0056f �4r •}•
NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
i
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: M-arembpr 15;_ 1 9A
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION On washing -ton Cf- C/CPT of 1,01-h
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION TO install new gas main Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Th install 54' of 2" PA
medium pressure Mastic aas main 275' S/SPL of 50th
St. proceeding west.
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN October 29, 1984
-1 _,2� .
p a /V � -5-
7C .
APPROXIMATE TIME OF COMPLETION January 29, 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.
Fuger L. Baughman - Distribution Supervisor
Signature of Applicant or Agent
Southern California Gas Ccnpany P.O. Box 2200 Riverside, CA 92516 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 YOU 9,56
Minor Improvement Permit — Class IV: See attached schedule
I
IQspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
Recorded by
None
Date
PERMIT NO.
PERMIT VALIDATION
n/a
DATE APPROVED h7n1XWnb-�
N
EXPIRATION DATE 70 1985
DATEISSUED— Nobember 7, 1984
By Qv A A 1: 01�_n
Administrative Authority
TELEPHONE: (619) 564-2246
UA
NOTE: _
With proper validation
this form constitutes an
encroachment permit
31244-839
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 II I
DATE: October 15, 1984 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION On Wa"shin-gton St. S/SP1 of Rnth
JI
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION To install new gds main Sketch (attach construction plans if appro .nate) fA
- SEE SKETCH TGP 214, E-5 EARTH
:DESCRIPTION OF CONSTRUCTION To 1 nsta I l 54 of 2 PA
medium pressure plastic gas main 275' S/SPL of 50th_
,Ave., beginning 26' W/O the centerline of Washington St., proceedinq west.
DIMENSIC": CF INST,-,LLATION OR REMOVAL '
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN October 29, 1984
RECEIVE®
OCT 16 1984
APPROXIMATE TIME OF COMPLETION January 29, 1984
COMMUNITY TY OF
DEPT
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 Quinti and to pay for any additional replacement necessary as the result of this work. n
SOUTHERN CALIFOMIA GAS C0? P. 0. E
Name of Applicant (please print)
Name of Contractor and Job Foreman
a
Contractor's License No.
S ttweef 1glic n Agentpl stri buti on Super_yi sor
tiverside. Cal.'fornia 92516 781-6106••
Business Address Telephone No.
Business Address Telephone No.
City Business License No.
Applicant's Insurance Company Policy Number 5
FEES: Subdivision Improvement Permit — Class III 4
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
Recorded by
S_ _
S
Date
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
TELEPHONE: (619) 564.2246
Administrative Author