0033NOTE:
With proper validation
this form constitutes an
encroachment permit
CJ
•
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: IA !2.,&O,
LOCATION OF CONSTRUCTION 4222'A4
Subdivision Improvement Permit — Class I I I
Minor Improvement Permit Class IV
'
`'%%!.I,/_7 �t'.�. �..7 •"� i /7J' �/3/.�.fJ //I X37 !7l/�./J�
(Street address or Description of Location)
J
PURPOSE OF CONSTRUCTION IN `ares- %� 4�1 c� /%%/# ol12 Sketch (attach construction plans if appropriate)
DIMENSION OF IN
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
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:
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.
/s/ R. L. Baughman - Distribution Supervisor
Signature of Applicant or Agent
Southern California Gas Carpany P. 0. Box 2200 Riverside, CA 92516 (714) 781-6106
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 fj
Inspection Fee $5�
Permit Fee
Penalty fr�
0
Cash Deposit -Surety Bond
if required 41�
TOTAL: $ —�
Receipt No
Received by Date
PERMIT VALIDATION
PERMIT NO. /17)�
DATE APPROVED
-?,%� / `2
EXPIRATION DATE
DATE VISSU!EF-
-'—
By..
Recorded by 11 TELEPHONE: (619) 564-2246
i istraikle Authority
31244-047
NOTE: _ With proper validation
this form constitutes an
encroachment permit CITY OF LA QUI NTA
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
2/22/84 Subdivision Improvement Permit — Class III
DATE. Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION On the past cirie of qVe M ndoza south of Calle Tampico
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Install new gas main
DESCRIPTION OF CONSTRUCTION Install 125' of 2" PA
medium pressure plastic -gas main 7' WE PL of'Ayp
Mendoza, beginning 12' N%S PL of Calle Tampico.
DIMENSIO"d CF INST.',LLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 3/7184
Sketch (attach construction plans if appropriate)
APPROXIMATE TIME OF COMPLETION 6/7/84
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:
31244-047
SEE SKETCH TGP-214, D-6
MAC & EARTH CUTS
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 Quinti and to pay for any additional replacement necessary as the result of this work.
pljq
SignaturbpfAp—obl IBUTION SUPERVISOR
SOUTHERN CALIFORNIA GAS COMPANY P.O. Box 2200.KLR.iveArlslli'FdlMeH_IVCA 92516 714-781-6106
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 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 S_ -
Permit Fee —
Penalty
Cash Deposit -Surety Bond
if required --
TOTAL: S
Receipt No.
Rec.pived by Date
Recorded by
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
TELEPHONE: (619) 564-2246
Administrative Author
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YEAR C.P.
INSTALLED
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COMPANY FACILITY: A' SO. CAL. ❑ P.L.S. Cl
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PERMIT ISSUED BY
PERMIT NO.
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REASON
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PLANNED BY
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COMPANY
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YEAR C.P.
INSTALLED
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STAKED ❑
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NO STAKES NEEDED
COMPANY FACILITY: A' SO. CAL. ❑ P.L.S. Cl
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CODE
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COUNTY RI V E' (? `S 1 `D F
W M AC -RETIREMENT
PERMIT ISSUED BY
PERMIT NO.
DATE MOVED DATE MOVED DATE OF
ON JOB OFF JOB OPER.
DISTRICT L 1
REASON
CREW FOREMAN
PLANNED BY
TRACT
COMPANY
NO.
-CATHODICALLY
-PROTECTED YES ❑ NO ❑
YEAR C.P.
INSTALLED
OPER. 20% OR OVER ❑
qT LESS THAN 20Yi ❑ S.M.Y.S.
STAKED ❑
❑
NO STAKES NEEDED
COMPANY FACILITY: A' SO. CAL. ❑ P.L.S. Cl
ELS1 E_RIVDIVISION
n
W,p, 3 i244 - ORG.
CODE
REVIfE4DSB YSTAKINGREQ'D
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DISTRICT UPE ISOR
SOUTHERN CALIFORNIA GAS CO. 2938.1-J