3933NOTE:
With proper validation -
2
this form constitutes an 1 Y4.�
encroachment permit
CIT OF LA QUINTA .
+ APP:LICATION YFOR PERMIT
t PUBLIC WORKS CONSTRUCTION (ENCROACHMENT).��
' .t10F9
For the construction jof 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: June 13, 2003 Minor Improvement Permit Class IV . X
LOCATION OF CONSTRUCTION _ 50th and. Washington
(Street address or Qescription of Location)
'PURPOSE OF'CONSTRUCTION Installation of power poles Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION _install, operate-, and
maintainTour power poles
*See Attached Special Conditions*
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED Four (4) feet deep `
,DRAWW6
N WoRK ,o 4 (� �
APPROXIMATE TIME WHEN WORK WILL BEGIN June 16, 2003 n
APPROXIMATE TIME OF.COMPLETION __June 26, 2003 PR�.1-r- r F-40
49
ESTIMATED CONSTRUCTION COST $. 113,000
(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, off icers,.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
Imperial Irrigation District P.O. Box 9.37-2 Imperial, CA '92251 (760) 339=9239
Name of Applicant (please print) Business Address Telephone No. .
IRBY 100 W. Keystone Rd., Brawley, CA 92227 (760) 3.44-4478
Name of Contractor_and Job Foreman. Business Address Telephone No.
163338
Contractor's License No. 1 City Business License No. '
Self—Tn.Gured � - - � •
Applicant's Insurance Company Policy Number
FEES: •Subdivision Improvement Permit- Class III i
Public improvements: 3% of'estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit - Class'IV: See attached schedule . 3033
Inspection Fee $
PERMIT VALIDATION
Permit Fee
PERMIT NO. - •3933
Penalty DATE APPROVED June 13. 2003
Cash Deposit -Surety Bond ,
if required EXPIRATIO DATE 00 '
TOTAL: $ G /G Q3
c p No. se>�IQL cc3w 6 rn(SNS DATE IS ED .
Received by Date Administrative Authority
Recorded by Telephone: (760) 777-7075
•
Permit No 3933
Imperial Irrigation District
In addition to the standard permit conditions, the following shall apply:
1. Imperial Irrigation District is hereinafter referred to as `.`Permittee". Asa public agency, the Permittee
is entitled to pay only direct expenses incurred by the City while administering tasks related to the
permit, in lieu of paying the standard encroachment permit fee adopted by the City Council. City staff
and its contract staff will maintain monthly time and material ledgers of expenses incurred, and the City
will invoice the Permittee on a monthly basis for the accrued cost.
The "T&M" note, and the "TBD" note, that appear in the "FEE" section on the face of
the permit form, respectively mean "Time & Material" and "To Be Documented" and is a
reference to the direct expense method defined in the previous paragraph.
2. Pursuant to Section 14.16.320 of the La Quinta Municipal Code (LQMC), 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.
3. The Permittee is responsible for, and shall provide, continuous dust and erosion control.
a) Streets shall be kept clean. They shall be completely cleaned at the end of each working day and
more frequently if required.
b) 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.
4. Pursuant to Section 6.08.050 LQMC, 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 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 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 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.
Special Conditions .. - Page 1 of 2
Permit No 3933
.Imperial_ Irrigation, District
6. Pursuant to Section 14.16.110 LQMC, 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. It should be noted, however, this permit does not envision any
pavement restoration work. If pavement restoration work, is needed pursuant to work authorized by this
permit, the Permittee shall apply for an amendment to this permit.
7. Pursuant to Section 14.16150 LQMC, 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.
8. Pursuant to Section 14.16.290 LQMC,,street closures shall not be permitted. A minimum of two (2)
travel lane of paved surface shall be maintained 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 Permitte,e as directed,, by and to the satisfaction of the City Engineer'at no cost to the
City of La Quinta.
11. All landscaping, irrigation, decorative rock, decorative concrete, lighting, etc., shall be replaced to its
original condition.
12. Access and egress to all local properties shall be maintained at all times.
13. Pursuant to Chapter 12.56 LQMC 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.
14. The City of La Quinta reserves the right to revoke, suspend or void this permit at any time.
15. 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.
Special Conditions Page 2 of 2
City of La Quinta
The following General and Special Provisions are attached to and made a part of
Permit Number 3933
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 contract or 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 (7) 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) Priorto 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.
❑ R5 PARKWAY GRADING: Area between the property line and top of the proposed concrete curb shall be graded to a slope of
one-fourth inch ('/d") to one foot (1').
❑ 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.
❑ R8 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 '/2") 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.
City of La Quinta
. 0R11 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 not more than fifty percent (50%) of the total depth of the
trench before flooding or a maximum of five feet (6) 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. Backfill 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 of intervals of not more than one -
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 backfilled 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.
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CALIFORNIA DEPARTMENT OF TRANSPORTATION (CALTRANS) �-; r ''trf. ; "', •.� ;•5.•4,N
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REPRESENTATIVE. Electric System_ Improvements
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_ ' s ( NRNRIG CONSTRUC110 •r
' , y lli _ _ AHEAD t
4 a' •"t 1 T L e EXISTING r
_ - 500 FT �l
•+ ,` ..t 1. �,�s `' FC
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LANE CLOSED
500 FT -
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500 FT 500 FT, . • 500 FT "� p WASHINGTON ST. '
C-18 C-20 (RT) C-20 R �I y
-
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NOTES: 1. ALL TRAFFIC CONTROL DEVICES FOR THIS PROJECT SHALL BE IN ACCORDANCE WITH THE STATE OF PHASE I I 0 N LY 1 DAY
CALIFORNIA DEPARTMENT OF TRANSPORTATION (CALTRANS) , ' - . '
MANUAL OF TRAFFIC CONTROLS FOR CONSTRUCTION AND MAINTENANCE WORK ZONES. - ` . j O '•.� i -Approved By . _ - r De Speed UmIt
'2. TRAFFIC CONTROL SHOWN HEREIN IS THE MINIMUM REQUIRED. ADDITIONAL TRAFFIC CONTROL MAY BE'I II! Q �• .' ` +': "' = ," `_ Y 50
REQUIRED TO FACILITATE PUBLIC SAFETY AND TRAFFIC FLOW IF DEEMED NECESSARY BY CITY OF LA QUINTA '' II D - j`a Plow Nam ^
S NTAT VE l` ,i'' 0.
' Electric S stem Im rovements
REPRE E I �,
b
tr
-
Y P
-
'
3. THROUGHOUT EACH WORK PERIOD, CONTRACTORSHALL INSPECT TRAFFIC CONTROL (SIGNS, BARRICADES
,'
Prime
Traffic Control contraam
`AND DELINEATORS) AND MAINTAIN SAME IN ACCORDANCE WITH TRAFFIC CONTROL PLANS.
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•
Imperial Irrigation Dist.
Tops N Barricades, Inc.
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4. CONTRACTOR SHALL MAINTAIN A MINIMUM 10' TRAFFIC LANE WIDTH AT ALL TIMES.
_
- . "
Phone Prepared By
Based on SbmdeN
5. ACCESS TO PRIVATE PROPERTY SHALL BE MAINTAINED AT ALL TIMES.
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� • •
(800)852-TOPS Ron Fifield CALTRANS T-11
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6.,THIS TRAFFIC CONTROL SHALL BE IN PLACE DURING WORK HOURS ONLY. AT END OF THE WORK HOURS, THE
r ,. , '.
Number Dole
'
Permit Number
,•
• ROAD SHALLBE CLEAR OF DEBRIS AND, RETURNED TO NORMAL -
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'
2 of 2 . 5/27/03 ,
To Be Issued on'Approval
,
o
- - RISTALL hJ/p AAC 7.Y/125KY JI (L )
A TOTAL OF (a) EIOSiIHG PPoYARY MlM TO BE ANSfEREp�j1♦iN CKT .OnI I
r EXISTING. 002107 4- '"AAC 7.2ft5KV b TO BE THE EvRESS MAY TO -
• - THE U OUOITA HOTEL' AREA. NPPFR [EM O
4
--------------- -- - AVE. 50 -- —-- --
UN IV.
9P11PSL �J ' I
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STRUCTURE NOTES ,� CONDUIT NOTES -
to
v S INS I
AiCZ >i AID -PER SiiO{VI�L
P2 IN:
�.
WIRE NOTES_
P3 IN: 6 17 48 350 INSTALL 3-350MCM 7.2/12.5KV 30 PRIMARY CA.
' P4 RM: POLE COMPLETE
IN: 7 17 48 17 48 21 48 49 21 48 49 33 *. -
AV
` PS ADD: 17 48 4 4 _ Ptj
E7fiSTING 2-6-
r y - SUB OUT ,
P6 t ADD: 17 48 NEW UNDER -BUILT bar
TRANSFER PRIMARY RISER TO LOWER LEVEL NEW 0011 CKT
RM: CAPACITOR'BANK COMPLETE I . ' •'
IN: 21 49 DEAD-END UNDER -BUILT (NEW 0011 CKT
NEW UNDER-BUILT-
P8 ADD: 17 48 TRANSFER O.H. TRANSFORMERS AND SEC. RISER u �. 1�. ,
TO LOWER LEVEL NEW 11 CKT NOTE TO FOREMAN , .
POWER -
OPERATING HEADQUARTERS • P. O. BOX 937 • IMPERIAL. CALIFORNIA 92251
GENERAL SERVICES • REAL ESTATE SECTION
(760) 339-9239 PHONE • (760) 339-91 27 FAX
t
GS-RE June 13, 2003 -
0
VIA OVERNIGHT MAIL -
John M. Freeland 03
Public Works/Engineering
City of La Quinta ®���
78-495 Calle Tampico ���
La Quinta,, CA 92253-1504 yA��
Dear Mr. Freeland: ,
Subject: Application for Encroachment Permit, 50th Avenue/Washington Street '
The Imperial Irrigation District hereby requests permission to,enter the City
of La Quintals Avenue 50 and Washington Street for the installation of
electrical facilities.
Installation to consists of four (4) power poles approximately 81 feet east
of Washington Avenue's centerline from the north side of 50th Avennue south
approximately 975 feet.- In addition, a new circuit on existing power poles
will be installed on the north side of 501-h Avenue from the northeast corner
of 50th and Washington west approximately 2,705 feet. Enclosed is our
application along with five '(5) copies of IID• Drawing for Network No.
4011849, Project No. P-4049 with detailed information..
The District would greatly appreciate approval of this necessary permit.
Please call (760)•339-9239 if you'have any questions.
Sincerely,
r • , .1F JIM, KELLEY; Sup isor
- Real Estate Section
/sls
v,
Enclosures 1
TYLER-HART
June 13, 2003 License No.OB95284
«.gd ti 8
City of La Quinta � u�
P, O Box 1504 j.�� ��
La Quinta, CA 92253-1504 aIks
Fax: 760-777-7155
Attn: John Freeland
R::_. lmperi_alrlrr..gati.on District
Letter/Certificate of Insurance
Dear Mr. Freeman:
Our agency handlesinsurance for the Imperial Irrigation District {IID). The IID, in the course of
conducting business with other companies,•is frequently asked to provide a Certificate of
Insurance showing that they carry liability insurance in the amount of $1,000,000 per occurrence. "
s, -in the case with many other large ,companies; IID does not,carry commercial
'general/automobile liability insurance,at levels below $I,000,000 per•occurrence. "The lII) also
self .insures their Workers' Compensation exposure, as well as physical damage to,automobiles
andtequipment.
Therefore; this letter is being provided in lieu of a Certificate of Insurance indicating excess
insurance of the IID's self -insured retentions.
Please be assured that the IID is financially able to respond to losses in the uninsured level. Such
"self-insurance" does not change any obligations assumed by the IID under the provisions of
their agreements. The IID Will respond directly,to any losses or claims arising from such y.
�.�..:�.:. ,,,-,--cibligatioris::''~—;^' .. ,i...:a ram.' . '---`�-"-^-...:�.�• -- --,�.-�. ... ,,, - - ..-.:�•—r..: ..._.M:-i=-:..._-`. " .,e _+:ter%=: `� _
Please call me at (760) 352-2611 if you have any questions or concerns regarding this matter.
Yours truly,
TYLER-HART INSURANCE SERVICES
Allen Tyler, CP U, ARM
cc: Jim Kelley, IID
Fax: 760-339-9127 ;
1225 Main Street P.O. Box 1866 El Centro, CA 02244 (760) 352-2611 Fax (760) 337-8428
NOTE:
With proper validation C�
this form constitutes an CITY. OF LA OUINTA'
t:
encroachment permit
APPLICATION FOR PERMIT
PUBLIC ,WORKS 'CONSTRUCTION (ENCROACHMENT) 'r
OF I118�
For the construction of public or private curbs, driveways, pavements, sidewalks,, parking lots, sewers, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit — Class III
DATE: 6-12-03 • Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 50th, and Washington
•(Street address of Description of Location)
PURPOSE OF CONSTRUCTION Installation of power poi Ach(attachconstructio lansi appr rate
DESCRIPTIO O CONsrRUCj10N see a ace
ro ec Oae.scriptim.
DIMENSION OF INSTALLATION OR REMOVAL
See
SIZE F EXCA IONE ED.
Kour : to
AA
APPROXI ATE TIME EN W L
Wi..,oveten.$)
APPROXIMATE TIME O ETI E
STIMATED CONSTRU AN
Including removal of all r o , ma r Is, a d deb ipaction and placing per anent r s rfaci nd/o re
In consideration of the r n f this mit,-the applicant hereby agrees to:
Indemnify, defend so a City, its authorized agents, officers, representatives and employees, harmless from and against any and all '
;penalties, liabilities r. loss resulting from m claims or .court action and arising out of any accident, loss or damage to persons or property -
f
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 al the permit and all applicable rules and regulations of the City of -
Le Quints and to pay for any additional replacement necessary as the result of this work.
offrgnature of Ap leant or Agent
Imperial' Irrigation bistrict P.O. Box 937,,,Imperi f, CA` 92251 (760 339-9239
Name of Applicant (please print) Business Address Telephone No.
IRBY
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. City Business License No. ,
Self -Insured Will send letter of justification.
Applicant's Insurance Company, 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 — Class IV: See attached schedule
Wi 1.1 pay when advised r PERMIT VALIDATION
• Inspection Fee g _ _ "
Permit Fee PERMIT NO.
Penalty DATE APPROVED f
Cash Deposit -Surety Bond
if required i 'EXPIRATION DATE
TOTAL: $ Ii DATE ISSUED
Receipt No. I By
Received by Date Administrative Authority
Recorded by Telephone: (760).777-7075