12020I Tityl'.
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See. below for Finance Revenue Codes
ENCROACHMENT PERMIT
Fn,oF moo. PUBLIC WORKS CONSTRUCTION
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
now Minor Improvement Permit - Class IV
DATE: 4/3/2012
LOCATION OF CONSTRUCTION: Washington Street and Hidden River Road
PURPOSE OF CONSTRUCTION: The Gas Company; SAP 52-290343; Lane Closure on Washington Street (Work is on Bermuda Dunes Side)
DESCRIPTION OF CONSTRUCTION: Lane Closure
DIMENSION OF INSTALLATION OR REMOVAL:
APPROXIMATE TIME WHEN WORK WILL BEGIN: 4/10/2012 TIME OF COMPLETION:. 4/10/2012
ESTIMATED CONSTRUCTION COST: Less than $5,000 (Including removal of all obstruction, materials, and debris, backfilling, compaction and placing
permanent resurfacing and/or replacing improvements)
COMMENTS
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 occuring 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 at (760) 777-
7097. To submit an inspection request, leave a message on the Inspection Request Hotline at (760) 777-7097 prior to 1:30 P.M. at
least twenty-four (24) hours prior to the anticipated inspection.
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 of Appliorgor Agent
Sandi Stamper - The Gas Company P.O. Box 3003, ML 8032, Redlands, CA 92373 909-335-3982
Name of Applicant Business Address Telephone No
The Gas Company P.O. Box 3003, ML 8032, Redlands, CA 92373-0305 909-335-3982
Name of Contractor and Job Foreman Business Address Telephone No.
N/A
Contractor's License Number
Self -Insured
Applicant's Insurance Company
FEES Subdivision Improvement Permit - Class I
Minor Improvement Permit - Class I
Finance Revenue Code
Inspection Fee E_1
$0.00
Permit Fee E_1
$100.00
As -Built Deposit E-A
$0.00
Cash Deposit -Surety Bond, EE=6
$0.00
if required
TOTAL
100.00
N/A
City Business License No
Self- Insured
Policy Number
Public Improvements: 3% of estimated construction costs
Private Improvements: 3% of estimated construction costs
PERMIT NUMBER: 12020
DATE ISSUED: I.10•IZ
EXPI TION DATE: 0, 17—
B Y:
yBY:
WORK INSPECTED BY*:
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PERMIT COMPLETION DATE*: , 12-
* If the work is covered by a Subdivision Improvement Agreement, Subdivider
shall request final acceptance of improvements from the City Council.
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