3820�iLFNOTE '
st: 2
. With proper validation Y .
trpachment
•fdrrn constitutesanpermit CITY- OF LA . QUINTA U
APPLICATION 'FOR 'PERMIT:
.. PUBLIC WORKS CONSTRUCTION (ENCROACHMENT).
OF
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
+
r` 2003 Subdivision Improvement Permit — Class III
;r DATE: January 10, Minor Improvement Permit Class IV
�I ?LOCATION OF COIVSTRUCTION The Gas Company hereby applies for A blanket to do routine main and
c` service maintenance of gas fraciiitie4 within the city limits of La quinta -tram
r
. ! 9..1.:?I�If1� tl�rrax:l�••�1.,?n,Q� tin �n.xxt G srm }x+w11 ixo1A nR nOrAi'aaartir at e:%kr•1Q11a 1ncatCAinxt1q
(Street addressor Description of Location) and make necessary street repairs.
PURPOSE OF. CONSTRUCTION UOR 18" Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION **See attach6d spocia:l. conditions**
DIMENSION OF INSTALLATION OR REMOVAL
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,.backfill ing, com-
paction and placing permanent. resurfacing and/or replacing improvements)
is
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 piropefty-
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.
Chris Conzonire
Signature of Applicant or Agent YtCN ..JI etCUl ��
•• Southem California G4.a 'Co. , Y.O. Box 30.03, Redlands, CA '92373 (909) 335-4879
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: 'SubdivisionImprovement Permit — Class 11.1
Public improvements: 3% ofestimated construction costs
Private improvements: 3% of.estimated construction costs
Minor Improvement Permit —Class IV: See attached schedule j"g, 38.0
Inspection. Fee $ PERMIT VALIDATION
Permit Fee PERMIT NO. 'Ho. 3820
Penalty January 14, 2003
Cash Deposit -Surety Bond DATE APPROVED
if required EXPIRATION DATE January 14, 2004
TOTAL: $
DATE ISSUED
Receipt No:. .".} Victor Mopz# Assistant .Engineer I
BY`
. Received by Date ��'�%��./ Administtative Authority
Recorded by r Telephoner (760) .7T/7-7075 .
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r y DEC 10 2002 ' + .
�' rr VIR ;1
BLANKET FOR, 2003 `
` K ftxrw aao an —~
CITY Op, t A 1�lIIyTA ,
• r , APPLICATION FOR FERMiIT,-
` PuBL,IC WORKS CONSTRUCTION IFNCiROtACmMENT)
' E Fat tho awwwuctdah Of 'Pudic Or privM eurbs. drK*a*Yr. pr*wr wmL ti m*iko, OO tL Irw erraort. aPtt► morph$ ~ , -y ,r
ouur Glso pYb1iC warts IlhtpTCt�getrhti inw --A iMPROVEMINTS and APPROVED $U8OIVtS*
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,
DATE: 12-3-02 - SebdA, dm I�nt�ammm�epprltit PPwRit - CI= III'
1F bl k
LQCATIONDI<CQNSTRIKiION The Gas Compan�r heteby applies for a an et y
! do routine main and service main en fac'.i i s within the ci zmics n uln a.' '
rt ,, 1 �- i -'T.00 tin c.ii� r 4-�- as neces�a 6yvari 7 caa i us
Ukwmodaa.paQaaf rtpMtaattttxM and make necessary street repairs. • u
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PIJRP06E OF.COAISTRUCTIOPI BLANKET b'OR• 20U3 WOUA 14ttadt amnaftctimn D1wn if apoprtaorl `
DEScairTIGN OF CON"RUC'TION
EDDIM04ION OF INSTALLATION OR REMOVAL t , .
SIZE OF EXCAVATION, IF N$E9ED eve a 44: rr'
,�L?•G 8 i✓C5 f
APPROXIA$ATS TINA WtIEN WORK WILL MIN $L -7 u6��/lT
' APPROXIMATE TIME OF CO,MPUMON i •%1; W' "" C
,`�►' `oo r
ESTIMATED COPISTRI.XTION COST i
' (Im*Airy to n*W of Ni danKtion, wawiafllr: "Oft -
In comidwation of rise wm" of this pmnf,t tM mpdiatn$ hm W r aw to: ;
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rnrarnnifr. gram aid rarw oa C,fy. ha mptaerWi awwL gawam lvmuwmKkm "d arnrloaow hwwd m tram a,a ptt im onp uq all
parr 168 r:d AAS or loot .od" frawr Ouija or mare t+cum ww OW0 ow of any OwdLK. rom or , e to WWII* or trt ow" _.
Nmemlow IN M.- il0 as a pm"WA tw "m of arb ,rwa wmwto oa Wogs Oar Owa Uwe ONVA +tor w *0 spp:wNm• `
Notify ore Arno" atMko AKtlrmlry ar 400 arntty rar t241 antra it adww of 00 tWm ,aRoa wort .art tw t MIL
Comov rate° As attat=Wo C11v Or4au m% err 0 N aer Mmdlwa of am arpraN mW art 406o " poem of aro of f
to 0"ft ad a par for mr addmb tra0 truuarmr as Go 4tla pA has aagt.
Chris ? 'ononire _
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'Inandion Fee S PERMIT -VALIDATION
PrrmitFcs tr_
y PERMIT NQ I 1-jr
Codh Daooait.Suraq BondDATE APPROVED `? �
if nmWkW E"tAATION OA.
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TOTAL r . $ DATE I ED� lfi�-r" l >-a
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