2639NOTE:,-�;„,,�...,.owl
.2.
I .With proper validation,
this for constitutes an 71 CITY OF LA QUINTA
I� encroachment permit •-,
i -1k APPLICATION FOR PERMIT $
j _• � _ .PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
OFTIiB�
y - veways,•pavements, sidewalks, parking lots, sewers, water mains
For" the construction of public or private curbs, dri
and other like, public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
�. Subdivision Improvement Permit — Class III ,
DATE: ,3U4 ,iS 97. t Minor Im_provemek,Permit Class IV.
LOCATION'OF,CONSTRUCTION Air oda •8sx> rilltuF - � ' " '
(Street address or.,Description of Location) .; • ! F' - i "
PURPOSE OF CONSTRUCTION S
- ketch.(attach construction plans if appropriate)
. - ' . , s,..,':. - • , .�, y = •` - ,await �i'a�#►a 1 .. �.:.
DESCRIPTION OF• CONSTRUCTION. }'
xrt4'1 n6 ti kMA(`'Vf►~f A At ���te L��t tYa•_ r �. �� ��'
t` r . •
'DIMENSION OF•INSTALLATIOWOyR.REMOVAL
1*1 1 "e f�laA'fa�f'i' 4�`� R�lSlilAt�:- f �'� i►V211
l � tY' t r.." i y �a��� � u - :�' •.�, � "� :N tS�,r�;- . ,s4 y - . r T ,a�i.� �+'� . } , It .
w
SIZE OF'EXC_ AVATION, IF NEEDED; et�fti is> d � J
_APP ROXIMATETIME WHEN"WORK,WILL BEGINvj
, •,� :..•' w,•,: x y,-�a1 `d . � � i • � .� . � SIT �• , •moi .. •f'{- �a •"" 3 a•'' ,
` APPROXIMATE TIME OF COMPLETION��'=
ESTIMATED�CONSTRUCTION COST
5. I
(Including -removal of,'all obstruction.materials and'debris,abackfllling; com
paction and, placing ;permanent resurfacing and/or..*replacing improvements) }
! r„•
r In consideration o0the granting of.this permit, the•applicant herebyragrees to: t
Indemnify, defend `and save the City,..its authoriied;agents, officers, representatives, and employees, harmless from and_ against any and all L
• penalties ,liabilities or loss resulting,from`claims,or court action"and arising out of'any;accident,aoss o� damage to personslor.property
happening.or occiirringTas a proximate result:of any work undertaken under'the permit`granted,pursuant+to'this application.'
r' •,".Notify•the„Administrative 'Authority at least twenty-fo6r-(24) hours in advance of the time,when work will be, started.
Comply with all epplicable,City Ordinances, the terms,and conditions of the'permit and 'alI applicable rules and regulations of the City of
"La ,Quinta andato pay for any' additional replacement necessary as the result of this work.
It
Signature of Applicant or Agent,f �7 l
!lt 1r3atf le..4a' �” ► lots` �`:>,i".04
►
Name of.Applicant (please print) _ r Business Addressr , t Telephone No h. .
lfaairi6 �t1►3:Q' �
T�li't� :�
'.�3#�i? a"Q�z�?i� y ���61�� '_���#",
Name.0 Contractor`and Job Foreman 'i Business Address ; "d:1• i. Telephone No':
Contractor's License -No:• City Business License'No. x:
Applicant's;lnsurance Company-.', r r` Policy Number '
7. -
FEES: •Subdivision Improvement Permit —.Class Ill G
Public improvements: 3% of estimated construction costs
(Private improvements: 3%'of estimated construction,costs AUG .04 1997
;• v.
'Minor Improvement Permit - Class'IV: See attached schedule 1 {�
•
Inspection Fee $ � f" �y,f � t.f f".;r:' r'• ` !"" r`�.� �'�
, DAT90
VALIN
PermitrFee�i X69
1
PERMIT NO..
Penalty $/4/9' '
1 Cash Deposit -Surety Bond DATE APPROVED'
if required EXPIRATION DATE 3/31/98
TOTAL: $ ���• DATE.ISSUED 8/4/97
Receipt No
By _
Received by Date '� Administrative Authority
Recorded by
i_ Telephone: (619) 777-7075
:.
1' A
The following General and Special Provisions are attached to and made a part of Permit No.
GENERAL PROVISIONS
The following shall always apply:
ENROACHIM ENT ON PRIVATE PROPERTY:. This permit authorizes work to be accomplished within City of La Quinta right of
way ONLY. Whenever construction extends within private property, it is the responsibility of the permittee for his contractors to
secure permission from abutting property owners. Such authorization must be secured by the permittee prior to starting work.
TRACKLAYING CONSTRUCTION EQUIPMENT: Cleated tracklaying construction equipment shall not be permitted to operate on
any paved surface unless fitted with smooth -faced street pads. All mechanical outriggers shall be fitted with rubber street shoes to
protect the paving during excavations. Rubber -tired equipment only shall be used in -backfill operations in paved areas. If the existing
pavement is scarred, spalled, or broken during the term of this contract, or if the pavement is marred, City of La Quinta shall request
that these portions of road be resurfaced. over their entire width. Resurfacing shall consist of one coat of two inches (2") of A.C.
surfacing plus appropriate seal cost as specified above.
PROTECTION OF TRAFFIC: All excavations and work areas shall be properly lighted and barricaded as deemed necessary by the
City Engineer or La Quinta City Public Works inspectors. Suitable detours -and detour signs shall be placed and maintained for the
duration of the project. The City shall be notified.24. hours in advance of any traffic detours or delineations. .
CARE OF DRAINAGE STRUCTURES: Any drainage structure including corrugated metal pipe, concrete pipe, steel.culvert and
concrete structures encountered during excavation which necessitate removal, shall be replaced in kind. In the event it becomes
necessary to remove or cut existing drainage structures, City of La Quinta shall be notified prior to commencement of this work.
Drainage structures and open drains shall be kept free of debris at all times for proper drainage.
RIGHT OF WAY CLEANUP: Any surplus material resulting from excavation and backfill operations shall be removed from the right
of way. All paved surfaces shall be broomed clean of earth and other objectionable materials immediately after backfill and compaction.
Existing gutter line and drainage ditches shall be replaced to their original standard or better. All excess material shall be removed
prior to paving. Water tanker shall be used, as required, to sprinkle the job site to keep down dust conditions and shall be used
immediately after backfill.
DE -WATER OPERATIONS: If de -watering operations are required and pumps are forcing water on City of La Quinta roads, it shall
be the responsibility of the permittee (contractor) to control this water and to provide off-street barricades when necessary.
CLOSING STREETS: No street shall be closed. A minimum of one lane of traffic shall be maintained at all times to provide limited
access for the adjoining property owners and emergency vehicles. In the event it is felt by the permittee that he must close a street for
any length of time, permittee shall contact this office to obtain the necessary permission.
SPECIAL PROVISIONS
The following shall apply when indicated:
RI NOTIFICATION: Permittee shall notify the City at (619)777-7075 at least 48 hours in advance of starting construction.
R2 UT LM CLEARANCE: (Substructures) Prior to making any excavation within the City of La Quinta right of way
authorized by permit, the permittee shall contact all concerned utility companies relative to the location of existing
substructures. Damage to existing substructures resulting from operations conducted under this permit shall be the sole
responsibility of the permittee.
R3 UT 1LXrY CLEARANCE: (Surface Structures) No work shall be done under this permit until all utilities are clear of the
proposed work site. The permittee shall notify all concerned utility companies'of the proposed work.
R4 PAVEMENT WIDENING: Area between the proposed concrete gutter line and the existing road pavement shall be surfaced
with inches of A.C. paving placed on inches of class aggregate subbase course having an "R"
value of not less than and in conformance with City of La Quinta Road Improvement Standards and
Specifications, Ordinance /1461.
R5 PARKWAY GRADING: . Area between the property line and top of the proposed concrete "curb shall be graded to a slope of
1/4 inch to one foot (1').
R6 GRADE CHECKING: City of La Quinta shall check grades upon receipt of plan and profile and/or grades as established by
a licensed engineer.
R7 CURB REMOVAL FOR DRIVEWAYS: A portion of the existing concrete curb and/or curb and gutter ( _feet) shall be
removed.; Curb and/or curb and gutter shall be saw cut prior to removal. Depressed.curb, matching concrete gutter and
concrete driveway approach shall be constructed in conformance with City of La Quinta Standard #207.
R8 DRIVEWAYS: A.C. driveways shall be constructed as not to alter existing drainage pattern. Surfacing between the property
line and the existing road paving shall be 2.1/2 inches of A.C. paving placed on (_� of class aggregate base.
Driveway construction shall conform to attached drawing. .
R9 SIGHT CLEARANCE: Sight clearance of 600 feet in all directions shall be assured and maintained at all times.
R10 SOIL STERILIZER: The area to be surfaced shall be treated with soil sterilizer. Rate of application shall commply with the
manufacturer's specifications.
R11 COORDINATE WORK: The proposed work shall be subordinated to any operation which the State of California or City of
La Quinta may conduct in this area during the period of this permit. Work shall be coordinated with the State or City of La
Quinta forces to preclude delay or interference with State of City of La Quinta projects.
R12 SURVEY MONUMENTS: Prior to excavation or beginning of construction, all survey monuments which exist on the
centerline of all streets or property lines when involved shall be completely tied out so they may readily and correctly be
replaced by a licensed civil engineer or surveyor at the expense of the permittee. A complete set of notes showing the ties to
these monuments shall be furnished to the City Engineer prior to the removal of any monuments. This office shall be notified
upon completion or replacement of all survey monuments for proper project clearance.
R13 PAVEMENT CUTTING: Pavement will be mechanically saw cut to a straight to a straight edge prior to excavation. Method
of pavement cutting shall be approved through the office of the City Engineer. (Under no circumstances shall excavating
equipment be used to excavate prior to cutting of pavement.) Excavation material shall be placed in such a position as to best
facilitate the general flow traffic. Prior to final paving operations, any damage to pavement straight edges shall be corrected.
R14 LIMIT OF EXCAVATIONS: Excavations shall be limited to 1000 linear feet of open trench before backfill operations must
begin. All excavations shall be properly barricaded with lights overnight, on weekends and holidays for the protection of the
traveling public. The Public Works Inspector shall determine the suitability of excavation barricading in each case. No
excavation shall remain open for a period exceeding five (5) days. No excavation shall be made unless the construction
material is actually on the work site.
R15 BACKFILL MATERIAL: Backfill shall be free of brush, roots or other organic substance detrimental to its use for purposes
of producing an adequately consolidated backfill. Any material which the City of La Quinta deems unsuitable (spongy or
saturated material) which is encountered during excavation shall not be used for backfill, but shall be supplemented or replaced
by an approved sand or gravel.
R16 BACKFILL SAND: Backfill shall be approved transit -mix sand or equivalent and shall be'placed in lifts of not greater than
three feet (3') and vibrated using vibrotamper or equivalent equipment. Alternate methods may be substituted, but in any case,
a relative compaction of 95 percent shall be attained with the structural section of the roadway.
R17 BACKFILL PLACEMENT: Backfill shall be applied in layers of not more than 50 percent of the total depth of the trench
before flooding or a maximum of five-foot (5') lifts where trenches are of excessive depths. Care is to be exercised that the
backfill material is not subjected to extreme swell by flooding operations. Backfill material shall be placed so that the resulting
compaction shall be not less than 90 percent or equivalent to the surrounding ground, whichever is the greater compaction.
Where ponding or flooding is used for a maximum settlement, adequate dikes will be constructed to retain the water. Where
jetting is used, the jets shall be of sufficient length to reach the bottom of each layer and the water supply shall be continuous.
R18 COMPACTION TESTS: If so required by the inspector, compaction tests shall be made at intervals of not more than 1000
feet and a minimum of one (1) test on each road. One (1) copy of each test shall be forwarded to the City Engineer for
approval and filed prior to making permanent repairs. Compaction tests shall be made as outlined in Section 6.3.01 of the
Standard Specifications, Division of Highways, State of California, dated January 1973.
R19 COMPACTION TESTS: If so required by the inspector, compaction tests shall be made for each crossing or service line.
One (1) copy of each test shall be forwarded to the City Engineer for approval and filed prior to making permanent repairs.
Compaction tests shall be made as outlined in Section 6.3.01 of the Standard Specifications, Division of Highways, State of
California, dated January 1973.
R20 TEMPORARY PAVEMENT REPAIRS: After completion of backfill and compaction operations, a temporary patch
consisting of 2 inches of SC -800 shall be placed on a prepared subgrade. The SC -800 temporary paving shall be placed after a
maximum of 3000 linear feet of trench has been excavated and backfill operations completed, but in no case shall the
placement of the temporary pavement exceed a five (5) day limit.
R21 PERMANENT PAVEMENT REPAIR: After backfill and compaction have been completed, a temporary patch consisting of
two inches (2") of SC -800 shall be placed immediately. A permanent patch of inches A.C. surfacing placed on a
inch class base shall be placed no later than days after completion of temporary road repair.
R22 FOG SEAL: A fog seal coat consisting of an application of asphaltic emulsion shall be applied over all patch areas as
determined by the City Engineer.
R23 STREET RESTRIPING: Where street striping is still visible on streets to be excavated, such striping shall be replaced upon
completion of permanent repairs.
R24 TREE RELOCATION OR REMOVAL: Tree relocation within the City of La Quinta road right of way shall be
accomplished by a licensed, bonded and insured tree service, and handled safely without interference or hazard to the traveling
public. It shall be the responsibility of the permittee to maintain the tree in a vigorous growing condition at its new location.
Trees to be removed shall be in sections which can be handled safely without interference or hazard to highway traffic. The
entire width of the tree stump shall be removed and disposed of so that no debris remains in view of the highway. The stump
hole shall be backfilled and thoroughly compacted as specified in the following paragraph. Where is becomes necessary to
restrict traffic, the work shall be restricted to a maximum of 500 feet at any one time. Adequate signs, flagmen and or
barricades shall be provided to protect the traveling public at all times.
Large holes resulting from tree removal shall be backfilled and compacted to not less than 90 percent or equivalent to the
surrounding ground, whichever is the greater compaction as determined by the impact or field method. Compaction tests shall
comply with Section 6.3.01 of the Standard Specifications, Division of Highways, State of California, dated January 1973.
SPECIAL CONDITIONS --PERMIT NO. 2639
--- Tradition Club Associates ---
In addition to the standard permit conditions, the following shall apply:
1. Pursuant to Section 14.16.320 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982), all
work shall be performed in accordance with the latest edition of the Standard Specifications For
Public Works Construction and as directed by and to the satisfaction of the City Engineer.
2. Tradition Club Associates, hereinafter referred to as "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. Pursuant to Section 6.08.050 of the La Quinta Municipal Code (Ordinance 1.8 § 1, 1982), throughout
the work site, the Permittee shall comply with City regulated work hours. 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.
5. Pursuant to Section 14.16.110 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982),
Permittee 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. Pursuant to Section' 14.16.250 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982),
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). A traffic control
plan shall be prepared in accordance withthe WATCH Manual and submitted to the City for review
and approval one (1).week prior to starting any construction. It shall be the Permittee's responsibility
to detour and barricade all construction sites.
7. Pursuant to Section 14.16.290 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982),
street closures shall not be permitted. A minimum of one travel lane of paved surface shall be
maintained with flagmen at all times.
8. Prior to excavating, if required, the permittee shall contact Underground Service Alert at 1-80,0-422-
4133.
Special Conditions - Pennit No. 2639
Page I of 9
SPECIAL CONDITIONS=-PEPMT NO. 2639
--- Tradition Club Associates ---
9. 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.
10. Pursuant to Section 14.16.370 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982),
backfill compaction within street rights-of-way shall conform with Section 306-1.3 of the latest
edition of the Standard Specifications For Public Works Construction (SSPWC), except as otherwise
required by the City Engineer.
11. All excavations within City of La Quinta right-of-way shall be backfilled, and temporarily paved if `
within the existing travel way,- at the end of every workday as directed by and to the satisfaction of
the City Engineer for the protection of the public. Lengths of open trench shall not greatly exceed
that which can not be backfilled in the same day. Excavated trenches shall not be allowed open.
overnight, however, contractor may leave a length of excavated trench, not to exceed twenty (20) feet
in length, open overnight at a point where construction will begin the next day, provided that this
length of trench is completely covered by steel plating,
12. All landscaping, irrigation,' decorative rock, decorative concrete, lighting, etc., shall be replaced to"
its original condition.
13. Access and egress to all local'properties shall be maintained at all times.
14. Pursuant to Section 14.16.375 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982),
permanent pavement replacement shall be completed no later than seven (7) days. after the
completion of the work. Permanent. pavement replacement shall conform to the following
conditions:
A. Existing asphalt concrete pavement shall.be sawcut one (1) foot beyond trench edges. Edges
shall be straight and clean.
B. Permanent pavement: replacement structural section,, within all trenches, shall be 1" thicker
than existing, or 4" minimum, of asphalt concrete over the same existing thickness, or 41/2"
minimum, of crushed aggregate base or crushed miscellaneous base, meeting the requirements
of Sections 200-2.2 and 200-2.4 of the Standard Specifications for Public Works Construction.
The replaced pavement and base material shall be compacted to 95% relative compaction and
respectively tested, for each 300 linear, feet of trench. Verify exact structural replacement
section thicknesses with City prior to replacement.
C. Asphalt concrete mix design shall be approved by the City prior to its placement.
D. The existing pavement surface, fifteen (15) feet on either side of the excavated trench, shall
be cold -milled to a depth of one (1) inch, with a "butt" joint created along each edge of the
Special Conditions - Permit No. 2639
Page 2 of 9 "
SPECIAL CONDITIONS--PERMIT'NO. 2639
--- Tradition Club Associates ---
cold-milled area, and a new one (1) inch asphalt concrete pavement overlay applied throughout
the cold -milled area.
E. Any existing lane striping affected by this resurfacing shall be replaced in kind by the
Permittee, as directed by and to the satisfaction of the City Engineer. The finished pavement
surface shall be smooth, consistent, and shall conform to the surrounding grades.
15. Permittee shall notify the City of La Quinta Public Works Department a minimum of 48 hours prior
to commencement of any construction at (.760) 777-7075.
16. Permittee shall stabilize any soil that was disturbed (shoulder areas, etc.) as a result of work
performed under this permit with an approved dust control treatment.
17. Pursuant to Chapter 12.56 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982). the City
has designated certain city streets as -Truck Routes. The weight.limit for restricted streets (i.e., streets .
not part of the 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/or equipment.
18. The City of La Quinta reserves the right to revoke, suspend or void this permit at any time'.
19. This permit authorizes the installation of temporary overhead power lines across Avenida Bermudas
at Calle Ensenada. The minimum overhead clearance shall be twenty (20) feet.
Special Conditions - Permit No. 2639
FROM :
PHONE NO. : 9096762099 Jul. 29 1997 02:07PM P3
07/07/1997 13:43 6197777155 CITY OF LA QUINTA
NOTE: ;
V100 Drum valWation
thb torn constitute$ on CITY OF LA 4UINTA
Moroadhnwrtt permit
.—. APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
PAGE 02
For the mnstructlon of public or private curbs, driveways. pavements, sidewalks, parking lots, sewers, water maim
and other like ouolic works improvements in eonneaion with MINOR IMPROVEMENTS and APPROVED SUBOI JISIONS
DATE-_
LOCATION OF CONSTRUCTION
Beare am "or O+ocr*U n M l ootlonl
Subdivision Improvernont Permit — Cleu 111
Minor Improvement Permit Clau IV
PURPOSE OF CONSTRUCTION lrC7J/i0a�t'Lf�,2Y �G �✓N� Sketch (attach ce, u%rufaion plane if apwooriou)
Q11111CRIPTIOM CONSTR ION
Aar .09- 622awDIMENSION OF INSTALLATION OIREMOVAL
its rnic Gars O P.c
SIZE OF EXCAVATION, IF NEEDED
C/lu� F °tiVAOr'T
APPROXIMATE TIME WHEN WORK WILL BEGIN 9% o
APPROXIMATE TIME OF COMPLfi ION
NnMATEO CONSTRUCTION cosi sQ--
Ortemafim ninto al of 411 obikruction, ltlatfr(ala, and debris, bataffioing, carr,_ apo
pfamein end P"no pernnanent nuotadnp and/or replaolnii Imarovmnlaml
In imnawri tlen of the pantlep of this permit, the applicant hereby eras to:
t4dil mMr,.alfafd ass mro Ow Gey, In ahrdhorltod q oui, officals, nvrvMMOva a,ha 61Tom>/4n• hr"*" fan std pain any PW all
Tharhdtiss, 1110111611111105 of 10115 r6011101 ffpha dsinhs OF giant Ioaon ane arw" out of any mcww t. ieaf at dowdo to sonans or Pfao+fty
ltwpwdnfl or OMIMfy a I suoalhWN ntwh of MY weft urtiMRakan Wider the Pamhh tfansae ounsuP.e to this aopilaftion,
asoaltfr up AOrArAumhe Aut iwity as Want Rent -/err 1241 bows M mWance of the tNna vfl►M work v011 be eluted.
CM 9 V wet ad Wphlopla sty OrdWanol, the inns and hasndhlom of gibe Pwmlt are nil ro0"1 rules and I'Mistions of Um City of
Ir W"lle wsa to parr for env edditfonal foohaclsaant natstrlttir a the fmk 1 thh work.
r . Slprla Of Applicant or�paftt, _ _
y
Nine of ApOicent Iplaesa we"I "new Address
✓ 2J f -A b1A--- 7e" dd &
Nana of Con%rvaw and Job Foramen Business Addem
Cm "aaot a 1.4c.ew No.
No.
Taisphone No.
City Businm LipMa1 No.
AOpkatttls Inaureft0e Comppty "A. LIAGM.ITY Policy Number
PEN: Subdivision Imorovamam Parmit —elm III
Public tMaroveflonts: 3% of onimated colutrudion mm
Pfflrtlta Improvements: 3% of astimstecl ppnstructlon cols
MAW ImprOVORWnt Permit Class IV: See atWOW4 schedule
1 1010d0n Fora S 1 PERMIT VALIDATION
lalrfrlit Fres PERM17 N0.
Panity
Co h 0*00 iaS.rsty pores DATE APPROVED
Itrhafluletal
t
.'
'.
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1
NOTE:
r„
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
DATE:
Subdivision Improvement Permit — Class I I I
inor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Z2J8 I- &A _ r31/l l 5�
(Street address or Description of Location)
f
PURPOSE OF CONSTRU TION _ V 7P Sketch (attach construction plans if appropriate)
4DESCPTIO F CON RUCTION r �� ��+ ✓ " 1 !, �rlS
�p
DIMENSION OF INS ALLATIOR R VAL
SIZE OF EXCAVATION, IF NEEDED
.APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ � I I- �`,
(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:
Indemnity, -defend and save the City,* its authorized agents, officers, representatives and employees, harmless from and against any and ah
penalties, liabilities or toss resulting from claims or court action and arising out of. any accident, lou 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 124) 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 Quina and to pay for any additional replacement necessary as the result of this work.
Signature of Applicant or Agent
� � lib �2� L� • Cit �2�3
Name of Applicant (please print)B'�
usiness Address Telephone No. � �4
�( (olgp Q �.0. 6D/, (C 1260 L,Q 06 �?,��, (7r��
Name of Contractor and Job Foreman
Contractor's License No.
Business Address
Telephone No.
City Business License No.
Applicant's Insurance Company GEN. LIAISILtTy 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:
oo
/� •
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED g
By
Administrative Authority
TELEPHONE: (619) 777—?075