0279 (2)a711;�lc .1
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to
4h, proper Widatiorf.'
this form constitutes an.
CITY' OF LA,«0,14.114TA—
lot
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encroaqhmen `�irlltF1
�T•a
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-!P- WORKS CONST. -RUCTION
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,-
For the 'cons of public or private curbs, drvqWaVs,,pavements iideWalks:'OakirrlDts;wsewers-wate-mains-..,
.11P.Wo'
SITpprovemen s in,connection with'MINgRIMPROVEMERT -and�4.FRR VEp.%Jp
LV
JONS
nfzh' tonbim% canorw'.Ni Ion 041*1
."..*—.Subdivision Improvement *Permit
Class, I I I
Oqtob'ee_"q,,TrF Minor Improvement Permit Class IV
LOCATION OF -~Dune- ',- Miles
(Street address or Description. of Location) N
P,URP(iSEOF,.CONSTRUCTION, J!LU--'G PPM-PUD144
DESCRIP.T, ON
I ,.OFP.QN,§TRUCTIOTj
t_.Sketchlottach construction plans if appropriate)
.��,w,.>.»�5�� attac ed�.drewinq:,..,.,,�„��, -
0
Q_LM_EV,.�4QJ9�tO LA- f
•,;..,s:.S
_,+�4nate Issued:
t
4t tO.Ittl3Vc I ;h:
I - J l -- $ � - A`�l T e " v V'" C A f ' � -' -Vn MW r; b� t�,r* Ti If i t,
SIZE -OF EXCAVATION, IF NEEDED
i-,AFPR.OXIMATE;TIME,WHeN,-W.O,RK�;WI-Lt',- PPIN 3444
y... PW7%1_ , ...
TIME QFCOM
APPRQ�IMA� 1711
TE
_TtqN
V, AMk—, 1,1a4-
114,
-,RPCTION CO, —
ESTIMAT�P�CONST t&,T L $
47 0,
ddebris;,bac filling, comp U, -.4; �0.
(including removal of all obstruction, materials, an backfilling,
'and pla'iiij bviiments)',
paction c permanent resurfacing cindl& repla ing,impr
In consideration 'of the 'granting of t ivpermit,the*4a
Indemnify, -defend a`nd save the City its authorized agents officers, rep resentitiy9i'ind-emp I oy0s, harmless,fr9m and against any and all
n g
liti@§!&r 1. -,from claims or'court action'and arisinq-j�ot ot,any,acci t, . qss damageto"persons or-propertym—.,,,,
- C*Pt-tf'l
_cjjipi� 9g.rek9ttinq ;�7 � _. oar 4a?6dg
i- - . -I , .. , , ' ' ' V � VD� I ." t I I
an q,pr oL;q,�rigg as a pro :mate�fesultwdean un t* ., �;t, �i
Y�`Wo*ikl -.dertaken�under�,thdipOrmit--grenteo-purs'u'ari to hV�,app!ip"on,,,_,_,
,..',Nojity_jhefAclrn Y hours in the 'tirrie when 'work will .be started
init�ratiyqrAuthority,�vleapt ti�e -foy advance of
writy _ r
` applicable"' 6i'ty0_d h 0_h6bld`,�qle n
Comply.. with all r inances,..t a terms and conditions of thi p�rinitjn&i ap sa d`r6aUlations,of the City of,,
Le Quinta and to pay, for' any additional replacement nqq"ry as the,result bi'this "Witrk.,"
U mt'i Ins tC4
Signature1q.Mt4
of or Agent
40
F
64
Genre4-_g -22 f.- I 11SIr, I= � Adip CA..22201"619-342-0535
Dr. QArrrou A W
'ft�§ine _..!;Address ;Telephone No. -
Name of App IntuUM, I _..!W�
_k1,ca,qt (ple sayr .:rV f s
W
01 Ie
Name of CqnJrajtqVpd.I11b d Telephone No. -- ,t� dress
Contra6to•
d License -No ., ss
City Buiine
Applicant's Insurance Company
Policy N6m6e;7"
FEES: Silbdivisiofill'lmbrovement Permit- Class III
,
Public improvements: $% of estimated, consU
•construction costs .
:Pii'v ate impe vements:.a%,of�e
t
-cos s
-,. Class, 'IV': See attached schedule
Minor Improvement Permit
PERMIT'VALIDATION
7
Permit Fee
PERMIT N
ya4 ,r ti�04
.Penalty
DATE APPRnvr-n
Bondy 4 140: 4.,
.'Cash• Deposit -Surety
lrE�XPiRATI N-,.
if requited.
RATE 4,2=
TOTAL:. it'r, ISSUED'
&I
-DATE
ReceiptNo
.44 �777 7
,Re Da �Administ e, Authority
qeiVed,'by te:,:
ff�-, 11'x
?JJ �., r
cordedby. K 1r ),'�6 4
Re TELEPHONf., 6
16
k— S dits tsitptinseoithe pormittee.Acompl6teset of notes showing the
ties tothese 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