01871�.
NOTE:
With proper validation
this form constitutes an
encroachment permit
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+ CITY OF LA QUINTA .
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 — Classl l
DATE: May 8• 1986 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Calle Chihuahua
(Street address or Description of Location)Th i
PURPOSE OF CONSTRUCTION install 193' Of 2° PA med Sketch (attach construction plans if appropriate)
Pressure plastic gas main, 12' S/NPL of Chihuahua, beginn-ThT10''W/EP'L of Navarro, proceeding west
DESCRIPTION OF CONSTRUCTION
Y
Gas Co. Work No. 31246-397
DIMENSION OF INSTALLATION OR REMOVAL
' Gas co. Permit No. 180 .
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN May. 86
t APPROXIMATE TIME OF COMPLETION 7-16-86
ESTIMATED CONSTRUCTION COST $ �O�p
(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.
Signature of Applicant or Agent
Macro Construction - P.O. Box 783 Palm Desert, CA 92260 343-1180
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address - < Telephone No.
N 259619 A & B '
Contractor's License No. City Business License No.
Travelers Ins. Co. TRSLG 1737795 A'85
,,,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 $ 90.00 PERMIT VALIDATION
Permit Fee 10.00
• PERMIT NO 187
Penalty
' Cash Deposit -Surety Bond
if required
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TOTAL: $ 100.00
Receipt No.
Received by
Date
Recorded by r
DATE APPRO\(ED May 8, 1986
EXPIRATION DATE _Selft—• 1,-1986
DATE ISSUED 4ay 8, 1986
By
Administrative Authority
TELEPHONE: (619) 564-2246
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