0057NOTE:'
With'proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
31244-127 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: 1\Tr ymbiF?r 7. 1,984 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Orl Eisenhower Dr. W/O Washington
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Tb install new gas main
-DESCRIPTION OF CONSTRUCTION Th .install 85° of 2" PA
meditmt pressure plastic etas main 707' W/0 the center] -
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN Oct. 3, 1984
APPROXIMATE TIME OF COMPLETION January 3, 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:
Sketch (attach construction plans if appropriate)
TGP 214, E-4 501 Oil & Gravel
SEE SIC= -
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.
Roger L. Baughman - Distribution Supervisor,,
Signature of Applicant or Agent
Southern California Gas Company P.O. Box 2200 Riverside, CA 92516 781-6lV,%,,
Name of Applicant (please print) Business Address Telephone No*..'
�v
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 111
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 No Fee
Penalty
• Cash Deposit -Surety Bond
if required
TOTAL: $
Receipt. No.
Received by Date
Recorded by
N101 x)57
PERMIT VALIDATION
PERMIT NO. N/A
DATE APPROVED November 7, 1984
EXPIRATION DATE May 6, 1985
DATE ISSUED,. Nobember _7. 1984
By
Administrative Authority
TELEPHONE: (619) 564-2246
NOTE:
With proper validation
this form constitutes an
lencroachment permit
► 31244-127
I
REcvVED
.SEP 211984
_ _... _. CITY OF LA
p'INTA
COMMUNITY DEVELOPMENT DEPT
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 III
DATE: September 7, 1984 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION On Eisenhower Dr. W/O Washington
(Street address or Description of Location) 4�
0
"PURPOSE OF CONSTRUCTION To i nstal 1 new gas mai n Sketch (attach construction plans if appropriate) <' "
DESCRIPTION OF CONSTRUCTION To install 85' of 2" PA TGP 214, .E-4 50' Oil &'Gravel ,
medium pressure plastic gas main 707' W/O the center- SEE -SKETCH
line of Washington, beginning 15' N/SPLof Eisenhower Dr. ,.
DIMENSIC^: CF !!'1'ST.'.L!_ATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN October 3, 1984
APPROXIMATE TIME OF COMPLETION January 3, 1984
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.
Signature of Applicant 6r gent Roger L. Baughman
Southern California Gas Company P. 0. Box 2200 Riverside, California 92516 781-6106
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
w
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
4 .r 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
Date
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED .
EXPIRATION DATE
DATE ISSUED
By
TELEPHONE: (619) 564.2246
Administrative Author