4119With pfoper validation
this form constitutes an r 'CITY OF LA QUINTA
encroachment permit 1,
APPLICATION ' FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)��
OF IE�9
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
i
Subdivision Improvement Permit— Class III
{ DATE: 3/22/04 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 50920 Calle Pal.oma / Calle Tampico WR# 1420019
r (Street address or Description of Location)
PURPOSE OF',CONSTRUCI.ION New•bueineaa main', OC of t7«; r �Sketc°h"(a.tach construction plans if appropriate)
DESCRIPTION OF CONST UCTION Pi 11 MA rAnnir5-
DIMENSION OF INSTALLATION OR REMOVAL 14'xV a d 4"
A IV x2' 4/0 AC .
- I
E V T SIZE 0F XC ' A ION IF NEEDED �
1 i
APPROXIMATE TIME WHENjWORK ;ILL BEGIN �� r
4 r
G' APPROX,IMATE T ME.OF COMPLETION -
ESTIMATED CONSRUCTION COST
(Including removal of�all obstruction, materials, and'debris, backfilling; com-
paction and placing �ermanent resurfacing and/or replacing improver nts)
In consideration of 'the, granti lg of this\pirmit, the applican�t hereby agrees to:'
Indemnify,.defend• a d save the City, iuthorized agents, officers, representatives and a ployees, harmless from and against any and all
penalties, liabilities o loss t
iiiiiisulting from1claims or court action and arising out of 'any ccident, loss or damage_ to persons or property
'4
happening or occurring as a roximate resin of any work undertaken and r the permit ranted pursuant to this application.
Notify the Administrate Alhority at least t enty-four (2fl) hours in advance of the the wherf/work •will be started..
Comply with all applicabFV ity Ordinances, the t rms_,,,•and conditions of the permit 'and'all app icable rules and regulations of the City of
La Quinta and to pay for any•additional replacement necessary as the result of this work.
0
Signature of Applicant or Agent
The.Gas Company; PO Box 3003 Redlatads CA, 92373; 909--335-7879
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 $ NA
Permit Fee 100,00 II
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 100.00
Receipt No:
Received by Date
Recorded by
4119
PERMIT. VALIDATION
PERMIT NO. 4119
DATE APPROVED 3/23/04
EXPIRATION DATE
DATE ISSUED��'"`
By
Administrative Authority
Telephone: (760) 777-7075
FINANCE
Revenue Code
NOTE:
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, water mains
and other like public works improvements. in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit — Class I I I
DATE:_3/22/04 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 50920 Calle- Paloma / Calle Tampico WR# 1420019
(Street address or Description of Location)
PURPOSE OF CONSTRUCVION New business'main ,
DESCRIPTION OF CONST UCTION
Q
DIMENSIO OF INSTALLA ION OR
r n
1EMOVAL ' 2' a 4"
SIZE OF EXC NATION, IF EEDED
APPROXIMATE IME WHEN WORK
ILL BEGIN
APPROXIMATE T E OF CO PLETI
ESTIMATED CON RUCTIO COST
(Including removal o all obstr ction, m
paction and placing rmanen resurfaci
In consideration of'th granti of this
N
terials, and debris, b ckfilling, com
g and/or replacing mprovem nts)
ermit, the applica hereby ree
to:
Indemnify, defend a d save he City, its uthorizejagents, ficers, repre ntatives and epenalties,liabilities o loss suiting'from laims oon and arisi g out of any chappening or occurrin as a roximate resu of anertaken and r the permitNotify the Administrati e A thority at least t enthours in ad nce of the ti EComply with all applicab ity Ordinances, the tnditions of the permit ands II
La Quinta'and to pay for any additional replacement necessary as the result of this wo
construction plans if appropriate)
floyees, armless from and against any and all
:ident, I ss or damage to persons or property
nted p rsuant to this application.
whe work will be started.
app cable rules and regulations of the City of
Signature of Applicant or Agent
The Gas Comvanv: PO Box 3003 Redlands CA, 92373-, 909-335-7879
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 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 $ NA
Permit Fee 100.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: 1$ 100.00
Receipt No.
Received by Date"
Recorded by
,NS 4119
PERMIT VALIDATION
PERMIT NO. 4119
DATE APPROVED 3/23/04
EXPIRATION DATE
DATE ISSUED
By,
Administrative Authority
Telephone: (760) 777-7075
NOTE YV
�+
With proper validation Q'
this form constitutes an �" �..
encroachment permit a CITY, OF -L'A QUINTA
APPLICATION 'FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT).��
` 0F�
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] ll''
DATE: . 3/22/04 Minor Impr1. ovement Permit Class IV
LOCATION OF CONSTRUCTION 50920 Calle Palma / Ca11e Tampico WR# 1420019
(Street address or Description of Location)
I' PURPOSE OF'CONSTRUCTION 'New busiiness main t�C' 1 (?a r ^S`c`hya• tach construction plans if appropriate)
DESCRIPTIONOFCONSTAUCTION P�isi�a rcnair�_
DIMENSION OF INSTALLATION OR .R+EMOVAL WxV a1A 4"
SIZE OF EXCAVATION, IF EEDED 1
'4 APPROXIMATE `IME WHENWORK ALL BEGIN
j APPROXIMATE T))ME OF COMPLETION l
ESTIMATED CONSTRUCTION COST
(Including'removal o�all obstr'ction, m�terials, and debris, backfilling,com
action and placing ermanen resurfaA and/or replacing'I'm rovements
P P 9P g. P 1
•n
In consideration of th granting of this �ermit, the applicank hereby grees to:
Indemnify,. defend and save he City, its authorized agents, officers, representatives and a ployees, harmless from and against any and all
j penalties, liabilities or loss fsulting from claims or court ac-ion and arisIg out of any.accident, loss or damage to persons or property
i
happening or. bccurrin�j as aroximate resu t�of any .work',uldertaken und`r the permit anted p�rsuant to this application.'
Notify the Administrati a A�thority at least tv�enty-four �4//////) hours in advvnce of the tirlihe when .work will be'started.
Comply with all applic\ ' Grity Ordinances, the tterms_and conditions of the permit and 'all applicable rules and regulations of the City of
If w - 1
La duinia and to pay for any additional replacement necessary as the result of this work.
II.
t 1
` Signature of Applicant or Agent.
The Gas ComAanv ; PO Box 3003 Redlands CA, 92373; 909-335-7879
Nam f e o Applicant (please print) Business Address Telephone No..
Name of Contractor and Job Foreman Business Address Telephone No. y
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 Pill 0 411.9
A d,
Inspection Fee $ NA PERMIT VALIDATION
Permit Fee 100.00 PERMIT NO. 4119
Penalty
Cash Deposit -Surety Bond
if.required .
TOTAL:' $ 100.00R
Receipt No.
Received by Date
Recorded by r
DATE'APPROVED 3/23/04
EXPIRATION DATE
:DATE ISSUED`**""'
By
Administrative Authority
Telephone: (760) 777-7075
f
NOTE:
With p,Foper 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 I
DATE: 3/22/04 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 50920 Cmlle Palma / Caile Tamp7lCo W.# 1420019
(Street address or Description of Location)
PURPOSE OF'CONSTRUC TION bu �� i Set h`�(a,ttach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION ?A*Vinrr\xanaira. )
DIMENSION OF INSTALLATION OR.FiEMOVAL 14'22 aid 4"
A181W 4o' �C i ; )
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATEtTIME WHENIWORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTIO l COST $� 4
(Including removal of all obstruction, materials, and debris, backfilling com-
paction a'nd placing permanents' resurfacing and/or replacing improvements)
In consideration of the �granti Ig of this permit, the applicarrh hereby agrees to: }
Indemnify,. defend, and save the City, its authorized agents,. officers, representatives and employees,
penalties, liabilities or esulting fromNclaims or court'act�ion and arising out of any Iccident,
happening or occurri A as a, proximate result of any work undertaken under the permit granted p
Notify the Administrate a Authority at least 'twenty-four (2 1 hours in advance of the time when/
i.
Comply with all applicable City Ordinances, the t rms„and conditions of the permit and all appl ca
La Quinta and,to pay for any additional replacement necessary as the result of this work. . f/
Harmless from and against any and all
loss or damage to persons or property
ursuant to this application.
work will be started.
ble rules and regulations of the City of
Signature of Applicant or Agent
Tire Gas. Cotpamy; PO Box 3003 Redlands CA, 92373; 909-335-7579
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 111
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule liE�, �.g
+a ", .11�
19
Inspection Fee $ NA PERMIT VALIDATION
Permit Fee IOObOi!
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 00.00
Receipt No.
Received by Date
�119
PERMIT NO.
DATE'APPROVED 3/23/04
EXPIRATION DATE
DATE ISSUJE'D`
By
Administrative Authority
Recorded by
Telephone: (760) 777-7075
�-1
.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 id -connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit — Class II I
DATE: 3/22/04 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 30920 Ccellt Pa loma Call* Tampico WRO lei; 0019
r-
(Street address or Description of Location)
Rocs busineca main `.
PURPOSE OF CONSTRUCTION Sketch`(attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
f f I
DIMENSION OF INSTALLATION OR REMOVAL S4'2Ti 4"
4\ 18'x2t oaf` AC
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEMWORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $�
(Including removal of all obstruction, materials, and debris, backfilling,=com-
paction and placing permanent resurfacing and/or replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrees to:
:Ihdemnify, defend• and save ,the City, its akuthorized agents, officers, representatives and employees,
penalties, liabilities or, loss resulting from "claims or court action and arising out of any accident,
happening or occurring as a proximate result of any work undertaken under the permit granted p
Notify', the Administrative Authority at least twenty-four (24) hours in advance of the time when!
Comply with all applicable City Ordinances, the terms and conditions of the permit and all applica
La Quinta and to pay for any additional replacement necessary as the result of this work.
u
harmless from and against any and all
loss or damage to persons or property
rsuant to this application.
work will be started.
ble rules and regulations of the City of
Signature of Applicant or Agent
The gate Comps ty; ft Box 3003 Redlands CA, 92,373; 9€19y-33$-7879
Name of Applicant (please print),- Business Address Telephone No.
Name of Contractor and Job Foreman Business Address
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
sat . •
Minor. Improvement Permit — Class IV: See attached schedule
VA
Inspection Fee $
Permit Fee
Penalty
Cash Deposit -Surety Bond
i,f required
100.00
TOTAL: $
Receipt No.
Received by Date
Recorded by '
one No.
4119
PERMIT VALIDATION
4119
PERMIT NO.
DATE APPROVED 3/23/04
EXPIRATION DATE
w- ,DATE ISSUED"`'� "
By
Administrative Authority
Telephone: (760) 777-7075
i
�- i