3646NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA,
encroachment permit IFAPPLICATION FOR PERMIT !
". PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
t
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
03/07/02 Subdivision Improvement Permit — Class II I
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION TRACT 30125-1 KISENHOM DRIVE AND AVENUE. 50
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION THSTAT.iT.,ATION OF GAS MAIN Sketch (attach construction plans if appropriate)
SEIS Al CACHED SPECIAL CONDITIONS
DESCRIPTION OF CONSTRUCTION WTIf.T. ACCMRR ACR0gS
r DIMENSION OF INSTALLATION OR REMOVAL SCE ROLE
91131.19 Al -w Al
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
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, 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 a:d regulationsiof the City of
La Quinta and to pay for any additional replacement necessary as the result of t is work.
v
Signature of Applicant or Agent
SOUTHERN GALIFORNIA GAS CO 75095 MAYFAIR PALM DESERT CA 92211 U) 341 2348
Name of Applicant (please print) Business Address Telephone No.
SAKE AS ABOVE
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 I II
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:
Receipt No
Received by
$ 0.00
0.00
$ 0.00
Date
P11 3646
PERMIT VALIDATION
3646
PERMIT NO.
03/11/02
DATE APPROVED
EXPIRATION DATE 06/30/02
DATE�,IISSUED
gy �./. G t r YI
Administrative Authority
Recorded by II Telephone: (760) 777-7075
The following General and Special Provisions arc attacbed to and made a part of Permit No. ✓ &
GENERAL PROVISIONS
The following shall always apply: '
ENROACHMENT ON PRIVATE PROPERTY: This permit authorizes work to be accomplished within City of La Quints right of
way ONLY.. Whenever construction extends within private property, it is the responsibility of the permittee for his contractors to
secure permission from abutting property owners. Such authorization must be secured by the permittee prior to starting work.
TRACKLAMG CONSTRUCTION EQUIPMENT: Cleated tracklaying construction equipment shall not be permitted to operate on
any paved surface unless fined with smooth -faced stint pads. All mechanical outriggers shall be fitted with rubber street shoes to
proteci 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 Quints shall request
that these portions of road be resurfaced over their entire width. Resurfacing shall, consist of out coat of two inches (2*) of A.C.
surfacing plus appropriate seal toot as specified above.
PROTECTION OF TRAFFIC: All excavations and work areas shall be properly lighted and barricaded as deemed necessary by the
City Engineer or La Quinta City Public Works inspectors. Suitable detours and demur signs shall be placed and maintained for the
duration of the project. The City shall be notified.24 hours 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 Quints 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 surfaces shall be broomed clean of eartb and other objectionable materials immediately after backfill and compaction.
Existing gutter line and drainage ditches ihall 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.
DE -WATER OPERATIONS: if de -watering operations are required and pumps are forcing water on City of La Quints roads, it shall
be the responsibility of the permittee (contractor) to control this water and to provide off-street barricades when necessary..
CLOSING S17RF-EI'S: 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 is felt by the permittee that he 'must close a street for
any length of time, permittee shall contact this office to obtain the necessary permission.
SPECIAL PROVISIONS
The following shall apply when indicated:
NOTIFICATION: Pirmittee shall notify the City at (619)777-7075 at least 48 hours in advance of starting construction.
UTILITY CLEARANCE: (Substructures) Prior to making any excavation within the City of la Quints, right of way
authorized by permit, the perminee shall contact all concerned utility companies relative to the location of existing
substructures. Damage to existing substructures resulting from operations conducted under this permit shall be the sole
responsibility of the permittee.
ITI LJTY CLEARANCE: (Surface Structures) No work shall be done under this permit until all utilities are clear of the
proposed work site. The perminee shall notify all coocerned utility companies of the proposed work.
R4 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'
value of not less than and in conformance with City of La Quints Road Improvement Standards and
Specifications, Ordinance 0461.
GPARKWAY GRADING: Area between the property line and top of the proposed concrete curb shall - be graded to a slope of
1/4 inch to one foot (I).
R6 GRADE- CHECKING: City of La Quints shall check grades upon receipt of plan and profile and/or grades as established by
a licensed engineer.
R7 CURB REMOVAL FOR DRIVEWAYS: A portion of the existing concrete.curb and/or curb and gutter ( _feet) eball 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 Quints Standard #207.
RS 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.
SIGHT CLEARANCE: Sight clearance of 600 feet in all directions shall be assured and maintained at all times.
RIO SOIL STERILIZER: The area to be surfaced shall be treated with soil sterilizer. Rate of application shall commply with. the
manufacturer's specifications.
COORDINATEWORK: The proposed work shall be subordinated to any operation which the State of California or City of
La Quints may conduct in this area during the period of this permit. Work shall be coordinated with the State or City of La
Quints forces to preclude delay or interference with State of City of Ls Quints projects.
(1 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 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 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 or replacement of all survey monuments for proper project clearance.
PAVEMENT" CUTTING: Pavement will be mechanically saw cut to a straight 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 traffic. Prior to final paving operations, any damage to pavement straight edges shall be corrected.
t14 LIMIT OF EXCAVATIONS: Excavations shall be limited to 1000 linear feet of open trench before backfill operations 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 suitabUity 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.
`.1 BA0011,L 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 Quints deems umitable (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.
t16 BACKFJLL SAND. Backfill shall be approved transit -mix sand or equivalent and shall be'placed in lifts of not greater than
three feet (Y) and vibrated using vibrotamper or equivalent equipment. Alternate methods may be substituted, but in any case,
a relative compaction of 95 percent shall be attained with the structural section of the roadway. .
t17 BACKFH.L 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 of five-foot (51 lifts where trenches are of excessive depths. Care is to be exercised that the
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 daces 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.
LIS COMPACTION 7TM: If so required by the inspector, compaction testa shall be made at intervals of not more than 1000
feet and a minimum of one (1) test on each road: One (1) copy of each teat shall be forwarded to the City Engineer for
approval and filed prior to making permanent repairs. Compaction tests shall be made as outlined in Section 6.3.01 of the
Standard Specifications, Division of Highways, State of California, dated January 1973.
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 teats shall be made as outlined in Section 6.3.01• of the Standard Specifications, Division of Highways, State of
California, dated January 1973.
2 TEMPORARY PAVEMENT REPAIRS: After completion of backfill and compaction operations, a temporary patch
consisting of 2 inches of SC400 shall be placed on a prepared subgrade. The SC-800 temporary paving shall be placed after a
maximum of 3000 linear feet of trench has been excavated and backfill operations completed, but in no case shall the
placement of the temporary pavement exceed a five (5) day limit.
21 PERMANENT -PAVEMENT REPAIR: After backfill and compaction have been completed, a temporary patch consisting of
two inches (2') of SC-800 shall be placed immediately. A permanent patch of_inchea A.C. surfacing placed on a
nch class +base shell be placed no later then_deys after completion of temporary road repair.
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.
2 STREET RES RIDING: Where street striping is still visible on streets to be excavated, such striping shall be replaced upon
completion of permanent repairs.
124 TREE RELOCATION OR REMOVAL: Tree relocation within the City -of La Quints 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 in sections which can be handled safely without interference or hazard to highway traffic. The
entire width of the -tree stump &ball be removed and disposed of so that no debris remains in view of the highway. The stump
bole shall be backfilled and thoroughly compacted as specified in the following paragraph.. Where is 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 teats shall
comply with Section 6.3.01 of the Standard Specifications, Division of Highways, State of California, dated January 1973.
SPECIAL CONDITIONS --PERMIT NO. 3646
--- SOUTHERN CALIFORNIA GAS CO. ---
In addition to the standard permit conditions, the following shall apply:
Pursuant to Section 14.16.320 of the La Quinta Municipal Code (Ordinance 10 § 1 (part),
1982), all work shall be performed in accordance with the latest edition of the Standard
Specifications For Public Works Construction (SSPWC) and as directed by and to the
satisfaction of the City Engineer.
2.' SOUTHERN CALIFORNIA GAS CO., hereinafter referred to as "Permittee", shall be
responsible for providing continuous dust and erosion control. All areas shall be kept
watered down daily including weekends.
3. Streets shall be kept clean. They shall be completely cleaned at the end of each working
day and more frequently if required.
4. Pursuant to Section 6.08.050 of the La Quinta Municipal Code (Ordinance 18 § 1, 1982),
throughout the work site, the Permittee shall comply with City regulated work. hours.
Operation and maintenance of equipment within one-half mile of'human occupancy shall
be performed only during the following time periods:
October 1 st to April 30: Monday -Friday 7:00 a.m. to 5:30 p.m.
Saturday 8:00 a.m. to 5:00 p.m.
May 1 st to September 30: Monday -Friday 6:00 a.m to 7:00 p.m.
Saturday 8:00 a.m. to 5:00 p.m.
Work shall be prohibited on legal holidays and Sundays.
5. Work performed within 500 feet of a signalized intersection is restricted between the
hours of 9 a.m. - 3 p.m. Traffic control shall be set up after 9 a.m. and removed
before 3 p.m. The Permittee shall contact the Riverside Country Traffic Signal
Maintenance Department at (909) 275-6894 if signal operation at the intersection is
to be altered in any way.
6. Pursuant to Section 14.16.110 of the La Quinta Municipal Code (Ordinance 10 § 1 (part),
1982), Permittee shall assume responsibility for repair of any pavement damage to any
public or private street and for any damage to other City streets or facilities as a result of
work performed under this permit.
7. Pursuant to Section 14.16.250 of the La Quinta Municipal Code (Ordinance 10 § 1 (part),
1982), advance warning signs and traffic control shall be installed and maintained in
accordance with Cal Trans Standards or the Work Area Traffic Control Handbook (WATCH
Manual).' A traffic control plan, if required, shall be prepared in accordance with the
WATCH Manual and submitted to the City for review and approval one (1) week prior to
starting any construction. It shall be the Permittee's responsibility to appropriately detour
and barricade all construction sites.
Special Conditions - Permit No. 3646
Pagel of 5
SPECIAL CONDITIONS --PERMIT NO. 3646
--- SOUTHERN CALIFORNIA GAS CO. ---
8. Pursuant to Section 14.16.290 of the La Quinta Municipal Code (Ordinance 10 § 1 (part),
1982), street closures shall not be permitted. A minimum of one travel lane of paved
surface shall be maintained with flagmen at all times.
9. Prior to excavating, if required, the Permittee shall contact Underground Service Alert at
1-800-422-4133. It shall be the Permittee's responsibility to notify the Public Works
Department of anticipated excavation which impact City facilities, including but not limited
to traffic signal conduits and loops, irrigation lines, electrical conduits, and storm drain
facilities.
10. Should additional work, materials, or modifications of the work be required in order to meet
City standards, safety requirements, signage requirements, or to fit actual field conditions,
the work shall be performed by the Permittee as directed by and to the satisfaction of the
.City Engineer at no cost to the City of La Quinta.
11. Pursuant to Section 14.16.370 of the La Quinta Municipal Code (Ordinance 10 § 1 (part),
1982), backfill compaction within street rights-of=way shall conform with Section 306-1.3
of the latest edition of the Standard Specifications For Public Works Construction
(SSPWC), except as otherwise specified herein.
Native material may be used as backfill material provided that minimum compaction,
achieved in the manner prescribed herein, is achieved. Backfill shall be performed by
mechanical means; no water densified compaction via jetting or flooding or other means
shall be allowed. It shall be the Permittee's responsibility to provide appropriate
geotechnical supervision, testing, and inspection, onsite, at all .times during backfill
operations.
Backfill compaction shall be achieved by the following conditions:
A. When a firm foundation is not encountered due to soft, spongy or other unsuitable
material, such material shall be removed to the limits directed by the Geotechnical
Inspector and/or the City Inspector and the resulting excavation backfilled with pipe
bedding material.
B. Backfill materials shall be brought to or maintained at an appropriate moisture content
for compaction. The appropriate moisture content range shall be established at the
onset of the project and ensured prior to use of the materials through progress testing
on the stockpiles.
C. The first length of trench backfilled shall be backfilled in the presence of the City
Inspector. Compaction shall be tested at random depths at approximate three-foot
vertical intervals as backfill is placed to ensure the effectiveness of the compaction
methods and to establish the depth of lift that can be compacted.
D. If lifts greater than one foot are attempted in this trial length of trench, compaction
tests shall be taken within the lifts to ensure that the full depth of the lift is compacted.
Special Conditions - Permit No. 3646 Page 2 of 5
SPECIAL CONDITIONS --PERMIT NO. 3646
--- SOUTHERN CALIFORNIA GAS CO. ---
Upon satisfactory completion of this portion of trench, the City Inspector shall
establish the maximum lift thickness to be compacted for the remainder of the project.
F. In subsequent lengths of trench, the frequency of compaction tests shall equal one
per each lift of backfill, per 300 linear feet of open trench, at randomly selected
locations within the open length of trench.
G. The depth of the randomly selected compaction tests shall also be randomly selected
except that where multiple tests are required in a given length of trench, the tests
shall be no closer than three feet (vertically) from each other. '
H. If any compaction test fails, previously placed backfill (in the same length of open
trench or previous lengths of trench) which is represented by the failing test (as
determined by the City Inspector), shall be tested for compliance with compaction
requirements.
All costs incurred due to the conditions above shall be borne by the Permittee.
Copies of all test results shall be furnished to the City Inspector.
12. All excavations within City of La Quinta right-of-way shall be backfilled, and temporarily
paved if within the existing travel way, at the end of every workday as directed by and to
the satisfaction of the City Engineer for the protection of the public. Lengths of open trench
shall not greatly exceed that which can not be backfilled in the same day. Excavated
trenches shall not be allowed open overnight, however, Permittee may leave a length of
excavated trench, not to exceed twenty (20) feet in length, open overnight at a point where
construction will begin the next day, provided .that this length of trench is completely
covered by steel plating.
13. All landscaping, irrigation, decorative rock, decorative concrete, lighting, etc., shall be
replaced to its original condition.
14. Access and egress to all local properties shall be maintained at all times.
15. Pursuant to Section 14.16.375 of the La Quinta Municipal Code (Ordinance 10 § 1 (part),
1982), permanent pavement replacement shall be completed no later than seven (7) days
after the completion of the work. Permanent pavement replacement shall conform to the
following conditions:
A. Existing .asphalt concrete pavement shall be sawcut one (1) foot beyond trench
edges. Edges shall be straight and clean.
B. Permanent pavement replacement structural section, within all trenches, shall be 1"
thicker than existing of asphalt concrete over the same existing thickness of crushed
aggregate base or crushed miscellaneous base, meeting the requirements of
Sections 200-2.2 and 200-2.4 of the Standard Specifications for Public Works
Construction. The replaced pavement and base material shall be compacted to 95%
Special Conditions - Permit No. 3646
Page 3 of 5
SPECIAL CONDITIONS --PERMIT NO. 3646
--- SOUTHERN CALIFORNIA GAS CO. ---
relative compaction and respectively tested, for each 300 linear feet of trench. Verify
exact structural replacement section thicknesses with the City prior to installation.
C. Permanent pavement replacement shall be installed using a City approved %" max
medium asphalt concrete as the base course lift and a City approved Y2" max medium
finish course lift for capping. Asphalt concrete mix design shall be approved by the
City prior to its placement.
D. Cold -Mill and Overlay - The existing pavement which was properly protected in place
during the trenching operation located adjacent to the trench sawcut shall be cold -
milled to a depth of 0.10 feet with butt joint created next to the existing unmilled
pavement surface. The cold -milled area and base asphalt concrete in the trench area
shall be overlaid with a City approved C2-AR-4000 asphalt concrete mix. The width
of the cold milling area shall be as follows:
For longitudinal trenches located in a parking lane: two (2) feet outside the
sawcut removal lines.
For longitudinal trenches located in a traffic lane: two (2) feet outside the sawcut
removal lines, or to.the lane line striping, whichever is greater.
For transverse trenches across existing street: two (2) feet outside the sawcut
removal lines.
E. If grinding and capping operations are not performed in the same day as base paving
operations, the base course lift of 3/4' max medium asphalt concrete shall be installed
from saw -cut edge to saw -cut edge flush with the existing street surface. The base
course lift of paving shall not be left 0.10' low in anticipation of grinding and capping.
F. Any existing lane striping affected by this resurfacing shall be replaced in kind by the
Permittee, as directed by and to the satisfaction of the City Engineer. Affected traffic
signal loops shall be removed and replaced in kind. The finished pavement surface
shall be smooth, consistent, and shall conform to the surrounding grades.
16. Permittee shall permanently stabilize any and all soil that was disturbed as a result of work
performed under this permit with an approved dust control treatment. Soil stabilization shall
be done immediately after completing the operation.
17. Pursuant to Chapter 12.56 of the La Quinta Municipal Code (Ordinance 10 § 1 (part),
1982) the City has designated certain city streets as Truck Routes. The weight limit for
restricted streets (i.e., streets not part of the Truck Route network) is three (3) tons; trucks
exceeding the weight limit may use a restricted street if making a delivery or pickup on the
subject street, or if this permit specifically grants permission to use the street to deliver
street construction materials and/or equipment.
Special Conditions - Permit No.. 3646 Page 4 of 5
SPECIAL CONDITIONS --PERMIT NO. 3646
---SOUTHERN CALIFORNIA GAS CO. ---
18. This permit allows for the installation of a 2" gas main to 'be bored approximately 80' across
Ave. 50 This permit work is for Sedona Homes, Tract 30125-1.
19. The City of La Quinta reserves the right to revoke, suspend or void this permit at.any time.
Special Conditions - Permit No: 3646
Page 5 of 5
01� % I
NOTE:
With proper validation C'
this form constitutes an CITY OF LA QUINTA .
ncroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT).
0 TH8°ws
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
3 — D� Subdivision Improvement Permit —Class I I I
DATE: _ aC , Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION — �% S /l/%f011Jg'R f{ ✓C. t O
BRA C,-t' SO 2 5
(Street address or Description of Location) '
PURPOSE OF CONSTRUCTION & 5 71 Cis f/r��l� Sketch (attach construction plans if appropriate)
D SCRIPTION OF CONSTRUCTIO L e-c.. A f44_J--,.
DIAIIENSION PF INSTALLATION�OORR R�IyIOVAL w^�� J10Y`f
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN -70
APPROXIMATE TIME OF COMPLETION 0 Q
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 appli le rules regulations of the y,of
La Quinta and to pay for any additional replacement necessary as the result of is work.
Signature of Applicant or Agent
3 yi .73 yg
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:
Receipt No.
O
Received by Date
Recorded by
0
PERMIT VALIDATION
PERMIT NO. 3 e. 4
DATE APPROVED 3 0 Z
EXPIRATION DATE 6 3 D L6 Z
DATE IS D
By
ministrative Authority
Telephone: (760) 777-7075
NdCT:ZT ZO/ZO/TO
The
A Gas
Company
6� Sempra Energy' a«ma-y
51223-085
4'M 6-66
54156-007 2'PEM
100' T
I
I
CALLE AZATLAN i
E
96-A-54156-007 I W
ti - -
i
I
62' i
14
o
I
54157-014
PCB MEGARULE
ABANDON PIPELINE SAMPLING
COMPLETED
PER GAS STANDARD 104.0042
INITIALS: DATE:
CHARGE LABOR TO MWO# 99300.000
Isolation Area Affected
Yes
❑
No
E
Pressure District Affected
Yes
❑
No
l3
Business District Affected
Yes
❑
No
El
Supply Line Affected
Yes
❑
No
EI
Regulator Station Affected
Yes
❑
No
❑
Valve(s) Required
Yes
❑
No
❑
FEET TRACT # 30125-1.
ua.w .wa ATLAS # IND 92 YEAR C.P. INSTALLED:
30 0 30 60 120 180 TAX CODE # 20-999
PE: YES El NO C�e.�� OPER. 20% OR OVER ❑ S.M.Y,
v_anorr�r�n._�tLCI.- _1.kinT _sL1FSS_THAN .2wi, 71S.M.Y.
PLAN FILE # BASE SKETCH CONSTIR SKETCH COMPL. °KETCH W.O. SHEET #
BY: GSA 01-02-02 BY: BY: O1 OF O1
44Co
\-` 3=, DR'
4i22o_ AV�� a,
/S6
u
r)c
EIJ P
ETS +141221-318
3'M 9-71 PIPING LEAK TEST (MEDIUM)
3.M TESTED AT: P.S.1.
❑ AIR ❑ NITROGEN ❑ OTHER
FOR: _ HRS. AND/OR _ MIN.
(GAS STANDARD #184.0150)
SIGN: DATE:
PRINT NAME/TITLE:
LOT H �/� GAS HANDLING WAS REVIEWED AND PERFORMED
AS PLANNED PER GAS STANDARD #184.06
'�►-...,.,.LOT 1 „7 NO ❑ YES ❑
+ IF NO PLEASE GIVE EXPLANATION TO LEFT
a SIGN: DATE:
PRINT NAME/TITLE:
V► i �-ANY CHANGES TO THE DESIGNED PIPE AND
COMPONENTS REQUIRES APPROVAL FROM
24 ` ,�C I i TECHNICAL SERVICES PLANNING.
�( IF CHANGES WERE MADE TO THE PLANS:
ENGINEER CONTACTED:
,�► l I ; 1 " = 60' URe DATE: _
LA QU I NTA FPA / PA:
DATE:
23
1 I N UPDATED TO R.E.R.:
\26 i. I I SOIL TYPE GROUP RED YELLOW GREEN
22 I I a (LA CIT'i' ONLY) 1 2 3
31' /
I � /Dw BACKF[Li_ TYPE:
21 I ` 6-yI/ ��,"� / USED ME:HANICAL COMPACTION Yes❑ No❑
E 7 �� /'��' JOINT TRENCH (TYPICAL)Yes❑ No❑
l- / / -
z L�--- - - - - -GASH
'F� - LTEL GAS - - - - _ _ El LCATV ELECTRIC ❑
TELEPHONE ❑
-
- - O-.POWER T.V. CABLE ❑
OTHER --
STUB SUMMARY
ALL STJBS ARE 2' UNLESS OTHERWISE POSTED
SHORT SIDE STUBS
LONG SIDE STUBS
FT. INSIDE PROP. LINE
FT. INSIDE LOT LINE
— / V THOMAS UIDE 849 F6
CITY OF LA QUINTA
PRESS. DIST. NO.
JY�)� DIST. PRESS. /MAOP: CC O SET/MOP: G/
/ I N
CLASS I.00ATiON ❑1 ❑2 ❑3 ❑4
a ISO MAI) NO.
SUPPLY LINE NO.
T SUPPLY LINE PRESS.
W
1 N REGULA70R STATION I.D.# / R.S.#
I ' VALVE(`.) REQUIRED Yes ❑ No[D
16 P I PEL INE MARKERS REQUIRED: Yes ❑ NoEl
IF YES SHOW LOCATION
�w ENVIRONMENTAL
rn a REQUEST FORM: Yes ❑ No[]
N Iv E.C.S. ISSUES: Yes[] No❑
M C.P. APEA N0.
C.P. CONTACT:
\ \ PHONE NO.
�\ \ THIS BLDG. OR AREA QUALIFIES
��\ \ FOR ANPIUAL LEAK SURVEY: Yes ❑ No❑
�l \ (POST LIMITS)
,r\ A PRE -JOB MEETING WILL BE HELD WITH A GAS
6,
COMPAN\, REPRESENTATIVE PRIOR TO THE START
OF ANY CONSTRUCTION. Yes[] No[]
REVIEWED BY PRINT NAME DATE
REG. E_NG.
TECH. SUP.
L.P.A.
90/4 kj
P. AF P . A . i / r:..
_ __. _.
- ��` D.O.M./P.M. � 5!
F . 0. S . / F . S .
��//��/.� �,I� /�� � �,,, � ""-�� � • Underground Service Al
ert
//
/zz. 151 _ Call Two Work i nq Days
c BEFORE YOU DIG
1-800-227-2600
� Q
�F'UND.;isis"', � Ticket #
PROD. 'P 37897 WR• # 1246043
EPOCH # RER.#
PJ ANNING PRINT
,cTOTAL FEET INST'D DATE MOVED NOTICE OF DATE MOVED COMPLETION
INSTALL MAiN WITH AT LEAST 3D N COVER BELOWL..TGy%%ECE/tg/,AOTAL FEET RETIRED ON JOB: OPER. DATE: OFF JOB: DATE:
COUNTY RIVERSIDE RETIREMENT REASON: PERMIT ISSUED BY' PERMIT #:
DISTRICT PALM DESERT ! 1 7 V CREW FOREMAN
COMPANY
PLED j3Y: THERN CALIFORNIA GAS COMPANY FACILITY: X❑
0 SOU
U STAKED ..........
STAKING REOWRED ❑ INLAND EMPIRE REGION
S' NO STAKES NEEDED W- 0O. # 54141-663 COST CENTER