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With proper validation (Retllrll tt`�t.,- Copy with payment) 04
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this form constitutes an
CITY OF LA.QUINTA �
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encroachment permit s
APPLICATION FOR PERMIT !�>:';:
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PUBLIC WORKS CONSTRUCT ON (ENCROACHMENT) <r •'
Box so y C���OF ��S
P0. l tiff
LH- 4uin4-A -CA • 9aaS3
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: May 15, 1985 Minor Improvement Permit Class IV X
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LOCATION OF CONSTRUCTION See attached description.
(Street address or Description of Location)
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PURPOSE OF CONSTRUCTION Gas Main installation. Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTIONap .-+_h jpaueup^+ cui z- E; All general and
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special provisions associated with
Permit #097 issued
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DIMENSION OF INSTALLATION OR REMOVAL AMMS, 8000 lin. ft. .1�tcroachment
to Southern Ca. Gas CO. are
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applicable to this permit.
SIZE OF EXCAVATION, IF NEEDED seP above Southern Ca. Gas Canpany
Work Order #31225-060 SP
APPROXIMATE TIME WHEN WORK WILL BEGIN 4-1-85
APPROXIMATE TIME OF COMPLETION 7-1-85
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 Ouinta and to pay for any additional replacement necessary as the result of this work.
�O Signature of Applicant or Agent
MACOD Construction, Inc. P.O. Box 783 Palm Desert, CA 92262 34 -1180
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
459619 A & 12
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 $ 639.84
Permit Fee 10.00 '
Penalty I
Cash Deposit -Surety Bond �-
if required
TOTAL: $ 649.85
Receipt No.
Received by i Date
Recorded by ' _7777
N° 123
PERMIT VALIDATION
��. PERMIT NO. 123
-'S-15-85
DATE APPROVED
EXPIRATION DATE 7-30-85
DATE ISSUED 5-15-P5
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T1616EPHON-E:1619) 564-2246
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