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7167T4ht °��WQw ENCROACHMENT PERMIT PUBLIC WORKS CONSTRUCTION See below for Finance Revenue Codes 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 Minor Improvement Permit Class IV DATE:September 7, 2007 LOCATION OF CONSTRUCTION (Street address or Description): Martha's Village & Kitchen Thanksgiving Day 5k Walk-a-Thon; From La Quinta Park to Adams St to Miles Ave to Jefferson St. to Westward Ho back to La Quinta Park. PURPOSE OF CONSTRUCTION: Special Non -Profit Event - Lane Closure jirr� DESCRIPTION OF CONSTRUCTION: See temporary traffic control plan.no DIMENSION OFINSTALLATION OR REMOVAL: See temporary traffic control plan. APPROXIMATE TIME WHEN WORK WILL BEGIN:November 22, 2007 8:00am TIME OF COMPLETION: November 22, 2007 11:00am ESTIMATED CONSTRUCTION COST: $N/A (Including removal of all obstruction, materials, and debris, backfilling, compaction and placing permanent resurfacing and/or replacing improvements) COMMENTS: Coordination among City of Indio and Riverside County Sheriff Dept 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 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 at (760) 777- 7075. 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. i/ -A�w Signature of Applicant or Agent Gloria Gomez 83-791 Date Avenue, Indio, CA 92201 (760) 347-4741 x303 Name of Applicant (please print) Business Address Telephone No. Tops N Barricades 44-631 Jackson St. Indio, CA 92201 (760) 347-2111 Name of Contractor and Job Foreman Business Address Telephone No. Contractor's License No. City Business License No. Philadelphia Ind Ins Co PHPK244256 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 Finance Revenue Code Inspection Fee E_1 $No Fee Permit Fee E-1 $0 As -Built Deposit E_A $0 Cash Deposit -Surety Bond, E_B $0 if required TOTAL $No Fee PERMIT NO.7 1 67 DATE APPROVED: Mail, EXPIRATION^D�ATE:; U�JV. G— zoos, BY: � `_4. Administrative Authority A-r T-j i T4hf 4 4a(4rw PUBLIC WORKS DEPARTMENT APPLICATION FOR PERMIT Date: 9 — Co - 2o-6 '4 Tract No: :Project Name: L.,-4Cn0, k-A tip T'.4 Vicinity: li— l.G QK� n-�w fDis A,&--s St Ave. Purpose of Construction (Ex: $opgh Grad' site Street etc.) T� S GI�t Oh-��� Q :� Jane C (OS y r.e. Description of Construction (Ex: See Plan Set No. 01234)5 Dimension of Installation or Removal: Sea f -pl,�,tp„- wv e f va.-FC,' c Approximate Construction Start Date: 2 v{ 2 no 4 8 A-wl Approximate Construction Completion Date: Estimated Construction Cost: $ M / A Estimated Construction Cost shall include the removal of al obstructions, materials, and debris, back -filling, compaction and placing permanent. resurfacing and or replacing improvements Contact Name: 6n L- w �L- , A 6, o rt EL Phone Number: 7 - -e 7 u l �c Name of Applicant/Owner: c L_o rL, A c o ►1 z Z Applicant Address: 83 -7 q 9A . It— As y ,� >✓ oa c �► 'r z�� l Applicant Telephone Number: C-7 6 & 3 y -7 - ti ? LC Name of Contractor: To �S ,4 a C_A 1> IZEs Contractor Address: H `l (D , AL IC n jJ Y ,,,, ,, 10 � c,or R Z2o l Contractor Telephone Number: -7 & o - _1z, 14 4 - y 1 t l Contractor State License Number: -7 g -7 G k, L4 Contractor City Business License Number: � A COPY OF TIE CURRENT INSURANCE CERTIFICATE MUST BE PROVIDED 4 Applicant or Contractor General Liability Insurance Company: Applicant or Contractor General Liability Insurance Policy Number: Office Use Only: Inspection Fee: Permit Fee: As -Built Deposit: Dust Control Deposit: Credit Office Use Only: Assigned Penrtit Number: Approval Date: Expiration Date: Issue Date: --Administmtive-Authority: Gitl,N VAl pla 11\ ar- TOTAL FEE DUE: "�s t�u 1-7 10 -/a] ,raao von=�.�10� DO 0-zLb Desert Sands Unified School District 15351 47-950 Dune Palms Road, La Quinta, California 92253, (760) 771-8543 APPLICATION FOR USE OF SCHOOL FACILITIES FOR PUBLIC PURPOSES The undersigned hereby applies for use of school property for public purposes in accordance with policies, rules, and regulations of the - (See reverse side of last page.) STATEMENT OF APPLICANT Applicant hereby agrees to hold the Desert Sands Unified School District, Board of Education, the individual members thereof, and all District Officers, Agents, and Em- ployees free and harmless from any loss, damage, liability, cost or expense that may arise during or be caused in any way by such use or occupancy ofschool property to include users or event patrons coming from or going to the event. School property shall include the physical structures on the school site, classrooms, restrooms, and any adjacent parking lots, walkways, sidewalks or thoroughfares. The undersigned hereby certifies that he will be personally responsible on behalf of the applicant for payment of all charges assessed for the use of the facilities and for any damages sustained by the building, furniture, equipment or grounds accruing through the occupancy or use of said building, furniture, equipment or grounds by the applicant. The undersigned hereby certifies that he has read the rules; regulations, conditions and terms set forth on the reverse side of this application and that he, and the applicant which he represents, will abide by them and will conform to all applicable provisions of the Constitution and laws of California and to all other directives of the Board of Education and its authorized agents which May be communicated to the applicant. The undersigned states that, to the best of his knowledge, the school property for use of which application is hereby made will not be used for the commission of any act intended to further any program or movement the purpose of which is to accomplish the overthrow of the government of the United States or of the State of California by force, violence, or other unlawful means. PLEASE NOTE: Your application must be received at least two weeks in advance of scheduled event. Please attach Certificate of Liability or other insurance for the protection of the public and the district, as the district may require, and also submit an insurance declaration or certificate identifying the Desert Sands Unified School District as an additional named insured. Sponsoring Organization or Group i`1 A P--- o a4 - V Y I= L.a c:., 0 IQ Street 2�3 --KlI o044-r &17 AVC- t-j �� City — I jam! r, t [3 zip—q,ZZ0 i Description of Activity T H A :J;z-SC:v Y ./ r ni DAy "ti I4 Lv4�lr< Name of Person Reque 'no se (Please Pri t tt a Telephone �"/ 6e� Signature Date 7 /Z5/p• School/Facility Requested (_ y, �y - Fl 1 L+VI S C.tiCa Room/Building �/���� Nam► L`,, •.., Will admission fees be charged? Will contributions or other fees be solicited at the meeting? If charge is made or contributions are solicited, please describe the purpose for which money will be used. Please check equipment needed: (Equipment will NOT be provided unless it has been requested in advance.) ❑ Chairs (How many? ) ❑ Other: ❑ Microphones (How many? ) Special Instructions, Arrangement of Furniture, Etc.: ❑ Tables (How many? ) CUSTODIAL: TECHNICAL: FOOD SERVICES: OTHER LABOR: UTILITIES: RENTAL: OTHER FEES: (Attach drawing if necessary) For Office Use Only Hours Per Hour $ Hours Per Hour $ Hours Per Hour $ Hours Per Hour $ lCertificate of Insurance expiration date: TOTAL Principal's Approval ❑ Disapproval ❑ Date Signature Comments: District Office Approval ❑ Disapproval ❑ Date Comments: Siture gna WHITE Copy - Risk • GREEN -Applicant • YELLOW - Principal • PINK -Accounting PLEASE DO NOT DETACH COPIES. CONFIRMED COPY WILL BE RETI RNED TODYOU�tnty rev 8/06 (10)-61 GENERAL CONDITIONS --PERMIT NO. 7167 --MARTHA VILLAGE & KITCHEN 5K WALK-A-THON-- 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 starting the special event activities. The applicant, Gloria Gomez or Ricardo, shall be available during the event by cellular phone at (760) 972-6314. 2. This permit or copy of it shall be on the work site (usually the job trailer) for inspection during the actual work performed. 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 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. 5. The permittee shall not encroach upon private property without prior written approval (submit to the Public Works Department, attention to the Assistant Engineer II) of the private land owner whom is being encroached upon. 6. All landscaping, irrigation, decorative rock, decorative concrete, lighting, etc., shall be replaced to its original condition. 7. The necessary traffic control signage, barricades, and cones identified on the approved traffic control plans will be provided and set up by Tops N Barricades. 8. The applicant shall be responsible to coordinate traffic control with the Sheriff Department at the intersections of Dune Palms Rd and Miles Ave and Dune Palms Rd and Westward Ho during the event as indicated on the traffic control plans. 9. The permittee is responsible for making sure that temporary no parking signs along the parking area affected by the special event is existing. The signs shall be placed along the area 48 hours prior to the start of closing the area and removed immediately after the construction completion date. 10. The City of La Quinta reserves the right to revoke, suspend or void this permit at any time. 11. 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 pen -nit. '1':\PERMITS\ENCROAC14MEN'RNwnbers 7000\7167 - Martha's Village and Kitchen 5K Walk-a-thon; La Quinta Park\5k Walk-a-thon_condition.doc Page I of I TO: FROM: DATE: RE: Dear Ms. Yu, T-vf 4 4 Qu&Z MEMORANDUM Amy Yu, Public Works Department Eric Ceja, Assistant Planner 15a— 9/4/2007 Traffic Control Plan for TUP 07-730; Martha's Village and Kitchen 5k Walk-a-thon (City of La Quinta/City of Indio) On September 4, 2007, the Planning Department received the traffic control plan for the Martha's Village and Kitchen 5k walk-a-thon. The event, which is in the City of La Quinta and the City of Indio, will be held on November 22, 2007. Please review the Traffic Plan and submit your initial comments to the Planning Department, by September 14, 2007. We would appreciate receiving any comments immediately so that concerns may be remedied within a timely manner. Once comments are received, a meeting between the applicant, applicable City Departments, and the City of Indio. will be held to mitigate any potential problems associated with this event. Thanks you in advance for your review. a 4p n Vol • •� r:,3 fa 0 0 4 'Aw a 4w qr op GG1. cc w -0 0 c •0 t EVENT Information • Course starts and finishes in beautiful La Quinta Park • 8 a.m. start, fast 5K course • Medals presented to top three finishers in each age group (5-year increments). • All participants receive a quality event T-shirt • FREE Continental breakfast provided _ • FREE Beer garden • Wheelchairs, pets and baby strollers welcome • Sorry, no roller blades, scooters or bikes "f FREE parking is available throughout La Quinta Park & La Quinta H.S. All parking is within walking distance of 5K START/FINISH; no shuttles required. Families, civic organizations, churches, businesses and corporations are encouraged to form teams for pledge collection and event participation. Why not challenge another team to see who can raise the most funds to help feed our neighbors in need? Please indicate on your registration form if you are part of a team. From PALM SPRINGS take Indio Blvd/Jefferson exit. A s H t N c T 0 N s T Registration by mail and online registration NOT ACCEPTED after 11/10/07. After 11/10/07, register at Martha's Village or at registration table on event day. Registration opens at 6:30 a.m. on event day at the La Quinta Park. NO CREDIT CARDS will be accepted for registration on event day. Cash and checks only. Pre -registration, T-shirt/race number pickup: Sat., Nov. 17, 1-4 p.m.; Wed., Nov. 21, 2-5 p.m. Martha's Village & Kitchen 83791 Date Ave., Indio, CA 92201 See Web site for pre -registration, latest 5K info, online registration, or to download additional forms: www.mvkthanksgivingrun.org 760.347.4741 ext. 316 Mail Entry Forms and Payment to: Martha's Village & Kitchen 83791 Date Ave., Indio, CA 92201 Mail -in Deadline: 11/8/07 One entry form per person; photocopies accepted. This form is NOT VALID after 11/10/07. On race day, use form provided at registration table. r i o Participant o Team Name I_I_I_I_I_I_I_I_I_I_I_I G I_I_I_I_I_I_I_I_I_I_I_I_I_I_ o Team Leader O Pledge Supporter O MVK/FJV Employee Age on race day Please print clearly First Name I_I_I_I_I_I_I_I_I_I_I_I_I_I_I_I_ Last Name Address I_I_I_I_I_I_I_I_I_I_I_I_I_I_I_I_I_I_I_I_I I_I_I_I_I_I_I_ City ; State I_I_ Zip I_I_I_I_I_ I_I_I_I_I_I_I_I_I_I_:I_I_I_I_I_I_I_I_I_ Email Phone Gender M I F Minimum Entry Donation Entry Donation ... $ Children under age 5 on race day are free Adult $25 after 11/10 — $30 Child $15 after 11/10 — $20 Donation ............. $ Payment Information Pie Order ........... $ Make checks payable to Martha's Village & Kitchen Receive Number in Mail Add $1 �eck closed O Visa O MasterCard OAmEx O Discover Total $ Please PRINT name on credit card r First Name I_I_I_I_I_I_I_I_I_I_I_I_I_I_I_I_ Last Name Credit card # I_I_I_I_I_I_I_I_I_I_I_I_I_I_I_I_ Exp. Date Mo I_I_ Yr I_I_ Security Code (back of card) ,n Signature Date / f accepting this entry I hundersigned intendin to be legally bound hereby, form self, m heirs executors and WAIVER -Must be signed or application will be rejected. In considerationo ccepl g l s ry, the g g y y, y y administrators, waive and release any and all rights and claims for damages I may have against Martha's Village & Kitchen, Tops and Barricades, City of La Quinta, City of Indio, Desert Sands Unified School District and any and all sponsors and their represetatives, successors,'officers, and assigns for any and all injuries sustained and suffered by me during this run. I verify that I'm physically fit and sufficiently trained for this event and my physical condition has been verified by a licensed medical doctor. I consent to receive medical treatment, which may be deemed advisable in the event of injury or illness during the event. I understand that in the event this run cannot be held as scheduled due to an act of God or circumstances beyond control, such as a national emergency, the run is not liable to refund any money paid by me to participate. I grant full permission to Martha's Village & Kitchen to use any photopgraphs, video tapes, or other recordings of me that are made during the course of this event. I have read and understand the above statement and hereby agree to the terms set forth therein. Participant's Signature Guardian Signature Date Date (for participants under 18) Entries from minors will only be accepted with parent or legal guardian's signature. Failure to sign the above agreement invalidates registration. Those people who can't attend the event on Thanksgiving Day can still support the cause with a pledge to you or your team. Pledge checks can be made payable to Martha's Village & Kitchen. Mail checks to Martha's Village & Kitchen 83791 Date Avenue, Indio, CA 92201-4737. Name: Address: City: State: Zip: Amount: $ Check #: 0 O Check box if in cash Name: Address: City: State: Zip: Amount: $ Check #: © O Check box if in cash Name: Address: City: State: Zip: Amount: $ Check #: © O Check box if in cash Name: Address: City: State: Zip: Amount: $ Check #: © O Check box if in cash Name: City: _ Zip: Name: Address: City: State: .Zip: Amount: $ Check #: O Check box if in cash This new limited edition MVK commemorative plate is your special gift with your contribution or pledge of $100 or more in support of Martha's Village & Kitchen Thanksgiving Day 5K Run/Walk. Don't miss this opportunity to own a one -of -a -kind li a collector's item. The special MVK commemorative plate is available only while ° supplies last, so send in your pledges and donations early! MVK plates will be available for pickup on event day at the registration table. Gifts not picked up on event day will be mailed to the address you have provided with your contribution. If you expect to gather more than 6 pledges, THANK YOU! You may download additional pledge forms at www.mvkthanksgivingrun.org or copy this form. Please call 760.347.4741 ext. 316 if you have any questions or to have additional pledge forms sent to you by fax or mail. s FM Iwo • O O • Our delicious pies are baked fresh by La Quinta Baking Company. To order pies, fill out this s ��� Ameirocal form and return it with a check. uu u Name: Phone:( ) Quantity $20 each Total Apple Tart $ Apricot Tart $ Creme Brulee Pumpkin $ Pecan $ Grand Total $ Make checks payable to: Martha's Village & Kitchen To pay by credit card please use event registration form. Orders must be received by November 12, 2007 and can be picked up at event between 8 and 11 a.m. For more information, call 760.347.4741 x 316 OM F? * WAPI, 'Z f, 7 EE a CITY OF INDIO 1 va�� La Quinta Baking Company 11 /e>I TIME WARNER CABLE Media Sales BURRTEC == WASTE & RECYCLING SERVICES "We'll Take Care Of ft" Martha's Village & Kitchen., is a member of Father Joe's Villages®, a registered trademark of S.V.D.P. Management, Inc. 3350 E Street, San Diego, CA 92102-3332 © 2007 S.V.D.P. Management, Inc. 002007 I ;.�. 11 I1111'1131r] Entry Donation $25 1 $50 1 $100 1 $200 1 $500 Meals Served 12 1 24 1 48 1 96 1 240 In 1990 Gloria Gomez and Claudia Castorena set up Martha's Village & Kitchen as a "soup kitchen" in their church's hall to provide meals to the homeless and people with very low incomes. Recognizing that many underserved people lived in the Coachella Valley, Ms. Gomez and Ms. Castorena wanted to expand the scope of their outreach to a "Village" where homeless neighbors in need could stay in a safe shelter and obtain comprehensive services to become self-sufficient. In 2001, with support from members of the community and special donors, Martha's Village & Kitchen opened its beautiful 120-bed facility in Indio, the first resource of its kind in the region. Its mission is to help residents break the cycle of homelessness and poverty by promoting self-sufficiency. The Village addresses the underlying causes of homelessness, such as domestic violence, mental illness, drug addiction, and finding employment that pays a livable wage, with its innovative continuum of multi -disciplinary programs and partnerships all in one location. Martha's services to homeless and impoverished children, families and singles in the Dan Dunlap Center and Emergency Shelter now include: Transitional housing for 220 persons per night; up to 500,000 meals annually to our neighbors in need; a state -licensed community clinic offering basic medical care for more than 2,400 patients annually; case management to guide residents in their rehabilitation plans; and career and education providing employment preparation and career development. With all these programs under one roof, Martha's Village & Kitchen is the largest provider of homeless services in the Coachella Valley, changing thousands of lives a year with respect and compassion. M ►� t M,,pAR T Hcy�.1� � �HPNKSGIVING F �41* tiSKwa,� ► 5 LIAL ErR"RUIM/Maoft Thursday, November 22, 2007 8 a.m. La Quinta Park (Adams at Westward Ho Dr.) La Quinta, CA MARTHA°. VILLAGE & KITCHEN A MEMBER OF FATHER JOE'S VILLAGES'