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"With proper, validation ; t 1' t +„nr�•r .t "s ?•+�},,.¢' ++ _' �' i• yap. +. =� d
t lncroachment is form cohitltutevan +c �, �' l F t * l+ x` + i.
epermit �'� i t� CITY«OF LA 4UIN°TAS„ Y{�I �Ji•t: }! " 1 el
1 '
,"' w :•c"t r,�iy ";APPLICATIONOR,r PERMIT „�• .a µ1.
UBL.ICWORKS�`CONSTRUCTION( NCiOACHQ/1111T),�h' �' f,'•
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;
For.- the construction :of',publlc or private'` curbs,' dnveways,`'pavements, sidewalks; parking lots,' sewers, water mains
1�5�%and other like, public works improyernents in connection with MINOR IMPRQyMENTS and APPROVED SUBDIVISIONS
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+ q.� `� w •'t. `' _•. !<� R r _ y c' k t r L^ !'•.-^ ''" }. E s. - )
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`
'T ' ` ,�;� ,# r "t' Subdivision Improvement Permit = Class III
DATE Jul }30+ +. i x..t�l.� k 1 t� t .a.. i w..xtY 1 .r X
y MinorJmprovement Permit. Class IV
` • 0CATION OF CONSTRUCTION. Mac son street E/S. S,(O Ave: `X58: Refer to nrdp
x543-31231I 'i,'.,- }
f (Street address or Description of Locationl' . �" i �•' s' )'+t ° +` {
I'... _ ,.i/., - �-`t � ,,^' ,• yam`• t'M�_ Ip+"• 44-�• '' '. `'' ' -•
" PURPOSE OF CONSTRUCTION, Sketch (attach construction plans if appropriate)
DESCRIPTION OF,CONSTRUCTION� EI3 eW ux'i AA1T? a $ee attached, sketch''
�... ri}ikar�sil�tZ.f Madi.An.
_ �.. ,..., Yx
The.Attached
general and special
IMENSION OF INSTALLATION-OR`REJVICIVAL!"w �" "' ` provisaions"axO' inclu-ded and• _. a
. made apart ,o> tis. permit.` ' J
..EXCAVATION; IF NEEDED 4 ` u'i <TTO. ,tJ
.� 'ya, q+ r:'' + :a ,;, •F N� i r
PPROXIMATE TIME, WHEN WQRK WILL-BEGIN ` yDA, S d �
i" APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST,$'
• '(Including removal, of all obstruction, materials, and debris, backfilling; com•'`? ;, i G.• `.. k I
t coon and, placing permanent resurfacing and/or• replacing,improvemertts) f
f„ ,{�•.1, L.'l•isur' c
�n consideration' of the' granting of this permit, the applicant here y `agrees to:
} ` . Indemnify,:defend and save. the-City,•its authorised agents, officers, 'representatives'and employees, harmless from and against any and all
penalties,. liabilities or loss resulting -from claims or court action ane arising .out of-any accident, lgss'or'damage. to persons of„property
• happening or occurring as a proximate result of ny work undertaken undyr the permit granted, pursuant to this application.--A
”
:Notify she Administrative Authority, at"least .twenty-four 1241 hours n advan �+ oc f .tthe^time;when work will•be.startad
...Comply. with all, applicable City�Ord inances, the°terms-. aid conditions of the permit'and all applicable rules and regulations of,%t City of '
•%Lo Quints and to pay for ,y additional replacement necessary as the result of. this works`
I 7 n ' ., ,}y.: ii �ti • � `�- tr 1 .. ;w'+� r .r,' .1 - •. w � '
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t1 Al
Signature of Applicant or Agent 619.'342=0535
GENERAL BELEPHONE- 83-793 D
T
aof Applicant (please print) Business Address " • ,' �` ' Tglephone No
( 1 T• .1• xi`^
eel P '.r' 7i fl /I T • n i«-a i =" 'n p.., } > t l ie � .:+.r ..,....w,�.
E H t Name` { C ntractor and Job For mai _ ' s `' uslness A ess Te phone No:t-: `
A! 4 c s n.' d� " 1./J . a ,� . •1 xr l+ ;izt MOV.
i"}� `�'"�
r_ fel �.rr,cmt s ,
Contract
License No
1 -2 �' Y4CttAa�ellrY, ,g �}
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f- , Y z t- t �? r 4 t` �. n •-� IiC�/ NufTla.
• Applicants Insurance Compan '+ p
-'Subdivision Improvement Permit — Class I II :• :•tom• ��•-�»,.r.r,.•-•-. }
r^ .
-."Public improvements: 3% of estimated construction costs . � � �,a,ys.�t�,t�-x4'� tt�htacxr'�in •� w...� t{� ,�_
Private improvements: 396 of estimated construction costs"yOlt
Minor Improvement'Permit'=Class•IV�:-�See attached schedule
PERMIT *VALIDATION
! t Inspection Fee $ - 1Q�i$ _ '} .
1l,! .*
y...vraxa. ,� `!+, uiKtxlvVtx��y t�• t-.;x�5ra rir r�.�` t ,,;s I''i II."l,Att$til r, t o'
Permit Eee*e#sv lot '.ns r. a t itt u �t
'" x , a F +: s :.PERMIT'
N0 ., t.. . '� %% ,�
. �N��SS'L'Jft Er,'iiiey I�ftattk4'�[4 t>Sl+...'tf ' :l.ef ! ' ira.�} i'1•F'rr. �_ a '' ..-:.. . , ,_e ..• e � .. ` .
Penalty: }t•' �z , x r3 t• L, ,' , - 7 3
« _ -
` CasFi Deposit- .urety and r -- +#ate;cwt ,r* J..� f �D(AyTEyAPaP�RO�/E�D>fw /� y� y f T �A r
S , 4 t4 - �� M. ,� ', '� ,l �� a.I1 bC n:•' ,V.=!tfT.� } Vii, iJ1Y inn i ivi i` •� ,
r f re uireiihalo arer! r:;. wF1t . t . t{ �, r'nx+ , - t4
i '. r r
»9. w _ . t ,' 4_L4hiEXPIRATION "DAT x r s + s
�, I iiNO ' ,e►il A' yt ri, f qty 3 r ,
`4... TOTAL. $++ #. r&r+r+.
z" p111 �?}IL iiFislll r2 ;i*� i ,.,� � - DATE:ISSUED
Receipt No + u ea`4ta tis��lt.t�aaa�7 � > i�.t + r " �:;r�� ire+• ,. + . s = ' qe
.,v5,},d�ixNMirurwr. s 6::
+;;:. tr4ri �, .s • ; ,, - - :'a.-.tl . • By F 'r
t +w t: ;,� �t rx.n ,,s , �d ins ative Authorit t
Received by *r Date tt:# i;+''a:.y rap+a.tlort whi„ii titr,';'tai,i.'.t, �a .� y '
•pify of La �'t3:E�"e•¢NtL+i�' TiEi irK In iit15 F�i'Fi i f)wrtt � " 0{<Y.ii �+ R4E,r�� }e t + e .•ifrtr}. l
Recorded,by_, __ _ _. T EPHOI E: (619);564-2246`l`�`tn!h'A 'tar�z`
.••;, x+xi'". :.�.:!'. ;rzv ,t^ '� ili`tx,
i9?y SLl9t/FY' i t~>;dxrtdl -xT"5; Ytttzr t+� Uxtt7� tlrr,. +,t �.r*' .-n}1•,,t a �tnn}"oci an till ourvey nVnwinfinL-.whii;h ux►5t t}rt i:1g
r cMrllt rlr rix;rf wtd �.Lt �;-7 or';3ttwo fx a 31 wlion xi f+r�wi k �uiij� ��, xtir'ACJ6.41,�.(L� � OiJft ti413ri ,il }
beret�lts. ,. , s_+;.>+ ,.,,e + c; ;l „tl c$; :;r ;L7.eyu, at t, itl expense or the perrriitfee. A complete set of notes showing the
ties to these monuments sliall be-fu'r'nished to the City Engineer prioW to the removal of anjr monuments. This office shall
be notified,upon completion of replacement of all survey monuments for proper project, clearance:0I-Li t,t t� • ,.k ,,t ,
RD-31 1t 1 010 au5,vd 't.: K LS. �''t.{S1tii I�
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FORM 809535 (5-87j
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