0263 (2)W,-+i0P'4A'N, ,ai•,.14�•• tw, .i,•txF-..e air, rL " .. .
NOTE:_:
Witlt proper validation t i ::i; sr :Yl Cti t: ' # , , , ' IY n, jr4 w: 'i L'"f} ?�/;
this form, constitutes an * i CIT SOF kA� aUIN A`
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encroachment permit a
qP. CATION. F 4 ''PERMIT _ �. 'fl
'' rua '" �' "'y t"�" '' PUBLIC -WO i;KS CONSTRUCTION (ENCROACHMENT),.
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For the construction' of public' od private. curbs, driveways, pavements,' sidewalks, parking lots, sewersi .water mains,
fF1A app-1other Ilke'public works improvements In •connectipr with;MINOR` IMPROVEMENTS and APPROVED'SUf3DIVISIONS .
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QATE,.;., ,Mair 1�1t x.,9.$7 , y Minor Improvement Permit Class IV XX
LQqATION OFOOJVSTRICTiQN, NOrth Side 01,'Bottlebrub,. EaBt, qt Washingtoi>L Street_. !
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(Street address or'Description of Location) 1:
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PURPOSE OFrCONSTRUCTION I'.LS'` �' + , ' �, .ut�S rtub, I. �i
Sketch ,(attach construction plans if appropriate) I'
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DES�RIPTI.ONrO CONSTRUCT
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sketch'. r ,
PA `meditun restaur� 1 - �s N l: . .w
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+ : S/NPL 'o>Q" Bottlebru�h% D .-SE SRE H' — I GP� 214';- `F.Th®r att4ched'vspecial • and
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+' r • .$ttt.ti� .::r} E=5 C[1'1`�* ` en®ral "orodisions' are"included
IMENSION OF INSTALLATION Oi+REMOVAL r �I l
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,r ti ! ,Y1:-. r:.:uk�' r r#'in v' wi+r;r,- :.w" ; ,�f. '+'�}Ttx•1 ,,. =,and' 11t idyl part of- this 'permit.
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SIE OF'EXCAVAT,ION, IF NEEDED All excavation in earth areas.
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APPROXIMATE.TIME WHEN WO K'WILL BEQIN 4%; /87`' Q T n L�ny
USA /A-inqqiry' NO. '�
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APPROXIMATE TIME;OF COMPLETION " 7/7!8% � i �1i it, f, Et' } IL-wrt Ai '
ESTIMATED'CON$TRUCTION'COST $ 's'` , f "++•t '�+ >ry f fat; a e = i.
(Including removal' of all'obstructioh, matgrials, ;and debris, ¢ackfilling, cin
it
_ paction and placing permanent resurfacing and/or replacing improvements) .
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In consideration of the granting of this permit, the applicant hereby agrees'to: i'
I^demnify;•"defend and save'the CitV, its` authorized•agents,'officers� representatives'and employees, har _ `m' end* against'any.and all
penalties,'liab)lities,or loss,, resulting from claims or court action land arising out of any -accident; toss or damage to persons or property
happening or occurring as a'proximate res�ilt of'any` work undertaken under- the' permit granted pursuant -to this application.
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Notifyr Rhe, A In trativs Au horjty t least tinty-four• (?4)' hours in ,advapce of the.jime'w ten work willtbe�startec�.
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Comply: with, all #ppltcable y: Ordinanp@s; tharterms and conditions of the'permit and all applicable rules and regNlations of the City of
La Quints and to pay for any, additional replacement necessary as the result `of this work.` !
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t„t •, i Signature of Applicant or Agent (-710369 —4512 `l
SOUTHERN CALIFORNIA GAS COMPANY, _P..1.0.,• BOX .220,0,-,RIVERSIAE., ,,CA. 9.251'6 ' }
Name of Applicant (P)eese priDt)ria r,.�riit,i.k itt�!L rn.LFY� ..„ ct.,B,ysiness Address,ttni:N�. ei SFt, t f uiT.elephone No.
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Name of Contractor and Job Foremanf�t -•.fit ,.fin �:> ��!'I3 `�Business-Ad- uus zea �- •. � t�.Telephone No.,'�° -• ;'
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Contractor's License No.-
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t` r {y City Business License No., a.
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APpliw's,lns�Ia� CQmpaP�yt ° .N*!r�tb4 �t1L'tR1ryC'irf'<7tt s:ttsc-
FEES: :.Subdivision Improvement Permit - Class III t
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Inspectiz t F i _ ,. _ PERMI VALIDATION,
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Permit F' �� ..�...,...,...._ ._«.. fat ' it . tt3 P R IT NR; pi:.t,.r/�,i.`6 Itif F O'_j
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Penalty (f (/ ..,� .._.. _.. r
Cash De ,;:.ci st•, �urtcf DATE 14PPROVDp ,
if'requil ' 6 a .13,d_f T4Z t 1L.c A+�j/
EXPIR TIOkDATE
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Received b`r -- . _.«�,..... «...,.. l.�z� .. �..�.__ _� to -' .,tt. By }'r : < . rc a tr, st:Ad istrative Authority 1
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Recorder. by ._... ,... ...._ .»..... �.� ... ,».. ,. ,,.. .ir'` TELEPHONE; (619).564 2246 �, �,.;,•.>,:
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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
. 4 , • , .7, 2 F
be notified upon completion'of replacement'of all survey mon
uments for properrproject clearance.'
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RD -31