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CITY�a�� 3OF LgIQU(NTAi
encroachment permit
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ar APPLICATION ' FOR '.PERMIT
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' PUBLIC "WORKS CONSTRUCTION 1ENCROACHMENT)
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Loc the; oonstructiori .oft public or.privatgtcurbs, <drlvewa s, pavements;-sldewalks,tparking' lots, servers,. Water' mains I r
and, othe dike bli orks improvement I, i <.
�} �, pub C w provementS,yi�nS+connection withtMINOR'IMPROVEMENTS and: APPROVED SUBDIVISIONS
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,$ubdlvlslon Impt;ovesmept Permit
DATE:Jtute` `: �s tt�_ ai ns 4sxrtr.t t..
ea ! �, r , }�.+y•...�'{+� - ,:1rt;.•• ,.y }}t� ,j �, Miltor#Improvemyp(qq�j�nt Per�ry��• ��it ClatTs•IV
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J LOCATION OF CONS,TRUCTION'' i9-400' Avenue 54 (North aide of A�nue •'54 aPpro Timate1
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• 1' went of Jefferson-Stre®t)
(Street address or t)escnPtion of Locationl i f° �" N t� ��,1.� tae �, �.. ts..•. ,� q+ef� #•w k�eatC.:'�OA;%. s„ea411
ri Q.v...•�. i its �,3't'3°d'i1 :st ;r }� a`�ik,y r�?t�`3.t� i ' tre(af<. y't�j«•<.?L• `.+ 3T E: 's?: # 9
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PURPOSE
ch OF CONSTRUCTION Parkipga�R�--��_ ,,Sketch,(attaFonstructionpinsf apprp riat ).
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—DESCRIPTION OF CONSTRUCTION 4 ,;T�B �}� l2$YQ Aa�iai$SSL~^ ,See,attached sketches
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The attg6ed�epecialand general .
DIMENSION OF INSTALLATIONOR REMOVAL 22' % ,22 s' 'Provi�ionar at�asAalNiAq and-made ;
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.a p4rt' 4f hi .-permit.r'-
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SIZE OF. EXCAVATION, IF NEEDED: ' LA11 wore is adjacent to agjj. tltig ; i
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Paned at oet:.amd ron. rt ► araaa,
.t. PROXIMA T M E r x. x, :h� �a,Y � a z ti'4i. X,�(-Pj,;•'b�4 <
T r ,,(AP TE I P wry ,.. _ R �W11.L EGIN Jy}�a 23 87r { p _ rrY t �f� �y> rf ; s, t 1
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APPROXIMATE TIME OF'COMR4 ETION :a-,�... ;r•rK ,�-;�'r' t r?R t• ;.�.t y s,
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ESTIMATED CONSTRUCTION COST $ ,iWQ " Date Ia uedt
(Iltcluding removal of;all obs truction;materials, and debris, backfilling, com- ' '' .,•
,paction and,p)acing permanent�resu,facing and/or're�Iacing i rgvetrlents)a
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In consideration of the granting of this permit the, appllcant'hereby,agrees to:: > Y "�` "< r �{ < ,ti• ' r -
q ti y r i.. ., .� r. S.
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IndemnifY, defend a� spvethe City; its authorized agents, officers;, rep resentatives'and employees, harmless from and against any'and all {
penalties, liabilities, or:loss•resultirig.fromtclalms{or cooff �ctipnand
arising out;of)any,acaderit;,loss oridamage torpeisops:or.property
s.' , happening or ocgyrring a;_a proximate result•of any work,undertaken:under the permit grented pursuant to this application t: !
,,y r ) <:. - ' .,,' 4v '-'r t. 4 , i.;. k ♦ Zg
s , ; Notify the Administrative Authority at least twgntyfour (24) hours m advance of the time when work will be 4started.
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Comply^with all applicable'City Ordinances; ,the .terms and conditions of the'permit and all BppUca6le rules and regulations of'the City of tl
(a Qwnta' and to'Cpay for.`any additional }�epiacement necessary as the result of this work'Vrl' 1 F;sr k7f� T�� y► i,s
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j,! -1 i1 •'' Y +) i',. k.1 4?w7 Signature of Applicant or, Agent)-4 '<ti,e: r•
• AT 0NAL ri0RT6�SB& LAND "CO]H ?ANY ��75,005 Country Club Dr. , Palm Desert9":C4-.92260-'-
568-2828'
i.
:.Name of AppllcanY (pleast�prin) i w,y�}:z> ~,." try*usiness Address , ,� 411 �Telephone No
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'Name of Contractor and Job Foremgnrtt �kV-*N "BusinesiiAddreis- t t�=IMVTelephone No'�I
k�1r+;i�t�FA""�,,?�. Cw�I.t.t �'C'� �`r r' 2 ,`�'i"'�••* Y ' }t#,
r +'ContraCtorr's License;N City Business Llce(ls8'I�O
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`''`. •.. 3,s -PQ •1 �i-Jr�t.+"�i ,r4.,. M1+. °I:�1 d 4a.•.:. ' w•a ��`.. v-�f' ki 7sr lr ' '-Ft •r.- ►f yi..
'Applicant's Insurance Company,' f;Policy;Number r` • ��
FEES: ` Subdivision-improvement Permit — Class 111 r=° • ,� +� i i r<w� „ < Y' :+ -
{Public improvements 396'0f estimated construction costs'` •r 3 z �;: ' ' " , `�;'
Private improvq)jtents, 416 estimates(,cQ,nstructio.n.costs, w LA 'r, ,' <�t� { /' y {✓fir ' y a
! :�5' M� wa•.- .. r,i.. r�� WJ�'F 4f 4, rT1 �. • • -V. ki- iviA.1 JO`tihi�r'Pe.A i,Y�9 `4 �,,. 4f's_Mr< V• �4 K7 r r - i.�
Minor Improvement Permit —'Glass IV See attachedsch@dole's ,.1.°' ,•}rt e n '` f `�
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• ` Inspection Fee ' $ iii �!%..;_� ��. ' �ry t t, PERMIT ,VALIDATION
Permit Fee -1 `ta}- tt ;.t r r•!a rr*�'z` f r ) w�+,..r`. , •y`:.Y,'-'i `,•t +'�-t.t t • ,.
4, 7 ,....P* `� tt'`d� rii''tr fr' A. '!"^fir a 44 +L'�. 4 t +' w kiA .'i.Gi» '. w •r.••,t -�4&P 'r
• ,� � ,r. �F � PERM ISO. 1.
Penalty .% // 1 7.
` ! ` t'i'n . 4 t* r^� c eF r'ti ; R`�?s �y;i > • ° 1� y^* K, ria 10? 0_ DATE APPROVEDY''`�ri .n t'T I
• ''! _
Cash Deposit �Surety,Qnd t t"t'• 1M1w, fit[, G%�a+f . ` `l rrii
of, requires( ' EXPIRATION DATE Z 3 X-•
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z� TOTAL
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LAK _L i�H la"•11,•3l'RJ1 Qtr.w <-t`i' 71:. -1< �' t l - 1 «r[ a , G, ,� ,• t.4-;�o
-Receipt I40�.:
it ga 1.1.►tiyt4itt{t}:""{ freSFIfr11Lhli?BYBy - rr Ad nlSifatlV Authority
'+� Rece,Ved by • w.� .�Bi@• v 'tl, 14/d 4w +?13t '�1(:rr+tltiii fi�ew7?eVi . ei �i y
Recorded t r1 .' , ': LtC• i14 �} 't(} t ,Kftl`, t3 u,r4 TEL
i Itr-uf t+ ,
by TELEPHONE. (619) 564.2246'T
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t• t•p. 'Cbi tfi.fLt 73 .f w�",4:rk3F.4!,rJ�t4CTt1 T,:,,y�"�� `71 i(stiitlxtl'�r1L11 ix�s, xtl,tic;i'b Cl,):I .t? 1 la.+ii lrEt}'l1ti1 jQS'Cfk7 to lL fNy18^I :fG4yyJ
tt3'V4;i1 fffr C'kQtk+:rFliiil,ll lit7S19�1itSLHP;itiftltial•$�. 'hi+Yliljj�{
ties'to mese monuments snau oe turniShea to the"City engineer prior to the removal of any monuments. This ottice shalt`
{ be notified upon completion_'of replacement of'ell survey, monuments for proper, projectclearances
RD-31 f.,"1 , f C. t.1•t ,,; rtxa iri+=;i 3f:t olluli N! ra ;lot f 3'. ;..L't:Tiart; G5 Ciire4!s�f! i)r he C O�^' i't,trt`yG