1679! NOTE:
With proper validation
ti `•T- this form constitutes an
encroachment permit
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
Fo-r,• the constructionof 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 3/1/93 Subdivision Improvement Permit — Class III
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION CALLE TAMPICO/AVE NAVARRO e» AVE VILLA NORTH EAST CORNOR
• •.`
OF AVE 20 WZA AND CALLR TAMPICO
'IStreet address or Description of Location)
4. TO CLEAR PROPOSED STROM DRAIN.
PURPOSE OF CONSTRUCTION _ Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION LOMM 501, OF 6" STD. GAS
f'tt ,MAIN & ALTER 10' OF 2", PE GAS MAIN SES ATI!ACS®
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGINM503 :A41:913tH.
'e,
` APPROXIMATE TIME OF COMPLETION 3/12/93 ' '4�
"ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, com-
,.paction and placing permanent resurfacing and/or replacing improvements)
-i:• 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 accideni!loss or damage to persons or property
'r
happening or occurring as a y p g p
pp g g proximate result of an work undertaken under the permit ranted 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 per it'and all applicable rules and gulations of the City of
La Quinta and to pay for any additional replacement necessary as the resultof his work.
SO. CAL. GAS CO.
75-095 MAYFAIR DR
gnature of A
1
Name of Applicant (please print) Business Address Loll Telephone No.
i. •MACCO CONST."INC. �' (619) 343--1180
Name of Contractor and Job Foreman Business Address Telephone No.
:2596 19 l* 566
Contractor's License No. City Business License No.
}AEUMCE INS NG125356004
Applicant's Insurance Company Policy Number
5 1. -
s FEES: Subdivision Improvement Permit = Class I II
Public improvements: 3% of estimated construction costs
'}'fy Private improvements: 3% of estimated, construction costs
Minor Improvement Permit — Class IV: See attached schedule 9
Inspection Fee. $ PERMIT VALIDATION
Permit Fee 0 PERMIT NO. 1679
Penalty -
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No
$
0
Received by Date
DATE APPROVED 3/1/93
EXPIRATION DATE 3/15/93
DATE ISSUED 3/1/93
By
Administrative Authority
Recorded by II TELEPHONE: (619) 564-2246•
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