0163 (2)F
(dation
nstitutes an CITY OF LA QUINTA
ment per
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
Subdivision Improvement Permit— Class III
DATE:_ pecember 5, 1985 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
• • • •
10-615 _I •. •_. • • • •
p�.7,J,J4fiA..i��fi��J�i�i�4•.I;i(I�riJi4�P., ..lii• • •-• •
Sketch (attach construction plans if appropriate)
-See Sketch ZGP 214, D-6 CUT -EARTH & MA
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 12-9-85 �O
v �p
D o
APPROXIMATE TIME OF COMPLETION 3-9-86
�D
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 willbe 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 cTpany PO 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: Subdivision Improvement Permit — Class I I I
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
$ N/A
$ N/A
Received by Date
N° 163
PERMIT VALIDATION
PERMIT NO. 163
DATE APPROVED 12-21-85
EXPIRATION DATE
DATE ISSUED
12-5-85
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564.2246