0170oper validation o�
s form constitutes an
encroachment permit -
, CITY OF -LA QUINTA
APPLICATION; FOR PERMIT
PUBLIC WORKS CONSTRUCTION, (ENCROACHMENT) I" www
OF
• •For the construction of public ,or private curbs, `driveways, pavements; sidewalks, parking lots, sewers; water mains
and.other like public works improvements'in conhection.with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
/ l . • 'k 4
Subdivision Improvement Permit — Class III
r DATE aanuary 38, 1986` Minor Improvement Permit Class -IV T
LOCATION OF.CONSTRUCTION •FreCl Waning Dr -
(Street address or Description of Location) s "
PURPOSE OF CONSTRUCTION TO install. aas'main. Sketch (attach construction plans if appropriate)
•.
DESCRIPTION OF CONSTRUCTION To install .178' of 311 PA
n* cdiirn nrPRsure nlaatin' crag Tn1ai71 22' N/SPL of Fred Waring Dr.4 ♦ ,`
%
be-ainnina .130 WAAMT, Of Manleton' Dr... nrooeedina•West. w, ,
DIMENSION,OF- INSTALLATION OR REMOVAL'
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 1-27-86
APPROXIMATE TIME OF COMPLETION 3-27-86
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction,•materials, and debris, backfilling, com
paction and placing permanent resurfacing and/or replacing improvements) 4
In consideration'of the granting of this_permit,• the applicant hereby agrees to: t
Indeinnify,.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 thetime 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; Dist. SUPervisor
Signature -of Applicant or Agent
Southern California Gas Ccm:)anV ,P.O. Box 2200 Riversidt, CA 92216' (710 369-4812 r
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 7
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ PERMIT,VALIDATION ,,
'
Permit Fee N/A PERMIT NO. 170 '
t
Penalty 1-28-86
Cash Deposit Surety BondDATE APPROVED'
if required EXPIRATION DATE.'
4-27-86'
TOTAL: $ ... ♦ s .
' 1-28-86
- •DATE ISSUED
Receipt No.
By
Received by • Date Administrative Authority
Recorded by t`' TELEPHONE: (61'9) 564-2246 ^
- '• �. o.' + ••t j ♦ fl. I,r Ir .p ` +• s•< : - o�`y•
31245=923 Verbal. O,K Per ,Pam .N.ieto., 1=27-'86.-
#170
K. b
Fr`S�- r
NOTE:.—
. With proper validation
this fon: constitutes an _
encroacAment permit CITY OF LA OUINTA
APPLICATION FOR PERMIT
PUBLIC, WORKS CONSTRUCTION. (ENCROACHMENT)c�,� ^^ �S�e•
OF it(E
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
January 27' —1986 Subdivision Improvement Permit- Class III
DATE: ' Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION On Fred Waring Dr-.
(Street address or Description of Location)..,j.i:
PURPOSE OF CONSTRUCTION TO install gas main. Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION To .install 178' of 3" PA Inedi um pressure plastic gas main,- 22'
N/SPL of Fred Waring Dr., beginning 130 W/WPL of Chape"Iton Dr., proceeding West..
DIMENSION: CF !^!•ST.-,LI.ATION OR REMOVAL
SIZE OF EXCAVATION,•IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 1-27-86
APPROXIMATE TIME OF COMPLETION 3-27-.86
ESTIMATED CONSTRUCTION. COSTS.
(Including removal of all obstruction, materials, and d6bris; 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 whenwork 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...
ignatur�Qf N �t�IS RIBUTION SUPERVISOR`
SOUTHERN CALIFORNIA GAS COMPANY, 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: Subdivision Improvement Permit — Class III
Public improvements: 3°b of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV': See attached schedule
Inspection Fee S_ _ PERMIT VALIDATION
Permit Fee — PERMIT NO.
Penalty
DATE APPROVED
Cash Deposit -Surety Bond.
if required -- ' EXPIRATION DATE
TOTAL: S_
DATE ISSUED
Receipt No.
By
Regi^ived by Date Administrative Autfto;
Recorded by TF1 FPHnNF• (6191 564-2246
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