00441
NOTE: t z •;
With proper validation
this form constitutes an CITY OF LA QUINTA I
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
Subdivision Improvement Permit — Class I II
DATE: ?C;. IgAA Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION To cut 4' X 4' bellholes in Sketch (attach construction plans if appropriate)
irarious streets as necessary to repmir, maintain, abandon
DESCRIPTION OF CONSTRUCTION and install services on Gas Company Lines
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED 7
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION August 1, 1985
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:
j1clrI� eJ
1981
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.
A.H. Obst - Distribution Sepervisor
• Signature of Applicant or Agent
Y'
SoutherngGalifornia Gas Caq)any P.O. Box 2200 Riverside, CA 92516 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
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ II
Permit Fee
Penalty
Cash Deposit -Surety Bond s
if required
TOTAL: $
Receipt No.
Received by
Recorded by
Date
Y
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED A'���-��/
EXPIRATION DATE p August -1-1985
DATE ISSUED �(1 �_ ?/
Administrative Authority
TELEPHONE: (619) 564-2246
0
.r` IJ7. � ==Z .. _
NOTE:
With proper validation
this form constitutes an
encroachment permit
Blanket Permit
I
RECEIVED JUL 3 0 198N
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
—ly-
Subdivision Improvement Permit — Class I I I
DATE: July 25, 1984 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION -Blanket P.ermi t, for 1984
(Street address or Description of Location)
PURP. SE OF CONSTRUCTION To Cut 4' X 4' bel l hol es in Sketch (attach construction plans if a
VdrI us S eefs 4s neces dr o reps r, mall n a1 n, d andon p appropriate)
DESCRIPTION OF CONSTRUCTION
BLANKET PERMIT FOR 1984
DIMENSIO^d CF !"!•S-,-,LLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION August 1, 1985
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.
Southern California Gas Company
Name of Applicant (please print)
Name of Contractor and Job Foreman
Contractor's License No.
Signa re f A I� nt o�4;91P. 0. Box 2200 � Rive�rsside, T1 I A�IPM Multi
Business Address Telephone No.
Business Address
Telephone No.
City Business License No.
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit —Class III
Puplic 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:
Receipt No.
Received by
Recorded by
S
Date
1�
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE I AW i t
DATE ISSUED `
By
TELEPHONE: (619) 564-2246
Administrative Authoi