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0192` 4; With propefr"validation • , ' Q this form constitutes an. 4 �4 CITY OF LA. QUIN.TA encroachment permit + APPLICATION FOR PERMIT ' + PUBLIC -WORKS CONSTRUCTION' 'IENCROACHME+NT)'�� 'SOF c[�° 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 May 12- 1986 Subdivision Improvement Permit — Class III DATE: Minor Improvement Permit Class IV _ s LOCATION OF CONSTRUCTION Avenida Velasco ` (street address or Description of Locatiori) . PURPOSE OF CONSTRUCTION ' 0 iJlta11 'S52of ' 2" -PA Sketch (attach construction plans if appropriate) macliinn nYraa tr.P nlact_ir. clac mainr• 11 WLFPT. of AxAmn;•da •Velasco,' beginning 13' S/NPL of Calle DESCRIPTION OF CONSTRUCTION Ervsenada, proceeding South. • Gas Co., Wor'k Order 31246-455 DIMENSION ,OF INSTALLATION OR REMOVAL Cut=Eerth_,hand Mac ';SIZE OF EXCAVATION,, IF NEEDED `APPROXIMATE TIME WHEN WORK WILL BEGIN S—Iti—�H ,. APPROXIMATE TIME OF COMPLETION 8-16-86, ' ESTIMATED CONSTRUCTION COST $ ti• r (Including removal of all obstruction, materials, and debris, backfilling, com- paction om 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, liabilitiesor 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 thepermit 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 Southern Ca. Gas Cc7r10ariy P.O. .BOX 2200 RiVorSide; CA 92516' ...(714 369-4512 Name of Applicant (please print) Business Address Telephone. No. , _ ,. Name of Contractor'and Job Foreman Business Address ' Telephone No: • • 1: Contractor's License No. - ' ' . City.Business License No. Applicant's Insurance Company Policy Number , �.. FEES:- Subdivision Improvement Permit —,Class 161 Public improvements: 3%:of estimated construction costs, Private improvements; Wof'estimated.construction costs- �j r • Minor Improvement Permit =Class IV: See attached schedule' x`� .. - 92 y, Inspection Fee $ N/a 'PERMITVALIDATION f "• ' Permit Fee i 192 ' PERMIT NO. i Penalty5=12=-56 Cash`Deposit-Surety Bond DATE APPROVED - if required EXPIRATION DATE .9-16-86 TOTAL: $ N/A 5-12-86 , DATE ISSUED ` -Receipt No. r w y .Received by Daterity • Administrative'Autho • _ r w 4 - Recorded by f TELEPHONE: (619) 564-2246 .I• � Q d/.t�T� F '000,4, '� O 77- -91 7d:�- E � ... • C �/T � ✓ET �� 0 9 G D.P s F sT � _ S �P, sER, PL -=-TOTAL FEET INST`D. ' - � Q d/.t�T� "3 '000,4, '� O 77- -91 7d:�- E � ... • C �/T � ✓ET �� 0 9 G D.P s F sT � _ S �P, sER, PL -=-TOTAL FEET INST`D. - - INSTALL MAIN WITH AT LEAST ELOW 1' COVER BELOW— TOTAL- FEET RETIRED -.�y�/ RETIREMENT, �{�, PERMITISSU PERMIT_ ED BY _ PERMIT - PE M T NO. MOVED VE OF DATE M DATE MOVED DATE _ . V�•f�:•��i yh1 9' �ONJOB OFF JOB .-_— OPER, .--- -- OREMAN CREW FOREMAN— DISTRICT1/.Sf� h�. DISTRICT ASON RE- -- ------ - - -- ---- -- - -- - - ' -- TRACT NO. ' p i- PLANNED ,BY TD/S'y -- COMPANY _. -• ,.. ---- STAKED _ � ❑ COMPANY FACILITY: ' SO. CAL. P.L.S.- ❑ - �j . � -- - - --- ' ATLAS /Q L I I -YEAR C.P. - INSTALLED - REVIEWED BY STAKING REQ'D. ❑ �� T�:. ft• r',J . _ --:DIV1610N - - NO. CATHOOICALY YES ❑ NO ❑ OPER. Eo7. OR OVER - ❑ - S.M.Y.S. LEGE THAN 207. ❑ - .: - - ." `� NO STAKES NEEDED � - L .0 ORG W.O. �� 1S- CODE ' PROTECTED AT' DISTRICT SUPERVISOR 31.246-4-5.5 NOTE: . With proper validation this form constitutes an encroachment permit ECE)VED MAY 12 1986 COMMUNITYTA DEVELOPMENT DEPT CITY OF LA QUI NTA 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: _ Ma"y 9, °1986 Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION Avenida Velasco (Street address or'Description of Location) PURPOSE OF CONSTRUCTION - To install 552' Of 2" PA medium Sketch (attach construction plans if appropriate) pressure plastic gas main, 13W/FPL of-Aveniiia Velasco, beginning 13; S/NPL of. -Calle' DESCRIPTION OF CONSTRUCTION Ensenada; proceeding South. See Sketch TGP 224, C-2 CUT -EARTH`& DIMENSION'QF !N!•S-;-.LLATION OR REMOVAL MAC SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN 5-16-86 APPROXIMATE TIME OF COMPLETION 8-16-86 ESTIMATED CONSTRUCTION COST S (Including removal of all obstruction, materials, and defiris, 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. • r 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 Appiicaa r SSAggenlIt pN SSU(� VVIISS 0. 02200,R: I. BAUGGHMAN DI92R16U 714 369E45120R Name o.f. 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: 31/b of estimated construction costs Private improvements: 3% of estimated construction costs Minor Improvement Permit — Class IV: See attached schedule Inspection Fee S_ Permit Fee — Penalty Cash Deposit -Surety Bond if required -- TOTAL: S Receipt No. Rer-ivtd by Date Recorded by PERMIT VALIDATION PERMIT NO DATE APPROVED EXPIRATION DATE .DATE ISSUED By Administrative Autho: TELEPHONE: (619) 564.2246