0260 (2):.a, . +,a,l�L,.'S,, ;.,,7[�r+s.,.on. -. .r., °S,'b y � t i�+,mu•.n..�:nt"."t•W''<�w:,w„ :1•kC`w:!'"��� "„�,},wvr,«. .. ,••.. r. .. ,.• � -
roper; validation ; ti r` r •
•
this i
s f CITY OF L.A` aU1111TA
. l encroachment permit
+ - APPI ICATION FOR_"PERMITT•83
,,.�. r
f r PUBLIC WORKS CONSTRUCTION (9NCROACHMENT) or
;�-
sit -Wil �Seila`�! i�2ilGt!!,l7t ; . " x r 1 �'f •. ; Y, t 4+ « iOP`J"
attl {:� rr1 :.3ti;Ytt`. ?ss _.( s �+•..,_, _. ,f �, i�` tx rG�?/f .>�-. • y
'jFY Jam.^ •. Y•'{ + h 'prf.�Y,' • t %• 4 T
For he�oonstructjon of -public or private,. curbs '^drive ways,:pavements;,sidewalks, parking, lots, sewers, water 1mms::� H
and other like- public work§ improvements in connectlgrt"4vlth MSINOR �MPQiI�ENTS and APPF{OVE4 SUBDIVISIONS
��'
• . r - w•i # .I+^ a #-' �,,,� • _.t" ,� h aa.�t•, Y
x 'iJ`y '.,! r.•;.-1�,t`!-1•'W,'I'Y��'Jfl��ViI'.,iltwi:F,•, ilia�dK 4,j *t,i+�.YT Y ys ,,,-�.
Subdivision Improvement Permit C.lass III'""''
p 2, .i
DATE: A r 9 7- k�.> • �� ,a. ,. t il, gid: a F, �;uLr:+; 'Minoermit Cuss IV
LOCATION`OF CONSTRUCTION' M i -`Avenida!' B®rmudala 'and r`Aven>!8a "V®lasco.�" '� ^ S; -E,e- '
(Street address or Description of L'ocation)�-_ '« • " "� ` -
' 'Domestic water .improvement
PURPOSE OFA CQNSTRIj-CTION Sketch (attach eonsiruion plans 1f appropriate)
l' DESCRIPTION OF CONSTRUCTION " "`Ihstallation` ibif-`12—f-".. el�c tta�hed,i Bke
inch domestic water
Iw*�r�a liiTn, a eq',77
ere -+Theattach4d,.pQcar,ad- general,
provisions are included and made
DIM.ENSIO(y OF,INSTALLATION 4R REMOVAL �__RBf.Ar. .Sa p4..in t. This,
.P, T =,C , permit is for the construction
and maintenance of.' water line fat
l a SIzEROF'.EXCAVATI,0N: ;I F_ E - r .• ' _.K. 'a facilities"
<�
¢ r APPROXIMATE TIME THEN, 4RK VIIII:L"(31rGIN 1?.2Z�" 1987
•-��. ,,. ,USA Inquirer'•- No. O 2. k
ew"f „ APPROXIMATE•TIME,OF,COMPJ..ETION may i5,7
$ Date t
ESTIMATD ONST CTIO COST
€,, •, •
(Including -removal •of all obstruction, materials, and debris, backflllingr com-,. -�
• i paction and •playing .permanent tes(jrfacing land/or'replacm9, improvements),,. ,
t In C��lsjderaXti b of the"grantin�,y f `this (�rtnjt',the applicant hereby agrees To:
M+ti'l.tt�J"iItSYYd7,W%1�.{
li lndertlpify,•defend
an cava `EhS;.City,; its authorized agents, officers,•.representatiyes and employees, harmless from•and against any and all
(2 pen�lti�g, liabilities-or'rloss^�fQ;u�lt�)n� from.;l�aims or'court action and'arising out of. any accident, loss or damage to. persons or property,. ,
r ...
happening of occurring as' a pproximate result of any work undertaken `7 rider the' permit granted pi rsMent to this application'.
Q,+Y ,ii. +..bClf V k++17 %'17!!!1!•:Y'rr►t7ii� Arc:,'" regi
Notify-advance'the Administrative Authority_at least twenty-four (24) hours in
of the tiii7a when work will'be'started"""''^" "'''""^^•�+
"t,:!f!{e± e"• t; ,.,. , 1 . ,; +. tt.
k Comply with all applicable City Ordinances, the terms and:condjtions of the'pe'6it and all applicable rules and rggulations of the City of
t l.e Quints and to pay for any additional ieplac9'ineni;. necgsSery as.the ,result, of..this•.works pra3�r �zt, cyrris7si; r>,,;m Nt *I_ -W4 p,
:►.. �. �. w.r: *e„e �t I;r.'Y„'.5,1.'.L,i14,t f1'!i:r'J 't:,�++.•? 4t .EY.;xt', i4. 1 ".0`+ 4'+Y�a :r;:i•C� »i'�-�";{ i''#+ •p:•;..,;f�t:. 1L:1 '.dr i..:.Tii'y;• sti DGr+Tri0. 7, y,....•txtr;'
' :..•�, .1 ,J _,ft7aQ i1A,l7>�'.�i!k'w.1'.z:?,�•(r?'r L . t. >r-J,°+driy �T2�°:x4Y+ tbt'r.! ih1EC:iy:At �fyq e�yjtxhA`ilF.S: t''.; ,;•'�a!•„cLwh
'Signature`of'Applicant or Agent'
COACHELLA iJVALLEY�fWATERDIST tICT,PLR 0:' BOX {71OS'8 a`OOACHELLA -CA. "412°236
Name of Applicant. (please print) ' : ” Business Address .
Tele hone No.
398-2651
�.
Name of Contractor andJob Forema�ny • ,4
BusinQss AcJijress F'^*�" 4r ►�j4.hl Telephone No.
.«
''$ 1t filtrt 4 �, 7..
'S pyactgr's License No " ' "4`""'
,'"ss''•` .City Business License No:
Applicants Insurance Company, ..
`Policy Number
fl� FEE$ rSubdivisiori`Imp'r6vement'Permit — Class III
P.ublic•improvements .,396,of,estirneted
Private improvements. 396 of estimated construction costs
' syr
Minor Improvem ne t Permit 'Class WSee attached schedule " ~ "'�'"'"" �1""»`"^26
lit
Inspection.Fee $
PERMIT VALIDATION
• . ;"''• ' . { y fir �,�,;,� ,.•«. � i '
.. ;�, .. ,. . -..
.. Permit •Fee1 ', ` t y
1 � ,..7•..a ,..a 1..�.•-
•.+-A . '� '.lam
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l�--I
j
PERMIT NO Z6>• o ..
4 •Y -
lf.y .-. . - R•i S, •i• i '+ I i
'•'«*, ,•Pena -
- • t
7 _ -
^ peppsit-Surety Bond "+ M.t
DATE APPROVED,
.
of required I ,....� • , s� •t`.
%�Z
i . �. �i .,. i ,,.� + _ i. *
.'EXPIRATION DATE
- L:g
iTA
7.e.ceipi'NT'p"1
—,DATEISSNED
w ! ,.
D'
•Received.bY �' ; Date
, •�-�" Admjriistr a Authority
'ax_
;,�.
ecorded bY• ..» `•
TELEPHONE: (619) 564-2246
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