2581NOTE
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 III
DATE: JanuaRY 31, 1997 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Avenue .50 and Eisenhower*
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Repair of gas leak
DESCRIPTION OF CONSTRUCTION Backfill. & repair
AaVement within street exeavation
DIMENSION OF INSTALLATION OR REMOVAL 101 X 10t
SIZE OF EXCAVATION, IF NEEDED N/A
Sketch (attach construction plans if appropriate)
SEE ATTACHED CONDITIONS
APPROXIMATE TIME WHEN WORK WILL BEGIN 2/4/97
APPROXIMATE TIME OF COMPLETION N/A
ESTIMATED CONSTRUCTION COST $ NSA
(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 tc• 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.
Name of Applicant (please print)
Signature of Applicant or Agent
P.O. 3003 Redlands, CA
Business Address
92373 (714) 335-7879
Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
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
Penalty
Cash Deposit -Surety Bond
if required .
TOTAL: $ ..0..
Receipt No.
Received by
Recorded by
Date
PERMIT VALIDATION
PERMIT NO. 2581
DATE APPROVED 1/31/97
EXPIRATION DATE " / f
DATE ISSUED
By k- 11 4 r.,lil^ az A A •
A86nistrative Authority
Telephoner (619) 777-7075
i NOTE:
With proper validation
this form constitutes an
encroachment permit
CITY OF LA OUINTA'
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 SUBDI'ASIONS
Subdivision Improvement, Permit — Class I I I "
DATE: �7 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION AA,e
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OFCONSTFtUCTION i
t
DIMENSION OF INSTALLATION OR REMOVAL 1,02<10
SIZE OF EXCAVATION, IF NEEDED
.APPROXIMATE TIME WHEN WORK.WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ •
(Including removal of all obstruction, materials, and debris, backfilling, com-
pactiri 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 ell
penalties, liabilities or lost 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
A Ouinta and to pay for env additional replacement necessary as the result of this work.
Z
Signature of Applicant or Agent.
� 1 -
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
e
Contractor's License No. City Business License No.
Applicant's Insurance Company GEN. LIASILITy 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 '
Penalty
Cash Deposit -Surety Bond
if required i
Receipt No.
Received by Date
TOTAL:
Recorded by
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619).777 -?075
SPECIAL CONDITIONS --PERMIT NO. 2581
--- Southern California Gas Company --
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.
2. Permittee shall be responsible for providing continuous dust and erosion control.
3. Streets shall be kept clean. They shall be completely cleaned at the end of each working
day and more. frequently if required.
4. 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 1 st to April 30:
May 1 st to September 30:
Monday -Friday
Saturday,
Monday -Friday,
Saturday
7:00 a.m. to .5:30p.m.
8:00 a.m. to 5:00p.m.
6:00 a.m. to 7:00p.m.
8:00 a.m. to 5:00p.m.
Work shall be prohibited on legal holidays including Sundays.
5. 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. .
6. Advance warning signs and traffic control shall be installed and maintained in accordance
with Cal Trans Standards or the Work Area Traffic Control Handbook (WATCH Manual).
It shall be the permittee's responsibility to detour and barricade this site. Traffic control
plans shall be submitted by permittee for work occurring within any signalized
intersection or for work requiring lane closures. Traffic control shall be inspected prior
to commencing any work.
7. Street closures shall not be permitted. A minimum of one travel lane on paved surface
shall be maintained with flagmen at all times.
8. Prior to excavating, the permittee shall contact Underground Service Alert at 1(800)
422-4133.
Special Conditions - Permit No'. 2581 Page 1 of 2
h
SPECIAL CONDITIONS ---PERMIT NO. 2581
(continued)
9.1 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. J
10. All work shall be coordinated with the City's inspector and others working within the
area as directed by and to the satisfaction of the City Engineer.
11.. All backfill and subgrade soil shall be compacted to 90% relative dry density, all
backfill soil within the top 2' of finish pavement surface shall be compacted to 95%
relative dry density, all base material shall be compacted to 95% relative dry density.
Backfill soil may be native soil, so long as the soil is not expansive or otherwise
unsuitable.
12. All excavations at or near the 'travel way shall be backfilled and paved at the end of
every workday as directed by and to the satisfaction of the City Engineer for the
protection of the traveling public.
13. All landscaping, irrigation, decorative rock, decorative concrete, lighting etc. shall be
- replaced to its original condition.
14. Access and egress to all local properties shall be maintained at all times.
15. Permanent pavement replacement section shall be one inch greater than existing and be
paved within seven (7) calendar days from completion of the work. Asphalt concrete
shall be of a mix design approved by the City. Material tickets and compaction test
results shall be submitted to the City.
16. The City has designated by ordinance certain city streets as Truck Routes. The weight
limit for restricted streets (i.e. streets not. part of Truck Route network) is three (3) tons;
trucks exceeding the weight limit may use a restricted street if making a delivery or
pickup on the subject street, or if this permit specifically grants permission to use the
street to deliver street construction materials and .equipment.
Special Conditions - Permit No. 2581 Page 2 of 2