2310NOTE:
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 III
DATE: 2-21-95 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Calle Tampico westbound west of Washington St.
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Install bus shelter Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION lnstatl pre—raon-catea
bus shelter on existing 10'x 20 concrete pad
DIMENSION OF INSTALLATION OR REMOVAL 10 x 2
SIZE OF EXCAVATION, IF NEEDED N/A
APPROXIMATE TIME WHEN WORK WILL BEGIN ASAP
See attached conditions
See attached drawings
APPROXIMATE TIME OF COMPLETION within 30 days
ESTIMATED CONSTRUCTION COST $ 12,000
(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 ii
Comply with all applicable City Ordinances, the terms and conditions
La Quinta and to pay for any additional replacement necessary as thf
nce of the time whenworkwill be started.
permit and all applicalble rules and regulations of the City of
of this work
Signature of Applicant or Agent
Sunrise Media 303 N. Indian Canyon Dr. Palm Springs, CA 325-7078
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman
Business Address
3637
Telephone No.
Contractor's License No. City Business License No.
Republic Indemnity Co. of America 03502477
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class 111
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
Recorded by
$ 40
10
$ 50
Date
PERMIT NO
2310
PERMIT VALIDATION
2310
DATE APPROVED
EXPIRATION DATE
2-21-95
3-21-95
DATE SSUED 2-22-95
By
Administrative Authority
TELEPHONE: (619) 564-2246
X
NOTE:
With proper validation
this form constitutes an
encroachment permit CITY OF LA . QUINTA
APPLICATION FOR PERMIT
-PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For the oorimction of 'public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water fnains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
2 S Subdivision Improvement Permit — Claaa ill
GATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION PV 6 6z Yl n 1 r .o
v U
(Street address or Dascription of Location) I K.
PURPOSE OF CONSTRUCTION r� u4 Sketch (attach construction plans if appropriate)
DESC PTION OF CONSTRUCTION
KSOAO — tom C7---F-C k—TTr C f4 rt D czW L's(TInu S
DIMENSION OF I ALLATION OR REMOVAL — /0`x-18 '
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN _
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST S _ /2 , Q0
(Including removal of all obstruction, materials, and debris, backfilling, eom.
paetion and placing permanent resurfacing and/or replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrees to:
Indeennifv, defend aro save the City, its audhori:eC agents. officers, rsPrtsenteUves and arnplovea, hamdes from aro against any
and all
pappenjt, liabilities in IOU 'resulting from tlaof or court action and arising out of env accidans, los or damage to persons or prop"
happening or occurring d a Orosunate result o} any wort undertakan under the pa. it granted pursuant to this application.
Notlfv the Adminittrative Authority at Is= twenty-four 1241 hours in advance of the tine when wort will be start
Com Ply with au appliceble City Ordinances, the tarnq and conditions of the Pari[ and all aPpllceble rules and regulations of the City of
V Quints and to pay for any addltlonal replacement neoassary as the result of this wort.
Applicant or
Name of Applicant (please print)— `" V uv t G' • I 1_%1F44_u r
X
Businm Address Telephone Nfs,
Name of Contractor and Job Foreman Business Address
Telephone No.
x
Contractor's License No. ?_ ory r:LF, 3G3-
City Business License No.
Appli ht's Insurance Company GEV, LI,oB LIT Policy Number
FEES: Subaivision 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 S s7/
Permit Fee /
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: S ��
Receipt No.
Received by Date_
Recorded by
�v
PERMIT VALIDATION
PERMIT NO. - Z 3 410
DATE APPROVED
EXP IRATIONDATE 3_u -9S
DATE ISSUED Z �z
By 1
Administrative Authority
777- 7D7
TELEPHONE: (619)5+1b'S
3as-�a�8
1 ji'l Republic Indemnity Company of America
l.Ompany No. lY/1Y wt,uwuvan
WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY POLICY
INFORMATION PAGE
Policy Number. 03509477
Renewal of Policy Numbers 03500025
1. Name and mailing address of the Insured Insured is: Partnership
SUNRISE MEDIA
Bee endorsement
303 SORTS INDIAN AVENUE
PALLS SPRINGS CA 92262
Other workplaces not shown above:
2. The policy period is from July 01, 1994 To July 01, 1995 12:01 a.m. standard time at the insureds mailing address.
3. A. Workers' Compensation Insurance: Part One of the policy applies to the Workers' Compensation I.aw of the states listed here:
CA
B. Employers' liability Insurance: Part Two of the policy applies to work in each state listed in item 3A. The limits of our liability under Part Two are:
Bodily Injury by Accident $1,000,000 each accident
Bodily Injury by Disease $1,000,000 each employee
Bodily Iglury by Disease $1,000,000 policy limit
C. Other States Insurance: Part Three applies to the states, if any, listed here:
All states except SV, ND, OH, WA, WV, WY and CA
D. This policy includes these endorsements and schedules:
1.WC100, 2.WC202, 3.WC300A, 4.WC301, 5.WC040601A
4. The premium for this policy will be determined by our Manual of Rules, Classifications, Rates and Rating Plans. All information required below is subject
to verification and chance by audit
Producer. BFINGI i BANNON
Code Number. 0004003977
Producing Office: Ban Diego
Form No. WC011 10/93
7 Countersigned by: 4_" �Q+��t •.�
Date: July 02, 1994
Insured Copy
Premium Basis
Code
Total Estimated
Rate Per $100
Estimated Annual
No.
Classification
Annual Remuneration
of Remuneration
Premium
See extension of information page (WC012)
$2,500
1►.." nnT51N
AWO UATF
✓r;L. tilJ•:'
NTRA
bpsnce ;:
;-;au:rr Inas Al rinope,
. en, subcorli-
601Ws be
ely :n : r'an Yuji mus! :,hr
n? certificam
';� I��litlrancr: wlr!c
clr-r yenrrn' harihty ;• : -ncel�
�BnSSI:OI J7"
'aQCS irorr al! SU;rB L:111i'
' to Irlallltain
JOIDdate rertlt•r:
of rr ;rri' fill
Moy
�Ylt in yo,::
coaro;.:; •. It.:•
-'„ are Yaw
4010"ees.:.
iave ant ques'llons, please
discuss them
your agent.
Deposit $2,500 +Assessment $8 - Total $2,508
Minimum $2, 500 Total Estimated
Premium Annual Premium
$2,500
Mariana
If indicated, interim adjustments of premium shall be made: Annual
Non -participating
Producer. BFINGI i BANNON
Code Number. 0004003977
Producing Office: Ban Diego
Form No. WC011 10/93
7 Countersigned by: 4_" �Q+��t •.�
Date: July 02, 1994
Insured Copy
Republic Indemnity Company of America
Company No. 19739
WC000001A
WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY POLICY
EXTENSION OF INFORMATION PAGE
Policy Number. 03502477 Effective Date: July 01, 1994 Expiration Date: July 01, 1995
4. Premium
Code
Premium Basis
No.
Classification
Total Estimated
Annual Remuneration
Rate Per S100
of Remuneration
Estimated Annual
Premium
9549
ADVERTISING COMPANIES--OUTDOOR-SELLING SPACE
$7.94
FOR ADVERTISING PURPOSES—INCLUDING SHOP
OPERATIONS, AND THE ERECTION, PAINTING,
REPAIR, MAINTENANCE, OR REMOVAL OF SIGNS;
BILL POSTING; SIGN PAINTING OR LETTERING
IN OR UPON BUILDINGS OR STRUCTURES.
8742(l)
SALESPERSONS—OUTSIDE.
$1.13
8810(1)
CLERICAL OFFICE EMPLOYEES--N.O.C.
$0.79
Fraud Investigation & Prosecution Sa chg 0.1893000%
Workers Comp Administrative Surcharge 0.1235000%
=3
Form No. WC012 10/93
Insured Copy
SPECIAL CONDITIONS --PERMIT NO. 2310
--- SUNRISE MEDIA ---
In addition to the standard permit conditions, the following shall apply:
1. Streets' shall be kept clean. They shall be completely cleaned at the end of each working day
and more frequently if required.
2. 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 5:30p.m.
Saturday 8:00 a. m. to 5:00p. m.
May 1 st to September 30: Monday -Friday 6:00 a. m. to. 7:00p. m.
Saturday 8:00 a. m. to 5:00p.m.
Work shall be prohibited on legal holidays including Sundays.
3. 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.
4. Prior to excavating, the permittee shall contact Underground Service Alert at 1(800) 422-4133.
5. . Should additional work, materials, or modifications of the work be required in order to meet city
standards, safety requirements, signage requirements, or to fit actual field conditions,' the 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's contractor and others working within the area as
directed by and to the satisfaction of the City Engineer.
7. All landscaping, irrigation, decorative rock, decorative concrete, lighting etc. shall be replaced
to its original condition.
8. Access and egress to all local properties shall be maintained at all times.
Special Conditions - Permit No. 2310 Page 1 of 1
SIZE: 7 X 16'0".X 7'011 ( ) (x) ( )
height length depth NIL WSS RTW/
Yes:kxy No ( 1
Lamps
Yes ( I Na ( x) "Palm Desert" Shelters with pitch roof
Pack to Ship
Other and DO NOT have the 4' telephone back
- c�
j QUANTITY—Pitched Roof "Palm Desert"*** shelter w/bench......
SIZE: 7'6" high (plus 2'/pitched roof) -X 1'6' long -X•7'0" wide......
Construction per engineering dwgs./6"x6" post & frame,..090 roof...
A ,. 6 Ad B x'and 2"x 18" x 7' Fibprgalss bench ..............
1. Base
Quoted Price(ea) s_/Dy��
2. Aluminum Face/Backing_• S . NA
3. Wiring — NIL / %VBS / RTW s Incld
800ma & Fixture
J
v
�J
�d
.Standar x o v
Incld. J
_ 4. Mountin — POIe /W311/Base S
f,
elevations
%last
Estimatoreill Angier Iva.
BOOT MOUNTING
` .
S. Lamp Charge F72T 12H0 S Incld . 1
6. FinishTan/Rust Textured' S . Incld
7. Other 71 Fiberglass Bnct- ^ Incld
S. other
Delivered to P.S. s j
S°°
sus -Total .
9. Tax
io. ()th3f'
-rLfrA L
end view: qg'
—A roved by telecon per Frank Jones pate Quoted( P PRA l
c ,Lion► rn Roninnal nffirn Anninval - Rpeon firm P.ices Aller 60 Days) l
.` t` CC 4 v", a ��_ • "/ Ll
EsU to Only
�:t. • Co;t3 Mesa, CA E'625 • (714) 557.6010
lv . °ot j
1.�, ;, SU\^ISE t'1EGIA
Ship to: PALM SPRINGS AREA
_ contact: FRANK JONES
— No.
(s3me unless specified other.rsel
Phone: (619 I 325-7078
Dat
303 North Indian Avenue
_
Palm Springs, CA 92262
Via:_HcNeese/Signpac
Poe ve1U4_4_l/Frank Jones Reyd.� �
I
"Palm Desert Shelt6r s"
( x ) ( ) Qtv. Finish
Tan/Textured mounting: Pole fix) Wall(
1 8352 ( 1 Omar( 1
Type Const ruction
D,'r S/ F
SIZE: 7 X 16'0".X 7'011 ( ) (x) ( )
height length depth NIL WSS RTW/
Yes:kxy No ( 1
Lamps
Yes ( I Na ( x) "Palm Desert" Shelters with pitch roof
Pack to Ship
Other and DO NOT have the 4' telephone back
- c�
j QUANTITY—Pitched Roof "Palm Desert"*** shelter w/bench......
SIZE: 7'6" high (plus 2'/pitched roof) -X 1'6' long -X•7'0" wide......
Construction per engineering dwgs./6"x6" post & frame,..090 roof...
A ,. 6 Ad B x'and 2"x 18" x 7' Fibprgalss bench ..............
1. Base
Quoted Price(ea) s_/Dy��
2. Aluminum Face/Backing_• S . NA
3. Wiring — NIL / %VBS / RTW s Incld
800ma & Fixture
J
v
�J
�d
.Standar x o v
Incld. J
_ 4. Mountin — POIe /W311/Base S
f,
elevations
%last
Estimatoreill Angier Iva.
BOOT MOUNTING
` .
S. Lamp Charge F72T 12H0 S Incld . 1
6. FinishTan/Rust Textured' S . Incld
7. Other 71 Fiberglass Bnct- ^ Incld
S. other
Delivered to P.S. s j
S°°
sus -Total .
9. Tax
io. ()th3f'
-rLfrA L
end view: qg'
—A roved by telecon per Frank Jones pate Quoted( P PRA l
c ,Lion► rn Roninnal nffirn Anninval - Rpeon firm P.ices Aller 60 Days) l
.` t` CC 4 v", a ��_ • "/ Ll
CJo