3085;.NOTk.:•
With proper validation
this form constitutes an
encroachment permit
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For the construction' of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit — Class III
DATE: 11/16/99 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 51275 CALL•E HUENEME
LOT 02 51360 CALLS. RUENL'ME
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION TXRTALT. AM MAT13'.!<AINA A 1"
T1nNR9TTC WATRR SERVE CE LTNE
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
.APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION 90 DAXS.
ESTIMATED CONSTRUCTION COST $ 1 -100
(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)
Inconsideration of the granting of this permit, the applicant hereby agrees to:
SEE ATTACHED C00171ONS
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.
Signature of Applicant or Agent
cam. P.O.BOX 1055 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 II 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 $ —0—
Permit Fee —0~
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by Date
0.851
PERMIT VALIDATION
PERMIT NO. 3085
DATE APPROVED 11/16/99
EXPIRATION DATE 2/25/00
DATE ISSUED .�
By ' �f �i ] %�
. 1- 6 VAdmiplistrative Authority
Recorded by
Telephone: (619) 777-7075
The following General and Special Provisions are attached to and made a part of Permit No.
G)NERAL PROVISIONS
The following shall always apply:
ENROACTII4I M 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 EQUB M qr. Cleated tracklayiag concoction equipment shall not be permitted to operate on
any paved surface unless fitted with smooth -faced street pads. All mechanical outriggers shall be with.rubber street shoes to
protect the paving during excavations. Rubber4ired 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 (27 of A.C.
surfacing plus appropriate seal coat as specified above.
PROTECTION OF TRAFFIC: All excavations and work areas shall be properly lighted end barricaded as deemed necessary by the
City Engineer or La Quints City Public Works inspectors. Suitable detours and detour signs shall be placed and maintained for the
duration of the project. The City shall be nodfied.24 hours in advance of any traffic detours or delineations.
CARE OF DRAINAGE SIRUCI IRES: 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 Quints 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 materiel roAlting from excavation and backfill operations shall' be removed from the right
of way. All paved surfaces shall. be broomed dean. 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:, U de -watering operations are required and pumps are forcing water on City of Is Quints roads, it shell
be the responsibility of, the permittee (contractor) to control this water and to provide off street barricades when necessary..
CLOSING SIMEM: 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 atreat for
any length of time, permittee shall contact this office to obtain the necessary permission.
SPECIAL PROVISIONS
The following shall apply when indicated:
R'1 NOTIFICATION: Permittee shall notify the City at (619)777-707S at least 48 hours in advance of starting construction.
U IUM CLEARANC& (Substructures) Prior to melting 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.
TIT UM CLEARANC& (Surface Structures) No work shall be done under this permit until all utilities are clear of the
proposed work site. The permitter shall notify all concerned utility companies of the proposed work.
R4 PAVFd Off WIDENING: Area between the proposed concrete gutter line and the existing road pavement shall be surfaced
with inahes of A.C. paving placed on inches of class aggregate subbase course having an 'R•
value of not leas than and in conformance with City of La Quints Road Improvement Standards and
Specifications, Ordinance 0461.
R5 PARKWAY GRADING: Aron 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).
R6 GRADE CHKKI dG: City of La Quinta shall check grades upon receipt of plan and profile and/or grade.a 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 Ia Quints Standard FM.
R8 DRIVEWAYS: A.C. driveways shell 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 C ) of class aggregate base.
Driveway construction shell conform to attached drawing.
R9 SIGHT CTLARANC& Sight clearance of 600 feet in all directions shall be assured and maintained at all times.
R10 SOIL SIERHM L. The area to be surfaced shall be treated with Boil sterilizer. Rate of application shall commply with.the
manufacturer's specifications.
R 1 COORDINATE WORK: The proposed work shall be subordinated to any operation which the State of California or City of
La Quint& 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 of City of La Quinta projects.
R 1 SURVEY MONUMENTS: Prior to excavation or beginning of construction, all survey monuments which exist on the
centerline of all streets or property fines 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 f trniabed 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.
R 3 PAVEMENT CUITING: Pavement will be mechanically saw cot to a straight to a sraigbt 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 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.
R1-5 BACKFII.L 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 and or gravel.
R16 BACIGUL SAND: Backfill shell 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 ease,
a relative compaction of 95 percent shall be Attained with the structural section of the roadway.
R17 BAC30F7LL PLACEMENT. Backfill shall be applied. in layers of not more than SO percent of the total depth of the trench
before flooding or a maximum of five-foot (S) lifts where trenches are of excessive depths. Caro 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 roach the bottom of each layer and the water supply shall be continuous.
RIB 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 (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 Ifighways, State of California, dated January 1973.
R1.9 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 remin.
Compaction tests shall be made as outlined in Section 6.3.01 of the Standard Specifications, Division of Ifighways, State of
California, dated January 1973.
92.0 11MMRARY 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 subgmde. The SC4W temporary paving shall be placed after a
maximum of 30DO linear feet of trench has been excavated and backfill operations completed, but in no can shall the
placement of the temporary pavement exceed a five (5) day limit.
R21 PERMANFNr•PAVENffidr REPAIR: After backfill and compaction have been completed, a temporary patch consisting of
two inches'(27 of SC4W 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.
R22 FOG SEAL: A fog seal coat consisting of an application of asphaltic emulsion shall be applied over all patch arose as
determined by the City Engineer.'
S1RM RFSTRIPING: Where street striping is still visible on streets to be excavated, such striping shall be replaced upon
completion of permanent repairs.
R24 TRW 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 condidon at its now 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 SM 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 bacldlled and compacted to not less than 90 percent or equivalem to the
surrounding ground, whichever is the greater compaction as determined by the impact or field method. Compaction teats shall
comply with Section 6.3.01 of the Standard Specifications, Division of Ifighways, State of California, dated January 1973.
it
SPECIAL CONDITIONS --PERMIT NO. 3085
--- CVWD ---
In addition to the standard permit conditions, the following shall apply:
1. Pursuant to Section 14.16.320 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982), all
work shall be performed in accordance with the latest edition of the Standard Specifications For
Public Works Construction (SSPWC) and as directed by and to the satisfaction of the City Engineer.
2. CVWD, hereinafter referred to as "Permittee", shall be responsible for providing continuous dust
and erosion control. All areas shall be kept watered down daily including weekends.
3. ' Streets shall be kept clean. - They shall be completely cleaned at the end of each working day and
more frequently if required.
4. Pursuant to Section 6.08.050 of the La Quinta Municipal Code (Ordinance 18 § 1, 1982), throughout
the work site, the Permittee shall comply with City regulated work hours. Operation and
maintenance of equipment within one-half mile of human occupancy shall be performed only during
the following time periods:
October Ist to April 30: Monday -Friday 7:00 a.m. to 5:30 p.m.
Saturday 8:00 a.m. to 5:00 p.m.
May last 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 and Sundays.
5. Work performed within 500 feet of a signalized intersection is restricted between the hours of 9 a.m.
- 3 p.m. Traffic control shall be set up after 9 a.m. and removed before 3 p.m. The Permittee shall
contact the Riverside .Country Traffic Signal Maintenance Department at (909) 275-6894 if signal
operation at the intersection is to be altered in any way.
6. Pursuant to Section 14.16.110 of the La Quinta Municipal Code (Ordinance -10 § 1 (part),_ 1982)9
Permittee shall assume responsibility for repair of.any pavement damage to any public or private
street and for any damage to other City streets or facilities as a result of work performed under this
permit:.
7. Pursuant to Section 14.16.250 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982),
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). A traffic control
plan, if required, shall be prepared in accordance with the WATCH Manual and submitted to the City
for review and approval one (I) week prior to starting any construction. It shall.be the Permittee's
responsibility to appropriately detour and barricade all construction sites.
Special Conditions - Permit No. 3085 Page 1 of 4
1J`
SPECIAL CONDITIONS --PERMIT NO.3085
--- CVWD ---
8. Pursuant -to Section 14.16.290 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982),
street closures shall not be permitted. A minimum of one travel lane of paved surface shall be
maintained with flagmen at all times.
9. . Prior to excavating, if required, the Permittee shall contact Underground Service Alert at 1-800-422-
. 4133. It shall be the Permittee's responsibility to notify the Public Works Department of anticipated
excavation which impact City facilities, including but not limited to traffic signal conduits and loops,
irrigation lines, electrical conduits, and storm drain facilities.
10. 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.
11. Pursuant to Section 14.16.370 of the La Quinta Municipal Code (Ordinance 10 § - 1 (part), 1982),
backfill compaction within street rights -of --way shall conform withSection 306-1.3 of the latest
edition of the Standard Specifications For Public Works Construction (SSPWC), except as otherwise
specified herein.
Native material may be used as backfill material provided that minimum compaction, achieved in
the manner prescribed herein, is achieved. Backfill shall be performed by mechanical means; no
water densified compaction via jetting or flooding or other means shall be allowed. It shall be the
Permittee's responsibility to provide appropriate geotechnical supervision, testing, and inspection,
onsite, at all times during backfill operations.
Backfill compaction shall be achieved by the following conditions:
A. When a firm foundation is not encountereddue to soft, spongy or other unsuitable material,
such material shall be removed to the limits directed by the Geotechnical Inspector and/or the
City Inspector and the resulting excavation backfilled with pipe bedding material.
B. Backfill materials shall be brought to or maintained at an appropriate moisture content for
compaction. The appropriate moisture content range shall be established at the onset of the
project and ensured prior to use of the materials through progress. testing on the stockpiles..
C. The first length of trench backfilled shall be backfilled in the presence of the City Inspector.
Compaction shall be tested at random depths at approximate three-foot vertical intervals as
backfill is placed to ensure the effectiveness of the compaction methods and to.establish the
depth of lift that can be compacted.
D. If lifts greater than one foot are attempted in this trial length of trench, compaction tests shall
be taken within the lifts to ensure that the full depth of the lift is compacted. Upon satisfactory
completion of this portion of trench, the City Inspector shall establish the maximum lift
thickness to be compacted for the remainder of the project.
. Special Conditions - Permit No. 3085 Page 2 of 4
SPECIAL CONDITIONS --PERMIT NO.3085
--- CVWD ---
F. In subsequent lengths of trench, the frequency of compaction tests shall equal one per each lift
of backfill, per 300 linear feet of open trench, at randomly .selected locations within the open
length of trench.
G. The depth of the randomly selected compaction tests shall also be randomly selected except
that where multiple tests are required in a given length of trench, the tests shall be no closer
than three feet (vertically) from each other.
H. If any compaction test fails, previously placed backfill (in the same length of open trench or
previous lengths -of trench) which is represented by the failing test (as determined by the City
Inspector), shall be tested for compliance with compaction requirements.
I. All costs incurred due to the conditions above shall be borne by the Permittee. Copies of all
test results shall be fumished-to the City Inspector.
12. All excavations within City of La Quinta right-of-way shall be backfilled, and temporarily paved if
within the existing travel way, at the end of every workday as directed by and to the satisfaction- of
the City Engineer for the protection of the public. Lengths of open trench shall not greatly.exceed
that which cannot be backfilled in the same day. Excavated trenches shall not be allowed open
overnight, however, Permittee may leave a length of excavated trench, not to exceed twenty (20) feet
in length, open overnight at a point where construction will begin the next day, provided that this
length of trench is completely covered by steel plating.
13. All landscaping, irrigation, decorative rock, decorative concrete, lighting, etc., shall be replaced to
its original condition.
14. Access and egress to all local properties shall be maintained at all times.
15. Pursuant to Section 14.16.375 of the La Quirita Municipal Code (Ordinance 10 § 1 (part),- 1982),
permanent pavement replacement shall be completed no later than seven (7) days after the
completion of the . work. Permanent pavement replacement shall conform to the following
conditions:
A.. Existing asphalt concrete pavement shall be sawcut one (1) foot beyond trench edges. Edges
shall be straight and clean.
B. Permanent pavement replacement structural section, within all trenches, shall be 1" thicker
than existing of asphalt concrete over the same existing thickness .of crushed aggregate base
or crushed miscellaneous base, meeting the requirements of Sections 200-2.2 and 200-2.4 of
the Standard Specifications for Public Works Construction. The replaced pavement and base
material shall be compacted to 95% relative compaction and respectively tested, for each 300
linear feet of trench. Verify exact structural replacement section thicknesses with the City
prior to installation.
Special Conditions - Permit No. 3085
Page 3 of 4
SPECIAL CONDI•TIONS--PERMIT NO. 3085
--- CVWD ---
C. " Permanent pavement replacement shall be installed using a City approved N4" max medium
asphalt concrete as the base course lift and a City approved '/z"max medium finish course lift
for capping. Asphalt concrete mix design shall be approved by the City prior. to its placement.
D. Cold -Mill and Overlay - The existing pavement which was properly protected in place during
the trenching operation located adjacent to. the trench sawcut shall be cold -milled to a depth
of 0.10 feet with butt joint created next to the existing unmilled pavement surface. The cold=
milled area and base asphalt concrete in the trench area shall .be overlaid with a City approved
C2-AR-4000 asphalt concrete mix.. The width of the cold milling area shall be as. follows:
• For longitudinal trenches located in a parking lane: two (2) feet outside the sawcut
removal lines.
• For longitudinal trenches located in a traffic lane: two (2). feet outside the sawcut
removal lines, or to the lane line striping, whichever is greater.
• For transverse trenches across existing street: two (2) feet outside the sawcut removal
lines.
E. If grinding and capping operations are not performed in the same day as base paving
operations, the base course lift of 3/4" max medium asphalt concrete shall be installed from
saw -cut edge to saw -cut edge flush with the existing street surface. The base course lift of
paving shall not be left 0.10' low in anticipation of grinding and capping.
F. Any existing lane striping affected by this resurfacing. shall be replaced in kind by the
Permittee, as directed by and to the satisfaction of the City Engineer. Affected traffic signal
loops shall be removed and replaced in kind.. The finished pavement surface shall be smooth;
consistent, and shall conform to the surrounding grades.
16. Permittee shall permanently stabilize any and all soil that was disturbed as a result of work
performed under this permit with an approved dust control treatment. Soil stabilization shall be done
immediately after completing the operation.
17. Pursuant to Chapter 12.56 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982) the City
has designated certain city streets as Truck Routes. The weight limit for restricted streets (i.e., streets
not part of the Truck Route network) is three (3) tons; trucks exceeding the weight limit may use a
restricted street if making a delivery or pickup on the subject. street, or if this permit specifically
grants permission to use the street to deliver street construction materials and/or equipment.
18. This permit allows for installation of 2 - .1" water services at the. locations listed -on. the permit.
19. The City of La Quinta reserves the right to revoke, suspend or void this permit at anytime.
Special Conditions - Permit No. 3085 Page 4 of 4
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NOTE:
With proper validation
this form constitutes an
encroachment permit
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
q Subdivision Improvement Permit — Class III
DATE: Minor Improvement Permit Class N
LOCATION OF CONSTRUCTION - 5��� �S L �-� /`tUE/1/ L=z" 46—
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION 1 NSTALL ANh /YIAINTA/AI .4 Sketch lattach construction plans if appropriate)
Q N E I N C_ )a C 1 '9 .DOII'}D.S71C L.0 A TEP —'MQ VICE L JAI E t��;
DESCRIPTION OF CONSTRUCTION Sv� A<�� 6041iu[4aU
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION 121610TY C 901 DAYS
ESTIMATED CONSTRUCTION COSTS 1 h9Q_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 a.
penalties. liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage to persons or proprn�
happening or occurrina 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. — _ _ /)
ignature of Applicant or
COACHELLA VALLEY WATER DISTRICT , P-0. Box 1058 COACHELLA, CA. Q�y 398-2651
Name of Applicant (please print)
Name of Contractor and Job Foreman
-- 6 f
Business Address
Business Address
;�a S 5—
Telephone No.
Telephone No.
Contractor's License No. 1 I / G � Q 1 City Business License No.
Applicant's Insurance Company Policy Number
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