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2307G7 NOTE: With proper validation this form constitutes an CITY OF LA QUINTA encroachment permit APPLICATION FOR PERMIT _ 1 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 II I DATE: 2"13-95 Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION North east corner of Fred Waring Dr. & Washington St. (Street address or Description of Location) PURPOSE OF CONSTRUCTION Traffic signal modification Sketch (attach construction plans if appropriate) and Street Improvements ' DESCRIPTION OF CONSTRUCTION Modify signal & See attached conditions Widen road See improvement plans DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED small jacking pits APPROXIMATE TIME WHEN WORK WILL BEGIN 2-15-96 APPROXIMATE TIME OF COMPLETION March 195 ESTIMATED CONSTRUCTION COST $ 166,921 (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. IJ1 Signature of Applicant or Agent TDS Engineering 2899 Agoura Road Ste 171 Westlake Village, CA 91361 (805) 584-3537 Name of Applicant (please print) ' Business Address Telephone No. Greg Reaps Name of Contractor and Job Foreman Business Address Telephone No. 667073 Contractor's License No. City Business License No. Calvert Insurance Company GL 003864 Applicant's Insurance Company Policy Number FEES: Subdivision Improvement Permit — Class I II 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: 45,— s — en Receipt No. Received by Date Recorded by PERMIT NO 2301 PERMIT VALIDATION 2307 DATE APPROVED 2-13-95 EXPIRATION DATE 5-30-95 DATE SUED i 13 S By .w -- Administrative Authority TELEPHONE: (619) 564-2246 07/1995 09:32 6197777155 NMI = Wfat1I opm valldaWn Btr bnm a011aUtalfot an «+ao.alw+am owrwie CITY OF LA QUINTA CITY OF LA WINTA APPLICATION FOR PERMIT -PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) PAGF 02 for *" 90"MV0011 Of PA116 Of WIYata t'yrbf, drlvawaw, pnwrw . sWwm & p&r" Iota. alarm, WOW mallet end odtar Ilk$ publla worts lopprovemem in m+uwclon will MINOR IMPROVEMENTS end APPROVED SUBDIVISIONS DATE: vt Sy dIvIsIon InVow"rignt ►wmPt' dM 111 �_ MInW Improvernom P**A am IV WCATIONOFCONSTRUCnON aA4Yl ecL. w ln p A ..j . 1 . _ _ _ Bart t is III *108motirn d LamtlM o y —a- ��Nu�C atUlatldooruvoetiowphis M iPp►oprla)'y � 1 DESCRI11TION OF CONSTWJCT161 DIMENSION OF INSTALLATION 001 REMOVAL SIZE OF EXCAVATION. IF NEEDED &"ROXIMATE TINS WHEN WORK WILL BEGIN -- A , 77475 WROXIMATE TIME OF COWUMON ESTIMATED CONSTRUCTION cW S 11 J (o r, , g4 4, Urithf" nm"I of as obttteucoet m~811, laid debrb, bmkflR tq, aoln- Pete" and owar.p pareatdm IaMfaenq and/or roPlatfetp i nprow w4u, _ In cont+ep*tion Of the pa^fbl 0 Ole owmit ft spplitrnt lWmby &WM1 W CITY OF LA QUINTA FEB 0 9 1995 PUBLIC WORKS IF4*mwq, dam ami mina >~ f2N, to &Avwtm taw". offimm fmmmetlwr ire alrpla fook Iiaiwaso INN asst apint my nrr aN aat.Mtw, limumo or 11a ruwft from t:faift scan wtibn WW arWrie OA of arm evo!Crw. low a f ww r iA m"m or olm ►IaaOorena a am—bw IF a �M fWA of am wtargaaa pra vrWMwf dw aawill owlrw fewswo M q* moistim Natlftr Uta A" -begin Avalalt ft %= twmi►aar (241 uo.s w @&Wm of tib *n, wlwr W% wW by MMS Cawoly voo aM aaaum" Cllr alwwtm trw slant ab aatt kwm of on pm" it IN ar000aeb rut. w wgrglp r M CIN tM Lo Ot" wo» mov err ow motanfl rvpaewrwrw mammv a oil IMA of ms weft 90ueum of Ap Imm or Apar X = IiSl)a Alvi q6qou69d I wesL9ctte. iC�9 C11.361 Nath. of Avolloia (slow VW uSudY Ad*= T�11to110 Nt► Nan" Of C411111`6406M Job Fwrwi�f sigit"ta AddfMa Tewtpfgl" M0. X U&7�%3 Camra wl Lxwm Na /.I i , r, _ - I r. — Clty sudn an Umme Ntf. Aopkant't Inwrferoa Calltoany (�qL Ll�st�lii ►ollgr Nwliar FEST: liifboivisw impovanwN` III Pwic Imp m"or M 3% of "*Mud a wwwatlon mm FMwta imaowit Oft JX of OOfMtad aatwln dol a as Mlaw Imoravvr "evn It — Claret IV: an amdlw uAadub Ilwoactlon iM pwma Fu ..,..�_.. Paw"' cash Detptxit&f"y sone it romfAld TOTAL ROW" Ifs ltfodvad b► Raaw" M 1386 PERMIT VALIOATiON PERMIT NO. 2-367 DATE APPRQVEv 2. -13 - 7 /^ 5 EXPIRATIO14 DAW • DATE ISSUED AdsM.fta>KM ILeVlorhy TELEPHONE: (aim wno . 1994 15:10 FROM F & I Insurance Seru TO 18055841039 P.01 CERTIFICATE OF INSURe.SCE I I1/ 7/1994 JUNM PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF P i I Insurance Services, Inc. INFORMATION ONLY AND CONFERS NO RIGHTS UPON 28720 Roadside Drive, 0275 THE CERTIFICATE HOLDER. IT DOES NOT AMEND, Ag®ure Rills, CA 91376-1469 EXTEND OR ALTER THE COVERAGE AFFORDED BY THE (818) 706-9900 POLICIES BELOW. I COMPANIES AFFORDING COVERAGE I INSURED CO Y A: Calvert laouranoe company TDO Sagineering COMPANY B: 2899 Agoura Road, Suite #171 COMPANY C: WO&tlake Village, CA. 91361 COMPANY D: COMPANY E: I COVERAGES I I I This to to Certify that policies Of insurance listed below have been issued to the sured named above for the policy period indicated, notwithstanding any requirement, term or condition of any contract or ot. r document with respect to which this certificate may be issued or may pertain, the insurance afforded by the Potfcies deb.ribed herein is subject to all the teras, exclusions and conditions of such I1cies. Limit$ shown may have been reduced by p.id claims. ICOI1 INSURANCE , POLICY NUMBER DATES NNEW I A GENERAL LIABILITY [X]Comp [ ]XCU GL 003864 Effective 01/13/96 $ Bodily Inj Oc $ Bodily In) Ag [X]OCP [X]BFPD [X]Premises/ops / / $ Prop Dmge OCC [XJProd/Comp 0 Personal In Expiration $ 1,000,OOOBI&PDDComb ge Oo [X ury [X]Contractual Liab 01/13/95 $ 1000000BI&PD Comb Ag $ Pers Inj Agg AUTO LIABILITY Effective [ ]Any Auto [ ]AL1 Owned (PP) / / $ BI (Person) $ ]]Allowned(other) Hir[ [ BI(Accident) $ Prop Damage ]Non -owned Expiration $ BI&PD Comb I]Garage Liab Description of operations/locations/vehicles/other Riverside County and City of La Quinta are named as additional insured. VNMI CERTIFICATE HOLDER I County of Riverside a City of La Quinta P.O. Dox 1090 Riverside, CA. 92502 Attn: Fran Victor CANCELLATION l Should any of the above described policies be cancelled before the expiration date thereof, the issuing company will endeavor to marl 30 days written notice to the certificate holaer named to the left, but failure to mail such notice shall pose no obligation or liability of any kind upon the company,�ge: or reps. d -----� Authorized Representative TOTALP.01 EXCESS LIABILITY [ ] Umbrellas [ J Other / / / / $ Occurrence $ Aggregate Statry Lints 5 Ea Accident S Disease-Lmt s Disease-Empl WORKERS COMP AND EMPLOYERS LIAR / / Description of operations/locations/vehicles/other Riverside County and City of La Quinta are named as additional insured. VNMI CERTIFICATE HOLDER I County of Riverside a City of La Quinta P.O. Dox 1090 Riverside, CA. 92502 Attn: Fran Victor CANCELLATION l Should any of the above described policies be cancelled before the expiration date thereof, the issuing company will endeavor to marl 30 days written notice to the certificate holaer named to the left, but failure to mail such notice shall pose no obligation or liability of any kind upon the company,�ge: or reps. d -----� Authorized Representative TOTALP.01