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1884r, 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 I II DATE: 9`20-93 Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION South side of Fred Waring 0 43.900 Block (Street address or Description of Location) PURPOSE OF CONSTRUCTION trench & place pvc conduit DESCRIPTION OF CONSTRUCTION Hand trench behind curb 1% DIMENSION OF INSTALLATION OR REMOVAL 0 Cf PVC SIZE OF EXCAVATION, IF NEEDED 3011 aft cover APPROXIMATE TIME WHEN WORK WILL BEGIN 3 APPROXIMATE TIME OF COMPLETION 10- 145 ESTIMATED CONSTRUCTION COST $ 800 (Including removal of all obstruction, materials, and debris, backfilling, com- paction and placing permanent resurfacing and/or replacing improvements) Sketch (attach construction plans if appropriate) ase attachred sketch see attached conditions M In consideration of the granting of this permit, the app!icant hereby agrees to: pQ�°D OCT 1 199 D By_ 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 t0persons 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. 4 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 r u of this work. Signature of Applicant or Agwt - Can Am Const. 1306 W Brooks 8t. Ontario, CA (909) 988-5507 Name of Applicant (please print) Business Address Telephone No. David CZingenpesl. Mobil 367--5200 pager 864-3472 Name of Contractor and Job Foreman Business Address Telephone No. 445494 Contractor's License No. Insurance Co. Of The West 2299 City Business License No. CSD 114268500 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 $ 80 10 Permit Fee Penalty Cash Deposit -Surety Bond if required TOTAL: $ 90 Receipt No. Received by Date Recorded by 884 PERMIT VALIDATION PERMIT NO. 1884 DATE APPROVED 9-X20-93 Aft. EXPIRATION DATE �' 10"j5.93 �i DATE ISSUE f7— Z I— q3 By (Administrative Authority TELEPHONE: (619) 564-2246 d' 43815 • i II II 43845. I 120 3 v II PARKING AREA �I I I I IU PARKING AREA I i I I I II ZN ST,z)LG IjMin DoG H � T1s c 3k Imo 0 t .. M2ro I I o I �6S 4060 ' e 44095 44090 I �� 44125 0 II N 44155 I j 44185 ( _.......... Footage from lost Amp PS Number Power Mode Amp ID No. :Model Number In -Design Freq Out -Design Freq In-54MHz Out 54 MHz FWD Pod INT Pod INTO Eq VOLTAGE AMP -Draw PH plug-in Split Value Design Freq Sec lug -in Split pVafus Low -loss Port Low -loss Port =N.5?/44 G '' -A I 0 vAuC- r P 0 If�O o 6s � 44090 144095 44120 144125 44150 1 44155 44180 I 44185 co r` N Ir - L0 \ 18930 r . X\ cLoo 0 CITY: PALM DESERT REVISION 570 570 57o STATE: CALIFORNIA 1 Bio• 78940 78950 1983- 568 1986- 568 1989- 568 Ib960 1 78920 I 1 527' L.-- 2 245' 0 0 0 ' 1566 1566 1566 MAP NO. 1986-5-68 1 78975 M. — 11 '' 0 8 00 co 00 00 _4 Sr1sT/� LL v/aL-A ct i7x 70 soo • \ 0.0.60 4, 44090 78810 111 44120 44095 Coble: - —• - P-3 .500 P-3 .750 ---- •••• -- MC2 .500 FIBER Conduit: — --- --- 1.1/2" - _ 3. 44150 1 44155 1 44180 1 44185 DESCRIPTION STRAND FOOTAGE U.C. FOOTAGE AERIAL PASSINGS U.C. PASSINGS TOTAL PASSINGS DENSITY 43900 y��T�LL Vqu�T c co,so VAC —� AREA 141' 202' 155' i I \ 1 � I N fj oil 3 26 AREA —� I 109' 145' 146' 98' C►- - - - -0 cl-- - - --1 r- -- -- -0 DESCRIPTION AERIAL MULTI UNITS U.C. MULTI UNITS COMMERCIAL UNITS TOTAL TRUNK TOTAL DISTRIBUTION TOTAL FIBER I 1 11 I LAST 1983- 1986- 1989- CITY: PALM DESERT REVISION 570 570 57o STATE: CALIFORNIA 1983- 568 1986- 568 1989- 568 SYSTEM: PALM DESERT SCALE DATE: 6/92 0 0 0 ' 1566 1566 1566 MAP NO. 1986-5-68 a/ SCHI 13 The following General aria Special Provisions are attached to and made a part of Permit No. GENERAL PROVISIONS The following snail always apply: ENCROACHMENT ON PRIVATE PROPERTY: This permit authorizes work to be accomplished within City of La Quints right of way ONLY. Whenever construction extends within private property. it shall be the responsibility of the Permrttee for his contractors) to secure permission from abutting property owners. Such authorization must be secured by the permittee prior to starting work. TRACKLAYING CONSTRUCTION EQUIPMENT: Cleated tracklaving construction equipment shall not be permitted to operate on any paved surface unless fitted with smooch -faced street pads. All mechanical outriggers shall be fitted with rubber street shoes to protect the paving during excavations. 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 it the pavement is marred. City of La Quints shall request that these portions of road be resurfaced over their entire width. Resurfacing shall consist of one cost of two inches 12") of A.C. surfacing plus appropriate seal coat as specified above. PROTECTION OF TRAFFIC: All excavations and work areas shall be -properly lighted and barricaded as deemed necessary by the City Engineer or La Quints City Public Works Inspectors. Suitable detours and detour signsshall be placed and maintained for the duration Of the project. The City shall be notified 24 Hrs. in advance of any traffic detours or delineations. CARE OF DRAINAGE STRUCTURES: Any drainage structure including corrugated metal pipe, concrete pipe, steel culvert and concrete structures encountered during excavation which necessitate removal shall be replaced in kind. In the event.it becomes necessary to remove or cut existing drainage structures. City of La Quints shall be notified prior to commencement of this work. 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 fromthe right of way. All paved surfaces shall be broomed clean of earth and other objectionable materials immediately aherbackfill 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 backfill. DE -WATER OPERATIONS: If de -watering operations are required and pumps are forcing water on Cityof La Quints roads. it shall be the responsibility of the permittee Icontractorl to control this water and to provide off-street bameades when neeasaary. CLOSING STREETS: No street shall be closed. A minimum of one lane of traffic shall be maintained at all times to provide limited access for the adjoining property owners and emergency vehicles. In the event it is felt bythe permittee that he mustcicm a street for any length of time, permittee shall contact this office to obtain the necessary permission. SPECIAL PROVISIONS The follwing shall apply ONLY when indicated: NOTIFICATION: Permittee shall notify the City at 5642246 at least 48 hours in advance of starting construction. R2 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 Quints to cover all work involved in the restoration of the various La Quints roads and survey monuments. This bond shall be continuous until cancelled by the City Engineer. This bond must be posted prior to commencement of any work on this project. ®UTILITY CLEARANCE: (Substructures) Prior to making any excavation within the City of La Quints right of waysuthorized by permit, the permittee shall contact all concerned utility companies relative to the location of existing substructures. Damage to existing substructures resulting from operations conducted under this permit shall be the sola responsibility of the permittee. R4 UTILITY CLEARANCE: (Surface structures) No work shall be done under this permit until all utilities are dear of the proposed work site. The permittee shall notify all concerned utility companies of the proposed work. R5 PAVEMENT WIDENING: Area between 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 "R"valueof not less than -and in conformance with Cityof La Quints Road Improvement Standards and Specifications. Ordinance #461. R6 PARKWAY GRADING: Area between the property line and top of the proposed concrete curb shall be gradedto a slope of 1 /4 inch to one foot I �. R7 GRADES & STAKES: City of La Quints shall establish grades and stakes for the proposed concrete curb and gutter construction. R8 GRADE CHECKING: City of La Quints shall checkgrades upon receipt of plan and profile and/or grades as established by a licensed engineer. R9 CURB REMOVAL FOR DRIVEWAYS: A portion of the existing concrete curb and/or curb and gutter I feet)shall be removed. Curb and/or curb and gutter shall be saw cut prior to removal. Depressed curb, matching concrete gutter and concrete driveway approach shall be constructed in conformance with City of La Quints Standard #207. RIO DRIVEWAYS. A.C.: Driveways shall be constructed as not to alter existing drainage pattern. Surfacing between the property line and the existing road paving shall be 2-1/2 inches of A.C. paving placed on I ") of cls: aggregate base. Driveway construction shall conform to attached drawing. R11 CULVERTS: A :nch diameter ( culvert shall be installed with the raven approximately 1-1 /2 incnes below and in line with the existing flow line. Culvert installation shall conform to the attached drawing. SIGHT CLEARANCE: Sight clearance of 600 feet in either direction shall be assured and maintained. R13 SOIL STERILIZER: The area to be surfaced shall be treated with soil sterilizer. Rate of application shall comply with the manufacturer's specifications. R14 COORDINATE WORK: The proposed work shall be subordinated to any operation which the State of California or City of La Quints may conduct in this area during the period of this permit. Work shall be coordinated with the State or City of La Quints forces to preclude delay or interference with State or City of La Quints 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 may be readilyandcorrectly be replaced by a licensed civil engineer or surveyor at the expense of the permittee. A complete set of notes showing the cies to these monuments shall be furnished to the City Engineer prior to the removal of any m urttents. This office shall be notified upon completion of replacement of 80 survey monumems for proper "Ga clearance. R16 -SURVEYMONUMENTS: Prior to excavation or oeoin nine of construction. ail survev monuments snail be ttea out by City OT La Quinta ano suitaoie oavment or guarantee or oavment snail be mane as reimbursement for all work invoivea. R17 PAVEMENT CUTTING: Pavement will be mechanically cut to a straight edge prior to excavation. Method of pavement cutting shall be aocroveo throuan the office or the Citv Engineer. (Under no circumstances snail excavating equipment be used to excavate prior to cutting of pavement). Excavation material shall be placed in sucn a position as to best facilitate the general flow of tratfic. Prior to tinal oaving operations. anv damage to oavement straight edge snail be corrected. R18 PAVEMENT CUTTING: Pavement snail be saw cut prior to removal. Prior to final paving operations, any damage to pavement straight edge snail be corrected. R 19 LIMIT OF EXCAVATIONS: Excavations shall be itmitea to 1.000 lineal feet of open trench before backfill operations must begin. All excavations snail be properly barricaded with lights overnight, on weekends and holidays torthe protection of the traveling public. The Public Works inspector snail determine the suitability of excavation barricaoing in each case. No excavation snail remain open for a period exceeding Live 151 days. No excavation snail be made unless the construction material is actually on the work site. R2 BACKFILL MATERIAL: Backfill shall be free of brush, roots or otherorganic substance detrimenta.::.:s use for purposes of producing an adequately consolidated backfill. Any material which the City of La Quinta deems unsuitables ngyor saturated materiall 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 equivaient equipment. Alternate methods maybe substituted, but in any case a relative compaction of 95 percent shall be attained within the s:ructural section of the roadway. R2 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') liftswhere 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 oercent or equivalent to the surrounding ground, whichever is the greater compaction. Where ponding or flooaing 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 ;ager and the water supply shall be continuous. R23 COMPACTION TESTS: If so required bythe inspector, compaction tests shall be made at intervals of not more than 1,000 feet and a minimum of one (1) test on each road. One 11) 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 COMPACTION TESTS: If so required by the inspector, compaction tests shall be made for eacn crossing or se One (1) copy of each test shall be forwarded to the City Engineer for approval and filed prior to making permanent rvice line. repai Compaction tests shall be made as outlinea in Section 6.3.01 of the Standard Specificationsrs. , Division of Higftw t r 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 the placement of the temporary pavement exceed a five (5) day limit. R26 PERMANENT 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 surfacing placed on a inch class inches A.C. base shall be placed no later than 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 (2'7 of cold mix paving (SC -800) shall be placed immediately. A permanent batch of three inches (31 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. R29 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 Seaton 37, Standard Specifications, State of California. Division of Highways, dated January 1913. 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 mterference 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 highwav traffic. The entire width of the tree stump snail 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 anyone 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 oermit. 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 snail, in all instances. be at the shoulder of. the crotch to insure even, fast healing in all cuts of two inches !21 and above -in size. Sealant shall be aoobed to all cut sec inne ac nvm�mft n...ae 0 ...... ._ 2 go T abed NBST 'ON ATmiad - SUOTITPU03 IeTbadS - ezujnj3 ej to AIT3.yq; a; Zso3 ou Ze jaa6TBu3 AZT3 aqZ jo uoTZmejsj;es a44 o; pue Aq paqma_ Tp se aaqqlwjad aq; Aq pamogjad aq-ile4s liom aq4,1spoj4Tpuom plaly len;3e jTj a; no 9s;1rawajTnbaj aBeuBjs 6sjuamaj7.nbaj Alayes 6spiepuels AjTn jaaw al ypjo ul pajjnbaj aq Jim aqj go suOj;e3TjjPOW no as1e1jazew aliom IeuOj;jppe Plnoqs -OT "EET5-22b (0081T jo 4"alU a3TAjaS puno-Wapun 43eluon lleqs aaqqlwjad aqq 61:7sr140AMma o; jolid -6 -aaj ajelidaidde aqj Aed pue ;Twjad Zuawqmeojnua jeuoWppe- us _rod. Aldde lleqs AundwoD butjmw4uon aqj Aundwoo- A4TIT4n. aqw 10 4eq4 ueqj jaqjo saojol Aq pawiolied aq o4 s, Aom aqj 11 .8 Ile je uambell qj;m pauTejuTqw aq lleqs a0ejAnS PaAed uo aur l jaAwJj WAO J-0 turmiTuTw V -paj4Twgad aq 4ou Tleqs sainsoln qaej4S -L -aq;s sTqj apeDTineq pue anoqap o4 A4TITqTsuadsaA s,aaqjTwAad aq-1. aq Ile4s 41 -SpAepuels sueAyleo 441M anuepwnne ul pauTeJuTew pue-palle"Sul aq iTeqs loAquan nj4jeA4 pue suBjs ButuAem,aMUqAPV -? " sat M!mej no s4aaAls A113 waq4o aq. a5ewsp Aus no, pue qaaAqs'ajeATAd no DTlqnd Aus a, ssannT peon Ineq aqj go umopleanq jUaWaAwd Aus go iTudai ia, AjTjTqTsuodsaj awnsse lleqs aaq4Twjad .9 -sAmpunS bulpnInuT sAepTlaq lebal uqpajTqTqoid aq lleqs jAoM -W-dooNq 01 -w-e 00se Aepinjes -w-doocL Oq -W-e 00l9 AFPTAJ-AFPUOW WE jaqwajdag aq jsj AsW -W-doo:g a; -m-e 0oue Aepin4eS -w-drE:9 04 -w-e OWL AepjjA.AGpuaW KE IjjdV al jsj jaqojnO sspaTiad awTj BuTmaTToj aqj Bujinp Aluo pawjojjad aq TTeqs Amuednnma uewnk..l go aTTw jTeq auo uTq;lm ;uawdlnba,jo anueua;uTew pue uoT;e,nadO -amueulpia asTou Te mal a4; q;Tm Aldwom TTeqs jolnew;UO3 '17 -pajjnbaj jt Al;uanbaij ajow pue Aep Buj4jom qmea go pua aqj. ;e pauealm Ala;aldwon aq lleqs Aaqj -uealn jdaM aq lleqs sjaajjS .6 i .100JU03 UOTSOJF) pue 4snp snonuTluam BuTPTAOJd _sol alqTsuodsaa aq lleqs ae4lTwaad .2 -uoTjnnajsuaD sjjoM oTlond _.raj suo;4wnTjjDadS pjapusIS a, go uoTITpa 4sa4e1 a, q4Tm aouepionne uT pawAolAad aq lleqs jAom IIV. -T uAldde lleqs buimolTol aqj 6suoTqTpuan jTwAad pjepuwqs aqq al uoTqTppe u). --- "ISNOD WV-NV3 V88T "ON IIW83d--SNOIIIUNOO IVIOMS ti 2 10 2 abAA NNS T "ON 4TWAOd - SUOTUMOD IsTDadS -lTsuap AjjJ dwi p aAT.Ia%96 04 pa_ aq lleqs leTagew aseq Ile 6AAqTSUap Ajp aAT4?IaJ %96 01 paqwdwoD aq lleqS aDelinS 4UaWaAed 4sTuTj a �a do:} aql uTqMm ITOS jjTjjDwq ljwAA4Tsuap Ajp aAljejal %06 01 palDedwon aq lleqs ITas apeq6qns pup TITlyneq IIV -W -loom Bullie;s aq jolid siq 9, ja wnwTuTw e aleTidaidde se S589-889 (6T9) W -%daa leubTs suejqTeo ja 5689-OL2 (V i,) je "Idaa TeuBjS Ajunao aplsjaATH Alljou lleqs aajjjWjad aq; guallpasia4ul pazTleuBjs e ja loog uT411m sT liam aq4 uaqM -ET -jaaujBu3 A113 aq4 ja uaTjmejsjjes a44 al pue Aq palmaATp-se eaAe aqq ujq;jm BuTMiom sw4jo pue Aaj3ejjua3 s,A;13 aq, qjTm pa4eulpioan aq lleqs loam TIV "2*f -uajjjpua3 IeujBTAa sjj a4 paneldaA aq lleqs -34a InaA aATjeAOnap 6uOj;eBTA`oT Qujdewpuel TIV AT 1 � i �� " j NOTE: With proper validation this form constitutes an eneroachmern 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:- �- /7 — / Q LOCATION OF CONSTRUCTION 51-S, ��- (Street address or Oncnptlon of Location) �M Subdivision Improvement Permit - Class 111 Minor Improvement Permit Class IV 0 O R1 OF CONSTRUCTION _Lie - 3- a- ?�-_- ��Sketch (attach construction plane if a � A,(a ppropriate) DESCRIPTION OF CONSTRUCTION OIMCSSL N OF INSTALLATION OR REMOVAL `"''��- �� (( ll SIZE OF EXCAVATION, IF NEEDED 1 T-0 -(- -t- , :1 Le �Tx 7'a ,art,+1 pat_ APPROXIMATE TIME J .00 WORK WILL BEGIN 7 -20 - APPROXIMATE TIME OF COMPLETION 4-wz> `-a 4 D4_4 ESTIMATED CONSTRUCTION COST S It q 00 (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. representative and emptoyen. harmine from and against any and all penaltlee, liabilitin or toes resulting from cisums Or sours action and wising out of sny accident, loss or darnage to persons or property happening or o=umng e a proxurim result of env wort undersaMIS under the permit granted pursuant to this application. Notify the Administrative Authority at hast twwnty-four 1241 hours in edvanee of the time when worst will be started. Comply with all epplicabh City Ordinances, the teens and conditions of the permit and all applicable ruin and regulations of the City of La Ouints'and to psy for arty additional replsewrient neonwry as t result of this work. Signature of Applicant or Agent I�l]l0 W) 00(=3 9�t Name of Applicant (please print) Business Address Name of Contractor and Job -sem - / 0_0� li4 G Business Address oq Tel phone No. 5-161- 9'.2 00 Telephone No. Contractor's License No. City Business License No. ry S U� A1y cA a ,' -r-t. Applicants Insurance Company Policy Number FEES: Subotvlsion 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 Penalty Cash Deposit -Surety Bond if required TOTAL: $ Receipt No. Received by Date Recorded by PERMIT VALIDATION PERMIT NO. DATE APPROVED . EXPIRATION DATE DATE ISSUED By -SS'o') Administrative Authority TELEPHONE: (619) 664.2246 N J