0280 (2)71 TM
W.
NDIJ,wo—
Wilh'proper, validation
thi# form constitutes an CITY OF, 4A QYINTA
encroachment Permit
APPLICATION FOR PERMIT
PUBLIC uuna . ve CONSTRUCTION (ENCROACHMENT)
bs, driveways, pavements, sidewalks, parking lots, sewers, water mains
For the construction of public or private cur c works,'improvements like 'improvements in
and other liconnection with MINOR IMP ROVEMENTS'and APPROVED SUBDIVISIONS
li
like pu Ii
Subdivision Improvement Permit -Class III
DATE: Minor Improvement Permit Class IV
P .
L CATION OF CONSTRUCTIO, Dune Palms .Road liDo
(street address or Description of Lo cation
Sketch ((attach construction plans if appropriate)
Ej;41;13 rgjawl.113 Qla
P OF CONSTRUCTION, 6
PURPOSE 7
DISPRIPTION OF CONSTRUCTION Tzexl�cb aMA pla eddrawings
anndi'l t�*"
7 --
DI ENSION OF INSTWLLATION 013, RE OVAL'
—7— S-5 94 F,
SI VXCAVATIOINF NEED
1 n-7n—R7
.WHEN,,Wl%- Wll_� BEGIN 14
APPROXIMATE TIME c n$
APPROXIMATE TIME OF COMPLETION
E§TIMATED CONSTRUCTION COST $ I
I 1r1 -
of 4117rn , obstruction, ate i al s, and debris, backfilling, com-
(including removal j
paction and pIocing-peimanent resCrfacinq and/or replacing improvements)
,
In consideration of the granting of this -permit, the ap plicant hereby agrees to: -
Inclemnifj,'ilafencl and save theit , it�'rauthoOized agents, officers, representatives and employees, harmless from and against any and all
" r
- court action and arising out of any accident, loss or damage to persons or property
penaltiesj-fiabilities:�or loss, resyltiflq- fro F
T'-cla'ms 0 it granted pursuant to this application.
happening or occurring as a prpximate result of any work undertaken under the Perm
•
Nptify the Administrative ,Authority at I�ast-four (24) hours in. advance of the time when work will be starts(
-. twenty
'
Comply with all applicable City Ordinanqes, the term's and conditions of the permit and all applicable rules and regulations of the City Of
necessary as the result of this work.
La Quints and to 'pay for any additionall
replacement
Signature of. Applicant or Agent
"Teleph2rig,Co.
— 723 Dr. Q,agrr, Blvd. Iildi2,- C 922
of Ca. Q3 gn
01
r-eneral- :
N e of. Applicant (pleas"t print) Business Address Telephone No.
.619-342-0535-11--
r
AAA W=6%uTelephone No.
Name of Contractor and Job Foreman Business
L01:1
_City,BusinePiqe
License L .. I N
.CTtractor's License No. Ir, - .- I ?-_
P-7-7717
,_.Z- —
Applicant's Insurance Company f___Po�icy Number
FIES: Subdivisiol7VI'mprovement Permit —Class III
Publid improvements: 3% of estimated construction costs
A, it -AWA OINI
Private improvements: of estimated construction costs5
N0OW1 4
Minor Improvement Permit — Class IV: See attached schedule
PERMIT VALIDATION
Inspection Fee $. Al Z&
Permit Fee PERMITNQ.,T____"_7_,
•J I
Penalty DATE -APPROVED.
Cash Peposit-Surety Bond
if requiredi�'r Y' EXPIRATION- PAT
t -or
PA
TOTAL: TE ISSUED
p
Receipt, No.
P
D
EXPIRATION_
P
7
B
u4Ke�,Authority
6 i's
'Received by
77
m r.
TELEPHONE: 46.1[P1),,,,.564-2246:
Recorded by ')`TELEPHONE
L
J-,' . -s. " i': 0.
irl nto�ma:r.,
tilt,
dil-111bicil'Itals-p1
I UF LU tri ping trees.
f. Pruning shall, in all instances, be at the shoulder of the crotch to insure even, he
fast aling in all cuts of two inches
(2") and above in size. Sealant shall be applied to all cut sections as directed by the City Public' Works Inspector.