0261 (2)NOTE: -,1,',4
Wio
proper validation;.
this form constitutes an.
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AA Y,;NT' Y
encr "ament-permit
'APPLICATION FOR* P, T
,PU13k,!C,-,•WORKS:,PgNSTTRVCTIO[4 !(ENCROACHMENT),.
F6r -the. construction of public or ,private -curbs, driveways,, pavements4-si lots, sewers,w ter
mains
and other like public works improvements in connection With MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
014W iC4NUM
Subdivision Improvement Permit —Class I I I
DATE: April 27 1701 _..
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LOCATION OF CONSTRUCTION Qj11g133
- S Minor Improvement Permit Class IV &A
fa fkt, b Ru
(Street ad4nissor Description of -j: r P t"
PURPOSE OF CONSTRUCTION lnstallatior�"of eliactricarI.r
nstruction plans i.
ff.,,allpropriate)
service- 'for "LTM `ilii4 Rev& sit,
4.
DESCRIPTION -OF,CONSTRUCTIO'N 'I'At4op nt
a 2 ac sketch
'no, cop
01 1� I
4Lttached` ,opecia;'and.general
1 - - " - "-'-
PIMENSIONOFINS LLATIONOR REMOVAL 1181711'
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"
Provisions ar'e,mcluded"and made
A pa;t 9 f'this-POrmit.
Acia AJ4
•
;,
-SIZE OF EX 1,"PE�E[ U9k lncpl� No.,wk JX
Date i -
ILZ X2
r APPROXIMAT9.,TIME WHEN WORK WILL BEGIN
; 7
APPROXIMATE TIME OF COMPLETION 7
ESTIMATED CONSTRUCTION COST,$
• - removal l'o'f I bstr" com
(Including remova al ol 4ction, m
pterials;,anj debris, backfilling,
paption and placing, permanentres4rfalcing and/or' replacing. improvements)
In copsideration of the.graptirig of- this permit, the applicant hereby agrees, to:
Inclemnify,'-dafend and save the City, its authorized agents,. officers, representatives and employees, harmless from and against any and all
penalties, .. liabilities"or loss res4itino , from claims o , r court . action
n pridarising'out of f any accident loss'or damage to persons or property
happen ng '($r 2!icurring as a proximate result of any work undertaken 'under the permit
granted pursuant to this application.
-four (24) hours in advance of the time when work will be start
Notify the Admini-strative'Auth,ority at least twenty-four ad.
'Comply with all a,ppi icable'. City Ordinances, the terms and conditions of the permit and"all applicable rules and regulations of the City of
La QUInta and to P pay
for pny,odditional. re lacement necessary as the -result of, this work..
.,.
Signature of Applicant orAgent
-
POAQ94"A VALT-FOX R=g 1)Zg#"'0'rQrP'D O. Box 1058.'Co4ohella 398-2651
B -Address
Name of Applicant (please print) Business Telephone No.
�
Cliff Larson I CVWD► 398-2651 EXT. 373,.
Name of, Contractor and Job Foreman, .Business Address': Telephone No.
Contractor's License N
Business License No.
- u
Applicant's Insurance, nripompany - I _Policy Number
FEES: 'Subdivision Improvement Permit —Class III
-Public improvements: 3% of estimated construction costs
Private. improvements: 3% ofestimated construction costs
MMino,
r Improvement Permit Class IV: See ata holschedble .
Inspection Fee $PERMIT VALIDATION
•
'Permit F
ee PERMIT'N9
4iOtt,
Penalty j-, ,
•� 9 . . , - 11 9 . I . . 1 9 9'. DATE APPROVED &7
Cash Deposit-SurglBond
9 1.. 4 1 1i , ?1,'( 1.14 %-r
if require - 1.. .. * `7 1.7
• iOTAL: $ A471-7
DATE ISSUED
Receipt.No.- I* Qlv,A f f ir
61 oni-T,;04-4 - i rA4
MiminislFative Authority
Received b D "wo 0 '14'. F_* , �,_' �. r
1�� 711;r�51> IRT r.44,
w - 0'. 04-04 r � 1 If " r1l"r, �r f 1.
Recorded by TELEPHONE ,(619j 564-2246'T"
11 .• I .
AME
T-NeLs
j.1': 4;avtfit 440 01"I .Q
_pr10r to't
1115td11Gt15,rimming or -topping trees:
I I, I % , IT, e, 11 7 - �' : it 't
.
It, �, ,, i I .. e "s I , . r"l, I -
J.j, -Prun i ng shall,, in,#11. instances, bp at the, 0041d0!• of, the crotch to insure even, fast healing in all cuts of two inches
(2")and above in size.Sealant shall be applied to-all
cut sections as directed bythWdity Public Works Inspector.
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