2836 (2),Oct.21-98 03:29P RHI CALIFORNIA 760 7764329 P:02
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Wht1 Poor validation
Oils form aomsitu m an CITY OF LA QUlNTA r
orisrcod lmom mmit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
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for . the mftevuttion of pplltic of ,odtfata EUfbs, drirsWaVa, pWafiMhtl, Ildasrllkd. oafli VlR lots, sowers, Wagner mains
and Other likag oublie workl irnprd"smawts in CagflnaOtion with MINOp IMPROVEMENTS end APPROVED SUBOIV ISIONS
O ( £trbdbi6on IatpfOvatrtstlt Permit = Clssa'11I
GATE: Minor Imororenunt Permit Class IV
LOCATION OF CONSTRUCTION lad I
�.._.._.,._..� 1-A QU l
flow gommus or Dsatsiiougo"of lopetrottl R 11(- 'r
PU OPCO
NSMtICTI 5 9FO0 AF 51tmeh lattm% wmvuoion plans if soorooristsl "
IS t:.o
6.4F-
6118mmON COPWRUCTION
,.��if►cr1 �vv�T��y
01015041II-0141OF INISTALLAT10NOR REMOVAL
9131OF EXCAVATM. IF NEEDED
APPROXIMAT<TIMC WNEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION .�,
IMMATEO CONSTRUCTION COSTS , • .•
Ilmita lrip to ltpedl of all dabYOHon, mmrials, Ind tllbria..WO[itgi+tlj Wire
Peotlort and placing parmsesam raarrfatinl and/or rdolacinp irnorovlrnentll
In talsidaafuei+ et the pnm Vnp Of thil peanut, the eP0liceAt harebV even to;
fgeetwnify, daread ow stem the City, ." w0wisar gtfnu, o4ho rs..pwrwuttiw wed ewofovtas. rwrwrar t.wa Iwo Retail env ww am
pewMttef. tnatoniw a raw •earltiap from claim ar sawn amtaa end Mffwa Oaf -or env w0deet, tau o, 4~ to areowt w orapeity
mason,' / V taaanine n a Praalmste ""it M low work vndtrukerf +rider the oomii granted ourauws to entt opprlaatfon.
rastlty vw Amori lfetlM tseatorinr at tstat CM OW40 v 430) rgate M at tee to" whew waA suits 0e so"",
Cawtsty 000 to ImmoOU City Ov n mw. " arms'awd' om, iifafe of this taatraat erta of apagfid bw mar N1Wedana of the Clay at
V Oui-M am r ow far any g000ntfal F40hem Am wedetaary a Air f Mir .
...�+�Slp tun /lppi�nt Of Aptnt - -
IG11_ _.�1 � V_ �. t l�a.� J/�� /I L /!/ •
Namt/ o Applivent (PrestNPrint RVsimm Addrou Telephaw NO, 7& O
/3 1r�)5 /4 _ RAA�ctl 0 l' I RArt,4c -7 7� Y 3 O
NMne_of CoM►Wegr and Job Fwemagn Business Addmu �rTNaohom No.
-7 Z:Z (ay9 -538a
Contrstaw) L,taitae Nn City Businats Llano No.
I,( f�1 t= CA--P1 VC ►j I til 6(-A-A i300`34 3
Aw6aimt's Insurance Como" Ptlliey Numsbar
PE{R: 5ubo ft6on Iftwewnrrtt Pafmit — Ciao III _
' Ptrdlia tfslprreetfwto: 7K of grlrftata0 mntseuctlon Dolts , .
06148% IfIgIVOV4011111rMs: 3% of sititlatld aMutitilon coati .
Minor Irtt P !! MRt' Farms — peat IV: Ula altatiMd schodule 2774
leflliaetisn iss Q Pf11MITT VVAAUDAAV10111plermil %
♦�� Fee
PERMIT h10; ___�_iG�
,i �ia1ar�t 5o G2�i o Z '9 `��
Cam Ommitdusery Rend O �Q ' RS, By/`r1/ DATE APPROV[D
if law"d / fl(PIRATION OAT[ o - 97
TOTAL: i DATE I$RVED'
R1lai01 fast.
ey
Recomw by Data Admirorlrstnte Authority
Remedad bV lflaeesene' star pl 777.71175
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