0258 (2)h
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With'PrQper y4l-jdation_I r„ " �' i, f �1is '
this form constitutes an f INT' c'
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encroachment permit • a � ` . , ,CITY +f aE tell
•� ` ' I° - APPLICATJQNFOR PERMIT -
'
LICS WORKS CONTRUC IfJN (NCRO CHME'NT
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For the construction of. public . or' private 'curbs; driveways, pavements, sidew Iks, -parking lots, sewers, ..water `mains
and other likqpualjc,works improvements in connection=with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS-=.
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✓:. ;S4d;i�visio%'� I p�ro.. ve`xm�ep!�Puer�m.i.i;t:aClasiPATE• Aril 20 1987„:^vi ";1�` .0 rF'. -'n'e- Gsll
i MinompromP,i.assveIV , ` A
RUCTIoNCAven �7pW sOfJeff3 LQCATION OFCO�
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(street address or Do'sc )rption of Location►`- ,� {• '
s PURPOSE OF CONSTfiIICTION yv�4 s!'t�s. #kf: f c :`1� ., 3*� ,
*. y y„ ,. -4,__ =:Sketch (atych.construction plans if appropriate)
+ DESCRIPTION OF�CONSTRUCTIAN 77"S ' X' 4' X'4 ii Pit' .See ' a4child' drawing$ .
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t+$!.,.. ^� ...,.i, .'{ t ♦ ?'i+ Y,. •_ j ,'• ,� h •r -• ^. ^I '.
�. at'ach4d splec al and general
PIMENSION OF INSTALLATIONyOR_ REMOVAL Y µ.4 w .. provi>gions are' included and made '
1" D t 'Telephone' Cable': •' 'A part of this geirmit
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SIZE OF EXCAVATIONJF NEEDED ' USA No.. zt
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{D�APPMATF,T
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.APPROXIMATE TIME OF COMPLETION ', 30-m87”, "'" ', •. >• • � �
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ESTIMATED CONSTRUCTION COST $77
• ; • (Including removal of all obstruction; rpaterials, and debris,•backfilling,'com-
paction ancj,placingipermanent resurfacing and/or replacing`.improvements) '
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.In' consideration of :the granting of this permit, the applicant ,hereby agrees: to
Indemnity, -defend and save the City,'its authorized agants,'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.
.. pursuant
..,d
Notify the Authority at least (24) hours in advance of the time -when
,Administrative .twenty-four 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 '
Le Quints and to pay for any adjtional replacement necessary as the res►lt of this work. ' ' ` ` ,'•«�•""'�'
Signature of Applicant oi'Agerlt 92201
. ,. r ` GENERAL TELEPHONE CO. • OF CALIFORNIA " 83-793 ' Dr.p, Carreon'"'Blvd. , ' Indio CA
Name of Applicant'(Please print),.'.,,' i' t ; Business Address ti ; ' Tele h ne o.
e'' P. o N.
60"'342'0535
. Nome of Contractor and Job Foreman,• ,: , ; .x Business •i0.ddress Telephone No:
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' Contractor's, License No City Business License No.
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. Applicant; Insurance Company Policy Number r
FEES: Subdivision Improvement Permit — Class I I I v
Public improvements: 3%'of estimated construction cost; '
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• Private irr)provements, •3% of estimated construction costs R
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ti Minor ImprovemenilPermit — Class IV See attached',scheilule% 1.t>3i ,�.. !►i»iFr,N24t
. + Fee $ PERMIT VALIDATION
,Inspection
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Permit Fee . . .
PERMIT NO.
Penalty
Cash'Deposit.Surety"Bond :�•. -- �.�r. r;•.... 4 +.:.1.DATE,APPLRO,VED;^ ^`�Al'-'
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` if requiredLt4 ��: l : i;a " , ,, 'i .I {.,X 1 {••' r,�. � t r .ttu :�,�., ti �i , ; •ts: e.c til
EXPIRATION DATE
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• ;.,TQTAL': wit ar;; • $ ', /fit i r at )1W , r� t in t. • w ;-i r#r.,� .. , tx; tsL. • of r,,,, f 4 -
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L i ♦r )_ f �i DATE•I$qUED'�
rt'iir1, I}'i'�•al(..-•/?A tl,� I.{�Ft i1?�•fr# I:s ?;::7 ���.�iy:. a3�'�,il -SI � 111i .1�' �''I t�'l �I... ni, 1!, ,tf iY r,'.M •w— '�.f',t y,,...y,, .,_,.._, Y
Receipt•No r =
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-�.. _.. .r klminis atlve Authority
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C4 1" ►lit wli $ w: a tltl'ir1YYe!ilrlil#, 'n, i`C'I'�il,S.•y4'.,l�iifs ti�4i�l .i�tc...°1•.,• i,. s.t t{..�, }.w �.' . rtt!:.,3rw.: L,:
Recorded Oyt _ _ 'uriWZ,.• %t. ',T-2246• t•-
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RD -31
.�i1JFt4rC't it+SlliLt- ii fqF-� fr`iOJr ttj r?k�s7'vc;iii>• .4tb"ir+rl+'rtti:U f SlArve - Itspi1 j:•ttt:,'f3'v!if .:t.,.�-F :11t t'S0
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ties to these monuments shall be furnished to the City Engineer prior to the removal of any monuments. This office shall
be notified upon completion of replacement of all survey monuments for proper project• clearance: I " 1 1. , '
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