1722t
NOTE .;�1
With proper validation Q'
• this form' constitutes an
encroachment permit CITY OF LA. QUINTA
APPLICATION FOR PERMIT.-
PUBLIC
ERMIT.PUBLIC WORKS 'CONSTRUCTION (ENCROACHMENT)��
SOF T[��
For the construction. of,public or private. curbs,' driveways, pavements, sidewalks,
parking lots, sewers; water 'mains
and other like public works improvements in connectiori•"with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit Class III
DATE: 4/.26/93 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 79"255 Westward Ido La Ouinta
(Street address or Description of Location)
Temp Telephone Pole �s"tr
PURPOSE OF CONSTRUCTION Sketch (attach coristruction plans if appropriate)
.44
DESCRIPTION OF CONSTRUCTION Setting oft telebhone SEE ATRACHED CONDITIONS
., pole on Westward Ho' SEE ATTACHED -,',SKETCH
DIMENSION OF INSTALLATION OR REMOVAL ,Y.Bgl `�T�LT�7. 5?6 50'(1L�1
`SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN ASS' ,.
APPROXIMATE TIME OF COMPLETION '
ESTIMATED CONSTRUCTION COST.$ N/A
(Including removal of all obstruction, materials, and debris, backfilling; com-
paction-
ompaction 'and placing permanent resurfacing and/or replacing improvements)
In consideration of the 'granting of thi's permit, the applicant hereby agrees to:.
.'Indemnify, defend and save the City, its authorized agents,'officers, representatives and employees, harmless from and;against;anyand all.,' i•
} 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. vvork 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., '�
Signature of pplicant or•Agen ,'
John N. Stinnett 16981 Viatazou San Dieao, CA(619) 487-1101
Name of Applicant (please print) - Business Address Telephone No.
Douglas E. Barnhart Inc SAME''•
Name of Contractor and Job Foreman Business Address Telephone No.
1. 439407 2922
ontractor's License No. City Business License No. ~`
Ins. Co of NorthAmerica(United National. Ins) 0957092-186•`
Applicant's Insurance Company Policy Number
FEES:Subdivision Improvement Permit — Class I I'I�
i Public improvements: 3% of estimated construction costs
i Private improvements: 3% of estimated construction.costs ,
.,Minor Improverrient Permit:— Class IV: See attached schedule '
4•Inspection Fee . $ 40.00 PERMIT VALIDATION
10 00 1722
'-Permit Fee PERMIT NO.. rw
Penalty
APPROVED, 4/23/93 , 4
DATE '
Cash Deposit-Surety Bond
if required ' EXPIRATION DATE
` TOTAL: ' $ -50.00
DATE ISS U D
Receipt No:
By
4 Received byDate �,. M', `; '`'�' Administrative Authority I
` K; „,Recorded by s .. TELEPHONE: (619) 564-2246 1NA
n r +?.,. ,, ..i�;y±�r "'t I',��.��•"` J.r•' ,e'� j •+ •j' y�••' .r yip.. 'a`, r„ t ` j '
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Wallop velldadOn Ii
•thit form conatitutae en
no—mohn4m 0111mit CITY OF LA QUINTsA
APPLICATION FOR PERMIT
PUaI,iC WCRK% COMMUCTION (WROACHMENT)
For the construction of public or privelto Oft &, dr(wtfAmm pevamerit0, eldewalks, pSritinp lots, mw0n. wotaf maim
Other IIk4 au>ellti worite lmprowamer►es In 40nnerWon with MINOR. IMPROVIMENTS and APPROVED i tiablVI&ION8
oATEr r �� 80*1110n Impfbiffiment Permit -clan ill
LOCATION OF CONVRUMON t4l�g MIMt Ilril:mwent Permit Cioee IV �_ X
r�Cd4 0 ., aA� �► c
t8treet edan,m pr parc;ion of Lotstionl
-PURPOSE OF CONSTRUCT ION 33� LAPA60C ?oIE
�-+�--�•� Sketch (attach os+r+atruotlers pleftc If epP►oPtl+to)
Oti6CPiii+TlpoGFtGON6TR�UCTION 12 am I oAF- SIFE rc�TTrq�Cf� CoA/Ai7ioNS
CIMEN416N Ole INISTALLATION OR R91AOVAL i4TT✓4 ���� e_7G_: f
SIZE OF EXCAVATION, IF NEIDeD
APPROXIMATE TIME WHIN WORK WILL BRUIN
APPROXIMATE TIME OP COMPLETION _
ESTIMATED CONSTRUCTION e0gT t
(Including remavel of ail Obstruction, mswfl4le, &Ad dobtle, bkd0II1j;; aesnh
Peeflon end Biasing pBMM74rtt rasurfodrtli endlOr teplealn; in+Ptov4mentoi
In consideration of the venting of this parmit, �+ 4PpAoeftt P141rrby egraes to:
Indmtw fv,.cfv%r4 end earn the City; Re SWIMONtea 48fnb, "413111 14014ORMIM and
AtM111e1, liabilities or Im reswiln4 troth Cjalm► at OW aes;04 sad uetlf�l out of enw 40016 nt,!on jjgMI cam to rg ��of ap t
ngr�enim or cowmne se a PMIraeto M -11 of I" woft w oetv"" unow the pomie nn oortens w RptOeiw
NOUN the A4mIni@1fethll AM OtAly.4t lead trwnty.fotti i$4i lteurs in a Of the ttn� wh�nh" woePt VAIL be(mrt41000c>�M,
eefnpfy MAth ul eaRlteaile Slltq At9{nam, t" alhfli end saAetttoes Of she pe fnk alid wi 14wo naso end 1111p e*i6m of ON CSW 44
L4 C48nti am to 64Y for 6" eddtticow nFig aMm neeew, ae tibs (Malt 0
J AP01101M Or A"t
Name of A®plloant (pleaes
�•• , ••^, c.. farsry dq T a NC 14s
Name of Con:ra�or and Jolt Foremen a o 4i o ► ;�-p7,,,d ty�,r,l
Connector t Licaflu N0. r ��
Addrgts Z Q 2 ?i T.ieP+hone Nm.
City Business 161IM cs No.
ffreia r%11
Appi(Otlnt's Intute,nea C&rnlm v - •. -_-t4�� r (ilk
�V 1T$C�,�tO�'�oN d►�.+ IPJ i�AW/CG POIPay :k Ufiber
FEES: SubaivistonimaroyefnentPyrmI
t � Ctase I I P
iao�lic improuetftents► 3t4 of as>dMated construction costs
Prlvete Impm jor Ntttei 3% Of estiftntIed constmetloa MM
Minor Im rovemons ACC = Cie! aV! See attached Idwuls
(nepeCtien Ree qo
Permit Fee
Penalty
c+.h 0gP&Ai=.su1eTy D®na
If neftuimd
TOTAL; g 5 ~`
RnNOt No.
RetWnd by
AmrdW by
1386
PERMIT VALIDATION
Yi37-//al
PERMIT NO.
®ATE APPROVao - Z3 •93 ,�
EXPIRATION DAT!
OAT! 166IJ ID
Adminwriii AOthorlty
TBUIPHONE., tolgi 6$64i4E ,
CITY OF I N T (4'
005182 10 6612 04-22-93
iquSl. LIC, 2922 100.00
J. () , CASI-i J. TOTAL i 100.00
JL AMOUNT 'UAMERED 400 A A
IUSINESS LICENSE APPLICATION FORM
send Completed Form To:
CITY OF LA QUINTA,
BUSINESS LICENSE DIVISION
io P.O. Box 1504
La Quinta, CA 92253
,.BUS. LIC. NO.
CHANGE .00
DOUGLAS E., BARNHART, INC.
YOU :'16981 VIA TAZON-9TE.'H
SAN DIEGO CA 92127
3. Mailing Address: P.O. BOX 270399
SAN DIEGO CA 92198
4.. Business Phone: 619 487-1101
5.. Owned By: CORPORATION- PARTNERSHIP INDIVIDUAL
6. If Corporation or Partnership: Tax- I.D.# 95-3814480
lf Individual Owner: Social Security
8. Name of. Owner or Officers and Title: Douglas E. Barnhart, President/owner
9. SBEResale Number:
10.- Number of Decals Needed: Q 3
P i Q 4 2 9
AL -3.100,06
P) 1.31
11. CONTRACTORS ONLY: COPY OF STATE CONTRACTORS LICENSE IS:REQUIRED
A.,,Type of :EIQEAAb
B. Classification: A B ASB'
C. State -License Number: 439407
CONTRACTORS $100.0.0 Per !e*ar or $50.00 Semi-annual
CONTRACTORS $ 50.00 Per Year or ..$25.00 Semi-annual
CONTRACTORS ARE ON A CALENDAR 'YEAR BASIS -ONLY; ANNUAL FROM JANUARY IST
THROUGH DECEMBER 31ST. SEMI-ANNUAL FROM*JANUARY 1ST THROUGH JUNE
30TH; OR.JULY 1'ST THROUGH DECEMBER 31ST.
I HEREBY CERTIFY that all the information supplied by me is correct.and,-
any licenses required'by the County, State or Federal Government have. been
issued pe and are in full force and effect'.
7-19 President 3
gnature Title Date
`
P. 02
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PA.
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LA
J
SPECIAL CONDITIONS --PERMIT NO. 1722
--- LQHS Site ---
In addition to -the standard permit conditions, the following shall apply:
1. All work shall be.performed in accordance with the plan submitted by Permittee.
2. This permit is only for work within the City of La Quinta and.it's right-of-way:
Permittee/contractor shall acquire a permit from any other abutting agency and/or
jurisdiction, ie, Caltrans, CVWD, City of Indio etc.
3.. Permittee shall be responsible for providingcontinuous dust and erosion control.
4. Streets shall be kept clean. They shall be completely cleaned at the end -of each
working day and more frequently if required.
S. Contractor shall comply with the local noise. ordinance. Operation and
maintenance 'of equipment within one half mile of human occupancy shall be
performed only during the following time periods:
October 1st to April 30: Monday -Friday 7:00 a.m, to 5:30 p.m.
Saturday, 8:00 a.m. to 5:00 p.m.
May 1st to September 30: Monday -Friday 6:00 a.m.
Saturday to 7:00 p.m.
8:00 a.m. to 5:00 p.m.
Work shall be prohibited. -on legal holidays including Sundays.
6. Permittee shall assume responsibility for repair of any pavement breakdown at the
haul road .access to any public or private street and for any damage to other City
streets or facilities.
7. Advance warning signs and traffic control shall be installed and maintained in
accordance with Cal Trans Standards. It shall,be the permittee's responsibility
to detour and barricade the site.
8.• Permittee shall notify the City Engineering Dept. at 564-2246 at least 24 hours.
in advance of starting construction.
9. All backfill subgrade soil shall be compacted to nothing less than 90% relative-.
'dry density, all backfill soil within the top 2' of finish pavement surface shall
be compacted to nothing less than 95$ relative dry density, all base material -
shall be compacted to nothing less than 95% relative dry density:
10. A11 excavation at or near the travel way shall be backfilled at the end.of 'the
work day, 'for the protection of.the traveling public.
11. Street closures shall not be allowed'at any time, a minimum of one travel lane
on paved surface shall be maintained -at all times with flagmen present.
12. Ingress and egress for all. local properties shall be maintained at ,all times.
Property owners in'the area shall be notified in advance of any inconvenience.'
13. It is the permittee's responsibility to remove the temporary telephone pole from
the Right -of -Way and return the area to its original condition when the utility
is no longer required.
14. Prior to excavating,..permittee shall contact Underground Service Alert at .1800-
422-4133.
15. Should additional work or modifications of the work be required in order to meet
City Standards or to fit actual field conditions; the work shall be performed by
the permittee as directed by the City Engineer at no cost to the, City of 'Lia
Quinta. • .
Special Conditions- Permit No. 1722 Pagel of. I.