0613`4 -�a� qty'4++4�';s'J,.�...i��•-"-...�"twa �--"'4 -.L w-.+✓+."'.t"Zrµ�$.�►►sir..+ry1"M�y�rr•..r"1�.-..+'.K�wr-•..r'.`^-�ti....d.-�:'«;"�+�w'i�+'�.^":,,�,�vi4.;:�jf,,,J •-,�v:fir. -weJ. r,.+Yl-`�;�.y _..
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Ai.r.
5 440-472
NOTE:
With proper validation
thisform constitutes an CITY OF LA QUINTA
encroachment-. ermit
s APPLICATION FOR PERMIT
K
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
. I ,
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 I II
DATE: Mav 1, 1990 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION _ E/side of Aven: fda Obreaon
(Street address or Description of'Location);
PURPOSE OF CONSTRUCTION to ,install new ' gas Sketch (attach construction plans if appropriate)
mLa ,
DESCRIPTION OF CONSTRUCTION to install 1891 Of 2" SEE SKETCH TGP 214, C-6
plastic medium bressure ctas main 15' W/EPL of
Ave. Obreaofilbeain�ning 126' N/NPL,of Avenida Montezuma <<
DIMENSION`OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 5/.10/90
APPROXIMATE TIM E,OF COMPLETION $/10/90 `
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.
T - M CZnxfriA-r _ T)i ci•ri hh•1-.i on Sitnervi sor
Signature of Applicant or Agent V
Southern Califtmnia Gas Co PO Box 3003 Redlands, CA 92371.. 714/335/7742
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor -and Job Foreman Business Address Telephone No.
Contractor's License No.
4
r
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 a
0.613
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ —0 II 4 PERMIT VALIDATION
Permit Fee'
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ —0—
Receipt No.
Received by Date
Recorded by
PERMIT NO. 0613
DATE APPROVED 5/1./90
EXPIRATION DATE 10/31/90
DATE ISSUED it 5/1./90
By—
Administrative Authority
TELEPHONE: (619) 564-2246
v1•c.....A: +`tiv�v .. ..�.-.+e ,..w �'ia r: q' � "• .� , �:+�,•.� .. +µ t."..O e,a•' f +M :'-I' 1 'R' • .,Vi, �- Yr.s•.g. *r\ r • n .. ;. 4',
�#
i."n'83440-472
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
�.- ,-,a,� .t . : d- - • }t r r. .
Subdivision Improvement Permit — Class I II
DATE: May l", 1990 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION E/s"ide of Avenida Obrecton
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION to install new gas
DESCRIPTION OF CONSTRUCTION to in
plastic medium pressure gas ma
Ave. Obrecton beginnina 126' N/
Ilk
of 2
Sketch (attach construction plans if appropriate)
SEE SKETCH TGP 214, C-6
tezuma
DIMENSION' -OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN. 5/10/90 _
APPROXIMATE TIME OF COMPLETION 8/10/90
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.
r - J_M_ Snvdpr. Dastrihttion Supervisor
Signature of Applicant or Agent
Southern Califmmnia Gas Co PO -Box 3003 Redlands,,CA 92373 714/335/7742
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: 30/- of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ —0—
Permit Fee `
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: f $ —0—
Receipt No.
Received by
Recorded by
Date
PERMIT NO
N! ' 0613..
PERMIT VALIDATION
0613
DATE APPROVED 5/1/90
EXPIRATION DATE 10/31/90
DATE ISSUED /7 5/1/90
By./`�/+` .��
� e V Administrative Authority
TELEPHONE: (619) 564-2246
i3The
following General and Special Provisions are attached to and made a part of Permit No.
s, 41
GENERAL PROVISIONS
The following shall always apply: y
q ,+1
ENCROACHMENT ON PRIVATE PROPERTY: This permit authorizes work to be accomplished'within City of La Quinta right of way
ONLY. Whenever construction extends within private property, it shall be the responsibility of the permittee (or his contractors) to
secure permission from abutting property owners. Such author;zaticn must b^ secured by the permittee prior to starting work.
TRACKLAYINGCONSTRUCTIONEQUIPMENT: Cleatedtracklayingconstr1. uctionequipmentshallnotbepermittedtooperateonany
paved surface unless fitted'with smooth -faced street pads. All mechanical outriggers shall befitted with rubber street shoes to protect
-
the paving during excavations. Rubber -tired equipment only'shall be used in backfill operations in paved areas. If the existing
pavement is scarred, spalled; or broken during the term of this contract, or if the pavement is marred, City of La Quinta shall request
' 'f •
that these portions of road be resurfaced over their entire width. Resurfacing shall consist of one coat of two inches (2") of A.C.
surfacing plus appropriate seal coat as specified above. T
PROTECTION OF TRAFFIC: All excavations and work areas shall be properly lighted and barricaded as deemed necessary by the City i
Engineeror La Quinta City Public.Works Inspectors. Suitable detours and detour signs shall beplacedand maintained for the duration
r
of the project. The City shall be notified 24 Hrs. in advance of any traffic detours or delineations.
''.
CARE OF DRAINAGE STRUCTURES: Any drainage structure including corrugated metal pipe, concrete pipe, steel culvert and
+ ` {
concrete structures encountered during excavation which necessitate removal shall be'replaced in kind. In the event.it becomes
^
necessary to remove or cut existing drainage structures, City of La Quinta shall be notified prior to commencement of this work.
Drainage structures and open drains shall be kept free of debris at all times for proper drainage.
RIGHT OF WAY CLEANUP: Any surplus material resulting from excavation and backfill operations shall be removed from the right of
'
'Way. All paved surfacesshall bebroomdd clean of earthand other objectionable materials immediately after backfill and compaction.
Existing gutter line and drainage ditches shall be replaced to their original standard or better. All excess material shall be removed
prior to paving. Water tanker shall be used, as required, to sprinkle the job site to keep down dust conditions and shall be used
immediately after backfill..! , :y .• s,
• t .
DE -WATER OPERATIONS: df de=watering operations are required and pumps are forcing water on City of La Quinta roads, it shall be
the responsibility.of the permittee (contractor) to control this water and to provide off-street barricades when necessary.
CLOSING STREETS: No street shall be closed. A minimum of one lane of traffic shall be maintained at all times to provide limited '
access for the adjoining property owners and emergency vehicles. In the event it isfelt bythe permittee that he must close a street for
t `
any length of time, permittee shall contact this office to'obtain the necessary permission.
A
- t ., SPECIAL" PROVISIONS
t'
The follwing shall apply ONLY when indicated:'
NOTIFICATION: Permittee shall notify the City at 564:2246 at least 48 hours in advance of starting construction.
R2 CASH DEPOSITS OR BONDS: A cash bond or an approved surety bond in an amountof not less than $
shall be furnished in the name of City of La Quinta to cover all work involved in the restoration of the various La Quinta
roads and survey monuments. This bond shall be continuous until cancelled by the City Engineer. This bond must'be
posted prior to commencement of any, work on this project .
UTILITY CLEARANCE: (Substructures) Prior to making any excavation within the City of La Quinta right of way authorized
by permit, the permittee shall contact all concerned utility companies relative to the location of existing substructures.
w.
7_ Damage to existing substructures'resulting from operations conducted under this permit shall be the sole responsibility
of the permittee. '
R4 UTILITY CLEARANCE: No be done of
(Surface structures) work shall under this permit until all utilities are clear the
L%
proposed work site. The permittee shall notify all concerned utility companies of the proposed work.
•
'R5 PAVEMENT WIDENING: Area between the proposed concrete gutter line and the existing road pavement shall be
surfaced with inches of A.C. paving placed on inches of class aggregate subbase course
'
having an"R_n �valueof.not less than and in conformance with City of La Quinta Road Improvement Standards
-and Specifications, Ordinance #461. r'
+
R6 PARKWAY GRAbING:Area betweenthe property line and top of the proposed concrete curb shall be gradedto a slope of
1 /4 inch to one foot (1').;
R7 GRADES &STAKES: City of La Quinta shall establish grades and stakes for the proposed concrete curb and gutter
n
--construction.
/R8 GRADE CHECKING: City of La Quinta shall check grades upon receipt ofplan and profileand/or grades as established by
-
J "—"'a licensed engineer. '
r R9 CURB REMOVAL FOR DRIVEWAYS: A portion of the existing concrete curb and/or curb and gutter ( feet)shall be
removed. Curb and/or curb and gutter shall be saw cut prior to removal. Depressed curb, matching concrete gutter and ,
concrete driveway approach shall be constructed in conformance with City of La Quinta Standard #207.
r
R10. DRIVEWAYS, A.C.: Driveways shall be constructed as not to alter.existing drainage pattern. Surfacing between the
property line and the existing road paving shall be 2.1 /2,inches of A.C. paving placed on (_") of class
'
aggregate base. Driveway construction shall conform to attached drawing.
• R11 CULVERTS: A 'inch diameter ( )culvert shall be installed with the invert approximately 1-1 /2
inches below and in line with the existing flow line. Culvert installation shall conform to the attached drawing.
R12 ,SIGHT CLEARANCE: Sight clearance of 600 feet in either direction shall be assured and maintained.
R13 SOIL] STERILIZER:, The area to be surfaced shall be treated with soil sterilizer. Rate of application shall complywith the
r
►'. manufacturer's specifications` ,
' RR14' COORDINATE WORK: The proposed work shall be subordinated to any operation which the State of California or
City of La Quinta may conduct in this area during the period of this permit. Work shall be coordinated with the State or
City of La Quinta forces to preclude'delay or interference with State or City of La Quinta projects..
R15 . SURVEY MONUMENTS: Prior to excavation or beginning of construction, all survey monuments which exist on the
+
centerline of all streets or property lines when involved shall be completely tied out so they may be readily and correctly
'
be replaced by a licensed civil engineer or surveyor at the expense of the permittee. A complete set of notes showing the '
-
r ,
ties to these monuments shall be furnished to the City Engineer prior to the removal of any monuments. This office shall
be notified upon completion of replacement of all survey monuments for proper project clearance.
^`
.1 . • �<
RD -4 {
R16 `- Y MONUMENTS: Prior to excavation or beginning of con: on, all survey monuments shall be tied out by City
of La Quinta and suitable payment or guarantee of payment shall be made as reimbursement for all work involved.
R17 PAVEMENT CUTTING: Pavement will be mechanically cut to a straight edge prior to excavation. Method of pavement
cutting shall be approved through the office of the City Engineer. (Under no circumstances shall excavating equipment
be used to excavate prior to cutting of pavement). Excavation material shall be placed in such a position as to best
facilitate the general flow of traffic. Prior to final paving operations, any damage to pavement straight edge shall be
corrected.
Y19
PAVEMENT CUTTING: Pavement shall be saw cut prior to removal. Prior to final paving operations, any damage to
pavement straight edge shall be corrected.
-•-- LIMIT OF EXCAVATIONS: Excavations shall be limited tol,000linealfeetofo c^trench before backfilloperations must
begin. All excavations shall be properly barricaded with lights overnight, on weekends and holidays for the protection of
the traveling public. The Public Works inspector shall determine the suitability of excavation barricading in each case. No
excavation shall remain open for a period exceeding five (5) days. No excavation shall be made unless the construction
material is actually on the work site.
LR20 ACKFILL MATERIAL: Backfill shall be free of brush, roots or other organic substance detrimental to its use for purposes
of producing an adequately consolidated backfill. Any material which the City of La Quinta deems unsuitable (spongy or
saturated material) which is encountered during excavation shall not be used for backfill, but shall be supplemented or
replaced by an approved sand or gravel.
R21 BACKFILL SAND: Backfill shall be approved transit -mix sand or equivalent and shall beplaced in liftsof notgreaterthan
three feet (3') and vibrated using vibrotamper or equivalent equipment. Alternate methods maybe substituted, but in any
case a relative compaction of 95 percent shall be attained within the structural section of the roadway.
R22 BACKFILL PLACEMENT: Backfill shall be applied in layers of not more than 50 percent of the total depth of the trench
before flooding or a maximum offive-foot (5') liftswhere trenches are of excessive depths. Care isto beexercised thatthe
backfill material is not subjected to extreme swell by flooding operations. Backfill material shall be placed so that the
resulting compaction shall be not less than 90 percent or equivalent to the surrounding ground, whichever is the greater
compaction. Where ponding or flooding is used for a maximum settlement, adequate dikes will be constructed to retain
the water. Where jetting is used, the jets shall be of sufficient length to reach the bottom of each layer and the water
supply shall be continuous.
R23 COMPACTION TESTS: If so required bythe inspector, compaction tests shall be made at intervalsof not more than 1,000
feet and a minimum of one (1) test on each road. One (1) copy of each test shall be forwarded to the City Engineer for
approval and filed prior to making permanent repairs. Compaction tests shall be made asoutlined in Section 6.3.01 of the
Standard Specifications, Division of Highways, State of California, dated January 1973.
C.R24 COMPACTION TESTS: If so required by the inspector, compaction tests shall be made for each crossing or service line.
-- One (1) copy of each test shall be forwarded to the City Engineer for approval and filed prior to making permanent repairs.
Compaction tests shall be made asoutlined in Section 6.3.01 of the Standard Specifications, Division of Highways, State
Cof California, dated January 1973.
R25/TEMPORARY PAVEMENT REPAIRS: After completion of backfill and compaction operations, a temporary patch
consisting of 2 inches of SC -800 shall be placed on a prepared subgrade. The SC -800 temporary paving shall be placed
after a maximum of 3,000 lineal feet of trench has been excavated and backfil! operat'cns complaied, but it no case shall
Ctie placement of the temporary pavement exceed a five (5) day limit.
26P RMANENT PAVEMENT REPAIR: After backfill and compaction operations have been completed, a temporary patch
consisting of two inches (2") of SC -800 shall be placed immediately. A permanent patch of inches A.C.
surfacing placed on a inch class base shall be placed no laterthan days after completion of
temporary road repair.
R27 PAVEMENT REPAIR: F.A.S.: Upon completion of backfill and compaction, a temporary patch consisting of two inches (2")
of cold mix paving (SC -800) shall be placed immediately. A permanent patch of three inches (3") of A.C. surfacing shall
be placed on six inches (6") concrete base as directed, but not later than fifteen (15) days after completion of temporary
paving. Concrete base shall be of five -sack mix and shall conform to the City of La Quinta Road Improvement Standards
and Specifications, Ordinance #461.
R28 FOG SEAL: A fog seal coat consisting of an application of asphaltic emulsion shall be applied over all patch areas as
determined by the City Engineer.
R29 SEAL ARMOR COAT: A seal coat consisting of an application binder and screenings shall be applied on all patch areas
where such seal coats existed prior to issuanceof this permit. Seal or armor coats shall be applied as specified in Section
37, Standard Specifications, State of California, Division of Highways, dated January 1973. Work of pavement repair to
be accomplished by a licensed contractor engaged in the business of pavement repair.
R30 STREET RESTRIPING: Where street striping is still visible on streets to be excavated, such striping shall be replaced upon
completion of permanent repairs.
R31 TREE RELOCATION OR REMOVAL: Tree relocation within the City of La Quinta road right of way shall be accomplished
by a licensed, bonded and insured tree service, and handled safely without interference or hazard to the traveling public.
It shall be the responsibility of the permittee to maintain the tree in a vigorous growing condition at its new location.
Trees to be removed shall be removed in sections which can be handled safelywithout interference or hazard to highway
traffic. The entire width of the tree stump shall be removed and disposed of so that no debris remains in view of the
highway. The stump hole shall be backfilled and thoroughly compacted as specified in thefollowing paragraph. Where it
becomes necessary to restrict traffic, the work shall be restricted to a maximum of 500 feet at any one time. Adequate
signs, flagmen and/or barricades shall be provided to protect the traveling public at all times.
Large holes resulting from tree removal shall be backfilled and compacted to not less than 90 percent or equivalent to the
surrounding ground, whichever is the greater compaction as determined by the impact or field method. Compaction
tests shall comply with Section 6.3.01 of the Standard Specifications, Division of Highways, State of California, dated
January 1973.
R32 TREE TRIMMING:
a. Only the necessary trimming shall be accomplished to provide clearance of the facility for one calendar year.
All broken or weak sections within the trimming shall be removed.
b. Where it becomes necessary to restrict traffic, the workshatlberestrictedtoamaximum of500feetatanyonetime.
Adequate signs, flagmen, and/or barricades shall be provided to protect the traveling public at all times.
c. If tree trunks are partially outside of the City of La Quinta road right of way, permittee shall make his own
arrangements with adjoining property owners for consent to the trimming in addition to the authorization provided
by this permit.
d. All tree trimming on EVERGREEN TREES, PALM TREES, and other ORNAMENTAL TREES shall be accomplished to
the satisfaction of the City Public Works Inspector.
e. Abutting property owners shall be contacted, in all instances, prior to trimming or topping trees.
f. Pruning shall, in all instances, be at the shoulder of the crotch to insure even, fast healing in all cuts of two inches
(2") and above in size. Sealant shall be applied to all cut sections as directed by the City Public Works Inspector.
-ADDITION- •-ENCROACHMENT PERMIT NO.0 -=CONDITIONS -
R33'.
Survey monuments shall be protected in place or
re-established.pursuant to City.standards and the•State of
California Land Surveyor.'-s Act..
' R34'
Work shall be coordinated:,with 'the City ,4of ' La Quintals
forces Fto "reclude:.delay' or interference with "the _City of La
-Quintal°s'"project's. .
R35'
Contractor shall`comply'with the. local noise ordinance and
construction•operations and maintenance of equipment within
4•• one half mile ;of 'human occupancy shall be performed only `
'
during the time periods as follows:
Octbber-lst to April 30: Monday-Friday 7:00a.m.'-5:30p-:m.,
Saturday.-•8:00a.m.-5:00p.m.
,May 1st to September 30:' Monday-Friday.6:00a.m..-7:00p:m.
,Saturday. 8:00a.m.-5:00p.m.
•
'Work shall be prchibited.,ahytime"on ;Sunday -and Federal
.
holiday. +
•'
'Manual
R36
`Traffic ;control shall be. * as , per Cal Trans Traffic . "
`.
-Field adjustments-,in detouring shall be accomplished as
directed in'order'to.adjust to actual,ffield'conditions. It
shall be'the,•coiitractor'stresponsibility to,adequately
barricade and.-detour this-site. A Trafficycontrol plan shall
'be submitted for approval by the.City Engineer. ;
` R37'
'All'excavation at or near the travel-way shall.be backfilled"
' ` •G :rt-
at, the„•end sof' the,work day,' for• the .protection of' the'
•
traveling public. -
' R38-
Sereet closures shall not be allowed at an ,time. '
R39:
A'minimum of one travel lane, shall be'maintained at all
,.
times, with 'flagmen during. working hours.-
ours._R40'.
R40'.
All work to be performed,.within the, existirig paved".section
shall be,;tempor.ary`paved.and maintained by the,Permittee,'
-
permanent pavement shall be placed' no later than. 15'" `days-'
after completion of the temporary road repair-. `
R41
Ingress and•egress:..for local properties shall be-maintained. ;
.
-at all times.
'work-,starting,
R42
Prior to Underground.4Service Alert shall be
contacted at 1-800-422-4133 and�an 'inquiry number” shall 'ber
provided .to the-City Public'_WorksrInspector'. ,
R43
Pavement* shall be sawcut�prior to removal.
-
...Additional:Conditions - Encroachment Permit No. 0613
y
Page
2
R44
-`All backfill subgrade.^soil shall -be -compacted to nothing
`
less than -,90% relative dry_density, .•all backfill. soil within
,
F
the top 2'',oft. fi dGh • pavement surface • shall be. compacted to,
*.
nothing:}less •than 950-.' relative' dr'y.density, al -1 -base'
`
material .shal,I• be•compactedi- to, nothing less,:than 950
relative: -dry density. "
R45
Replacement pavement , sections .�" shall be•- 3" AC .over 411• Class
R f.
II aggregate base.
�•
R46
If the.:work is,to be performed by forces other than that'of•.
the utility company;• the- contracting company will.`be '
'
required to+apply for an'additional•encroachmerit,permit
-appropriate
and pay the ,fee. }
1
40
t t:
` ... .fit' ..
_�
,53440-472
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:
4-26-90
LOCATION OF CONSTRUCTION E/side of Avenida Obregon
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch install new gas main Sketch (attach constructionlans if appropriate)
ppropriate)
DESCRIPTION OF CONSTRUCT)ON ' tic
me zum pressure gas main 1 ot Avenida 0 regon,
tP"jjn MPT,06
DIMENSION DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 5-10-90
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COSTS
(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 lou resulting from claims or court action and arising out of any accident, lou 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 (241 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 Quinn and to pay for any additional replacement necessary M the 1 is
: SN ; D TRIG N SUPERVISOR
- tun o Applicant or Agent.
-SOUTHERN CALIFQRIGIN GAS'co_ " P_Q_ >3nx -inn�' R=.ANns� rn 'c)2.171 (7 ,4) -:335 7742`
- 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% 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 DapositSurety Bond
it required
TOTAL:
Receipt No.
s
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (6191564-2246
AOL
- - AN FILE NO. BASE SKETCH /c )p NSTR. SK M- COMPL. SKET�H
Br:. 1 IV� le7r: xL
Ier: '' SHEETI OF I -