ENC2021-0071 AY
12-2-2021
12-2-2022
Date: __________________________________
Tract No: _________________ Project Name: ________________________________
Vicinity:_______________________________________________________________
Purpose of Construction (i.e.: Rough Grading, Offsite Street, etc.)_________________
______________________________________________________________________
Description of Construction (i.e.: See Plan Set No. 01234) _______________________
Dimension of Installation or Removal: _______________________________________
Approximate Construction Start Date: _______________________________________
Approximate Construction Completion Date: _________________________________
Estimated Construction Cost: $ ____________________________________________
Estimated Construction Cost shall include the removal of all obstructions, materials, and debris, back-filling, compaction and
placing permanent resurfacing and or replacing improvements
Contact Name: _____________________________Phone Number: ________________
Name of Applicant/Owner: ________________________________________________
Applicant Address: ______________________________________________________
Applicant Telephone Number: _____________________________________________
Applicant E-mail Address: ________________________________________________
Name of Contractor: _____________________________________________________
Contractor Address: _____________________________________________________
Contractor Telephone Number: ____________________________________________
Contractor State License Number: __________________________________________
Contractor City Business License Number: ___________________________________
Contractor E-mail Address:
T Drive/Checklists – Forms & Applications/Application for Permit posted 8-26-09
:
Inspection Fee:
__________________________________________
Permit Fee:
__________________________________________
As-Built
Deposit:___________________________________
Dust Control
Deposit: ___________________________________
Credit
Amount: __________________________________
:
Ź
Ż
Applicant or Contractor General Liability Insurance Company:
______________________________________________________________________
Applicant or Contractor General Liability Insurance Policy Number:
______________________________________________________________________
:
Assigned Permit Number:
__________________________________________
Approval Date:
__________________________________________
Expiration
Date:______________________________________
Issue
Date: _____________________________________
Administrative Authority:
_________________________________________
N/A IRONMAN 70.3 Indian Wells La Quinta
City of La Quinta
No construction. Race e
event taking place on Sunday, December 5th 2021
Road Closures due to cycling portion of IRONMAN 70.3 Indian Wells La Quinta
Traffic Control equipment
staged on December 4th and fully deployed December 5th
December 4th
December 5th
NA
Sabrina Houston 760-703-1200
IRONMAN
9330 Scranton Rd STE 150 San Diego CA 92121
760-703-1200
sabrina.houston@ironman.com
Coast Hills, INC DBA Southern California Barricades
5930 Lakeshore Dr , Cypress, CA 90630
714-676-8460
CA LIC #786758 C31
jim@scbarricades.com
Excelsure Insurance Services
CA000023885-05
78495 Calle Tampico La Quinta, CA 92253 760.777.7000
RE: Encroachment Permits – Compliance with Insurance Requirements
Per Engineering Bulletin #97-04 please provide proof of the insurance items and
endorsement certificates below:
ޭ General Liability – $1M per occurrence / $2M general aggregate
ޭ General Liability – Additional Insured Endorsement (for ongoing and
completed operations)
ޭGeneral Liability – Primary / Non-contributory Endorsement
ޭAutomobile Liability – $1M combined single limit
ޭWorkers’ Compensation – Statutory Limits / Employer’s Liability $1M per
accident or disease
ޭWorkers’ Compensation – Waiver of Subrogation Endorsement
PERMIT NO. ENC2021-0071
Ironman 70.3 Indian Wells La Quinta / Traffic Control / Various Streets; See
Attached Traffic Control Plan (No asphalt or earthwork permitted)
The following permit conditions shall apply:
1. Jim Sprinkel with Southern California Barricades shall be available during the event by
cellular phone at (714) 676-8460.
2. 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.
3. This permit or copy of it shall be on the work site (usually the job trailer) for inspection during
the actual work performed.
4. The permittee must maintain proper stopping and sight distances for the vehicular traffic users
using the public right of way.
5. 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, 5
th Edition” or latest, in the installation
of all appurtenances abutting and within the public street right-of-way.
6. Streets shall be kept clean. They shall be completely cleaned at the end of each working day
and more frequently, if required.
7. The Applicant or Contractor shall furnish the City satisfactory evidence of insurance in the
amounts provided in the Engineering Bulletin #97-04 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 and endorsements shall be submitted to the City. Each policy shall name the City as
an additional insured.
8. 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.
9. 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 R/W.
PERMIT NO. ENC2021-0071
Ironman 70.3 Indian Wells La Quinta / Traffic Control / Various Streets; See
Attached Traffic Control Plan (No asphalt or earthwork permitted)
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. 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.
12. 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.
13. The permittee shall not encroach upon private property without prior written approval (submit
to the Design and Development Department, attention to the Associate Engineer) of the private
land owner whom is being encroached upon.
14. All landscaping, irrigation, decorative rock, decorative concrete, sidewalk, lighting, etc., shall
be replaced to its original condition.
15. Access and egress to all local properties shall be maintained at all times.
16. 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.
17. 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.
18. The City of La Quinta reserves the right to revoke, suspend or void this permit at any time.
19. 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.