3692J
NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
�t
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
i�fa 16 ZOfl2 Subdivision Improvement Permit — Class III
DATE: + Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Avenue 47 S/8 E/O Washington Street
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION PlAce new pair gain device Sketch (attach construction plans if appropriate)
for new growth in area
DESCRIPTION OF CONSTRUCTION Place pair gainand
power ped and power transformer vad
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED 2' x 48" D x 320'
APPROXIMATE TIME WHEN WORK WILL BEGIN 05130/02
See Attached Conditions
APPROXIMATE TIME OF COMPLETION 30 days
ESTIMATED CONSTRUCTION COST $ 15.000.00
(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: A
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. s
Notify the Administrative Authority at least twenty-four (24) hours in advance of the tir" when work will be started.
Comply with all applicable City Ordinances, the terms and conditions of the ermit and a"II when
rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the rest of thif A
s worm `
Signa lure of Applicant or Agent
Veriaon 295 N. Sunrise Way Palm Springs, CA 92262 (760) 864-1715
Name of Applicant (please print) Business Address Telephone No.
on State utility Post Office Box 2968 Tuirlock, CA 95381 (209) 634--4981,
Name of Contractor and Job Foreman
4/ r C�
Contractor's License No.
Applicant's Insurance Company
Business Address
SG: 4 / /Y C"G'%
r
FEES: Subdivision Improvement Permit — Class 111
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor. Improvement Permit — Class IV: See attached schedule
Inspection Fee $ 450.00
Permit.Fee 100.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
$ 550.00
Receipt No.
Received by Date
ephone No.
City Business License No.
Policy Number
'D °
VffYORAQUINTA
4 Z' M
' :6
PERMIT VALIDA I I NANCEDEPT.
PERMIT NO. 3592
r
DATE APPROVED 06/13/02
EXPIRATION DATE /12/31/02 t
DATE ISSUED / f 411Q --Zl— t
By
Administrative Authority
Recorded by
Telephone: (760) 777-7075
The following General and Special Provisions are attached to and made a part of Permit No. 3 (o9Z
GENERAL PROVISIONS
The following shall always apply:
ENROACENENf ON PRTVATE PROPERTY: This permit authorizes work to be accomplished within City of La Quints right of
way ONLY. Whenever construction extends within private property, it is the responsibility of the permittse for his contractors to
secure permission from abutting property owners. Such authorization must be secured by the permittee prior to starting work.
TRACKLAMG CONSTRUCTION EQUEPMENJ': Cleated tracklaying construction equipment shall not be permitted to operate on
any paved surface unless fitted with smooth -faced street pads. All mechanical outriggers shall be fined with rubber street shoes to
protect the paving during excavations. Rubber -tired equipment.only shall be used in backfill operations 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 Quints shall request
'that these portions of road be resurfaced over Weir entire width. Resurfacing shall consist of one coat of two inches (2' of A.C. '
surfacing plus appropriate seal cost as specified above.
PROTECTION OF TRAFFIC All excavations and work areas &ball be properly ligbted and barricaded as deemed necessary by the
City Engineer or La Quints City Public Works inspectors. Suitable detours and detour signs shall be platted and maintained for the
duration of the project. Ile City shall be ootified.24 hours in advisee 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 Quints 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 CIEANUP. Any surplus material resulting from excavation and backfill'operations shalt be removed from the -right
of way. All paved surfaces shall be broomed clean of earth and other objectionable materials immediately after backfsll and compaction.
Existing gutter line and drainage ditches shall be replaced to Weir 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 aball be used
immediately after bacldill.
DE-WA7ER OPERATIONS: If de -watering operations are required and pumps are forcing water on City of Ea Quints roads, it shall
be the responsibility of the permince (contractor) to control this water and to provide off-suset barricades when necessary..
CLOSING FIREET'S: No street shall be closed. A minimum of one lase 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 fell by the permutes that he must close a street for
any length of time, perminec shall contact this office to obudo the necessary permission.
SPECIAL PROVISIONS
The following shall apply when indicated:
Rtl N07MCATION: Perenittee shall notify the City at (619)777-7075 at least 48 houn in advance of starting construction.
R2 V1MJ7Y CLEARANCE: (Substructures) Prior to making any excavation within the City of La Quints, light 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 @ball be the sole
responsibility of the permittee.
R3 MUJ7Y CLEARANCE: (Surface Structures) No work shall be done under this permit until all utilities are clear of the
proposed work site. The perminee shall notify all concerned utility companies of the proposed work.
R4 PAVEN07fT WIDENING: Area between the proposed concrete gutter line and the existing road pavement shall be surfaced
with inches of A.C. paving placed on inches of class aggregate subbase course having an'R'
value of not leas than abd in conformance with City of I..s Quints Road Improvement Standards and
Specifications, Ordinance 1461,
R'S PARKWAY GRADING: Area between the property line and top of the proposed concrete curb shall •be graded to a slope of
i/4 inch to one foot (11).
R6 GRADE. CHECKING: City of La Quints &ball check grades upon receipt of plan and profile and/or grades as established by
a licensed engineer.
R7 CURB REMOVAL FOR DRIVEWAYS: A portion of the existing concrete.curb and/or curb and gutter (_feet) iball 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 Let Quints Standard IM
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 2 1/2 inches of A.C. paving placed on (_) of clan aggregate haft.
Driveway construction shall conform to attached drawing.
R9 SIGHT CLEARANCE: Sight clearance of 600 feet in all directions @ball be assured and maintained at all times.
R10 SOIL S'IVULI U The area to be surfaced shall be treated with soil sterilizer. Rate of application shall commply'with.the'
manufacturer's specifications.
G)ILa
COORDINATE WORK: IDe proposed work sball be subordinated to any operation which the State of California or City of
Quints may conduct in this area during the period of this permit. Work sball be coordinated with the State or City of L
Quints forces to preclude delay or interference with State of City of La Quints projects.
12 SURVEY MONUMENTS: Prior to excavation or beginning of construction, all survey monuments which exist on the
centerline of all streets or property lines when involved shall b'e completely tied out so they may 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 Eagioeer prior to the removal of any monuments.' This office sball be notified
upon completion or replacement of all survey monuments for proper project clearance. . .
13 PAVENVWT' CVTMNG: Pavement will be mechanically saw cut to a straight 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 traffic. Prior to final paving operations, any damage to pavement straight edges &ball be corrected.
14 LUMT OF EXCAVATIONS: Excavations shall be limited to 1000 linear feet of open trench before backfill operations must
begin. All excavations shall be properly barricaded with lights overnight, on weekends and holiday& for the protection of the
traveling public. The Public Works Inspector shall determine the suitability of excavation barricading is each cage. -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.
1 S BACKFILL MATERIAL: Backfill shall be free of brush, roots or other organic substance detrimental to its use for purposes
of producing an adequately consolidated backfill. Any material which the City of Lo Quints deems unsuitable (spongy or
saturated material) which is encountered during excavation shall not be used for backfill, but shall be 'supplemented or replaced
by am approved &and or gravel.
16 BACKFILL SAND: Backfill shall be approved transit -mix sand or equivalent and shall be•placed in lifts of not greater than
three feet 07 and vibrated using vibrotamper or equivalent equipment. Alternate methods may be substituted, but in any case,
a relative compaction of 95 percent shell be attained with the structural section of the roadway.
I7\ BACKFILL PLACENIEWT: Backfill shall be applied• in layers of not anon than 50 percent of the total depth of the trench
before flooding or a maximum of five-foot (51 lifts where trenches are of cxcessive depths. Care is to be exercised that the
backfill material is not subjected to extreme Ewell by flooding operations. Backfill material shall be placed so that the resulting
compaction shall be not leas than 90 percent or equivalent to the surrounding ground, whichever is the greater compaction.
Where poDding or flooding is used for & 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.
18 COMPACTION TESTS: If so required by the inspector, compaction tests shall be made at intervals of not more than 1000
feet and a minimum of one (1) tut on each road: One (1) copy of each test &ball be forwarded to the City Engineer for
approval and filed prior to making permanent repairs. Compaction tuts &ball be made as outlined in Section 6.3.01 of the
Standard Specifications, Division of Mgbways, State of California, dated January 1973.
L.9 COMPACTION TESTS: If to required -by the inspector, compaction tests sball be made for each crossing or service line.
Out (1) copy of each test &ball be forwarded to the City Engineer for approval and filed prior to making permanent repairs.'
Compaction tuts shall be made as outlined in Section 6.3.01• of the Standard Specifications, Division of )Ugbways, State of
California, dated January 1973.
20 T1aVVORARY PAVEMENT REPAIRS: After completion of backfill and compaction operations, a tens
porary consisting of 2 inches of SC-800 shall be placed on a prepared subgrade. The SC400 tens in shall be patch
temporary paving after a
8
maximum of 3000 linear feet of trench has been excavated and backfill operations completed, but in oo ease shall the
placement of the temporary pavement exceed a five (5) day limit.
�) PER IAN04T.PAVEMEPTI' 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 ioebe& A.C. surfacing placed on a
inch class base shall be placed Do later than • days after completion of temporary road repair.
2 FOG SEAL: A fog seal coat consisting of an location of application asphaltic emulsion shall be applied over all patch areas am
determined by the City Engineer.
3 STV T RFSTRIPDVG: Where street striping is still visible oo streets to be excavated, such striping shall be replaced upon
completion of permanent repair.
24 TREE RELOCATION OR REMOVAL: Tree relocation within the city -of La Quints road right of way shall be
accomplished by a licensed, bonded and insuredtree 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 Dew location.
Trees to be removed shall be in sections which can be handled safely without interference or hazard to highway traffic. TLe
entire width of the•trec stump shall be removed and disposed of so that no debris remains in view of the highway. The stump
bole sball be backfilled and thoroughly compacted as specified in the following paragraph. Where is becomes necessary to
restrict traffic, the work sball be restricted to a maximum of 500 feet 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 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.
X,
SPECIAL CONDITIONS--PERMIT-NO. 3692
--- Verizon ---
In addition to the standard permit conditions, the following shall apply:
1. 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. Verizon, hereinafter referred to as "Permittee", shall be responsible for providing continuous dust and
erosion control.
3. Streets shall be kept clean. They shall be completely cleaned at the end of each working day and more
frequently if required.
4. Pursuant to Section 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 1 st 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.
5. Work performed within 500 feet of a signalized intersection is restricted 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 Riverside Country Traffic Signal Maintenance Department at (909) 275-6894 if signal
operation at the intersection is to be altered in any way.
6. 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.
7. Pursuant to Section 14.16.250 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982),
advance warning signs and traffic control shall be installed and maintained in accordance with Cal
Trans Standards or the Work Area Traffic Control Handbook (WATCH Manual). A traffic control
plan shall be prepared in accordance with the WATCH Manual and submitted to the City for
review and approval one (1) week prior to starting any construction. It shall be the Permittee's
responsibility to appropriately detour and barricade all construction sites.
Special Conditions - Permit No.3692
Page 1 of 4
r 1r
SPECIAL CONDITIONS --PERMIT NO. 3692 '
--- Verizon ---
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 lane of paved surface shall be
maintained at all times.
9. 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.
10. 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.
11. 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 with 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 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.
Backfill compaction shall be achieved by the following conditions:
A. 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 Geotechnical Inspector and/or the City
Inspector and the resulting excavation backfilled with pipe bedding material.
B. Backfill materials shall be brought to or maintained at an 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.
C. 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.
D. 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.
Special Conditions - Permit No.3692 Page 2 of 4
SPECIAL CONDITIONS --PERMIT NO. 3692
--- Verizon ---
E. 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.
F. 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.
G. 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.
H. 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.
12. All excavations within City of La Quinta right-of-way shall be backfilled, 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.
13. All landscaping, irrigation, decorative rock, decorative concrete, lighting, etc., shall be replaced to its
original condition. .
14. Access and egress to all local properties shall be maintained at all times.
15. 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:
A. Existing asphalt concrete pavement shall be sawcut one (1) foot beyond trench edges. Edges shall
be straight and clean.
B. Permanent pavement replacement structural section, within all trenches, shall be 1" thicker than.
existing of asphalt concrete over the same existing thickness of crushed aggregate base or crushed
miscellaneous base, meeting the requirements of Sections 200-2.2 and 200-2.4 of the Standard
Specifications for Public Works Construction. The replaced pavement and base material shall
be compacted to 95% relative compaction and respectively tested, for each 300 linear feet of
trench. Verify exact structural replacement section thicknesses with the City prior to installation.
Special Conditions - Permit No.3692 Page 3 of 4
SPECIAL CONDITIONS --PERMIT NO. 3692
---Verizon ---
C. Permanent pavement replacement shall be installed using a City approved 3/4" max medium
asphalt concrete as the base course lift and a City approved %" max medium finish course lift for
capping. Asphalt concrete mix design shall be approved by the City prior to its placement.
D. Cold -Mill and Overlay - The existing pavement which was properly protected in place during the
trenching operation located adjacent to the trench saw cut shall be cold -milled to a depth of 0.10
feet with butt joint created next to the existing unmilled pavement surface. The cold -milled area
and base asphalt concrete in the trench area shall be overlaid with a City approved C2-AR-4000
asphalt concrete mix. The width of the cold milling area shall be as follows:
For longitudinal trenches located in a parking lane: two (3) feet outside the sawcut removal
lines.
For longitudinal trenches located in a traffic lane: two (3) feet outside the sawcut removal
lines, or to the lane line striping, whichever is greater.
For transverse trenches across existing street: two (2) feet outside the sawcut removal lines.
E. If grinding and capping operations are not performed in the same day as base paving operations,
the base course lift of 1/4" max medium asphalt concrete shall be installed from saw -cut edge to
saw -cut edge flush with the existing street surface. The base course lift of paving shall not be left
0.10' low in anticipation of grinding and capping.
F. Any existing lane striping or any existing detour lane striping affected by this resurfacing shall
be replaced in kind by the Permittee, as directed by and to the satisfaction of the City Engineer.
Affected traffic signal loops shall be removed and replaced 'in kind. The finished pavement
surface shall be smooth, consistent, and shall conform to the surrounding grades.
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.
20. This permit allows for placement of new pair gain device. This work is located Avenue 47 S/S E/O
Washington Street.
Special Conditions - Permit No.3692 Page 4 of 4
9 FROM (THU) 5. 16' 02 13:24/S7. 13: 24/NO. 4860068687 P 9
' '�J corm ynt:.SU:n sr '
.^croaotme rt iNrrn.
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTgIJCT10N (ENCROACH ENT_
Fcr Me construction of public or private curds• driveways, pyvernants, sue- plasity illom samR vasaw mmi"
and other like public works improvements in connection wilts MINOR IMPROVE31� andAPPROVED amwo,ypft
Subdivision t Vsraarc — c� IU
DATE: 05 16 02
Minx 3-6. n woest ft at chm [V
LOCATION OF CONSTRUCTION AVENUE 47 -5/5- U0 WASHINGTON STREET
IStreat address or Description of Location)
PUSRPOSE OF CONSTRUCrAI TION PLACE NEW PAIR GAIN DEVICE sRe;, / a )
FOR NEW GROWTH IN ARFg
D t��D I&TI►' W F C� N RU8T WER e /1 4 c,1�z �D ► `,�
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 05130409 VZ W.O. # 0543-7FOOIDD
APPROXIMATE TIME OF COMPLETION J0
DAYS
ESTIMATED CONSTRUCTION COST $ *I
(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:
Indemnity, defend and save the City. its authorised aganiu, offlens, rapresantatives and srnpa.sam bovskm toles mod aa7:raa apv and as
penalties, liabilities or lass resulting from claims or court action and arising out of arty acicaraL Its or daew s, limas or prop"
happening or occurring as a proaimae result of any work undertaken under the permit grtrst aiorsat to fie aydsa:kry
Notify the Administrative Authority at hest twenty-four (24) hours In advance of the r1ma ass_ no ars be sarsesi
Comply with all epPlicsWe City Ordinances, the terms and conditions of the permit and an accMiI�WTIMZ AM cab4 rss4.s aed *If =0 Gty or
La Quints and to pay for any additional replacement necessary as the revel f this
Signature of Appliarc s Ag %If
VERIZON 295 N. SUNRISE WAY PALM SPRINGS CA 92262 760/864-1715
Name of Applicant (please print) Business Address TNo_
GOLDEN STATE UTILITY P.O. SOX 2968 TURLOCK CA 35381
Name of Contractor and Job Foreman Business Addre Teepftcr,e I:o_
jAR
=_y_5LBM1D7 �y3�� FAX # 209/b34-019
Contractors License No. ��TEL 209/634- ttr Ea.svrtss Lacers
Applicant's Insur$nt'a Company / arty Nuati7rC
FEES: Subdivision Improvement Permit —Class Ill
Public Improvemenu: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See anachad schedule
h Inspection Fee = 4�� •C19-
.3 �� PE vALDIATIC+!'I
Permit Fee
I GCS �
PERMITNO. .
Penalty
Cash Deposit -Surety Bond DATE APPn: t�
it required EXPIRATV, ::A7E
TOTAL: S SSC�. no
DATE ISSUE:
Receipt No.
By
Received by Date
Recorded by Teleph:cre w) 777-77
MAY-16-2002 THU 12:26 TEL:760-777-7155 NAME:LA QUINTA PUBLIC WORKS P. 1