0256NOTE:
With proper validation
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
Subdivision Improvement Permit.— Class II I
DATE: Nkirch 24e 1987 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION South Side Of Sacrebrush Avenue
(Street addressor Description of Location)
PURPOSE OF CONSTRUCTION BLAMM PFRMTT Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION 'Th install 433' of 2t° 51247-140
PA mediun pressure plastic eras main, 13' N/SPL'of
DIMENSION OF INSTALLATION OR REMOVAL See Scetch TGP 214;..a-5, CUT-FARTH
& MAC
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 3/25/87
APPROXIMATE TIME OF COMPLETION 6/25/87 PFRNII:T EXPIRES 12/87
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.
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 on File - BLVffW-r PF T
Signature of Applicant or Agent (714) 369-4512
J. M. Snyder, Distribution Supv., SOCAL Cis 'Cimpany, Pa 0. Bax 2200, Riverside, CA(92516
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: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV -'See attached schedule , .25�,
Inspection Fee $ - N/A PERMIT VALIDATION
Permit Fee PERMIT NO. 256
Penalty
Cash Deposit -Surety Bond
if required .
TOTAL: $
Receipt No.
Received by Date
Recorded by
DATE APPROVED., • = 3/24/87
EXPIRATION DATE
��Decettber ]987
DATE IS/QLD (j `• 4/87
By
Administrative Authority
TELEPHONE: (619) 564-2246
PLAN FILE NO. BASE %C C:MSTR.SKETcm COMPL. SKETCH
' ISHEET 1 OF 1 _
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TOTAL FEET INST'D
COVER BELOW /J S�
TOTAL FEET RETIRED
DATE MOVED
-
GATE MOVED
DATE OF
INSTALL MAIN WITH
ATLEAST •�._..._"
-
PERMIT ISSUED BY PERMIT NO.
ON JOB
OFF JOB _
' OPER.
RETIREMENT �.�-/��
_
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FOREMAN
—�
COUNTY
,CREW
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REASON
COMPANY
DISTRICT 1-�E
PLANNED BY.
SO. CAL. �-
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/ di'Y ! STAKED ❑
COMPANY FACILITY:
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ATLAS
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YEAR C.P.
INSTALLED
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DIVISION
J ORD. -
CODE_- --'%
NO.
N' ATHODICALLY
❑ NO ❑
OPER. 20%OR❑ S.M.Y.S.
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NO STAKES NEEDED
DISTRICT SUPER
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PROTECTED
YES
AT LESS THAN 20%
-
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51247-140 •
NOTE: ~--- �--•
. With proper validation
this form constitutes an
encroachment Permit
•
--------------
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 II I
DATE: MARCH 11, 1987 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION South side of Sagebrush Ave.
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
51247-140
DE$CRIPTION OF'CONSTRUCTION To install 411 of Z" R.A. medium' pressure plastic qas main, 13'
N/SPL of Sagebrush Ave.
DIMENSION. OF !NS7.-,L1_ATION OR REMOVAL SEE SKETCH •TGP 214,1 E-5 CUT -EARTH
& MAC
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 3/2.5/87
APPROXIMATE TIME OF COMPLETION 6/25/87
ESTIMATED CONSTRUCTION COSTS
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfaci.ng'and/or.replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrees to:
Indemnity, 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 Ouinta and to pay for any additional replacement necessary as the reult of this work. .
lgy ture of-ADD_Ilcant or SSTTenlIt pN SSU(� vvIISS
0 2--S_SYDERuCA..�I92516U 714 369E45120R .
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: 340 of.esti mated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit -. Class 1V: See attached schedule
Inspection Fee S_
Permit Fee —
Penalty
Cash Deposit -Surety Bond
if required --
TOTAL: S
Receipt No.
Rer-ived by Date
Recorded by
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Autho:
TELEPHONE: (619) 564.2246