0764r
NOTE:
Withypropvalidation
this for constitutes an
encroachment permit
771
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
.;,
+3
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
August 1 1990 Subdivision Improvement Permit — Class I II
u
DATE: g Minor Improvement Permit Class IV
-r
LOCATION OF CONSTRUCTION Washington sTreet South of Avenue 47 at the Church
(Street address or Description of Location) r
PURPOSE OF CONSTRUCTION nrnvi AA r3nmAcf-i e~ uaat-Rr Sketch (attach construction plans if appropriate)
arsr,tri r.,o
DESCRIPTION OF CONSTRUCTION inst-a11 1.-1' 1./2"
riny;=r—f i n lzaf-Ar Ge nri pe
DIMENSION OF INSTALL'ATIPN�OR REMOVAL 44 hole an
east slae and .� x nose on w•eszc sMe for
lnnri nn arch i t,A
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN Aua 90 at 10am
4 �
APPROXIMATE TIME OF COMPLETION Ana 90
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
In cons deration'of the granting of this permit, the applicant hereby agrees to:
7
Indeinnify,•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.
�. Signature of Applicant or Agent
Coachella Valley WAter District PO Box 1058 Coachella, CA.,
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.
T d
Applicant's Insurance Company Policy Number'
FEES: Subdivision Improvement Permit —Class II I
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs 0764
r .
Minor Improvement Permit —Class IV: See attached schedule. e �,
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
$ —0—
Received by Date
PERMIT VALIDATION
PERMIT NO. 0764
DATE APPROVED 8/l/90
EXPIRATION DATE 12/31/90
DATE ISSUED' / 8/1/90
By ,4 A,
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
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NOTE:
Witl pr,,oper-,vaIIdation 0� Q
-this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)��
_ w
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
August 1 1990
DATE: � - Minor Improvement Permit Glass IV
LOCATION OF CONSTRUCTION Washington sTreeti soauth of . Avenue 47 at the Church
(Street address or Description of Location) r
PURPOSE OF CONSTRUCTION r)rovi clP domPsti-e water' Sketch (attach construction plans if appropriate)
�0nT _P
DESCRIPTION OF CONSTRUCTION install 1-1 1/2"
arwnpiAtir.wa�tAr' sPrvi'ra -
r �
elast slae Ian(A 5 `�X L I�ORriRUi OV IL /}eb L bJ.UU r
hnri nct mair.h i nP
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN Auer 90 at ham ,
APPROXIMATE TIME OF COMPLETION Aug 90
ESTIMATED CONSTRUCTION COST $
(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. r
Signature of Applicant or Agent.
Coachella' Valley WAter District' PO BOX 1058 Coachelila, CA
Name of Applicant (please print) Business Address Telephone No.
' Name of Contractor and Job Foreman Business Address Telephone No.
t
' Contractor's License No. City Business License No.
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I I I
Public improvements: 3% of estimated construciion'costs s..
Private improvements: 3% of estimated construction costs0764
AA
Minor Improv ment Permit — Class IV: See attached schedule leo
j
Inspection Fee $ _0'PERMIT VALIDATION
Permit'Fee PERMIT NO. 0764
,.
Penalty'/ /90
' `Cash Deposit -Surety Bond DATE APPROVED 8 1
if required EXPIRATION DATE 12/31/90
TOTAL: $
DATE ISSUED' / 8/1/30
Receipt No.
By
Received by Date Administrative Authority
Recorded by TELEPHONE: (619) 564-2246
w The following General and Special Provisions areattachedto and made a part of Permit No. �/ r
GENERAL PROVISIONS
t
The following shall always apply r1 -
ENCROACHMENT ON PRIVATE PROPERTY: This permitauthorizes work to be accomolished within City of La Quinta right of way
TS • ,
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.
-*•TRACKLAYINGCONSTRUCTION EQUIPMENT: 'Cleatedtracklayingconstruction equipment shall not bepermitted tooperate onany
paved surface unless fitted with smooth -faced street pads. All mechanical outriggers shall be fitted with rubber street shoes to protect
the paving'du�ring excavations. Rubber -tired equipment only shall be used in. backfill operations in paved areas. If..the'existing
pavement is scarred, spatted, or broken during the term of this contract, or if the pavement is marred. City of La Quinta shall request
1 *' that these portions of road be resurfaced over their entire width. Resurfacing shall consist of one coat of two inches (2') of A.C.
` µ surfacing plus appropriate seal coat as specified aboc
PROTECTION OF TRAFFIC All excavations and work areas shall be properly lighted and barricaded as deemed necessary bythe City
. Engineer or La Quinta City Public Works Inspectors. Suitable detours and detoursignsshallbeplacedandmaintainedfortheduration
of the project. The City shall.be notified 24 Hrs. in advance of any traffic detour's or delineations. '
CARE OFDRAINAGE 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: Anysurplus material resulting from excavation and backfill operations shall be removed from the right of
way. -All paved surfaces shalt be broomed clean of earth and other objectionable materials immediately after backfitl 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. .,
' . r 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 (contractor) to control this'water'and to provide off-street barricades when necessary.
CLOSING STREETS: No street shall 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 emergency vehicles. In the event it is felt 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 t
The follwing shall apply ONLY when indicated: t
(R1)NOTIFICATION: Permittee shall notify the City at 564-2246 at least 48 hours in advance of starting construction.
s." 4 R2 CASH DEPOSITS OR BONDS: A cash bond or an approved surety bond in an amountof notlessthan s
shall be furnished in the name of City of La Quinta to coverall 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
sted prior to commencement of any work on this project . - t .
R3 IU TILITYCLEARANCE:(Substructures) Prior to making any excavationwithinthe City ofLaQuinta right ofway authorized
4 v,: 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
of the permittee. , t
(/R4 TILITY CLEARANCE: (Surface structures) No work shall be done under this permit until all utilities are clear of the
\,-- proposed 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 be
surfaced with inches of A.C. paving placed on inchesof class aggregate subbase course
having an "R" value of not less than and in conformance with City of La Quinta Road Improvement Standards
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 IV):
' R7 GRADES & STAKES: City of La Quinta shall establish grades and stakes for the proposed concrete curb and gutter
construction.
R8 'GRADE CHECKING: City of La Quinta shall check grades upon receipt of plan and profile and/or grades as established by
t.; µ a licensed engineer. ,
+r R9"61_1813 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
he, 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
}` R property line and the existing road paving shall be 2-1/2 inches of A.C. paving placed on ( ") of class
aggregate base. Driveway construction shall conform to attached drawing.
,fir - • _
f,
R 11 CULVERTS: A inch diameter ( )culvert shalt be installed with the invert approximately 1-1/2
inches below and in line with the existing flow line. Culvert installation sliall conform to the attached drawing.
R1 SIGHT CLEARANCE: Sight clearance of 600 feet in either direction shall be assured and maintained.
R13 SOIL STERILIZER: The area tobesurfaced shall be treated with soil sterilizer. Rate of application shall complywith the
anufacturer's specifications' 11 ` `
/•R14.. OORDINATE WORK: The proposed work shall be subordinated to any operation which the State of California or
%, City of La Quinta may conduct in this area during the period of this permit. Work shall be coordinated with the State or
,City of La Quinta forces to preclude delay or interference with State or City of La Quinta 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 may be 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 '
Y 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 RVEY MONUMENTS: Prior to excavation or beginning of ruction, all survey monuments shall be tied out by City
La Quinta and suitable payment or guarantee of paymt.... ... all 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 excaming 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
",,',-J�pavement straight edge shall be corrected.
R19 LIMITOF EXCAVATIONS: Excavations shall be limitedto 1,000 lineal feet of open trench before backfiil 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.
`820 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 La Quinta deems unsuitable (spongy or
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 (31 and vibrated using vibrotamper or equivalent equipment. Alternate methods may be substituted, but in any
case a relative compaction of 95 percent shall be attained within the structural section of the roadway.
C,�R22 ACKFILL PLACEMENT: Backfill shall be applied in layers of not more than 50 percent of the total depth of the trench
eforeflooding bra maximum offive-foot(5') lifts where trenches are ofexcessive depths. Care istobeexercised that the
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 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 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.
824 CbMPACT10N TESTS: If so required by the inspector, compaction tests shall be made for each crossing or service linea
\.�_,_,-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.
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 -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
the placement of the temporar, p ierr,eoi exceed d iiia 13) day limit.
R26 PERMANENT PAVEMENT REPAIR: After backfill and compaction operations have been completed, a temporary patch
consisting of two inches 12") of SC -800 shall be placed immediately. A permanent patch of inches A.C.
surfacing placed on a inch class base shall be placed no later than days after completion of
temporary road repair.
R27 PAVEMENT REPAIR: F.A.S.: Upon completion of backfill and compaction, 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 It 5) 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 #461.
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 streelstobe excavated. such striping shall be replacedupon
completion of permanent repairs.
831 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 safelywithout 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 sectionswhich can be handled safelywithout 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 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.
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 500 feet at any one 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
(2'1 and above in size. Sealant shall be applied to all cut sections as directed by the City Public Works Inspector.
..SPECIAL.. CONDITIONS--PERMIT'-NO.. •0764
n
6
The- following conditions -shall . be -,inet., .to•.• the satisfaction of;:
City Engineer. .• :. ' _
' 1.
All work must be completed by August- 10, 1990--
990. "2.
2.
Street 'closures shall. not •be..allowed, at any time.
Streets,shall.be kept,clean. They shall.be-be completely
1 F
cleaned -at =the, end: of the working . day, and,.more frequently if
required..
3..
Contractor -11 comply with. the local noise ordinance and
-
constructi_on'.operations, ands maintenance, of_ within.
'equipment
one --half . mile of, `human occupancy, .shall_ be, . performed"only---.
during the 't-ime periods as"follows: „ .
"
October lst to.April 30: Monday-Friday-'7:OOa.m.-5:30p.m:r�
Saturday 8:00a:m.-5:00p.m:
,
May 1st -to September 30:• Monday -Friday 6:00a.m.17:00p._m.+F
_
Saturday,,8:OOa.m.-5:OOp.in..
Work ° shall be - .prohibited' anytime *on- Sunday, and Federal.
-
holidays. «
j
4.r
Advance warning signs and.traffic control shall be -installed
and.maintained,in-accordance with Ca1.Trans Standards -and
'
subject to the approval of the City Engineer.
5.
Two lanes . of 'traffic. on` paved surface shall remain open on
•
'Washington Street'at all.'times., Temporary pavement shall,
-be placed following each working day. Traffic.control,shall '
%be as�per. Cal'Trans Traffic Manual.' Field adjustments in
;.
•
detouring -shall be accomplished as'.directed in order:to adjust
to actual field conditions. It shall be.the•contractor's
i
responsibility'to adequately barricade,and detour this site.
.Flagmen'shall be required at.all.times during work on st<,
Washington Street.; A Traffic.control plan shall,,be submitted r
prior to -commencing, construction for the approval by the City,
.Engineer .
' a:
; ,
-6.
All backfill sub`grade soil shall -be compacted to.. nothing- -less = „F
than X90% relative dry density,, . all backfill soil within the -
top 2.''of."finish�pavement surface shall be compacted to
`-
nothing less than -95% relative dry density, all•base material..
+.
shall be. -compacted to.nothing less .than 95% relative dry'.
density. -
'7 .
Permanent` replacment pavement shall be : 4 1 / 2" =AC over, 8" . Class.,.
II aggregatebase." a
,
8.
f Permittee shall notify the -City at - 5'64-2246 at. least 24',hours
in' advanceof starting construction.
9.
If`..work- is •to be- performed-•byothers than those of ,the utility
i
company,+ the, contracting `company wi-ll .be required to..apply,,,
for ,an additional- encroachment permit and pay"'the F
appropriatefee.,
NOTE: .. ` Lr *1 • .; � • �- • .
With proper validation f1,Q
this form constitutes an
CITY OF •LA QUINTA
encroachment permit
APPLICATION': FOR PERMIT-
{ PUBLIC-WORKS CONSTRUCTION (ENCROACHMENT)7.
\'
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 II `'
GATE: %3 �7' j ,` =� Minor Improvement Permit Class IV
5 LOCATION OF CONSTRUCTION iArsl'-�-� �'� `�-'J S-T SD U7?-la' drF% f=A'V I�'y
U.
1 f5treet address or. Oescription of Location! ti }
PURPOSE OF CONSTRUCTION �� V t .(�c•' r70 t/v-cS TN' Sketch (attach construction plans if.appropriate)
�• ,
j DESCRIPTION OF CONSTRUCTION. 1.1 S T L L- I I/2 11
1DQV1tiES-nC__ >.fA AA—G1Z -SCS-VLC'L,
' 'OIMENSIQ":-CF !NVALLATION OR REMOVAL
T r7 c. //l! N ST A 'X 2I 1_M aN '
Gf/t✓5T 5/f7� (Z1ASLl/A/(n7DAy Sr FyA_ 7QOP_(NQ, 04Af_ 1"JE,
;.
SIZE.OF EXCAVATION; IF, NEEDED
APPROXIMATE TIM WHEN WORK WILL BEGIN, AUh 9 �`
APPROXIMATE'T''IME OF COMPLETIONA Uin Q'.O `
ESTIMATED CONSTRUCTION COSTS'
(Including removal of all:obstruction, materials; and debris;.backfilling, corn-
i
Ram ion and placirig permanent, resurficing 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 remployees, harmless from and against any and air
! penalties, liabilities or loss resulting from claims or court action and arising out of any'accident, lois or damage to persons or property•"
happening dr 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 1241' hours in advance of the time when work will be-started. .
Comply with all applicable City Ordinance s. the. terms 4and conditions I of the permit and all applicable, rules and regulations of the City of .
La Quinta ano to pay for any additionalreplacement necessary, as_the,result. of. this work.
,Signature of Applicant ar Agent
Name of Applicant (please printf ; • Business Address Telephone No..
Name of Contractor and Job Foreman Business Address Telephone No.
? ' Contractor's License No. ='.. City Business License No:
i ' Applicant's Insurance Company , = Policy Number