0265 (2)W
7)4th proper N
this f9irmconstit4tes-an .4
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4- F LA,'QUI!4TA;-V
encroachment permii"' CIT
7
FOR .':PERMIT-
PPLICATIPP,
A
PUBLIC WORKS "CONSTRUtTIOWC
(ENCROACHMENT)
e.
For the construction of 'driveways,- pav'
public Rr pTivat ' curbs', emenii,- sidewalks, parking lots, sewers,
and, other like improvemen t. water mains.
public ts�m,connec ion with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
fA
Y.
Subdivision, Irrigrovement PerMit,—.Class I I I
no. m: s is h;�;, tt pro t e V�sz (4 :L. i i � , , i I I -. x I _ -
DATE: 15-13902 Minor f I I-
1— n Im int Oeri�it qla �,I
.775 x iproveme
� I ? A
7=4
LOCATION OF C014_STR
VPTION: dIS'J%ifrf eragn -St. 180 N/0 Vie. -Avenue . 54,31021 W/O
Jefferlpon. 9treev
K.0%- 44, A
A pr,,.:�w- W;
PURPOSE OFCONSTRUCTION .,to'provid service, for Sketch - 'L
jl 1$ke (!1Lt�9hRp9�jrtA.qion plans if 4ppr
777 - 9priate)
ir 7
J�Andffln k, 1AU4
i
DESCRIPTION OF CONSTRUCTION q&%A See attached sket'
ch
*7
The attached spec#1 and general,`
DIMENSION OVINSTALLATIO
N OR REMOVAL
...... . of thief-pormit.
a;lfs s\ -IAP
eX 'i�'ja'tfi
SIZE,O,F EXCAVATION, IF.NEERE$"- R&M gtr.M�.A A'�;.�Ag on r a so
All ..*ava a
APPROXIMATE Tl,,,MEMHEN,V
�Yq IS 1,
#
-0 Coe dl
T
F,- `8N'
APPROXI.MAT TIR��q
777
ESTIMATEP'CONSTRUPTION 160STL.$-*
c6M`PLETJ,
(including removal of 4,11'obstruction,,1paterii
als, and debris, backfilling, com-
paction and'placirig pgrmanenta.qurfiging -anq jreplarin
g,
-�i' � •s. Z
improvements)
1r)'.cqnsideration ofjI1S,9rp
permit the qpptic
-privh,ereby agrees to:
Indemnify, -defend and save the City'. its authorized agents, officers, representatives and employees, harmless from and against any and all
penalties, liabilities or. loss ;resulting -,f ro'm.,'clain'is
.. or court, action and, arisingout of- any accident, loss ordamag,
happening or occurripq, as a to persons, or property
Prp�imajqjps pywork un_!ert#,4pn- under pe re
a. Fmit grant, 0, pu��yant, to,thip application._
v"Notify the Administrative, AuthorityA 'le Ithe time-, wh an $ - w' be started: till
pst twenty-four. (24),'hours tin advanceof I
i� 1, . . ork,will, V, SA -0 ,i�
1 4 ir i,
Comply with all applicable 'City bidi'" '-,'the terms and the permit and all applicable ruiesoAand'rleg"61at4io'h-s-o'f'
ppi . nances the City of
Le -Quinta prid to pay. for _,anyt Odd tibnorl, replacement 'necesiaryll s7the-resylt1of thi;"work.) 4 9 r*
1ltiUed, C T", -J 1;
r 'A 4
Sig1natu're,of, : pplicant6r Agent "619-342-;-0535
�Ai_ f 1,6 r -
General Tel *" - '0201.:
ephone4Compauy o alifornia, 83-493'Dt. Carreon . III Indio; CA
Nome of Applicant (please print)
Business Address 'Telephone -No-
_�Ijer t te
W 4•1
Name of Contractor and Job Foremanephone No.'
Business Address"' Tel
Contractor's License No.
City .Business License No..
-5A 11'i�41. i NuZbex d
Applicant's Insurance.Co Oa' k*C�0,
m an. "•
Policy Number
FEES: Subdivision Improvement Permit r bass III"
Public imp'r6v/ements: 3% qf9stimated construction
Costs
Private improvemen.i 3$ of construct posts.
i - tjt i r. ij tj I r CA I A F -in 1 9-0fw4w�
.
Minor Improvement Permit —'Class IV: See attached schedule'
Inspection Fee NSA-
$ PERMIT VALIDATION
4.
Permit Fee -_
FERM]IT-NO.
41
Pan.1t
/9S-7 -
Cash Deposit-Surett Bond DATE�APPROVEP
if required 4'
EXPIRATION DATE PA—,"y
3 9S7'
TOTAL: �*:'tf L"P
QQ1
I
PATE: ISSI 1
D,;
-Receipt Nor. ',njf,-
—L V-1il— Frit, The V•:,P. Pip
. 6" 1 -'k I ", Y
Reqqive , ; Z 4L,40 tr . YU
by Data1'AdnWk4iive'Au
1A, 1..i 4 IiJ I otir Tnoy.�ZAAJd if) ylts,,77,7 7,,%'4',p& 4" tot? 1!111�p 4it - 1, vJ . I thority
r7'
..Reccircle0by
•TELEPHONE:(6119)'564-2246�
N
44,
COLOIC,"V.;� ,?w
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�44,L qi,
ties to these monuments shall be furnished to the City Engineer prior to the removal of any monuments. This office shall
be notified upori completion of replacement of all survey monuments for proper project clearancel� , Wt 4 -k
1,
.