0145.,:NOTE: :� ..: ;. •' +i; j• .l ; i� .
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It proper validation
this form constitutestian _ CITY 'OF LA QUINTA
encroachment permit t v • .
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)��
SOF TI$�
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 I I b .d r
DATE: ' August •9; 1985E-
Minor Improvement Permit Class IV X _ -
LOCATION OF CONSTRUCTION Ruudel Lane
(Street addressor Description of -Location) .
PURPOSE OF CONSTRUCTION Gas Main Tnstallation Sketch (attach construction plans if appropriate)
"DESCRIPTION OF CONSTRUCTION Install 145' of 2" PA
Medium' Pressure Gas Main. r NME: All conditions. appliabable '
�E to•P2rtnit #122,' issued to'''
DIMENSION OF INSTALLATION OR REMOVAL So. Ca. Gas CO, apply to
V. thus permit.
So. Ca. •Gas Co. W/O 31245-•376
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGINF- Aucrust e12,- 85.
APPROXIMATE TIME OF COMPLETION Au4ust 20. 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.ordamage to persons or property
happening or occurring as a proximate result of any work undertaken under the permit granted pursuant to this application. s>
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..
. _ _ ..F�%' !/..c51'7r-••wt`s' l' ��.•� �
Signature of Appl cant-orrTAge� ::
Macco Const. Inc. P.O. BOX 783 Palm De6drt, CA 92262 343-1180-
Name
4'3-1180
Name of Applicant (please print) -• „ Business Address Telephone No.,...�
salve
Name of Contractor and Job Foreman Business Address' Telephone No.
259619 A & B
Contractor's License No. City.Business License No.
Travelers Inc. Co. TRSLG 1737,7§5-A' 85 '
Applicant's Insurance Company •+ Policy Number eti
FEES: Subdivision Improvement Permit — Class III `
Public improvements: 31/o of estimated construction costs
Private improvements: 3% of estimated construction costs „
Minor Improvement Permit — Class IV: See attached schedule • N ie
t
• Inspection Fee $ 11.60 PERMIT'VALIDATION,.'
Permit Fee 10.00 J F 11
t�
<., PERMIT NO: .14.5
Penalty DATE APPROVED, 8-9-85
Cash Deposit -Surety Bond t _ �
if required
EXPIRATION DATE 9-1-85
f
TOTAL: $ 21 . Ff1 t ,I
DATE ISSUED
Receipt; No.
B
V
Received by Date t i?�, �. '-Administrative Authority
Recorded by TELEPHONE: (61.9) 564-2246