4072 (2)NOTE: • — -
With proper validation
this form constitutes an
encroachment permit
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
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: 1/27/04 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 81805 Ave Juarez and Cille Sinaloa
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Paving Only Repair Sketch (attach construction lans if a p ppropriate)
DESCRIPTION OF CONSTRUCTION 3'X3"n LINX-
Calle Sinaloa Ill' W�aat of c4nter\1
DIMENSION Ok INSTALLATION OIL' REMOV
1 i
side R� 112�9'
SIZE OF EXCAVATION, IF NEEDEIJ I I
APPROXIMATE TIk1E WHEN WOR144WILL,BEGIN 2--29-04 1
i
APPROXIMATE TIME OF COMPLETION I
ESTIMATED CONSTR UCTION COST $ -
(Including removal ofVll obstruction) materials, and debris, backfillin j, com-
paction and placing permanent resurlacig and/or replacing ilmprove$nents)
In consideration of thigranting of this permit, the applicant hereby agrees to:
Indemnify, de?end a d save the C �y, its authorized agents, officers, reRresentatives ani
penalties, liabilitiesr loss resulting from claims or court action and a ising out of ai
happening or occurs g as a proximate result of any work undertaken der the perm
Notify the Administrative Authority at lest twenty-four (24) hours in fdvance of the
Comply with all applicable City (IrdinanA, the terms and conditions ofj the permit ar
La Quinta and to pay fqr any additional repl,ac,, ement sec sary as the result of this w
employees, harmless from afid against any and all
accident, loss or dams to persons or property
granted pursuant to t fs application.
ime when work wil a started.
all applicable rules and regulations of the City of
Signature of Applidant or Agent
Southern Califronia Gas; PO Box 3003; Redlands, CA 92373; 909--335-7963
Name of Applicant (please print) Business Address Telephone No.
A.M. Ortena►s 10125 Channel Rd; Lakeside, CA; 619-390-1988
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No.
04114
City Business License No.
Gag: Comvanv Self Insured
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
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
100.00
$ 100.00
Date
A 4072
PERMIT VALIDATION
PERMIT NO. A079
DATE APPROVED 1-28-04
EXPIRATION DATE 2--28--04
DATE ISSUED 4� 2A
By �`,�,r
Administrative Authority
Recorded by
Telephone: (760) 777-7075
v.�
NOTE: FINANCE
With proper validation Revenue Code —
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
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: 1/27/04 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 81805 Ave. Juarez and'Calle Sinaloa
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Paving Only: Repair Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION 3 `::3' in 3"m u. South side F,
Calle Sinaloa 121' W st of c nter ine of ve Juar
DIMENSION 0 INSTALLATION O fREMOV L
SIZE OF EXCAV AT ION, IF NEEDE
APPROXIMATE TI E WHEN WOR WILL EGIN 2-29— 4
APPROXIMATE TI OF COMPLE ION ' r
ESTIMATED CONST UCTION COS $
(Including removal of II obstruction ma rials, and debris, b kfillin
paction and placing p rmanent resu aci g and/or replacing i prove
In consideration of th granting of his ermit, the applica hereb
Indemnify,. defend• d save the Ci y, it authorized agents, o ficers, re
penalties, liabilities r loss resulti g fro claims or court ac ion and a
happening or occurri g as a proxi ate r suit of any work u dertaken
Notify the Administr ive Author. y at le st twenty-four (2 hours in
Comply with all appli ble City rdinance the terms and conditions o
La Quinta and to pay r any a ditional re cement nec ssary as the
, com-
ents)
agree
resenta
ising c
der tl
dvana
the F
r suit c
> to:
tives and employees, harmless from d against any and all
ut of an accident, loss or from/hid
to persons or property
ie permi granted pursuant to t s application.
of the :ime when work wil a started.
ermit an all applicable r s and regulations of the City of
IF this wo k.
Signature of App ' nt or Agent
Southern Califronia Gas; PO Box 3003: Redlands, CA 92373; 909-335-7963
Name of Applicant (please print) Business Address Telephone No.
A.M. Ortega; 10125 Channel Rd; Lakeside, CA; 619-390-1988
Name of Contractor and Job Foreman Business Address Telephone No.
496111
Contractor's License No.
04114
City Business License No.
Gas Company Self Insured
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement.Permit — Class 111
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 100.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 100.00
Receipt No.
Received by
Date
Ng 4072
PERMIT VALIDATION
PERMIT NO. 41717?
DATE APPROVED 1-28-04
EXPIRATION DATE 2-28-04
DA IS ED — Z7O
By
Administrative Authority
Recorded by II Telephone: (760) 777-7075
_ ; OTE - _- 4 t r /
h� With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT).��
For the construction • of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers l water mains
and other like public works improvements .in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit — Class III
DATE: 1/27/04 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 81805 Ave Juarez and Calle Sinaloa
1
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Pav1.nt- Onlv Repair Sketch (attach construction plans if appropriate) �" +
DESCRIPTION OF CONSTRUCTION13y1.3Yin 3"m e. South side �(1�R '� )�Z'�9
Calle Sinaloa 121~" W st of c4nter\l.ine of �A.ve Juar
DIMENSION O�FkINSTALLATION OR REMOVAL
L )
SIZE OF EXCAVATION, IF NEEDE
APPROXIMATE TIME WHEN WORK(WILL`I3EGIN �—
APPROXIMATE TIME OF COMPLE
ESTIMATED CONSTRUCTION COE
(Including removal ofUl obstructior
paction and placing permanent-resu
In' consideration of the granting of
Indemnify, defend. and save the C
penalties, liabilities .M loss resulti
happening or occurring as a proxi
Notify the Administra
Comply with all appli
La Quinta and to pay
ble City
pr any i
;ION
f1. matl
aclnl
This P
Iy, its
g fro
late r(
yatli
•a1.1 rn
itional
rials, and debris, bab kfillind, com- /
and/or replacing improvements)
)rmit, the applicant hereby1 agrees to:
authorized agents, officers, representatives and employees, harmless from �nd against any and all /
i claims or court action and. arising out of an accident, loss or damage to persons or property
sult of any work urr�ldertaken u�,nder the permi , granted pursuant to th�fs application.
t twenty-four 12%4') hours in �dvance of the time when work will be started.
es,�the terms and of, the permit ani all applicable rules and regulations of the City of
replacement nece//ssary as the result of this work.
Signature of Appl:ieant or Agent
Southern Oalifronia Gas; PO Box 3003; Redlands, CA 92373; 909-335-7963
Name of Applicant (please print) Business Address Telephone No.
A.M. Orteea; 10125 Channel Rd; Lakeside, CA; 619-390-1988
Name of Contractor and Job Foreman Business Address Telephone No.
/AA61111
Contractor's License No.
04114
City Business License No.
Gas Cotnnany Self Insured
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 '
100.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 100.00
Receipt No
Received by Date
4072
PERMIT VALIDATION
PERMIT NO. An77
DATE APPROVED 1-28-04
y -EXPIRATION DATE 2--28-04
DATE ISSUED` J-2Z_j4A
Administrative Authority
Recorded by
Telephone: (760) 777-7075
NOTE:
With proper validation
this form constitutes an
encroachment permit
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
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
`, t ' K,'
DATE: -
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION -' =
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION �� "�°"' �� �'' �"
Sketch (attach construction plans if appropriate)
DESCRIPTION OF, CONSTRUCTION ' \r
DIMENSION OF INSTALLATION OR' REMOVAL
SIZE OF EXCAVATION, IF NEEDED i
rye
APPROXIMATE TIME WHEN WORK'WILL BEGIN
APPROXIMATE T14E 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 occurri%g as a proximate result of any work undertaken d,nder the permit, granted pursuant to this application.
Notify the Administrative Authority at leest twenty-four (24) hours in advance of *the time when work wi kbe 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. f�
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 License No.
City Business License No.
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class II I
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
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE - `"�' A-0
DATE ISSUED
By
Administrative Authority
Recorded by
Telephone: (760) 777-7075
NOTE:
With proper validation
this form constitutes an
encroachment permit
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
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
DATE
1/27/0+4
Subdivision Improvement Permit — Class I I I
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 81005 Ave Juarox and C4110 ULnal.oa
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Pa'vinn Only Aopoir Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION ".3 2g' fsogii3 tsac:r
Cairo �f.ivaloc tii ugo-r or coneorNixnc of Ave .
DIMENSION OF INSTALLATION OR REMOVAL t
1t f i i
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN"
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(Including removal oflall obstruction' materials, and debris, backfiIIing, com-
paction and placing permanent resurfacing and/or replacing improvements) {
In consideration of the t 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.
' f
Comply with all applicable City Ordinance's, the terms and conditions of the permit and all applicable rulend regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result of this work.
Signature of Applicant or Agent
Southara ColiProniaa Gnn# PO Box 3003; tludlcn4c, CA 92373; 909-335-7963
Name of Applicant (please print) Business Address Telephone No.
A.rL Ortoro; 10125 Chn-anol 11d; Lahuclido. CA; 619--SOO-1980
Name of Contractor and Job Foreman Business Address Telephone No.
486311
Contractor's License No.
Goo Co:nVcnp Solt Insured
04114
City Business License No.
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit —Class Ill
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:
$
100.00
$ IGO.00
Receipt No.
Received by Date
fi t 072
PERMIT VALIDATION
PERMIT NO. 6072
1.20-04
DATE APPROVED
�--2C-04
EXPIRATION DATE
DATE ISSUED `
By
Administrative Authority
Recorded by 11Telephone: (760) 777-7075
Routing
Path
m
0
I
L�J
I
FE-1
i•1
" city'"'f -a uin anCheckFf2eview(White)
o
Q ta`
Final.Review (Green) Y k ,PublicWos nf 6y
`PLAN APPROVAL / REVISION REVIEW Plan Re eived By iv:
Protect Name: %
9w5 DIN:
"� of Description:
Pla��}},,Check Round
t��// 1 2 3 /4t 5 6 7 8 9 10
City's Consultant Approval Date:
DIRECTOR
Tim Jonasson, Public Works Director
Needed By:
[ ] Approved [ ] Rejected
Signed On:
Comments:
ENGINEERING
Steve Speer, Assistant City Engineer
Needed By:
[ ] Approved [ ] Rejected
Signed On:
Comments:
DEVELOP114ENT
Paul Goble, e n er
Needed By:
[ ] Approved [)(Rejected
Signed On: ,D
Comments:
DEVELOPMENT
Brian Ching, Associate Engineer
Needed. By:
[ J Approved [ ] Rejected
Signed On:
Comments:
DE LOPMENT
Tkqy Co i, Assistant Engineer I
Needed By:
[LyApproved [ ] Rejected
I Signed On:
Comments:
MA T & OPERATION
James Lind se , Maintenance Mana er
Needed By:
Approved [ ] Rejected
Signed On:
Comments:
BUILDING & SAFETY
Greg Butler, Building Mana er
Needed By:
[ ].Approved [ ] Rejected
Signed On:
Comments:
COMM DEVELOPMENT
Oscar Ord, Interim Director
Needed By:
[ ] Approved [ ] Rejected
Signed On:
Comments:
PCLOADMFSI\PUBWRKSIPWDEPTD=TORMSXFO05.dx - I PLAN CHECK NUMBER: