0058NOTE:
With proper validation
this form constitutes an
encroachment permit
31244-787
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: Noymbear 7. 1984
Subdivision Improvement Permit — Class II I
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION FisenhcuTer pr. and Vista Laauna
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION `10 install new gas main Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
171 NW10 the
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
211 PA
Dr. proceeding northwest.
APPROXIMATE TIME WHEN WORK WILL BEGIN September 21, 1984
SEE SKETCH SGP 214, D-4 Cut Earth
and Mac
APPROXIMATE TIME OF COMPLETION December 21, 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 Quinta and to pay for any additional replacement necessary as the result of this work.
Roger L. Baughman - Distrubtion Supervisor
Signature of Applicant or Agent
Southern California Gas Chnipany P.O. Box 2200 Riverside, CA 92516 714-781-6106
Name of Applicant (please print) Business Address Telephone No. G
6
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 costst+p
Minor Improvement Permit — Class IV: See attached schedule o Q
Inspection Fee
Permit Fee
Penalty
Cash, Deposit -Surety Bond
if required
TOTAL:
Receipt No,
No Fee
Received by Date
PERMIT VALIDATION
PERMIT NO, n/a
DATE APPROVED "mm -y -r 7. 1984
EXPIRATION DATE May 7, 1985
DATE ISSUED _ Noyanber 7,1984
(
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
NOTE: _
With proper validation
this form constitutes an CITY O F LA QU I NTA RECEIVE M
encroachment permit
31244-787 APPLICATION FOR PERMIT SEP 10 1984
PUBLIC WORKS CONSTRUCTION(ENCROACHMPTPLA QUINTA
COMMUNITY OEVELOPMENT OEPI
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 Eisenhower Dr., and V.i sf.,a .l aglana
" -(Street address or Description of Location)
PURPOSE OF CONSTRUCTION TO install neW gas main
Sketch (attach construction plans if appropriate)
SEE SKETCH TGP 214 D-4 CUT EARTH
DESCRIPTION OF CONSTRUCTION To install 85' of 2" PA ,
medium pressure plastic gas main 17' NW/01'the center-. and MAC
Center—
line of Vista Laguna, beginning_SE/NWPL of Eisenhower Dr., proceeding northwest.
DIMENSION' C_F I^'•ST,-,LI.ATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED r 1y
APPROXIMATE TIME WHEN WORK WILL BEGIN September.,. 21, 1984
APPROXIMATE TIME OF COMPLETION December 21, 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 Quinta and to pay for any additional replacement necessary as the result of this work.
Signature of Appli a or Agent Roger L. Baughman
Southern California.Gas Company P.0-. Box2200 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 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 S_ _ II PERMIT VALIDATION
Permit Fee —
Penalty —
Cash Deposit -Surety Bond
if required —
TOTAL: S
Receipt No. —
Received by
Recorded by
Date
PERMIT NO.
DATE APPROVED .
EXPIRATION DATE
DATE ISSUED
By
TELEPHONE: (619) 5642246
-Administrative Author