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3681NOTE: 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 I II DATE:, Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION - 1) AVenue. 50 Median across from Orchard Lane 2) North side of Avenue 50 400' east of Washington Street 3).defferson Street Median north of Ave 48 (Street address or Description of Location)4)Avenue 52 200' want ©f Cetrino , PURPOSE OF CONSTRUCTION inetall directiowl Bigne Sketch (attach construction plans if appropriate) for builders and developers DES RIPTION OF CONSTRUCTION Install Brood signs See attached conditions at , locationo (see ab*ve) DIMENSION OF INSTALLATION OR REMOVAL 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- 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 vvork 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 Bldg Industiv, Assoc. 77-570 Surinafi.eld Lane #E Palm Deaert, CA 360-2476 Name of Applicant (please print) Business Address Telephone No. Best Signs 1550 Gene Autry balm Springs, CA 320-3042 . Name of Contractor and Job Foreman Business Address Telephone No. 524483 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- Date 3681 PERMIT VALIDATION PERMIT NO. 3681 DATE APPROVED 5•-8-02 EXPIRATION DATE none DATE VSSL�hE;D � 5`8"02 l7u! .� By Administrative Telephone: (760) 777-7075 t SPECIAL CONDITIONS --PERMIT NO. 3681 --- BIA/BEST SIGNS --- Streets and Parkways shall be kept clean. They shall be completely cleaned at the end each sign installation if required. 2. Pursuant to Section- 14.16.110 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 19.82), 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. 3. 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). It shall be the Permittee's responsibility to appropriately detour and barricade this site. 4. 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. Special Conditions - Permit No. 3681 Page 1 of 1