0957GEORGE H. CHANEY CO.
Inspection Services
TO:
a THE FOLLOWING WAS'NOTED p
111141,1111 1
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14-188
DATE . �
JOB NO.O
PROJECT DESCRIPTION
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LOCATION
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NOTE:
With proper validation '• %
ti•�
thIs�form constitutes an.
_ encroachment permit CITY `OF LAQUINTA 4
,.
APPLICATION*'FOR PERMIT
• ` -PUBLIC.f.WO_RKS CONSTRUCTION ' (ENCROACHMENT):
For the construction -6f-,public or, private, curbs, driveways, pavements,' sidewalks, parking'' lots,� sewers, water mains
"a`nd other like public works improvements in connecttion'with.MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Peimit — Class III
DATE: 'r: December 1.1?,..1990 Minor Improvement Permit Class IV .
LOCATION OF CONSTRUCTION, Avenue 52- TR 24890
(Street address or.Description of Location)
install' .18" water. J
PURPOSE OF CONSTRUCTION "•Sketch (attacWconstruction plans if appropriate").
A
line,per CVWD. _ r
r DESCRIPTION OF CONSTRUCTION same as, •Above. . •see attached° exh1abit I dated
„•' • ' Dec.- 7,'.' 9,90 r
14
• #DIMENSION OF'INSTAL'LATION OR REMOVAL
e t`
. ;5,' deep, 3' wide
.a;t•€ SIZE OF EXCAVATION, IF NEEDED
E
'APPROXIMATE TIMWHEN WORK.WILL BEGIN. 12/11/90
+" , ,APPROXIMATE TIME OF COMPLETION ,.1'2/17/90 °
:ESTIMATED CONSTRUCTION COST $ ' 3,000
P t' : (Includirig removal of debris, materials„and debris, backfilling, com
paction .and placing permanent resurfacing and/orreplacing improvements) { 4•
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
:perialties,• liabilities or loss resultingfrom claims or court action out of anaccident; loss"or” a to, ersons,or
9 Y 9. P Property ,
1 - 'happening' or occurring as •a proximate result of 6n' y work undertaken under the permit granted pursuant to this applications + "
rity at least twenty-four (241,hours in advance of the time when work will* started.
Notify the Administrative'Autho
". - t; •. xr ti , -.- 'moi. - � -'_ -, '- '' • Y ;. F
} Comply with all applicable City Ordinances, the toms and conditions of. the permit and, all applicable rules'and regulations of.the City of
t - . La Quinta,and to pay for any additional "replacement, necessary as the *result of this work.
: �:- Signetre of,4bplicant or'Agent r
,.
r,l Landmark •Land" Co:.; (Greg.'BUrkhart0}_PO Box' 1'000 La gurita.. 345-2888
Name of Applicant (please print), "r F'.••* Business"Address • Telephone No. -
t, -
..
Jones.Bros Landiriark x :.
Name of Contractor and Job Foreman Business Address + ;4 Telephone No.
551449
' on fi1P r
Contractor's License'No. City Business License No.
' onf a le �� _ ' "
'Applicant's'Insurance Company ' Policy Number
..FEES: -Sub'division Improvement Permit — Class 111 '
�
Public improvements: 3% of. estimated construction costs
��`'• Private improvements: 3% of estimated construction costs ', t
Minor Improvement Permit —'Class IV: See attached schedule ;, ' + `+r 0,9'57, , ',• :
Inspection Fee '• $ AjV7019 �''� a r PERMIT 'VALIDATION .
• '.. ,
Permit Fee
PERMIT NO.
Penalty', r, 1
;+ Cash Deposit Surety Bond DATE APPROVED 17!
if required Q EXPIRATIONDATE / / �U
' TOTAL: • $ ' /i�
-,DATE ISSUED
Receipt No: ,. . `'
Received by Date 4 Administrative Authority _
Recorded by - , ., TELEPHONE: (619) 564'-2246
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NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit — Class III
DATE: :�ccertEr 11, 1990 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Avenue 52 Ti' 24850
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION install 1810 tater Sketch (attach construction plans if appropriate)
line per l✓" niD
DESCRIPTION OF CONSTRUCTION sane az above see attached exh}Lbit I datod
Dec. 7, 1990
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED 73—L
L1022, 31 trifle-
APPROXIMATE TIME WHEN WORK WILL BEGIN .12/11/90
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $ 3 0 000
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrees to:
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.
Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result of this work.
Signatu re of Applicant or Agent
Landmark Land Co. (Gree DUrkhartO)PO Loan 1000 La Quinta 345-2888
Name of Applicant (please print) Business Address Telephone No.
Jones Lros/ Laneb.iark
Name of Contractor and Job Foreman Business Address Telephone No.
551449 on file
Contractor's License No. City Business License No.
on file
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class 1.11
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ '0/4
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ A)
Receipt No.
Received by Date
Recorded by
f!1 nlk "
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED 17- it r o°4
• r
EXPIRATION DATE l 7�
DATE ISSUED 17- 1771
By
Administrative Authority
TELEPHONE: (619) 564-2246
:y
The following General and Special Provisions are attached to and made a part.of Permit No.
_ GENERAL PROVISIONS , •< -, .
The following shall always apply:
ENCROACHMENT ON PRIVATE PROPERTY: This permit authorizes work to be accomplished within City of La Quinta right of way
ONLY. Whenever construction extends within private property, it shall be the responsibility of the permittee (or his contractors)to
secure perm ission.from abutting property owners. Such authorizatiommust bersecured by the,permittee prior'to starting work:
TRACKLAYING"CONSTRUCTIONEQUIPMENT: Cleated tracklaying'c'onstruction equipm'eht shill not be peirmitted to operate on any
paved surface unless fitted with smooth -faced street pads. All mechanical outriggers shall be fitted with rubber street shoes to protect-
the paving.during excavations.rRubber=tired equipment only shall be used in backfill operations in•paved areas. If the existing
pavement is scarred, spalled, or broken during the term of this contract, or if the pavement is marred,'City of La'Quinta shall request
that these portions of road be resurfaced over their entire width.-Resurfa6hg shall'consist of one coat of two inches_ (2") of A.C.
surfacing plus appropriate seal coat as specified above. ' = �'•'
PROTECTION OF TRAFFIC: All excavations and work areas shall be properly lighted and barricaded as deemed necessary by the City
Engineer or La Quinta City, Public Works Inspectors. Suitable detours and detour signs shall be placed and maintained for.the duration
of the project. The City shall be notified 24 Hrs. in advance of any traffic detours or delineations. ,
CARE OF DRAINAGE STRUCTURES: Any -drainage structure including corrugated metal pipe, concrete pipe, steel culvert and
concrete structures encountered during excavation which necessitate removal shall be replaced,in kind. In the event.it becomes
necessary to remove or cut existing drainage structures, City of La Quinta'shall be notified prior to commencement of this work.
Drainage structures and open drains shall be kept free of debris at all times for proper drainage.
RIGHT OF WAY CLEANUP: Any surplus material resulting from excavation and backfill operations_ shall be removed from the right of
way. AII'paved surfaces shall be broomed clean of earth and other objectionable materials immediately afterbackfill and compaction.
Existing gutter line and drainage ditches shall'be replaced to their original standard or better. All excess material shall be removed.
prior to paving. Water tanker shall be used, as required, to sprinkle the job site.to keep down dust conditions and shall be used
immediately after backfill."`''
DE -WATER OPERATIONS: If de -watering operations are required and pumps are forcing water on City of La Quinta roads, it shall be
the responsibility of the permittee 4 (contractor) to control this water and to provide off-street barricades when necessary.
CLOSING'STREETS`No street stiall 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 emergericy vehicles. In the event it isfelt bythe' 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 follwing shall apply -ONLY when. indicated:
PR1OTIFICATION: Permittee shall notify the City at 564:2246 at least 48 hours in advance of starting construction.
ASH DEPOSITS OR BONDS: A cash bond or an approved+surety bond in an amount of not less than $
shall be furnished in the name of Cityof La Quinta to cover all work involved in the restoration of the various La Quinta
roads and survey monuments. This bond shall be continuous until cancelled by the City Engineer. This bond must be
osted prior to commencement of any work on this project . R,, A•
LR:333�, ILI
TYCLEARANCE:(Substructures),tures), Prior to making any excavation 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
��I
the permittee.
�LITY CLEARANCE: (Surface structures) No work shall be done under this permit until all utilitie's are clear of the
�oposed work site. -The permittee,shall notify all concerned utility companies of the proposed work.'
R5`, PAVEMENT'WIDENING: Area between the proposed concrete gutter line and the existing road pavement shall'lie
surfaced with inches of A.C. paving placed on inches of class aggregate subbase course
..havingan':R"valueofnot lessthan -- andinconformancewithCityofLaQuintaRoadlmprovementStandards
and Specifications, Ordinance #461.
R6 PARKWAY GRADING: Area between the property line and top of the proposed concrete curb shall be graded to a slope of
1/4 inch to one foot (1'). -
R7, GRADES & STAKES: City of,La,Quinta shall establish grades and stakes for the proposed concrete curb and gutter -
cons ruction
utterconstruction
g RADE CHECKING: City of La Quinta shall.check grades upon receipt of plan and pFofile and/or grades as established by.
a licensed engineer.
R9. CURB REMOVAL FOR DRIVEWAYS: A portion of the existing+ concrete curb and/or curb and gutter,(.. feet)shall be
' removed. Curb and/or curb'and gutter shall be saw cut prior to removal. Depressed curb, matching concrete gutter and
concrete driveway approach shall be constructed in conformance with City of La Quinta Standard #207'.,,'.
R10 DRIVEWAYS, A.C.: Driveways shall be constructed as not to alter existing drainage pattern. Surfacing between the
property,line and'the existing road paving •,shall be 2-1/2 inches. . of.A.C. paving placed on ( ") of class
z aggregate base. Drivewayconstruction shall conform to attached drawing.-
R11
rawing.•
R11 CULVERTS: A inch diameter ( )culvert shall be installed with the invert approximately 1-1 /2
riches below and in line with the existing flow line. Culvert installation shall conform to the attached drawing. - -
(j:Wl:21GHT. CLEARANCE: Sight clearance of 600 feet in either direction shall be assured and'maintained.
SOIL STERILIZER: The area to be surfaced shall be treated with soil sterilizer. Rate of application shall comply with the
nufacturers specifications. , r , T • • • s': 1 .41 -
1314 ' C ORDINATE WORK: The•proposed work shall be subordinated to any operation which the'State of California or
ity of La Quinta may conduct in this area during the period of this, permit. Work shall be coordinated with the State or
tv of La •Quinta forces to preclude delay or interference with State or City of La Quinta projects.
y
R15 S VEY MONUMENTS: Prior to, excavation or beginning of construction, all survey monuments which exist on the
terline of all
75l streets or propery lines when involved shall be completely tied out so they maybe readily and correctly
be 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 of replacement of all survey monuments for proper project clearance.
RD -31
R16 SURVEY MONUMENTS: Prioi xcavation or beginning of construction, all SL - monuments shall betied out by City
of La Quinta and suitable payment or guarantee of payment shall be made as reimbursement for all work involved.
R17 PAVEMENT CUTTING: Pavement will be mechanically cut to a straight edge prior to excavation. Method of pavement
cutting shall be approved through the office of the City Engineer. (Under no circumstances shall excavating equipment
be used to excavate prior to cutting of pavement). Excavation material shall be placed in such a position as to best
facilitate the general flow of traffic. Prior to final paving operations, any damage to pavement straight edge shall be
corrected.
R18 PAVEMENT CUTTING: Pavement shall be saw cut prior to removal. Prior to final paving operations, any damage to
pavement straight edge shall be corrected.
19 IMIT OF EXCAVATIONS: Excavations shall be limited to 1,000 lineal feet of open trench before backfill operations must
n
egin. 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.
', R20 BACKFILL MATERIAL: Backfill shall be free of brush, roots or other organic substance detrimental to its use for purposes
,qf producing an adequately consolidated backfill. Any material which the City of La Quinta deems unsuitable (spongyor
saturated material) which is encountered during excavation shall not be used for backfill, but shall be supplemented or
replaced by an approved sand or gravel.
R21 BACKFILL SAND: Backfill shall be approved transit -mix sand or equivalent and shall be placed in lifts of notgreaterthan
three feet (3') and vibrated using vibrotamper or equivalent equipment. Alternate methods may be substituted, but in any
se a relative compaction of 95 percent shall be attained within the structural section of the roadway.
22 B. CKFILL PLACEMENT: Backfill shall be applied in layers of not more than 50 percent of the total depth of the trench
-before flooding or a maximum of five-foot (5') lifts where trenches are of excessive depths. Care isto be exercised thatthe
backfill material is not subjected to extreme swell by flooding operations. Backfill material shall be placed so that the
resulting compaction shall be not less than 90 percent or equivalent to the surrounding ground, whichever is the greater
compaction. Where ponding or flooding is used for a maximum settlement, adequate dikes will be constructed to retain
the water. Where jetting is used, the jets shall be of sufficient length to reach the bottom of each layer and the water
supply shall be continuous.
R23 COMPACTION TESTS: If so required bythe inspector, compaction tests shall be made at i ntervals of not more than 1,000
feet and a minimum of one (1) test on each road. One (1) copy of each test shall be forwarded to the City Engineer for
approval and filed prior to making permanent repairs. Compaction tests shall be made as outlined in Section 6.3.01 of the
Standard Specifications, Division of Highways, State of California, dated January 1973.
(R24; MPACTION TESTS: If so required by the inspector, compaction tests shall be made for each crossing or service line.
rte (1) copy of each test shall be forwarded to the City Engineer for approval and filed prior to making permanent repairs.
ompaction tests shall be made as outlined in Section 6.3.01 of the Standard Specifications, Division of Highways, State
California, dated January 1973.
R25 T MPORARY PAVEMENT REPAIRS: After completion of backfill and compaction operations, a temporary patch
onsisting of 2 inches of SC -800 shall be placed on a prepared subgrade. The SC -800 temporary paving shall be placed
after a maximum of 3,000 lineal feet of trench has been excavated and backfill operations completed, but in no case shall
e placement of the temporary pavement exceed a five (5) day limit.
R26 P RMANENT PAVEMENT REPAIR: After backfill and compaction operations have been completed, a temporary patch
onsisting of two inches (2") of SC -800 shall be placed immediately. A permanent patch of inches A.C.
surfacing placed on a in class base II be paced no later thandaysafter completion of
temporary road repair.
R27 PAVEMENT REPAIR: F.A.S.: Upon completion of backfill c p ction, a temporary patch consisting of two inches (2")
of cold mix paving (SC -800) shall be placed immediately. A permanent patch of three inches (3") of A.C. surfacing shall
be placed on six inches (6") concrete base as directed, but not later than fifteen (15) days after completion of temporary
paving. Concrete base shall be of five -sack mix and shall conform to the City of La Quinta Road Improvement Standards
and Specifications, Ordinance #1461.
R28 FOG SEAL: A fog seal coat consisting of an application of asphaltic emulsion shall be applied over all patch areas as
determined by the City Engineer.
R29 SEAL ARMOR COAT: A seal coat consisting of an application binder and screenings shall be applied on all patch areas
where such seal coats existed prior to issuance of this permit. Seal or armor coats shall be applied as specified in Section
37, Standard Specifications, State of California, Division of Highways, dated January 1973. Work of pavement repair to
be accomplished by a licensed contractor engaged in the business of pavement repair.
R30 STREET RESTRIPING: Where street striping is still visible on streets to be excavated, such striping shall be replaced upon
completion of permanent repairs.
R31 TREE RELOCATION OR REMOVAL: Tree relocation within the City of 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 permittee to maintain the tree in a vigorous growing condition at its new location.
Trees to be removed shall be removed in sections which can be handled safely without interference or hazard to highway
traffic. The entire width of the tree stump shall be removed and disposed of so that no debris remains in view of the
highway. The stump hole shall be backfilled and thoroughly compacted as specified inthefollowing paragraph. Where it
becomes necessary to restrict traffic, the work shall be restricted to a maximum of 500 feet at anyone 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 90 percent or equivalent to the
surrounding ground, whichever is the greater compaction as determined by the impact or field method. Compaction
tests shall comply with Section 6.3.01 of the Standard Specifications, Division of Highways, State of California, dated
January 1973.
R32 TREE TRIMMING:
a. Only the necessary trimming shall be accomplished to provide clearance of the facility for one calendar year.
All broken or weak sections within the trimming shall be removed.
b. Where it becomes necessary to restrict traffic, the work shall be restricted to a maximum of 500feet at anyone time.
Adequate signs, flagmen, and/or barricades shall be provided to protect the traveling public at all times.
c. If tree trunks are partially outside of the City of La Quinta road right of way, permittee shall make his own
arrangements with adjoining property owners for consent to the trimming in addition to the authorization provided
by this permit.
d. All tree trimming on EVERGREEN TREES, PALM TREES, and other ORNAMENTAL TREES shall be accomplished to
the satisfaction of the City Public Works Inspector.
e. Abutting property owners shall be contacted, in all instances, prior to trimming or topping trees.
f. Pruning shall, in all instances, be at the shoulder of the crotch to insure even, fast healing in all cuts of two inches
(2") and above in size. Sealant shall be applied to all cut sections as directed by the City Public Works Inspector.
ADDITION ----ENCROACHMENT' PERMIT''NO.0957----CONDITIONS: ,
Survey mume s shall; be protected_:.in p e or., -
re-established pursuant°to.City standards.and..the-State of, -
F
CAlifornia'•Land 'Surveyor.'s Act. '
' R34,
Work shall `be ,,.coordinated. with the -City, of .La,-,Quinta'''s
'
-forces to;preclude delay,or interference with the City, of.� La- •,
.
,Quinta'' s projects
.R35 '{'.Contractor
a
shall comply:'with the loca.1 noise ordinance: -sand <
,-construction
operations and maintenance of equipment' within_.
'
,
one half mile of human occupancy shall-be,"'erformed only
ti w
during the' time.'periods-as follows:- `
October lst.to April'30,:Monday-Friday .7:00a.6.-5:30p.m.
'
.-Saturday'. 8: 00a. m. ='S s 00p.m.'
May•lst.to.Septembet.30:' Monday -Friday 6:OOa.m.-7:OOp:.m.�
ti f , Saturday `. 8: GO&.•m. -5 OOp.m:
Work shall be prohibited.. anytime on Sunday 'and Federal-°�1'1'
holiday,.
R36
Traffic control shall be as per Cal Trans Traffic,Manual: ;
`Field'
adjustments in detouring shall be 'accomplished' as
f
directed in order. to adjust' to -•actual field conditions. -,It•
shall '15e -the contractor.' s-• responsibi<lity .to . adequately .. -
barricade and detour this'site: No overnight,detours,will.
be.permitted.' A•Tra'ffic control plan shall .
be, submitted- for• approval by the, City. Engineer:
R37
All. excavation at or :•near the ;travel s
way ,shall�-.be` backfilled ',
at the end> of ..the work day,, for the.. protection' _ .
-of. the
n n.
traveling,public.
«.
R38
Street closures shall not'..be allowed at ,,any time., -
` `R39
A minimum 'of. -one paved; travel lane shall. be maintained -at
all. times* with flagmen. during working 'hotirs .
R40
All 'work` to' be. performed within the' existing•'paved .section-
'
shall`be':temporary paved and .maintained by the'Permittee,
permanent -`pavement shall'be.placed_no later,thane15 days
''• ,.
after, completion of "the temporary road -.repair.
R41 � ,
Ingress- and 'egress for local ,properties shall`, be maintained
at all times.
R42
Prior to work starting, Underground- Service Alert shall be
contacted --at'- 1-800-422-.41.33 •and an,,' inquiry number",(shall be,
',provided
to' -the City-Public.Works''.Inspector.,
R43
Pavement -shall be sawcutprior ,to.4removal'.
Additional
Conditions -,.,Encroachment Permit No., 0957 .
- Page
R44 .
-.All backfill 'subgrade soil shall• be compacted to nothing
`
.less than{ 90 o relative.,,'dry density, 'all backfill soil within
-Ithe e -top 2,!, of., ffinish pavement surface' shall be:''compacted' to
nothing -less -.,.than 95%' relative, dry density,, ail base
material .sha11P be, compacted, to nothing. less than . 95 a
=
relative.dry'density. $'
R45
Grind and, 'remove 1" Rthickne'ss. A.C. ` for a,. distance' of 20' •
minimum." Replacement.pavement shall` be,1V thickness, to.meet,
existing, pavement,.over the :original thickness of 4'1/2.`"
A.CC.•with: 81'' Class, !I `-aggregate' base within the trench
area.' a s
r.
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` 25+0 2"aE.e%CE 4
IRRIGATION
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z. INSTALL 1-18"X6' TEE',. r.=
1-6" GATE VALVE
32'-6" DIP 00
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With properwafidationv_,_ r -
this form constitutes an"
encroachment-permit"CITY- OF' LA QUINTA'
APPLICATION -FOR' PERMIT" "
PUBLIC- WORKS
;CONSTRUCTION= (ENCROACHMENT)" i
For the construction of, public- of private=. curbs, driveways; pavements-, sidewalks;. parking lots, sewers; ,watW,;rfgi>W�,
and other like public workr•improvements,in connection with MINOR IMPROVEMENTS -and APPROVED SUBDIVISIONS,,;"
_ t Subdivision Improvement Permit— Class.11l
DATE: Minor improvement,Permit Clash;IVB-.,
LOCATION OF CONSTRUCTION' AWE
(Street address or Description of Location) -.
PURPOSE OF CONSTRUCTION �� W r-� Sketch (attach construction pians if apptoprya )*,
' DESCRIPTION OF CONSTRUCTION mss- Ababa% _> .Ir DvAimt>
DIMENSION OF INSTALLATI04OR REMOVAL a�.>c.—I s 11C%q0
• SIZE OF EXCAVATION, IF NEEDED •.�—i D�� ���
APPROXIMATE TIME WHEN WORK WILL BEGIN '
APPROXIMATE TIME OF COMPLETION'S-� 11 '
ESTIMATED CONSTRUCTION COSTS
(Including removal of all obstruction, materials, and debris, ba:kfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)-
Inconsideration of the granting of this permit, the appiicant'hereby agrees to:
Indemnify, defend and,sane the City; its authorized agents, officers, representatives -end employees, harmless from and against anti ww all -
penalties, liabilities or loss resulting from claims or court action and arising out of any accident, lois or damage,to persons -or propww—1
happening or occurring as a. proximate result of any work undertaken under:the permit granted purwant'to this application.
Notify the Administrative Authority at least twenty-four (241 hours in advance of the time whenwork will be started:
Comply with all applicable City Ordinances; the terms and' conditions -of the, permit and all appliesble=rules and reguletionwof the-City-.of—
La Quint@ and to pay for any additional,replaeement,necessary-as the -result of this rk
Sig"40 of A iicant or Agent
i e f 7 e—rum A_ ii X11. -a -4—,1_,ml Iftr%
Name of Appiicant'(piease print). Business Address , Telephone No.. .
Name of Contractor and Jo Foreman- Business Address ^" Telephone No.
Contractor's License No. r City Business License No.'
Applicant's Insurance Company, Policy Number
FEES:~ Subdivision Improvement Permit — Class'I11
Public improvements:, 3% of estimated construction costs t
Private. improvements: 3% of estimated constiuction'costs
NO
Minor Imorovement Permit — Class IV: See attached schedule
lr 0.
Insiiectlon Fee S PERMIT VALIDATION., b
Permit Fee PERMIT NO:
Penalty �: x
r
-Cash Deposit -Surety Bond DATE APPROVED . �
if required EXPIRATION DATE �.
' TOTAL• $ , s.' ., .
DATE ISSUED
'Receipt No.
By
Received by Date s - Administrative Authority
Recorded by+
TELEPHONE::(61915642246~ O. , .
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