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4140NOTE:'. With proper validation this form constitutes an encroachment permit; CITY OF LA QUI,NTA 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 — w - -;.- ' Subdivision Improvement Permit,— Class II I _ DATE: " 3/25/04 Minor'lmprovement Permit Class IV LOCATION OF CONSTRUCTION Avenida Bermudas (Street address or Description of Location) PURPOSE OF CONSTRUCTION Soap Boat Derby (face Sketch (attach_ construction plans if appropriate). DESCRIPTION OF -CO . NSTRUCTION Temporary street closure, .ramp assembly, straw for safety *See Attached Conditions* DIMENSION OF INSTALLATION, OR REMOVAL SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN May 1, 2004 APPROXIMATE TIME OF COMPLETION May L Zu 4 ESTIMATED CONSTRUCTION COST $ N A (I'ncluding 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,.defen6 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 a. La Quinta and to pay for any additional replacement necessary as the result of this work. Signature of Applicant or Agent Don Berry Memorial. Greater Coachella Valley Soap Boa. Derby Name of Applicant (please print) Business Address Telephone No. c/o B&G Club - 'of .CV, 42400 Cook Street #120., Palm; Desert, CA 92211 (760) 564-3761 (Lucia) Name of Contractor and Job Foreman Business Address Telephone No. N/A N/A Contractor's License No. City Business -License No. NIA N/A Applicant's Insurance Company Policy Number FEES:. Subdivision Improvement Permit— Class 111 Public improvements: 3% of estimated construction costs �7 Private improvements: 3% of estimated construction costs Minor. Improvement Permit — Class IV: See attached schedule PI/A Inspection Fee $ N/A Permit Fee N/A Penalty Penalty Cash Deposit -Surety Bond N/A if required N/A TOTAL: $ Receipt No. Received by Date Recorded by- 044140 PERMIT VALIDATION PERMIT NO. 4140 DATE APPROVED6� EXPIRATION DATE S,13 1LI DATE ISSUED Gf 7.G L)4 By t Administrative Authority Telephone: (760) 777-7075 GENERAL CONDITIONS --PERMIT NO.4140 --GREATER COACHELLA VALLEY SOAP BOX DERBY -- This. permit authorizes special event activities to be accomplished within City of La Quinta right-of-way ONLY. Whenever the special event activities extend into private property, it is the responsibility of the applicant; or their agents, to secure permission from•abutting property owners. "Such authorization must be. secured by the applicant prior to staring the special event activities. 1. The applicant, Lucia �Moran, shall be available during the event,by cellular phone at 805- 1603; pager.836-6135 or a message can be left at 347-1412. 2. The necessary traffic control signage, barricades, and cones identified on the approved traffic control plans will be provided and• set up by the City. The applicant shall -notify the City immediately if replacement equipment is needed. 3. The applicant shall be responsible.to have volunteers, at the intersection of Bermudas & t Nogales at all times during the event to allow,residents, living on Avenida Bermudas within the event'area, their guests, mail carriers, and.companies delivering to them, access to, the southbound one-way fire lane provided on the traffic control plans. p. 4. The applican"t shall also assign volunteers to regularly monitor the intersections of: 1) Bermudas & Chihuahua, 2) Bermudas & Monterey,- 3) Bermudas & .Colima, and 4) Bermudas & Arroba. E Page 1 of .1 TAMDEMEncroachment Permits\Numbers 4000\4140_Soapboxderby\SoapBoxDerby_.conditibn.doc i PUBLIC WORKS DEPARTMENT APPLICATION FOR PERMIT' Date: Location of Construction: A vq-N i bA Be-Rrnu D AS Purpose of Construction: �.(�. A So � 1o65 �e r 6 Ra C Description of Construction:' L��-�- . (os tom- RF_ , q R SA F,�5 Dimension 'of Installation or Removal: Approximate Construction Start Date: 1R� �. 0240 Approximate Construction Completion Date: Estimated Construction Cost: $ ^�® Estimated Construction Cost shall include the removal of all obstructions, materials, and debris, back -filling, compaction and placing permanent resurfacing and or replacing improvements Name of Applicant: VSo 13ERR P A �RE.AT�FZ CaA A . A PP a-p -Dox ne-R"l14 Applicant Address:-R+6:ClOU, 'Applicant Telephone Number -.An td -7(; ( (o�, L,_,R1 q I / Name of Contractor::.S4 o. s wool Contractor Address: Contractor Telephone Number: Contractor State License Number: Contractor City -Business License Number:. kppli a t or Contractor General Liability Insurance Company: kpp nt or Contractor General Liability Insurance Policy Number:, f� A Office Use Only: Inspection Fee: I I� Permit Fee: As -Built Deposit: Dust Control Deposit: Credit Amount: 1 ' TOTAL FEE DUE: Office Use Only: Assigned Permit Number: Approval Date: Expiration Date: Issue Date: Administrative Authority 0 flrtERtG-�ti Berry oMemorial Greater CoachellaVal ley Soap Box -Derby The Honorable President A Program of the Boys & Girls Club:of Coachella Valley Gerald R. Ford Honorary Chairman March 25, 2004 Faxed & HandDelivered Dodie Horvit:t City of La Quinta Re: Date -change for the Soap Box Derby Dear Dodie: This letter is to confirm our,conversation on the change of date for the 10" annual Don Berry Memorial. Greater Coachella Valley Soap .Box Derby. Due to unanticipated scheduling conflicts with Racers and Volunteers, we were forced to move the scheduled race of March 27`h to May We have.gotten the word out to the news media and they are announcing the date change on air and in the newspaper.: I've already gotten several phone calls from kids and parents that want to participate, so it seems like this date'change will be ve ositive b ry p for our race. • I hope'this has n4 caused any inconvenience for the .City or any of the Staff. We will be holding several construction clinics and we anticipate a great turnout with this new,date. If you have any questions, please don't hesitate to give me a call or refer people to my phone numbers or ;,rive out my email address. They are 564-3761 (home) or 805-1603 (cell), LuciamCCdc.rr.com. Sin rely; l_ Lucia Moran, -Race Director: cc: Mayor & City. Council Members City _1Vifanager Public Works, Plan.niiag Department 42-600 Cook Stre et, Suite 120, Palm Desert, CA 92211 760.564.3761 Fax: 760.564.8350 E-mail: luciam.@dc.rr.com