0189I �
NOTE: ".. � { '. ., � ' ; -� ' - [• ,
With proper validation
4
this form constitutes an
CITY OF ,LA QUINTA
encroachment permit v
APPLICATION . FOR PERMIT _
• ' PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)��
SOF
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 II I
DATE: May 9, 1986 > rMinor ImprovementPermit Class IV .
b
ttlerush Dr. t
LOCATION OF CONSTRUCTION Bo ' • ,
(Street address or Description of Location) r _ i , r
PURPOSE OF CONSTRUCTION TO install 265' �of 2" PA ntied.
Sketch (attach construction plans if appropriate)
prepsue plant c gas mein, 5�, SM
or ttenrusnf,g"East r
1 V L 1'G_ YY r't •t V • vv�..�..� ' . z
DESCRIPTION OF CONSTRUCTION t
Gas Co. Work Order 31246-470
DIMENSION OF INSTALLATION OR REMOVAL •'t,
. Gas •Ob. P&x t No.
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN May 12, 86 ` z
APPROXIMATE TIME OF COMPLETION 8-1,866
ESTIMATED CONSTRUCTION COST $
(Including. removal of all 'obst'ruction, 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 propert
Y
happening or•occurring as a proximate result of any 'work' undertaken under the permit ranted ursuanf to this application.
9 P
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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 �
• Signature of Applicant or Agent r
mcco Construction P.O. Box 783 Palm Desert;'CA 92260 .r 343-1180,` `.
Name of Applicant (please print) Business Address' ,• -Telephone No..
Name of Contractor and Job Foreman. Business Address ' _Telephone No.
256919 A & B ,
e
Contractor's License No. ' .Cit Business License No. -
. Y
Travelers Ins'. Co. TRSLG 173T 795A 85
Applicant's Insurance Company Policy'Number r
FEES: Subdivision Improvement Permit —'Class III
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 $ 90.00 PERMIT VALIDATION ti
10.00
Permit Fee 189
PERM IT,NO.
Penalty • , - ;
Cash Deposit -Surety Bond ' DATE APPROVED 5-9=•86 '
if required EXPIRATION DATE 9-1-86 ••
TOTAL: $ 100.00 • '
DATE ISSUED
Receipt No. `
BY
Received by Date r Administrative 'Authority
* £
Recorded by TELEPHONE: (6.19),564-2246
r
C 0AC.H.ELL.A• VALL EY WATER D I S T R ICT
Coachella, California 92236. Post Office Box 1058 Telephone (619) 398-2651.
to , Q�
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WE'ARE SENDING YOU:
ATTACHED CHANGE ORDER.
PR0TSCOPY OF, ;r ZTTER
SHOP DRAWINGS REPORTS
PLANS ANALYTICAL DATA
SPECIFICATIONS- OTHER
SAMPLES SHIPPED SEPARATELY VIA
Copies; Date Description
THESE.ARE TRANSMITTED AS CEEC= BELOW:
FOR APPROVAL RETURN. CORRECTED PRINTS
APPROVED AS SUBMITTED: FOR YOUR USE
APPROVED AS NOTED AS REQUESTED
RETURNED FOR. CORRECTIONS' FOR REVIEW AND COMMENT6
RESUBMIT COPIES FOR APPROVAL FOR BIDS-DUE._ 1982
SUBMIT COPIES FOR DISTRIBUTION PRINTS, RETURNED AFTER LOAN TO .
US
REMARKS X-isSE Vv�-Mw D -TN 5 -Is 1 R Ps.-T \ b N U p?E
'90 3.0 1k .S,
Yours perp. naY;
CVWD-378
(Rev. 8/84) .
C 0 A C H E L L A V A L ..L •E •'Y W A T. E R D I S T R I C T
Coachella, Calif oruia�92236 ',,Post Office Boit 1058 Telephoue (619) 398-2651 Y1.
TO: Q� F �A CA, IIJI' }l DATE,
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WE ARE .SENDING YOU:
ATTACHED -CHANGE ORDER
PRINTS COPY OF :.:.TIER
• SHOP DRAWINGS REPORTS•
PLANS , ANALYTICAL DATA
SPECIFICATIONS OTHER
SAMPLES ; SHIPPED,. SEPARATELY VIA
Copies Date Description
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THESE CITY 0. ' `•
ARE TRANSMITTED AS CHECKED BELOW: GO�,<<Un;TY -V-L r:':.".T eFPT
11". FOR APPROVAL RETURN CORRECTED PRINTS.
•APPROVED AS. SUBMITTED FOR YOUR 'USE
APPROVED AS NOTED AS. REQUESTED
RETURNED FOR CORRECTIONSFOR REVIEW AND,
RESUBMIT COPIES•FOR APPROVAL FOR BIDS -DUE 1982
SUBMIT, COPIES FOR DISTRIBUTION PRINTS.RETURNED AFTER LOAN TO
Ug. ,
;REMARKSE�Tl ;uQ 1y)A . F_X.p 1R�{aU su n T F
1 s C& BAST 2i4�f.5T-.DATiD %ZS QCT f_1aT101J
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Yours ve tru
CVWD-3.78 F
G' (Rev. '8/84)
C 0 1 .0 •H T T V' A L L Y*
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Coacze l la, CaL•'=or-aia 92236.1 .Post Of== c
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ANALYTICAL DATA
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Descr:ot_oa
THESE .�E MAINS. 1TT' TJ AS .CyZCZ")i 3c"T..OW:
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FOR APPROVAL
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APPROVE As SUB:(' =.
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Rr'TUicNED FOR CORRECTIONS
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R:Su3L%= COPIES .rtR APPROVAL.-.
FOR 3�S DU'c 1982
SUBu?T COPIZ-S FOR DISTRIBUTION
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