01661
NOTE:.
With proper validation
this form constitutes an ,CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENTY
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:__ January 3, 1986 Minor Improvement Peimit�Class IV
LOCATION OF CONSTRUCTION Within the paved and earth sections Of various La Ouinta roads
Within the boundaries of GTE operatinct area.
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION SLA= PERI! T ' Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Maintenance and repairs
of existing underground eauinTent and installation
This authorization does not include
DIMENSION OF INSTALLATION.OR REMOVAL' Not more than 80 excavations of FAS roads (major roar
Lin. feet excavated under blakket permit. permitee shall notify C tarnuzity
SIZE OF EXCAVATION, IF NEEDED 3' x 4' bell holes and Development Department a min. of
24 hours prior to start of work.
'installation of new services.
APPROXIMATE TIME WHEN WORK WILL BEGIN Notify City
24 hour's in advance of any work. Separate permits.are required for
Permit expir '
APPROXIMATE TIME OF COMPLETION e8 January 3, 87 FAS roads.,
ESTIMATED CONSTRUCTION COST $ NA
(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.
G.T.E. 83-793
Name of Applicant (please print)
Signature of Applicant or Agent
Indio, CA 92201
Business Address
619 347=2711
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 6
Public improvements: 3% of estimated construction costs
Private improvements: 3%'of estimated construction costs
Minor Improvement Permit = Class IV: See attached schedule o" 166
Inspection 'Fee $ —0—
'Permit Fee
Penalty
Cash Deposit -Surety Bond
if required'
TOTAL: $ -0—
Receipt No. .
Received by Date
Recorded by
'PERMIT VALIDATION
PERMIT NO. 166
DATE APPROVED 1-3-86
EXPIRATION DATE 1-3-87
DATE ISSUED 1-3-86
By
Administrative Authority
TELEPHONE: (619) 564-2246
PLAN FILE NO. SASE SKETCH I COHSTR. SKETCH I CO, PL, SKETCH
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PERMIT ISSUED BY PERMIT NO. DATE MOVED DATE MOVED - DAT-_ OF
CM 6 LAQVIYJT"A ON JOB OFF JOB OPER.
CREW FOREMAN
PLANNED BY
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TOTAL FEET RETIRED INS P F r T R ^�� C. PP INT
PERMIT ISSUED BY PERMIT NO. DATE MOVED DATE MOVED - DAT-_ OF
CM 6 LAQVIYJT"A ON JOB OFF JOB OPER.
CREW FOREMAN
PLANNED BY
L- 3.C4MSn�_�IL
REVIEWED BY -
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SOUTHERN CALIFORNIA GAS CO. -2956.3)
_ TOTAL FEET INST'D. - -' -
TOTAL FEET RETIRED INS P F r T R ^�� C. PP INT
PERMIT ISSUED BY PERMIT NO. DATE MOVED DATE MOVED - DAT-_ OF
CM 6 LAQVIYJT"A ON JOB OFF JOB OPER.
CREW FOREMAN
PLANNED BY
L- 3.C4MSn�_�IL
REVIEWED BY -
DISTRICT
COMPANY
STAKED ❑ COMPANY FACILITY: SO. CAL. P.L.S. ❑
STAKING REQ'D. ❑ J�lt\7!STEF_ty 'DIVISION! _
NO STAKES NEEDED ❑V� p, _�L-t 6, 1, 4 ORG. '