SOW6raRetch'(attach Onstructio,r plans if appropriate)
Construct
Curstre6t imnroyement.6
tW,ly
ns a
a. ...�,�...,—,..See_approved:,straet. plans.. —The
PTIOwO:S®eDESGRIb
� � AC_/ �' attached ;Oecial and general
. ,,. •r ..I , :a �. i :.1;� , ,;. � . �. ,. w a P 9 N _�pn. ArQ;, iAq�uded ;. apd made
DIMENSION'OF INSTALLATION OR REMOVAL' ^'8" port .of the permit.
er��°`moo=►> _ .. USA Inquire No.
--L'alie� ramptnn-- -1 1 00 ! -
�$IZE OF EXCAVATION,,-IF NEEDED--
,•i. r;0 t j..° 3" TA;.t.'iYie"IF:i�I'd _t.' �,� Y-.. { �.- •,,. w,,.. Date: a
��"APPROXIMATE TIME,WHEN,YV K WIL,'—BEGIN-
APPROXIMATE'TIME OFCOMPLETION-De ~199 '�• T
ESTIMATED. CONSTRUCTIOWCOST $-�
'(Including removal of all �obstryction,materials, and debris, backfilling; com '
"paction ,and placing permanent resurfacitng and/or-replacing improver Tents) / ,
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, I,n onsid�eratlon of. he.igrontin of his permit, the. applicant hereby agrees to: r ``
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lit Indemnify, defend.,e the ,,City tjts authocjzed agents, officers; representatives and employees, harmless from and against any and all
,penalties, liayilitjesror loss�r��yltjng„f�QmVc�aim, gr.Cqurt.yection 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'pursua.nt to this+applicetion.''
Notify the.Admiriistrativa�Authority, at least twenty 124) hours in advance of the time where work will be started.
�-
Comply •withiall -applicable City, Ord inances,'th6. terms and conditions of the permit andall'applicable'rules and regulations of the City of
•La.¢uinte and:to pay for any'additjonal. replacement necessa y-as t ofrthis`work.tA;o'•t•, '.. y 4, CMR�;�
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�..f* om,,-folu, t, .•u.. s . �..,,p t}'s' Signature. of, Applicant or Agent. .t:� t1+ r
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LANDMARK LAND COMPANY; .P..0. BOX 1000, LA QUINTA,•- CA. X2253 '(619) 5.64-304''4
Name of Applicant, (please print) `' Business Addressx ` *t` T Tele hone No.
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- N EVANS 6946 VAN 'NUYS BLVD V 4ivyS • CA. 91405 (619) 564-2838
Name of �ontcctor and,Jpb Foreman" ';� ./ Business Address r .q4 ,. « % Telephone No.
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Contractor's License No.�'"rte;� !� i .< , 'City Busin } cW of i — 4 ■;/��/�12-
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Applicant's lni�!fance,omRan,Y. Policy Nurnbet ...
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FEES: Subdivision Improvement Permit, Class III,:
"-'Public improvements'3%-dfestimateil'constructign costs'"'*
P,., ,• c< s ..=i. l�vifst' i1#iisriis,'8' '
ri ate' improvements: 3% of constructionestimated .costs
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' Minor Improvement Permit,,; Class IV: See attached schedule'
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Inspection;Fee's=�r•>''t' +r'$ 10,..�� `'.r .r ; ''!'1'" Utz PERMIT VALIDATION
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Permit Fee .� PERMIT NO. Zs' % r
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1, t' DATE APPROVVD Z %
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if required ` ' EXPIRATION DATE
TOTAL:Iii..; I f;
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By
I l-Received by —^ «' Date E e�-I t3' i' �A��., „ .._";_Admin rative'Authori
Recorded,by' TE:LEPHONE:' (619►�564,2246,�..� ......�-«M
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Recorded by fl TELEPHONE: (619) 564.2246