0259NOTE :.�.
With proper: validation
this form constitutes an
encroachment permit
r
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: April 20, 1987 " Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Avenue Ultimo'.East of Washington Street
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Rl anket Permit Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
See sketch 512.47-283
To install 175' of 2" PA medium
pressure plastic bas main, 14'
N/SPL. of Avenida Ultimo.
USA Inquiry NO.
APPROXIMATE TIME WHEN WORK WILL BEGIN
Da@ea '
APPROXIMATE TIME OF COMPLETION
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, of 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 result of this work.
R' v Signature of Applicant orDAgent
gl TI gUpq
^�17TNFRN C'AT,TFO�2NIA GAS COMPANY, P. O.J80K.'29H ERjVR?RSIIIEBUC ?N9Z516' 714-369-
12
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
Inspection Fee $
Permit Fee
Penalty
Cash Deposit -Surety Bond
if'required
TOTAL: $ Al/A
Receipt No.
Received by
Recorded by
Date
PERMIT VALIDATION
PERMIT NO. - 2"3`9
DATE APPROVED i%/Z' o 4F 7 ,
.EXPIRATION DATE /JP7
-DATE ISSUED.—
By
SSUED By
r' Administrative Authority
TELEPHONE: (619) 564-2246
51247-283
NOTE:
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 III
DATE:_ APRIL 15, 1987 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION South side of AvPn i da 11 It imq
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION 51247-283
To install 175' of 2" PA medium
DIM ENSIC CF !N'•ST.:,LLATION OR REMOVAL pressure plastic gas main, 14' N/SPL
of Avenida Ultimo.
SIZE O.F EXCAVATION, IF NEEDED
SEE SKETCH TGP 214, E-6
APPROXIMATE TIME WHEN WORK WILL BEGIN 4/29/87 CUT -EARTH & MAC
APPROXIMATE TIME OF COMPLET)O,N 7/29/87
ESTIMATED CONSTRUCTION COSTS '
(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 resuliing 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 124) 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...
Name of Applicant (please print)
ig- tur f -Applicant dr Agent
_ W. ;�fSY:UT DISTRI
Business Address
369E45120R
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
Publi= imprcve.rents: 3% of estimated construcTion cnsts_.
Private improvements: 36/o of estimated construction costs '
Minor Improvement Permit - Class IV: See attached schedule'
Inspection Fee S _ _ PERMIT VALIDATION
Permit Fee — PERMIT NO.
Penalty DATE APPROVED
Cash Deposit -Surety Bond
if required -- ; EXPIRATION DATE
TOTAL: S
. DATE ISSUED '
Receipt No.
By
Rec-ived by Date Administrative Autho:
Recorded by TELEPHONE: (619)1564-2246
NOTE:
With proper validation
this form 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, parking lots, sewers, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
DATE:
�(_A.411_ 7
LOCATION OF CONSTRUCTION
U /A* A%,
G,
Subdivision Improvement Permit —Class III
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Alh'JAgl" ;P42400" T Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTIO
Sego SA&44ge 21 3
DIMENSION OF IN CATION OR RE OVAL
SIZE OF EXC VATION, IF NEEDED �'"' �' A `
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIM TE TIME OF COMPLETION
ESTIMATED TRUCTION C I qttr+`Yy w roo"s'
(Including removal of al o struction, 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 -1
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 result of this work.
.e do ZSR' °w xa-vNe 4a
h tls� Grir�a�i + ,(r y
�Signature of Applicant or Agent
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
Inspection Fee $
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ Aj A -
Receipt No. "
Received by Date
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Recorded by 11 TELEPHONE: (619) 564-2246
Administrative Authority