0139NOTE:
With proper validation
this form constitutes an
encroachment permit
CITY -OF 'LA OUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
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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
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Subdivision Improvement Permit — Class III
DATE: Ttz]„y 10. 1985 Minor Improvement, Permit Class IV X
LOCATION OF CONSTRUCTION Avetr.da Diaz
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION - nkit. 11 new qas main. Sketch, (attach construction plans if appropriate)
Sketch,
TGP. 224, C-3. EARrfl 88'
'iin instiall 120' of 2" PA Cut & Jet 32'
DESCRIPTION OF CONSTRUCTION ,
rrAdiurrz nresstire plastic c'«s main 10' IVEPL of Aeenldda Oil & Gravel
Diaz, x-_Qinni g• 13' S/NPL of CelleEn.Senada;PJMQe in13 SOU Ll -
DIMENSION OF INSTALLATION OR REMOVAL NOM: The attached General and' Special
provisions are included with and
made part of this permit.
SIZE OF EXCAVATION, IF NEEDED `
A separate.Encroachment Permit
APPROXIMATE -TIME WHEN WORK WILL BEGIN July 9, 1985 shall be .obtained if work under
this permit is performed by other
APPROXIMATE TIME OF COMPLETION tdb r 9 1985 than So. Ca. Gas Co. forces.
ESTIMATED CONSTRUCTION COST $ ENTERED DEC 0-1985
(Including removal of all obstruction, materials, and debris, backfilling, com- O
paction and placing permanent resurfacing and/or replacing improvements)
enn M
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 lean 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.
P.oger Baugl-a-wi - Dist. Supervisor
Signature of Applicant or Agent
Southern Ca. Gas Company P.O. Box 2200 riverside, eA 92516 309=4512
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. f'
Applicant's Insurance Company Policy Number
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FEES: Subdivision Improvement Permit — Class I I I
n1 -TC C RED NQv
Public improvements: 3% of estimated construction` costs L'V L
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: $ i�;Jl3
Receipt No.
Received by Date
Recorded by
139
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE •l.0 -3G -c 5
r-12--85
DATE ISSU
By
Administrative Authority
TELEPHONE: (619) 564-2246
be replaced by a licensed civil engineer or surveyor at the expense'of the permittee. A complete set of notes showing the
ties to these monuments shall be furnished to the City Engineer prior to the removal of any monuments.'This office shall
be notified upon completion of replacement of all survey monuments for proper project clearance.