0162With proper validation '.
this form constitutes an
CITY. OF LA QUINTA
encroachment permit c�
APPLICATION FOR -PERMIT .
PUBLIC WORKS .CONSTRUCTION JENCROACHMENT)
`SOF TRB9
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'APPR_OVED SUBDIVISIONS
~ Subdivision Improvement Per — Class II I
DATE: flar_Pmher. 2, 1985 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION ra1.1P Estado
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Th install 240!. of 2" PA medium .
z
Sketch (attach construction plans if a
p appropriate "
re laS 1C a5 main; 5' NMI of Calle Etta o,
s
. v+n
Q 1 7 -- YYL ' ttsex 4 C - t N tx.Gv�� • •L vrc„t Zvc 214, D-6 .
DESC I TION OF CONSTRUCTION.,
w.
See Sketch ,..CUT—FSH
DIMENSION OF INSTALLATION OR REMOVAL -
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN , ):
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ ..
(Including removal of all obstruction, materials, and debris; backfilling, com; r ''
' 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 Quirita and to pay for any additional replacement necessary as the result of this work.
t R. L. BaugYiman, Distribution Httpervisor
• Signature of Applicant or Agent
Southern California Gas Company P.O. Box•2200 ' Riverside, CA 92516'.714 369-4512 <
Name of Applicant (please print) Business Address Telephone No.
Name of Contractorand Job.Foreman Business Address Telephone No.
Contractor's 'License No. City Business License No.
Applicant's Insurance Company Policy Number
r
FEES: Subdivision Improvement Permit — Class I II
Public improvements: 3% of'estimated construction costs
• ;
Private improvements: 3% of estimated construction costs
��
Minor Improvement Permit — Class IV: See attached schedule 4
Inspection Fee, ,1 $ NSA
PERMIT.VALIDATION
Permit Fee 162`
'
W PERMIT NO.
.. • Penalty -12-2=$5
Cash Deposit -Surety Bond ” DATE APPROVED'
if required EXPIRATION DATE
TOTAL:$ NSA
DATE ISSUED -. 12-2-85'
Receipt No. `
By
Received by Date Administrative Authority '
Recorded by TELEPHONE: (619) 564-2246 &
1
Kt 1,. • .t. .p. 11x.,1...{VI r,�n �.lh.1 1*ti� .. _ i:4"-. .
,
NOTE:
With proper validation
r.- . this form constitutes an
encroachment permit
• 31245-003
lop . EIC E: I . pgzar
NOV 2 7 �19$5
CITY OF LAQUINTA
COMMUNITY DEVELOPMENT DEPT
CITY OF LA QUINTA /
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For the construction of public or private curbs, driveway.s, pavements, sidewalks, parking lots, sewers, water mains
and other like public works improvements, in connection'with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
DATE:- November -- 25; 1985
LOCATION OF CONSTRUCTION Calle Estado
Subdivision Improvement Permit -.Class III
Minor Improvement Permit Class IV
(Street address or Description of Location).
PURPOSE of �oNsTRucTION To instal.:l:. 240' of 2" PA medium
.pressure plastic gas main, of Calle Estado
[ZESCRIPT N:O& CONSTRUCTION beginning nni ng 1'58' .W/WPL of
Desert Ll�u r., proceeding est. T.GP`214, D-6
_ _.\
DIMtNSIC^: CF !:^•'•ST,.LI.ATION OR REMOVAL,
Sketch (attach construction plans.if appropriate)
See Sketch CUT -EARTH
SIZE OF EXCAVATION,.IFiNEEDED
APPROXIMATE T'IME..WHEN WORK WILL BEGIN.'
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COSTS.
(Including removal..of all obstruction, materials,.'and'debris; backfill_ing;.com-
paction and placing' permanent resurfacing and/or replacing improvements)
In consideration of., the granting .oft his permit, thy, .applicant, hereby.agrees. tc: ... .
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•land 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.. i
t 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.— �
naZure,gf AW, 0EItIBUTION` Sf1PERVISOR
-SOUTHERN CALIFORNIA GAS CO., P. 0. BOX 2200.,.RIVERSIDE, CA. 92516 -714-369=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.
Applicant's Insurance Company: Policy Number
FEES: Subdivistb,�•Irnpr'ovement 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
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
Recorded by
S_ —
Date
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
TELEPHONE: (619) 564.2246
Administrative Autho;
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30 z
¢' S.
76-060
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LE A 0
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SHEET__l OF I'
4o SPL J
Aven"da (-aFDIIJ&
TOTAL FEET INST'D
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�X1.S T. S/•
INSTALL MAIN WITH AT LEAST
" COVER BELOW
TOTAL FEET RETIRED
-
-
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Q
'PERMIT
AG RETIREMENT
ISSUED BY
PERMIT NO.
DATE MOVED
DATE MOVED
DATE OF
COUNTY 1 v el
/ A
ON JOB
-"OFF JOB
OPER.,"
D S �'l
CREW FOREMAN
DISTRICT l
REASON
TRACT
PLANNED BY
COMPANY
NO.
SO. CAL. P.L.S. ❑
ATLAS Tn'I D , U�
IND
YEAR C.P.
REVI B
STAKED ❑
COMPANY FACILITY:
U_
lyy
"
v
NO.-
INSTALLED
I
STAKING REQ'D ❑'
E AST
DIVISION
CATHODICALLY
YES ❑ NO ❑
"OPER. 20% OR OVER ❑
S.M.Y.S. lf-DIST
/ �j) l
�O
^' ORG.
PROTECTED
AT LESS THAN 2014 ❑
SUPE U
NO STAKES NEEDED
W.O. G..7{
CODE
SO -FRU CALAFORNIA GAS CO. 2956.1•J
10
I- z40. 2 /W`7 07 2.
I-2 PA'CAP.
PLAN FILE NO. A.E... TCH CONSTR. SKETCH COMPL. SKETCH'B BYL
Br:lISHEETOF
X8085 � � •
W4 SPLJ
;... 5v � /even tda LwFondc�
J xrl�uG.7i t Illlpr-ibl 7_-74- �1 —
INSTALL MAIN WITH AT LEAST ---= "' DOVER WLLOW -
MAL rCcl RCI IRGIJ
,
n
ryG RETIREMENT
-
��
PERMIT ISSUED BY
PERMIT NO.
DATE MOVED
DATE MOVED -
DATE OF -
COUNTY V 11
L�
ON JOB
OFF JOB
OPER.
D F_S ERT
CREW FOREMAN
DISTRICT
REASON
PLANNED BY
TRACT
COMPANY
-
yy
STAKED ❑
COMPANY FACILITY: SO. CAL. Ily P.L.S. ❑
ATLAS Tn I_� 1 �C
NO. IND y LLD _
YEAR C.P. �
INSTALLED
OPER. 20% OR OVER ❑
SAYS.
STAKING REO'D ❑
-"-
E A -S dE=
�/
Q
� O ORG.
DIVISION
REV'D B�OR
.
C`ATHODICALLY
- YES ❑; NO ❑
"PROTECTED
AT LESS THAN 20y� ❑
SUPNO
STAKES NEEDED
W.O..
—.3 CODE
SO UT:IERN CALIFORNIA GAS CO. 293E•1•J
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