484Owl
With proper validation f ` Q'
this forrn,constitutes an
encroachment permit
-, ` CITY OF LA QUINTA
APPLICATION FOR PERMIT - --
,`• 7' w`'.PUBLIC WORKS CONSTRUCTION' (ENCROACHMENT)
OF
For the construction` of public; or private, curbs, driveways, pavements, sidewalks, parking lots,'sewers, water mains
Cana other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS'
' Subdivision Improvement Permit — Class I II
DATE: +' 9/ 2 2/ 8 9 Minor I mprovement' Permit Class IV
' _b 2 ). Avenida Montezuma - from Eisenhower to' Navarro . 21 7�17pn c a
LOCATION•OF-CONSTRUCTION
r•.
en.doza- frorla Tampico • to Montezuma 3) Avenida Madero from •Ensenadas .to'Montezuma ,
" ti , • '(Street address or Description of Location)
• to replace undersized - and 1-ak' ,rr
PURPOSE OF CONSTRUCTION Sketch 3attach construction plans if appropriate) i
• tlld.11l:� ,
DESCRIPTION,OF CONSTRUCTION na i xi '1 i r,LR roil nrt i
1) 61 mains on Madero and Mendoza. and Mont- puma SEE A2'4IiACHED PLAT SHEETS
.,DIMENSION OF."INSTALLATION OR. REMOVAL ann.r_c),x 1 1 1 ADD' on
Prmonte ub� a' ,:'��;;:,,�80 � on -Mendoza. 3) 16001 en- 1` adp.ro
'.SIZE OF EXCAVATION, IF NEEDED
= APPROXIMATE TIME'.WHEN WORK WILL BEGIN •-t
r APPROXIMATE TIME OF COMPLETION `
ESTIMATED CONSTRUCTION COST $
(I ncluding.removal of all obstruction, materials, and debris, backfilling, com-
?I, paction and placing permanent resurfacing 'and/or. replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrees, to: t
Indemnify, defend and save the City;, its authorized agents, officers, representatives and employees, harmless from and 'against any and all
r penalties, liabilities,or loss resulting from claims or court action and arising out of'any accident, loss or damage topersons or, property
happening -or occurring as a proximate result of any work undertaken under the permit granted pursuant to this application: ,
• •~. Notify the 'Adrriinistrative'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
Y•"; La Quinta and to pay for any additional'replacement necessary as the result of thisswork.
Signature of Applicant or Agent r' xz• '
Ilk
Co chella'Valle� Water District -PO Box 1058 Coachella, CA 92236 398�2.551. '
rNeme of Applicant (please print) ' Business Address . Telephone No.
14
r Name of Contractor and Job Foreman : Business Address _ Telephone No.,
`*e
Contractor's License No. City Business License No.
Applicant's Insurance Company 1 : 'Policy Number
FEES: Subdivision Improvement Permit — Class I I I '
Public improvements: 3%of estimated construction costs �' = r ;► „
Private improvements: 3% of estimated construction costs No
484
Minor Improvement Permit - Class IV: See attached schedule
Inspection Fee l$ "��"`' PERMIT•VALIDATION,-
f . Permit Fee Z7 `'.
r. PERMIT NO.
ac + - ; ••.
Penalty DATE APPROVED �l✓ ��
t Cash Deposit -Surety Bond y
•' if required EXPIRATION DATE
TOTAL:.] $ :. DATE ISSUED t`/r��f �>f....
Receipt No. f{ % it,r�• �� �_.
By —
Received by , Date Administrative.Authority
Recorded by �7ELE`RHONE:'(619►'S64 224.6f'
T t;n•-+r,F- - 'S cj .. r- - ��' .4.. i. i:;r+e :.i t
_0... \ e��`i`If �i.x,,F-�ir'+%a:Lr<1: "$.,�� r ,K. fix' � r.• N � 4 l� ,�r�"<: Y=`:�+:"--G'.,w�airMi •`0.2 •,�'L .gYy�.►pf .'C.,t s•'i�'i�Y.i '?•�kIST„`� ¢
NOTE:
With'proper validation • ` �,� Q
this form,constitutes•an _ } A* QUINTAo `
encroachment permit Y „
CITY'OF. L '
APPLICATION FOR PERMIT
,�..-�k_ , • '' PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
G. For the constructiori 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 t
• DATE: 9/22/89' Minor Improvement Permit Class IV
LOCATION OF CONST_R,UCTION 2) 'Avenida Montezuma from Eisenhower , to Navarro`, 2) Aveiii a
Mendoza,from Tamp -to Montezuida. 3.) AVenida Madero from. Ensenadas to Montezuma ,
(Street address or Description of Location)
,, to replace undersized grid (-akinct + , � t
PU.RPOS,E OF CONSTRUCTION Sketch (attach construction plans if appropriate)
Thai O E
DESCRIPTION OF CONSTRUCTION ;ar-•r ,•,r=n-r
1)-6" n>a? ns or. Made!rb and' Mendoza, and- Montezuma% R EF ATZACHEL, PLAT SH ',ETS .,
DIMENSION OF INSTALLATION OR REMOVAL a7212102r, 12Ea0' 'O72
Montezu..ma, .2) 400' - on Mendoza, 301600' on Madero .
• SIZE OF EXCAVATION, IF NEEDED 3 4 ,•.ram' trench
APPROXIMATE TIME WHEN WORK WILL BEGIN '
APPROXIMATE TIME OF COMPLETION ���' �:,^ ley r>�,;•��r7�fr',{,/ I�
ESTIMATED CONSTRUCTION COST $
(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: = A, +
Indemnify, defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and all
penalties; liabilities or loss resulting from, claims or court action' and arising out of any accident, loss or damage to persons or, property `
happening or occurring as a proximate result of any -work undertaken under the'permit granted, pursuant to this application. +' '
} Notify the Administrative Authority at least twenty-four (24) hours in advance of the time when Work will be started. r ; ' 1 •'
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. r' +
Signature of Applicant or Agent w r =
r ,.• • ,
Coachella Valley . Wate.r •District -'PO' Box. 1058' Coachella; . CA - 92236 •.-398-2651.
Name of Applicant (please print). Business Address Telephone No.`. ,' K
'Name of Contractor and Job Foreman a' ' Business Address "'Telephorie No.
d'''''(fntractori.s License No. City Business License, No. ' t'
1 • ;
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' L t 84 .. r
MinorAmprovement Permit —'Class IV: See attached schedule -•, ` '
AV Inspection Fee $ ~� '"`f ' ' , PERMIT'`VALIDATION +, ,
•. r; Permit Fee
, , ' . •- - . ', . PERMIT N0. =jf% •F'• , '
Penalty
Cash Deposit Surety Bond DATE APPROVED •�� ��'711" �') '
if required :'EXPIRATION'DATE 'r' TOT
$ " DATE.ISSUED
i�,. ,
Receipt NoBy
. j
i"" , Received by + Date v Administraiive'Authority
;Recorded by'' `• TELEPHONE:' (619) 564 2246 , -
',
The following General and Special Provisions are attached to and made a part. of Permit No. v
GENERAL PROVISIONS
The following shall always apply
ENCROACHMENT ON PRIVATE PROPERTY: This permit authorizes work to be accomplished within City of La Quinta right of way
ONLY. Whenever construction extends within private property, it shall be the responsibility of the permittee (or his contractors) to
secure permission from abutting property owners. Such authorization must be secured by the permittee prior to starting work.
TRACKLAYING CONSTRUCTION EQUIPMENT: Cleated tracklaying construction equipment shall not be permitted to operate on any
paved surface unless fitted with smooth -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 operations 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 (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 La Quinta City Public Works Inspectors. Suitable detours and detour signsshall be placed and maintainedfor the duration
of the project. The City shall be notified 24 Hrs. in advance of any traffic detours or delineations.
CARE OF DRAINAGE STRUCTURES: Any drainage structure including 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 OPERATIONS: 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 bythe permittee that he must close a streetfor
any length of time, permittee shall contact this office to obtain the necessary permission.
SPECIAL PROVISIONS
The follwing shall apply ONLY when indicated:
QRNOTIFICATION: Permittee shall notify the City at 564-2246 at least 48 hours in advance of starting construction.
R2 CASH DEPOSITS OR BONDS: A cash bond or an approved surety bond in an amount of not less than $
shall be furnished in the name of City of La Quinta to cover all work involved in the restoration of the various La Quinta
roads and survey monuments. This bond shall be continuous until cancelled by the City Engineer. This bond must be
posted prior to commencement of any work on this project .
®R3UTILITY CLEARANCE: (Substructures)Priorto making any excavation within the City of La Quinta rightof wayauthorized
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.
R4 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.
R5 PAVEMENT WIDENING: Area between the proposed concrete gutter line and the existing road pavement shall be
surfaced with inches of A.C. paving placed on inches of class &aggregate subbase course
having an "R"value of not less than and in conformance with City of La Quinta Road Improvement Standards
and Specifications, Ordinance #461.
R6 PARKWAY GRADING: Area between the property line and top of the proposed concrete curb shall be graded to a slope of
1 /4 inch to one foot (1').
R7 GRADES & STAKES: City of La Quinta shall establish grades and stakes for the proposed concrete curb and gutter_
construction.
R8 GRADE CHECKING: City of La Quinta shall check grades upon receipt of plan and pFofile and/or grades as established by
a licensed engineer.
R9 CURB REMOVAL FOR DRIVEWAYS: A portion of the existing concrete curb and/or curb and gutter ( 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.-
R10 . 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 2-1/2 inches of A.C. paving placed on ( ") of class
aggregate base. Driveway construction shall conform to attached drawing.
R 11 CULVERTS: A inch diameter ( )culvert shall be installed with the invert approximately 1-1 /2
inches below and in line with the existing flow line. Culvert installation shall conform to the attached drawing.'
4Rl SIGHT CLEARANCE: Sight clearance of 600 feet in either direction shall be assured and maintained.
3 SOIL STERILIZER: The area to be surfaced shall be treated with soil sterilizer. Rate of application shall comply with the
manufacturer's specifications.
• R14 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.
R15 URVEY MONUMENTS: Prior to excavation or beginning of construction, all survey monuments which exist on the
centerline of all streets or property lines when involved shall be completely tied out so they may be readily and correctly
be replaced by a licensed civil engineer or surveyor at the expense of the permittee. A complete set of notes showi ng 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 of replacement of all survey monuments for proper project clearance.
f R16 SURVEY MONUMENTS: Prior toovation or beginning of construction, all surve*onuments shall be tied out by City
rV, of La Quinta and suitable payment or guarantee of payment shall be made as reimbursement for all work involved.
R17 PAVEMENT CUTTING: Pavement will be mechanically 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 of pavement). Excavation material shall be placed in such a position,as to best
facilitate the general flow of traffic. Prior to final paving operations, any damage to pavement straight edge shall be
corrected. `
R18 PAVEMENT CUTTING: Pavement shall be saw cut prior.to`removal. Prior to final paving operations, any damage to
pavement straight edge shall be corrected .
LIMIT OF EXCAVATIONS: Excavations shall be limited to 1;000lineal feet 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.
20 BACKFILL MATERIAL: Backfill shall be free of brush, roots or other organic substance detrimental to its use for purposes
of producing an adequately consolidated backfill. Any 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.
R21 BACKFILL SAND: Backfill shall be approved transit -mix sand or equivalent and shall be placed in lifts of not greaterthan
three feet (3') and vibrated using vibrotamper or equivalent equipment. Alternate methods maybe substituted, but in any -
case a relative compaction of 95 percent shall be attained within the structural section of the roadway. -
R22 BACKFILL PLACEMENT: Backfill shall'be applied in layers of not more than 50 percent of the total depth of the trench
before flooding or a maximum of five-foot.(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. Backfill material shall be placed so that the
resulting compaction shall be not less than 90 percent 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 continuous.
R23 COMPACTION TESTS: If so required bythe inspector, compactiontests shall be made at intervalsof not more than 1,000
° feet and a minimum of one (1) test on each road. 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 Section 6.3.01 of the
tandard Specifications, Division of Highways, State of California, dated January-1973.
R24 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 Section 6.3.01 of the Standard Specifications, Division of Highways, State
of California, dated January 1973.
TEMPORARY PAVEMENT REPAIRS: -After completion of backfill and compaction operations' a temporary patch
consisting of 2 inches of SC-800 shall be placed on a prepared subgrade. The SC-800 temporary paving shall be placed
after a maximum of 3,000lineal feet of 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.
�26PERMANENT PAVEMENT REPAIR: After backfill and compaction operations have been completed, a temporary patch
consisting of two inches (2") of.SC-800 shall be placed immediately. A permanent patch of inches A.C.
surfacing placed on a inch.class base shall be placed no later than days after completion of
temporary road repair. 4_X�
R27 PAVEMENT REPAIR F.A.S.: Upon completion of backfill and compaction, a temporary patch consisting of two inches (2")
of cold mix paving (SC-800) shall be placed immediately. A permanent patch of three inches (3") of A.C. surfacing shall
.-.-.be placed on six inches (6") concrete base as directed, but not later than fifteen'(15) days after completion of temporary
paving: Concrete base shall be of five -sack mix and shall conform to the City of La Quinta Road Improvement Standards
and Specifications, Ordinance #461.
R28 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. . ,w
R29 SEAL ARMOR COAT: A seal coat consisting of an application binder and screenings shall be applied on all patch areas
where such seal coats existed prior to issuance of this permit. Seafor armor coats shall be applied as specified in Section '
37, Standard Specifications, State of California, Division of Highways, dated January 1973. Work of pavement repair -to
be'accomplished by a licensed contractor engaged in the business of pavement repair. '
R30 _ STREET RESTRIPING: Where street striping is still visible on streets to be excavated, such striping shall be replaced upon
completion of permanent repairs.
R31 TREE RELOCATION OR REMOVAL: Tree relocation within the City of Ca 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 permittee to maintain the tree in a vigorous growing condition at its new location. `
Trees to be removed shall be removed 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 thoroughlycompacted as specified inthefollowing paragraph. Where it
becomes necessary to restrict traffic, the work shall be restricted to a maximum of 500 feet at any onetime. 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 90 percent or equivalent to 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
' S January 1973. G
R32 -TREE TRIMMING'
-a. Only the necessary trimming shall be accomplished to provide clearance of the facility for one calendar year.
All broken or weak sections within the trimming shall be removed.,-. -
b. Where it becomes necessary to restrict traffic, the work shall be restricted to a maximum of 500feet at anyone time.
Adequate signs, flagmen, and/or barricades shall be provided to protect the traveling public at all times.
• c..•:If tree•trunks are partially outside of the City of La Quinta road right of way, permittee shall make his own
arrangements with adjoining property owners for consent to the trimming in addition -to the authorization provided
• %' by this permit.
d. All tree trimming on EVERGREEN TREES, PALM TREES, and other ORNAMENTAL TREES shall be accomplished to
the satisfaction of the City Public Works Inspector. •
e. Abutting property owners shall be contacted, in all instances, prior to trimming or topping trees.
f. - Pruning shall, in all instances, be at the shoulder of the crotch to insure even, fast healing in all -cuts of two inches
_(2'.) and.above in -size. Sealant shall..be..applied to all cut sections. as directed by.the.City Public Works.lnspector.
•ADDITION*ENCROACHMENT'PERMIT NO.4 --CONDITIONS --
R33
Survey monuments shall'be protected in-place.or
re-established pursuant.•to:'City standards and the"State of,!
California• Land• Surveyor'-s Act.
t R34-
Work shall be coordinated with the City of La Quinta's
forcesY'to preclude delay o,r•interference with the City of La
Quinta's projects,
R35
Contractor• shall- comply with .the local.• noise; ordinance -and
<construction operations and maintenance of equipment within_
'
one half mile.of human occupancy shall_ :be performed only
during the time periods as follows:
_October 1st to April 30: Monday-.Friday,7:00a.m:-5:30p.m.
-:-
- Saturday 8:00a.m.-5:00p.m.
May 1st to.September.30c• Monday -Friday 6:00a.m.-7:00p.m.
: Saturday 8:00a.m.•-5:00p.m.` -
work shall be prohibited anytime on Sunday'and•Federal
: holiday -
R36
Traffic 'control shall -be as per Cal Trans Traffic Manual'.` -
Field adjustments.in detouring shall be accomplished as
directed in.order,to adjust to actual field conditions.''It.
shall'be the contractor's responsibility to adequately
...
.-barricade and detour this.site.
R37
All excavation at or near. the travel,way shall be backfilled.'
at the end of the -.work -day. for the. protection of the -
travel'ing . public .
R318
Street closures shall not be allowed atanytime.
R39
A minimum of one travel lane shall be, maintained at all _
times with flagmen during working hours..
R40
All,work.to be performed -•within the -existing paved section
shall be.-temporary-paved''and maintained by the Permittee,
permanent pavement shall be placed no later.than 15 days
-
after. completion of the temporary road :repair.
r
R41"
Ingress and egress for local properties shall be'maintained-
.at all times.`
'.R42
Prior .to work starting, Underground"Service. Alert shall be-
'-contacted.at 1-8,00-422-413.3 and-an,"inquiry number" shall be
provided to the City Public Works Inspector.
jR43
Pavement shall be sawcut,prior•to.removal.
R44
A11 .backfill. subgrade- soil shall be compacted- to nothing
less than 90. relative`dry.density, all backfill soil within
the top 2' of finish pavement surface shall be compacted to,
t
nothing,less than..95o relative dry density,. all base
'. ...material
shall be.•compacted to nothing less than-95%•'
relative dry density.
R45
Replacement: pavement -sections- shall be 3" AC over -A", Class. ,
�
II 'aggregate -base /o,-ct/lS?r is o�of-,�is�nhorv�i; rolr���m
-
m�nr` an �� a�•n�io�ei- .sfia// 6� _ .¢ ��AL' �v�i' B N C'l�.�s _7I. A, ram',
E
NOTE; .. } • _
With proper validation
this form constitutes an f�
CITY OF LA QUINTA
` - encroachment permit '. s.._T
i APPLICATION FOR PERMIT...
• " PUBLIC WORKS CONSTRUCTION `(ENCROACHMENT)\'Ell
'"_
' 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: 22 - " Minor, Improvement Permit Class IV
LOCATION OF CONSTRUCTION J � ' RVGI�I0q' 14O pTE Zu'A A F-FOh E ISG—puOwG2 . TO NA V A 9 f�a Z) A VGti117R
TIGuDoZA F:?AM ri oeuHa 1i�1� c-.0 tiaD.'To our�a�w�
;.,(Street address or Oescription:of Location): y,
PURPOSE OF CONSTRUCTION' (LG—PLAGC—: 'uN�G(Yi1ZGD Sketch (attach'construction plans if appropriate)
•!.. �rxt�0 �4r1L1>J6 F•tRi�S' ,, .. .- " ..
- ' DESCRIPTION OF CONSTRUCTION ,s AA'1p `L6oc,G IZEPt,AGirfNFrN(
4'jtA105 ON MADe#p APO' / 42.
DIMENS10": nc !"lST..L TION OR REMQV ki A?PRO)QKATPL Y
y ' I� Y IZ00�• ON I Ave 140HTCLu104= .� L- 00 09j • A 206 1 Dot t 6lu001A
j SIZE OF XCAVATION;:hF NEEDED
i APPROXIMATE TIME WHEN WORK WILL BEGIN SIL D ' "u�G
r APPROXIMATE. TIME OF.COMPLETION
WE" D • " D F..D G G (d EQ fL,
l ESTIMATED CONSTRUCTION COSTS
l (Including,,removal of all obstruction; materials, and debris, backfilliitg; corn-
pactlon,and placing permanent resurfacing and/or•replacing ;improvements)
In>consideration of the,:granting,of this permit, the applicant hereby agrees to:
j rInoemnify, defend and: save the City, its authorized agents, officers; representatives and employees, harmless from and against any and all .
i ;:;y;• '= penalties, liabilities"..or: loss resulting from claims or court action' and arising out of any accident, loss, or damage to persons or property
;:.
- >_;happenin9 or occurring. as a proximate result of any work undertaker- under the permit granted,pursuant to this application.
r ,Notify. the Administrative -Authority at least twenty-four (24) .hours in advance of the time when work will be.started.
v:
::-Comply with all applicable City Ordinances, the terms and. conditions of the permit and all applicable rules and regulations of the Ci[y of
>:La. Quinta,ano to pay for any additional replacement necessary•as the result of this work.
Signature.of Applicant or Agent
:� y µas GCE �G U �✓� � gip' 66,4, 10.5�- Go�kG4tGUt ,�A -62236 3981651 365
:i .Name of Applicant (pleaseprint) Business Address Telephone..No.
• 10 D- IGj?.fti 11JGD
Name of Contactor and Job,Foreman Business Address Telephone No.
Contractor's License No. City Business License No.
I Applicant's Insurance Company Policy Number