0162 (2).alidation S
�7• "constitutes an CITY OF LA QUINTA
,achment 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
f�-
Subdivision Improvement Permit — Class III
DATE: December 2, 1985 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION rAl lP Fstado
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION To install 240' of 2" PA medi= Sketch (attach construction plans if appropriate)
pressure plastic,gas main, 5' N SPL of Ca a Esta o,
'-YVT4vPL� s " egg -blest TGP 214, D-6
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
See Sketch CUT—EARTH
APPROXIMATE TIME OF 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 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.
R.L. Baughman, Distribution Supervisor
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 Contractor and Job Foreman
Contractor's License No.
Business Address
Telephone No.
City Business License No.
Applicant's Insurance Company Policy Number
FEES:
Subdivision Improvement 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 $ N/A 11
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ N/A
Receipt No.
Received by
Recorded by
-31
Date
ENTERED DEC .0 ;935
N° 162
PERMIT VALIDATION .
PERMIT NO. 162
DATE APPROVED
EXPIRATION DATE
12-2-85
DATE ISSUED 12-2-85
By
TELEPHONE: (619) 564.2246
Administrative Authority