481NOTE: z
Witk proper validation
this corm 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: 19 /d /Rq
Subdivision Improvement Permit — Class III x
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION mR 91771 r of t9A c0h i nrr+-nn qi, T,,,,i/nf AaArng on north drip
re:d Waring Drive
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION to provide water to tract Sketch (attach construction plans if appropriate)
23773 - Starlight Dunes
DESCRIPTION OF CONSTRUCTION install 1-18" stub out
connection approx. 1450:� west of Adams on
Far-,& Tvu�arinq Drive
DIMENSION OF INSTALLATION OR REMOVAL 6 1 x6'
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 12/89
APPROXIMATE TIME OF COMPLETION 12/89
ESTIMATED CONSTRUCTION COST $ 16,000
(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:
SEt ATTACHED DRAt7INGS
District to operate and maintain
all sewer and water lines
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.
0 ri nv-A
Signature of Applicant or Agent
Coachella Valley 'eater District PO Bozo 1058 Coachella, CA 92236 393-2651
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No.
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
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No
$ n/a
Received by Date
PERMIT NO.
PERMIT VALIDATION
481
DATE APPROVED 17 /Q /RP
EXPIRATION DATE 1/31/90
DATE ISSUED 12/4/89
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
-
NOTE: i.
a Wit1h proper validation
thisa`orm 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 I I I }'
DATE: 12 /4 /Rq Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION T-Q ? -177 2 V - of T#A ah i ncx+-On Rf- _ PnT/nf Lviarng nn nc) rf-h C i ap
Fred daring Drive
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION to provide water to tract
237773 -- Starlight ight Dunes
DESCRIPTION OF CONSTRUCTION install 1-°18" Stub out
connection approx. 1450t west of Adams on
Food Warinq Drive
DIMENSION OF INSTALLATION OR REMOVAL C e X6 f
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 12/a19
Sketch (attach construction plans if appropriate)
APPROXIMATE TIME OF COMPLETION 12/tit9I
ESTIMATED CONSTRUCTION COST $ Yo c FI��
(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:
SEE ATTACHED DRAWINGS
District to operate and maintain
all serer and eater lines
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.
`i3 _ PnyY,3
Signature of Applicant or Agent
Ccaa,;_'r=o11« Valey 14at4z District �)G >oa: 105C Coachal.la, CA 92236 3! `--?G,"l
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. 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 s r;
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
$ n/a
Received by Date
PERMIT NO
PERMIT VALIDATION
481
DATEAPPROVED 1"'/4/RS
EXPIRATION DATE 1/31/50
DATE ISSUED
Byv
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
Y
• • ^
: The following General and Special Provisions are attached to and made a part of Permit No.
} y
!►; yr;;,
r l
., -GENERAL PROVISIONS •
- -
The following shall always apply:
ENCROACHMENT ON PRIVATE PROPERTY: "This permit authorizes work to be accomplished within City of Ls Quints right of way.
•ONLY. Whenever construction extends within private property; it shall be the responsibility of the permittee (or his contractors) to
_
secure permission from abutting property owners. Such authorization must be secured by the permittee prior to starting work.
TRACKLAYING CONSTRUCTION EQUIPMENT:, Cleated tracklaying construction equipment shall not bepermittedtooperateon any
paved surface unless fitted with smooth -faced street pods. All mechanical outriggers shall befitted 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 '
• •_
J
pavement is scarred, spelled, or broken during the term of this contract. or if the pavement is marred. Cityof La Quints shall request
,S _
,• 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 erects shall be properly lighted and barricaded as deemed necessary by the City
•
Engineeror La Quints City Public Works Inspectors. Suitable detours and detour signs shall be placed and maintained for theduration"
• .` a,' , 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
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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 alltimesfor proper drainage: -
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RIGHT OF WAY CLEANUP: Any surplus material resulting from excavation and backfill operations shall be removed fromthe rightof
'way.All paved surfacesshall bebroomed clean of earth and other objectionable materials immediately after backfill and compaction.
t - -
Existing gutter line and drainage ditches shall be replaced to their original standard or better. All excess material shall be removed
` ..
prior to. paving. Wateatanker shall be used, as required, to sprinkle the job site to keep down dust conditions and shall be used
�, _ . ,� •
immediately after backfill. - - 4 • '
'• DE -WATER OPERATIONS: Nde-watering operations are required and pumps are forcing wateron City of La Quints 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 line 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 bythe permitteethat he mustclose a streetfor J
,•
any length of time, permittee shall contact this office to obtain the necessary permission. -
.
SPECIAL PROVISIONS • _ T' 'e .
The follwing shall apply ONLY when indicated: -
Rl / NOTIFICATION: Permittee shall notify the City at 564.2246 at least 48 hours in advance of starting construction. -
2 CASH DEPOSITS OR BONDS: A cash bond or an approved surety bond in an amount of not less than
y
} -
shall be furnished in the name of City of La Quints to cover all work involved in the restoration of the various La Quints
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roads and survey monuments. This bond shall be continuous until cancelled by the City Engineer. This bond must be
.,
,. -,posted prior to commencement of any work on this project .
• - -
R3 .,UTI LITY CLEARANCE: (Substructures) Prior.to making any excavation within the City of La Quints right of way authorized 'I"'
',. 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 bethesole responsibility
- - *
of the permittee. -
-4
-" R4 UTILITY CLEARANCE: (Surface structures) No work shall be. done under this permit until all utilities are dear of the
proposed work site. The permittee shall notify all concerned utility companies of the proposed work. .
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.R5 PAVEMENT WIDENING: Area between the proposed concrete gutter line and the existing road pavement shall be
' _ - •
'' '," surfacedwith inches of A.C. paving placed on ` inchesofclass aggregate subbase course
• ,� -�
having an"R".valueof not less than - " and in conformance with Cityof La Quints Road Improvement Standards
- - •
and Specifications, Ordinance #461. r "-
" "
R_6 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').
• I -� - - -
, • R7 GRADES & STAKES: City of La Quints shall establish grades and stakes for the proposed concrete curb and gutter
"
construction. `- • , -
• •-
RB GRADE CHECKING: City of La Quints shall check grades upon receipt of plan and prof its 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 ( fee0shall be =
removed. Curb and/or curb and gutter shall be saw cut prior to removal. Depressed curb, matching concrete gutter and
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concrete driveway approach shall be constructed in conformance with City of La Quints 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 1 ,I of class `
"
aggregate base. Driveway construction shall conform to attached drawing.
All CULVERTS:A- ' inchdiameter(•)culvenshall beinstalled with the invert approximately l•1/2
-
inches below and in line with the existing flow line. Culvert installation shall conform to the attached drawing. 3• '
•
),R12 SIGHT CLEARANCE: Sight clearance of 600 feet in either direction shall be assured and maintained. • - "
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813 SOILSTERILIZER: The area to be surfaced shalt be treated wiih soil sterilizer. Rate of application shall comply with the -
manufacturer's specifications.
•
/ R14 !COORDINATE WORK: The proposed work shall be sutiordinaied'to any operation which the State of California or
•
City of La Quints may conduct in this area during the period of this permit. Work shall be coordinated with the State or
City of La Quints forces to preclude delay or interference with State or City of La Quints projects.
•R15% 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 be completely tied out so they maybe readily andcorrealy
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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 monumems:This office shall
+,
' be notified upon completion of replacement of all survey monuments for proper project clearance. c • -
t
- - R16
SURVEY MONUMENTS: Prior to excavation or beginning of construction, all survey monuments shall betied out by City
�t
of La Quinta and suitable payment or guarantee of payment shall be made as reimbursement for all work involved.
R17 .
PAVEMENT CUTTING: Pavement will bemechanically 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,
PAVEMENT CUTTING: Pavement shall be saw cut prior to removal. Prior to'final paving operations. any damage to
.�
pavement straight edge shall be corrected.
R19/
LIMIT OF EXCAVATIONS: Excavations shall be limited tot.000lineal feet ofopen 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.
�R20
BACKFILL MATERIAL:.Backfill shall be free of brush, roots or other organic substance detrimental to its use for purposes
•
Q
of 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 ofnotgreaterthan
three feet 01 and vibrated using vibrotamper or equivalent equipment. Alternate methods maybe substituted, but in any
case a relative compaction of 95 percent shall be attained within the structural section of the roadway.
R22
,BACKFILL 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 (5'1 lifts where trenches are of excessive depths. Care istobe 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 equivalenttothe surrounding ground. whichever isthe greater
compaction. Where pending or flooding is used for a maximum settlement, adequate dikes will be constructed to retain
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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. -
. _023-
COMPACTION TESTS: If so required bythe inspector, compaction tests shall be made at intervals 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 andfiledpriorto making permanent repairs. Compaction tests shall be madeasoutlined in Section 6.3.01 of the
..
Standard Specifications. Division of Highways, State of California, dated January 1973.
- R24
COMPACTION TESTS: If so required by the inspector, compaction tests shall be made for each crossing or service line.
One 11) 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.
R25
TEMPORARY PAVEMENT REPAIRS: After completion of backfill and compaction operations.'a temporary patch
�,.
consisting of 2 inches of SC-800 shall be placed on a prepared subgrade. The SC-800temporary paving shall be placed
after a maximum of 3,000lineal feet of 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.
• R26
PERMANENT PAVEMENT REPAIR: After backfill andcompactionoperations have been completed, a temporary patch
consisting of two inches (2") of SC-800 shall be placed immediately. A permanent patch f inches A.C.
surfacing placed ono inch class base shall be placed no later than days eftercompletion of,
•
temporary road repairp ii /'�� y�1 } L
dcotnpaction,atemporarypatchconsistingoftwoinches(2'1
R27
PAVEMENT REPAIR: F.A.S.:Uponcomjleftiorip�b73ckfilla
of cold mix paving (SC-800) shall be placed immediately. A permanent patch of three inches (3'1 of A.C. surfacing shall
be placed on six inches (6") concrete base as directed. but not later than fifteen 0 51 days after completion of temporary
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paving. Concrete base shall be of five -sack mix and shall conform to the City of La Quinta Road Improvement Standards
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and Specifications, Ordinance f1461. - - -
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 Quints 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
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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 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
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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 week 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 atanyone 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 oermit.
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.
1. Pruning shall, in all instances. be at the shoulder of the crotch to insure even, fast healing in all cuts of two inches
(21 and above in size. Sealant shall be applied to all cut sections as directed by the City Public Works Inspector.
ADDITION ---- ENCROACHMENTlPERMIT'NO.4 --CONDITIONS
r R33.
Survey monumts.shall'be protected in :place, or,
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=re-established; pursuant to-City''standards ;and the State of'R". ,
California. Land Surveyor's Act.,.
° R3`4
-.
Work -shall -be coordinated with ' the • City , of . La. Quintals
forces to -preclude delay br interference wiah'the City' of La,
Quintal s projects. `.,;' �"
- R35
Contractor shall comply ,with the local noise ordinance and
cF f
construction operations` acid maintenance of, -equipment within,
one% half mile of human 'occupancy shall_ be 'performed only
during',the .time periods as 'follows-c '.
October. -1st to°•April '.30: Monday.=Friday •7: 00a.m. -5: 3,0p.:m.-
;t, Saturday`,; 8:00a.m.-5:00p.m.
May,,lst ' to' September 30: `Monday-Friday,,'6: 00a.m: -7 : 00p.m.: -
f Saturday, 4. ' 18: 00a.m: -5: 00p.m'
' .
Work shall. -be prohibited -anytime on Sundayand Federal- .--
holiday. ,• ,
R36.
Traffic control shall`be as .per Cal Trans Traffic Manual•.
Field`,adjustments n.detouring shall be accomplished.as',.
directed in order. to adjust -to actual ,'field "conditions.-,.'xIt'..
shall be the -contractor's responsibility to'adequately
•
barricade and detour this site., ..
R37
A11 excavation at or '.near°.the"travel way shallbe backflled -.
at .the °end of •.the-. work day, for `the protection of the •
tt ra'velirig public.
' r R38
Street _;closures x shall not be allowed at any time.
R39
A ' minimum of one •travel , lane shall.be, maintained`` at all
times•with`.f1agmen during working hours.
R40
All work to,be..performed within,the-ekisting paved section
shall be temporary paved and maintained- by, .the Permittee, ,
y permanent`.pavement°shall be placed no later than 15 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;-422-4133 and',an "inquiry number"0, shall . ' be t
provided -to the City.Public Works Inspector. f
R43
.- 'Pavement shall be , sawcut prior to 'removal'.
R44 r
- xIF
All backfi_ll subgrade_ soil' -%shall be compacted .to nothing
less ' than' 90 o relative dry density, all backfill ,soil within-
t
the top 2' • 'of finish pavement. surface .sYiall; be ,compactedLtQ
nothing less than 95 o relative ' dry density, ,- all --base
.'
material. shall be compacted to .nothing .less -than 95 0 €
'
relative' dry. .density. "
R45•
Replacement pavement, sections shall be_4"' AC over 8',' Class
II aggregate base, on Fred' Waring.,Drive, ,3"_AC over- 4•" .. Class
II aggregate.base on all ,minor`streets.: ,`
,
NOTE:
With proper validation
this form constitutes an �► i�� '.
CITY OF LA- QUINTA . r
encroachment permit ' �, 1
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)��
- OF THE��S
- -_- � ��- • -mil-- y
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 SUB0IVISIONS
• { r Sac \: C�ac 'O �c�e.S _ . -
' - Subdivision Improvement Permit— Class III
s : DATE: 2 ' Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION �RRG� Z3ti�13 E_ OF WPrS��NG*C-OtJ s�. \P4 OV Y"C*lnS
• cx-\ . x toc'v\<'%\ c�2, o'� Trcec� W P,9LW(:7 , .
IStreet address of Description of Location)
PURPOSE OF CONSTRUCTION CTO C0%SkC- Sketch (attach construction plans if appropriate)
• • 23�1t1"3 - STA0.�-�GE1� we�EbS -
DESCRIPTION OF CONSTRUCTION =t�S}A\\ \-VY %1 b o.�k SEE M tw_,Ic i 8ra>-��nCt >
• C.0 \t a k' Ot\ 'Ar?99,0%A SO I t v4 esk- 0,5 46clim S 0o t ��
ced wf�� _A wYj Z) eve, sus c cs1' C
OIMENSIO:: v9 !",ST, .LLATION OR REMOVAL X �� A\\ � �� O,,x•� W PA-er `irw—,:.
i
SIZE OF EXCAVATION; IF NEEDED ,
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION t�18`t
ESTIMATED CONSTRUCTION COST S (C300
(Including removal of all obstruction, materials, and debris,'back fill ing, 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 authorised agents, offtars, rep
resentatives and employes, harmless from and against any and ali
penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loci or damage to persons or property
happening or occurring as a proximate result of any workundertaken under the, permit yranred pursuant -to this application.
Notify the Administrative Authority, at least twenty-four (24) hours in advanea'of• the time when work will be started.
Comply with - all applicable City Ordinances, the terms and conditions of the. permit and all applicaWs rules and. regulations of the City of
La Quints ana to pay for any additional replacement necessary as the result of this work.
Signature of Applicant or Agent
�223b
Name of Applicant (please print) Business Address , - Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No, City Business License No,
Applicant's Insurance Company: Policy Number
i
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