0674-_ �_,'_ .. -c-.'..._.,,... _ � _ -. ::=i.%W�..'�.�va. a -a ch e.s .-.• k:•__ mac_-Gw'wt _s w�.,..- �. 4. •ae�t,sc� �'—w �•� �_, .� s_�.��. � _-wa_is� .a a� Fearr w.w� aG trn�w .rn �.s ... r w-.,
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 I
and other like public";works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit — Class II I
DATE: 'Yuyl� ��'��� Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION :wA� ,_ 11 cjcJ ocxy co Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL A So. C-rA CQO permit 302
SIZE OF EXCAVATION, IF NEEDED �" G
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 hens'work will be started.
Comply with all applicable City Ordinances, the terms and conditions of the pe�rmit4and all applicable rules and yregulations of the City of
La Quinta and to pay for any additional replacement necessary as the result gf;thjs work.//
9
Agent
Name of Applicant (please print) Business!AddrAss Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
25915:1.9 36
Contractor's License No. City Business License No.
_,_ anc -t �i> n . /TA,-� I,4 �_n? �,IK' � .r s� � 1 �, I.� �'t jf f
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit —Class III bays "I,laL9'cccitia n 0 X45.00 $90. 00
Public improvements: 3% of estimated construction costs �� `' gc 10.00 WOO
Private improvements: 3% of estimated construction costs �g\a
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
ToW,
10.00
TOTAL: , $ 1 nn nn
Receipt No.
Received by
Date
PERMIT VALIDATION
PERMIT NO. 0674
DATE APPROVED 6/1/9()
EXPIRATION DATE 11/31/90
DATE ISSUED
By r•..���'i�G-�
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
f
i
.,__!:.'r-"'_:�;=_•.--:�:�'lka^:'�..,r�[.-rET3't'f�v'car �+a err w. M. fr � _
NOTE:
With proper validation
this form constitutes an V CITY OF LA QUINTA
encroachment permit V
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
�c,a ca a i+w ri wi F� era it �Y .a .l6c".�> IW p M ti •F, C_'� .�'� w,w�'!� K � .+ r 4. c..�� O c:. c:S S � �. R;• G., rl
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: June 1, 1990 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 47225 11aShington Street
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION install gas service Sketch (attach construction plans'if appropriate)
DESCRIPTION OF CONSTRUCTION d t40 -1n h0re,
DIMENSION OF INSTALLATION OR REMOVAL 4 x `* reference So. Cal Gas permit 5C2
SIZE OF EXCAVATION, IF NEEDED Q �*
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION 2 claw* i 7 T 1 1 7
ESTIMATED CONSTRUCTION COST $ V
(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 apyplicable rules and regulations of the -City of
La Quinta and to pay for any additional replacement necessary as the result of,this work./,
6 of Applicantior'Agent
343-1153
Name of Applicant (please print) BusinessEAddress Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
259619 566
Contractor's License No. City Business License No.
Reliance INS./Liability Auto/General NG 1253560
Applicant's Insurance Company Policy Number
FEES: Subdivision. Improvement Permit —Class III 2 days inspection $95.00 $90.00
P br 30/ f d permit fee 10.00 00000
u Ic Improvements. o o estimate construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Q j
90.00 II
Inspection Fee $
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
10.00
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO. 0674
DATE APPROVED 6/1/90
EXPIRATION DATE 12/31/90
DATE ISSUED
By'G.
Administrative Authority
TELEPHONE: (619) 564-2246
The following General and Special Provisions are attached to and made a part. of Permit No. , Q
'GENERAL PROVISIONS
t,.
'The following shall always apply:
x•`
ENCROACHMENT ON PRIVATE PROPERTY: This permit authorizes work to be accomplished within City of La O
+
f t _
ONLY. Whenever construction extends within private property, it shall be the responsibility of the permittee (or'l
secure permission from-abutting property owners. Such authorization must be secured by the permittee prior t,
t q k
TRACKLAYING CONSTRUCTION EQUIPMENT, Cleated tracklaying construction equipment shall not be permittee
paved surface unless filled wittismooth-faced street pads, All mechanical outriggers shall be fitted with rubber strei
+= the paving during, excavations.' Rubber-tired equipment only shall,.be used in backfill operations in paved are.
pavement is scarred, spalled, or broken during the term of this contractor if the pavement is marred, City of La CIL
i."
that these portions of road be resurfaced over; their entire width. Resurfacing shall consist of one coat of two it
. f
surfacing plus appropriate seal coat as specified above..
PROTECTION OF TRAFFIC: All excavations and work areas shall be properly lighted and barricaded as deemed nec ,
3 r{•
�r„ Engineer or La Quinta City Publi c Works Inspectors. Suitable detours and detour signs shall be placed and maintain(
`
of the project. The City shall be notified 24 Hrs. in advance of any traffic detours or delineations.
js.CARE
OF DRAINAGE STRUCTURES: Any drairiage structure including corrugated metal pipe, concrete pipe,
r
concrete structures encountered during excavation which necessitate removal shall be replaced in kind. In the
" necessary to remove or cut existing drainage structures, City of La:Quinta shall be notified prior to commencen
Drainage structures anis 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 remove,
'`�'• +
way. All paved surfaces shall be broomed,clean ofearth anclother objectionable materials immediately after backfil
s
- , Existing gutter line and drainage ditches shall be replaced to their original standard or better. All excess material
. prior to paving, Water tanker shall be used, as required, to sprinkle the job site to keep down dust conditions i
`
'immediately after backfill.
DE-WATER OPERATIONS: If de-watering operations are required and pumpsare forcing wateron City of La Quinti
v. the responsibility of the permittee (contractor] to control this water and to provide off-street barricades when n, •,
CLOSING STREETS;. N; street shall be closed. Aminimum of one lane of traffic shall be maintained at all times
i
access for the adjoining property owners and emergency vehicles. In the event it is felt bythe permittee that he mus
any length of time, permittee shall contact this office to obtain the necessary permission.
SPECIAL PROVISIONS
The follwing shall apply ONLY'when indicated: `
' R1 NOTIFICATION: Permittee shall notify tfie City.at 564-2246 at least 48 hours in advance of starting c
•
T CASH DEPOSITS OR BONDS: A cash bond or•an approved'surety bond in an amount of not less than $
shall be furnished in the name of City of La Quinta to.cover all work involved in the restoration of the var
." roads and survey monuments. This bond shall be continuous until cancelled by the City Engineer. This
-posted prior to commencement of any work on this project:
r ,
TILITYCLEARANCE:(Substructures) Prior to making any excavation within the City of La Quinta right of+
Eby
permit;.the permittee shall contact all concerned utility companies relative to the location of existing
" > `
_ ` '
)Damage to existing substructures resulting from operations conductedunder this permit shall be the soh
•• "
of the permittee. t' +.•
R4 /UTILITY CLEARANCE: (Surface structures) No work shall be done under this permit until all utilities a
proposed work site. The permittee shall notify all concerned utility companies of the'proposed work.
,
" C• •
' d IR 5PAVEMENT WIDENING: Area between the proposed concrete gutter line and the existing road pave
_
surfaced with inches of A.C. paving placed on r ` inches of class aggregate s
•
having an "R'•value`of not less than and inconformancewith City of La Quinta Road Improverr
and Specifications, Ordinance 17461.
R6 ' PARKWAY GRADING: Area between line the be
the property and top of proposed concrete curb shall grao
`. 1/4' inch to one foot (1'). , .�.{ , • - • • "`
E
. R7 GRADES & STAKES: City of La Quinta shall establish grades and stakes for the proposed concrete ci
construction. M {
R8 GRADE CHECKING: City of La Quinta shall check grades upon receipt of plan and profile and/or grades as
�i. .j„•., ,
. a licensed engineer.' +
_ y :'..'R9 CURB REMOVAL FOR DRIVEWAYS: A portion of the existing concrete curb and/or curb and gutter
removed. -Curb and/or curb and gutter'shall be saw cut prior to removal. Depressed curb, matching concr
concrete driveway approach shall be constructed in conformance with City of La Quinta Standard q2C
r't ;R10, DRIVEWAYS, A.C.:•Driveways shall be constructed as not to alter existing drainage pattern. Surfacinc
property line and the existing road paving shall be 2=1 /2'inches of A.C. paving placed on ( ”) of + ,
aggregate base. Driveway construction shall, conform to attached drawing. • '
"
R11 CULVERTS:A- -'inch diameter( )culvert shall be installed with the invert approx
inches below and in line with the existing flow line. Culvert installation shall conform to the attached
r
, 12 SIGHT CLEARANCE: Sight clearance of.600 feet in either direction shall be assured and maintair
` R13 SOIL STERILIZER:' The area to be surfaced shall be treated with soil sterilizer. Rate of application
•c,; ,y,.
,,
, , manufacturer's specifications..�a'�•',� ,
14 OORDINATE WORK: The proposed work shall be subordinated to any operation whicf-
City of La Quinta may conduct in this area during the period of this permit. Work shall be
p
City of La Quinta forces to preclude delay or interference with State or City of La 0• • J
R15 URVEY_ MONUMENTS: Prior to excavation or beginning of construction, all survey m,'
a " • i ;" •-
T r • centerline of all streets or•property lines when involved shall be completely tied out so they.' +
be replaced bylicensed civil engineer or surveyoi at the expense of the permittee. A complett
%4 • •
.a
, tiei to these monuments shall be furnished to the City Engineer prior tothe removal of any monui, r
'be notified upon completion of replacement of all survey monuments for proper project clearance
T
R16 S Y MONUMENTS: Prior to excavation or beginning of cons )n, all survey monuments shall be tied out by City
ouinte and suitable payment or guarantee of payment s'.._.. __: made as reimbursement for all work involved.
R17 PAVEMENT CUTTING: Pavement will be mechanically cut 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 of traffic. Prior to final paving operations, any damage to pavement straight edge shall be
corrected.
R18 PAVEMENT CUTTING: Pavement shall be saw cut prior to removal. Prior to final paving operations, any damage to
pavement straight edge shall be corrected.
R19 LIMIT OF EXCAVATIONS: Excavations shall be limited to 1,000 lineal feet of open trench before backfill operations must
begin. All excavations shall be properly barricaded with lights overnight, on weekends and holidays forthe protection of
the traveling public. The Public Works inspector shall determine the suitability 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.
R20 BACKFILL 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 Quinta deems unsuitable (spongyor
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.
R21 BACKFILL SAND: Backfill shall be approved transit -mix sand or equivalent and shall be placed in lifts of notgreaterthan
three feet (3') and vibrated using vibrotamper or equivalent equipment. Alternate methods may be substituted, but in any
022
case a relative compaction of 95 percent shall be attained within the structural section of the roadway.
BACKFILL 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 (5') 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 isthe greater
compaction. Where ponding or flooding is used for a maximum settlement, adequate dikes 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.
R23 COMPACTION TESTS: If so required bythe inspector, compaction tests shall be made at intervalsof not more than 1,000
feet and a minimum of one (1) test on each road. One (1) copy of each test 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.
R24 OMPACTION TESTS: If so required by the inspector, compaction tests shall be made for each crossing or service line.
ne (1) copy of each test shall be forwarded to the City Engineer for approval and filed prior to making permanent repairs.
Compaction tests shall be made asoutlined in Section 6.3.01 of the Standard Specifications, Division of Highways, State
of California, dated January 1973.
R25 TEMPORARY PAVEMENT REPAIRS: After completion of backfill and compaction operations, a temporary patch
consisting of 2 inches of SC -800 shall be placed on a prepared subgrade. The SC -800 temporary paving shall be placed
after a maximum of 3,000 lineal feet of trench has been excavated and backfill operations completed, but in no case shall
e placement of the temporary pavement exceed a five (5) day limit.
R26 PIERMANENT PAVEMENT REPAIR: After backfill and compaction operations have been completed, a temporary patch
consisting of two inches (2") of SC -800 shall be placed immediately. A permanent patch of inches A.C.
surfacing placed on a inch class base shall be placed no laterthan days after completion of
temporary road repair./.,/� �/
R27 PAVEMENT REPAIR: F.A.S.: Upon completioYofbaclPlilland compaction, atemporary patch consisting oftwo inches (2")
of cold mix paving (SC -800) shall be placed immediately. A permanent patch of three inches (3") of A.C. surfacing shall
be placed on six inches (6") concrete base as directed, but not later than fifteen (15) days after completion of temporary
paving. Concrete base shall be of five -sack mix and shall conform to the City of La Quinta Road Improvement Standards
and Specifications, Ordinance #461.
R28 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.
829 SEAL ARMOR COAT: A seal coat consisting of an application binder and screenings shall be applied on all patch areas
where such seal coats existed prior to issuance of this permit. Seal or armor coats shall be applied as specified in Section
37, Standard Specifications. State of California, Division of Highways, dated January 1973. Work of pavement repair to
be accomplished by a licensed contractor engaged in the business of pavement repair.
R30 STREET RESTRIPING: Where street striping is still visible on streets to be excavated, such striping shall be replaced upon
completion of permanent repairs.
R31 TREE RELOCATION OR REMOVAL: Tree relocation within the City of La Quinta road right of way shall be accomplished
by a licensed, bonded and insured tree service, and handled safely without interference or hazard tothe 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 removed in sectionswhich can be handled safely without interference or hazard to highway
traffic. The entire width of the tree stump shall be removed and disposed of so that no debris remains in view of the
highway. The stump hole shall be backfilled and thoroughly compacted as specified in the following paragraph. Where it
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
tests shall comply with Section 6.3.01 of the Standard Specifications, Division of Highways, State of California, dated
January 1973.
R32 TREE TRIMMING:
a. Only the necessary trimming shall be accomplished to provide clearance of the facility for one calendar year.
All broken or weak sections within the trimming shall be removed.
b. Where it becomes necessary to restrict traffic, the work shall be restricted to a maximum of 500 feet at anyone time.
Adequate signs, flagmen, and/or barricades shall be provided to protect the traveling public at all times.
c. If tree trunks are partially outside of the City of La Quinta road right of way, permittee shall make his own
arrangements with adjoining property owners for consent to the trimming in addition to the authorization provided
by this permit.
d. All tree trimming on EVERGREEN TREES, PALM TREES, and other ORNAMENTAL TREES shall be accomplished to
the satisfaction of the City Public Works Inspector.
e. Abutting property owners shall be contacted, in all instances, prior to trimming or topping trees.
I. Pruning shall, in all instances, be at the shoulder of the crotch to insure even, fast healing in all cuts of two inches
(2") and above in size. Sealant shall be applied to all cut sections as directed by the City Public Works Inspector.
n
' SPECIAL -CONDITIONS --PERMITS N0. .0674 •
The following conditions -shall,•"be met • to- the satisfaction of ,the f '
City,Engineer.
' '1 � Street ^ closures,' shal-l- not be allowed, at, any time. '
`2�. ',"Streets shall bekept clean. They shall'be Ybe completely
`scleaned at the end of the-working:day,and more frequently if
required: y
3...,Contractor:shall comply with the-local+.noise ordinance and'-
.,construction
nd-;construction operations -.and---maintenance, ` of equipment within '
' one half mile' . of human' occupancy, ,shall be performed only
during the time.periods as follows:
October_ 1st .to April 3_0'... Monday=Friday 7.00a.m.-5.30p.m.
1 Saturday 8:OOa.m.-5:OOp.m.
May 1st.:to:,Septembe`r 30: Monday-Friday„6:00a.m.-7:OOp.m.
•Saturday 8:OOa'.m.-5:OOp.m.•
Work- shall be '.prohibited anytime_ on, Sunday and Federal.
=holidays
i;4.. In .tlie event that it is.y necessary to, cut,'pavement on
?s - Washington Street two unrestricted paved'.travel lanes shall
;remain open at all times. Temporary pavement.shall be•
placed follcwing•each working'day.'Traffic may be.detour_ed'
onto paved surfaces only.
5:,' All traffic control signage ne6essary fora. contigency. of
``- having.to dig on,Washington Street shall be,made readily ”
'�. !available.. A traffic control plan will need to be '
submitted for approval of the'City Engineer.
Traffic control shall be as:pei Cal Trans'Traffic Manual.
r� Field adjustments in detouring shall'be accomplished as
directed _`in order. to adjust.,to actual. field
•.. „` `r � 'conditions .:• • It - shall' be. the contractor's responsibility 'to
ade uatel 'barricade and detour this site...
. _ q y Flagmen shall be
4 ` required � at all . times' during work on •Washington• "Street. A•. •
.Traffic control plan shall be submitted prior -to commencing
construction for the approval•`by'.,the City Engineer._.
l 6. All backfill subgrade :,isoil :shall be compacted to• nothing less
"* '.-.than 90 o:�relative dr densit ' all' backfill' soil within the
top .2:' ' of finish pavements surf ace r shall' be' compacted to
4T,•r�, nothing-less'tithan 95% relative dry density, all base material. .
'"shall be.compacted to nothing less than''.95o relative dry
""density.
.�..;. - - . -• Y _ .
<� r7' ,Pavement replacement shall be 411.AC over 8" Class II aggregate-
base.
ggregate-base. f
8. '' Permittee 'shall notify the City at,, 564-2246 at least , .24. .hours
ti:.. in advance. of starting construction.
'r t- 4 ,
PLAN FILE NO. I BASE SKETCH CON5TR, SKETCH COMPL. SKETCH
Bv: BY: BY: SHEET
v
C ' "N
`a.
-�E' ga >�
SOUTHERN CALIFORNIA GAS CO. 2956.1-J
TOTAL FEET INST'D
I
,,pp
t�.� 5 ,
INS ALL MAIN WITH AT LEA "COVER BELOW TOTAL FEET RETIRED
PERMIT ISSUED BY
'PERMIT NO.
DATE MOVED DATE MOVED DATE OF
RETIREMENT
COUNTY
-
ON JOB OFF JOB - OPER.
-
CREW FOREMAN
DISTRICT
REASON
PLANNED BY
TRACT
COMPANY
NO.
STAKED ❑
COMPANY FACILITY: SO. CAL. ❑ P.L.S. ❑
ATLAS
NO.
YEAR C.P.
INSTALLED
OPER. 20 % OR OVER ❑ S•M•Y•S•
STAKING REQ'D ❑
DIVISION
ORG.
REVIEWED BY
CATHODICALLY YES ❑ NO ❑
PROTECTED
AT LESS THAN 20% ❑
DISTRICT SUPERVISOR
NO STAKES NEEDED ❑
W.O. CODE
SOUTHERN CALIFORNIA GAS CO. 2956.1-J
NOTE:
With proper validation Q'
this form constitutes an ,CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC- WORKS CONSTRUCTION' (ENCROACHMENT) I• Sw�
OF.�
For the construction of public or private curbs, driveways, pavements, sidewalks, parking. lots, sewers, water mains
' and other like publicvvorks improvements in connection with MINOR•IMPROVEMENTSand APPROVED SUBDIVISIONS
�O� �/� Subdivision Improvement Permit — Class III
DATE:y _ , Minor Improvement Permit Class IV
F LOCATION'OF:CONSTRUCTION �_')
w
(Street address or Description of Location)
PURPOSE
OF.CONSTRUCT•ION Z�(_ . Sketch (attach construction plans.if appropriate)
DESC IPTION OF CONSTRUCTION e OC
DIMENSION OF INSTALLATION OR REMOVAL XS
SIZE OF EXCAVATION,'IF NEEDED %�14,:��
APPROXIMATE TIM WHFN ORK WILL BEGIN
APP OXIMATE TIME OF COMPLETION �' s
ESTIMATED CONSTRUCTION COST $
(Including removal.of all obstruction, materials, and debris, backfilling, com-
paction and
ompactionand placing permanent resurfacing, and/or replacing improvements) . r
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 a a 'licable rules and g 'lations of the City of
La Quinta'and to pay for any additional replacement necessary as the result s wo• .
Si ature ppli 5PA nt
Name of Applicant (please print) Business A ess Telephone No.
Name of Contractor and Job Foreman Business Address . Telephone No. ''•
Cor's License No. City Business License No. -
Applicant's lnsuranceCompany Policy. Number
FEES: Subdivision'Improvemen't.Permit'—Class III
Public improvements:'3% of estimated construction costs .
Prlvate.improVements: 3% of estimated construction costs
Minor Improvement Permit - Class "IV: See attached, schedule. lr 486k
Inspection Fee; - $ PERMIT VALIDATION
Permit Fee PERMIT NO: _
Penalty
DATE APPROVED
Cash Deposit -Surety Bond '
if.re.quired
EXPIRATION•DATE
i TOTAL: $ "DATE ISSUED
Receipt No.
By
Received by Date Administrative Authority
,Recorded by TELEPHONE: (619) 564-2246
4