0146la
NOTE:
With proper validation
this form constitutes an
encroachment permit
, . 6
CITY OF LA QUINTA ,
APPLICATION FOR PERMIT j ..
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)��
'SOF T[i8
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
August •9,. 1985 Subdivision Improvement Permit — Class I I I
DATE: Minor Improvement Permit Class IV X
LOCATION OF CONSTRUCTION Avenida Navarro
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Gas Main Installation Sketch (attach construction plans if appropriate)
'DESCRIPTION OF CONSTRUCTION Install 220' Of 2"
PA medium bressure.aas main NOTE: All conditions applicable to
Permit # 136, issued to.
DIMENSION OF INSTALLATION OR REMOVAL ,So. Ca. Gas Co. apply to this
Permit
So. Ca. Gas Co. W/O #31245-650
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN August 16, 85
APPROXIMATE TIME OF COMPLETION Oct. 12,- 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 thereby 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.A'uthority 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 App1 cant o�Agent
Macco Const. Inc. P.O. BOX 783 Palm Desert; CA 92262 343-1180
'Name of Applicant (please print) Business Address Telephone No. `
same
Name of Contractor and Job Foreman Business Address Telephone No...
259619 A &4B
Contractor's License No. City Business License No.. ,
Travelers -Ins. Co. TRSLG 173T 795-A-85
Applicant's Insurance Company Policy Number
FEES:. Subdivision Improvement Permit — Class I I I -
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs s
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ 17.60 PERMIT VALIDATION
Permit Fee 10.00
PERMIT N0. 146
Penalty 8-9-85
Cash Deposit -Surety Bond ° • DATE APPROVED
if required
EVE11 R10-31-85
TOTAL: $ 27.60.
Receipt No.
Received by
•Recorded,by
Date '
ATION DATE
DATE. SSUED / I 4�!
OIL
I
By
_ -00�y Administrative Authority r
TELEPHONE: (619) 564-2246