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WlthtprOper validatigni a �l`'CQ"i'Ltdlr:ti ="r!t� r tir.. ilii xtiS+rt `s-tifi"a:`�.;`,< t.kf, .t *,Auo: this form constitutes an f encroechment`permit'= Y ,,: i CITY;:;:QUINTA 'APPLICATIO.N,r FOR PERMIT tt h f 4. ~ ' ~'Ei�t •C4�.'3 i���h��a � t*7t,,h}'�¢t,�.�ti'�. `, '•• , - .,y -- � ERM r ^ •, _" �r - PUBLIC WORKS CONSTRUCTION'„(ENC.ROACHMENT) uG.1c4 ti.',1,�Y�r.°•^r";,wS {.;� �:'re«:� .t,,,+�'. y,= 2i i �i::u piie ta'!'}a '� Y%:,, -F b �.'w �,�vt�,,a;:t,'(trrr�,slf�ts4tl;,vf1`trtll.,i:t+ ``i � pts >4i+.tri i n f ; • t N , e r • s`3!.!' 4 tti;i"� t I.: d;f r IS?, 7i =_ ., L +' it E7r1S �kt 3 ti pZ1 ri;:1 ;Y A ' r ,t: { �!� • , Is } R � ., . `r 3V ti' {+- Yv r• � # i':� r" f:,srt r r zu ,T"%�fa=J..f�t��rg • ti .-::'.x`;ai' ."•c-' '� ,•i'.''-��.,.: `�#,`C4i.rx;l.�lyyihF'. r,Yt�t,;1G'�t:� �1t'�•? It, iati:",r"tt}>tJ v,;;Y��, , For the construction of public or -private ' curbs, drsveways, pavements, sidewalks,' parking lots, sewers, water mains and other Ilke public works `improvements m-connectton with MINOfi -IMPROVEMENTS and'APPROVED"SUBDIOSIONS r< , k 33 ', aNn3G': rr ti d:� ;'iir4 ui lsflr to p. u;+t:4t i1reY (Yt;..tY?frG .ed{ .tj a 't�:`v4i�•"?t.�tr �! }t3:`s%}?"'1X+ itisd�T1d't11 d11 /.t�{i�#+t "li 't?isw,in, trE1Wti ai.OctOttortiid�k� #ja�WW.d 'bead it tllUy"t',wt�11,S1' : aaYt3tPtri+t1«ip�ijr„ta,,:ii{ s-ia4 F;(r'tt-it� l4btst.-a;h,tt.'•i'3•;3Ciftif dt jiitt�til#}lai9e'(kmi3nt€SYYk'3I'i'b)tlt+tijyClfl{7 .t1 `t7tas}1t11trt"iu�LtE " tittii tlYt3.� ;;:{t, ;att '.). {rFj tit$1.1 4irir;i/lii' tH: u ts,iitd , to , R Swa�e�:sSubdivisior ,I mpr�ovemenVPerrtilte-;p Class if 1112"sem_ DATE:,iry"i_-+7 30-8% t r.:,t r ; �s�r tt�t ,ls��t _ ~ '' Minor'lmprovement Permit X t P mit Class IV LOCAL TIO.NiOF,CONSTRUCTION,il;l,nAsert= Cly -' v B tenatrtV , rxF:<: „ .+,•, �r _'' S �:�,�� A��,_�gAt_Lr� Refer .� Gltr"%rty,da, T'4C.':t = "3tt•:tfl Y trlirl�},i{;jf.4..11i.'}:i.:t�16i,�;IGirbilS'y�'ir!'tt e�'tt;�.'rb3�tltta$.Il-�1��'�tt�FrS�X»St24'����r}:titrJN1G111�?" 3�5�'.!:}fry,.tid}f1' (Sires; address -of Description of Location)- P,U jrP SE OF�� O .�STRUC.TtIrYN f Y R d, 7r. 'sect -,fits; ,.t ! �1 Clot a,tr Tcitctcet:io 'Cxt.�, + I t:t:s: :s ^>r' Replace a badonaof Sketch. R , Q r l oOY , .r x , .(attac n tryst on plans if pppro riate cable under Desert"C fir.` _ �, P , );, PF R? RTION,OF� QNSTRUC�TJON .*3t ta7,i to c:t,�'.�rtest C ,` R trrwnni�: arrnala ilAacar. f•t {$6eeLttached , drawing •-.FF '.> . t Y d"' W.�Gf 4laaleYlei'" .-1f; L't` tt� Iti°3ii ? .6Y 1'•,tr•t.•, - tT C7t t , 5, • •i� t= f . i tr r I"f'Yq r, •• i { t•dtq its c8; �;,>,:t+r1t 7+ T %Jf" t , .t'ri• t'r ., -The..��wtachedtr,> ®cia7� and general DIME)ySlO.(� Q� �NSTAtrLAT_ OR �3EM_OVAL 12cn1 ��Q 1.<=haf9 t p p' "? r ,,, grow#dons c.ar�t ine P.4pd ILz}�.�, r -sr ► � i mace AmP%rit o ;:ithi;�d Pern►it_R F Work`by utility company -forces SIDE OF EXCAYAT4ON IF DEEDED 1 x All 1f 7LLr ©r lrirlar t4 VF}r t} c ! tvait3t€tai ;sir UO,.;i•0'r+ i.:rt rd , ;r'.rr# t itt :a •li•i.' i} F' ,ie;r r1r t try t`r Q `Zt,>lti� rOrGu� ►i:ilt iii �ti' APPROXIMATEYTIM'E WHEN tY � �` tt �tUSA d WOR3I<ff�WII,L BEGIN $�1,7-P7 < i (•t }`s �ili�1 (;: �3"tsr e'S fi ,,,. grit rtl "t :illi)€I t1t,-ilts.•-»Ltr,ts $ '.! rt', •Wn:c{'�-^ iY= t'tr� ts=A't`, • R } ,Date' issued s,i-£i1t i:li,r_ -•" APF 30XIMATE°TIME OF'COMPLETION`'i' t1'Q-1 t1-8?r,,t : +it tt/ii trir�� :t'tt :s:+u3tt,ysllt7tKsam,`tia3eti x a, a .; r' � F,r: r,,:. ESTIMAI ED CONSTRUCTION}COST $'� r t:ttr; t), stCrr 14 r;4S{,,:r, tiro 04.1tt JIt ,Jly ptr,fr;,, .,(Including removal of all obstruction, .materials;nand debris; backfilling; com'�; r 1 pctioani andlplac�ng��e permanent �uf`ci g,�nd/or .replacing improvements), G Hu In consideration of,•the. g�anting,of-this_permit,-the'applicant hereby agrees to:' ` ` f,lf,•.•t •wt�r„ ,rt+1.tl r.t 'ir�•.tA } ,•. �� f 'L-'1 A1.n•11 1'. - .F" ,tS,lt+ Lk,,ft •.;?•�, f'at ,rr ..v- ,•M,rt�, ni•(jh 1 %Indemnify,•defend and save the,CityI its authorized agents, officers, representatWes and employees, harmless from and against any and all penalties,il{qbillttes or,loss,,re uYii, g4frq •�claims.or��ourt ale;ion,fnq arising out.of.�nylac�i os �or;4dame�e to persons or property happening or o�cu�nna a{ a proxi ate r2 I' of any worl,Adertaken-ujelnder the pq! it r�(n1 p� pllrs ant, tp th'g,Bpp i tro , 4 ttr t! -..q; tSTP'.;r+SLC tY! Yrt(Y titY.{, r .Y ;..'A, -•,.t. }�7 rrr-i rS'1 °r?rfr,!" wf., t•,Cr;.t.Ft"Ti%yc}:y.yt,3ta«+tJfi[y�1.,tL'VA+r,Wiliit,:±Ul,itrF. ,. • Notify th@,:Ad�tinistt@tive,AyfklQdzity a;,lis;;,threnty-foup;l24};tioursrsn adv�nre?,ofitfte�,tirtgevyFle wgEk �will;;be;sjartQd.; f tqq irt,t �, Complyswith all,iapplicable Cityl'Ordinarices �tha'term and "conditions•of the permit and all.applicable rules and regulations of the City of, L q'`RQuintP. and to',p y fo $ny adt�jitional relacenecestary as the result of'this,work.' 3%•'CYkr ''Utf 1}.jy t, C,.,.tY<r•tl f,w t*SLi'.1.•r'trt.a :n, jY tB•cstr {(, r+sit "r!'I}jitiltF to i�ilA�'Iii+Erfi�!�i1t_ftCdii1 .,{�+i,•t. �:.!� `t�i,'i't iij'x:iU'11�{+br'ciftilt.RF,is.Y{�`"t y `r v, sp, 4.1k- ihs ilt?°RlE(Ct 9 "st1R,11 tzn(,i�j zA lw Sar:?. t7E+i'4,Silj!v wr)i3tlLtlas9t+ij.t = r• f;%;,,'''i �+%#4-eklrati; 'n:;04ttiltjGttdi :t t.;'dlyst•N. rt - ('!; + �`>^' <:'l:lw� ri►� :t:- <+,a+h,.•t •r• � t „rrstrl,ttr;t: ' Signature of Applicant or -Agent ti -` GENERAL..,TELEPHONE,-8,3a,7.93�,ftooCarreoni;Blvd�.:,-,1ndio.,,401t92201: _1,.t`!'.61% -34Z-.05-35 Name of A li.canti(please print) N,'- P8f i ♦l1W^' 41 !l l;otti' i$,, i na t.rfisls f ttt�> sy;;,:€ 'v, ,PP � d Business Address�,.s� ,o _ ,. ,Telephone No. ,�V DEr�lWG: Aiv s, i,ie; udari i:s3. t �, st-*izt� r rn ;:ata, 3� t,e�r`tsti+s.xrs�. thts OyHFi1 :( rr,;)' 4 �3 -i:i? 4ol.shtilt bV , ! • 'r"tt,13G, d Fll:t*NY"tiMt.i 1t1. :' "fti •• . •k'isd't !" .i5 rv,-,,.«...,,.. dj�V t1,' t r ...Jilf:ri9 ; Name of.Contractor=aidVo4"Forerri �]} Business'Address Telephone.No. ' t • tt,tlVl! V 9., i 4'• Ma:it!itf4t'Z1Q(.f�`4EtiFflft t.,...._,,.,,.,...,,_».'W,ltjitlt�/at'{i�;fY'rlYtdiL.xi��tt;�l�Ity.AE,1.8�21i€C'3tit'±iJzi4f}liitx.f'Jv6,'L't��,"ill :>'i�tiLl�t4iG. . ar.rj `;ui%':C:r'�rt;iir•?iS Oirlinnti(-4 5:4"i't ,- .ontr ctor's Lic€ense,� o. t t� C* Btl ire; Li�ensg No: U tK:c',►is6. t32tr:Jlibt,,.Attsst€:rtutlLEis'tiht.r,.lt+jt:�.iat3{t�1fF ri,di`1t]i�}ifljitS r� tti, 1+Mi ttycit»:tf{j lliiliut0.�3.`ilCtp?t'itt. 1 /�t .irli 1'tts tum foist { i `} - Applic�r)t's Insyrs�n�e4Co,,�Jl'tpknyx i;tty`of L.a•Qtiinut �t;si ti < hgl`.t • ;w . = �cttkzs� + -' poli�cYi B !befcin r' to urF� rlt<I srtsar FEES:. Subdivision Improve ent,P„ m t Class LL •gl f i, d E l3� is Yyjt3L;': ;1:1.'Uf► rdY:t> dii {ae j ICttr liwl pirali" o,0,/(X q Idi;.Stsr't! rzIj Iit;h :i b K Public'im'prb4ernents: 3% of estimate onstruction costs. tna `.&,rjVatq irt�Rr�yemen�� j�`�6 cf�,gsti(rtf��e�d:construy�ion gosh tyr fate' r�sso•rant# Ater ci; Otter (� M�► ttF�hadl k,tr� ` t' Minor'Improvernent•Perm€t''' Cia+ss"11/. See attach'ed`sr hedtilel t }s zf r,v ttt(; i ;irs3zksetf CuaLsftr:t�snq t �. u ' , t3f t lit sdiil + r, f*f ji,it t sbuw't v ' I tt,C c1LY1 sats r K4•s E»L}ri+�;dbi��lt ar t7ti.',.'v! 4+7a#fSCi1 :Sts;Cily v't 1.8 (�stsrSi{, aCAssradrl.'I r7 ti .` Inspection E,e�, t:1N:z>1'S. `$ N/A o r - p RM T;rVA' IDAT /�N M l �.•.. .:r V774 7117V { IF 07 , ..77ZiI F, tI' '. ta. i•,tt i ii7519{ilt{} ttdillrt= I .. ldlY "-wc n m,3 , .Permit Feel t�ttiYr�' ano n;,W th r i;, :tr 1Wi MiIlt;.Srklv.StCi i', �; 1,:ti tL-Ili inr,ti'i., ° i+ t'. r7 :w€rte pksst f:cf' .�. v")rpt �t•'�$q•. _ yarct;c,.a a a. ,.46, QrivCzvi'Fs.Yy' Firsaiuct,i h 9hfit# d'`t i'ri1Lr3 t;tGi t;tT:P ��VIIT N0. • Penalty ` ,tvtK4DATE APPROVED .Cash Deposit-qurety Pond ' al firse *mw =r fttltu;*, rT ,. t t p taA + r� +Y ♦ Z r i +I if required ,' uv.lth, r pzv` : 1 ., ttt }u .r i s a ,s to tt a �c. +fkt2,Lt EXPIRATION DATE- ..�3� � 7 ' TOTAL. $: w'r itiTt%A.t�,nCM of � :t x., •i; to �=ritt ,~'1�1 ; r .1,'�t t> #I*ttt Yc t! s r�ttlr•,r > L 0(4 `i1ErRlt i�.c'r Ttt� ;�►r},ef. ci t,cl�+trfal>rlt t.?�-°>i;.. ra?�>I y; PAT ;I$$UED. _ 3/ Re P r,�rrc,t£,uts,rti'r r �,�,i r'CIC�€d :fJ^:1C4tt'?Ci fet r-•ir,tedwori i ,r•.: d ll .}•tf'twkt.''+ 'I,+,.rla�iY,-r:i.?°.vil'FC' i}ai-�.ra'iw.,c.�r-g• Rece ve fby� Date msnlStratsve Authority Y: A h Y -cliv tar dpi, _lutnis ,trot' csdir. 1 ril, t:t;. JI't t a(a.J' Recorded byi - r•r �. �x.: ,.. rf r 11 ,4 ,ir r, twtq�srtn ; �y4u}: TELEPHONE` (619)`564-22A6~' i �Y s.. R1;iiilrtY ^irttTi'1i i.VreS� 1.�`,:i`Y+'ttyi"?fJ,i'-Kl`.lriitlft4t; Eld',LA,3`!�t(rtY"�dtt�•+iFi'�,'Lr'ix tk�a:.F,�st'Fyy�it 'Y3C±C`:+}=�t tY� ttsli'ii5"yL4 �i='tta,;, it7tt.isx .Jkt %''fix . L ,. 'C�ttteri4"lu o. da.,yit�ta�.i�4r,pfo ptirsyitn et;vhr.:i'trftiaCitacl�.'i�sci�i�#,+E�j*;• x�i;j�antaat�r,�t��G.k3+y'1i��Kee�:f�ltr.ifs:;Grrrfit��ki: . R�..=:,,.:.,.r,:_:r...�.:i�w�i2fitt}kaF•;r-�9ici�f3ti�4'ttviiSsRf}it54;;�,r:s;,iru3SY�j¢i.4ii;iti�tsft�t,Ifs'tCc4i•C�atY+t#`�:11th;�fdiY�'t�''►itprStQt�il{s€tti]Y.tt:��l'sni+yt;s�dtt(s ....L�. ..� ties to these monuments shall be furnished to the City Engineer prior to the removafof any monuments. This office shall q be .notified -,upon completion. of, replacement of+aiillSunrey,monuments.,for;.;prop8r.projQct clearance. < ,. Yss :.; ,•. s• ., RD -31 t^ i t3 il3 ?`sr. . s<:. .i c ° h' +I I.rs �trt .& i f tl7n*i <, . t ir:lCtoo a Ow my K'tdo C 1� ,, tii r:l tit irs:: ,t,. G� l..lt•. .. _ -. .r-.......is.rs.L.-...• ,...Lagar .+.a-,..-.....�. , «- .. .- �,...' .,`+.+>. -- - - - -' - - - . 1 k ICE►J�-�E.. . , : ( . ; - . -, ; , v 1. v .. Bheet ' No. i < _.�.r«-........Sr......m.<..x.a:.:.wa.........,..4�...,.-,z:.,. ,,f ....r .,.. v.Y.-... .,.4 - � ,d..r. .1- I - r .ru.,s -.sa .i. w-ar..w,✓do-.�a. f.. ... i L--I'�