0223 (2)NOTE'-—,�
a
With. propgNalidation
this f=irm constitutes an
'-+ CITY OF LA QUINTA .
encroachment permit
APPLICATION FOR. PERMIT
-PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) ''• .Sw�f,
0F fHg9w
For the constructionof 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: SeA r 23, 1986,..Minor I mprovement. Permit Class IV
LOCATION OF CONSTRUCTION Avenida Ultimo
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION install qa5 main. Sketch. (attach constructionlans if appropriate)
ppropriate)
DESCRIP.TIONAF CONSTRUCTION to install 322' of 29 PA
medium pressure Plastic.gas main; 12' N/SPL of Avenida Ultimo
bidinnincr 12''W/EPL of.Washington St. praceedinq east (See Sketch
DIMENSION OF INSTALLATION OR REMOVAL
CUT —EARTH AND MAC
SIZE OF EXCAVATION; IF NEEDED
;•� If other than teas Co. forces preform
APPROXIMATE TIME WHEN WORK WILL BEGIN 9-25-86 the work, .a spparte permit must be
obtained prior to start of any work.
APPROXIMATE TIME OF COMPLETION '12-25-86
ESTIMATED CONSTRUCTION COST $
(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.
. y
Notify the Administrative-Authority- at least twenty-four (24) hours in'advance of the, time when work will be started.
i Comply with all applicable City Ordinances, the termsand'conditions off the permit and-all applicable rules and regulations of the City of
La Quinta and to pay for•any,additonal replacement necessary as the result of this work.
J.M. Snyder, Distribution Supervisor
Signature of Applicant or Agent
Southern Calffornia Gas'Cmpany Poo. Box 2200 Riverside, CA .92516 369-4.512
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
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
o. 211 t
Inspection Fee : $ PERMIT VALIDATION .
Permit Fee . PERMIT NO. 223
Penalty
Cash Deposit Surety Bond f. DATE APPROVED 9-22-86.
if required EXPIRATION DATE 1-1--87
TOTAL: $ .N/A DATE ISSUED 9-23.86.`
Receipt No.
By
Received.by Date Administrative Authority
5 Recorded by TELEPHONE: (619) 564-2246
1111111110
y � _
,<,.31X46-836 RECEEWED
' S E -P . 9 1936
NOTE: CITY OF
_ CiLIIL LrA
nn
4nrNTA
With proper validation
this form constitutes an
encroachment permit CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) 1
OF
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
DATE: S e n t_ 1 R. 1`986 Minor Improvement Permit Class, I V
LOCATION OF CONSTRUCTION Avenida Ultimo
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION I n s t a l l i.n g g a S main. Sketch (attach construction plans if appropriate)
DE$CRIPTIONOFCONSTRUCTION To install 322' of 2" PA medium pressure plastic gas
main, 12' N/SPL.of Avenida Ultimo, beginning 12' W/EPL.of.Washington St,,
proceeding East. SEE SKETCH TGP 214, 0-6 CUT -EARTH & MAC
DIMENSION: CF !NST,'.LI_ATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME,WHEN WORK WILL BEGIN 9/25/86
APPROXIMATE TIME OF COMPLETION 86
ESTIMATED CONSTRUCTION COST S
(Including removal of all obstruction, materials, and d6ris, 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 arid 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...
can
• BOX -2200,
22 9 I --T11 re s ND t�€Cdt p 92516U 714 369E4512UR
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 111
Public improvements: 3°0 of estimated construction costs
Private improvements: 3% of estimated construction costs '
Minor Improvement Permit —Class IV: See attached schedule
Inspection Fee S_ _ � a PERMIT VALIDATION
Permit Fee fG.6-y
PERP.11T NO.
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
S
Rer-ived by Date
Recorded by
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By .
Administrative Autho;
TELEPHONE: (619) 564.2246
PLAN FILE NO. BASE SKETCH CONSTR, 611ETCH COMPL. SKETCH 5
SHEET OF
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{_ \I- 2 R.4 CAP.
i /10 -
2 _ TOTAL FEET INST'D
INSTALL MAIN WITH AT,LEAST 1 3 � --COVER BELOW L X /"s r' 'S �� TOTAL FEET RETIRED
PERMIT ISSUED BY PERMIT NO.- DATE MOVED DATE MOVED DATE OF
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COUNTY - ' `ty "' o� ,RETIREMENT C.-.
� I {.-` ON JOB OFF JOB OPER
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s E^ .•1 t i CREW FOREMAN
DISTRI�
TRACT '•" 'i _ - i ""-'}" - PLANNED BY - - COMPANY_
. .'NO. -
� STAKED ' - ❑ COMPANY FACILITY: SO. CAL ❑ P.L.S.,❑ •.;
AAS %�� 1 7 YEAR C.P. - ` `,- REVI D
NO
TL. I r `l"' -INSTALLED DIVISION '{ T
STAKING'REO'D ❑
�CATHODICALLY { - - OPER. 20% OR OVER ❑ '
YES ❑' NO ❑ r s.M.Y.s.(-z•-�D Q?,/. ORG. ��•.•_ _
PROTECTED .Ar LEssTHANzo% ❑ DISTRICT SUPERVISOR NO STAKES NEEDED W.O. L� �IICODE
SOUTHERN CALIFORNIA GAS CO. 2956.1-J Y-^