2170With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
Q�1 E "T'2 \ p ov EA Z S I Z.E LOAD k;4Z,1 it
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
DATE: 5-13-94
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Haul Permit
DESCRIPTION OF CONSTRUCTION section of Mobile Home
DIMENSIQN OF INSTALLATION OR REMOVAL 1615% k� 141w
85'1 40 0001bs
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
Subdivision Improvement Permit— Class III
Minor Improvement Permit Class IV
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrees to:
Sketch (attach construction plans if appropriate)
Haul Routes Jefferson at City
limits s/b to AvC'� 52 c► --_1
Bermudas southl-t U
J �I
Haul Date. 1 MAY 4 1994 X'j
Pilot Car itegn d _
PerAitteeis zespoasible f ~ veri i
the clearance overhead of 1 signs
utility lines etc.
Indemnify, defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and all
penalties, liabilities or loss resulting from claims or tour: action and arising out of any accident, loss or damage to persons or property
happening or occurring as a proximate result of any work undertaken under the permit granted pursuant to this application.
Notify the Administrative Authority at least twenty-four (24) hours in advance of the time when work will be started.
Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result of this work.
C17
Name of Applicant (please print)
of Applicant or
Business Address
Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No.
City Business License No.
on file
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class III
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ 10.
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL
$ 10.
Receipt No.
Received by Date
PERMIT NO
2170
0
PERMIT VALIDATION
2170
DATE APPROVED
5-13-94
EXPIRATION DATE 5-2.0--9 4
DATE ISSUED
By—
Ad strative
yAdrrlinistrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
ou WTO
yTxbort ,Lxwvebort
0
82,T 00,000TP'
a-ra--ae
ti r
a-13-ae
3110
10'
b'0' 8ox 3308'
H4= (aoa) �8-area , I `
re,a„u 1e,x
aw"TOa aL HOPTTo Uwe
HYn'T bowTv
o✓iE _„Ltsr1b
atmt1► TTmn Give
qm cT"zu co "expauq of *I&-
baxwtteov xGaboaa:rple AG&TO
bmt Caz orze
HwaT Dew s
Bsz=gffa nontP to CcTTM-
TMTV8 a\P to yae aT a\P to
HQnT gontes '1$4;atoou et C;t1
�.
a
Nimsnv �+►pE4>1vlWFtt
�4
Jec �
. , a Aq gassy;
dagwnN
`aly tauloll ss�yr"�^—r��
rop +vo4dile1 ?�
- - -- 1-.01—' V PJ4 "i pupJq .11-j"
•ani >dr�+ay�
rlYlgl
paimbiu p
oq AS¢ing.1110dtq too,
A&Rufd
es.434w,ld
DIrOtWr >eu.
40 Jul
12"" ua _ amO 'Al ARTIO — 111u,wd juf�uNp�q
Um vo lan4j„w� I i°' �nUKU#A*4WI,Turd
f>rlWN'tso ;�v uae0xlwy oltaru
III tnya b iuMM24 at uolaAt
ap9 �9rl3d
�"%�.��ttlsri^� •ri�� Au.dwo0a,uurn�l+'au.�!ydae'
v +► d ocr Pus aemeiwa, is
10 +RW!•�
d
to 'yq +w is w+omreau y„t, wta WOMItlesr , river uwnd"PAN 04 J;PA WOM a w ~ Avg � MANratvo AW.*j 4a w wf avr,p n
•+a�ad�weY jiy�yqppb, t t+yt io uu WM+vv6auwN+anmr11w ,msf !µb„ tpy�ttot,ew4.A�filia rs rvmd k(Iw ►t y
�o nww Ni nAve
iaaa,�nfw#ts>�e + b +wpt•� WaNo ufes »rrytr}u�"4ft
a'ylZ 0% ma aur fP 'Mwutypvt
Meat Ae4"44 Wftl;dde f
(+1v+urM01d,ur
"!'"100 1141 1a 4el4um4 e4% to vopu$p11uc, u1
lupe I 1p/'" Eupf�++. weveu,Jfd eu!9fl
#k7jj Vgq 'AijgrP11@1448W 'VO=
N� a Pve uop�p R i0 r.�L e�,lp+�t0u1)
N011g1oiloo 40 BWj atyyyl
1'NIb3811W XbOM'A13HM 9YYI,1, 31"tX0U&V
V lav
1:1
1 O -d
s is cr yr �, 4 03 N jt'NOILVAYDXQ dO i719
44J. - � �: c � h.Lr;l �v trod ---.--- .,. IiQ tZ►�1 .fit► F�oIgN lc
r
-7''-
I+n*►�detroce ,u ---.:'.1-1
f 1 rrd
"' �,+� !�'(7 Ngllanb.WNoO �C aS4darld
Al Virm
u+utor; w@vreRo�alury �OuIW N0I12nii- 9NOJ 10 NOf 110q
11y trx;q 31W94 kWVWOA04Wl ub"rl4p"
,, gMQ161Ai�>7y'1Sfl9Ai}ddd1l pt.►1 �NdW9AQddyyy b�N1M'dt��! uor y
y ' °wig 'u> 's7a1 tk1> '�>lI IIIt+ 'SWWMy d IL4* V WjM e3sNad a p 1Cn0 io vDAN
NMiev 1 JoLne0"
etp jai
%a�Nor. zuAsNoa
4wd-g4 il�I NOUVOMelivvt�M ii811�,
b•�Nll1tJ tri �0 A.LIr�' .,
r'r -
Al�
t'
M,j - .
i
T.
Ys�+sa w+ww+ro�w
ur +auu,rauao uuey RSA
'��P1Pe•+ �»a01C11i3Gt'i
tua�t
y
C4
Ivry 00