3888CONSTRUCTION ACTIVITY SUMMARY
WORK BY SPECIAL
YR D MO /� DATES: LO thru 2-* WORK
MON TUE WED I THU I FRI SAT SUN NITE
RA IC CONTROL
TEMPORARY TRAFFIC
T RARY T
Conforming implementaton
Non -conforming implementation
T C DUS ONTROL
.............................. ......... ......... ...................
Onsite Measures
Conforming implementaton
Non -conforming implementation
le Track -out Cleanup
P
..................
Conforming implementaton
Non -conforming implementation
GRADING
Clearing & Grubbing
Earth Moving: Cut & Fill
Fine Grading
Compaction Testing/Reports
ST
REET IMPROVEMENTS
C&G
SUBGRADE
AGGREGATE BASE
AC - BASE LIFT
AC - CAP
STRIPING & SIGNS
TRAFFIC SIGNAL
Compaction Testing/Reports
Material Certifications
AC Design Mix
WATER IMPROVEMENTS
MAINS r=7 I
LANDS APIN C G
MEDIAN
PERIMETER
1-13U 04/02 Page 2 of 2
I
NOTE:
Withpropervalidation
this for m constitutes an
encroachment permit
CITY OF LA. QU:INTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION. (ENCROACHMENT)
For the 'construction 'of public or private curbs, driveways, pavements, sidevvalks, parking lots,- sewers,. water mains
and' other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
'Subdivision Improvement Permit —Class I'l I
DATE:. April 2, 2003 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Santa Rosa Plaza TR #29909
(Street address or Description of Location)
n)
PURPOSE OF'CONSTRUCTION Gas Main and Services Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
SEE ATTACHED
DIMENSION OF. INSTALLATION OR REMOVAL
SIZE &.'-EXCAVAT'ION,,IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 4/11/03
APPROXIMATE TIME OF COMPLETION 4/22/03
ESTIMATED CONSTRUCTION COST$
(Including,remova'l of -all obstruction, materials; and debris; backfilling, com-
--paction and placing permanentresurfacing and/or- replacing improvements)
In consideration of the granting of this perilit, the applicant hereby agrees to:
lndemhify,,d6fend- and save the City, its authorized agents, officers, representatives and employees, harmless from and against any arid'all
penalties, liabilities.or loss resulting from claims or court action and-arising.put 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 Auth6rity it 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 re u'lations of the. City of
La Quinta and to, pay for any additional replacement, necessary as the result of.this w(57r-*
Signature of Applicant or Agent
So'.- Calif Gas Co. 75095 Mayfair, Palm Desert 7661346-4248
Applicant (please print) Name of Business Address Telephone No:
-
Name 'of Contract& 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- 3888
'Inspection Fee - $ PERMIT VALIDATION
Permit Fee
PERMIT NO. 3888
Penalty DATE APPROVED. 4/9/03
Cash Deposit -Surety Bond
if required
TOTAL: $ No Fee
Receipt No.
Received by Date
Recorded by
EXPIRATION DATE 4/30/04
.._DATE ISSUED
By
i cam' 'dMinistrativiiA6thority
ka'oul-Maitinez, Asloistaftt.Engineer II
TeIephone: (760) 777-7075
M
NOTE:'
With proper validation rt 2
this -form constitutes an O
CITY OF LA •QUINTA
encroachment permit -
APPLICATION FOR PERMIT ;
PUBLIC- WORKS, CONSTRUCTION- (ENCROACHMENT) wSw�ti ,
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
DATE: AOril 26 2003 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Sa"4 R08a Plaza TR #29909.
It/t? 41A 4
(Street address or Description of Location)
Gas u and Services p appropriate)
PURPOSE OF CONSTRUCTION ' 'Sketch .(attach construction plans if a
DESCRIPTION .OF•CONSTRUCTION - SEE ATTAC99D
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APP•ROXIMATE`TIME WHEN WORK WILL BEGIN
' APPROXIMATE TIME OF COMPLETION 4/22/03
ESTIMATED. CONSTRUCTION COST $
(Including.re,moval 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:
r_ IndemnifV,,'. end•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 avroximate result of any work undertaken under the permit granted pursuant to this application. .
Notify the Administrative Authority at least tweniy-four.(24) hours in advance, of the time wlien work will be started:
-e..
Comply with all applicable City Ordinances, the terms' and conditions of the permit and all applicable rules and gulations of the City of
La Quinta and,to pay for any additional replacement necessary as the result of this r .
Signature of Applicant or Agent
SO, Calif Cae • Co. 75095 Mayfair$ PaI n Dessert 760-346-424.8
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
is Minor, Improvement Permit — Class IV: See attached schedule
Inspection Fee' $ PERMIT VALIDATION
Permit Fee PERMIT NO. • 3888..
a
Penalty DATE APPROVED. 4/9/03
A, Cash Deposit -Surety Bond-
-,'if required EXPIRATION DATE 4/30/04 '
TOTAL $ O. Nct dam
DATE ISSUED
Receipt No.
Received by Date I. i t. �Athor,ityA•
cbul int Fnginoe' IIs�i. Recorded by Telephone: (760)' 777-7075
i
r r,. ..•c''"i;'� �� ' �.— ..—.— ��Yi ��"'7 iad�i+YX� `. �y�,ny'�'�y1•��'�rFC: —• ---. .__...—'---•'�--:-- -----,—..—
C
'A
NOTE:
With proper validation Q'
O
this form constitutes an
encroachment permit CITY .OF' LA QUINTA
APPLICATION FOR PERMIT $s
PUBLIC WORKS .CONSTRUCTION (ENCROACHMENT)�� IYn,Sw�ir,
OFF
For the construction of public or'!private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains
and other likepublic works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
k 4' Subdivision Improvement Permit — Class
DATE:' APill ,20 2003 Minor Improvement Permit Class IV
' LOCATION OF�CONSTR jUCy�TION jt �r�^ i g
7 );,�.`3' 2rw-• r, i. ih�.e- ' In V. -'I'' x hlee"? d Y ,f ti- .l 11 - k :} �•Ae �i. !All , - -
(Street address or Description of Location) '
Qfm Mal p appropriate)
PURPOSE OF -CONSTRUCTION Sketch la'ns if a (attach construction
DESCRIPTION OF CONSTRUCTION
SHE ATTAIMED
DIMENSION OF INSTALLATION' OR :REMOVAL ,
SIZE OF EXCAVATION, IF NEEDED
' APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION 4122/03
ESTIMATED'CONSTRUCTIONCOST$;
(Including, removal of all obstruction,. materials, and debris, backf'illing, com
paction.and placing permanent resurfacing and/or replacingimprovements)
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 actionand 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 .wk.
Signature of Applicant or Agent
Name.of Applicant (please print) Business Address Telephone No.
Name'of, Contractor and Job Foreman Business Address Telephone No.
Contractor's. L'icense'No. City Business. License No.
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit - Class I I I
Public improvements: 3% of.estimated construction costs
Private improvements: 3% of estimated construction costs./w
Minor. Improvement Permit— Class IV: See attached schedule �� 0W .
v.
Inspection Fee $` PERMIT- VALIDATION '
Permit Fee PERMIT NO. 38
Penalty 4%9./63
DATE APPROVED.
Cash Deposit -Surety Bond % r
>. if required EXPIRATION ,
EXPIRATION DATE
0 go
.TOTAL: DATE ISSUED
R
p ecei t No. By rs`�'
Received by Date�,,,, Administrative Authority
Recorded by Telephone: (760) 777-7075:
�i
Isolation Area Affected Yes ❑ No I
Pressure District Affected Yes ❑ No V
Business District Affected Yes ❑ No 5Cl
Supply Line Affected Yes ❑ No IT
Regulator Station Affected Yes ❑ No
Valve(s) Required Yes ❑ No [
Reviewed By:
C. P. Reviewed By:
PLAN FILE # BASE SKETCH CONSTR. SKETCH COMPL. SKETCH W.O. SHEET #
LY:BGY 03-27-03 BY: BY: 01 OF 01
PARCEL# 7753
F
Man
o PIPING LEAK TEST (MEDIUM)
» TESTED AT: P.S.I.
❑ AIR [-]NITROGEN ❑ OTHER
FOR: HRS. AND/OR MIN.
(GAS STANDARD #184.0150)
SIGN: DATE:
PRINT NAME/TITLE:
GAS HANDLING WAS REVIEWED AND PERFORMED
AS PLANNED PER GAS STANDARD #184.06
NO ❑ YES ❑
IF NO PLEASE GIVE EXPLANATION TO LEFT
SIGN: DATE:
PRINT NAME/TITLE:
ANY CHANGES TO THE DESIGNED PIPE AND
COMPONENTS REQUIRES APPROVAL FROM
TECHNICAL SERVICES PLANNING.
IF CHANGES WERE MADE TO THE PLANS:
ENGINEER CONTACTED:
DATE:
FPA / PA:
DATE:
UPDATED TO R.E.R.:
SOIL TYPE GROUP RED YELLOW GREEN
(LA CITY ONLY) 1 2 3
BACKFILL TYPE:
USED MECHANICAL COMPACTION Yes ❑ No ❑
JOINT TRENCH (TYPICAL)
Yes ❑ No❑
—-----GAS��
a
\� z TEL GAS - - - - -- ❑
CATv ELECTRIC-- ❑
TELEPHONE ❑
'P0WERi T. V. CABLE ❑
OTHER - - --
❑
STUB SUMMARY
ALL STUBS ARE 2' UNLESS OTHERWISE POSTED
SHORT SIDE STUBS
LONG SIDE STUBS
FT. INSIDE PROP. LINE
FT. INSIDE LOT LINE
THOMAS GUIDE 849 F7
CITY OF LA QUINTA
PRESS. DIST. NO. 5/10 g y
DIST. PRESS./MAOP: _C0_ SET/MOP:e_/.S�
CLASS LOCATION ❑ 1 ❑2 I 3 El
1 ISO MAP NO. 411.-1-3 4
SUPPLY LINE NO.
SUPPLY LINE PRESS.
REGULATOR STATION I.D.# / R.S.#
VALVE(S) REQUIRED Yes ❑ No ❑
PIPELINE MARKERS REQUIRED: Yes ❑ No ❑
IF YES SHOW LOCATION
ENVIRONMENTAL
REQUEST FORM: Yes ❑ No ❑
E.C.S. ISSUES: Yes ❑ No ❑
C.P. AREA NO.
C.P. CONTACT:
PHONE NO.
THIS BLDG. OR AREA QUALIFIES
FOR ANNUAL LEAK SURVEY: Yes ❑ No ❑
(POST LIMITS)
A PRE -JOB MEETING WILL BE HELD WITH A GAS
1 COMPANY REPRESENTATIVE PRIOR TO THE START
OF ANY CONSTRUCTION. Yes [_j No ❑
REVIEWED BY PRINT NAME DATE
REG. ENG.
TECH. SUP.
- - P.A./F.P.A.
D.O.M./P.M.
F.O.S./F.S.
Underground Service Alert
gEfORE yQ
Q o
Call Two Working Days
c, o
Z
S
BEFORE YOU DIG
AUj 1-800-227-2600
9 v
o9OGNp SE L Ticket
#
PROJ. # 5174 �. WR• # 1340957
EPOCH # RER.#
santaplaza.pld
TOTAL FEET INST'D
% DATE MOVED NOTICE OF DATE MOVED COMPLETION
INSTALL MAIN WITH AT LEAST 30 COVER BELOW J,: (;`°�`��'� tOTAL FEET RETIRED ON JOB: OPER. DATE: OFF JOB: DATE:
COUNTY RIVERSIDE RETIREMENT RE, .ON: PERMIT ISSUED BY: PERMIT #:
DISTRICT PALM DESERT —..
TRACT # 29909 CREW FOREMAN
ATLAS # IND 92. 102 — — COMPANY
YEAR C.P. INS]-,`.LLED: PLANNED BY` -
TAX CODE # 20-999 L STAKED.......... ❑ SOUTHERN CALIFORNIA GAS COMPANY FACILITY: XD
PE: YES NO El STAKING REQUIRED ❑ EAST REGION _
OPER. 207 OR OVER [ �S.M.Y.S. �79,
CATHODICALLY PROTECTED: YES NO AT LESS THAN 20 [-JIS.M.Y. NO STAKES NEEDED W.O.# 54142-916 COST CENTER
Isolation Area Affected Yes ❑ No I
Pressure District Affected Yes ❑ No V
Business District Affected Yes ❑ No 5Cl
Supply Line Affected Yes ❑ No IT
Regulator Station Affected Yes ❑ No
Valve(s) Required Yes ❑ No [
Reviewed By:
C. P. Reviewed By:
PLAN FILE # BASE SKETCH CONSTR. SKETCH COMPL. SKETCH W.O. SHEET #
LY:BGY 03-27-03 BY: BY: 01 OF 01
PARCEL# 7753
F
Man
o PIPING LEAK TEST (MEDIUM)
» TESTED AT: P.S.I.
❑ AIR [-]NITROGEN ❑ OTHER
FOR: HRS. AND/OR MIN.
(GAS STANDARD #184.0150)
SIGN: DATE:
PRINT NAME/TITLE:
GAS HANDLING WAS REVIEWED AND PERFORMED
AS PLANNED PER GAS STANDARD #184.06
NO ❑ YES ❑
IF NO PLEASE GIVE EXPLANATION TO LEFT
SIGN: DATE:
PRINT NAME/TITLE:
ANY CHANGES TO THE DESIGNED PIPE AND
COMPONENTS REQUIRES APPROVAL FROM
TECHNICAL SERVICES PLANNING.
IF CHANGES WERE MADE TO THE PLANS:
ENGINEER CONTACTED:
DATE:
FPA / PA:
DATE:
UPDATED TO R.E.R.:
SOIL TYPE GROUP RED YELLOW GREEN
(LA CITY ONLY) 1 2 3
BACKFILL TYPE:
USED MECHANICAL COMPACTION Yes ❑ No ❑
JOINT TRENCH (TYPICAL)
Yes ❑ No❑
—-----GAS��
a
\� z TEL GAS - - - - -- ❑
CATv ELECTRIC-- ❑
TELEPHONE ❑
'P0WERi T. V. CABLE ❑
OTHER - - --
❑
STUB SUMMARY
ALL STUBS ARE 2' UNLESS OTHERWISE POSTED
SHORT SIDE STUBS
LONG SIDE STUBS
FT. INSIDE PROP. LINE
FT. INSIDE LOT LINE
THOMAS GUIDE 849 F7
CITY OF LA QUINTA
PRESS. DIST. NO. 5/10 g y
DIST. PRESS./MAOP: _C0_ SET/MOP:e_/.S�
CLASS LOCATION ❑ 1 ❑2 I 3 El
1 ISO MAP NO. 411.-1-3 4
SUPPLY LINE NO.
SUPPLY LINE PRESS.
REGULATOR STATION I.D.# / R.S.#
VALVE(S) REQUIRED Yes ❑ No ❑
PIPELINE MARKERS REQUIRED: Yes ❑ No ❑
IF YES SHOW LOCATION
ENVIRONMENTAL
REQUEST FORM: Yes ❑ No ❑
E.C.S. ISSUES: Yes ❑ No ❑
C.P. AREA NO.
C.P. CONTACT:
PHONE NO.
THIS BLDG. OR AREA QUALIFIES
FOR ANNUAL LEAK SURVEY: Yes ❑ No ❑
(POST LIMITS)
A PRE -JOB MEETING WILL BE HELD WITH A GAS
1 COMPANY REPRESENTATIVE PRIOR TO THE START
OF ANY CONSTRUCTION. Yes [_j No ❑
REVIEWED BY PRINT NAME DATE
REG. ENG.
TECH. SUP.
- - P.A./F.P.A.
D.O.M./P.M.
F.O.S./F.S.
Underground Service Alert
gEfORE yQ
Q o
Call Two Working Days
c, o
Z
S
BEFORE YOU DIG
AUj 1-800-227-2600
9 v
o9OGNp SE L Ticket
#
PROJ. # 5174 �. WR• # 1340957
EPOCH # RER.#
santaplaza.pld
TOTAL FEET INST'D
% DATE MOVED NOTICE OF DATE MOVED COMPLETION
INSTALL MAIN WITH AT LEAST 30 COVER BELOW J,: (;`°�`��'� tOTAL FEET RETIRED ON JOB: OPER. DATE: OFF JOB: DATE:
COUNTY RIVERSIDE RETIREMENT RE, .ON: PERMIT ISSUED BY: PERMIT #:
DISTRICT PALM DESERT —..
TRACT # 29909 CREW FOREMAN
ATLAS # IND 92. 102 — — COMPANY
YEAR C.P. INS]-,`.LLED: PLANNED BY` -
TAX CODE # 20-999 L STAKED.......... ❑ SOUTHERN CALIFORNIA GAS COMPANY FACILITY: XD
PE: YES NO El STAKING REQUIRED ❑ EAST REGION _
OPER. 207 OR OVER [ �S.M.Y.S. �79,
CATHODICALLY PROTECTED: YES NO AT LESS THAN 20 [-JIS.M.Y. NO STAKES NEEDED W.O.# 54142-916 COST CENTER