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TC2015-0046
4 See below for Finance Revenue Codes ENCROACHMENT PERMIT OF PUBLIC WORKS CONSTRUCTION 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. DATE: 8/11/2015 LOCATION OF CONSTRUCTION(Street address or Description): MONROE STREET PURPOSE OF CONSTRUCTION: GAS CONNECTION TO SUBDIVISION DESCRIPTION OF CONSTRUCTION: MONTERRA/ 32742 /_MONROE BETWEEN 54 AND AIRPORT DIMENSION OF INSTALLATION OR REMOVAI.:NO ASPHALT CUT1]NG, GAS TIE IN APPROXIMATE TIME WHEN WORK WILL BEGIN: 8/12/2015 TIME OF COMPLETION: 8/12/2015 ESTIMATED CONSTRUCTION COST: (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 o'r 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. - re ofØpJZcant or Agent STEVE ZABALA 27285 LAS RAMBLAS #230 MISSION VIEJO, CA 92691 (949)689-4388 Name of Applicant (please print) Business Address Telephone No. JAMES A SHIRLEY CONSTRUCTION I 59160 MESA DRIVE YUCCA VALLEY, CA 92284-1373 (760)228-0447 Name of Contractor and Job Foreman Business Address Telephone No. 710357 Contractor's License No. EVEREST INDEMNITY INSURANCE CO Applicant's Insurance Company Finance Revenue Code PERMIT INSPECTION TRAFFIC CONTROL ONLY - 1 DAY $290.00 TOTAL: $290.00 6432 City Business License No. EF4M L02276141 Policy Number PERMIT NO: TC2015-0046 DATE lSSUED:1JjI EXPIRATION DATE: BY:Ak WORK INSPECTED BY*: PERMIT COMPLETION DATE*:'/M *If the work is covered by a Subdivision Improvement Agreement, Subdivider shall request final acceptance of improvements from the City Council. City of La Quinta The following General and Special Provisions are attached to and made a part of Permit Number TC20150046 The following shall always aplv: ENCROACHMENT ON PRIVATE PROPERTY: This permit authorizes work to be accomplished within the City of La Quinta's right of way 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, spelled, 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 indicated: Z RI NOTIFICATION: Permittee shall notify the City at (760) 777 - 7097 at least forty-eight hours (48) in advance of starting construction. 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. 0 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. 0 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. C] 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. 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 W) 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 0 R11 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. 0 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 (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. RIB 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. 0 R20 TEMPORARY PAVEMENT REPAIRS: After completion of backfill and compaction operations, a temporary patch consisting of two inches (2") of SC-BOO shall be placed on a prepared sub-grade. The SC-BOO 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. 0 R2I PERMANENT PAVEMENT REPAIR: After backfill and compaction have been completed, a temporary patch consisting of three inches (3") of SC-BOO 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. C3 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. PJRMIT NO. TC2015-0046 Monterra /Gas Connection to Tract 32742/ Monroe Street Between Avenue 54 and Airport Boulevard 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. This permit or copy of it shall be on the, work site (usually the job trailer) for inspection during the actual work performed. Monterra (Steve Zabala) and James A. Shirley Construction, hereinafter referred to as "Permittee",' shall be responsible for providing continuous dust and erosion control. 4.' Streets shall be kept clean. They shall-be completely cleaned at the end of each working day and more frequently, if required. 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 á.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 (i.e. any 4 lane Street) before 8:00 a.m. Work within 500 feet of a signalized intersection shall be performed 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 City Traffic Signal Maintenance Division at (760) 777-7070 if signal operation at the intersection is to be altered in any way. 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. The permittee and/or contractor placing engineered fill must provide adequate time and safety for the Geotechnical Engineer of Record to perform soils testing during engineered fill placement. The testing frequency shall be determined by the Geotechnical Engineer of Record such that the fill can be determined to be placed according to the city approved plans. Special Conditions Page 1 of 5 PERMIT NO. TC2015-0046 Monterra /Gas Connection to T!act 32742/ Monroe Street Between Avenue 54 and Airport Boulevard 9. The permittee and/or contractor shall provide surveyor staking information adequate for the City Inspector to determine horizontal and vertical locations relative to the approved city plans. The minimum required wood lath type stakes shall be placed at all proposed building corners, and they shall state the horizontal location relative to building corner and the elevation of the top of hub next to the lath. 10. 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. 11. This permit is not valid until the permittee submits, to the Public Works Department 2 weeks prior to start of construction, a letter from any owners of the driveways/access ways that will be closed down due to the construction. The letter must be approved by the city and at minimum state from the owner the following: Approval of the construction Plan identification Time Frame of Closure Alternative Routes 12. Any land on which Williamson Act contracts apply shall remain undisturbed. 13. The permittee shall place temporary no parking signs along the parking area affected by the construction. The signs shall be placed along the area 48hrs prior to the start of closing the area, and removed immediately after the construction completion date. S 14. 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 (MUTCD). On Collectors to Major Arterial Streets, the permittee must submit a traffic control plan which shall be prepared under the guidance of the latest edition of the California Manual of Uniform Traffic Control Devices (MUTCD). 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. 15. 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. Special Conditions Page 2 of 5 PERMIT NO. TC2015-0046 Monterra /Gas Connection to Tract 32742/ Monroe Street Between Avenue 54 and Airport Boulevard 16. 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. 17. The City of La Quinta reserves the right to require modifications of the work be made at permittee's sole cost for proper sight distance requirements per guidelines in the AASHTO "A Policy on Geometric Design of Highways and Streets, 5th Edition" or latest, in the installation of all appurtenances abutting and within the public Street right-of-way. 18. The permittee shall be responsible for calling the city inspector to arrange the city inspector to observe random trench compaction testing performed by a city approved material testing firm. If the inspector's phone number is unknown, the permittee shall call the Public Works front counter phone at 777-7075 or the Assistant Civil Engineer at 777-7047 to determine the city inspector's phone number. The inspector shall determine the number and location of the test location/s. The above testing does not relieve the permittee's responsibility for future repairs due to settlement at and near the locations of the work area. Materials testing must be performed under direct supervision of a California Registered Civil Engineer. 19. 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 màdifications 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. 20. 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 21. The Applicant or Contractor shall furnish the City satisfactory evidence of insurance in the amounts provided in Engineering Bulletin for 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. 22. 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. 23. 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. Special Conditions Page 3 of 5 PERMIT NO. TC2015-0046 Monterra /Gas Connection to Tract 32742/ Monroe Street Between Avenue 54 and Airport Boulevard If traffic lanes are closed on an any Arterial street (any Street with more than 2 lanes) within the City of La Quinta right of way, The permittee is required to provide an informative message board (approved by the City Engineer). It shall inform the commuters using the affected roadways of possible traffic delays, time of construction, and if possible alternate routes. The message board shall be provided for the commuters 48 hours prior to the start of traffic delays. The board does not have to be electrical or solar powered. 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• densified compaction viajetting 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. Backfill compaction shall be achieved by the follo'ring conditions: When a firm foundation is not encountered due to soft, spongy or other unsuitable material, such material shall be removed to the limits directed by the Geotecimical Inspector and/or the City Inspector and the resulting excavation backfilled with pipe bedding material. Backfill materials shall be brought to or maintained at appropriate moisture content for compaction. The appropriate moisture content range shall be established at the onset of the project and ensured prior to use of the materials through progress testing on the stockpiles. The first length of trench backfilled shall be backfilled in the presence of the City Inspector. Compaction shall be tested at random depths at approximate three-foot vertical intervals as backfill is placed to ensure the effectiveness of the compaction methods and to establish the depth of lift that can be compacted. If lifts greater than one foot are attempted in this trial length of trench, compaction tests shall be taken within the lifts to ensure that the full depth of the lift is compacted. Upon satisfactory completion of this portion of trench, the City Inspector shall establish the maximum lift thickness to be compacted for the remainder of the project. In subsequent lengths of trench, the frequency of compaction tests shall equal one per each lift of backfill, per 300 linear feet of open trench, at randomly selected locations within the open length of trench. The depth of the randomly selected compaction tests shall also be randomly selected except that where multiple tests are required in a given length of trench, the tests shall be no closer than three feet (vertically) from each other. Special Conditions Page 4 of 5 PERMIT NO. TC2015-0046 Monterra /Gas Connection to Tract 32742/ Monroe Street Between Avenue 54 and Airport Boulevard If any compaction test fails, previously placed backfill (in the same length of open trench or previous lengths of trench) which is represented by the failing test (as determined by the City Inspector), shall be tested for compliance with compaction requirements. All costs incurred due to the conditions above shall be borne by the Permittee. Copies of all test results shall be furnished to the City Inspector. All excavations within City of La Quinta right-of-way shall be backfihled, and temporarily paved if within the existing travel way, at the end of every workday as directed by and to the satisfaction of the City Engineer for the protection of the public. Lengths of open trench shall not greatly exceed that which can not be backfilled in the same day. Excavated trenches shall not be allowed open overnight; however, Permittee may leave a length of excavated trench, not to exceed twenty (20) feet in length, open overnight at a point where construction will begin the next day, provided that this length of trench is completely covered by steel plating. All landscaping, irrigation, decorative rock, decorative concrete, sidewalk, lighting, etc., shall be replaced to its original condition. Access and egress to all local properties shall be maintained at all times. 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. 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. If it is the intent of the permittee to cut the pavement and have it restored by a third party, the permittee shall postpone cutting the pavement until the intended third party has acquired a permit from the City to perform the required restoration work.. Special Conditions Page 5 of 5 _~UDK_ * (20 PUBLIC WORKS DEPARTMENT APPLICATION FOR PERMIT Date: P71:5b4- ose of Construction (i.e.: Rough Grading, Offsite Street, etc.)__________________ 677'72 . Description of Construction (i.e.: See Plan Set No. 01234) 9S 7'i. I."). Dimension of Installation or Removal: Approximate Construction Start Date: Approximate Construction Completion Date: • Estimated Construction 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 Contact Name:. Phone Number: Name of Applicant/Owner: 4.4 //,?74 45//7e Applicant Address:7 ,j/tf ?l'M Applicant Telephone Number: - Applicant E-mail Address: Name of Contractor: . Contractor Address: . 4/ Contractor Telephone Number: Contractor State License Number: - Contractor City Business License Number: Contractor E-mail Address: 4'm110)V1/?. e47n A COPY OF THE CURRENT INSURANCE CERTIFICATE MUST BE PROVJDED4 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 Amount: TOTAL FEE DUE: Office Use Only: Assigned Permit Number: Approval Date.- Expiration Date: Issue Date: Administrative Authority: - t-orms & Applicatfons/Application ...-. : "S .5 . lb 5. 4.. I.. , •.s . - '- . •. •.. ' :.Z • : ,.•.._. S • "..• • 5 .•. • 5'...- •.,.. f ':. ... S ••.., 5,. •5 •s • ' !'•••S • :. •. z' ...• - S •• 4• • • . '•-- 1 sc' __ A3Rbe CERTIFICATE OF LIABILITY INSURANCE I DA IMMIDDIYYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(Ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this. certificate does not confer rights to the certificate holder In lieu of such_endorsement(s). PRODUCER James G Parker Insurance Associates License #0554959 P 0 Box 3947 Fresno CA 93650 CONTACT Carrie Stubblefield CXSR PH C (559)222-7722 I La. Not: (559)222724 ADDRESS: CarrieStubblefield@ jgparker. corn INSURER(S) AFFORDING COVERAGE NAIC# INSURERA:WeSCO Insurance Company 5011 INSURED James A Shirley Construction Inc 59-160 Mesa Drive Yucca Valley CA 92284 INsuRERB:Great American Alliance Ins Co 26832 INSURERC:SecUrity National Ins Co 19879 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:15-16 GL BA IM UMB WC REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE . ASBL U5k POLICY NUMBER POLICY EFF IMMIDDIVYYY POUCY EXP (MMtDDIYYYYI UMITS_______________ GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 PREMISES (Es occurrence) $ 300,000 COMMERCIAL GENERAL LIABILITY A C%.AIMS-MADE [] OCCUR X Y 1PP137273200 /22/2015 5/22/2016 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE s 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPP AGG 8 2 ,000,000 Limited Jobslte Pollution S 1,000,000 FJ POLICY Iii 1i LOC AUTOMOBILE LIABILITY - - s 11000,000 BODILY INJURY (Per person) $ A X ANY AUTO BODILY INJURY (per accidenl) S =ALLOWNED SCHEDULED x IPP137273200 /22/2015 /22/2016 AUTOS AUT0s x v NON-OWNED - HIRED AUTOS AUTOS PROPERTY DAMAGE (Per acoldenhi ___ Underinsuredmo*odst 1,000,000 X UMBRELLA UAB LJ OCCUR EACH OCCURRENCE 5 5,000,000 AGGREGATE S 5,000,000 B RDED EXCESS UAB I CLAIMS-MADE I I RETENTIONS 83842497 5/22/2015 /22/2016 WORKERS COMPENSATION - x I TORY LIMITS FR VC STAR)- I 10Th AND EMPLOYERS LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE E.L. EACH ACCIDENT S 11 000,000 OFFICERIMEMBER EXCLUDED? L (MandatorylnNH) N IA WC1075732 6/1/2015OF I 'I E.L DISEASE .EA EMPLOYEE $ 11000,000 - Ues, desonbe under SCRIPTlONOF OPERATIONS below - - E.LD(SEASE - POUCYUMIT 1 $ 1,000,000 A Scheduled Equipment WPP137273200 /22/2015 /22/2016 $1.000DethIb1e Per Schedule A Rented/Leased Equipment PP137273200 5/22/2015 1 5/22/2016 $1,000DeduIbie $400,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace Is required) Job: Monterra Project Woodbridge Pacific Group LLC, WPG Enterprise A LLC, The City of La Quinta and La Quinta Housing 1 LLC are named as Additional Insured as per form CG2010 0413, CG2037 0413, CG2001 0413, CG2404 0509, CA2048 0299, CG2154 0196 & WC040306 attached CERTIFICATE HOLDER CANCELLATION j ei ttreirn@ woodbridgepacifi SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Woodbridge Pacific Group LLC ACCORDANCE WITH THE POLICY PROVISIONS. 27285 Las Ramblas Ste 230 AUTHORIZED REPRESENTATIVE Mission Viejo, CA 92691 J Parker 111/CARRIE 1I (M ACORD 25 (2010105) © 1988-2010 ACORD CORPORATION. All rights reserved. INS025 i,nint ni ThQ AC.APfl nmre anell Inn,i nra rQsIIctQrQ,I nirkc ,f £(OPfl POLICY NUMBER: WPP137273200 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Blanket as required by written contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". However: The insurance afforded to such additional insured only applies to the extent permitted by law; and If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: Required by the contract or agreement; or Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of I POLICY NUMBER: WPP137273200 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Blanket as required by written contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV - Conditions: We waive any right of recovery we may have against. the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products- completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. I CG 24 04 05 09 ©insurance Services Office, Inc., 2008 Page 1 of 1 13 POLICY NUMBER:WPP1 37273200 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations Blanket as required by written contract. Blanket as required by written contract. It is agreed that such insurance as is afforded by this policy for the benefit of the additional insured shown shall be primary insurance, and any other insurance maintained by the additional insured(s) shall be ex- cess and noncontributory as respects any claim, loss or liability allegedly arising out of the operations of the• named insured, provided however that this insurance will not apply to any claim loss or liability which is determined to bd solely the result of the additional insured's negligence or solely the additional insured's responsibility. I Information required to complete this Schedule, if not shown above, will be shown in the Declarations. I A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury, "property damage" or "personal and advertising injury" caused, in whole or in part, by: Your acts or omissions; or The acts or omissions of those acting on your behalf; The insurance afforded to such additional insured only applies to the extent permitted by law; and If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for.such additional insured. in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: CG 20 10 04 13 ©Insurance Services Office, Inc., 2012 Page 1of 3 B. With respect to the insurance afforded to these additional insureds; the following additional exclusions apply: This insurance does not apply to bodily injury" or "property damage" ocurring after.- I. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principalas a part of the same project. Page 2 of 3 • ©insurance Services Office, Inc., 2012 CG 20 10 04 13 C. With respect to the insurance, afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 10 04 13 0 Insurance Services Office, Inc., 2012 Page 3 of 3 0 POLICY NUMBER:WPP137273200 COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless mod- ified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provi- sion of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement Effective:61112015 Countersigned By: Named lnsured:James A Shirley Construction Inc (Authorized Representative) SCHEDULE Name of Person(s) or Organization(s): Blanket as required by written contract. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An• Insured Provision contained in Section Il of the Coverage Form. . CA 2048 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 0 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84), WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce• our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2.00% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Any person or organization as required by written contract This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. Endorsement Effective 6/1/2015 Policy No. SWC 1075732 Endorsement No. WC 04 03 06 Insured James A Shirley Construction Inc Premium $ Insurance Company Security National Insurance Company Countersigned by POLICY NUMBER: WPP137273200 COMMERCIAL GENERAL LIABILITY CG 21 540196 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION - DESIGNATED OPERATIONS COVERED BY A CONSOLIDATED (WRAP-UP) INSURANCE 'PROGRAM This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Description and Location of Operation(s): Exclusion - Designated Operations covered by a consolidated insurance program (wrap-up): Any ongoing operations or operations included within the products-completed operations hazard, regardless of loca- tion, for consolidated (wrap-up) insurance program In which you are involved. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The following exclusion is added to paragraph 2., Exclusions of COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE LIABILITY (Section I - Cove- rages): This insurance does not apply to "bodily injury" or "property damage" arising out of either your ongoing operations or operations included within the "products- completed operations hazard" at the location de- scribed in the Schedule of this endorsement, as a consolidated (wrap-up) insurance program has been provided by the prime contractor/project manager or owner of the construction project in which you are involved. This exclusion applies whether or not the consolidated (wrap-up) insurance program: Provides coverage identical to that provided by this Coverage Part; Has limits adequate to cover all claims; or Remains in effect. CG 2154 0196 Copyright, Insurance Services 0ffice Inc., 1994 Page 1 of 1 WPP137273200 COMMERCIAL GENERAL LIABILITY CG200I 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: PrImary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. CG 20 01 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of I z NO SCALE ws-1 ROAD NARROI OAO G20-2 j IN :It MONROE ST (1' 2 14 04 1 -. 4 W20-1 J /oo\ WORK ) TO AVE 54 500' '4 TOAIRPORTBLVD --' '4---. W20-1 /ROAD'\' WORK AHEAy 41 500' 500' . W-1 C17 (CA) MOUNTAIN 'I (NA VIEWLN 11!20 E AN W1.4(RT) . . C30A (CA) R44 620-2 C L 0 '>'-v [REG ROADWORK NgRN 'N I E XISTING COURSE NEW GAS LINE 'OF CA- NQJE$i 1 ALL TRAFFIC CONTROL DEVICES FOR THIS PROJECT SHALL BE IN ACCORDANCE WITH THE 2014 CALIFORNIA MANUAL ON UNIFORM TRAFFIC CONTROL DEVICES (CALIFORNIA M.U.T.C.D.) TRAFFIC CONTROL SHOWN HEREIN IS THE MINIMUM REQUIRED. ADDITIONAL TRAFFIC CONTROL MAY BE REQUIRED TO FACILITATE PUBLIC SAFETY AND TRAFFIC FLOW IF DEEMED NECESSARY BY CITY OF LA QUINTA AND/OR COUNTY OF RIVERSIDE REPRESENTATIVE, THROUGHOUT EACH WORK PERIOD, CONTRACTOR SHALL INSPECT TRAFFIC CONTROL (SIGNS, BARRICADES AND DELINEATORS) AND MAINTAIN SAME IN ACCORDANCE WITH TRAFFIC CONTROL PLANS. CONTRACTOR SHALL MAINTAIN A MINIMUM 10(12 TYP.) TRAFFIC LANE WIDTH AT ALL TIMES. THERE SHALL BE A MINIMUM 2' BETWEEN THE EDGE OF CUT AND THE NEAREST TRAFFIC LANE. ACCESS TO PRIVATE PROPERTY SHALL BE MAINTAINED AT ALL TIMES, THIS TRAFFIC CONTROL SHALL BE IN PLACE DURING WORK HOURS ONLY. AT END OF THE WORK HOURS, THE ROAD SHALL BE CLEAR OF DEBRIS AND TRAFFIC RETURNED TO NORMAL. [ WORK AREA Retewed By Del. PW"Knbw Pending Tie Into Existing Gas Main with 2" Gas Line Contact Woodbridge Pacific Armando 949-547-2502 Traffic Conoct Deby Repined By Cfleded By Tops N Barricades, Inc. Mall Upp Ron Fifleld Phone Speed Linel Date Sheet l.jrnbeq (800)852-TOPS 55 07/29/15 1 REV