0027R
�190TE:
With proper validation
this form constitutes an
encroachment permit
s
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 II
DATE: kYY 27, 1984 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Avenida La Fonda frm t,liashington westerly to Calle Guatamala and
southerly to Calle Cadiz.
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Main rMlaCeMent
DESCRIPTION OF CONSTRUCTION Fieplaolnq 5" Steel water
main with new 8" A. C. pipe
DIMENSION OF INSTALLATION OR REMOVAL uZ5uut1nq
approximately 1,750 Ft. of 8" A.C. pipe and 4-6"
the hvid"s3.
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 3-12-84
APPROXIMATE TIME OF COMPLETION 3-26-84
ESTIMATED CONSTRUCTION COST $ 34,084.50
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
Sketch (attach construction plans if appropriate)
In consideration of the granting of this permit, the applicant hereby agrees to:
PLANS ATIPAI:'kW..
LRE MUST BE ZDiS'PA= ACRGiSS
`[ ASHMGMN STIRF!M, BY BORTWL
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.
R. L. M_rDowell ! )_ \N
Signature of Applicant or Agent
SotatheM California VVatElr CoPany, P. O. Box 6, La Quinta., CA 564-4426
Name of Applicant (please print) Business Address Telephone No.
J& G Pipeline, P. 0. BoX- 325, Moirongo Valley, CA (714) 622-9720
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 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
oa
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL
Receipt No.
$
$ -T9i. --e!1
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO. %
DATE APPROVED -1/2-6 14-44
or
EXPIRATION DATE„3/4A/ <
DATE ISSUED
By Administrative Authority
TELEPHONE: (619) 564-2246
.-;
NOTE:
With propet'validaYion
this form constitutes an CITY OF LA QUINTA
.encroachment, permit`
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:_
LOCATION OF CONSTRUCTIOI: �)'y p
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION N
Subdivision Improvement Permit - Class I I I
Minor Improvement Permit Clas� 1\'
, .n
._ . 11 - t
Sketch (attach construction plans if appropriate)
DES RIPTION OF CONSTRUC ION P o STI - - 9 i
�L i
S
DIMENSION OF INSTALLATION 0.9 RE O L h75 X11,1-��b� �%/7t Oaf
I -A I�ft P, (Q Y,:3 S
SIZE OF EXCAVATION, IF NEEDED /7 e- SUS l
APPROXIMATE TIME WHEN WORK WILL BEGIN e- 1-0,5 s
APPROXIMATE TIME, -OF COMPLETIONIMA 0-G 1-N z40 2-
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 applicarit :hereby agrees to:
Indemnify, defend and save the City, its authorized agents, officers, representatives and employees, harmless from and aaainst any and ali
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 Ag nt
)D0V1 r,j (�42 64-cZcfotc., r c co Oil S1.4-h►1-42 (,
Name of Applicant (please print? Business -Address Telephone No.
_
Name of Contractor and Job Foreman business Addres" Telephone No.
Contractor's License No. City Business License No.
Applicant's Insurance Companv Policy Numb
FEES: Subdivision Improvement Permit - Class III
Public improvements: 3% of estimated construction costs
Private improvements: 3`,; of estimated construction cos:
(viinot improvement Permit - Class IV: See attached schedu:'.
Inspection Fee S
Permit Fee {
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: S
Receipt No.
Received by Date
Recorded by
"pec ^`_ :n'�•-� f. ��'+��"t y``1: • n.
b., it't, tt bf
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED .
EXPIRATION DATE
DATE ISSUED
By
TELEPHONE: (619) 564-2246
Administrative Authont