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0894y -y,.. l..t.� 'l nYt.rM.••.. .�.r+rr.•rlr.— r•-r�.r.. r r r r — .-. r r , �1„+'.,,�^RI-."fr..�� ,^^C�''r�'.",.rti �^F'•.��i.i LZ•r•�[• aF .. t. , r NOTE:' +� * r w; ` • i With proper`validation 4 2 • this form constitutes an,/ ' r _' "CITY OF LA QUINTA encroachment perm• it APPLICATION. FOR PERMIT 7. 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 t r Sut;divisiori Improvement Permit — Class I I I _ • , November 6 1.990 DATE: _ � - •• m- • Minor Improvement Permit Class IV ; '.LOCATION OF,CONSTRUCTION. .Eisenhower,` Drive and San Pedro. SW ,Corner :(Street address or Description of,Location)�- '`: w " disconnect., temporary te> ephoBP /'PURPOSE OF.'CONSTRUCTION Sketch (attach construction plans if appropriate) to :La•.GuaiiA- de la pay DESCRIPTION'OF CONSTRUCTION aid abli mow? ni t reference 'GTE permit. 0804 r f conditionsof.;,permit 0804 :.`shall 'apply ,to this' permit , DIMENSION OF INSTALLATION OR REMOVAL ' 4x4x4 f - ` splice r - t '' - F. reference- WO X543 -31182'•-I SIZE OF EXCAVATIO0iF.NEEDED ,APPROXIMATE TIME WHEN WORK WILL BEGIN 1118190 ' , r ,fir .' '~ , • - . ,- • APPROXIMATE TIME'OF COMPLETION` 2 date ;EST IMATE D.CONST RUCTI'ON ACOST $ '•' (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: ,, F�.,• Indemnify defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and all ,penalties, liabilities or,loss'resu-Iting from claims or court action -'and arising out of any accident, loss, or damage to•persons or property ' e 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, peyifo�rj�aa.ny;,additional replacement necessary as the result of this work.--' ` a, x g .�, Signatu of A plicant or Agent r uA,-t„�>7•�Wgn4`mgleo T„,, j 2829 -Industrial �Dr.'�.Bloominttban 'dA ,714=877-2470 Name of Applicant,.(_please`pri;*nt)'' +� `` ' Business Address Telephone No. Name of Contractor ands Jobs Foreman,, t r� Business Address ' . •Telephone No. on File F� Y �• .+'� on f,a4,�'''sn.stnza s'�—n7:-90 Contractor's License No. 4.,,; 1� r i City Business License�IVoi' TUTAL 1 t3V.iivi4w »` on file , • Applicant's Insurance Corripany`, ,';.' '' Policy Number ” y FEES:. Subdivisioh�Improvement.Perrriit,— Class III Public improvements:;3%7of estimated construction costs " Private improvement's: 3% of estimated construction costs } Minoramprovement Permit -_Class IV: See attached schedule ;,.c�, .0 � ' ..8 0.0 0 F , '. 3 Inspection Fee $ ' `, �,.,, „''• PERMIT VALIDATION I» , ;.. ? Permit Fee '. •' _ : ` - 0894 ' - .PERMIT NO. 'Penalty - ;�;. Y; , ..i , , .. �• - ° � .. _ •- - .. , , Cash Deposit -Surety Bond �t. ' '` tDATE,APPROVED. .1116 19n if required I yf - • 2/31/90'. r t a EXPIRATION'.DATE TOTA'L'.:"~",r $ 80.00 6 �`, 1.1/6%90 r, DATE ISSUED< Receipt No. c '+ By— by ,' . ,` � Received Date 'Administrative Authority Recorded by "' TELEPHONE:,(619) 564-2246 � I ���jr ` � .. l�'r .li�.w �4. ar ���wu.o ..►.� 6+i.-.!i...s�.Jr..la..��:.y:T�!.-6 !!w•_.9+Cb W �++ �.. M-rs�.� i s+'-+A^e w.rr 1Me. �. ww' .►. ..1� la.^.. ea r. 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 DATE: November 6 1990 Minor Improvement Permit Class IV LOCATION'OF CONSTRUCTION Eisenhower Drive and San Pedro SW Corner (Street address or Description of Location) disconnect temporary telephone PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate) to La Guana de la naz DESCRIPTION'OF CONSTRUCTION aid - snliee pit reference GTE permit 0804, conditions of permit 0804 Df ENSION OF INSTALLATION OR REMOVAL 4x4X4 � shall apply to this permit sp ice pit reference WO 543-31182�I SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN 11/8/90 APPROXIMATE TIME OF COMPLETION 2 days 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 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. Signatu of Applicant or Agent Hprman . rJpi eckar _ Tnn _ 2829 Industrial Dr. Bloominotinn, CA 714--877-247C -Name of Applicant (please print) Business Address Telephone No. Name of Contractor and Job Foreman Business Address Telephone No. " ` on file on f i.Letzs a-� 4n dull 4 i—n7-.Qa ,14 Contractor's License No. City Business License-Noi TOTAL f S0.uu on file Applicant's Insurance Company Policy Number FEES: Subdivision,lmprovement 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 '$ 80.00 II Permit Fee Penalty Cash Deposit -Surety Bond if required TOTAL: Receipt No. 1. Received by Recorded by 80.00 Date PERMIT VALIDATION PERMIT N0. 11 0894 DATE APPROVED 11/6/90 EXPIRATION DATE 12/31/90 DATE ISSUED._ / 11/6/90 By— Administrative Authority TELEPHONE: (619) 564-2246 !The-followtng•General'and'Special Provision s: are. attached to'and,made a part of Permit No. t �.� • ' _ 1 { K' v �i } }' e ' ` GENERAL PROVISIONS;, r The following shall always apply: a ENCROACHMENT ON PRIVATE PROPERTY: This permit authorizes work to be accomplished within City of La Quinta right of way 'i ONLY. Whenever construction extends within private property. it shall be the`re•sponsibility of the permittee (or his contractors) to secure permission from abutting property owners. Such authorization musi be secured by the permittee prior to starting work. TRACKLAYING CONSTRUCTION EQUIPMENT: Cleatedtrac ktayii ng construction equipment shelf not be permitted to operate on any ` paved surface unless fitted with smooth -faced street pads. All mechanical outriggers shall be fittedwith rubber street shoes to protect the paving during,ezcavations:•Rubber-tired equipment only shall be used in backfill operations in paved areas. If the existing pavement is .'scarred, spalled, or broken during the term of this contract, or if the_pavement is marred. City of La Quinta shall request that these portions of road be resurfaced over their entire width. Resurfacing shall consist of one coat of two inches (2"1 of A.C. surfacing plusappropriate seal coat as specified above. a ? q i''ti "• PROTECTION OF TRAFFIC: All excavations and work areas shall be properly lighted and barricaded as deemed necessary by the City Engineer or La Quinta City Public Works Inspectors. Suitable detours and detour signs shall be placed and maintained for the duration of the project. The City shall be notified24Mrs. in advance of any traffic detours or delineations. CARE OF, DRAINAGE STRUCTURES: Any drainage,structure including corrugated metal pipe, concrete pipe, steel culvert and r concrete structures encountered during excavation. which necessitate removal shall be'replaced in kind: In the eveniit becomes necessary to remove or cut existing drainage structures, City of La Quinta shall be notified prior to commencement of this work. • ' " .y Drainage structures and 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 removed from the right of ` . way. All paved surfaces shall be broonied clean of earth and ot her objectionable materials immediately afterbackfill and compaction. + Existing gutter line and drainage ditches shall be replaced to their original standard or better. All -excess material shall be removed prior to paving. Water tanker shall be used, as required, to sprinkle the job site to keep down dust conditions and shall be used immediately -after beckfillr- ` DE -WATER OPERATIONS: If de -watering operations are required and pumps are forcing water on City of La Quinta roads, it shall be the responsibility of, the permittee (contractor) to control This water and to provide off-street barricades when necessary. CLOSING STREETS: No street shall be closed:•A minimum'of one lane of traffic shall be maintained at all times to provide limited `• 1 access for the adjoining property owners and emergency vehicles. li the event itis felt bythe permittee that he must close a streetfor `L t any.length of time. permittee shall contact this"office to obtain the necessary permission. r SPECIAL PROVISIONS �{ •The follwing shall apply ONLY when indicated. r. � °`, •. .' n ,. �' .,,, p , ._. it .:. - .•„ •' " ;R1i. NOTIFICATION: Permittee shall notify -2 City at 564-2246 at least 48 hours in advance of starting construction. r, R7 CASH DEPOSITS OR BONDS: A cash bond or an approved surety bond in an amount of not less than s shall be furnished. in ,the name of City of La Quinta to cover all work involved in the restoration of the various La Quinta roads and surveymonuments: This bond shall be continuous u,ntil.c_ ancelled by the City Engineer. This bond must be posted prior to commencement of any work on this project ., T '' •• - R3' UTILITY CLEARANCE:(Substructures)Prior tomaking any excavation within the City of La Quinta right of way authorized '` • by permit, the permittee shall contact all concerned utility companies relative to the location of existing substructures. r Damage to existing substructures resulting from operations conducted under this permit shall be the sole responsibility .+ i, of,the permittees ',}„ ;,Iq ' .. R4 TILITY CLEARANCE: (Surface structures) No work shall be done under this permit until all utilities are clear of the proposed work site. The permittee shall notify all concerned utility companies of the proposed work. { + - R5 PAVEMENT WIDENING: Area beiween the proposed concrete gutter line and the existing road pavement shall be surfaced with inches of A.C. paving placed on ' inches of class aggregate subbase course having an"A"value ofnot less than t� an di nconformancewith dityof La Quinta Road Improvement Standards and Specifications. Ordinance #461. r1r., R6 PARKWAY GRADING: Area between the property line and top of the proposed concrete curbshallbegradedtoaslopeof' 1/4 inch to one foot (1'). { R7 GRADES & STAKES: City of La Quinta shall establish grades and stakes for the proposed concrete curb and gutter ' construction. • - I R8GRADE CHECKING:CityofLaQuintashallcheckgradesuponreceiptofplanandprofileand/or gradesasestablished by ` \ a licensed engineer. , J R9 CURB REMOVAL FOR DRIVEWAYS: A portion of the existing concrete curb and/or curb and gutter ( feet)shall be removed. Curb and/or curb and gutter shall be saw cut prior to removal: Depressed curb, matching concrete gutter and + r. t t ,n • ' 'L r concrete:dri, eway approach shall be constructed in conformance with City of La Quinta Standard #2O7. ;R10 DRIVEWAYS. A.C.: Driveways shall be constructed as not to alter existing drainage pattern. Surfacing between the 5 r property line'and the existing road paving shall be 2-1 /2 inches of A.C. paving placed on ( ") of class +� r aggregate base. Driveway construction shall conform to attached drawing. t �• .111 CULVERTS: A inch diameter ( )culvert shall be installed with the invert approximately 1-1 /2 .. t� inches oelow and in line with the existing flow line. Culvert installation shall conform to the attached drawing. R12! SIGHT SIGHT CLEARANCE: Sight clearance of 600 feet in either direction shall be assured and maintained. R1 • SOILkSTERILIZER: The area to be'surfaced shall be treated with soil sterilizer. Rate of application shall comply with the anufacturer's specifications.. ` �47OORDINATE WORK:The proposed work shall be subordinatedio any operation which tfie State of California or ty of La Quinta may conduct in this area during the period of this permit. Work shall be coordinated with the State or City of La Quinta forces to preclude delay or interference with State or City of La'Quinta projects. R15 SURVEY MONUMENTS: Prior to excavation or beginning of construction, all survey monuments which exist on the centerline of all streets or property lines when involved shall be completely tied out so they maybe readily and correctly be replaced by a licensed civil engineer'or surveyor at the expense of the permittee. A complete set of notes showing the ties to these monuments shall be furnished to the City Engineer prior tothe removal of any monuments. Thisoffice shall ` r be notified upon completion of replacement of all survey monuments for proper project clearance. R16 SURVEY MONUMENTS: Prior to excavation or beginning of construction, all survey monuments shall be tiedout by City of La Quinta and suitable payment or guarantee of payment shall be 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. (fi18 AVEMENT CUTTING: Pavement shall be saw cut prior to removal. Prior to final paving operations, any damage to avement straight edge shall be corrected. LIMIT OF EXCAVATIONS: Excavations shall be limited to 1,000lineal feet of opentrench 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 (spongy or �. 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 bepiaced in lifts of not greaterthan three feet (3') and vibrated using vibrotamper or equivalent equipment. Alternate methods maybe substituted, but in any ase a relative compaction of 95 percent shall be attained within the structural section of the roadway. R22 OACKFILL PLACEMENT: Backfill shall be applied in layers of not more than 50 percent of the total depth of the trench 1`1\_ eforefloodingoramaximumoffive-foot(5')Iiftswheretrenchesareofexcessivedepths.Careistobeexercisedthatthe 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 is the 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, compactiontests 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 C IMPACTION 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 as outlined 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 nocase shall /-­`�.the placement of the temporary F,.Verr,arli txLeeu d fi,;a ;5) day iimit. R26 �ERMANENT PAVEMENT REPAIR: After backfill and compaction operations have been completed, a temporary patch ,consisting of two inches 12") 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 completion of backfill and compaction, a temporary patch consisting of two 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 (151 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. R29 SEAL ARMOR COAT: A seat 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 to the 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 sections which 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 shalt 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 equivalentto 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 any one 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. f. Pruning shall, in all instances, be at the shoulder of the crotch to insure even, fast healing in all cuts of two inches 12'1 and above in size. Sealant shall be applied to all cut sections as directed by the City Public Works Inspector. ADDITION ----ENCROACHMENT PERMIT NO 0804 ----CONDITIONS } z R33 Suvey�,mcn1ms p hall be protected4:in �• ` 7,re•..!ee,i he pu=suaht to City standards -T andg' `the State-- of . r " +California, Land}.Surveyor.; s_Act_ ., .i R34' Work: shall' be.:coordinateduwith- the -.,City--, of La Quintals -forces to- preclude• delay, or interferences with the City of La'. Quintals projects., ti, .- : ,., ' R35r, � • Contractor; shall' comply with .the, local noise .ordinance ,and F construction?operations and maintenance,of..equipment'within one .half' mile of ' human occupancy• shall . beperformed .only, , • during the time periods,as follows: ' October•lst to,•April. 30: Monday -Friday 7:00a.m.-5:,30p.m.. .Saturday, 8.00a.m.-5 00p.m. 4 May 'lst to September ,30 Monday=Friday .6.00a.m.-7.00p.m. , • _Saturday 8:00a.m.-5;00p.m. Work. sYiall"•, be prohibited anytime on -Sunday ' and Federal,' holiday. ,R36; :Traffic -control shall be•'as per Cal Trans Traffic Manual: Field adjustments, shall be accomplished as ^t •directed..in order to adjust;Ito actual -field conditions'.,,: It �.,. shall•`be:the contractor,.'s responsibility to adequately. -barricade.. and detour -this• site. 'A .Traffic. control -plan shall +~ be• submitted' for approval .by the City Engineer. ,. . R37 All excavation .at' or near the travel- -way `shall .be backfilled - at the, end` of . the 'work . day; for • +the, protection off the .t� traveling public. - - : R38-,.. Street closures shall not be allowed 'at' any time: R39, A".minimum of one travel lane•'shall' he maintained at all ' -times, with- flagmen during "working hours. y R40•, ..All work,to,.be performedwithin the existing -paved section-*,.. ` shall" be temporary -paved• and' maintained by the, Permittee,', permanent pavement shall �,be- placed: no later than 15 -days . after -'completion' of the temporary road repair. R41 Ingress,and•egress'for local'.properties shall be'maintained, - at -all ..times . R42 Prior, to work sxtarting, Underground Service Alert shall�,be•, x.: ,,, ., contacted ' at ,1-800-422-4133 and an, "inquiry number" shall be, ;provided to the City, -Public Works Inspector. ¢. 4 R43- Pavement shall 1 be'sawcut prior ,to' removal': - f : 41, f: ' -fir - iz, .d.• _ ... ..,> � '. ++� ' •.'{ � r — a'�Y+ _ 'a, _ - - - e l •� y o 1 �I. i 2R Ct1 . tr , ,...;•, ��r-' fi .a er: - -"• w ! t s„1• •z •a•s.- c..- �wt.y,• _ ..'.K : t i x f J-. 'z a y .: „!b ': 7 .'.j-, •r::,: .ra_. �k`�+-'� Adc�tonal''Coridtons= -� EncroaciimentyPermit' No: ,Page R44� All: bac.. . - ' ..' • . ;.. . y'. l arr F kf ll- subgrade soil = shall be` compacted. to. nothing , -less than '90V.relative dry density- all backfill soil within: .the top' 2' of• f,inish> pavement 'surface shall .`be compacted to, r nothing -less. than 95% relative dry .density, ;'all`'abase material shall be compacted to nothing less than 95%' relative•dry density. t R45`" Replabement4 pavement sections' shall be 4':1%2; 11 AC `'over 811 'Class ILy`aggregate Jiase. , t > a R46 .. If the work ,is to -be- performed by forces - other'•than thatx of the utility company, the contracting rcompany will be required, to apply for an ad!ditionaLiencroacizment permit y. 4' and pay ,the appropriate .fee•. l• rie 1. y , vim. Ft, # . .•, JA _OC ATiON SRN ?URD SIW MR EXCHANGE:INDIO. =.0:1 u:Qei ' �_yyxx y. .. Vey� li .SME AREA-GENERAL MANAGER '6 ;•oaM sossio is4n 7 NOTE: With proper-validstlon_. 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; watW.m8ji and other .like public works- improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS. Subdivision ImprovementPermit — Class III DATE: � Minor improvement Permit Class.IV LOCATION OF CONSTRUCTION: Its tdDt.� l � — �tii17 1A>� ft Is/i "60` (Street wtifen or Description of Loestianl- PURPOSE OF CON RUCTION �t SCt�t ��rcr.i `Tf�wt PDU-�►?y 11-2 Sketch )attach construction pians if approwilm► DESCRIPTION OF CONSTRUCTION �_ �$ �. �Er`,Mt t DSO DIMENSION OF INSTALLATION OR REMOVAL' SIZE OF EXCAVATION, IF NEEDED fwd -r APPROXIMATE TIME WHEN WORK WILL BEGIN APPROXIMATE TIME OF COMPLETION ESTIMATED CONSTRUCTION COST S (Including removal of all obstruction, materials, and debris, ba -+tiding, 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 saw the. City, its authorised 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. remit of ,any work undertaken under the permit granted pursuant to this application. Notity the Administrative Authority at least twenty-four (241 hours in advance of the time when work will be started. i Comoty with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City of La nuinte and to pay for any additional reciationent necessav as the remit of th' rk. `L) Signa of pplicant or Agent AJ IAOIJ hIRIAl N . %'wpmt&& CA 97316 (1114) x%=1420 Name of Aoplicant (please print► Business Address Telephone No. Name or Contractor and Job Foreman Business Address / Telephone No. f12( 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 Irhorovement Permit —Class IV: See attached schedule insoection Fee S , Permit Fee Penalty Cash Deposit -Surety Bond if required TOTAL: 1. $ Receipt No. Received by Recorded by Date �0 PERMIT VALIDATION ?ERMIT NO. DATE APPROVED EXPIRATION DATE DATE ISSUED BY Administrative Authority TELEPHONEe (619) 60;4-2248-