3767iN_OTE: _.
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
It
/ /�,/� Subdivision Improvement Permit —Class I I I
DATE:6 ,/� Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
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(Street address or Description of Location)
PURPOSE OF CONSTRUCTION --�' /fj/ L l� �14C,00&1 Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
L 4 �
DIMENSION OF INSTALLATION OR REMOVALS
SIZE OF EXCAVATION, IF NEEDED • I •,% j r / /, ' ',/// /.1 i.)
APPROXIMATE TIME WHEN WORK WILL BEGIN ��%��� i
APPROXIMATE TIME OF COMPLETION / n / / // G C
ESTIMATED CONSTRUCTION COST $ 12 AL • / 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:
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
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No. C
Contractor's License No. 'City Business Li ens .
Applicant's Insurance Company Policy NumbeY\
FEES: Subdivision Improvement Permit — Class I II
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: $ 72e.,
Receipt No.
Received by Date
a �t � G� •"
r. Cis
PERMIT VALIDATION
PERMIT NO. '3 7
DATE APPROVED /G / 1 `y 1e Z"-
EXPIRATION DATE
DATE ISSUED
By
L
Authority
Recorded by 11Telephone: (760) 777-7075
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See Chart A I See Chart y
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LEGEND 0
•
Traffic Cone or Delineator
T
Sign
Direction of Travel
( Not a pavement morking) ".
<
Flashing Arrow Sign (Where Required)
Refer to Page 5 to select Type A,
Type I , or Type II .
Y
High Level Warning Device (Flagtree)
Barricade (For Excavation Only)
Refer to Page 9 for Details on
Type I , ,Type II , or Type III .
Flogger
S Toper L Toper L
See Chart "A" See Chort "A" See Chart "A
GI�O
1, �\GyP���� Gib OP�Q�
P yak Cv=_ OR E.P.
.f_
RAISED MEDIAN OR DIVIDING STRIP
150' 45rn
Min.
—0gARTA—
MINIMUM RECOMMENDED
DELINEATOR
AND
SIGN PLACEMENT
TRAFFIC SPEED
TAPER LENGTH (L) DELINEATOR
SPACING
SIGN SPACING(S)
(Km/h)
(m)
(m)
(Advance or Tooer
& Between S,gns, (rn)
25 MPH
(40)
125 Ft.
(4
25 Ft.
(8)
300 Ft.
(90)
30 MPH
(45)
180 Ft.
(w5)
30 Ft.
(9)
300 Ft.
(90)
35 MPH
(50)
245 Ft.
(75)
35 Ft.
(11)
300 Ft.
(90)
40 MPH
(60)
320 Ft.
(1CW^)
40 Ft.
(12)
320 Ft.
(100)
•45 MPH
(70)
540 Ft.
(135)
45 Ft.
(14)
540 Ft.
(165)
•50 MPH
(80)
600 Ft.
(1:5)
50 Ft.
(15)
600 Ft.
(M)
•55+MPH
(85)
1000 Ft.
(305)
50 Ft.
(15)
750 Ft.
(230)
1. A Flashing Arrow sign shall be used for each lone closed.
«2. Two lone closure signs (C-20) shall be used on the approach
to a lone closure with speeds of 45 mph (70 Km/h) or greater.
NOTE: This chart based on 12-foot (4m) wide lones.
For lone widths greater than 12 feet (4m),
use the following formulae:
Taper formula:
L = S x W for speeds of 45 mph or more.
L = S x '3 W for speeds of 70 Km/h or more. ,
1
L = 60• for speeds of 40 mph or less.
r
L = 150 for speeds of 60 Km/h or less.
Where:
L = Minimum length of toper.
S = Numerical value of posted
speed limit prior to work or
85 percentile speed. '"oIcAtE "oan+ WITH A -r''
ANDPONT W = Width of offset.
i.e.: 80 Km/h. and 6m lane L = 80 x' (2/3)6 = 320 meters
i.e.: 40 mph and 19` lone; L = 19 x 402 = 507 feet
60
WORK G�
A
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WORKSITE TRAFFIC CONTROL. PLAN
MULTI -LANE a"OSUIRE ( LEFT LANES
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