0146 (3)NOT"t: -
Witti'pypper, alidation
this form constitutes an CITY OF LA QUINTA
encroachment permit "
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
August 9, 1985 Subdivision Improvement Permit — Class III h
DATE: Minor Improvement Permit Class IV
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 220of 2"
PA medium pressure aas main
7
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION,'IF NEEDED
NOTE: All conditions applicable to
Permit # 136, issued to
So. Ca. Gas Co. apply to this
permit.
' So. Ca. Gas Co. W10 #31245-650
APPROXIMATE TIME WHEN WORK WILL BEGIN August 16, 85
�OAPPROXIMATE TIME OF Oct. 12, 85 COMPLETION
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 leasti•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 his work.
Signature of Aunt q�Xgen .
Macco Const. Inc. -P.O. Box 783 Palm Desert, CA 92262 343-1180
Name of Applicant (please print) Business Address Telephone No. t
same
Name of Contractor and Job Foreman Business Address, Telephone No.
259619 A &-B -
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 IIIENTERED NOV 2 •5 �ga5
•
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs. 1V 146
Minor Improvement Permit — Class IV: See attached schedule 1.V
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 EXPIRATION DATE 10-31-85
TOTAL: $ 27.60
Receipt No.
Received by Date
Recorded by
DATE ISSI IE,n. Io
By
dfninistrative Authority
TEL (619) 564-2246
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SIGNED
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