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NOTE., •
i With propel validation' ;'r r , , ,,1j of Y �• ' t k.'' , T. s.r '`.}�i ! x.{ i
this form constitutes an e_ rf
encroachment permit ' CITY, OF "#Af!EnU1NTA
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APPL_ ICATION FOR`PERMIT !$
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A�tt//••�•nn�,r•• - ' - PUBLItCy�`WORKS_ CON&TRUCTIt,ON (EN CROACHMEIIIT)� ^_
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For the construction of public or private curbs,' dnriveways, pavements, sidewalks, parking lots., sewers, water "mains
and other like public works improvements in connection with`MINOR'IMPROVEMENTS and APPROVED SUBDIVISIONS
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a�t .,,July .8� r 1987 -�tl ,�J. f , r ",+
DATE:" ` • , , , _ � � � Minor,lmprovement Permit Class IV
F LOCATION OF CONSTRUCTION . Dune .Paltge Hpive ,, 1
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($treat address or Description of•Locatlogl ' +
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rPURPOSE OF CONSTRUCTION Sketch (attach construction plans�if appropriate)
4 S _,�dj” (attach
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Place "telnhon® cable '
,.,f)ESCRIPTION AF,�CON,ST:RU�rTIIVI�r�,,,i•,�}' �.....,�f.ye .+F . +r
and -RT box The. attached special' and general
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,D�I1`I�ENB(QN OF INSA) LAIOIOi Fjf�IOVAI, a=.part' of this permit.
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�^1.14 MITi• „� ...... ,:,. zAlVv6rk�FWetarth'Areas."
���SIJE OF EXCrAV T ON,rIF NEEDED s t r ±;
n •}.' 4 c USA Inquiry;No.•���.}:•, r .
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PROXIMATE TIME WHEN WORK WILL BEGIN Dente
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<tAPPROM. • i ,r�"L1, #, ,x sr• ' .. �. 1 - x '- . ., ..., � -
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KESTIMATED CONSTRUCTION COST$
(Including removal of a�obstructio' ,materials, and debris; kackfilling,,com-
�pactJo6tand plec1 tg,peirmarjent�r1surfstciin}g and/or replacing improvements)
In cwo,ynsideration of the`granting itthe applicant hereb
ranting of this perm, y agrees to:.
.Indomnify,•defend and save the.City;'itp u1boriked�agents officers, representativestend femployeas, harmless .fromAnd. against, any •and all
+-ipenaltiesr,liabilitiR;lor•lop resulting =from. claims. or court action,andtarising out of any accident; loss or damage to persons or property
happening or occurring as a prozrmate result of anyfwork undertaken. under the permit granted pursuant to this applicatign:"
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Notify;;the,.Adnlinistrative. Author4y�aF;least twenty-four (SA) hqurg in advance of -,the tiLnelwle iwork will ,bg'sterted
Comply -with all applidable City'Qrdinances, the' ter 'and conditions of the permit and allapplicable rules and regulations of the City of
Le Qyinte and to pay for any additional replpcement necessary as the result of this k
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Signature of Applic#nt or Agent -
GENERAL "TELEPHONE C0MPANYar,83-793'.,Dr. Carreon- Blvd.. : 019) 342=0535
Name of -.Applicant (please print) ''s •r' JIM SI.All ilattty .,;i cols,'.rBusiness'Address,tirti to at t! -,o tyel� i;Sket ;�,,:tTelephone No,
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-Name of Contractor and Job Foreman -`t' �' �' �' �! `;�' cc;�t clz. Busipess'Address�'` riN`=; �- - "-'V.10;Telephone No.
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Will . — .#•i� t.. � ,* �.1 rC}l1iiC� i,' �rI C {:� t f f is r� d1it..t 4�. ,-Jj •_4+l,it�(�sir;
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Contractor's License No " City Business License No.
.%vviabow-1*tr,11`10,11.y• s14i}f'.""3w-141,1!:! LY,tiYapri'txs.'CdCot vr'.F'.•:.utr,:tli:i#tfi}4�r£tia^tii<'.;5{jF
APPlicanf' I isyrarlce;C4R�PanYlily �f i 4 ui.1 ►.h a". ; .+; .' ,.e4- y� t .�. !� } Policy Number = .
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FEE$: Subdivision Improvement Permit';r,Class Ill,ut���
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a I"Public improgements:;3% of estimated construction cost;
r�sJ C ,,?F Yatg..lmptoyempe�s;%� 4f1 of., esstimAeO conjtructipn costs J..rt ,rte a; t"wtci/or tu v cttYy O t R,,,,f ! ••:,
i T Minor Improvement Permit?=''''Class IV ' See attached schedule T 4 C twt :t tvrF• I qJ i,.i:r #Yt'.,. �` .-• •.s.i
1;'57 777"M tli Av: 4,,{{' i i:Gir}y, •fia..i%,j voik1 L'':l`- ;.f L' IP'4,f 114:T:ts,r>v •f.
` Inspe4tion Fee ...� $ ,.., ,,., t PERM 'VALIDATION
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Permit'Fee•A; PERMIT NO. 2
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Penalty
ATE .DAPPROVER
Cash Deposit. -Surety Bond*
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if required h •EXPIRATION•DATa Of
E
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TOTAL: `
t r;, a%+.t ' , r;rt!t if• : - t':t. t .. s,.#, iat... # 4` ". d ':t'# aW q�T,,I IJED•
Receipt
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�ggce t r by r'�' .,v,+Tf t, t ', fu:r «: �• r' 2i LY' 0 ,y , t,;t I .� ,; Sty _ y` t. o
' `
Date" %' Adm rative Authority
Uv 7 4t! 7717,
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Recorded'by,1 Sr?,*TE'LEPHONE: "(619)' 564,2246' -
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(:4w. ,_t4i14:faft{�tA�:rl ,Ej „rr4%,' « •t= t- . ?t:: i1F i4•sh:: ►aFP+ell+i. :r#►it e.�sa Gf�ir •�. ot>;o"r�=-aw _.-
ties to these monuments shall be furnished to the City Engineer prior to the removal of any monuments. This office shall
be notified upon completion of replacement of all survey monuments for proper project' clearance'.
RD -31 �� }F ' ` • •-# s#, .:.. -. •.+ •yri. ;,�1 , , ,.rl r.uF . ' . .v.:a., ii„tc't;tF'I3y tf3.'. tit,y 4't: .. si4-f. >1 l,•. , ..
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