3920r �•,�. ii� ' • 1 • y YY Y • �. • ,
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With proper validation;;, ,1.-� s'' ! 2. c ,
this form constitutes an CITY ' OF • LA 'QUINTA'
encroachment permit
{ APPLICATION ` FOR PERMIT' -
-,PUBLIC. WORKS
:CONSTRUCTION (ENCROACHMENT)'
OF T�9ws
',•.For the construction of public* or private curbs, driveways, . pavements,'sidewalks, -parking lots, sewers,, Vvater. mains
and other., like public works4improvements in'connection with MINOR. IMPROVEMENTS and APPROVED SUBDIVISIONS 1
�; ' , •ti? � aye.: �,'' i ,' •.- • � •
f 'Subdivision Improvement Permit,- Class. III
" DATE: KEY, . 2003 Minor -Improvement Permit.Class IV R
LOCATION OF CONSTRUCTION Westward Ho Or West Of Jeffersan Street -
(Street addressor Description of Location)
PURPOSE OF CONSTRUCTION 'Relocate aeri8l' faCilitie�t Sketch (attach construction plans if appropriate)
to .undetArou d
!,DESCRIPTION OF CONSTRUCTION ' Place undarzround
*Soe Attached Speciiiiil Con4ifto s*
41�4^.':'°DIMENSIO,N``OF•-INSTALLATIONOR REMOVAL 2" PVC
T 1,Se' Utility. Company Work Order bar
7R0QICJ As .Referenced tin. Bra�Arig
"'•SIZE---OFEXCAVATION;�IF'NEEDEQ 3011 de»th (Sea 'Attach d)'
n
`•'APPROXIMpATE"TIME WHEN WORK WILL BEGIN .�Uooct recSlut
5 ?n' APPROXIMATE TIME OF COMPLETION Jtxlw`:1.' 2003 - !
4x4' ,ESTIMATED CONSTRUCTION COST $ 10.000
n
' `�";'� (Including removal bf aI obstrmuction, materials, and debris, backfilling, co ) '
pactlon ad placing; permanent resurfacing and/or replacing improvements)
peN k h'Y In consideration of .the granting of. this- permit,%therapplica`nt hereby agrees to: "
defend' and` save"the City,- its authorized, agents,` officers, representatives and empl yees, harmless from and against any and,all • .,
,1y *;•",,.>'penalties, liabilities or ;loss resulting from 'claims 'or court action aril arising out of any, accident, loss or damage to persons or property
2" happening'or occurring as a proximate result of any undertaken under -the permit granted pursuant'Yo'this application: .
+t Not�fi the'Admi'nistrative Authority at least twenty-four (24) hours in advance of•the'time when'wock will be started.! ; r'`•:
+ i' •-Comply with all,applicable'dity Ordinances, the terir►s and conditions of the permit and all applicable rules regulations of the City of I
,La Quinta and to pay'for any additional replacement,! necessary, as the result of,this work..-, +
r t�.
41
Sig ature of Appl)cant•or Agent`
a
i(36Q 8f4�1�2(9P�SPrl CA 92�62 er agn 2r•
Name of..Applicant (please print) Business Address' Telephone No.'
i>iCT, .i>�c 'P.O. xo 638, .'Nox'co, CA 92860 (909) 520-4200. ' '
Name'of Contractor' and Job Foreman 'Business Address Telephone No.
Contractor's,License No. " " , City,Business�License No.:
i'au3r Mar irte
Applicant s.lnsurance Company Policy Number'. nn n
' ` l!
FEES: ,'''Subdiyision'.Improvement.Permit — Class I I I
► . JUL' 3 0 "2003
Public improvements: 3% of estimated construction costs
R
Private improvements:' 3%,of estimated construction costs c C17Y Or LA €�ult4TA
Minor>Improvement Permit —Class IV: See attached schedule'.
;�. Inspectiori'Fee $. 3oci•0.0 PERMIT •VALIDATION .'
Permit Fee '' 160.00 .
PERMIT NO: 3920
;Penalty. t
Cash Deposit -Surety Bond
DATE APPROVED May 27., • 2003
if`required r EXPIRATION DATE May 30„ •2004
{ TOTAL: $' `400.00 r .
DATE ISSUED 1 f 741
Receipt No. ' r , l
tI'
. ' Received -by
..`
I, Date' � Administrative Authority
y .
< Recorded by` y Telephone:r (760)PP77-7075 , -
- • - 1 - .. i - „ y
i.
i
— PERMIT NO. 3920
Applicant': Verizon Telephone Company
Contractor: Arizona Pipeline
Location: Westward Ho Drive west of Jefferson Street
Scope of Work: Relocate utility underground.
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 (SSPWC) and as directed by and to the satisfaction of the City Engineer.
2. VERIZON, 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 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:
6'
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 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.
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 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 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 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.
PERMIT NO. 3920
Applicant: Verizon Telephone Company
Contractor: Arizona Pipeline
Location: Westward Ho Drive -west of Jefferson Street
Scope of Work: Relocate utility underground.
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 two (2) travel lanes of paved surface shall be
maintained at all.times.
8. 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.
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 to 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 j etting 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 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.
PERMIT NO. 3920
Applicant: Verizon .Telephone -Company .
Contractor: Arizona Pipeline
.Location: Westward Ho Drive west of Jefferson Street
Scope of Work: Relocate utility underground.
E. 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.
F. 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.
G. 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.
H. 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.
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, 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..
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 saw -cut 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.
PERMIT NO. 3920
Applicant: Verizon Telephone, Company
Contractor: Arizona Pipeline
Location: Westward Ho Drive west of Jefferson Street
Scope of Work: Relocate utility underground
C; Permanent pavement replacement shall be installed using a City approved 1/4" 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 saw cut shall be cold -milled to a depth of 0.10
feet with buttjoint created next to the existing un-milled, 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: three (3) feet outside the saw -cut
removal lines.
For longitudinal trenches located in a traffic lane: three (3) feet outside the saw -cut removal
lines, or to the lane line striping, whichever is greater.
For transverse trenches across existing street: two (2) feet outside the saw -cut removal
lines.
E. If grinding and capping operations are not performed in the same day as base paving operations,
the base course lift of/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 or any existing detour 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.
15. Permittee 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.
16. 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.
17. The City of La Quinta reserves the right to revoke, suspend or void this -permit at any time.
18. The permittee shall indemnify, hold harmless and assume the defense of.the City from all
damages, delay costs, costs or expenses in law or equity that may arise out of work_ under this
permit.
PERMIT NO. 3920
Applicant: Verizon Telephone Company,
Contractor: Arizona Pipeline
Location: Westward Ho Drive west of Jefferson Street
Scope of Work:. Relocate utility underground
19. The permittee shall bore under existing pavement. However, if the permittee determines it is.
necessary to . cut the pavement the following conditions shall apply:
A. Existing asphalt concrete pavement shall be saw -cut 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 orcrushed
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 thickness with the City prior to installation.
C. Permanent pavement replacement shall be installed using a City approved 1/4" 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 saw cut shall be cold -milled to a depth of 0.10
feet with butt joint created next to the existing un-milled 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 the
of the cold milling area shall be as follows:
• For longitudinal trenches located 'in a parking lane: three (3) feet outside the saw -cut
removal lines.
•. For longitudinal trenches located in a traffic lane: three (3) feet outside the saw -cut removal
lines, or to the lane line striping, whichever is greater.
• For transverse trenches across existing street: two (2) feet outside the saw -cut removal
lines.
E. If grinding and capping operations are not performed in the same day as base paving operations,
the base course lift of 1/4" 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 or any existing detour 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.
20. If it is the intent of the permittee to cut the pavement and have it restored by a third party, the
permittee shall post pone cutting the pavement until the intended third party has acquired a permit
from the City to perform the required restoration work.
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PRODUCER i THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Arms t rong/Rob i to i 1 1 e - ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
680 Langsdorf Drive, Suite 100 - ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Fullerton, Ca. 9283 1 _ '. _ � � COMPANIES AFFORDING COVERAGE
Phone: 714-578-7000' -
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Fax 7COMPANY
14-578-7489 CA St. Paul Fire t, Marine
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THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE
POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO
WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DE
AV BEEN.REDUCE.D BY PAID CLAIMS..
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TYPE OF INSURANCE
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POLICY EFFECTIVE
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10 Day Notice of Cancellation for Non-Payment•of Premium.
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SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City O f L a Qu I n t a
EXPIRATION DATE THEREOF, THE ' ISSUING COMPANY WILL ENDEAVOR TO MAIL
La Quin to ,, Ca . x 60 DAYSWRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED
TO THE LEFT,'
Fax J 6 O - J 7 J - 715 5
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Arhh proper validation
Ais form °DRsaftuM an CITY OF LA QUINTA
:neroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For the construction of public or private subs, driveways, pavements, sidewalks. parking lots, sewers, water mains
and other like public works improvements In connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
[)ATE; May 27, 2003
Subdivision Improvement Permit - Class I I I
Minor Improvement Permit Class IV B
LOCATION OF CONSTRUCTION Wescvard Ho Dr.. West of Jefferson Street
to underitround
DESCRIPTION.OF CONSTRUCTION place undArpraMd
c-r�-i►�c
DIMENSION OF INSTALLATION OR REMOVAL 2" PVC
SIZE OF EXCAVATION, IF NEEDED 30" depth
APPROXIMATE TIME WHEN WORK WILL BEGIN UO2A receipt:
APPROXIMATE TIME OF COMPLETION?a14. Is zuuJ
ESTIMATED CONSTRUCTION COST s lA _ On0
(including removal of all obstruction, materials, and debris, badcfilling, corn-
Paction and placing permanent resurfacing and/or replacing imorovements)
*See Attached Special Conditions*
See Utility Company Work Order Number
7P001CJ As Referenced On Drawing
(See Attached)
err -consideration .p#�!►e.granting of tl+is pew; he-appiieant 1weby-agrees-te
c4 P3/
Indemnify, d9end end save the City, in eardwrized alpnts, officers, represenmtives and amployem, harmless from and against any and oil
penalties, riabilities or loss resulting from clalrns or court action and arising out of any *evident, loss or darrapa to persons or property
happening or occurring as a oroxinmae rent of any work undertaken .under the permit granted pursuant to this application.
Notlty the Administrative Authority at last twenty4our (2e) hours in advance of the time when worst wG1i be started.
Comply with all applicable City Ordiften es. the terms and conditia m of the permit and all applicabe rules and regulations of the City of
1a Quin and to pay for any addit onat rcolacernent necessary as the rewit of this work.
Signature of Applicant or Agent
Verizon 295 N. Sunrise Way,. Palm Springs, CA 92262 (760) 864-1720
Name of Applicant (pkast: print) Business Address Telephone No.
Ay4yoma ptietire P.Q. — 40tQ65 sttaneria rn 9934n (760) 270-3100
Name of Contractor and Job Foreman Business Address Telephone No.
423545
Contractor's License No.
06849
City Business Lioense No.
Zurich American Insurance Company GL03697450-00
Applicant's Insurance Company Policy Number
FEES: Subdiviaon Improvement Permit -Class III
Public improvements: 3% of estimated construction costs 4=41m Py
Private improvements: 3% of estimated construction costs
NOTE:
With proper validation
this form constitutes an ' CITY OF LA QUINTA .
encroachment permit
APPLICATION FOR -PERMIT
PUBLIC. WORKS CONSTRUCTION (ENCROACHMENT).
oF9ws`O
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: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address of Description of Location) '
PURPOSE OF CONSTRUCTION Sketch (attach constructio lans i appr r ate
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, E ED
APPROXIMATE TIME W EN WL11 L
Tj
APPROXIMATE TIME O F ETI IS V
ESTIMATED CONSTRU O
(Including removal of all r o , .ma.r Is, a d deb i , a g; com-
paction and placing per anent r s rfaci g rid/o re g improvements) r
In consideration of the r n f this mit,. the applicant hereby agrees to::
Indemnify, defend sav a City, its authorized agents, officers, representatives and employees, harmless from and against any and ail
` penalties, liabilities r 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 lean 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 ell 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 Applicaht or Agent
Name o Appl cant (please print) Business Address Telephone No
11,4 Z,(Ue 10b BOy 6 A 11A& e-b 9Z��o = 9l�-SZG-4�Z�C9
Name of CcAtractor 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 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 VALIDATION
Permit Fee PERMIT NO.
Penalty DATE APPROVED
Cash Deposit -Surety Bond ,
if required EXPIRATION DATE
TOTAL: $ i DATE ISSUED
Receipt No.
r By
Received by Date I Administrative Authority
Recorded by Telephone: (760) 777-7075
VOTE: ' -
Arab proper validation
:his form constitutes an
tncroacbment permit
,41111111111r "11111111110F " s► .
CITY OF LA QUINTA .
APPLICATION FOR PERMIT ;
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)•
r
For the construction of public or primate 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: May 27 , 2003 _ _ Minor Improvement Permit Cless.IV
LOCATION OF CONSTRUCTION Westward Ho Ar. , 'West of Jefferson Street
'Street address or Description of location)
'URPOSE OF CONSTRUCTION Relocate aerial faeilitias Sketch (attach construction plans if appropriate)
to underground
DESCRIPTION OF CONSTRUCTION place gnPrground
Crp�c�ngC
.*See Attached Special Conditions*
DIMENSION OF INSTALLATION OR REMOVAL 2" PVC
See Utility Company Work Order Number
7POOICJ As Referenced On Drawing
SIZE OF EXCAVATION, IF NEEDED 30" depth (See Attached)
APPROXIMATE TIME WHEN WORK WILL BEGIN Pgon receipt
29 permit
APPROXIMATE TIME OF COMPLETION JSLly 1. 2003
ESTIMATED CONSTRUCTION COST" $ 10.000
(Includ(ng removal of all obstruction, materials, and debris, backfilling, corn. 1
Daction and placing permanent resurfacing and/or replacing improvements)
Ifl...sor+side er+ e# a �rletiFlg of is peralit, -xhe-.appticawt
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 Wlms or court action and. arising out of any accident, loss or damage to persons or property
happening or occurring as a oroximate mutt of env work undertaken under the permit granted pursuant to this application.
Notify the Administrative Authority at kart twenty -tour (24) hours in advance crf the time when work will be started.
Comply with all applicable City Ordinenoes, the terms and conditions of ,the permit and all applicable rules and regulations of the. City of
La Gulmm a6d to pay for any additional replacement necessary as the result of this work. '
{
Signature of Applicant or Agent .
Verizon '295 N.:Sunrise Way, Palm Springs, CA 92262 (760) 864-1720
Name of Applicant (please print) Business Address Telephone No.
Arizona_ Pipeline 0-Boxl 401865 Hisperii, CA 92340 (760Y 270-3100
Name o F Contractor and Job Foreman Business Address Telephone.No.
423545 .06849
Contra or's License No.. City Business Lioense No.
Lurid American Insurance Company GL03697450-00
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit - Class II
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction Cosa
A 6 r� ,n A'ev r1v
T. d :3WUN :_131
t-,S:,LT NOW -2002-6-Nnf
NETWORK ENGINEERING & PLANNING -WEST
296 NORTH SUNRISE WAY PALM SPRINGS, CAUFOMIA MW
7 7
_T74E TRIG H--IL C_�OUTRDL
FLAk1
- LU 7— IF TO VAX
FO 6 '9 (NOW)
woui
:3WUN : -131 bS :! T NOW 2:002-6-Nnf
NOTE:
1.. Flagmen shall coordinate traffic operations
using portable radios operating on o ,private
frequency (citizen's bond frequencies ore
not acceptable).
R-1
SIGN
CURB OR E.P.
fr .
BARRICADE
s $ s 100' 30m
Q'G See Chart "A' See Chart 'A" See Chart A'. Min,
MINIMUM RECOMMENDED 1
Gj �P ,fro TRAFFIC SPEED TAPER LENGTI`
G/�� ` �/ \vim • (Km�)
25 MPH (40) 125 Ft.
30 MPH (45) w180 Ft.
35 MPH (50) 245 Ft.'
40 MPH (60) 320 Ft. {
•45 MPH (70) 540 Ft.
_ } •50 MPH (80) 660 Ft.
8.55+MPH (85) t0oo Ft.
1. A Flashing Arrow sig, .
*2. Two lane closure sigr
to a lone closure wit
Traffic Cone or Delineator NOTE: This chart based
For lane widths g
Sign use the following
• � Direction of Travel
r Toper formula
( Not a pavement .marking) L m S
L = S
�. Flashing Arrow Sign (Where Required) _ w
- - Refer to Page 5 to select Type A. 6
Type I , or Type II . L w
High Level Worning Device (Flagtree)' Where:
L = Mi
S = NL
Barricade (For Excavation Only) SF
Refer to Poge 9 for Details on gt
'Type I . Type II , or Type ]II . W
i.e.: 50 mph and 19'
Flogger '
�.e.: 60 'Km/h and E
t , d :3WHN :131 SS:IT NOW .2002-6-Nnf, -
S �
Varies S S S
See Chart *A" See Chort 'A' See Chort 'A� i
Max. a OCin
o— e— s —� -�- ter— •— a —7 � ______ � — , — — ,
—^
dK AREA
PARK!r+G 9GN5 ,�A �rUR3 vr? P.
O AND S CN PLACEMENT
;LINEATOR SPACING SIGN SPACING(S)
(Advance of Toper +
'(T) & Bct.een Siyna)-
25 Ft. •(a) 300 Ft. (90)
30 Ft. (9) 300 Ft. (90) 1
35 Ft. (11) 300 Ft. (90)
40 Ft. (12) 320 Ft. (100)
45 Ft. (14) 540 Ft. (165) -
50 Ft. (15) 600 Ft. (185)
50 Ft. (15) M Ft- (230)
used for each lone closed.
} shall be used on the approach '
of 45 mph (70 Km/h) or greater..
A (4rn) wide lanes..
in 12 feet (4m).
peeds of 45 'mph or. more.
)r speeds of 70 Km/h or more.
eeds of 40 mph or `less. -
eeds of 60 Km/h' or less.
gth of toper.
glue of posted
prior to work, or
e speed. utacATE aW1W wrn, A 'N' WMS17E .TRAMC CONTROL
set. AND AN AReow PONT
TYPICAL LAIC CLOS JK
50 x 19 = 950 feet WrM REVERSIBLE -.CONTROL .
6 -x 602 "
150
144 metes
.. -
d GQC� N009.^,[% 'ONIU1 ::9I. "S/ZS: 9I. fi0 .6. '9 (NOW) r
-
•
` 00
} � NOTE: � "i_ " •- ���... , - _ fj 2
With proper validation
this form constitutes an i CITY OF IA QUINTA-
' w
encroachment permit
APPLICATION FOR PERMIT
'e+ PUBL' IC WORKS :CONSTRUCTION (ENCROACH
' ^�� �Sw�ti
OF
For the construction: of public -or. private curbs, driveways,. pavements, sidewalks,_ parkingYIots, .sewers, water, mains `
and other like public works improvements in connection with MINOR IMPROVEMENTS and'APPROVED SUBDIVISIONS
"" ' •� Subdivision Improvement Permit.' Class 111, F'
DATE: 271� 1)3 r Minor Improvement Permit Class IV
LOCATIOWOFCONSTRUCTION ,W,57,6I WARD 0Q O`2 weby EFF1 R9 0N' ST
�. k '-
(Street address or Description of Location) . s ->
:PURPOSE OF CONSTRUCTION R1=LoeATL- AERS.4C Skefch (attach construction plans if appropriate)
FAcrc z-T 17� n el
DESCRIPTION OF'CONSTRUCTION 12LAbF 4TTAeFI&d PtZZNT
GRo�G► i%r G S '�
DIMENSION OF INSTALLATION-OR.REMOVAL Pvt-
SIZE OF,EXCAVATION, IF NEEDED ' 3o�i dePTF(
APPROXIMATE TIME WHEN WORK WILL BEGIN. ASAR %-)-03' '
APPROXIMATE TIME OF COMPLETION - 1 - 3
ESTIMATED CONSTRUCTION COST $ bb. o00 r
(Including removal of all obstruction, materials, and debris; backfilling, com - _
paction and placing permanent resurfacing and/or replacing improvements)
Inconsideration of the granting of, this perm.it,'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 fy
�.
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 i f.the time•when workwill be started. ' l
Comply with all applicable City Ordinances, the terms and conditions of the permit/t�is"
an all applicable rules "and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result ofrk: '•
• • 5. ' - - ` • _ it - `; J - •
'Signature of.,Applicant or Agent
:IZ �.�Z b Q .2:GS 0. SC.ruQ, rSE'st✓i�Y' )?S. 'CA 0122•6-1 76cD-RAq-1 72o
Name of Applicant (please print) Business Address .,r "' 'Telephone No..
R A z pgt T N'
Name of Contractor and Job'For- eman� _ Business'Addre'ss /n � Q —•Te gfSc�nn� off-
Contractor's. License No. ; • `Grill Business License'NZo-.
_pplicant's Insurance Company - " Policy Number:-:)'
FEES: .Subdivision Improvement Permit - Class III
'"'"':Public;improvements: 3%'of estimated'construc[ion costs
Private improvements: 3% of estimated construction costs
Minor.lmprovement Permit - Class IV: See. attached, schedule
Inspection Fee" z $y-��' 0D PERMIT _VALIDATION• ;
•• Permit Fee Iw ` F PERMIT.NO. `
Penalty
Cash Deposit -Surety Bond.
S DATE APPROVED
if required j EXPIRATION DATE
TOTALS $ 41CO. 00
DATE ISSUED ~
Receipt No.
By
Received by Date Administrative Authority
Recorded by Telephone:-(760) 777-7075_
-io
verizon
Lex Treepaisan
Engineer
Network Engineering &
Planning - West
295 North Sunrise Way, CA602NC
Palm Springs, CA 92262-5295
Phone 760 864-1720
Fax 760 325-2536
ti
lex.treepaisan @verizon.com
i
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