0224With p�r�orper validation !'
this•fo:A constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION. FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For the construction of public or private curbs, driveways, pavements, sidewalks, parkirig lots, sewers, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit — Class III
DATE: Septenber 23, 1986 Minor Improvement Permit Class IV
LOCATION OF.CONSTRUCTION Avenida Herrera
(Street address or Description,of Location)
I
PURPOSE OF CONSTRUCTION Install Qas main Sketch (attach construction plans if appropriate) ,
DESCRIPTION OF CONSTRUCTION Th install 102' Of 2" PA
Herrera heainnina arurox. 340' S/SPL ,of Calle Sonbra proceeding North.
DIMENSION OF INSTALLATION OR REMOVAL '
f
CUT—EAME AND MAC
r
SIZE OF EXCAVATION, IF NEEDED w
If other than Gas Ca Tlpiny forces
APPROXIMATE TIME WHEN WORK WILL BEGIN 9-25-86 the job, a separate permit
' {must be obtained prior to start of
APPROXIMATE TIME OF CO,MPL'ETION 12-25-86
ESTIMATED CONSTRUCTION COST $ any work.
(Including `removal of a1I 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 agentsi 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 xesult of this work.
• r h ..
J.M. Snyder, Distribution Supervisor
Signature of Applicant or:Agent
Southern California 'Ga.s CCanpany
P.O. 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 I II
Public improvements: 3% of estimated construction
costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit• — Class IV:'See attached schedule No
.Inspection Fee $
PERMIT VALIDATION
Permit Fee
PERMIT NO. .224 -
224Penalty
Penalty
9-22-86
Cash Deposit -Surety Bond
DATE APPROVED •
if required
EXPIRATION DATE 1-1-R7
TOTAL: $ .. A
DATE ISSUED 9-23-86
Receipt No.
By
Received by Date
Administrative Authority
Recorded by
TELEPHONE: (619) 564-2246
0
NOTE: ~
With proper validation
r
31246-837..
0". .
v jV F
RF S tP ', 0'n86
clTy.Of LA�QpIN7�MT
t kllc� � n
this form constitutes an
encroachment permit 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
i Subdivision Improvement Permit — Class II
DATE: 9/18/86 Minor.lrnprovement Permit Class IV
LOCATION OF CONSTRUCTION Avenida • Herrera
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Install gas main Sketch" (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION To install 102' of 2" PA Medium pressure plastic gas
main, 10' W/EPL of Avenida Herrera. be inning approx. 340.' S/SPL of
Calle Sonora, proceeding North. SFF SKFTCH TGP 224, C-1 CUT -EARTH &
DIMENSION' OF !:"-'•S-:,LLATION OR REMOVAL MAC
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 91 1 Hh
APPROXIMATETIME OF COMPLETION 1 /25/Rh
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 of
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.
f •
Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City of
La Ouinta and to pay for any additional replacement necessary as the result of this work...
Sig ture off Applicant or Agent
#1-orl CAI TFf1RNTA GAS COMPANY P 0. BOX. . 2200 S.- CA.,. ��5�6.U�������9E4�LJ�OR
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: 390 of estimated construction costs
Private impr6yelinents: 3% of esti11.13-cd construction.costs
Minor Improvement Permit — Class IV: Seeattachedschedule
Inspection Fee 5 _ _ /`�vU PERMIT VALIDATION
Permit Fee — �U'GG PERMIT NO.
Penalty
Cash Deposit -Surety Bond
if required. --
TOTAL: S
Receipt No.
'Ret,ived by Date
DATE APPROVED.
EXPIRATION DATE
DATE ISSUED
By
Administrative Autho:
Recorded by II TELEPHONE: (619) 564,2246
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