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yA J
<r
NOTE -
With proper validation
this form constitutes an CITY OF LA QUINTA•
encroachment permit
m �
APPLICATION FOR PERMIT
•PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit — Class III
DATE: November 4, 1991 1-* Minor Improvement Permit Class IV 1
'LOCATION OF CONSTRUCTION N.E. Corner of WaSbington Street and, Highway Ill in La Quinta,
approximately 160' N. of Hw3►. 111 on Washington Street (Cliffhouse). I
(Street address or Description of Location)
- .PURPOSE OF CONSTRUCTION - To firovide sewer Aervicot• Sketch (attach construction plans if appropriate)
to the Cliffhouse Restaurant.
DESCRIPTION OF CONSTRUCTION Relocate an Existing` shown on attached District
18•- inch sewer force main to provide cloarance As shown
Nos. d �
182 1
from•e
. g 4 1,8243.
xistin water main,
5 R 6 operate
District to o
a e
p and plantain
DIMENSION OF INSTALLATION OR REMOVAL all sewer and water 1 nee.
SIZE OF EXCAVATION, IF NEEDED
li APPROXIMATE TIME WHEN WORK WILL BEGIN November 1991. ♦`
t w. l Syr, /
APPROXIMATE TIME OF COMPLETION G.r
II: ESTIMATED CONSTRUCTION COST $ •30,000.00
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements) '
In consideration •
0 of the granting of this permit, the applicant hereby agrees to:
9 9 P PP Y 9
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
tarted.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. �y
SbA W R
6 Signature of Applicant or Agent
C.V. Water District P.O. Box 1058 Coachella, CA 92236 (big) 398=2651
Name of Applicant (please print) • Business Address Telephone No.
C.V.W,D. Al Guitron Same as above i
Name of Contractor and Job Foreman Business Address - Telephone No.
Contractor's License No. City Business License No.
Applicant's Insurance Company Policy Number - r
•ti
FEES: Subdivision Improvement Permit — Class III
Public improvements: 370 of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit,— Class IV: See attached schedule
Inspection Fee $
Permit Fee r
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ ' 0
Receipt No.
Received by
Recorded by
It
Date '
PERMIT VALIDATION'' '
PERMIT NO.
DATE APPROVED 1�I 6 � 91
EXPIRATION DATE
DATE ISSUE /
By
ministrative Authority
TELEPHONE: •(619) 564-2246
I
•
•
NOTE:
i
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit S
APPLICATION FOR PERMIT Ip
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
OF Tfi69
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, watbr mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
November 4, 1991 Subdivision Improvement Permit —Class I I I
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION N.E. corner of Washington Street and Highway 111 in -La Quinta
approximately 160' N. of Hwy. 111 on Washington Street (Cliffhouse).
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION To provide sewer gPrvi
rP Sketch (attach construction plans if appropriate)
to the Cliffhouse Restaurant
DESCRIPTION OF CONSTRUCTION Relocate an existing
xisting18
18— inch sewer fore main to provide elparanrp
As shown on attached District
from existing water main.
drawing Nos. 18241 — 18243.
DIMENSION OF INSTALLATION OR REMOVAL -- 6 X 6
District to operate and mantain
all sewer and water lines.
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN _
APPROXIMATE TIME OF COMPLETION — Z
ESTIMATED CONSTRUCTION COST $ 30.000.00
(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:
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 124) 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
C.V. Water District P.O. Box 1058 Coachella. CA 97936 (619) 39R 9651
Name of Applicant (please print) Business Address Telephone No.
C.V.W.D. Al Guitron Same as above
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 Ill
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs 1 L I
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $
Permit Fee —�
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE f I'Z9'— ZZ
DATE ISSUE / -
By.
ministrative Authority
TELEPHONE: (619) 564-2246
The following General and Special Provisions are attached to and made a part. of Permit No. 1 Z7&
GENERAL PROVISIONS
The following shall always apply:
ENCROACHMENT ON PRIVATE PROPERTY: This permit authorizes work to be accomplished within City of La Quinta right of way
ONLY. Whenever construction extends within private property, it shall be the responsibility of the permittee (or his contractors) to
secure 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 be permitted t o* operate on any
paved surface unless fitted with smooth -faced street pads. All mechanical outriggers shall be fitted with rubber street shoes to protect
the paving during excavations. 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 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 areas shall be properly lighted and barricaded as deemed necessary by the City
Engineer or La Quinta City Public Works Inspectors. Suitable detours and detour signs shall be placed and maintained for the duration
of the project. The City shall be notified 24 Hrs. in advance of any traffic detours or delineations.
CARE OF DRAINAGE STRUCTURES: Any drainage structure including corrugated metal pipe, concrete pipe, steel culvert and
concrete structures encountered during excavation which necessitate removal shall be replaced in kind. In the event.it becomes
necessary to remove or cut existing drainage structures, City of La Quinta shall be notified prior to commencement of this work.
Drainage structures and open drains shall be kept free of debris at all times for proper drainage.
RIGHT OF WAY CLEANUP: Any surplus material resulting from excavation and backfill operations shall be removed from the right of
way. All paved surfaces shall be broomed clean of earth and other objectionable materials immediately after backfill and compaction.
Existing gutter line and drainage ditches shall be replaced to their original standard or better. All excess material shall be removed
prior to paving. Water tanker shall be used, as required, to sprinkle the job site to keep down dust conditions and shall be used
immediately after backfill.
DE -WATER OPERATIONS: If de -watering operations are required and pumps are forcing water on City of La Quinta roads, it shall be
the responsibility of the permittee (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 isfelt bythe permittee that he must close a street for
any length of time, permittee shall contact this office to obtain the necessary permission.
SPECIAL PROVISIONS
The follwing shall apply ONLY when indicated:
R1 NOTIFICATION: Permittee shall notify the City at 564-2246 at least 48 hours in advance of starting construction.
R2 CASH DEPOSITS OR BONDS: A cash bond or an approved surety bond in an amount of not less than $
shall be furnished in the name of 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
posted prior to commencement of any work on this project .
/ R3) UTILITY CLEARANCE: (Substructures) Priorto making any excavation within the City of La Quinta right ofwayauthorized
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 bethe sole responsibility
of the permittee.
R4 UTILITY CLEARANCE: (Surface structures) No work shall be done under this permit until allutilities 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"valueof not less than and in conformancewith Cityof 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 (1').
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 LaQuinta shall checkgradesupon receipt ofplanand profileand/or grades asestablished by
a licensed engineer.
R9
CURB REMOVAL FOR DRIVEWAYS: A portion of the existing concrete curb and/or curb and gutter ( feet)shall be
removed. Curb and/or curb and gutter shall be saw cut prior to removal. Depressed curb, matching concrete gutter and
concrete driveway approach shall be constructed in conformance with City of La 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 ( ") of class
aggregate base. Driveway construction shall conform to attached drawing.
R11
CULVERTS: A inch diameter I-) culvert shall be installed with the invert approximately 1-1 /2
inches below and in line with the existing flow line. Culvert installation shall 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 to be surfaced shall be treated with soil sterilizer. Rate of application shall comply with the
14
manufacturer's specifications.
COORDINATE'WORK: The
proposed work shall be subordinated 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 Quinta projects.
I 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 and correctly
be replaced by a licensed civil engineer or surveyor at the expense of the permittee. A complete set of notes showing the
ties to these monuments shall be furnished to the City Engineer prior to the removal of any monuments. This office shall
�^ ^I
be notified upon completion of replacement of all survey monuments for proper project clearance.
R16 SURVEY MONUMENTS: Prior to excavation or beginning of construction, all survey monuments shall be tied out by City
of La Quinta and suitable payment or guarantee of payment shall be made as reimbursement for all work involved.
R17 PAVEMENT CUTTING: Pavement will be mechanically cut to a straight edge prior to excavation. Method of pavement
cutting shall be approved through the office of the City Engineer. (Under no circumstances shall excavating equipment
be used to excavate prior to cutting of pavement). Excavation material shall be placed in such a position as to best
facilitate the general flow of traffic. Prior to final paving operations, any damage to pavement straight edge shall be
corrected. °
R1 PAVEMENT CUTTING: Pavement shall be saw cut prior to removal. Prior to final paving operations, any damage to
pavement straight edge shall be corrected.
LIMIT OF EXCAVATIONS: Excavations shall be limited to 1,000 lineal feet of open trench before backfill operations must
begin. All excavations shall be properly barricaded with lights overnight, on weekends and holidays forthe 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.
R2 BAC KFI LL MATE RIAL: B a ckf i I I sha I I be fre e of b ru sh, roots or other o rg a n ic s ubsta nce detr i menta I to its use for pu rposes
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 (3') and vibrated using vibrotamperor 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.
R2 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') lifts where trenches are of excessive depths. Care is to be exercised 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 intervalsof not more than 1,000
feet and a minimum of one (1) test on each road. One (1) copy of each test shall be forwarded to the City Engineer for
approval and filed prior to making permanent repairs. Compaction tests shall be made as outlined in Section 6.3.01 of the
Standard Specifications, Division of Highways, State of California, dated January 1973.
R24 OMPACTION TESTS: If so required by the inspector, compaction tests shall be made for each crossing or service line.
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 asoutlined 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 nocase shall
—the placement of the temporary pavement exceed a five (5) day limit.
R26 PERMANENT PAVEMENT REPAIR: After backfill and compaction operations have been completed, a temporary patch
consisting of two inches (2") 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 laterthan days aftercompletion of
temporary road repair. Cjce- C_^JI_> ,e 5/S
R27 PAVEMENT REPAIR: F.A.S.: Upon completibn 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 (15) days after completion of temporary
paving. Concrete base shall be of five -sack mix and shall conform to the City of La Quinta Road Improvement Standards
and Specifications, Ordinance #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.
30
STREET RESTRIPING: Where street striping is still visible on streets to be excavated, such striping shall be replaced upon
completion of permanent repairs.
R31 TREE RELOCATION OR REMOVAL: Tree relocation within the City of La Quinta road right of way shall be accomplished
by a licensed, bonded and insured tree service, and handled safely without interference or hazard to the traveling public.
It shall be the responsibility of the permittee to maintain the tree in a vigorous growing condition at its new location.
Trees to be removed shall be removed in sections which can be handled safely without interference or hazard to highway
traffic. The entire width of the tree stump shall be removed and disposed of so that no debris remains in view of the
highway. The stump hole shall be backfilled and thoroughly compacted as specified 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 iemoval 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 necessaryto restrict traffic, the work shall be restricted to a maximumof 500feet at anyone time.
Adequate signs, flagmen, and/or barricades shall be provided to protect the traveling public at all times.
c. . If tree trunks are partially outside of the City of La Quinta road right of way, permittee shall make his own
arrangements with adjoining property owners for consent -to the trimming in addition to the authorization provided
by this permit.
d. All tree trimming on EVERGREEN TREES, PALM TREES, and other ORNAMENTAL TREES shall be accomplished to
the satisfaction of the City Public Works Inspector.
e. Abutting property owners shall be contacted, in all instances, prior to trimming or topping trees.
f. Pruning shall, in all instances, be at the shoulder of the crotch to insure even, fast healing in all cuts of two inches
(2") and above in size. Sealant shall be applied to all cut sections as directed by the City Public Works Inspector.
ADDITION ----ENCROACHMENT PERMIT NO.1276 ---- CONDITIONS
R33 Survey monuments shall be protected in place or
re-established pursuant to City standards and the State of
California Land Surveyor's Act.
R34 Work shall be coordinated with the City of La Quinta's
forces to preclude delay or interference with the City of La
Quinta's projects.
R35 Contractor shall comply with the local noise ordinance and
construction operations and maintenance of equipment -within
one half mile of human occupancy shall be performed only
during the time periods as follows:
October 1st to April 30: Monday -Friday 7:OOa.m.-5:30p.m.,
Saturday 8:OOa.m.-5:OOp.m.
May 1st to September 30: Monday -Friday 6:OOa.m.-7:OOp.m.
Saturday 8:OOa.m.-5:OOp.m.
Work shall be prohibited anytime on Sunday and Federal
holiday.
R36 A)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 responsibility to adequately
barricade and detour this site. A Traffic control plan shall
be submitted for approval by the City Engineer.
B)Work area and traffic control signs shall be well lighted
in accordance with Section 5-06 Lighting Devices State of CA
manual of traffic controls.
C)Any modification to the operation of the traffic
signal shall be under the -direct control of Caltrans.
R37 All excavation at or near the travel way shall be backfilled
at the end of the work day, for the protection'of the
traveling public.
R38 Street closures shall not be allowed at any time.
R39 A minimum of two travel lanes shall be maintained at all
times on Washington street.
R40 All work to be performed within the existing paved section
shall be temporary paved and maintained by the Permittee.,
permanent pavement shall be placed,no later 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 1-800-422-4.133 and an "inquiry number" shall be
provided to the City Public Works Inspector.
R43 Pavement shall be sawcut prior to removal.
Additional Conditions - Encroachment Permit No., 1276
Page 2
R44 All backfill subgrade'soil shall -be compacted to nothing
less than 90% 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 Ibase
material shall be compacted to nothing less than 95%
relative dry density.
.R45 Replacement pavement section on Washington street shall be 9"
AC by deep strength operation.
R46 If the work is to be performed by forces other than that of
the permittee, the contracting•company,will be
required to apply for an additional encroachment permit
and pay the appropriate fee.
R47 The permittee shall comply with all requirements of
permits issued by and Caltrans. Any night time
operation shall only be permitted subject to the
approval of that agency.
R48 Work on Washington street is to be performed between_
10 pm -and 5 am to cause least impact on traffic;and subject
to the approval of Caltrans."
R49 Permittee'shall notify Riverside County Sheriff 24
hours prior to beginning construction.
NOTE: T
With proper validation _
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains '
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
DATE: 1 O - �)1 -01 1
LOCATION OF CONSTRUCTION
\.A QJ�CL. APPRox \fop'
(Street a00nst.or Description -at Location) -
Subdivision Improvement Permit — Class I I I
Minor Improvement Permit Class IV
"\\N,e \\\ oN \NASNI NVT oN SCQEzT • ((_L.\.FF\-b0 SC
PURPOSE OF CONSTRUCTION 70 PRoVtDE S��/t"1Z SERVICE
10 TWE _C.L\1V-lF"0 ISE RES"cF1v ^1T
DESCRIPTION OF CONSTRUCTION' RELOCATE AN EK\ ST \i.►C7
\56- VAC" SESNt R RCE -To PRaV VDE
C\2AfGWCE T -9.0M EXE vV RZE2 Muhl
DIMENSION: OF INS'+, .LLATION OR REMOVAL —6 X (1 _
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN IRS \
Sketch (attach construction plans if appropriate)
As c Aos_�ed
—
\8Z1 -k3 \S�C►C� oQQC�T�.
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COSTS Z10,000
(Including removal of all obstruction, materials; and debris; backfilling, com-
paction and placing permanent resurfacingand/or replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrees to:
Indemnify, defend and swe-the City, its authorized-sgems, oftkars, representsuves and employees, harmtesa from and against any and all
perteltieL liabilities or Ion resulting frorn-cialirmt,or court action and arising out of any accident, toss or damsge•to persons or properry
happening or oewrrintg•es a proximate,result of any work undertaken -under -the permit granted pursuant to this application.
Notify the AdministraUVf Authority at least twenty-four 124► noun 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 Outnta and to pay for any additional replacement necessary as the result of this work.
I
�-q",
Signature of Applicant or Agent
17�S�t i�AC%\\Q_, C,a_ g223(o Co19- 3�1 S-Z�5
Name of Applicant (please print) Business Address Telephone No.
C .y -W • D . - AL G\.) ► NS Nbclj e —
Name of Contractor and Job Foreman Business Address Telephone No. -
Contractor's License No.
City Business License No.
Applicant's Insurance Company Policy Number
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712 EUGENE ROAD
REGISTERED CIVIL ENGIN R N0. 23953 PALM SPRINGS, CALIFORNIA 92264 OFF-SITE SEWER.. PLAN 3:
�• rz,11 12-31-93 PHONE: (619) 327-7786 G t7M W Gf� n
DATE: REGISTRATION EXPIRES FOR PARCEL MAP 22576
SCALE: BENCH MARK: PD -3 FORf� f
ELEV . 76.19 HIGHWAY 1 1 1 OF
AS SHOWN ABOVE BRASS DISK IN BASE OF FILE NOHEETS
TRAFFIC LIGHT ON NORTHEAST S . W . 1 /4 SEC . 19 . T . 5S . , R . 7E .. S . B . B & M .
CORNER OF WASHINGTON ST. .,
[DATE: MARCH 1991 W.0.2220 FOR: T. S. RESTAURANTF. B. i
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