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3923
.NOTE: rWith proper validation �� Q this form constitutes an encroachment permit CITY -:OF LA QUINTA : . APPLICATION FOR PERMIT g' PUBLIC,,. WORKS CONSTRUCTION (ENCROACHMENT) 0 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 I I DATE:- May 30. 2003 Minor Improvement Permit Class I.V LOCATION' OF CONSTRUCTION Corner of Washington maid Lake La Quiata' Dlrive', (Outri & $oil (Street address or'D'escription of Location) PURPOSE OF CONSTRUCTION-$C'UIRture RiaC MOntE. Sketch (attach construction plans if appropriate) DESCRIPTION OF CONSTRUCTION C:raninr Aranite. smoxiolitt>t into mac ' **Soar Attached Special Conditions** DIMENSION OF,INSTALLATION OR REMOVAL - F ' SIZE OF`EXCAVATION, IF NEEDED 5C j'1 t� �••� :APPROXIMATE TIME WHEN WORK WILL -BEGIN .Ittiie®43 �• : APPROXIMATE•TIME OF COMPLETION Two. r4eek,6. ESTIMATED CONSTRUCTION,COST $ • N/A (Including removal of all obstruction, materials, and debris, backfilling, com K". paction• and.placi'ng'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 T 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 A�be started. Comply with all applicable City Ordinances, the terms and conditions of the pe,rrr,�i�6and.all applicable rules a 7d' r g lat ons) of the City of La Quinta and to pay for any additional replacement necessary as the result o. his work. Al (Signature of Applicant or Agent AoOic 1 0<xirie ' 44489 Ton Centex: Way, Suite D . (76a) 564-4781, (978) '828 605 . i•.' Name of.Applicant (please print) Business Address Telephone No. Same As Above Name of Contractor and Job Foreman Business.Address. Telephone No. Contractor's License NO.' City Business License No. ' First, Finauciial Insurance Co. 157F000274 Applicant's Insurance Company Policy Number' FEES: Subdivision. lmprovement 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 3923 AA Qg ., Inspection Fee, $ PERMIT VALIDATION Permit Fee PERMIT N0. 3923 Penalty r r" DATE APPROVED. May 30, 2003' Cash Deposit -Surety Bond' if required t May 31- 2004 EXPIRATION: DATE ,TOTAL: $ . 1407 FEE ' Receipt No.. Received by. Date Recorded by DATE ISSU •D_,;,_ 144. By Telephone: (760) 7075 Administrative Authority P, ►Z4 ; , City of La Quinta The following General and Special Provisions are attached to and made a part of ' Permit Number 3923 . The following shall always apply: . ENCROACHMENT ON PRIVATE PROPERTY: This permit authorizes work to be accomplished within the City of La Quinta's 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. TRACK=LAYING CONSTRUCTION EQUIPMENT: Cleated track -laying construction. equipment shall not be permitted to operate on any paved surface unless fitted with smoother -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 operation in paved areas. If the existing pavement is scarred, spalled, or broken during the term of this contractor 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 coat 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 City of La Quinta Public Works Inspectors. Suitable detours and detour signs shall be placed and maintained for the duration of the project. The City shall be notified twenty-four hours (24) in advance of any traffic detours or delineation. CARE OF DRAINAGE STRUCTURES: Any drainage structure to include 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 OPERTATIONS: 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: ® R1 NOTIFICATION: Permittee shall be notified the City at (760) 777 - 7075 at least forty-eight hours (48) in'advance of starting construction. ❑ R2 UTILITY CLEARANCE: (Substructures) Prior to making any excavations 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 UTILITY 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 (" N/A ") inches of A.C. paving placed on ( " N/A") inches of ( " N/A ••) aggregate sub -base course having an "R" value of not less than (" N/A ") and in conformance with the City of La Quinta Road Improvement Standards and Specifications, Ordinance #461. 1 ❑ R6 ' PARKWAY GRADING: Area between the property line and top of the proposed concrete curb shall be graded to a slope of one-fourth inch ('/4") to one foot (11'). . ❑ 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 (" N/A ".) 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. ❑ RB 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 two and a half inches (2 W) of A.C. paving on (" N/A ") of class (" N/A " ) aggregate base. ❑ R9 SIGHT CLEARANCE: Sight Clearance of six -hundred feet (600') in all directions shall be assured and maintained at all times. ❑ R10 SOIL STERILIZER: The area to be surfaced shall be treated with soil strerilizer. Rate of application shall comply with the . manufacturer's specifications. Y • • City of La Quinta ® 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 or 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 included shall be completely tied out so they may be readily and correctly, 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 clearance. ❑ R13 PAVEMENT CUTTING: Pavement will be mechanically saw cut 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 or 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 one -thousand feet (1000') 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 and adequately consolidated backfill. Ant 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 on lifts not greater than three -feet (3') and vibrated using vibrostamper or equivalent equipment.. Alternate methods -may be -.substituted; but in any case, a relative compaction of ninety-five percent (95%) shall be maintained with the structural section of the. roadway. ❑ R17 BACKFILL PLACEMENT: Backfill shall be applied in layers of riot more.than fifty percent (50%) of the total depth of the trench before flooding or a maximum of five feet (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. Backfiil material shall be placed so that the resulting compaction shall not be less than ninety percent (90%) 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 continuos. ❑ R18. COMPACTION TESTS: If so required by the inspector, compaction test shall. be made at intervals of not more than on Thousand (1000') feet and a maximum of one (1) test on each road. One (1) copy of each test shall be forwarded tot 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 Sections 6.3.001. 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 two inches (2") of SC-800 shall be placed on a prepared sub -grade. The SC-800 temporary paving shall be placed after a maximum of three -thousand linear feet (3000') or 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 ( " N/A " ) inches of A.0 surfacing placed on a ( " N/A " ) inch ('• N/A •' ) aggregate base shall be placed no later than.(" N/A ") 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 street 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 permitte 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 backflled and thoroughly compacted as specified in the following paragraph.. Where it becomes necessary to restrict traffic, the work shall be restricted to a maximum of five -hundred feet (500') 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 ninety percent (90%) or equivalent tot 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. In addition to the standard permit conditions, the following shall apply 1. Traffic control will be provided by the City. -Pe'ermittee shall coordinate with City Maintenance Manager, James Lindsey (275-0064), to arrange for traffic control on ' westbound. Lake La .Quinta Drive prior to , setting up and' operating crane in public street. 2. Streets shall be kept clean. They shall be completely cleaned at.the end of each working day and more frequently if required. 3. 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 &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. 4. 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. Special Conditions Page 4 of 4 I� 4 b"..•. 7':•�_. `air ;.:'a � �� .. �`,`•.d� > .,sue: iti�' S:\COMMUNITY• SEi RESTAURANT.DOC' . Mr IC RT•- • :rC�t..�rb.i =U 2 Policy Number: Date Entered: 1/27/2003 ' AC0 RD., ' CERTIFICA`,,�,.1/27/2oos1 OF LIABILITY INSURAI,._;E DDDNYY ATE(MMI003� PRODUCER Doug Mo z Xnsurance Agency THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 43-875 washington Street Ste A ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Palm Desert, Ca 92211 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (760)200-0270 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: First Financial Insurance Co. ROGER HOPKINS INSURER B: 67625 EAST PALM CANYON INSURERC: CATHEDRAT CITY, CA 92234 INSURER0: INSURER E OVERAGES v 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 DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR D'L E OF INSURANCEPOLICY NUMBER POLICY EFFECTIVE TE MMIDDIYYI POUCY EXPIRATION DATE M IDDIYY LIMITS A GENERAL LIABILITY COM CLAIMS MADE MERCVL GENERAL LIABILITY ® OCCUR ding ^ r7� L L/ 1/27/2003 1/27/2004 EACH OCCURRENCE $ 1 . 000 . 000 PREMISES ocauence $ 100.000 MM EXP (Any one perwn) S 5.000 PERSONAL a ADV INJURY g1.000.000 [GfEN'LGGREGATE GENERAL AGGREGATE $ 1.000.000 LIMIT APPLIES PER: POLICY PRO-JECT LOC PRODUCTS - COMP/OP AGG $ 1 . 000 . 000 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS AUTCS NON -OWN ED COMBINED SINGLE LIMB (Ea acckent) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accideri $ PROPERTY DAMAGE (Peracckert) $ . GARAGE LIABILITY ANY AUTO AUTO ONLY-EAACCIDENT S OTHER THAN EA ACC AUTOONLY: AGG $ $ EXCESSIUMBRELLA LIABILITY OCCUR CLAIMS MADE ]DEDUCTIBLE RETENTION $ - EACH OCCURRENCE $ AGGREGATE $ $ $ $ WORKERS COMPENSATION AND EMPLOYERS! LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? It yes, describe under SPECIAL PROVISIONS below S WC STATU- OTH- T % Y LIMITS ER EL EACH ACCIDENT $ EL DISEASE -EA EMPLOYEE S EL DISEASE -POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS ' CERTIFICATE HOLDER The City of La Quinta 6 its offirers,agents employees,representatives,6 volunteers P.O. Boa 1504 La Quinta, Ca 92253 / as additional*insured I ACORD 25 (2001108) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRfTTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR r © ACORD CORPORATION 1988 r.: ,_.' �..y _h � �Ls.':t't" 1 �( 'lam` ♦' s.t w _ ;' -- - NOTE: With proper validation this form constitutes an CITY OF LA OUINTA f encroachment permit APPLICATION FOR PERMIT PUBLIC WORKS CONSTRUCTION (ENCROACHMENT). oFpwS`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 ,. ;•� O /6 Subdivision Improvement Permit — Class III DATE: Minor Improvement Permit Class IV -- r �y�3i4/N(,TO/u �S' ("At'e, Cslvrn�T LOC ION OF CONSTRUCTION 0i- (Streetaddress of Description of Locau n) PURPOSE OF CONSTRUCTIOfI.����"" Sketch (attach constructio lans i appr rate DESCRIPTION OF CONSTRUCTION 'DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, E ED APPROXIMAI-ETI E W EN W L Tj APPROXIMAE O ETIESTIMATEDRU O(Including reall r o , ma r Is, a d deb i a g, Com- paction•and per anent r s rtaci nd/o re U g improvements) In considerahe r n f this mit, the applicant hereby agrees to: Indemnd sav a City, its authorized agents, officers, representatives and employees, harmless from and against any and allpenaltie,es 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 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 p t all applicable I nd regulations of the City of -La Quinta and to pay for any additional replacement necessary as the re ! f is work. ignarure pplicant rAgentn �( 7/�l /VS Lf77 (/ll J U� \\ IDCJJ P✓ 1 1— � Name of Applicant (ple a printl Business Address Telephone No. C 78) (5 Name of Contractor and Job Foreman Business Address` Telephone_No. Contractor's License No. City Business License No. t Applicant's Insurance Company Sae 1b) 6 O rzPolicy Number w IT`L , FEES: Subdivision Improvement Permit —Class I I I Public improvements: 3% of estimated construction costs Private improvements: 3% of estimated construction costs Minor Improvement Permit — Class IV: See attached schedule Inspection Fee $ I PERMIT VALIDATION . Permit Fee I PERMIT NO. Penalty DATE APPROVED' Cash Deposit -Surety Bond if required I EXPIRATION DATE TOTAL: $ I DATE ISSUED Receipt No. I 8y Received by Date Administrative Authority Recorded by Telephone: (760) 777-7U75 I • CA Q w