2356''146TE:
With proper validation,
tHis form constitutes an
`.encroachment permit
0
CITY OF LA QUINTA
----�` APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
A
,
'4.For the yconstruction 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: 6-19-95 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 78-822 HWY 111 - Eisenhower Medical Center
PP 94-533 One Eleven La Quints. Center
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Construct 1vxAdiate Care Sketch (attach construction plans if appropriate)
Facility
DESCRIPTION OF CONSTRUCTION Sitewor — Grading,
concrete work, and paving
DIMENSION OF INSTALLATION OR REMOVAL See approved
Pians
See attached conditions
See approved. site plan
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 6-21-95
APPROXIMATE TIME OF COMPLETION 9-30-95 �✓ '�i1/Y��
ESTIMATED CONSTRUCTION COST $ 51,125 (!
(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: r^:'
Indemnify, defend and save the City, its authorized agents, officers, representatives and employees, harmless from and �againstndall
.4
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�arted.
Comply with all applicable City Ordinances, the terms and conditions of the /�perlis
and all applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the resuJt'of twork.
Signature of_,pelican/r Agent
Desert Cities Development 46-100-1/2 W4ishington St. La Quints, CA
Name of Applicant (please print)
Name of Contractor and Job Foreman
620242
Business Address
Business Address
2108
3 (619) 771-3345
Telephone No.
Telephone No.
Contractor's License No. City Business License No.
Alpine Insurance Co. Certificate on File
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 $ 1533.75
Permit Fee 10.00 II
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
$ 1543.75
Received by Date
PERMIT VALIDATION
PERMIT NO
DATE APPROVED
2356
6-19-95
EXPIRATION DATE 12731-95
DATE ISSUED
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
I
The following General and Special Provisions are attached to and made a part of Permit No.
GENERAL PROVISIONS
The following shall always apply:
ENROACffiVIENT ON PRIVATE PROPERTY: This permit authorizes work to be accomplished within City of La Quints right of
way ONLY. Whenever construction extends within private property, it is,the responsibility of the permittee for 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 to 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 Quinta 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 cost 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 plaintained for the
duration of the project. The City shall be notified.24 hours 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 STREET'S: 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 by the 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 following shall apply when indicated:
(Rl/ NOTIFICATION: Permittee shall notify the City at (619)777-7075 at least 48 hours in advance of starting construction.
UTILITY CLEARANCE: (Substructures) Prior to making any excavation within the City of La Quinta right of way
authorized 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.
UTILITY 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.
R4 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 inches of 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.
® 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 (l').
QW GRADE CHECKING: City of La Quinta shall check grades upon receipt of plan and profile and/or grades.as established by
a licensed engineer.
R7 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 Quinta Standard #207.
R8 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.
SIGHT CLEARANCE: Sight clearance of 600 feet in all directions shall be assured and maintained at all times.
RIO SOIL STERILIZER: The area to be surfaced shall be treated with soil sterilizer. Rate. of application shall commply with the
manufacturer's specifications.
COORDINATE 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
Quina forces to preclude delay or interference with State of City of La Quinta projects.
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 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 be notified
upon completion or replacement of all survey monuments for proper project clearance.
1U3 PAVEMENT CUTTING: Pavement will be mechanically saw cut to a straight to a straight edge prior to excavation. Method
of pavement cutting shall beapproved 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 traffic. Prior to final paving operations, any damage to pavement straight edges shall be corrected.
R14 LIMIT OF EXCAVATIONS: Excavations shall be limited to 1000 linear feet of open 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.
R15 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. _.._ _.._..........
R16 BACKFILL SAND: Backfill shall be approved transit -mix sand or equivalent and shall be 'placed in lifts of not greater than
three feet (3') 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 with the structural section of the roadway.
17 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.
R18 COMPACTION TESTS: If so required by the inspector, compaction tests shall be made at intervals of not more than 1000
feet and a minimum of one (l) 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.
R19 ) COMPACTION 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 as outlined in Section 6.3.01 of the Standard Specifications, Division of Highways, State of
California, dated January 1973.
R20 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 3000 linear 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.
R21 PERMANENT PAVEMENT REPAIR: After backfill and compaction 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 later than ,5 days after completion of temporary road repair.
Sv C_-iDiT106
R22 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.
7=�) STREET RESTRIPING: Where street striping is still visible on streets to be excavated, such striping shall be replaced upon
completion of permanent repairs.
R24 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 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 is 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.
SPECIAL CONDITIONS --PERMIT NO. 2356
--- DESERT CITIES DEV. ---
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. Permitteeshall 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 5:30p.m.
Saturday 8:00 a. m. to 5: 00p. m.
May 1st to September 30:' Monday -Friday 6:00 a.m. to 7:00p.m.
Saturday 8:00 a.m. to S:OOp.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. Advance warning signs and traffic control shall be installed and- maintained in accordance with
Cal Trans Standards. 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. Prior to excavating, the permittee shall contact Underground Service Alert at 1(800) 422-4133.
9. 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.
10. All work shall be coordinated with the City, the City's contractor and/or others working within
the area as directed by and to the satisfaction of the City Engineer.
Special Conditions - Pernik No. 2356 Page 1 of 2
SPECIAL CONDITIONS --PERMIT NO. 2356
continued
11. 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 95.9o' relative dry density, all
base material shall be compacted to 95% relative dry density.
12. Work authorized by this permit shall be as shown on the plan labeled "PLOT PLAN 94-533
EISENHOWER MEDICAL CENTER - PRECISE GRADING PLAN".
13. All excavations at .or near the travel way shall be backfilled and paved if necessary at the end
of each work day for the protection of the traveling public.
14. All excavations in the roadway section shall be backfilled with Controlled Density Fill (CDF). .
Native material ,shall not be used.
15. Permanent pavement replacement section for trenches shall be 4" of A.C. over 4" of A.B. in
the parking areas and 5" of A.C. over 6" of A.B. in the driveway/travel-areas.
Special Conditions - Permit No. 2356 Page 2 of 2
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NOTE:
With proper validation
this form constltutn an
encroachment oerma CITY OF LA QUINTA
APPLICATION FOR PERMIT
-PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For the construction of public or private curbs, driveways, pavenwnu, sidewalks, parking lots, sewers, water mors
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
DATE: — �� Subdivision Improvement Permit —Clan III
Minor Improvement Permit Clan IV
LOCATION OF CONSTRUCTION 7/� f32 z /may iii
/571//�Du��?L�%IC�9� L—Gy17�7L_/d/��U�.t/�/i� ��•t/�fGl<
ISve.t address Of Oasvhpvon of l.0000nl
PURPOSE OF CONSTRUCTION �" t= ���%7� C��L�`. Sketch (attach construction plans if apprpprietel
D9SqRIPTIONOFq0NSTRUCT1ON 5
C-41ft
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION IV—
ESTIMATED CONSTRUCTION COST S e
(Including removal of all obstruction, materials, andbnde s�badktilling, nom
Pacdon and Placing permanent resurfacing and/or replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrees to:
Indrnmh. OMene and titre efM Clry, its eutnOrisW egems, officers. representative and emosweq, hainnuen from and apairut airy and ou
Danlos". I,""t"s or los "Imiting from claims or court action and wising out of arty accident. loo or damape to ww" or propirsy
halhpenw^e or occurring as a proximate recon of any wort undertakan under tot f W granted ptsrsn to this applbtion.
Notify sena Administrative Autfhoriry at Ism twentyfour (241 horn in advance of the time when worts will be irtaro6
Cornrxv wee til apolieable City Ordinances. tna tame and conditions of the pwmn Intl YI applleable nice end n9wations of the city of
V Oulns and to pay for any eddlklorW nptaearthmt na=uwv u the remit ofafla wort -
x
Name of ApplimnLAplase print)
X
Name of tbntractor aA Job Foreman
X zn � �Z—
Conn cors Licansa N .
Insurance Company Cy1ICV, LI.yg1LLITY
FEES: Subdivision Improvement Permit —Clan III
M70= or Agent
Telephone No.
Business Address
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction wets
Minor Imorovement Permit — Claes IV:See attached schedule
Inspection Fee S 53 7 s
Permit Fee / a , ao I
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 7'S y3' 7S_
Receipt No.
Received by Date
Recorded by
Telephone No.
City 8 ii/nes iiav/n= No. .x����,�r ,Cry
Policy Number
13086
PERMIT VALIDATION
PERMIT NO. 23�J
DATE APPROVED 9
EXPIRATION DATE
DATE ISSUED
By !
Administrative Aud wily
777- 7D7
TELEPHONE: (6 19)
73,
77
JOB NAME:
E.M.0 LAQ
BID DATE: 2/1/95
LOCATION:
LA QUINTA, CA
OWNER:
WASH/ADAMS
SQUARE FOOTAGE:
8,743
SITE FOOTAGE:
33,720
DESCRIPTION
SHELL
EMC SHARE EXPLANATION
SITE
PLANS AND ARCHITECT
BY OWNER
PERMITS
BY OWNER
ENGINEERING PERMIT
BY OWNER
TESTING/SOIL TESTING
BY OWNER
SHOD & FIELD INSPECTIONS
BY OWNER
Mason/Concrete Insp.
BY OWNER
TEMPORARY UTILITIES
$3,000.00
MISC RENTALS
$500.00
SURVEY
$1,650.00
GENERAL LABOR
$2,500.00
CLEAN UP
$5,500.00
12,800.0,0
GRADING/EXCAVATION/F. GRADE
CURB & GUTTER/SIDEWALKS
14, 000.0.0
PARKING LOT,
24, 325.00
POLE BASES
LANDSCAPE & IRRIGATION
C.0
DETECTOR CHECK
SEWER FEES
FIRE LINE & HYD
FOUNDATIONS AND SLAB
TRASH ENCLOSURE WALLS
STRUCTRIAL STEEL
ROOF ACCESS LADDER
TRASH GATES
ACCESS DOOR
CARPENTRY/LUMBER/HARWARE
FRAME SKY. EMC
FINISH CARPENTRY
DOOR CREDIT EMC
SKYLIGHTS
11111110010ft ADD PER EMC
ROOFING
SHEETMETAL�
INSULATION
ROOF HATCH
domw
AUTOMATIC DOORS
STOREFRONT
GIENft ADD DOORS E.M.0
PLASTER/STUCCO
>0
DRYWALL
PAINTING
BATH TILE PER EMD
1111110mam
gaIIIIIIIIIIIIIIIft ADD TILE /VINAL
CERAMIC TILE ACCENTS
BOLLARDS0
BATH HDW ACCESSORIES(ALLOW)
%slow
C.O
JUN -15-95 THU 09:51 DESERT CITIES DEVELOPMNT FAX NO. 6193455682
P. 04
CERTIFICATE OF
INSURANCE CSFI 0 "VE DAT6pAMA" .
07/05/94
PitOOVCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
AND
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
Wood-Gutmam Insurance Brokers
DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
3100 Bristol Street, Suite 390
POLICIES BELOW,
Costa Mesa, CA
92626'
COMPANIES AFFORDING COVERAGE
Donald L. Wood
714-557 0800
OOMPANT
A
L&TTER Atpine Insurance Coopany
UOEOTMTEPRANY me
B Homestead Insurance cony
RISURM
Desert Cities Development, Inc
Desert Cities Air Conditloninp
OOLIPANY C Safeco Insurance Carpanies
LETT ER
39-725 Garand Lane, Sufte A
Palo 922b0 Desert, G
.
�A, 0
LEITER
COMPANY F
LETTER
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN !SSUF.D TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOYWM4$TAHDiNG ANY REQUIREMENT, TEAM OR CONOITION OF ANY CONTRACT OR OTHER DOCUMENT WfTH RESPECT TO WHICH THIS
CERTIFICATE MAY BE L4SUEO OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE FOLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDfT10N$ OF SUCH POLICIES_ LIMITS SHOWN MAY HAVE BEEN RtUUCL•U BY PAID CLAIMS.
T.
TR: TYKOfMWAAA09 PoucyK1M8ER
POLICYEFffCT1VE POLICYE7(PIRATfON
DATC MWOOMI GATE OAKO �YYi Ul/IT3
GPMERAL LIAbiUTY
GENEML AGGREGATE" i t Q00, 000
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....,
07/01/94 07/01/95 PRoocrcrsooMR,oP At�o. 1.000 000
°
aAaMs MADE .. X .. 00010:
............... . .. ....
PE 6oNA1 a ADv,1N wRY t 1, 000,000
X ` o ra a axrtRweroag PfiOT.
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.......: .......................... ............... '.
FIRE OAkWE .. ......
W.. ono flrol e
, ... ............... 50,000
MED. DPQ�W 44w one oa.«4. i 5, ON
AUTOYo61lE UA81uTY
'
COMBINED Sw'LE
C :ANYAtlPO BA2308134
09116/93 09/16/94UMIr c 4,000,000.
`....... ALLOW MALTT08
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X NON'0wNED AUTOS
,.......;
+9 _
.
GAPACIE Lweuutt
..
f'PPY�PERTY DAA
®ccCsa uABuir+r
CAcmoNCe �.. 21000,000.
8 : LANBFlFItA FOFY XL0055607/01
/94 07/01/95 AGGRt7cATE i 2,000,000.
OrrCR hWI UMBP01A FORM
WORKKIFA 6 OOYNFJtSAT10M
......::: .. :.
AND
: E40HACCIDENT
EISPLOYm, UAMUTY
oISEAaF -POLICY UWi
.......... ..... ...............
.
D*FAA- EACH EMPtoYFE s
OTHER
.
PVsCRIPttOM Of OPEPAt1 NMLOCAT1oNs/YEMWAISMMCULL (TEY>f
•10 DAY NOTICE OF CANCELLATION FOR NON-PAYMENT OF PREMIUMS
E ;.trAN ss:<
T CA7'E OCD T
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
CITY OF %A QUINTA
MaIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER. NAMED TO THE
P.O • BOJt , 1504
LEFT. BUT FAILURE TO MAIL SUCH NOTICE SMALL IMPOSE NO OBUGAnON OR
L3 Quinta , CA 92253
LIABILITY OF ANY KIND UPON THE COMPANY, R9 AGENTS OR REPRESENTATIVES.
I
., AMORIZE+D REPRE.'BENYAT
Donald lWood '^'�-✓`-' -
iACORD 2S-3 (7M0
®ACORO CORPORATION 1990
''i
.JUN-15-95 THU 09:50 DESERT CITIES DEVELOPMNT FAX NO. 6193455682 P.02
t
BUSINESS LICENSE
C E RTt FtC ATE
R f
NOT TRANSF E ABLE
r
CITY OF L
The Licensee named herein having � OV NTA
n9 Paid to the GN a LaOuinteanteesroQul,eattoenselaherep r
business hereat bot forth, for the period stated.;n cont Y9 antedsald iiteneec to tr
without veritipati*n that the licensee {s subject to ore ompYt with
Pf OVIstong oI Ohfinsnte No. 2 of this, CItY. This 41,ense is
sIssued cithe PLEASE POST IN A
r b h OONSD
FOR PERIOD 1/01;9 J licensing Y the State of Gellfornia iCUOUS PLACE
TO 12/31/9`COC: 39725 GARAND BUSINESLIGENSE NO. 2108 I`
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PALM DEERERT Cry 92260•
1
DESERT CITIES DEVELOPMENT INC TYPE OF BUSINESS
39725 GARAND 4 �,:,>•:..::
`
PALM DESERT CA 92260 �
L, FRFtI INQ j
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