0259 (2)? i s -3 .a.. 2 x•:r,:; NN..' .. a. 'rRYY an . _- . °.n� • ..r r • ,.+�'ki,AdC3i.�" `Y..`V:...3i . ""iy .-..k;+4 :4 "1',2 .' Yr`i:•ifYi:a.,.., S. t ....ti. e - "j:
With proper yalidation ' a ' .
this form constitutes an,,,r •r
encroachmgnt°pe[mltS;( CITY. SOF .LA •,QUINTA
«�,..,:: ;,• API'LIGATlON• FOR' PERMIT ... • c : ' '�
PUBLIC WORKS COIySTRUCTION (ENCROACHMENT)
tti�i�f:�f;i+�X+ltst':IlCson`1.Zik'V'
' ytSi,i 1..,I •i�ti.)i 1 iI �ilt." .• r ,• r'. • �e��.� , t� 4i
--^•"For �the�oonsjruction of. public or private cyrbs,,lc)rlyevyays;' paVomenis;.sidew',alks,, parking lots, sewers, 'water mai�S"
an other lik ublic.vvorks lm rQ e anis in connection,witlj�� �lO,RrIMPFOVE�III,NTS�a anc� AP. ROVED SUBDIVI�SI NSt'r�"
d @'P P y mL• S f ->L+' R,NrK 4+�aw t# . Y .V• L .+
• w.,a,,,,..a, a,,,,,y,..,..,.- . 4w-=-y—v•.... ' y ..r,,.+.y..ir+-lr,w;..rv.. iy�w...+-•u-"'^"'..+'"..`e�' "'+.a«.nwr�y t
Subdivlslonslm rovement Permit(;., Class I11
r ;1c i.: r�t'a� , t}t prty;al ij WVI, 11i.3isP-4i^A;lr. P
DATE: AUri1 20`, 1987
�.:.�t �,� �;;,� •,,rrGr;�, �� ,g[rcy i•t'r.r~rr~�ctr�rrzyrst'��?•=fttgR tl:'fMinor.?Improvement-Permit`Class IV'��
LOCATION OF CONSTRUCTION
Avlanue Ultimo 'East of Washington' Street A
(Street address or Description of 49ntign) nt r rtr;:: Ca t. :
PURPO$E'QF CONSTRUCTION ""_A7 al*At- PArmfj; 1 Sketch (attach construction plans if appropriate)
.. .:tr•• , t.'• • {"➢� :T+"r; i ~`'1v1�Fi'i * '� r!.�:...ir _a.. ;s, +1 .)3 a„�. �--.+.�.+..�^V.,+w^'a`w..•-w.►,w+w-«,.......t....,...r. rw•,•..._...,,-,+-,..••J.•.,.
DESCRIPTIONPF CONSTRUCTION _„;-. - ...w.�-�»•. ,, a --.
.� �» w..., .....:.�� ....... a �.r
-sil sketch 51247-283 ..
DIMENSIONOF IN$TALLATION�OR REMOVAL',";`"To �:z stall ' 1751' of 2" PA' medium
preesy qi -plastic bas main, 14'.
n ' tt rl' ,.t ��1 ��'x� , :lr r`� �.�. ...�..� _.. �•:... --N/SPL`.. of . ynida Ultimo,
SIZE. OF EXCAVATION; 16 NEEDED"",,,°' r. r:,..�•,._.: Tn
, lt.""•+! ' •fi t t}i` 'e #iii 'll. i
t
SPL
'
_...�. .w USA �Iujy NO•r ,. , , i SPE.
vAPPROXIMATE TIME; WHEN WORK WILL'BEGIN� " "' """ """' Df' JivDt>•i r#? il.1? �:tr'►,
_ Aa6e,:.
AOXIMATE;TIME OF COMPLETION -
PPR '
ESTIMATED CONSTRUCTION CO$T.$ U ""'"" """""�`�"""""�: UVO;
(Including removal�of a11'obstryctlon; rra/eria1' and,dabrii7 ackfiI1ing, com-' '' 1`vT4.
�• AR*1T?
paction and placing. -permanent resurfacing" nd/9r .replacing.lmprovements)
In .considetirQn'of the grantingf thi; permit the a^pplicarit he eby ag�er;s job;
.n.«..,f «t-:....;..«..P-
E�Ilndqffinffv,idefend, and>savefthp.�ity; its authgrized egents;,'officers, representatives and employees, harmless from and against any and all
(I' penalties, )iebilitie� ql,. logs, rgsultjne,tfror>J,;cleims!or court±action and arising out `of any accident, loss or damage to, persons or property
t .
happening ocxrr(ing a�,a proxi�iaa�tre u1t� f any �rork. �ndert kan�under the,permit.gmpted.,purquont-to,this•appliiation,
pIt Notify, the Administrative
r -.I a.l'E'+tuYav?['l ti1•rl ,. Y. atis. �Aa �uit.h�ojrr+i•�t.y, Y}8t tlefta1st• w,tx s .., o�f.he time _when worc will be.,started
tonF-iurspdva
nc
• �" Comply. with .alf applicable City Ordinances, the terms and co�ndit ons of the permig and al,applieable �ryles�d �egulatlons of, the City,, of F,,f
Quinta`and to!pay for _,the, as the result of this w rk
Df, lcliti nal epipt 4. ant ocessatri is df •' oxidant. 145 trr ,d^ navtx ^L�a ' ':a t ¢t«S•:t1}
,�-; ai�''4 i�,�'e, rWt 'r.>as� .1rv, . r� #':jy_'�a.:7k3Et tui} .? anv WiiY�+c i/ti2^�.Fys�1'.tt,1s v'�:t tr•,C`,ixC,'"lift >p'ylatttt's lrAtt"Lura1.? ii `?r.1 t "t`nGiS?+r:'fi .
tf:r+. `1sh•r•? .>:« .: -a ar►tiliihAttstY Kt `,�^:1 :•'rr\frl•l{�yt t.a ... -.. _ ; • - - •3; •a .t r�i?
Signature of Applicant or.Agent
r . t ,a : .nix i.,tv (trt':.a'•; s .-te ta.tt+s ano' cn ; BU ON `714_369-'
$flL�THF:R�. <FQRNIA SQA Com. P;��'O:'�)�O 'AM Iy� t�, 4512
Nome of Applicant (please print) Busines$ Address= ,� Telephone No.
• � _ .. i,. >y...�A, ..;...�*.y,.....,:5.5..3'�.a" �xr.»..-,rte.,.:.: •...-. •
o• •, t.. Z f ,. .. is .�' .vv: J`.x t'- s't+ ft ,M' d'i. /' r •ye+!,- +r...'r ,.. _ r.w•,..:. �,
Name of Contractor -.and Job Foreman Business:Address '+ ,t`t?'i'� y.j`# '�''j, el,ephone';No ;,
�J TSar� Pa.Y, �' t_t A14.`.� %w�+..�t9r� -J.r #G�lv.lew•tl '.
No, fp �.i3 � ��i t,�yc.af't:kS .4}Cii._
Contractors License No. t City Business License No.
ApplicanYsilnsurarice Company `• Policy Number
_.,,__ __...- _ ,Y`...`_>+ ` . Cj4Y•Eitt.�+?�s� i.,;i,�:.,t-� c}>~ .-- .
FEt 4: - r,$ubdivision Improvement Permit —Class III ,
i Public improvements: 3% of estimated construction costs';.-_ .._y _ _� .:::.. o - -- r- «--. - -�-•
-Private tmprve�,ner__1
ts ;�6�of estimated construction costs ; {�4w;�?3n'r
�+ +Minor Improvement Permit = Class- IV -`See'attached-schedule
• , K r «, 'i��i.-.:T ' J.: S. i iS'1�: c�.+X't'�s�'�j F'{!rt;�'�1 �+ E : v' , �._ _ ; ' -
Inspection Fee ?"" $ ' ` 4 w , , " -x , PERMIT VALIDATION '
'- , �Ly 4Sr t..t(„C {.ii^ ;'. a.i.. r, :.;,. {.r ,It'r •r-,.
Permit`Fee PERMIT NO..,.
Penaltyr '
Gash Deposit -Surety Bond .' F DATE APPROVED VA ° f,i
if'required '�'"`' F"v " `"" _ EXPIRATION DATE' l 2�3/
3''yrrTOTAL: .. $, u /ns;..,.. .:..;,...��...:M,...r _a.,...;a,.,,r:;.y #�• '< � • .i.,F . _,,,»..- -,.. .,,•:. ..•.-.,..�
DATE ISSUED'. -
' ,�, s«.»+.w•w «�»,..y�.,....•-.•. ,� baa:,: -,.+.i, . p . ; �,5�.,. .'t� r�, - . ,+:«.vr...�«-,-•r•...... ,. _..
Receipt No. �'`
t+ ReceiYetiyF/y : Date try."' PLT —Administrative
-Administrative'Authority
, ,
' Recorded byTELEPHONE.;; 'l0 -) 56.4-22.46x...-
..►_ 19 �•'-
.. .�.....,,.___.._.•.�.
.`,.t` ;'t 4 Iv i•�- . �• •...+iM!r�o..na....+r,.•N� ' t; R` �rd.,, � .
Recorded by
Ji.'�ar•!••i'r'+•'"'•"•'�""'"+r .•+.-•rw•r••w«...aw�.-. ... I'�t{�i�• .. r. ♦F �+4*{aG'1
TELEPHONE: (619) 564.2246