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4438-NOTE" With proper validation . this form constitutes an encroachment permit CITY OF LA QUINTA 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 DATE: 'duly 7, 2005 Subdivision Improvement Permit — Class II I Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION 7aztrhv Mitltila Rebonl F TIAr'kv & WAnuinarnn (Street address or Description of Location) Export of dirt. PURPOSE OF CONSTRUCTION DESCRIPTION OF CONSTRUCTION Hauling DIMENSION OF INSTALLATION OR REMOVAL Sketch (attach construction plans if appropriate) SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN July 8. 2005 APPROXIMATE TIME OF COMPLETION Austust 30. 2005 0 Q ESTIMATED CONSTRUCTION COST $ N/A (Including removal of all obstruction, materials, and debris, backfilling, com- J I paction and placing permanent resurfacing and/or replacing improvements) 0 In consideration of the granting of this permit, the applicant hereby agrees to: :4 Q O� p Indemnify, defend -and save the City, its authorized agents, officers, representatives and employees; harmless from anNA �� SfQd a penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage to persons erty 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., Signature of Applicant or Agent JArry Rix1ifRon Sauthwesxern Dint 35600 frame Rtrept LakA Rlninnre CA 951 232 16 5 Name of ApplicantA(please print) Business Address Telephone No. Sane as above. Name of Contractor and Job Foreman Business Address Telephone No. N/A N/A Contractor's License No. City Business License No. N/A Applicant's Insurance Company Policy Number 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 A Inspection Fee $ Permit Fee _ Penalty Cash Deposit -Surety Bond if required TOTAL: Receipt No. Received by 100.00 $ 100.00 Date � ZE E� 4438 PERMIT VALIDATION 4438 PERMIT NO. DATE APPROVED 7 ­ J !; EXPIRATION DATE ?i — 7 O b DATE ISSUED By - a� .. Administrative Authority Recorded by ' :r, Telephone: (760) 777-7075 e\ Ste/ V"e T 0 -Vf 4 4Qdrw PUBLIC WORKS DEPARTMENT APPLICATION FOR PERMIT Date: Location of Construction: Purpose of Construction: X ,p,�-p't o Lp "q Description of Construction: �T Dimension of Installation or Removal: Approximate Construction Start Date: Ul 0,3. Approximate Construction Completio 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::ems J ✓ iz"%, Tscy'�', Phone Number: 9-/ as Name of Applican�f;(,G,S.��,}- Applicant Address: .3�"�0o ,he- 9L5t 'Or— 4f Applicant Telephone Number: - a5—� _70/ 6/ qR. Name of Contractor: Contractor Address: Contractor Telephone Number: Contractor State License Number: Contractor City Business License Number: ► A COPY OF THE CURRENT INSURANCE CERTIFICATE MUST BE PROVIDED 4 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: 1 00' O J Office Use Only: Assigned Permit Number: r1 1 Approval Date: —` l Expiration Date: Issue Date: Administrative Authority: Cs ti Office Use Only: Assigned Permit Number: r1 1 Approval Date: —` l Expiration Date: Issue Date: Administrative Authority: Cs ti FROM (WED) JUL 6 2005 2:38/ST. 2:37AO. '6326601223 P 1 CERTHOLDER COPY STATE . P.O. BOX 420807, SAN FRANCISCO,CA 94142-6807 COMPENSATION INSURANCQ FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 07-00-2000 GROUP: POLICY NUMBER 1609 371-2005 CERTIFICATE ID: 260 CERTIFICATE EXPIRES; 00-01-2006 00-01-2005/00-01-2000 CITY OF LA QUINiTA SK ATTN: ANTHONY POLAROSSI 73495 CALLS TAMPICO LA QUINTA C4 02283 This is to certify that we have issued a valid Workers' Compensation Insurance policy In a form approved by the California Insurance Commissioner to the employer named below for the policy period Indicated. This policy is not subject to cancellation -by the Fund except upon30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration This certificate of insurance Is not an insurance policy and does not amend, extend or at ter the _coverage afforded by the policy listed herein Notwithstanding any requirement, term or condition of Any contract or other document with respect to which this c,"f icate of tr>surance may be issued or to which it may pertain, the Insurance afforded by the policy described herein Is "Ject to all the terms, exclusions, and conditions, of such policy. AUTHORIZED REPRESENTATIVE PRESIDENT C' EMPLOYER'S LIABILITY LIMIT INCLUDING DEFEftiSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT 01800-.MICHAEL RULIFSON, S!C TREAS - EXCLUDED. ENDORSEMENT i16W - RYAN SCHEMER, PRIES - EXCLUDED. OMRSENOW 02086 ENTITLED CERTIFICATE IgLDERS' NOTICE EFFECTIVE 08-01-2005 IS ATTACHED TO AND FORTIS A PART OF THIS 'POLICY. EMPLOYER SOUTHWESTERN DIRT EXCHANQZ, INC, SK 31500 GRAPE ST STE 3 LAKE ELSINORE CA 02332 [815.SKI tRCv.2•e0 PRINTED p -Os-2 s nt'1 • i ' .- �• @'" rfi_ P �i�1 ..E 9. 8Y y�y�'^ 3 fi` i O �` - . r•'UEa 666 ppoi- 61 4L oil d €k • , �, r.. _ T fl?.�■R e2 A �i. $9q.1�_ry d_��3,cp- • �9� gi Nip ' Y ppCpp E jig ^9 i a' i • 7'� 4Lafi fi Y' A�$ 1 fil- d C9;� fi fiR� Q.t 8 n ai fiEiE 6 v 3 �fivv +ev iJA • a d� Si v$g • F 4 1 A a f i �i Eaa g c es a a i �� Y a "��9 fio:fi fi •� a gAA� a �� y �I -r_ �r �;. ; = � - .. ._.--: '��3.�� � i>L:.dY--..r„`=.._ _1t�= 4:�--�.'�.=1a:.—=•.... /2"::•"I i�'':,`:, . ' , r.� �Lr' f � IHA i i`' 4aaF�a _ •� ��, �a� �. Ii.fFylt . r • � � ` ,� +' a ¢.. 4 •. , _ r o O n 11� z - From: Jackie Murch At: RJS Insurance Services, Inc. FaxID: RJS INSURANCE SERVIC To: ANTHONY POLAROSSI Date: 7/6/05 03:35 PM Page: 2 of 2 ACORD CERTIFICATE OF LIABILITY INSURANCE OPIDJM 1 SOUTH-4 07/06/05 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE RJS INSURANCE SERVICES, INC. HOLDER. THIS CERTIFICATE DOES NOTAMEND, EXTEND OR 27782 El Lazo ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Laguna Niguel CA 92677 Phone: 949-349-1300 Fax: 949-349-1313 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A, Wilshire Insurance Company INSURER Or. Southwestern Dirt Exchange, Inc. INSURER C. 31500 Grape St. Suite #3 Lake Elisinore CA 92532 ' INSLRERU. i INSURER E: COVERAGES THE POUCIES OF INSURANCE USTED BELOW HAVE BEEN ISSUEDTO THE INSURED NAMED ABOVE F GRTHE POU CY PERIOD INDICATED. NOTWITHSTANDING ' ANY REQUIREMENT, TERM OR CONDITION OF AI4Y CONTRACT OR OTHER DOCLW84T MATH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN TIE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE UNITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR L SRD I TYPE OF INSURANCE POLICYNUMBER POUCYEFFECTIVE DATE QdM.DD:rY) POLICYEXPIRATION DATE(NIMDD:W) LINDTS GENERAL LIABILITY EACHOCCU7RENCE f 1,000,000 A X X COMMERCIAL GENERAL UABILItt BA2495078 lO /22/O4 Until DAMAGE TO RENTEDPREMISES Ea aarence) f 100,000 CA1..MACE X Cancelled OCCUR NED EXP(Aw me.p—" f 5, 000 PERSONAL&ADV INJURY f 1, 000 '000 GENERALAGOREGATE f 2, 000 " GENLAGGREOATEUMITAPPLIESPER PRODUCTS -COMPIOPAGO f 2,000,000 ! PRO- POLICY . JECT LDC AUTOMOBILE LIABILITY COMBINEDSINGLEUNIT S 1,000,000 X ANY AUTO _ ( ALLOWNEDAUTOS - BODILY INIURf f A X SCH®IAEDAIROS BA2495078 10%22/04 Until (Per PerwN X A HIREDAUTOS BA2495078 10/22/04 Cancelled ao = A X NON-pNNEDAUTOS BA2495078 10 /22/O4 (BPer al`OId'.Y ttMenp PROPERTY DAMAGE f . - (Per xcidwD GARAG E LIABILITY. AUTO ONLY - EA ACCIDENT f FA ACC f ANY AUTO OTFERTHAN f AUTO ONLY: A00 EXCESSUNBRELLA LIABDITY EACH OCCURRENCE f AGOFEOATE f OCCUR I� CLAIMS MADE f i DEDUCTIBLE ' f RETENTION { WORKERS COMPENSATION AND WC STATLL OTH ' - EMMOYER5 LIABILITY � . TORY LIMRB ER E.L EACH ACCIDENT f ANY PROPRIETO RIPARTNEFUEXECUTNE OFFICERIMEMBER EXCLUDED? E.L DISEASE - EA EMPLOYEE f ITYe4 OewrBe urda E.L DISEASE- POLICY LIMIT . f SPECIAL PROVISIONS bd- OTHER Until A TRLR INTERCHANGE BA2495078 10/22/04 Cancelled $1,000DED $20,000LMr DESCRIPTION OF OPERATIONS r LOCATIONS i VEHICLES i EXCLUSIONS ADDED BY ENDORSEMENT.: SPECIAL PROVISIONS PER VEHICLE SCHEDULE ON FILE WITH CARRIER. REQUEST TO CARRIER TO NAME HOLDER AS ADDITIONAL INSURED. FAX: 760-777-7155 CERTIFICATE HOLDER CANCELLATION LAQU I NT SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING INSURER WALL ENDEAVOR TO MAIL XXXXXXXXX 10 DAYSVIRITTEN - NOTICE TO THE CERTIFICATE HOLDER NAKED TO THE LEFT. BUT FAILURE TO DO SO SHALL CITY OF LA QUINTA WPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR 78495 CALLE TAMPICO REPRESENTATIVES. LA QUINTA CA 92253 Au HO NTa D , e _ , ACORD 25 (20OV08) I © ACORD CORPORATION 1988 From: Jackie Murch At: RJS Insurance Services; Inc. FaxID: RJS INSURANCE SERVIC To: ANTHONY POLAROSSI Date: 716105 :03:35 PM Page: 1 of 2 Fax From the Desk of Jackie Murch Company: RJS Insurance Services, Inc. Phone: (949) 349-1300 Fax: (949) 349-1313 .To: ANTHONY POLAROSSI Company: CITY OF LA QUINTA Phone: Fax: (760) 777-7155. Pages: 2 Date: 7/6/05 03:35:04 PM Subject: LA QUINTA CERT FOR SOUTHWESTERN DIRT Message: FOLLOWING PLEASE FIND THE CERTIFICATE OF INSURANCE THAT YOU REQUESTED, ADDITIONAL INSURED ENDORSEMENT WILL FOLLOW:DIRECTLY FROM CARRIER: THANK YOU CC: WILSHIRE INSURANCE SOUTHWESTERN DIRT - PERMIT NO.4438 Southwestern Dirt / Hauling Earth (Legal Load) / Darby Middle School 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. This permit or copy of it shall be on -the work site (usually the job trailer) for inspection during the actual work performed. 3. The haul route has been determined to be as follows: Start: a. Darby Middle School heading west on Darby to Washington b. Turn Right on Washington to Avenue 42 c. Turn Right on Avenue 42 to Jefferson d. Turn Right on Jefferson to Ave 48 site Return Trip: a. On Ave 48 heading west to Washington b. Turn right on to Washington to Darby c. Turn right on to Darby to the site 4. Southwestern Dirt (Jerry Rulifson), hereinafter referred to as "Permittee", shall be responsible for providing continuous dust and erosion control. A. During Soil Import/Export activities the following shall be accomplished a. A valid grading permit shall be active at both the import and export site. b. Premoistened at the import and export sites prior to loading transports c. Premoistened soil prior to cover in the loading transports to near 70% of optimum moisture content. d. All trucks shall be covered and have a minimum of 6" of freeboard prior to hauling. e. Street cleaning shall occur, as necessary, at import and export location. 5. Streets shall be kept clean. They shall be completely cleaned at the end of each working day and more frequently, if required. 6. 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 Ist to September 30: Monday -Friday, -6:00 a.m. to 7:00 p.m., Saturday 8:00 a.m. to 5:00 p.m. Special Conditions Page 1 of 4 J l .i PERMIT NO.4438 Southwestern Dirt / Hauling Earth (Legal Load) / Darby Middle School a Work shall be prohibited on legal holidays and Sundays. Note: Construction work (including setting up traffic control devices) is not permitted on any Arterial street (ie any 41ane street) before 8:00 a.m. 7. 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 Riverside Country Traffic Signal Maintenance Department at (951) 955-6894 if signal operation at the intersection is to be altered in any way. 8. 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. 9. 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 hauling procedures. The letter must be approved by the city and at minimum state from the owner the following: A. Approval of the construction B. Plan identification C. Time Frame of Closure D. Alternative Routes 10. 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. 11. Pursuant to Section 14.16.250 of the La Quinta Municipal Code (Ordinance 1.0 § 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. 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. Special Conditions Page 2 of 4 PERMIT NO.4438 Southwestern Dirt / Hauling Earth (Legal Load) / Darby Middle School 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 be responsible for notifying the inspection staff of import fill and overexcavated areas on a daily base's. If the inspector's phone number is unknown, the permittee shall call the Public Works front counter phone at 777-7075 or the Assistant Engineer I at 777-7089 to determine the city inspector's phone number. If the imported fill or overexcavated locations indicate to the inspector that inadequate soils exist based on the criteria set forth'in the Project Soils Report, Public Works Greenbook, or Uniform Building Code, the Public Works inspector may Halt grading,operations until the inadequate soil has either been removed or the Public Works Director authorizes grading to continue. The above testing or observations does not relieve the permittee's responsibility for future repairs due to settlement at and near the.locations of the work area. Prior to the city issuing a building permit, the permittee's Geotechnical Engineer of Record shall submit a certified letter indicating that the grading has been completed per the approved plan. A compaction report on all fill is required following pad certification and prior to building permit issuance. 14. The issuance of this permit and the City approval of the related construction improvement plans do not r provide a vested entitlement for all design parameters that may have been utilized for the plans. As such, plans approved for this permit may be "at risk" for further modifications as it relates to any follow up improvement plan requirements as required by the city or existing errors & omissions by the architect or engineer of record. 15. The permittee shall not encroach upon private property without prior written approval (submit to the Public Works Department, attention to the Assistant Engineer 1) of the private land owner whom is being encroached upon. 16. Prior to,performing construction work and closing any lanes in the Public Right of Way, the permittee shall call the City at (760) 777-7097 at least 48hrs prior to work and request an appointment for a preconstruction meeting with the City Inspection staff. 17. If public traffic lanes are required to be closed, this permit is not valid until the permittee submits, to the Public Works Department, an approved traffic control plan at least 2 weeks prior to start of construction or parking on'the paved R/W. . 18. All landscaping, irrigation, decorative rock, decorative concrete, lighting, etc., shall be replaced to its original condition. 19. Access and'egress.to all local properties shall be maintained at all times. Special Conditions Page 3 of 4 PERMIT NO.4438 Southwestern Dirt / Hauling Earth (Legal Load) / Darby Middle School 20. Any damaged asphalt must be replaced to its original condition and patched according to La Quinta Standards or the Greenbook. 21. 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. 22. 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. 23. The City of La Quinta reserves the right to revoke, suspend or void this permit at any time. 24. 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. . Special Conditions Page 4 of 4 NOTE: With proper validation ' this form constitutes an7>� encroa6ffient permit CITY OF LA QUINTA 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 117t,111 July 7, 2005 Subdivision Improvement Permit — Class III Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION T)nrhir Midello Rehnnl _ Dn—r1,1r x. Tjnnliincet-A" (Street address or Description of Location) !_ Export of dirt. PURPOSE OF CONSTRUCTION DESCRIPTION OF CONSTRUCTION Hauliniz DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN July 8. 2005 Sketch (attach construction plans if appropriate) APPROXIMATE TIME OF COMPLETION Aua_ustt 30. 2005 ESTIMATED CONSTRUCTION COST $ N/A (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: COMPLETED - 4J 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 r pay for any additional replacement necessary as the result of thiswvork./ Signatu ,Name of Applicantx(please print) Business Address Telephone No. Sane as above. Name of Contractor and Job Foreman Business Address Telephone No. M/A Contractor's License No. N/A M/A City Business License No. Applicant's Insurance Company Policy Number FEES: Subdivision Improvement Permit —Class III Public improvements: 3% of estimated construction costs Private improvements: 3% of estimated construction costs Minor. Improvement Permit — Class IV: See attached schedule N/A II Inspection Fee $ Permit Fee 100.00 Penalty Cash Deposit -Surety Bond if required TOTAL: $ 1.00.00 Receipt No. Received by , date . Recorded by 41� _ 4438 PERMIT VALIDATION 4438 , PERMIT NO. DATE APPROVED EXPIRATION DATE 7 — 7 - 0 6 DATEISSUE B y r, Administrative Authority Telephone: (760) 777-7075