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3615NOTE: With proper validation ` this form constitutes an CITY OF LA QUINTA r 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 DATE: 1/22/02 Subdivision Improvement Permit — Class II I Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION 54-905 CAME QUITO (Street address or Description of Location) PURPOSE OF CONSTRUCTION GAS MAIN AND SIMVICH Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTION SEE A' 'A6:1 D SPECIAL CO*DI IONS DIMENSION OF INSTALLATION OR REMOVAL „�IZE OF EXCAVATION, IF NEEDED APP•ROXlMATE TIME WHEN WORK WILL BEGIN APPROXIMATE TIME OF COMPLETION xf4.4fVd� ESTIMATED CONSTRUCTION COST $ (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 Signature of Applicant or Agent 561UTUEVX CA1.IFORNU CAA& CO 7S09$ MAYFAIR IJUX DESERT CA 92?61 766E 3464248 Name of Applicant (please print) Business Address 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 111 Public improvements: 3% of estimated construction costs Private improvements: 3% of estimated construction costs Minor. Improvement Permit — Class IV: See attached schedule 0. Inspection Fee $Q Permit Fee 0'00 Penalty Cash Deposit -Surety Bond if required i� . ttip TOTAL: $ Receipt No. Received by Date c Recorded by ,l 15 PERMIT VALIDATION PERMIT NO. 3615 DATE APPROVED 1/18/02 06/ 18102 EXPIRATION DATE DATE ISSUED By 1 Administrative Authority e/ Telephone: (760) 777-7075 ` SPECIAL CONDITIONS --PERMIT NO. 3615 --- SOUTHERN CALIFORNIA GAS COMPANY --- In addition to the standard permit conditions, the following shall apply: Pursuant to Section 14.16.320 of theta 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 (SSPWC) and as directed by and to the satisfaction of the City Engineer. 2. Southern California Gas Company, hereinafter referred to- as "Permittee", shall be responsible for providing continuous dust and erosion control. All areas shall be kept watered, down daily including weekends. 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 18 § 1, 1982), throughout the work site, the Pernttee 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 I st 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. Work shall be prohibited on legal holidays and Sundays. 5. Work performed within 500 feet of a signalized intersection is restricted between the hours of 9 a.m. - 3 p.m. Traffic control shall be set up after 9 a.m. and removed before3 p.m. The Permittee shall contact the Riverside Country Traffic Signal Maintenance Department at (909) 275-6894 if signal operation at the intersection is to be altered in any way. 6. 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. 7. Pursuant to Section 14.16.250 of the La Quinta Municipal Code (Ordinance 10 § l (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, if required, shall be prepared in accordance with the 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 appropriately detour and barricade all construction sites. Special Conditions - Permit No. 3615 Page 1 of 4 SPECIAL CONDITIONS --PERMIT NO. 3615 --- SOUTHERN CALIFORNIA GAS COMPANY--- 8. 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. 9. Prior to excavating, if required, the Permittee shall contact Underground Service Alert at 1-800-422- 4133. It shall be the Permttee's responsibility to notify the Public Works Department of anticipated excavation which impact City facilities, including but not limited to traffic signal conduits and loops, irrigation lines, electrical conduits, and storm drain facilities. 10. 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. 11. 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 specified herein. Native material may be used as backfill material provided that minimum compaction, achieved in the manner prescribed herein, is achieved. Backfill shall be performed by mechanical means; no water densified compaction via jetting or flooding or other means shall be allowed. It shall be the Permittee's responsibility to provide appropriate geotechnical supervision; testing, and inspection, onsite, at all times during backfill operations. Backfill compaction shall be achieved by the following conditions: A. When a firm foundation is not encountered due to soft, spongy or other unsuitable material, such material shall be removed to the limits directed by the Geotechnical Inspector and/or the City Inspector and the resulting excavation backfilled with pipe bedding material. B. Backfill materials shall be brought to or maintained at an appropriate moisture content for compaction. The appropriate moisture content range shall be established at the onset of the project and ensured prior to use of the materials through progress testing on the stockpiles. C. The first length of trench backfilled shall be backfilled in the presence of the City Inspector. Compaction shall be tested at random depths at approximate three-foot vertical intervals as backfill is placed to ensure the effectiveness of the compaction methods and to establish the depth of lift that can be compacted. D. If lifts greater than one foot are attempted in this trial length of trench, compaction tests shall be taken within the lifts to ensure that the full depth of the lift is compacted. Upon satisfactory completion of this portion of trench, the City Inspector shall establish the maximum lift thickness to be compacted for the remainder of the project. Special Conditions - Permit No. 3615 Page 2 of 4 N SPECIAL CONDITIONS --PERMIT NO. 3615 --- SOUTHERN CALIFORNIA GAS COMPANY--- F. In subsequent lengths of trench, the frequency of compaction tests shall equal one per each lift of backfill, per 300 linear feet of open trench, at randomly selected locations within the open . length of trench. G. The depth of the randomly selected compaction tests shall also be randomly selected except that where multiple tests are required in a given length of trench, the tests shall be no closer than three feet (vertically) from each other. H. If any compaction test fails, previously placed backfill (in the same length of open trench or previous lengths of trench) which is represented by the failing test (as determined by the City Inspector), shall be tested for compliance with compaction requirements. All costs incurred due to the conditions above. shall be borne by the Permittee. Copies of all test results shall be furnished to the City Inspector. 12. . 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, Permittee 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. 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. 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. 13. Permanent pavement replacement structural section, within all trenches, shall be 1" thicker than existing of asphalt concrete over the same existing thickness 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 the City prior to installation. Special Conditions - Permit No. 3615 Page 3 of 4 SPECIAL CONDITIONS --PERMIT NO. 3615 i --- SOUTHERN CALIFORNIA GAS COMPANY--- C. Permanent pavement replacement shall be installed using a City approved 3/4" max medium asphalt concrete as the base course lift and a City approved '/2" max medium finish course lift for capping. Asphalt concrete mix design shall be approved by the City prior to its placement. D. Cold -Mill and Overlay - The existing pavement which was properly protected in place during the trenching operation located adjacent to the trench sawcut shall be cold -milled to a depth of 0.10 feet with butt joint created next to the existing unmilled pavement surface. The cold- milled area and base asphalt concrete in the trench area shall be overlaid with a City approved C2-AR-4000 asphalt concrete mix. The width of the cold milling area shall be as follows: For longitudinal trenches located in a parking lane: two (2) feet outside the sawcut removal lines. • For longitudinal trenches located in a traffic lane: two (2) feet outside the sawcut removal lines, or to the lane line striping, whichever is greater. • For transverse trenches across existing street: two (2) feet outside the sawcut removal lines. E. If grinding and capping operations are not performed in the same day as base paving operations, the base course lift of 3/4" max medium asphalt concrete shall be installed from saw - cut edge to saw -cut edge flush with the existing street surface. The base course lift of paving shall not be left 0.10' low in anticipation of grinding and capping. F. 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. Affected traffic signal loops shall be removed and replaced in kind. The finished pavement surface shall be smooth, consistent, and shall conform to the surrounding grades. 16. Permittee shall pernlanently stabilize any and all soil that was disturbed as a result of work performed under this permit with an approved dust control treatment. Soil stabilization shall be done immediately after completing the operation. 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. This permit allows for Southern California Gas Company to in stall a 2" gas main service at Calle Quito and Calle Naranja. 19. The City of La Quinta reserves the right to revoke, suspend or void this permit at any time. Special Conditions - Pennit No. 3615 Page 4 01'4 NOTE: VNith 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 DATE: 1/22/02 LOCATION OF CONSTRUCTION 50--905 CALLS QUITO (Street address or Description of Location) Subdivision Improvement Permit — Class I I I Minor Improvement Permit Class IV PURPOSE OF CONSTRUCTION CAR MATT AM R1RRVTC Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTION DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED Pk'­4` *APPRO, .,IM TEATIME WHEN WORK WILL BEGIN w —APPROXIMATE TIME OF COMPLETION ESTIMATED CONSTRUCTION COST $ •'(Including removal of all obstruction, materials, and debris, backfilling, com- paction and placing permanent resurfacing and/or replacing improvements) SEE ATTACHED SPECIAL CONDITIONS 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�s�rted. Comply with all applicable City Ordinances, the terms and conditions of the permits d.a�l applicable rules and regulations of the City of La Quinta and to pay for any additional replacement necessary as the result of this work). Signature of Applicant or Agent SOUTHERN CALIFORNIA GAS CO 75095 MAYSAIR PALM DESERT CA 9.2261 760 3464248 Name of Applicant (please print) Business Address 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 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 0.00 0.00 $ 0.00 Date 3615 PERMIT VALIDATION PERMIT NO. 3615 DATE APPROVED 1/18/02 EXPIRATION DATE 06/18/02 DATE .IISS=SUED gy Administrative Authority Telephone: (760) 777-7075 6 SPECIAL CONDITIONS --PERMIT NO. 3615 a --- SOUTHERN CALIFORNIA GAS COMPANY --- In addition to the standard permit conditions, the following shall apply: 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 (SSPWC) and as directed by and to the satisfaction of the City Engineer: 2. Southern California Gas Company, hereinafter referred to as "Permittee", shall be responsible for providing continuous dust and erosion control. All areas shall be kept watered. down daily including weekends. 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 18 § 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 1 st 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 1 st to September 30: Monday -Friday 6:00 a.m to 7:00 p.m. Saturday 8:00 a.m. to 5:00 p.m. Work shall be prohibited on legal holidays and Sundays. Work performed within 500 feet of a signalized intersection is restricted between the hours of 9 a.m. 3 p.m. Traffic control shall be set up after 9 a.m. and removed before 3 p.m. The Permittee shall contact the Riverside Country Traffic Signal Maintenance Department at (909) 275-6894 if signal operation at the intersection is to be altered in any way. 6. 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. 7. 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, if required, shall be prepared in accordance with the 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 appropriately detour and barricade all construction sites. Special Conditions - Pemrit No. 3615 Page 1 of 4 E7 SPECIAL CONDITIONS --PERMIT NO. 3615 --- SOUTHERN CALIFORNIA GAS COMPANY--- 8. 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. 9. Prior to excavating, if required, the Permittee shall contact Underground Service Alert at 1-800-422- 4133. It shall be the Permittee's responsibility to notify the Public Works Department of anticipated excavation which impact City facilities, including but not limited to traffic signal conduits and loops, irrigation lines, electrical conduits, and storm drain facilities. 10. 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. 11. 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 specified herein. Native material may be used as backfill material provided that minimum compaction, achieved in the manner prescribed herein, is achieved. Backfill shall be performed by mechanical means; no water densified compaction via jetting or flooding or other means shall be allowed. It shall be the Permittee's responsibility to provide appropriate geotechnical supervision; testing, and inspection, onsite, at all times during backfill operations. Backfill compaction shall be achieved by the following conditions: A. When a firm foundation is not encountered due to soft, spongy or other unsuitable material, such material shall be removed to the limits directed by the Geotechnical Inspector and/or the City Inspector and the resulting excavation backfilled with pipe bedding material. B. Backfill materials shall be brought to or maintained at an appropriate moisture content for compaction. The appropriate moisture content range shall be established at the onset of the project and ensured prior to use of the materials through progress testing on the stockpiles. C. The first length of trench backfilled shall be backfilled in the presence of the City Inspector. Compaction shall be tested at random depths at approximate three-foot vertical intervals as backfill is placed to ensure the effectiveness of the compaction methods and to establish the depth of lift that can be compacted. D. If lifts greater than one foot are attempted in this trial length of trench, compaction tests shall be taken within the lifts to ensure that the full depth of the lift is compacted. Upon satisfactory completion of this portion of trench, the City Inspector shall establish the maximum lift thickness to be compacted for the remainder of the project. Spe ial Conditions - Permit Into. 3615 Page 2 of 4 °a SPECIAL CONDITIONS --PERMIT NO. 3615 . --- SOUTHERN CALIFORNIA GAS COMPANY --- In subsequent lengths of trench, the frequency of compaction tests shall equal one per each lift of backfill, per 300 linear feet of open.trench, at randomly selected locations within the open . length of trench. G. The depth of the randomly selected compaction tests shall also be randomly selected except that where multiple tests are required in a given length of trench, the tests shall be no closer than three feet (vertically) from each other. H. If any compaction test fails, previously placed backfill (in the same length of open trench or previous lengths of trench) which is represented by the failing test (as determined by the City Inspector), shall be tested for compliance with compaction requirements. I. All costs incurred due to the conditions above shall be borne by the Permittee. Copies of all test results shall be furnished to the City Inspector. 12. 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, Permittee: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. 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. 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 of asphalt concrete over the same existing thickness 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 the City prior to installation. Special Conditions Pennit No. 3615 Page 3 of 4 v Ji • 1 SPECIAL CONDITIONS --PERMIT NO. 3615 .� --- SOUTHERN CALIFORNIA GAS COMPANY--- C. Permanent pavement replacement shall be installed using a City approved 3/4" max medium asphalt concrete as the base course lift and a City approved '/2" max medium finish course lift for capping. Asphalt concrete mix design shall be approved by the City prior to its placement. D. Cold -Mill and Overlay - The existing pavement which was properly protected in place during the trenching operation located adjacent to the trench sawcut shall be cold -milled to a depth of 0.10 feet with butt joint created next to the existing unmilled pavement surface. The cold - milled area and base asphalt concrete in the trench area shall be overlaid with a City approved C2-AR-4000 asphalt concrete mix. The width of the cold milling area shall be as follows: • For longitudinal trenches located in a parking lane: two (2) feet outside the sawcut removal lines. • For longitudinal trenches located in a traffic lane: two (2) feet outside the sawcut removal lines, or to the lane line striping, whichever is greater. • For transverse trenches across existing street: two (2) feet outside the sawcut removal lines. E. If grinding and capping operations are not performed in the same -day as base paving operations, the base course lift of 3/4" max medium asphalt concrete shall be installed from saw - cut edge to saw -cut edge flush with the existing street surface. The base course lift of paving shall not be left 0.10' low in anticipation of grinding and capping. F. 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. Affected traffic signal loops shall be removed and replaced in kind. The finished pavement surface shall be smooth, consistent, and shall conform to the surrounding grades. 16. Pennittee shall permanently stabilize any and all soil that was disturbed as a result of work performed under this permit with an approved dust control treatment. Soil stabilization shall be done immediately after completing the operation. 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. This permit allows for Southern California Gas Company to in stall a 2" gas main service at Calle Quito and Calle Naranja. 19. The City of La Quinta reserves the right to revoke, suspend or void this permit at any time. Special Conditions - Permit No. 3615 Page 4 or4 NOTE: With proper validation this form .constitutes an encroachment permit CITY OF LA QUINTA s 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 V SIONS DATE: / ! `_ LOCATION OF CONSTRUCTION ­49 O wtreet address or Description of Location) PURPOSE OF CONSTRUCTION >,4��&xu DESCRIPTION OF CONSTRUCTION DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN — Z3-6:�'2— APPROXIMATE TIME OF COMPLETION ` 2-2 - 0 ESTIMATED CONSTRUCTION COST $ (Including removal of all obstruction, materials, and debris, backfilling, com- paction and placing permanent resurfacing and/or replacing improvements) Subdivision Improvement Permit — Class I I I Min-q&jmprovement Permit Class IV Sketch JAN 1 .2002 JB rF7Gf 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 end an ss resulting from claims or court action and arising out of. any accident penalties, liabilities or Ion 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 124) hours in advance of the time when work will be' st Comply with all applicable City Ordinances, the terms and conditions of the permit a applicable rules and ations of the City of La Quints and to pay for any additional replacement neeessary"as the result of thi rk ezSignature of Applicant or AgentC� Name of Applicant (please print) Business Address Telephone No. Name of Contractor and Job Foreman Business Address Telephone No. Contractor's License No. City Business License No. Applicant's Insurance Company GEIJ. L-IA151LITy 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 — ClassIV: See attached schedule Inspection Fee $ Permit Fee Penalty Cash Deposit -Surety Bond navv if required' C TOTAL: $ Receipt No. Received by Date Recorded by PERMIT VALIDATION PERMIT NO. %,115 DATE APPROVED I I/t IUZ EXPIRATION DATE DATE ISSUED By A Adm' istrative Authority TELEPHONE: (619) 777-1075 PLAN FILE NO. CONSTR. SKETCH I _COIIPL* SKETCH all An ZZ: L /12& c) . 60, rJ Q > C" u C ALLt 0 le"IZ511 74 TOTAL FEET INST'D. INSTALL MAIN WITH AT LEAST - TOTAL FEET RETIRED COVER BELOW F RETIREMENT PERMIT ISSUED BY PERMIT NO. DATE MOVED DATE MOVED DATE OF COUNTY OPER.- ON JOB- OFF JOB - CREW FOREMAN DISTRICT REASON TRACT COMPANY NO. COMPANY FACILITY: SO. CAL. P.L.S. 0 1 . PLANNED B VR. IEWED BY STAKED ❑ ATLAS YEAR C.P. 4 0 INSTALLED 1) N STAKING REQ'O. 0 DIVISION . CATHODICAILLY OPER. 20% OR OVER ORG. YES ❑ NO 0 S.M.Y.S. DIS7lfSUPVR. NO STAKES.NEEDED W.0 CODE PROTECTED AT LESS THAN 20%