0019r46TE:
With proper validation
this form constitutes an
encroachment permit
0
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
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:�t�s� 1® ��
Subdivision Improvement Permit — Class II I
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
? a�311t_"'�`'�'t
u/O
5Ku'-ate
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION � •"
DESCRIPTION OF CONSTRUCTION � ' :20'_C):- 2"
2, IIml,t°zlLm-
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED 90°
APPROXIMATE TIME WHEN WORK WILL BEGIN 12-2--03
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)
31 223-4 �!I.1
r �-,;l,F,
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 court 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.
Signature of Applicant or Agent
: Po Oo i= 2200, Ri 3i6-,, CA D2516 7EI— 106
Name of Applicant (please print)
Business Address
Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No.
City Business License No.
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit —Class I I I
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
$
Received by (' Ol Date
Recorded by
1 —7--�( 3
PERMIT VALIDATION
PERMIT NO
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
Administrative Authority
TELEPHONE: (619) 564-2246 y
31223-441 •
NOTE: —
With proper validation
this form constitutes an
encroachment permit
NUVI 41983
CRY -01 La Q„ uinta
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
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
Subdivision Improvement Permit — Class I I I
DATE: November 18, 1983 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Avendi a Obregon S/D Avpni da Montezl,lma
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION installing new gas main Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Install 530' of 2" medium
pressure plastic gas main 15' W/E PL of Avendia Obregon,
beginning approx. 185' S/S PL of Avenida Montezuma.
DIMENSIC": Cr- !"dST,',LI_ATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED 90'
APPROXIMATE TIME WHEN WORK WILL BEGIN 12/2/83
31223-441
EARTH & MAC CUTS SEE SKETCH
TGP-214, C-6
APPROXIMATE TIME OF COMPLETION 3/2/84
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:
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 court 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.
Signature of Applica or Agent
R. L. BAUGHMAN - DISTRIBUTION SUPERVISOR
SOUTHERN CALIFORNIA GAS COMPANY P_0_ Rom 2200, Riverside, CA 92536 781-6106
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman
Contractor's License No.
Business Address
Telephone No.
City Business License No.
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
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
S
Receipt No.
Received by ��?�ateP� - ,
Recorded by
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISS D
By
cl,z
Administrative Author
TELEPHONE: (619) 564.2246