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3781
NOTE: 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 x Subdivision Improvement Permit — Class II I DATE: November 12, 2002 Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION Mountain View Country Club (Tract #30357) 50-400 Jefferson Street La Ouinta CA 92253, Jefferson St. PKWiEast side of street (Street -address or Description of Location) Between Ave #50-52 / And Parkway on Ave. 50 South side of street PURPOSE OF CONSTRUCTION Joint Trench Utilities: Sketch (attach construction plans if appropriate) Elect., Tale, CATV, and Des DESCRIPTION OF CONSTRUCTION Trench, place conduits. Backfill & Compact. Please note: Trench depth will trot exceed 54" ' DIMENSION OF INSTALLATION OR REMOVAL Jefferson St. See attached Special eouditions ee utility trench- 3'Wide x 4.51deeo x'3500' IL AVe.50 utility trench- 3'Wide x 4.51deey x 2200 L SIZE OF EXCAVATION, IF NEEDED please See above s' Please see avorovred I.I.D. vlans & Suec's APPROXIMATE TIME WHEN WORK WILL BEGIN u00n issuance of this ancroachmnt oarmit APPROXIMATE TIME OF COMPLETION 3 WAS (11/27/02) ESTIMATED CONSTRUCTION COST $ 137.,472„50 D (Including removal of all obstruction, materials, and debris, backfilling, com Fiq paction and placing permanent resurfacing and/or replacing improvements) In consideration of the granting of this permit, the applicant hereby agrees to: C;Iry �QpIpNLA...._., Indemnify, defend, and save the City, its, authorized agents, officers, representatives and employees, ar 1r1"� 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. _ Gr. Underground, Inc. 37-670 Springfield Ln.. Suite #8 (760) 360-7994 Name of Applicant (please print) Business Address Telephone No. Eddie Cobb W/G.R. Underground 37-670 Springfield Ln., Suite #8 (760) 250-1767 Name of Contractor and Job Foreman Business Address Telephone No. CA 765654 (A, C-7) 00587 Contractor's License No. City Business License No. . Everest National Insurance Co. 3100000234-021 Applicant's Insurance Company Policy Number FEES: Subdivision Improvement Permit —Class III 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 $ 4.124.18 100.00 $ 4,224.18 Received by Date Recorded by 3781 PERMIT VALIDATION PERMIT NO. 3781 DATE APPROVED November 12, 2002 EXPIRATION DATE November 12, 2003 � DATE ISSUED November 12, 2002 By ', �` ._ Victor %!)GAu,Z, A$eglstere Admistr�at�ive Authority Telephone: (760) 777-7075 A, f .�: ^`3' r ,� _�Q; r' .: =l x r, ;y .,,y ;� :F�r, , 1 PERMIT NO. 3781 GR UNDERGROUND - TRACT NO. 30347 - 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. GR UNDERGROUND - TRACT NO. 30347, hereinafter referred to as "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. 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 1st 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 1 st 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), Permittee shall assume responsibility for repair of any pavemeni 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 shall be prepared in accordance with the WATCH Manual and submitted to the City for review and approval one (1) week prior to starting any construction. It shall be the Permittee's responsibility to appropriately detour and barricade all construction sites. Special Conditions -Permit No3781_ Page 1 of 4 PERMIT NO. 3781 GR UNDERGROUND - TRACT NO. 30347 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 two (2) travel lane of paved surface shall be maintained 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 with Section 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 encountered due 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 No3781_ Page 2 of 4 PERMIT NO. 3781 GR UNDERGROUND - TRACT NO. 30347 E. 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. F. 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. G. 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. H. All costs incurred due to the conditions above shall be borne by the Perm'ittee. Copies of all test results shall be furnished 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 can not 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 Quinta 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 No3781_ Page 3 of 4 PERMIT NO. 3781 GR UNDERGROUND - TRACT NO. 30347 C. Permanent pavement replacement shall be installed using a City approved 3/4" 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 saw cut 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 (3) feet outside the sawcut removal lines. For longitudinal trenches located in a traffic lane: two (3) 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 or any existing detour 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. The City of La Quinta reserves the right to revoke, suspend or void this permit at any time. 19. The permittee shall indemnify, hold harmless and assume the defense of the City from all damages, delay costs, costs or expenses in law or equity that may arise out of work under this permit. 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T, B a 'O Y ■ a F••' Y� G � n Y 1-4 CV M �u�u�su�u�su��ru�u�u�u�u�rrs�n�ncn�nu�r�sss�ru�suusssu�u�u�crcruanc rcr�nss�nu�ss�nu�sssssssu�u��ncncncr� nu��nu�uan�nr nu�cnu��nu�u�rnu��n� nu�cnsscrs�ncrsu�u�rrr nscrr ncnc ncrc n�ncnc rr n cry w BUSINESS LICENSE CERTIFICATE "°NTRANSFERA9L' CITY OF LA QUINTA 5 The Licensee named herein having paid to the City of La Ouinta all fees required, license is hereby granted said Licensee to transact the t' S business herein set forth, for the period stated, in comformity with the Provisions of Ordinance No. 2 of this city. This License is issued 5 without verification that the licensee is subject to or exempt from licensing by the State of California. NUMBER i . LOC: 77670 SPRINGFIELD LANE, SUITE #8 00587 -'A,,--S PALM DESERT,CA 92211- BUSINESS LICENSE ID TYPE ISSUED EXPIRES GR UNDERGROUND INC 1500 06/06/02 06/06/03-.'1-11 GENERAL CONTRACTOR LICENSEE: PLEASE POST IN A GR UNDERGROUND INC CONSPICUOUS PLACE 77670 SPRINGFIELD LANE, SUITE #8 {=-� PALM DESERT, CA 92211- - CONTROL NO. 13381 �sss�s�s�sss������ssssssss�sssss�sssss�ss�ssss�s��sss��� ��ssss�s s�����ss�sss�sssss�ssssss�sss��s�����s�ss =. STOTe of Colifornio n CONTRACTORS STATE LICENSE BOARD ACTIVE LICENSE Liars Hour 765654 Entity CORD &oinm Nor .GR UNDERGROUND INC Clusilplianl�lA C-7 6piivion Dye 0 7 / 31 / 2 0 0.3��=® i a Form W-9 Request for Taxpayer Give form to the (Rev. January 2002) requester. Do not Department of the Treasury Identification Number and Certification send to the IRS. Internal Revenue Service N Name o, M GR Underground, Inc. a Business name, if different from above c 0 m m a o u Individual/ Exempt from backup Check box: ElSole © ❑ ❑ El O appropriate propriety Corporation Partnership Other ► -------------------- withholding Address (number, vl street, and apt. or suite no.) Requester's name and address (optional) u 77-670 Springfield Lane, Suite 8 City, state, and ZIP code !� u Palm Desert, Caifomia 92211 yList account number(s) here (optional) m N ' Tax a er Identification Number (TIN) Enter your TIN in the appropriate box. For individuals, this is your social security number (SSN). Social security number However, for a resident alien, sole proprietor, or disregarded entity, see the Part 1 instructions on page 2. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 2. or Note: If the account is in more than one name, see the chart on page 2 for guidelines on whose number Employer identification number - to enter. 3 13 10 12 18 14 17 17 9 FMIM Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and 2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and 3. 1 am a U.S. person (including a U.S. resident alien). - Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally yments other than interest and dividends, you are not required to sign the Certification, but you must provide your correct TIN. (See tl TTstfuctionsAr page 2.) Sign re of Here U.S. person 0- , 11 ) L I A' Date 0- Purpose of Form J A person who is required to file an information return with the IRS must get your correct taxpayer identification number (TIN) to report, for example, income paid to you, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA. Use Form W-9 only if you are a U.S. person (including a resident alien), to give your correct TIN to the parson requesting it (the requester) and, when applicable, to: 1. Certify the TIN you are giving is correct (or you are waiting for a number to be issued), 2. Certify you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are a U.S. exempt payee. If you are a foreign person, use the appropriate Forth W-8. See Pub. 515, Withholding of Tax on Nonresident Aliens and Foreign Entities. Note: If a requester gives you a form other than Form W-9 to request your TIN, you must use the requester's form if it is substantially similar to this Form W-9. What is backup withhol in Persons making certain payments to you must under certain conditions withhold and pay to the IRS 30% of such payments after December 31, 2001 (29% after December 31, 2003). This is called "backup withholding." Payments that may be subject to backup withholding include interest, dividends, broker and barter exchange transactions, rents, royalties, nonemployee pay, and certain payments from fishing boat operators. Real estate transactions are not subject to backup withholding. You will not be subject to backup withholding on payments you receive if you give the requester your correct TIN, make the proper certifications, and report all your taxable interest and dividends on your tax return. Payments you receive will be subject to backup withholding if: 1. You do not fumish your TIN to the requester, or 2. You do not certify your TIN when required (see the Part II instructions on page 2 for details), or 3. The IRS tells the requester that you furnished an incorrect TIN, or 4. The IRS tells you that you are subject to backup withholding because you did not report all your interest and dividends on your tax return (for reportable interest and dividends only), or S. You do not certify to the requester that you are not subject to backup withholding under 4 above (for reportable interest and dividend accounts opened after 1983 only). Certain payees and payments are exempt from backup withholding. See the instructions on page 2 and the separate Instructions for the Requester of Form W-9. Penalties Failure to furnish TIN. If you fail to fumish your correct TIN to a requester, you are subject to a penalty of $50 for each such failure unless your failure is due to reasonable cause and not to willful neglect. Civil penalty for false information with respect to withholding. If you make a false statement with no reasonable basis that results in no backup withholding, you are subject to a $500 penalty. Criminal penalty for falsifying information. Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment. Misuse of TINs. If the requester discloses or uses TINs in violation of Federal law, the requester may be subject to civil and criminal penalties. Cat. No. 10231X Form W-9 (Rev. 1-2002) Form W-9 (Rev. 1-2002) Page 2 Specific Instructions Name. If you are an individual, you must generally enter the name shown on your social security card. However, if you have changed your last name, for instance, due to marriage without informing the Social Security Administration of the name change, enter your first name, the last name shown on your social security card, and your new last name. If the account is in joint names, list first and then circle the name of the person or entity whose number you enter in Part I of the form. Sole proprietor. Enter your individual name as shown on your social security card on the "Name" line. You may enter your business, trade, or "doing business as (DBA)" name on the "Business name" line. Limited liability company (LLC). If you are a single -member LLC (including a foreign LLC with a domestic owner) that is disregarded as an entity separate from its owner under Treasury regulations section 301.7701-3, enter the owner's name on the "Name" line. Enter the LLC's name on the "Business name" line. Other entities. Enter your business name as shown on required Federal tax documents on the "Name" line. This name should match the name shown on the charter or other legal document creating the entity. You may enter any business, trade, or DBA name on the "Business name" line. Exempt from backup withholding. If you are exempt, enter your name as described above, then check the "Exempt from backup withholding" box in the line following the business name, sign and date the form. Individuals (including sole proprietors) are not exempt from backup withholding. Corporations are exempt from backup withholding for certain payments, such as interest and dividends. For more information on exempt payees, see the Instructions for the Requester of Form W-9. If you are a nonresident alien or a foreign entity not subject to backup withholding, give the requester the appropriate completed Form W-8. Note: 1f you are exempt from backup withholding, you should still complete this form to avoid possible erroneous backup withholding. Part [—Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. If you are a resident alien and you do not have and are not eligible to get an SSN, your TIN is your IRS individual taxpayer identification number (ITIN). Enter it in the social security number box. If you do not have an ITIN, see How to get a TIN below. If you are a sole proprietor and you have an EIN, you may enter either your SSN or EIN. However, the IRS prefers that you use your SSN. If you are an LLC that is disregarded as an entity separate from its owner (see Limited liability company (LLC) above), and are owned by an individual, enter your SSN (or "pre-LLC" EIN, if desired). If the owner of a disregarded LLC is a corporation, partnership, etc., enter the owner's EIN. Note: See the chart on this page for further clarification of name and TIN combinations. How to get a TIN. If you do not have a TIN, apply for one immediately. To apply for an SSN, get Form SS-5, Application for a Social Security Card, from your local Social Security Administration office. Get Form W-7, Application for IRS Individual Taxpayer Identification Number, to apply for an ITIN, or Form SS-4, Application for Employer Identification Number, to apply for an EIN. You can get Forms W-7 and SS-4 from the IRS by calling 1-800-TAX-FORM (1-800-829-3676) or from the IRS Web Site at www.irs.gov. If you are asked to complete Form W-9 but do not have a TIN, write "Applied For" in the space for the TIN, sign and date the form, and give it to the requester. For interest and dividend payments, and certain payments made with respect to readily tradable instruments, generally you will have 60 days to get a TIN and give it to the requester before you are subject to backup withholding on payments. The 60-day rule does not apply to other types of payments. You will be subject to backup withholding on all such payments until you provide your TIN to the requester. Note: Writing Applied For" means that you have already applied for a TIN or that you intend to apply for one soon. Caution: A disregarded domestic entity that has a foreign owner must use the appropriate Form W-8. Part II —Certification To establish to the withholding agent that you are a U.S. person, or resident alien, sign Form W-9. You may be requested to sign by the withholding agent even if items 1, 3, and 5 below indicate otherwise. For a joint account, only the person whose TIN is shown in Part I should sign (when required). Exempt recipients, see Exempt from backup withholding above. Signature requirements. Complete the certification as indicated in 1 through 5 below. 1. Interest, dividend, and barter exchange accounts opened before 1984 and broker accounts considered active during 1983. You must give your correct TIN, but you do not have to sign the certification. 2. Interest, dividend, broker, and barter exchange accounts opened after 1983 and broker accounts considered inactive during 1983. You must sign the certification or backup withholding will apply. If you are subject to backup withholding and you are merely providing your correct TIN to the requester, you must cross out item 2 in the certification before signing the form. 3. Real estate transactions. You must sign the certification. You may cross out item 2 of the certification. 4. Other payments. You must give your correct TIN, but you do not have to sign the certification unless you have been notified that you have previously given an incorrect TIN. "Other payments" include payments made in the course of the requester's trade or business for rents, royalties, goods (other than bills for merchandise), medical and health care services (including payments to corporations), payments to a nonemployee for services, payments to certain fishing boat crew members and fishermen, and gross proceeds paid to attorneys (including payments to corporations). S. Mortgage interest paid by you, acquisition or abandonment of secured property, cancellation of debt, qualified tuition program payments (under section 529), IRA or Archer MSA contributions or distributions, and pension distributions. You must give your correct TIN, but you do not have to sign the certification. 9 Privacy Act Notice Section 6109 of the Internal Revenue Code requires you to give your correct TIN to persons who must file information returns with the IRS to report interest, dividends, and certain other income paid to you, mortgage interest you paid, the acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA or Archer MSA. The IRS uses the numbers for identification purposes and to help verify the accuracy of your tax return. The IRS may also provide this information to the Department of Justice for civil and criminal litigation, and to cities, states, and the District of Columbia to carry out their tax laws. You must provide your TIN whether or not you are required to file a tax return. Payers must generally withhold 30% of taxable interest, dividend, and certain other payments to a payee who does not give a TIN to a payer. Certain penalties may also apply. What Name and Number To Give the Requester For this type of account Give name and SSN of: 1. Individual The Individual 2. Two or more The actual owner of the individuals goint account or, if combined account) funds, the first individual on the account ' 3. Custodian account of The minor = a minor (Uniform Gift to Minors Act) 4. a. The usual The grantor -trustee' revocable savings trust (grantor is also trustee) b. So-called trust The actual owner' account that Is not a legal or valid trust under state law S. Sole proprietorship The owner' For this type of account Give name and EIN of: 8. Sole proprietorship The owner' 7. A valid trust, estate, or Legal entity' pension trust 8. Corporate The corporation 9. Association, club. The organization religious, charitable, educational, or other tax-exempt organization 10. Partnership The partnership 11. A broker or registered The broker or nominee nominee 12. Account with the The public entity Department of Agriculture in the name of a public entity (such as a state or local government, school district, or prison) that receives agricultural program payments 'Lust first and circle the name of the person whose number you furnish. If only one person on a joint account has an SSN, that person's number must be furnished. 'Circle the minor's name and furnish the minor's SSN. 'You must show your Individual name, but you may also enter your business or -DBA" name. You may use either your SSN or EIN (if you have one). ' List first and circle the name of the legal bust, estate, or pension bust. (Do riot furnish the TIN of the personal representative or trustee unless the legal entity itself is not designated In the account title.) Note: If no name is circled when more than one name is listed, the number will be considered to be that of the first name listed. Form W-9 Request for Taxpayer Give form to the (Rev. January 2002) requester. Do not Department of the Treasury Identification Number and Certification send to the IRS. Internal Revenue Service c` Name rn M GR Underground, Inc. tl Business name, if different from above c 0 mr a o_ `, `� O O Individual/ proprietor ❑ p ❑ Other ► withhold ng backup Check appropriate box: ❑Sole o eta © Partnership ___________________. ❑ Address (number, N street, and apt. or suite no.) Requester's name and address (optional) u 77-670 Springfield Lane, Suite 8 City, state, and ZIP code != u g In Palm Desert, Caifomia 92211 � List account number(s) here (optional) m • Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. For individuals, this is your social security number (SSN). Social security numbe► However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 2. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 2. or Note: If the account is in more than one name, see the chart on page 2 for guidelines on whose number Employer identification ntunber to enter. 3 1 3 10 12 18 14 17 17 19 Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and 2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and 3. 1 am a U.S. person (including a U.S. resident alien). Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally intents other than interest and dividends, you are not required to sign the Certification, but you must provide your correct TIN. (See tl�istructionsAi page 2.) Sign U.S. person re of s II I �/ t Here U.S. rson ► x �` h (moo � Date ► Purpose of Form J A person who is required to file an information return with the IRS must get your correct taxpayer identification number (TIN) to report, for example, income paid to you, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA. Use Form W-9 only if you are a U.S. person (including a resident alien), to give your correct TIN to the person requesting it (the requester) and, when applicable, to: 1. Certify the TIN you are giving is correct (or you are waiting for a number to be issued), 2. Certify you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are a U.S. exempt payee. If you are a foreign person, use the appropriate Form W-8. See Pub. 515, Withholding of Tax on Nonresident Aliens and Foreign Entities. Note: If a requester gives you a form other than Form W-9 to request your TIN, you must use the requester's form if it is substantially similar to this Form W-9. What is l "rt backup withhoPersons making certain payments to you must under certain conditions withhold and pay to the IRS 30% of such payments after December 31, 2001 (29% after December 31, 2003). This is called "backup withholding." Payments that may be subject to backup withholding include interest, dividends, broker and barter exchange transactions, rents, royalties, nonemployee pay, and certain payments from fishing boat operators. Real estate transactions are not subject to backup withholding. You will not be subject to backup withholding on payments you receive if you give the requester your correct TIN, make the proper certifications, and report all your taxable interest and dividends on your tax return. Payments you receive will be subject to backup withholding if.- 1. You do not furnish your TIN to the requester, or 2. You do not certify your TIN when required (see the Part 11 instructions on page 2 for details), or 3. The IRS tells the requester that you furnished an incorrect TIN, or 4. The IRS tells you that you are subject to backup withholding because you did not report all your interest and dividends on your tax return (for reportable interest and dividends only), or S. You do not certify to the requester that you are not subject to backup withholding under 4 above (for reportable interest and dividend accounts opened after 1983 only). Certain payees and payments are exempt from backup withholding. See the instructions on page 2 and the separate Instructions for the Requester of Form W-9. Penalties Failure to furnish TIN. If you fail to furnish your correct TIN to a requester, you are subject to a penalty of $50 for each such failure unless your failure is due to reasonable cause and not to willful neglect. Civil penalty for false information with respect to withholding. If you make a false statement with no reasonable basis that results in no backup withholding, you are subject to a $500 penalty. Criminal penalty for falsifying information. Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment. Misuse of TINS. If the requester discloses or uses TINS in violation of Federal law, the requester may be subject to civil and criminal penalties. Cat. No. 10231X Form W-9 (Rev. 1-2002) Form W-9 (Rev. 1-2002) Page L Specific Instructions Name. If you are an individual, you must generally enter the name shown on your social security card. However, if you have changed your last name, for instance, due to marriage without informing the Social Security Administration of the name change, enter your first name, the last name shown on your social security card, and your new last name. If the account is in joint names, list first and then circle the name of the person or entity whose number you enter in Part I of the form. Sole proprietor. Enter your Individual name as shown on your social security card on the "Name" line. You may enter your business, trade, or "doing business as (DBA)" name on the "Business name" line. Limited liability company (LLC). If you are a single -member LLC (including a foreign LLC with a domestic owner) that is disregarded as an entity separate from its owner under Treasury regulations section 301.7701-3, enter the owner's name on the "Name" line. Enter the LLC's name on the "Business name" line. Other entities. Enter your business name as shown on required Federal tax documents on the "Name" line. This name should match the name shown on the charter or other legal document creating the entity. You may enter any business, trade, or DBA name on the "Business name" line. Exempt from backup withholding. If you are exempt, enter your name as described above, then check the "Exempt from backup withholding" box in the line following the business name, sign and date the form. Individuals (including sole proprietors) are not exempt from backup withholding. Corporations are exempt from backup withholding for certain payments, such as interest and dividends. For more information on exempt payees, see the Instructions for the Requester of Form W-9. If you are a nonresident alien or a foreign entity not subject to backup withholding, give the requester the appropriate completed Form W-8. Note: If you are exempt from backup withholding, you should still complete this form to avoid possible erroneous backup withholding. Part I —Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. If you are a resident alien and you do not have and are not eligible to get an SSN, your TIN is your IRS individual taxpayer identification number (ITIN). Enter it in the social security number box. If you do not have an ITIN, see How to get a TIN below. If you are a sole proprietor and you have an EIN, you may enter either your SSN or EIN. However, the IRS prefers that you use your SSN. If you are an LLC that is disregarded as an entity separate from its owner (see Limited liability company (LLC) above), and are owned by an individual, enter your SSN (or "pre-LLC" EIN, if desired). If the owner of a disregarded LLC is a corporation, partnership, etc., enter the owner's EIN. Note: See the chart on this page for further clarification of name and TIN combinations. How to get a TIN. If you do not have a TIN, apply for one immediately. To apply for an SSN, get Form SS-5, Application for a Social Security Card, from your local Social Security Administration office. Get Forth W-7, Application for IRS Individual Taxpayer Identification Number, to apply for an ITIN, or Forth SS-4, Application for Employer Identification Number, to apply for an EIN. You can get Forms W-7 and SS-4 from the IRS by calling 1-800-TAX-FORM (1-800-829-3676) or from the IRS Web Site at www.irs.gov. If you are asked to complete Form W-9 but do not have a TIN, write "Applied For" in the space for the TIN, sign and date the form, and give it to the requester. For interest and dividend payments, and certain payments made with respect to readily tradable instruments, generally you will have 60 days to get a TIN and give it to the requester before you are subject to backup withholding on payments. The 60-day rule does not apply to other types of payments. You will be subject to backup withholding on all such payments until you provide your TIN to the requester. Note: Writing "Applied For" means that you have already applied for a TIN or that you intend to apply for one soon. Caution: A disregarded domestic entity that has a foreign owner must use the appropriate Form W-8. Part II —Certification To establish to the withholding agent that you are a U.S. person, or resident alien, sign Form W-9. You may be requested to sign by the withholding agent even if items 1, 3, and 5 below indicate otherwise. For a joint account, only the person whose TIN is shown in Part I should sign (when required). Exempt recipients, see Exempt from backup withholding above. Signature requirements. Complete the certification as indicated in 1 through 5 below. 1. Interes4 dividend, and barter exchange accounts opened before 1984 and broker accounts considered active during 1983. You must give your correct TIN, but you do not have to sign the certification. 2. Interest dividend, broker, and barter exchange accounts opened after 1983 and broker accounts considered inactive during• 1983. You must sign the certification or backup withholding will apply. If you are subject to backup withholding and you are merely providing your correct TIN to the requester, you must cross out item 2 in the certification before signing the form. 3. Real estate transactions. You must sign the certification. You may Cross out item 2 of the certification. 4. Other payments. You must give your correct TIN, but you do not have to sign the certification unless you have been notified that you have previously given an incorrect TIN. "Other payments" include payments made in the course of the requester's trade or business for rents, royalties, goods (other than bills for merchandise), medical and health care services (including payments to corporations), payments to a nonemployee for services, payments to certain fishing boat crew members and fishermen, and gross proceeds paid to attorneys (including payments to corporations). 5. Mortgage interest paid by you, acquisition or abandonment of secured property, cancellation of debt, qualified tuition program payments (under section 529), IRA or Archer MSA contributions or distributions, and pension distributions. You must give your correct TIN, but you do not have to sign the certification. Privacy Act Notice Section 6109 of the Internal Revenue Code requires you to give your correct TIN to persons who must file Information returns with the IRS to report interest, dividends, and certain other income paid to you, mortgage interest you paid, the acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA or Archer MSA. The IRS uses the numbers for identification purposes and to help verify the accuracy of your tax return. The IRS may also provide this information to the Department of Justice for civil and criminal litigation, and to cities, states, and the District of Columbia to carry out their tax laws. You must provide your TIN whether or not you are required to file a tax return. Payers must generally withhold 30% of taxable interest, dividend, and certain other payments to a payee who does not give a TIN to a payer. Certain penalties may also apply. What Name and Number To Give the Requester For this type of account Give name and SSN of: 1. Individual The individual 2. Two or more The actual owner of the individuals goint account or, if combined account) funds, the first individual on the account ' 3. Custodian account of The minor' a minor (Uniform Gift to Minors Act) _ 4. a. The usual The grantor -trustee ' revocable savings trust (grantor is also trustee) b. So-called trust The actual owner' account that is not a legal or valid trust under state law S. Sale proprietorship The owner' For this type of account Give name and EIN of: 8. Sole proprietorship The owner' 7. A valid trust, estate, or Legal entity' pension trust 8. Corporate The corporation 9. Association, club, The organization religious, charitable, educational, or other tax-exempt organization 10. Partnership The partnership 11. A broker or registered The broker or nominee nominee 12. Account with the The public entity Department of Agriculture in the name of a public entry (such as a state or local government, school district, or prison) that receives agricultural program payments 'List first and circle the name of the person whose number you furnish. If only one person on a joint account has an SSN, that person's number must be furnished. 'Circle the minor's name and furnish the minor's SSN. 'You must show your Individual name, but you may also enter your business or "DBA" name. You may use either your SSN or EIN (if you have one). ' List first and circle the name of the legal trust, estate, or pension trust. (Do not furnish the TIN of the personal representative or trustee unless the legal entity Itself is not designated In the account title.) Note: If no name is circled when more than one name is listed, the number will be considered to be that of the first name listed. SK STATE P.O. Ebk 607, SAN FRANCISCO,CA '94J 0 1 -0807. COMPENSATION INSURANCE FUND CERTIFICATE OFF WORKERS' : OMPENSATION"14WRANCE POLICY NUMBER: 044-02 ISSUE DATE: 10-01-02 CERTIFICATE EXPIRES: 10-01-03 CITY OF LA'QUINTA P Q Q)(.1504 LA QU I NTA C A 92253. -4az This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days' advance written notice to the employer. We will also give you'. -da.-y's-" advance notice should this policy be cancelled prior to: its ,'normal .expiration. ,30 f This certif icate �'b ,'insurance is not an insurance policy and does not amend, extend' oi� alter the coverage afforded . If 1 ..1., - I . nsuranc term, or contract' , - other document by the policies; listed herein. Notwithstanding any requirement, condition of any con rac or ifficate o . f risuran . c I e ,may p'y` be,Jssued or ma e Y .with respect. to which this" &ee i y',.p rtain-the insurance afforded. b the"""""'" policies described herein is subject to all -the tirrilis',' exclusions and conditions of such policies. a. PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1-,'900,000.00 P,WOCCURRENCE. `-.IENDORSEMENT'#2065 ENTITLED CERTIFICATE HOLDERS'°NOTICE.EFFEC-TIVE,.10/.01/02 IS ATTACHED TO AND -4 FORMS A PA RT--OF-THIS POLICY.` ),-f &4- 4.. .LEGAL NAME -4R UNbERGROYND.. INC. PRINTED: 09-18-02 P041 0 ACORD `. CERTIFICATE OF LIABILITY INSURANCE OP ID PS Urro-1 DA02/0DDlYY) TE o2/oa/o2 PRODUCER Desert Southwest Ins Brokers 74-785 Highway 111 Suite 209 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Indian Wells CA 92210 Phone:760-773-5955 Fax:760-776-4205 INSURERS AFFORDING COVERAGE INSURED INSURER A: Everest National Insurance Co-. INSURER B: INSURER C: GR Underground, Inc. 77-670 Springgf�ield Lane #8 Palm Desert CA 92211 INSURER 0: INSURER E: %1vv crcwvca THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILIT TR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MM/DD/YPOLICY Y LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1 / OOO OOO FIRE DAMAGE (Anyone fire) $ 100,000 A X COMMERCIAL GENERAL LIABILITY 3700000234-021 02/01/02 02/01/03 MED EXP (Any one person) $ 5 r 000 CLAIMS MADE a OCCUR PERSONAL & ADV INJURY $ 1, 000 , 000 X ADD' L INSURED GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s2,000,000 POLICY X JEcT LOC A AUTOMOBILE LIABILITY ANY AUTO 3700000265-021 02/01/02 02/01/03 COMBINED SINGLE LIMIT (Ea accident) $ 1 r 000 / 000 X BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS X BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN ACC AUTO ONLY: AGG $ ANY AUTO $ EXCESS LIABILITY EACH OCCURRENCE $ AGGREGATE $ OCCUR CLAIMS MADE $ $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND TORY LIMITS ER E.L. EACH ACCIDENT $ EMPLOYERS' LIABILITY TO FOLLOW - GAD)$R&D FROM E.L. DISEASE - EA EMPLOYE $ THE STATE FUND E.L. DISEASE - POLICY LIMIT 1 $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS *10 day Notice of Cancellation applies for Non -Payment of Premium 30 day Notice of Cancellation will be sent at Company Election only. CERTIFICATE ISSUED IN COMPLIANCE WITH CITY PERMIT REQUIREMENTS PFRTICICATF 41n1 nFR I v I anniTrnuar w_q"RFn• ruSIIRFR LFTTFR' IL CANCELLATION CITY LQ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSUR ILL ENDEAVOR TO MAIL �Q * DAYS WRITTEN NOTICE TO THE CERTIFICATE HO ER AMED TO THE LEFT, BUT FAILURE TO DO SO SHALL City of La Quinta IMPOSE NO OBLIGATION OR LI ILI OF ANY KIND UPON THE I RER, ITS AGENTS OR Public Works Dept. PO BOX 1504 REPRESENTATIVES. AUTHORIZED REPRESENT I lPenny_J. La Quinta CA' 92253 Say, n nn nnnwTrnu �eoo ACORD 25S (7/97) v W ^ 90 ' _" """ """ '--- Proposal Proposal No. 118021 .13 Fi - I L '(-3 Q('±Q L 'n tn- Sheet No. 1 UI I❑E� lU� 1❑U, 1❑.1 11 C. Date 8-Nov-02 77-670 Springfield Lane, Suite 8, Palm Desert, CA 92211 (760) 360-7994 Fax (760) 360-1334 LICENSE NO. 765654 Proposal Submitted To Work To Be Performed At Name Toll Brothers, Inc. Street Jefferson St. & Ave 50 Street City State City Date of Plans State Architect Telephone Number We hereby propose to furnish all the materials and perform all the labor necessary for the completion of IID Backbone along Jefferson Street Qty Description Unit Price Total 21,255 I.f. of 6" Conduit $4.50 $95,647.50 1,275 I.f. of 5" Conduit $4.00 $5,100.00 2 4.5' x6.5' Primary Pullbox $4,675.00 $9,350.00 5 5' x8.5' Vault $5,475.00 $271'375.00 Prices are Based on the Latest IID Specifications Including all Schedule 40 Conduit and Grounding. All material is guaranteed to be as specified and the above work to be performed in accordance with the drawings and specifications submitted for above work and completed in a substantial workmanlike manner for the sum of Dollars $137,472.50 Any alteration or deviation from above specifications involving extra costs, will be executed only upon written orders, and will become and extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance upon above work. Workman's Compensation and Public Liability Insurance on above work to be taken out by Desert Southwest Insurance Brokers. Respectfully submitted, G.R. Underground, Inc. Per This Proposal may be withdrawn by us if not accented within days T1\ George Ruark, President ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Accepted Date Signature Signature 0 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 -Nov.q �/®� Subdivision Improvement Permit - Class I I I X DATE:1 (mil Min r Improvement Permit Class IV LOCATION OF CONSTRUCTION /t . 11 &"A T 3D3� �D a1'�S0AJ Sr. Ll�(I WrA- ac f2`L.� �FF�sevj _<4-, Pt;w!j E_9 I or �.J%s (Street address of Description of Location) -rwC" A%! !fib ,SzAND k&AY a,,p 2_S-b Coto2ima—q* PURPOSE OF CONSTRUCTION _jcur ' LR-AI#1j_t uI mfflq o Sketch (attach construction plans if appropriate) a,12n1% . -rr- !c C A-n/ A, -A. AA0 DESCRIPTION DIMENSION OF INSTALLATION OR REMOVAL xz�64 se. `' - 1W X .5 X3I �.i x 2 S E OF EXCAVATION, IF NEEDED � " F -3w, AwAovm� T.T.D"PL&JS I &r-z n APZROXLb&AATE TIME WHEN WORK WJ.LL BMG APPROXIMATE TI CO T � ESTIMATED CONS R C I N (Including removal I b i n, a eri Is paction and placing r nen es a l g a / r In consideration oft tinQ th s De i . cant hereby agrees to: Indemnify, def nd n ve tUe City,�authorized agents, officers, representatives and employees, harmless from and against any and all penalties, liabi it's o I s resulting from claims or court action and arising out of any accident, loss or damage to persons or property happening or urring 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. YU Signature of Applicant or Agent 4-9 v Name of Applicant (pleas�e print) Business Address T Telephone No. Name of Contractor and Job Foreman Business Address Telephone No. &, I&s4s1All e-Z.l. ®6s-67- Contractor's License No. �- 6=ET AhliaW2 � �, 44-370,00 City Business License No. ®2_=3* -- ©7, d _ Applicant's Insurance Company Policy Number FEES: Subdivision Improvement Permit -Class III Public improvements: 3% of estimated construction costs Private improvements: 3% of estimated construction costs Minor. Improvement Permit - Class IV: See attached schedule Inspection Fee $ 4 / 7-4, Permit Fee Penalty Cash Deposit -Surety Bond if required 2 TOTAL: $ 24 Receipt No. Received by Date Recorded by PERMIT VALIDATION PERMIT NO. DATE APPROVED �ayL-�l/�3L=yl Uzi ZGY/ Z EXPIRATION DATE �G � �Z. -5 DATE ISSUED /GfJI/G?q.I -zic._ �Z'i ;2 �-Z._.- By jGT�L r��N Z Administrative Authority Telephone: (760) 7774-7.07555lSl7g�f/i �— Gws/w6*1101- _Z