PM102016-0003V
1 eIowFinance evenueç
ENCROACHMENT PERMIT
or
/•
PUBLIC WORKS CONSTRUCTION
CITYOFLAQUINTA
COMMUNflyDt OP :tiff n ty For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, watermainsand tr
works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS.
DATE: 10/6/2016
LOCATION OF CONSTRUCTION (Street address or Description): NORTHWEST CORNER OF JEFFERSON & AVE 50
PURPOSE OF CONSTRUCTION: PM-10 DUST CONTROL / STOCKPILING
DESCRIPTION OF CONSTRUCTION: FAIRWAY PLAZA; PM-10 FOR STOCKPILING
DIMENSION OF INSTALLATION OR REMOVAL: 100'X 100'
APPROXIMATE TIME WHEN WORK WILL BEGIN: 10/6/2016 TIME OF COMPLETION: 10/10/2016
ESTIMATED CONSTRUCTION COST: $11.685.00 (Including removal of all obstruction, materials, and debris, backfilling, compaction and
placing permanent resurfacing and/or replacing improvements)
COMMENTS:
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) 777-7097. To
submit an inspection request, leave a message on the Inspection Request Hotline at (760) 777-7097 prior to 1:30 P.M. at least twenty-four
(24) hours prior to the anticipated inspection.
Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City of and
to pay for any additional replacement necessary as the result of this work.
LUNDIN DEVELOPMENT -MICHAEL
LUNDIN 16400 PACIFIC COAST HWY STE 207 SUNSET BEACH, CA 90742 (562)592-6020
Name of Applicant. (please print) Business Address Telephone No.
J H THOMPSON & SONS - JACKSON 79-607 COUNTRY CLUB DR #2 BERMUDA DUNES, CA 92201 (760)345-6003
Name of Contractor and Job Foreman Business Address
734478
Contractor's License No.
WESCO INSURANCE COMPANY
Applicant's Insurance Company
Finance Revenue Code
PERMIT INSPECTION
PM10 $3,481.00
TOTAL: $3,481.00
Telephone No.
5205
City Business License No.
WPP120584501
Policy Number
PERMIT NO: PM102016-0003
DATE ISSUED:____
EXPIRATION DATE:/./7// 7
BY: -Ar.
WORK INSPECTED BY*:
PERMIT COMPLETION DATE*:
*If the work is covered by a Subdivision Improvement Agreement,
Subdivider shall request final acceptance of improvements from the
City Council.
REC1ED
Tay .4z ,ddL s 29 RECD
PUBLIC WORKS DEPARTMEN10Pmz,t Sences
APPLICATION FOR PERMIT
Date:
Tract No: Project Name: F1424
Vicinity: A->e. 5'0
t __ _
Purpose of Construction (i.e.: Rough Grading, Offsite Street, etc.)_________________
ti ftj1 P'nx 01'J6 —
Description of Construction (i.e.: See Plan Set No. 01234)
lee.. Li.. )rt4
Dimension of Installation or Removal: 'o' ,ic.io' jOo St—
Approximate Construction Start Date: 4..SM
Approximate Construction Completion Date: oc.r 10 7.0 d.
Estimated Construction Cost: $ Mu, Sç
Estimated Construction Cost shall include the removal of all obstructions, materials, and debris, back-filling, compaction and
placing permanent resurfacing and or replacing improvements
Contact Name: fltg cAa4- Lu woi 'J Phone Number: P3Z —c?z.42o
Name of Applicant/Owner: LuMp,,.. 0&%...e_1- pss'ir / L,ikA, I
Applicant Address:116-gc L iietbsidi, C ?'O'712..
Applicant Telephone Number:
Applicant E-mail Address:
Name of Contractor: . U- 1IoozpSsJ $riS 4c_
Contractor Address: 79-4cr7 4J#i fp.j C4U3 Q' GZt? £a2... 'we4-.
Contractor Telephone Number: o —
Contractor State License Number: A 73 447
Contractor City Business License Number: c52.oc
Contractor E-mail Address: AOL. Cô,1
00- A COPY OF THE CURRENT INSURANCE CERTIFICATE MUST BE PROVIDED I
Ap licant or Contractor General Liability Insurance Company:
Applicant or Contractor General Liability" Insurance Policy Number:
6u,°, '2 oc/s7Ji
Office Use Only: Office Use Only:
Inspection Fee: I I Assigned Permit Number:
Permit Fee:
As-Built
Dust Control
Deposit:______
Credit
Amount:
TOTAL FEE DUE:
I )rIuDI( M34-MMEM
Approval Date:
Expiration
Date:
Issue
Date:
Administrative Authority:
City of La Quinta
The following General and Special Provisions are attached to and made a part of
Permit Number PM102016-0003
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 (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 indicatect
0 RI NOTIFICATION: Permittee shall notify the City at (760) 777 - 7097 at least forty-eight hours (48) in advance of starting
construction.
0 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.
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 (W) 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.
RT 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.
0 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 14") of A.C. paving on ( N/A ••) of class (** N/A )
aggregate base.
0 R9 SIGHT CLEARANCE: Sight Clearance of six-hundred feet (600') in all directions shall be assured and maintained at all
times. .
RIO 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
R111 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.
0 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.
D 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.
D 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 (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 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 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 Asphalt Concrete surfacing per City of La
Quinta Standard 600 shall be placed no later than (5 ) days after completion of temporary road repair.
C] 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.
PERMIT NO. PM102016-0003
Fairway Plaza /Stockpiling of Dirt and PM* 10 Only/ Northwest Corner of
Jefferson St and Ave 50.
In addition to the standard permit conditions, the following shall apply:
Pursuant to Section 14.16.320 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982), 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.
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. The permittee shall submit inspection requests by calling the City Inspection Hotline at (760) 777-7097
.before 1:30 p.m. and at least twenty-four (24) hours prior to the anticipated inspection.
4. Lundin Development (Michael Lundin) and J H Thompson (Jackson), hereinafter referred to as
"Permittee", shall be responsible for providing continuous dust and erosion control.
5. The permittee shall be responsible for fugitive dust control as outlined in the approved dust control plan
and the following:
a. During Import/Export
The soil at the import or export location shall be premoistened to a minimum of 70% of
optimum moisture based on ASTM Dl 557 prior to transporting material on the public right
of way.
All trucks shall be covered and have a minimum of 6" freeboard prior to hauling.
Street cleaning shall occur at both import and export sites and both sites must obtain a city
approved trackout system.
b. Storage and Stockpile Handling
1. Wind Sheltering
Install PM10 fencing on 3 sides of pile equal to height of pile.
Coverings can be used on small piles and they must be secured
2. Stockpile Stabilization Methods
Continous watering by truck or sprinklers or
Chemical stabilization with continuous monitoring
3. Material Handling
Confine load in/out to downwind side of pile
Piles greater than 8ft in height must be a minimum of 100 ft away from occupied
buildings.
6. Streets shall be kept clean. They shall be completely cleaned at the end of each working day and more
frequently, if required. . .
7. 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 I of 4
PERMIT NO. PM102016-0003
Fairway Plaza /Stockpiling of Dirt and PM-10 Only/ Northwest Corner of
Jefferson Stand Ave 50
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 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.
Note: Construction work (including setting up traffic control devices) is not permitted on any Arterial
street (ie any 4 lane street) before 8:00 a.m.
Any land on which Williamson Act contracts apply shall remain undisturbed.
Pursuant to Section 14.16.250 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982), at
residential streets, advance warning signs and traffic control shall be installed and maintained in
accordance the latest edition of the California Manual of Uniform Traffic Control Devices (CA
MUTCD) or the latest edition of the Work Area Traffic Control Handbook (WATCH).
On Collectors to Arterial Streets, the permittee must submit a traffic control plan which shall be from or
prepared under the guidance of the latest edition of the California Manual of Uniform Traffic Control
Devices (CA MUTCD) or the latest edition of the Work Area Traffic Control Handbook (WATCH).
Traffic Control plans not from the CA MUTCD or the WATCH shall be signed and stamped by a civil
or traffic engineer registered in the State of California. It shall be the Permittee's responsibility to
appropriately detour and barricade all construction sites.
Pursuant to Section 14.16.290 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982),
Street closures shall not be permitted. A minimum of two (2) travel lanes of paved surface shall
be maintained at all times.
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.
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 Permittee as directed by and to the satisfaction of the City Engineer at no cost to the
City of La Quinta.
Special Conditions - - - - - Page 2 of
PERMIT NO. PM102016-0003
Fairway Plaza /Stockpiling of Dirt and PM-10 Only/ Northwest Corner of
JeffersonSt and Ave 50
13. The issuance of this permit and the City approval of the related construction improvement plans do not
provide a vested entitlement for all design parameters that may have been utilized for the plans. As
such, plans approved for this permit may be "at risk" for further modifications as it relates to any follow
up improvement plan requirements as required by the city or existing errors & omissions by the
architect or engineer of record.
14. This permit is not valid until the permittee submits, to the Public Works Department 2 weeks prior to
start of construction, the name of the City approved contractor, who shall submit to the City the
following items:
General Liability Insurance Company and Policy Number
City Business License
Contractors State License Number
15. The Applicant or Contractor shall furnish the City satisfactory evidence of insurance in the amounts
provided in Engineering Bulletin on Indemnification & Insurance Requirements. This insurance shall
be kept in full force and effect at all times by Applicant or Contractor during the prosecution of the
permitted work and updated Certificate of Liability Insurance shall be submitted to the City. Each
policy shall name the City as an additional insured.
16. The permittee shall not encroach upon private property without prior written approval (submit to the
Public Works Department, attention to the Associate Engineer) of the private land owner whom is being
encroached upon.
17. The permittee shall haul all offsite debris to a certified landfill. Prior to hauling debris, the permittee
shall inform the City (Inspection staff or 777-7047) of the name and location of the certified dump site.
18. Prior to excavating in native soils, the owner of the project shall have employed by proposal contract
an archaeological observer for the site excavations within native undisturbed soils. A copy of the
contract must be submitted to the Public Works Department and attention this to the Assistant Engineer
II. If the archaeologist determines the site note to be required to be observed, please submit a letter
signed by the archaeologist stating their determination.
19. If public traffic lanes are required to be closed, this permit is not valid until the permittee submits, to the
Public Works Department, a traffic control plan for review•and approval prior to start of construction or
parking on the paved RJW.
20. Pursuant to Section 14.16.370 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982),
backfill compaction within street rights-of-way shall conform to Section 306-1.3 of the latest edition of
the Standard Specifications for Public Works Construction (SSPWC), except as otherwise specified
herein.
Native material may be used as backfill material provided that minimum compaction, achieved in the
manner prescribed herein, is achieved. Backfill shall be performed by mechanical means; no water
Special Conditions - - Page 3 o14
PERMIT NO. PM102016-0003
Fairway Plaza /Stockpiling of Dirt and PM-10 Only/ Northwest Corner of
JeffersOn St and Ave 50
densified compaction via jetting or flooding or other means shall be allowed. It shall be the
Permittee's responsibility to provide appropriate geotechnical supervision, testing, and inspection,
onsite, at all times during backfill operations.
This permit is for stockpiling only. No excavation is permitted.
All landscaping, irrigation, decorative rock, decorative concrete, lighting, etc., shall be replaced to its
original condition.
Access and egress to all local properties shall be maintained at all times.
Pursuant to Section 14.16.375 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982),
permanent pavement replacement shall be completed no later than seven (7) days after the completion
of the work. Permanent pavement replacement shall conform to the following conditions:
Asphalt work of any kind is not permitted.
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.
Pursuant to Chapter 12.56 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982) 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.
The City of La Quinta reserves the right to revoke, suspend or void this permit at any time.
Thepermittee 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 4 of 4
Fugitive Dust Control Plan Ajliciltion lOrm
(FcnmA- Nee Inf4
Please print In ink or type. Blank spaces must be completed/or the application to be
processed. If an Item Is not applicable, please enter N/A.
1. Form Preparer: Property owner 0 Developer 0 Prime Contractorx Other 0'
(If Other, attach Owner Designee Form [Page 3.8])
CoNTAcT PERSON NAME
COMPANY NAME LJ- 9J / 5j
COMPANY ADDRESS r7q_.7CbuArre :2 C&JG
CIrY, STATE, ZIP CODE ,,.. Qj C4<.. r— 72-2 0.3
ThEPRONENUMBER
FACSIMILE NuMBER 74o C, 3 4— 0 9 Z ç
24-HOUR, MANNED
Anm HOURS PRONE
NUMBER
()lti't4-i "..e.z.
7(0 -z1c--o6s
AQMD DUST CLASS
CERTifICATE # (J j ç.4 - C0 30% -
2. Project Address or Location
PROJECT NAME pL,4.A-
PROJECT ADDRESS
CITY, STATE, ZIP CODE - - -
L9- Q.1MJ1J C4&
STREETS
NEAREST MAJOR CROSS
PAO
PARCEL NUMBERS * 34, 539
II
3.4 June 2003
S
46
PT,
Fugitive Dust Control Plan Application Form,
(Form A. Page 2 of 4)
Project Acreage (total land to be disturbed)
(include project site and associated unoaved access roads. stockpiles. and staging areas)
PROJECT SIZE (ACRES) jo,qc
WATER SOURCE SOURCE (GPM) / e77 k..
Prolect Owner (If Fuaftive Dust Control Plan oreDarer Is not the property owner)
NAME
COMPANY NAME (IF
APPLICABLE)
ADDRESS (INCLUDE (L'4CLUDE
CITY, STATE, & ZIP
CODE)
/i. 9k,,
TELEPHONE NUMBER — 5 1— (C'2
FACSIMILE NUMBER - 5' - C CO
S. The Person(s) responsible for dust control measures and to whom official notices
should be sent If necessary
RESPONSIBLE PERSON dbI) .fi1 P3.J
COMPANY NAME
ADDRESS (INCLUDE CITY, STATE, & ZIP ?%-7 :o)/ki ce> J z
CODE) I 4-
TELEPHONE NUMBER
- —34.T -
24.HouR, MANNED C1 'c.
AFTER-HOURS
TELEPHONE NUMBER
FAcsvdmNumBER
AQMD DUST CLASS
CERTIFICATE #
3-5 June 2003
-47
[ Fugitive Dust control Plan Application Form
I t(Pomi A. Pnge3 of 4
On-Site SurnrintendentJSuuervlsor!1roreman contact
N - a?)>
COMPANY NMIE _ P.,.j ç 4.
ADDRESS (INCLUDE 77 (5 CAO 42.., 2.
CITY, STATE, & ZIP
CODE) l2.a C4— ?2LoT3
TELEPHONE NUMBER 49x3
24.Houa, MANNED
AFTER-HOURS 7 2Q5 TELEPHONE NUMBER
AQMD DUST CLASS
CERTIFICATE # U i(Ci-f -Ci.)30Y( 31
Site Mapping
Provide a map showing the vicinity of the project clearly identifying the closest major
cross streets or other landmarks and the project location. Label this map "Vicinity Map".
Required map size is 8½ by 11".
Provide an 8 ½ by 11" or larger Assessor Parcel Map for the property(s) on which the
project will be occurring. Outline or highlight the affected parcels. Identify location of
site entrances, internal unpaved haul routes, wind fencing, areas to be chemically
stabilized and other proposed and required dust control mitigations. Projects that are only
installing or constructing linear features such as roads, pipelines or other utilities that
boarder or cross more than one Assessor's parcel do not require Assessor's Parcel Maps,
but must provide a detailed vicinity map adequately depicting the entire project area. If
the project is divided into construction phases (separate physical project areas), provide a
map clearly identifying the phases.
S. Attach a Fugitive Dust Control Plan
/ Projects with Less than 10 acres of disturbed surfaces must complete and attach
a Fugitive Dust Control Plan (Form DCP) or equivalent.
/ Projects with 10 acres or more of disturbed surfaces must complete and attach
a Site-Specific Fugitive Dust Control Plan. Guidance for preparation of a
Site-Specific Fugitive Dust Control Plan is included later in this Chapter.
3-6 June 2003
48
Fugitive Dust Cantrol, Plan Application }unu
11fl A PM 4 ( 4)
9.. Project notifications
For projects wi th it) acres or marc of thtu+.cd surface.. :,he dui control ordinance
requires notification to the local pcmiuiug authority and to the AQMD prior to project
initiation and at project completion. (Refer Chipter 4 of this Handbook for specific
requirements and forms.
Project Signage
Construction signage must be instilled on —we pnor to corstrucUon. Guidelines for
construction signage are found in Chapter 5 of iks Handbook.
Owner Agreement
The signatory on this application constitutes an agreement by the owner to be the
person with authority to enforce compliance by all contractors and subcontractors
of the Dust Control Ordinance Fugitive Dust Control Plan conditions, and any
supplements Identified by the permitting authority.. Once approved, this application
Is- incorporated by reference and becomes apart of the approved she grading plan..
!
Owirr Sinazn. Date
Printed Name Title and Company
C'S
AQMD Coachella Valley Fugitive Dust Control Class Certificate 0
2 L. .LL
Owner Signatur Date
J VY kca rt <
Printed Name Title and Company
June 2003
49
Fugitive Dust Control Plan
For Poju < 10 Acres
(FormDCP. Page I of 5)
Project Name: (r
Permit Number (If applicable):
Owner Name: '-'
Anticipated Start Date:
'44
Anticipated Completion Date: id
Total Earth-Movement (Cubic Yards): /- '1 ______
Note: Fill out completely and describe Control Actions (e.g.. # of watering trucks during phases, available water GPM. etc.).
Indicate N/A if not applicable
Proitct Phases
Source Category
Clearing. Grubbing, and Mass Grading
(Describe Control Actions)
Finish Grading
(Describe Control Actions)
Site Construction 1
(Describe Control Actions)
Backfithng ;42-
Clearing and
Grubbing 1-14
Clearing Forms 1-'
Crushing b /'*
- 10 June 2003
I
Fugitive Dust Control Plan
For Projects< 10 Acres
(Form CP. Page 2 of 5)
Project Phases
Source Category Cleating, Grubbing, and Mass Grading Finish Grading Site Construction
(Describe Control Actions) (Describe Control Actions) (Describe Control Actions)
Cut and Fill:
Demolition
- mechanical/manual
Disturbed soil
Earth-moving
activities / 4-
Importing/exporting
of bulk materials
June 2001
- --- Coath,ella Valley Fualtive DustCpffiaidI
.06
Fugitive Dust Control Plan
For Projeclsic 10 Acres
(Form CF, Pugc3 of 5)
Project Phases
ç Clearing Grubbing, and Mass Grading Finish Grading Site Construction
(Deicnbe Control Actions) (Describe Comro!Actions) (Describe Control Actions)
Landscaping
Road shoulder
maintenance
Screening
Staging Areas
Stockpiles/bulk / "4c- S) Ii CFI4 ¶ i Sfr t41fUC& iOt7 material handling
k 55 I-St jL'ttr.-'.-
öj OLIZ
3-12 June 2003
Fugitive Dust Control Plan
For Projecls <10 Mrcs
(Fwm, Pap 4ofS)
Prniet Phases
Soume Category
-
aeaang,Grubbng, and Mass Grading
-(Describe Control Actions)
Finish Grading
(Deicibe Control Actions)
Sue Construction
(Describe Control Actions)
Traffic areas for
construction
activities 14/4-
Trenching
P14 /-,J/,
Truck unloading ia— 15 L#05 Wdx.
Turf overseeding i
I'If)ç L114-. P/p..
Unpaved P19-
roads/parking tots
3-13 June 2003
61.
Fugitive Dust Control. Plan
For Projects < 10 Acres
(Form CP, Pap S of 5)
Project Phases
Source CategoryClearing, Grubbing, and Mass Grading
(Describe Control Actions)
Finish Grading -
(Describe Control Actions)
- Site Construction
(Describe Control Actions)
Vehicular track-out,
handling, clean-up yI/r- P/c1
*7
CQ.Qd'- %-f —
or,, i)/l
Weather
monitoring/work
practices
Other (describe)
3-14 June 2003
w lcl e il I I
Stockpile location
7
Legend
CVS Pharmacy I Photo
Desert Golf Connection
IL c Feature 1
Hairmasters
Ralphs
bzo- 41 11 13- :iii
-A
I
-
.
:w
7 IA
-
p
Ave 50 & Jefferson tFv
JHT Stockpile location
? JI
GUN 01,
17)