2290NOTE:.
With proper validation
this form constitutes an CITY OF LA QUINTA
encroach menj,zrerm it
\ 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
11295
LOCATION OF CONSTRUCTION 78-765 Lowe Dr.
Tract 23268 Lot 171 Acacia Homes
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Install & maintain a 4"
sewer lateral
DESCRIPTION OF CONSTRUCTION excavate install lateral
and repave street
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 1-13-95 8:00 am
Subdivision Improvement Permit— Class III
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
APPROXIMATE TIME OF COMPLETION
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:
See attached conditions
See attached drawing
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.
Xnature of Applicant or Agent
Coachella Valley Water District P.0 Box 1058 Coachella. CA 92236 398-2651
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 I I I
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.
-0-
$ —0—
Received by Date
Recorded by
2290
PERMIT VALIDATION '^
PERMIT NO. 2290
DATE APPROVED 1-12-95
EXPIRATION DATE 2-25-95
DATEIS E L 12-95
By
Administrative Authority
TELEPHONE: (619) 564-2246
'he 10110 luno lienersl ana Saec/al Nroyiluons are anacnea to aro mad a pan at Perron No,
Z 90
GENERAL PROVISIONS
-he following snail always apply:
i°
ENCROACHMENT ON PRIVATE PROPERTY' 'hi '
ONLY. Whenever construction enenas within orrvaee orooertv.rt snail be the reaeeomtnlsnee wimcn City of
secure permission tram V Quints rtgnt of wev
aCTION property owners. Sucn autnorizatlon must be secured nv tins oermin m°°for n
TRACKLAYING CONSTRUCTION a cantraetorsf m
UCT10N EQUIPMENT: ClasteotreckuW M prior to starting wore
owed sumacs capias$ tmedwitn sineet � tbnatrtltaron eduioment spell not paoerm
:no bawns curing ekcawtiona• pub ler r neo eau omen[ amv esenle+anll bree u tor, mento
ggera spall be lttteawl[n ruober street OO°rt1° on nus
cavemen[ is scarred. $called• or broken curing ins term amnia contract. sed in oaactlll operations in sro�tobrat"
tnat tnsaa ocrnons or rRor It the pavement la marten City at L areae• 1} the Hauser
dao be resurfaced &a s over tnelr ve. width. Reahp,acl City at V
' lurtaeing plus e00rabnate test opat as atatlfled °hove, r,9 small COnatat O} one Qu1nD anal) redia:
cost of two Inches 12.1 of A.0
PROTECTION OF TRAFFIC: All excavations and wars sicca spell be.oropeny ligntep ono barncedep ea sea
Engineer or la Quanta Cin Public Worths lnapeetors. Suinble detoursartsdatour sigma$map peO1 aro
oft a prole=. rhe City snail be notdted 24 Mrs. In advance of a naso tingat Ytne G4
arty traffic mi1^Talneofortneauranan
CARE OF DRAINAGE STRUCTURES:detours or dalitneabpry
concrete structures eneaumaredduri 9 excavaticrainaon struc necessitate
including corrugated metal
momswry to remove or cut °lusting drainage RrURurea. aloe. in kind. pith a w, culvert app
mama amen be feptacad in kind. In the eyent.lt WcpR1a{
Drainage structures and open drains spall be kept free ofGN of La Quints $flail be natdtisa ortar to commencema
aebrla at all tames for orocer drainage. tit Of
rota wars.
RIGHT OF WAY CLEANUP: Atty surplus material reaultirtq from excavation and backfill o
way. All paved surfaces snail be broomed clean of eanrl and otner oblecuunaole materials, mmeota Hai °per b
Existingperaflona snail
be
removes from the right of
Butter iine eco drainage di[cnea snarl be replaced to their original standard or patter. All excess material Prior to paving. Water tanker teriallafloepmp°t:ti"
immsaaateiv after batadill, spall be casco, as roffuirec. to sprinkle the (op site to two dawn dual °nip 01 rengwea
conaltiona ons snag be used
OE -WATER OPERATIONS: If de-watenng op°ruaans are recuirad nano outrms ars rorcinq water on Ci
the resconsiodity of ins ostmmes Icuntractori to control into water aro to
City of la Quints masa. it shall be
CLOSING STREETS: No street small be closed. A minimum of Wovae oil -street oamraaas va
ne,
^fin.
accosts for the eatolning property owners aro ems • �° t°n° of traffic spall be maintained at all times to
any length at time. Dermm" snag contact this officE p�nletes. In the aYent it is felt bvmepermmal that no must �elainar
obtain the f"K.& sry oermuaaon. cresiaaatreettar
The folMn -- -—%jVl4lUNS
iq small goofy ONLY when indicated:
R1 NOTIFICATION: Permrnse snail notify the City a 777 70 75'
R2 CASH DEPOSITS OR BONDS: A casn bane or an at haat 48 hours in advance of starting cpn�on
shall be lurnlsnea m [ma name of City of V amused surety bona in an amount at nations than a
rosins arta surveyGlenne to cover ell Work involved In [ns restoration at the y
monuments. This bona shall be continuous until cancelled by the City Eng rest. ThIs
posted prior to commencement of a arrow V Quina
any wort an this Malec.
borto anus} ba
R3 UTILfTYCLEAgANCE:ISubsruc}urealPriortomakln ,
Wpermit.the ANCE.(esnail ctucontact stall cert ganydia-vsttonwithlnin@Cityofto
Damage to eluati cam@d utility compvyes relative to the right
of way°ueherized
ng atmstnlcurea restarting from operations location of °nshng a
Of the Dermmea, c�du4ap under into parmn snail be m° acne �ruRures.
R4 UTILJTY rosOonstbiury
CLEARANCE (Surtap atruetureel
No wal Snail be doll
Drop-- wan sate. The permm e, snail natiry ail concerned uul unser this permit until all utilltlea ars clear
PAVEMENT WIDENING: Area between ice ty companies of the or the
R5 proposed wart,
surfaced win inches of A. C- paying proposed roncret• fNtter line end the existing road pa
having an "R- vsfuG of not less than placed ro�—inches Of c4ss anent shall be
ana Spacnications. Ordinance a461. andinczntormefleewtin ; agwagatesubbaesccurse
C Not La Quante Road Improvement Standards
1 PA inch to one
toot :I I., tw. tnedropertylineandtopoftheorpooaeoconcretecurbsnailbegradeaopau
(� 1 /4 into to one foot 11 j.•
R7 GRADES &STAKES: City of La Quints spall establish grades and stakes for the proposed concrete curb and ducat
construction,
R8 GRADE CHECKING: CityafLaQuanta snail cheagraoeaudonr gutter
a hrensed engineer. ."4101 of clan andordfde end/or
greaea as eeublitheo by
Re CURB REMOVALFOR DRIVEWAYS: A portion of the existing concrete curb and/or curb and gutter 1 f
removed, Curb and/or curb and gutter snail be ssw cut prior ro rentpyal. Decreased curb. mstching t:oncrete
concrete dnvewa , a Mtlsnag pp
OproaCf snag OO constructed in canto to
with City a e Quints Standard c 0207. crOgutter end
R10 DRIVEWAYS, A,C„ prnreways small be conatructed as not n
Property line and the eating road caving snail be 2.1 /2 into altIes r A.C. paying
aggregate case. Orlvewey construction snail conform to attacneo
R 11 CULVERTS..:_ drawing. g behilisen ins Placed
alter existing aralnage•oahern. Surfacing Placed an 1 __•) of cla ��
ncn diameter i
culvert snail be Installed with the invert acorosirmaten, 1 -1 ; Z
inches oelow and in lune won the existing now line. Culvert installation snail conform to the ettac neo drawing,
til SIGHT CLEARANCE. Sigm clearance of 600 lest to either direction snail be assured and maintained.
R13 SOIL STERILIZER:sbeatit:ationa The area to as surfaces sp
manuraaurar'sall be treated win esu sterilizer. Rate araccucation shagtmn
rer'a s
COORDINATE ptyw'lntntne
WORK: Thu proposed wort shatl be sucaralnat"
to any operation which the State of California or
Cit' of La Quanta may conduct in this area during
City of La Quima farces to 9 the period of this permit. Work snail be cooralnateo elm she State or
preclude delay or interference wim State or City of La•Qulme molecp.
R15 URVEY MONUMENTS: Prior to excavation or b
camenlne of all sueeta or oro aglnntng of construction. all survey monuments Wntah elu
be rearacaa oy • licanaed CJyfl�� tines wrier, involved anau be corttaleterir tied out so to st On the
tiest0 mees "Inew ar survsYpr at tris et�r arMne may be resalW fate pprr�ly
roanimMns MGM be hlrmanea toe» City ee�mK A e>»rteteoa octal polus
oe rotwtea soon ednai�.. Erhturteer orswm rr..
=16 -._RVEY k`10NUMENTS -P-.M,,o excavation or oeetnntno or construction. all survevmdnuments shall pet
:t W Uumis and suitaole oavment or Guarantee OT cavment snail be made as reimbursement t
rooeut pv t.ity
R17 °4VEMENT CUTTING. Pavement wool be mechanically Of all ware Involved
Cutin snail be accrovea tnrouan Ins Onice Ol the City Englmea/. tUnde► adocircumstancesrtartSnalnetcayaod
GQ used 10 excavate odor t0 cut[Irlb OI DaVlmentlD>rbment
facilitatesed one general flow Of tfartin ?riot to liner Gay Excavation material snail be placed In such a gequtoRiast
:erected 9 ooerarions. env damaoe to pavement straight
as to nest
18 G4VEMENT CUTTING. Pavement spall be saw cut otic to re t9nt cage snail be
Anointment straight edge snail be corrected. removal. Prior t0 riper caving operations,
R19 UtHTOF EXCAVATIONS: Excavations snail as limited to 1. any Damage to
begin. All excavations snail be 01`006M barricade° Witm "GhtO� lineal
me at open trench chafe DBClid"I Operations
Imetravalln g Weatends and noticays tortnmust
gpupne,ThePuoueWorsslnsoeaorsnauoeterminetnesunaolutvotextavationoarnao,n t n=ca e.No
excavation snail remain Goan tot a aerica exceeding live l6i Gave No excavation snail be mace unie
material Is actually on the work site. 9 neaahase. No
R20 BACKFILLss the C0112 -ruction
MATERIAL: Bat7ttlll shall be tree or brush. rootsor omer organic supstanee aetrimenta. , ..;s Ilea for
Of a00uCin9 an aaeouaelV consolidated Oncl[iGl. Any material `inns the City of 1 a
• saturated material) Whirn is encountered aurin a friftposes
9 xcavatron snaLL not be used for baact�ItjabuL snarl be suatwn�or
raputxa by an aowoved sane or gravel. _
R21 BACKFILL SAND: Barlfdl shall be approves OPlemente° at
throe feet 13'I and vibration limn wprota transit-miv sand ar equivalent an° snail beolaceo In lihs of rib[
9 mperoredurvaientequroment.Alrematemelhpasmavbesub praatertnan
Casa a relative compaction of 95 Percent shall be ahalned within the ;:ructurat secuOn of the roadway,
R22 BACKFILL PLACEMENT: Bactdill snail be ebailea in layers of not more than 50 percent at the total a llltrte0 put in any
rench
boilers flowing or a maximum Ot ftve-toot 151 lifts wnere trenches ara of excessive a
bst*tdl materiel is not suclet=e° to extreme 8`611 by fl depth
otitis
Goths. Care is to os exandaap that me
resulting compaction snail be not teas Than 90oereem or�ing operations. Baekttll matervelen, to iel shall be ate
cw compaction. Where comping or flooding is used tar a manmulm settlement, adequathe te dikes will be consw b Inst me
thawater. Where ggrouna.wnicneverismegrenter
Inning is used. the lets shall be at sufficient length to reacn -ins bottom of each :a and ins tetter
supply snail be continuous.
R2 COMPACTION TESTS: If so required by the inspector, co yet end the water
teat and a minimum df one (1 I test on each road. One t 1batOn tests shell be mope at intervals Of m
approval and filed prior to malum PY of each test snail be fonNaraea to the Cityot Inare as
1000
Standard Soacumatfons. Division of Hanan[ repairs. Compaction testsshall be maaeasoutlinea in Sear n 101 of tree
24 COMPACTION TESTS: If so required by the nsppaatec f Calitomie, dated January 1973.
One 11) copy of each Test snail be torwarden to the City Engineer tarctione tests
share be mace for eatsh QOisln
COtrOaction tests snail be made as autumnal In Section ti.3.01 ottne 0croat and tiled Ortor to matin gateauservielms.
�at California. Gated January 1973. SDeaflgtons. Divisionat permanent remits.
R25 TEMPORARY PAVEMENT REPAIRS: Attar tbfnptnlon of b tflhwatia5teta
consisting of 2 inrnes at SC -800 shall be placed on a prepared s�uog ade. The SC -800 temporary Dawn
after a maximum at 3.000 lineal test of trench nas aeon a compaction operations. a temporary
paten
Ina placement Of the tempora Raveled and oackfill averatlans completed. coot Inlnp Vp mC
temporary pavement exceed a five IS) day limit.
R26 PERMANENT PAVEMENT REPAIR: After backfill and cantpactidn operations nave been completed, a Ts
consisting of two inches 12'1 of SC -800 shall be laces immediately q ermaneT
o p ^'Donn patch
surfacing placed dna inch class paten of ��� inches A. C.
temporary road repair. base shall be pfact',b no later than
days aharptumpletlon of
R27 PAVEMENT REPAIR: F.A.S.: Upon completion Otbacirt'llan"Orricaction. a temocrarvpatcn consistingat
d cola mix caving (SC -8001 shall be placed immediately. A permanent patch of three Inches 13-1 of A.C. two swfactm
be Placed on six Inches le -I concrete base as air
easd. but not later than fifteen 1151 Gays cher completion Gini fres 12'1
D R"- Concrete base snail beat five -seat mix and shall t not later
to the Ci at � 9 snail
and Sattaheatona Ordinance a481. H OWnta Rona Imprevetn tethpoary
RZB FOG SEAL: A fog seal coat consisting of an application of asphaltic
aetStartdnras
determined try the City Engineer. emulsion snap be applied over all
petct areae as
R29 SEAL AsuchRMOR COAT: existed seal coat r a,$$ In9 of an application binder and screenings shall be acp1loo on 811
whNa Slot seal coats s.S prior fO al uahce of this permit. Seat or armor coats small be applied as sOecdieG m
37. Standard Specifications. State of California. Oatt7f areas
be lcmmottshed by a licensed contractor engaged0iin Ims at Highwaysof . dated January 1973. Work of pawmamSection
R30 STREET RESTRIPING. Where street striping Is sirsmble on streetsbusiness
Too exca epavemtearsuch striping snail be rapfncea u repair on
repair.
Completion at permanent repairs.
0
R31 TREE RELOCATION OR REMOVAL. Tree relocation witn,nins City bt la Qumnta roan rignt of way snail ben
bye licensed. bonded and insured tree service. and handled safelywitnout mterierence or nalara to the trvmh
aCOmDlishe0
It shall be the responsibility of the permittee to maintain the Tree m a vi ^9publia
ng condition at its now
Trees to as removed shall be removed In sections which can be handled sagely Wmmautl TefTerence or nazarq to hlgn On
traffic The enure `inti Of The tree stump shall be remove° and disposed of so trial no debris remains In view of the
highway. The stump Hale shall be backfilled and thbrou n tgnwev
becomes necessary to restrict traffic. the wart shall be restricted o a maximum ofSOD feet folta any one time.
tme
signs. flagmen end/or bamcades shall be provided to owing Paragraph. Where it
prates the travelingAdequate
Large notes resulting from tree removal snail be backfilledana corn public at all times.
surrounding ground. Whichever is the greater cam oaaea to not less than 90 oercent or
tests snail comply with Seaton 6.3.01 of the Standara Specifications. i Division of Highways. State of equivalent California. Gated
by me impact or field method. Comeactton
January 1973.
R32 TREE TRIMMING:
a. Only Ins necessary trimming snail be acc0111011snea to provide clearance of the facility for one calendar year
All broken or Weak sections within the trimming shall be flmpyeG,
,• Where it peCOm6s necessary to flstria traffic. th! wart shall be restricted to a maximum of 500 feet at any one,,
A�quats signs, flagmen. and/or oarrlcaaes snail be provided to protea the [raveling public at all times
C If ranme trunks are pa joins outside of the ref ty of La Quints road right of way, permmee anal) meta his own
by this
Wllh atlI0lhlRg Dra00Ry owners far cOrisamt TO the trimming In addition t0 the aulnontatOn provided
by mss oermn.
d. All tree trimming on EVERGREEN TREES, PALM TREES. and armor ORNAMENTAL TREES shall be accomplished to
the satsfaalon of the City Public Worsts inspector.
s' tonp proA ting ba conlaaed In an iLalancya. prior to Inmmtng or lapping Thea
f. PntnAbutna wLL0" awr1e_
♦1
SPECIAL CONDMONS--PERMIT NO. 2290
--- CVWD ---
In addition to the standard permit conditions, the following shall apply:
1. All work shall be performed in accordance with the latest edition of the Standard Specifications
For Public Works Construction.
2. Permittee shall be responsible for providing continuous dust and erosion control.
3. Streets shall be kept clean. They shall be completely cleaned at the end of each working day
and more frequently if required.
4. Contractor shall comply with the local noise ordinance. 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
.m:Saturday 8:00 a. m. to 5:00 p. m.
May 1st to September 30: Monday -Friday 6:00 a.m. to 7:00 p.m.
Saturday 8:00 a.m. to 5:00 p.m.
Work shall be prohibited on legal holidays including Sundays.
5. Permittee shall assume responsibility for. repair of any pavement breakdown at the haul road
access to any public or private street and for any damage to other City streets or facilities.
6. Permittee shall submit a traffic control plan to the Engineering Dept. for approval prior to
starting work in travel way. 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) . It shall be the permittee's responsibility to detour and barricade this site.
7. Street closures shall not be permitted. A minimum of one travel lane on paved surface shall be
maintained with flagmen at all times.
8. Permanent pavement replacement section shall be one inch greater than existing. Existing
pavement section on Lowe Dr. is 3" of A.C. over 4" of A.B.
9. All landscaping irrigation decorative rock etc. shall be protected in place as much as possible
or replaced to its original condition.
10. Prior to excavating, the permittee shall contact Underground Service Alert at 1(800) 422-4133.
11. All work shall be coordinated with the City's contractor and others working within the area ,as
directed by and to the satisfaction of the City Engineer.
Special Conditions - Permit No. 2290'
Page 1 of 2
SPECIAL CONDITIONS - PERMIT NO. 2290
CONTINUED
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. All backfill and subgrade soil shall be compacted to 90% relative dry density, all backfill soil
within the top 2' of finish pavement surface shall be compacted to 95 % relative dry density, all
base material shall be compacted to 9.5% relative dry density.
14. Site clearance of 600' in either direction shall be assured and maintained at all times.
15. Street striping that is damaged; removed etc. shall be replaced to its original condition by the
permittee at no cost to the City.
16. All excavations at or near the travel way shall be backfilled and paved as directed by and to the
satisfaction of the City Engineer at the -end of each work day for the protection of the traveling
public.
17. This permit authorizes work in the City of La Quinta Right -of -Way only. It is the permittee's
responsibility to secure permission from any other abutting agencies or property owners.
18. Ingress and egress for all properties shall be maintained at all times.
19. The City will determine the final limits of asphalt replacement.
20. The pavement replacement section width shall be one foot greater on each side of the trench.
21. Trenches shall be backfilled with a slurry mix approved by the City Engineer. The mix design
shall be, submitted to the Engineering Dept. for approval.
Special Conditions = Permit No. 2290 Page 2 of 2
01/12/95 USA/SC Page. 2
LAQO1 00002 USAS 01/12/95 09:54:23 0004500 INSUFFICIENT NOTICE GRID
Ticket :.0004500 Date.: 01/12/95 Time: 09:23 Oper: JRF
Old Tkt: 0898052 Date: 12/13/94 Time: 08:16 Oper: KOB Revision: 00
State: CA County: RIVERSIDE Place: LA QUINTA
Loca.t: 78765 LOWE OR X/ST N HARLAND OR
:-**SEE REMARKS***
Grids: 0214EO112 Delineated: Y
Work : EMERGENCY INSTALL SEWER LATERAL
Work date: 01/13/95 Time: 09:00 Hrs notc: 023 Priority: 1
Instruct : MARK BY Done for : CVWB5-COACHELLA VLY
Permit : NOT AVAIL
Company: CVW85-COACHELLA VLY Caller: JAVIER VILLARREAL
Address: P 0 BOX 1058
City&St: COACHELLA HEIGHTS, CA Zip: 92236
Phone: 619-398-2651 Ext: 604 Call back: 8-430
Formn: ED SALIS
REMARKS
REF#898052 EXP WORK NEVER STARTED, REO ALL MEMBERS TO REVALIDATE MARKS
Mbrs : CVW85 GTE10 II002 LAQ01 SCGIKA SCG41 UTI40 UTI68 UTI71
NOTE:
With proper validation
this form constitutes an
encroachment permit
CITY OF LA QUINTA
JAN 1 2 1995
PUBLIC WORKS
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
rq i,-_0
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: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION a=,Z:2
LDT: /%/ TRACT' 23C�Z66
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION /N37ALL AND MAINTAIN fk FOUR
I NCH C +'1j /JQU,SE LATTIZAL- TOIL =WK -E Srlli CZ
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION A)INE-TY C V0J DAYS
ESTIMATED CONSTRUCTION COSTS Md00.o0
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
Sketch (attach construction plans if appropriate)
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 a -
penalties. liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage to persons or prourrl�
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 o.
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 P. 0. Box 1058 COACHELLA, CA. 92236 398-2651
Name of Applicant (please print) Business Address Telephone No.
Telephone No.
Name of Contractor and Job Foreman Business Address p
Contractor's License No.
City Business License No.
Applicant's Insurance Company Policy Number
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