2044t -
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
1/25/94 Subdivision Improvement Permit —Class I II
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Citywide blanket encroachment permit to perform surveys.
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION N/A
DESCRIPTION OF CONSTRUCTION N/A
DIMENSION OF INSTALLATION OR REMOVAL N/A
SIZE OF EXCAVATION, IF NEEDED N/A
APPROXIMATE TIME WHEN WORK WILL BEGIN N/A
Sketch (attach construction plans if appropriate)
SEE ATTACHED CONDITIONS
APPROXIMATE TIME OF COMPLETION N/A
ESTIMATED CONSTRUCTION COST $ N/A
(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.
Jim Welker
Signature of Applicant or Agent
Jim Welker P.O.Box 296 Cathedral City, CA 92235 (619) 328-3539
Name of Applicant (please print) Business Address Telephone No.
Same as above ,!' f�
Name of Contractor and Job Foreman Business' Address Telephone No.
4396 P.L. S ;#' 272
Contractor's License No. r•�,� City Business License No.
FARMERS
Applicant's InsurancE.
TRUCK INSURANCE EXCHANGE 1483 8212
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 $
Permit Fee _
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
10
$ 10
Receipt No.
Received by Date
Recorded by
Policy Number
2044
PERMIT VALIDATION
PERMIT NO. 2044
DATE APPROVED 1/24/94
EXPIRATION DATE 12/31/94
DATE I SU D 1/24/94
By
Administrative Authority
TELEPHONE: (619) 564-2246
NOTE:
With proper validation
this form constitutes an
encroachment permit
i
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
ZS
Subdivision Improvement Permit - Class I II
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
treet address or Description of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION '¢-
DIMENSION OF INSTALLATION OR REMOVAL Nle
SIZE OF EXCAVATION, IF NEEDED u14
APPROXIMATE TIME WHEN WORK WILL BEGIN ti a
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:
Sketch (attach construction plans if appropriate)
�'<E farrTr►c e} Co r.►D IT on1 S
D Q �
JAN 21 1994
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 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
La Quinta and to pay for any additional replacement nece
of the permit and all applicable rules and regulations of the City of
esult of this work.
E%
Signature of Applicant or Agent
619 306-3S 3�
Name of Applicant (please print) Business Address q70'7-3 S'- Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
Id -3941; /Ic'L.S . 0-70
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 $
Permit Fee _�1,12
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO. ZOyy L/
DATE APPROVED /- Z V 171L/
EXPIRATION DATE /7 -3/- 9'Ll
DATE ISSUED l—Zy— 9`1
By
TELEPHONE: (619) 564-2246
Administrative Authority
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SPECIAL CONDITIONS --PERMIT NO. 2044
--- JIM WELKER. SURVEYING --
In addition to the standard permit conditions, the following shall apply:
1. All traffic control in the right-of-way shall be performed in accordance with the latest edition
of the Work Area Traffic Control Handbook (WATCH). The permittee shall show evidence of
ownership of a WATCH prior to issuance of the permit. The. WATCH may be purchased from
the Engineering Department for $7.00 if desired.
2. Permittee shall notify the City Engineering Department a minimum of 48 hours prior to any
work in the street (i.e. paved areas) at (619) 777-7075 when the work involves lane closure(§)
in a signalized intersection or within; 500 feet of a signalized intersection. Permittee may be
required to submit a site-specific traffic control plan for review and approval prior to
commencing work at or near a signalized intersection.
3. Work hours at signalized intersections or within 500 feet of a signalized intersection are typically
from 9am - 3pm to avoid peak traffic periods but may vary depending on the location of the
intersection. The permittee will be notified by the City of specific work hours (if different)
during the 48 hour notice period.
4. Permittee/contractor shall assume responsibility for repair of any pavement damage to any public
or private street and for any damage to other City streets or facilities as a result of work
performed under this permit.
5. Should additional work, materials, or modifications of the work be required to remedy damage
caused by the permittee, or in order to meet city standards and safety requirements, or to fit
actual field conditions, the remedial work shall be performed by the permittee as directed by and
to the satisfaction of the City Engineer at no cost to the City of La Quinta.
6. All work shall be coordinated with the City and others working within the area as directed by
and to the satisfaction of the City Engineer.
7. This permit and permittee is subject to additional fees if personnel time is required to review
traffic plans, traffic control layout, locations, etc., and assist with traffic control implementation.
Special Conditions - Permit No. 2044 Page 1 of I