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NOTE:
'With proper validation
this form constitutes'an'
� CITY OF LA: QUINTA+'
. encroachment permit : t
'x APPLICATION 'FOR PERMIT •'
' PUBLIC. WORKS :CONSTRUCTION (ENCROACHMENT);
t' SOF
For`` the construction 'of public . -or private 'curbs, driveways, pavements, sidewalks,.. -parking lots,`sewers, water mains
and other like public work`s improvements in connection with MINOR IMPROVEMENTS.and APPROVED SUBDIVISIONS
` + Subdivision Improvement Permit - Class II I ,
DATE: ' May• 8, 1996.Minor Improvement Permit Class IV
`CONSTRUCTION Y TR 23971 Washingti-ri/Via Sevilla' '° " "
LOCATION OF "
,- _ ' `
r.
(Street address or Description of Location)
PURPOSE OFCONSTRUCTIONI' Gas�Main' <. ' +
Sketch (attach construction plans if appropriate')"
• DESCRIPTION OF CONSTRUCTION bore under r' - - ,,, ,
Washinctton "Street }
"REFERENCE: SO., .CALIFORNIA..GAS'
PERMIT••#` 0582 ' "Y
DIMENSION OF INSTALLATIONOR REMOVAL- bore aoAarox + ' . - .
80' - 2" �'' .ALL .CONDITIONS. OF' PERMIT 05.82-
} SHALL APPLY TO THIS PERMIT.r
x2x3 ov r. x n
•. SIZE OF EXCAVATION, IF NEEDED 4 6 e e esti g _ . + •' .
( SEE .ATTACHED) '
APPROXIMATE TIME WHEN WORK.WILL BEGIN 5/140/90 ` N0 OPEN, GUT TRENCH
MAINTAIN MINIMUM OF 2' EACH' 1'6'
.APPROXIMATE TIME OF COMPLETION" _5111o/40
- WIDE UNOBSTRUCTED. TRAFFIC LANES--
ESTIMATED CONSTRUCTION COST $ • .
•(.including removal of all obstruction, materials; and debris, backfilling, com-
paction
om paction and placing permanent resurfacing and/or, replacing improvements')"._+
JIn consideration of'th6'granting' of this permit, the' applicant hereby agrees, to:
Indemnify, -defend and. save the City, its authorized agents,: officers,. representatives and'employee's, 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
h ippening.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 iri advance of the time•when work,.will be started. f r
. r - r •
Comply with all applicable City OrdinancL,'the terms and .conditions of the permit and� all applicabli rules and'regul tions'of the City of. ,
s La-�Quinta and,to pay•for any additional replacementJiecessary as the result of this woPk. 1
Signature of'Applicant oAg
r epnt +.
K Macco Construction PO Box 783 Palm Desert, CAt' %, 343`=1180' .
Name of Applicant (please print)• + �' Business Address v. .t Telephone No.
Name of Contractor. and Job Foreman ": 'Business Address ' ` = Telephone No.
259619 _ 566
Contractor's License No,. �' City Business License'No..
Reliance -Ins. Liability NG 1253560 `_ }
r.
ApplicantIs'Insurance Company ` ' »" '.: Policy'Number
s fin';s�t7 in ,ASPEN tm-no.-tart' 1()
10 UA.)H - 1 I IJ I AL 1 •. 45.00 ,
FEES: Subdivision Improvement Permit — Class I I I - -
Public improvernents: 3% of estimated construction costs ,
' Private•improve ments: 3% of estimated construction •costs' o 0634
=
Minor Improvement,Permit — Class IV: See attached schedule
'Inspection Fee' $•' 45.00 PERMIT."VALIDATION.'• '
PermitfFee • + `' " 0634
i PERMIT -.NO; '
.• Penalty . Y � ' . ' _
Cash Deposit -Surety Bond DATE APPROVED
if required � ' ., � .. .. ... .• ,
�. EXPIRATION DATE 11/8/90
TOTAL: .. . $ 45.00. ••• _ - ,
- _DATE ISSUE 58/90'Receipt No..
;
B
.. y
Received by Date Administrative Authority
Recorded,by TELEPHONE: (619) 564-2246
1
....f.. — .. r .w r r — w rn r r .i. r .s. w ... s. is c1"a.Y r w •w.r r r r r+• r w..r �..+. ar sea. r .. nv+n. .� w
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
Subdivision Improvement Permit — Class II I
DATE: May 8, 1990 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION TR 23971 Washingtin/Via Sevilla
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION I— Gay. Main Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION bore under
Washington Street REFERENCE: SO. CALIFORNIA GAS
DIMENSION OF INSTALLATION OR REMOVAL bore annrox PERMIT 4 0582
ALL CMIDITIONS OF PEn1IT 0532
SHALL APPLY TO THIS PERMIT
SIZE OF EXCAVATION, IF NEEDED 4x2x36 over existing
suhs (SEE ATTACHED)
APPROXIMATE TIME WHEN WORK WILL BEGIN 5/10/90 NO OPEN CUT WRENCH
11AINTAIN YiINIIM�UM OF 2 EACH 16'
APPROXIMATE TIME OF COMPLETION 5/10/90
�JIDE UNOBSTRUCTED TRAFFIC LANES
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.
A Y P y
Signature of Applicant oriiAgen�t
Placco Construction PO Box 783 Palm Desert, CA f 1343-1180
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
259619 566
Contractor's License No. City Business License No.
Reliance Ins. Liability NG 1253560
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit— Class lit
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ . 45.00 II
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No
$ 45.00
Received by Date
Recorded by
by 3�-2
PERMIT VALIDATION
PERMITNO. 0634
DATE APPROVED 5/8./90
EXPIRATION DATE 11*/8/90
DATE ISSUED 5/0/90
By
Administrative Authority
TELEPHONE: (619) 564-2246