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2807
A-iNOTE":` Wlth'p`roper validation 4 Q' this.f6rm constitutes an encroachmerit°permit: CITY; OF L'A .,OUINTA f • Kf, ,,. R . ` APPLICATION FOR PERMIT r• fit. , PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) OFyg�`�S Foy 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 " t ,- Subdivision ImproverrientPermit — Class I•I I r DATE.' I �,;r.Se t rilbar '23..' 1998 _• '� - Minor Improvement Permit Class•IV "' •�- r.. r LOCATION'OF CONSTRUCTION' to Qql. to (rraUces •Mack) Ceromun t Park.' Avenida Mnntezu ' (Street address or bescnption.of Location)' ' PURPOSE OF'GONSTRUCTION PZ�tae `d�ra�ctfpn�il r3szxt-. r Sketch (attach construction plans if•appropriate) , Qfg�lstr+ et^;aarkitig. 'traffic conatxal �xnd.watw�ir' xxnek rent !. f-` r.DEk134TION OF CONSTRUCTION Install atii to .� DIMENSION OF -INSTALLATION OR REMOVAL SAE ibR ° t SBE'TAGHBU GQltiilZTONS.'' lr`/ -SIZE OF EXCAVATI;,ON, IF NEEDED SVA 71. APPROXIMATE TIME WHEN WORK WILL BEGIN; APPROXIMATE TIME`OF COMPLETION_ . 10/12/91 gESTIMATED CONSTRUCTION COST,$N/A I, (Including rerimoval-of-'all obstruction, mate'rials,'and debris, backfilling, com r _ Cj paction'and. placing",permanent resurfacing and/or replacing improvements) ' In consideration` of the granting _of this permit, the applicant hereby agrees to: _ r.J. i. Indemmfy., defend'and save the City,.its authorized agents, officers, representatives and employees, harmless from and against any,and all , penalties,. liabilities or loss resulting fro' *'clainis'or•court action,and arising out of,any accident,, lois or damage to ,persons or propeiity' happening or occurring as 'a proximateresult 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'wili be'started. ' 2 Comply with'all applicable City Ordinances, the terms and conditions ofthe permit and all.applicable rules and regulations of -the City.of < •' Le buinta+andao'pay for any additional replacement necessary as the result of this, work:' 7; `_ �.».•., r"'1= -f^• � ,•.f�' _ - .. _ .• -' • �, �`�i�7 /AuUtF�l�i4..v �/Ult �VY��• .� Signature of Applicant or`Agent r �` . •Coachel A,Valley Rackealtion and Park ti�strirt.45-8i1 CiiritAn; lx�dlo� CA �322Q1. (6Q): 3&7-,A4i34' Name.of Applicant (please print) Business Address :r ,' Telephone Nos. ' 9atap% t i4ra McCal.ltard �. ;1 } Name of Contractor and Job Foreman ] Business Address' . Telephone No. N/A N/1� r -' Contractor's License .0'. '. City Business License No. Oapri 1�0G9899,' ' ApplicariVs Insurance;CompanyiPolicy Number:,.. ` FEES: =-`Subdivision Improvement Permit =Class III ( f Public improvements: 3% of estimated construction costs Private improvements: 3% of estimated constr'uction,costs Minor Improvement Permit —' Class IV: See attached schedule r Inspection' Fees $ PERMIT VALIDATION Permit Fee r T 5i �` 10©'. ' :•''7. 2807 t ' PERMIT NO. Pnalrtaler Tu►clr 360. :� 10/7/98 enra DATE°APPROVED Cash Deposit -Surety Bond _ -•• if required EXPIRATION DATE 10/13/98 '- 464. TOTAL:'': `• WA�vr.0 Receipt No. Received by Date Recorded,by 'DATE ISSUED 10/7/98, Administrative Authority Telephone: (619) 777-7075 :q: ' ,*,Is, t