2345NOTE:
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: 4-19-95 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION North East Corner of 52 & Jeffereon
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION - Ramove hydrocarbon Sketch (attach construction plans if appropriate)
imacted soil
DESCRIPTION OF CONSTRUCTION Excavate & remove soil
See attached conditions
DIMENSION OF INSTALLATION OR REMOVAL
r
SIZE OF EXCAVATION, IF NEEDED approx. 107012
APPROXIMATE TIME WHEN WORK WILL BEGIN 4-20-95
APPROXIMATE TIME OF COMPLETION 4-22-95
ESTIMATED CONSTRUCTION COST $ 4875.00
(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:
.f'
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.
,r
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 ork.
Signature of/Applb ant or Agent
Tait Environmental 1100 Town 6 Country Rd. Orange, CA 92668 (714) 560-8200
Name of Applicant (please print) Business Address Telephone No.
Frank Echenique
Name of Contractor and Job Foreman Business Address Telephone No.
588098 3719
Contractor's License No. City Business License No.
Home Ins. Co. of Illinois SLMC 200785
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 $ 146.25 II
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
Recorded by _
10.00
$ 156.25
Date
2345
PERMIT VALIDATION
PERMIT NO. 2345
DATE APPROVED
EXPIRATION DATE
4-19-95
4-26-95
�%v
DATE SSU D 4-19-95
By
Administrative Authority
TELEPHONE: (619) 564-2246
SPECIAL CONDITIONS --PERMIT NO. 2345
--- TAIT ENVIRONMENTAL --- .
In addition to the standard permit conditions, the following shall apply:
1. All work shall be performed in accordance with the latest edition of the "Standard Specifications
For Public Works Construction".
No'fill shall be placed which will cover or obscure asphalt concrete, petroleum product spillage,
or other non-native materials.
2. Permittee shall furnish the name(s) and phone number(s) of the individual(s) responsible for
maintaining dust control after hours, weekends, holidays, etc. __ _..
3. All streets shall be kept clean of all trackage or spillage from vehicles using this site. The roads
shall be completely cleaned at the end of each work day, if necessary, and more frequently if
required.
4. 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. to 7:00 p.m.
Saturday 8:00 a.m. to 5:00 p.m.
Equipment may not be operated or. maintained on legal holidays including Sundays.
5. Permittee is responsible for repair of any pavement damage or other damage to access roads and
other public facilities.
7. Should additional work or modifications be required in order to meet established City Standards
or in order to fit 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.
8. It is the permittee's responsibility to comply with the California Regional Water Quality Control
Board's National Pollutant Discharge Elimination System (NPDES).
.9. Any on-site haul road shall be effectively destroyed at the conclusion of the work to prevent use
by unauthorized vehicles.
10. Permittee/contractor shall install stop signs to stop construction traffic prior to entering any street
from the construction site.
Special Conditions - Permit No. 2345 Page 1 of 2
SPECIAL CONDITIONS - PERMIT NO. 2345 continued
TAIT ENVIRONMENTAL
11. If buried remains are encountered during development, a qualified archaeologist shall be
contacted immediately. and appropriate measures shall be taken.
12. All grading shall be performed per the soils report.
13. It is the permittee/contractor's responsibility to provide continuous dust control while the grading
is being performed, or at any other time as deemed necessary by the City Engineer. Permittee
shall provide soil stabilization on the entire site per the approved dust control plan immediately
after completing the operation.
14. Street closures shall not be permitted at any -time. A minimum of -one lane_on paved-surface__—
shall be maintained at all times with flagmen at all times per CALTRANS standards or the
WATCH (work area traffic control handbook).
15. All excavations at or near the travel way shall be backfilled at the end of each work day for the
protection of the traveling public. No trenches shall be allowed to remain open overnight.
16. No left turns out of the project will be allowed the haul. route shall be set-up as a right -in right -
out operation.
Special Conditions - Permit No. 2345 Page 2 of 2
RPR -18-1995 14;16 TAIT & ASSOC 714 560 8211 714 560 8211 P.002/003
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APR -18-1995 14:17 TAIT & ASSOC 714 550 8211 714 550 8211 P.003i003
ISSUE DATE (mummy)
ACI 0131) 25 iZi941 ......... -ACUND CORPORATtON 144D:..
ISTE ►►
1 09/13/94
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
Brakke-Schafnitz Insurance
Brokers, Inc.
DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
POLICIES BELOW.
28202 Cabot Road, Suite, 500
COMPANIES AFFORDING COVERAGE
Laguna Niguel, CA 926771251
c°MPAI`Y A Horne Insurance Co of Illinois
LETTEn
ST
I COMPA"' B Golden Eagle Insurance
LEITER
I
INSURED
COMP
LETTER C
Tait & Associates, Inc. dba:
1100 Town & Country Rd.,#1200
P 0 Box 4429
COMPANY
LETTER D
Orange, CA 92613
COMPANY E
LETTER
•
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
CO
LTR
TYPE OF INSURANCE I POLICY NUTABEA
POLICY EFFECTIVE
DATE (M"DrM
POUCY EXPIRATION
DATE(MWOWY)
LIMITS
A
GENERALUABIUTY
BODILY INJURYOCC. t
X
COMPREHENSIVE FORM
SLMC200785
+ 07/01/94
07/01/95
BODILY INJURY AGG. S
X
PREEpMISEWOPERATIONS
!1111
I
PROPERTY DAMAGE OCC. $
EXPLID IONNCDOLLAPSE HAZARD
(
i{
X
PROPERTY DAMAGE AGG, t
Jt
61 A PO COMBINED OCC, S 51000,000
PRODUCTSPOOMPLETED OPER.
X
BI A PO COMBINED AGO. S 5000000
CONTRACTUAL
PERSONAL NJURY AGG. f IO.
WDEPENDENT CONTRACTORS
i
I
BROAD FOAM PROPERTY DAMAGE
i
X
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PERSONAL KIURY
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I
B
AUTOMON
E UANUTY
ANY ALIToM121811842
09/08/94
09!08195
BODILY INJURY
IP" P'"0"1
X
BODILY INJURY
(P•r.acddam) f
ALL OWNED AUTOS (PTH. Pau.)
ALL OWNED AUTOS {•P�
I
HIRED AUTOS
�!
X
NON -OWNED AUTOS
PROPERTY DAMAGE f
X
BODILY INJURY 6 _
COMBINED DAMAGE 1.00 .000
GARAGE UABILRY
f
i
EXCESS UABJUTY {
EACH OCCURRENCE f
UMBRELLA FORM i
!
AGGREGATE f
OTHER THAN UMBRELLA FORM
'<'it't;;„%>•'•>a;; '':; i?;i`; ntyExS%? ”>;"
i
WORKER'S COMPENSATION
STATUTORY LIMITS :'':e:4''<t%:<`? .'r"? s'•"•`:i
EACH H ACCIDENT
AND
DISEASE—•POLICY LIMIT 3
EMPLOYERS' UABWTY
DISEASE—EACH EMPLOYEE $
OTHER
I
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLE"PECIAL ITEMS
M:LMION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 8E CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL 2IIAN Otow
MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO T'iE
LEFT,
AUTTIDfi[ZED RMNTATIve
ACI 0131) 25 iZi941 ......... -ACUND CORPORATtON 144D:..
ISTE ►►