0614ti.,r., • •r..--..� t•�r{'"c;:a��=:a4.w,•s••.-. :'..:f¢`,ri�'��:i!a6,;.�+•y4. ,�',�av�,a+.J�.-drwc^s.r ��i+q •'a"`.�;.�^=,�+w-,�+ak ,r ,ti`r., en,+.a:•::n�'4"„':+W`ua,i:nrw..+:i:aw.wr_ Yt �z. r � w... ..
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NOTE:
With proper validation'
this form constitutes an • CITY OF LA iQUINTA
encroachment permit ,
• APPLICATION `FOR PERMIT.. t
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 I I
DATE: May 1, 1990 Minor Improvement Permit Class IV
LOCATION OF -CONSTRUCTION Calle Barcelona between. Avenida Bermudas,arid Desert
Club Drive• ,
(Street'address or Description of Location) ,
PURPOSE OF CONSTRUCTION to oroyide fiare .proteetionSketch (attach construction plans if appropriate)
to 78-073 Calle Barcelona MArio's El Gardena 'Res urant
DESCRIPTION OF CONSTRUCTION, install 1 -6" -fire hydrant,'
DIMENSION OF INSTALLATION OR REMOVAL 6x6 See attached 'DistriGt Plat
-Sheet No 6-7-6-3 `
SIZE OF EXCAVATION, I_F NEEDED ;
APPROXIMATE TIME WHEN WORK WILL BEGIN -MAY 1990
APPROXIMATE TIME OF COMPLETION May 1990: ' =
ESTIMATED CONSTRUCTION COST $ 7; 5f10
(Including removal of all obstruction, materials, and,.debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrees to:
Indemnify, defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and all
penalties, liabilities'or loss resulting"from claims or court action and arising out of any accident, loss or damage* to persons or.property
happening or occurring as,a proximate result of any work undertaken under the permit granted pursuant to this application.
Notify the Administrative Authority at least twenty-four (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. rt
Robert Ford
` Signature of Applicant or Agent
Coachella Valley Water District. PO`Box 1058.Coachella.-.CA 398-.2651x265
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 III '
Public improvements: 3% of estimated construction costs
- Private improvements: 3% of estimated construction costs_ -0614
6 1 4
Minor Improvement Permit —.Class IV: See'attached schedule d
'Inspection Fee $
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required '
TOTAL: $ '
I. Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
0614
PERMIT NO.
DATE APPROVED .5/1/90
EXPIRATION DATE 10/1/90
DATE ISSUED A 5/1/90
By—
--"Administrative
y•-"Administrative Authority
TELEPHONE: (619) 564-2246
I-h`...•�i"`. -.-....abs-�rl-. ri�+"'�`r....v"'.-r"'"J-'Yr'•., +w• ....-;t `. ��....-.s.,�---..�-7.v.:�•'^v-.w--.f+-•-�..,-.�+s-.r.,.�.,,�.,.f'•t •y.r�. ,y+^�•..-,.`Y...
i
{ Z 1
h t
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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 III
DATE: May 1, 1990 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Calle Barcelona between Avenida Bermudas and Desert
Club Drive
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION to provide fire protectlonSketch (attach construction plans if appropriate)
to 78-073 Calle Barcelona Mario's E1 Gardena Restaurant
DESCRIPTION OF CONSTRUCTION install 1-6" fire hydrant -
6x6 See attached District Plat
DIMENSION OF INSTALLATION OR REMOVAL Sheet No 6-7-6-3
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIMI WHEN WORK WILL BEGIN May 1-990
APPROXIMATE TIME OF COMPLETION May 1990.
ESTIMATED CONSTRUCTION COST $ 7.500
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrees to:
Indemnify, defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and all
penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage to persons or property
happening or occurring as a proximate result of any work undertaken under the permit granted pursuant to this application.
Notify the Administrative Authority at least twenty-four (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.
{
:hella Valley Wa
Robert Ford
Signature of Applicant or Agent
lla, CA 398-265.1x265
Name of Applica;t (please print) Business Address Telephone No.
s
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
Penalty
Cash Deposit -Surety Bond )
if required
• i
TOTAL: $
Receipt No.
Received by Date
Recorded by
0614
PERMIT VALIDATION
0614
PERMIT NO.
DATE APPROVED 5/1/90
EXPIRATION DATE 10/1/90
DATE ISSUED— .f 5/1/90
By
Administrative Authority
TELEPHONE: (619) 564-2246
t. r f
+ " The following General and Special Provisions are attached to and made a part. of Permit -No.
GENERAL PROVISIONS
y �
The following shall always apply:
ENCROACHMENT ON PRIVATE PROPERTY:, This permit authorizes work to be accomplished within City of La Quinta rightof way
ONLY. Whenever construction extends within private' property, it shall be the responsibility of the permittee (or his contractors) to
secure permission from `abutting property owners. Such authorization must be secured by the permittee prior to starting work.
TRACKLAYING CONSTRUCTION EQUIPMENT: • Cleated tracklaying construction equipment shall not be permitted 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 payed areas. If the existing
pavement is scarred, spalled, or broken during the term of this contract, or if the pavement is marred, City of La Quinta shall request
r that these portions of road be resurfaced over their entire width. Resurfacing shall consist of one coat of two inches (2'► of A.C.
�• 'surfacing plus appropriate seal coat as specified above.e ,
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 Insp;ctors. Suitable detours a hd detour signs shall be placed and maintained for the duration
-of the project. The City shall be notified 24 Hrs. in advance of any traffic detours or delineations.,
, -
r ^ 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
1 immediately after backfill. , -
z DE -WATER OPERATIONS: If de -watering operations are required and pumps are forcing wateron City of La Quinta roads, it shall be
L the responsibility of the permittee (contractor) to control this water and to provide off-street barricades when necessary.
CLOSING STREETS: No street shall be closed. A minimum of one lane of traffic shall be maintained at all times to provide limited
access for the adjoining property owners and emergency vehicles. In the event it isfelt bythe permittee that he must close a street for
any length of time, permittee shall contact this office to obtain the necessary permission.
t SPECIAL PROVISIONS
The follwing shall apply' ONLY when indicated:
e R1 NOTIFICATION: Permittee shall notify the City at 564-2246 at least 48 hours• in advance of starting construction.
2 . CASH DEPOSITS OR BONDS: A cash bond or an approved surety bond in an amountof not less than $
shall be furnished in the name of City of La Quinta to cover all work involved in the restoration of the various La Quinta
roads and survey monuments. This bond shall be continuous until cancelled by the City Engineer. This bond must be
posted prior to commencement of any workonthis project . r -
R3 _UTILITYCLEARANCE: (Substructures) Prior to making any excavation within the City of LaQuinta right ofWay authorized
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.
,"114" 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.
R5 • PAVEMENT WIDENING: Area between the proposed concrete gutter line and the existing road pavement shall be
surfaced with inches of A.C. paving placed on ' inches of class aggregate subbase course
" having an "R" value of not lessttian and in conformance with City of La Quinta Road Improvement Standards
` arid Specifications,. Ordinance #461. .
R6'• PARKWAY GRADING: Area between the property line and top of the proposed concrete curb shall be graded to a slope of
1/4 inch to one foot (1').
* R7,- GRADES &STAKES: City of La Quints shall establish grades and stakes for the proposed concrete curb and gutter
construction.
CR8 - GRADE CHECKING: City of La Quinta shall checkgrades upon receipt of plan and pFofile and/or grades as established by
—%'a licensed engineer.
! R9 CURB REMOVAL FOR DRIVEWAYS: A'portion of the existing concrete curb and/or curb and gutter ( feet) shall be
k y - 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.
+, R10 SDRIVEWAYS, 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 constructionshall conform to attached drawing. y
R11 CULVERTS: A— inch diameter()culvert shall beinstalled with the invert approximately 1-1/2
inches below and in line with the existing flow•line. Culvert installation shall conform to the attached drawing.
r , .�R12 SIGHT CLEARANCE: Sight clearance of 600 feet in either direction shall be assured and maintained.
R13 SOIL STERILIZER: The area to be'surfaced shall be treated with soil sterilizer. Rate of application shall comply with the
tk manufacturer's'specifications.' '
R14 , OORDINATE WORK: The proposed work shall be subordinated to'any operation which the State of California or
r.. City of La Quinta may conduct in this area during the period of this permit. Work shall be coordinated with the State or
n Citv of La Quints forces to preclude delay or interference with State or City of La Quinta projects.
` D15URVEY MONUMENTS: Prior to excavation or beginning of construction, all survey monuments which exist on the'
enter line of all streets or property lines when involved shall be completely tied out so they may be 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 of replacement of all survey monuments for proper project clearance.
'RD -31
R16 SURVEY MONUMENTS: Prior to excavation or beginning of construction, all survey monuments shall be tied out by City
of La Quinta and suitable payment or guarantee of payment shall be made as reimbursement for all work involved.
R17 PAVEMENT CUTTING: Pavement will be mechanically cut to a straight edge prior to excavation. Method of pavement
cutting shall be approved through the office of the City Engineer. (Under no circumstances shall excavating equipment
be used to excavate prior to cutting of pavement). Excavation material shall be placed in such a position as to best
facilitate the general flow of traffic. Prior to final paving operations, any damage to pavement straight edge shall be
// corrected.
r R18 PAVEMENT CUTTING: Pavement shall be saw cut prior to removal. Prior to final paving operations, any damage to
pavement straight edge shall be corrected.
LRI9) LIMIT OF EXCAVATIONS: Excavations sha 11 be Ii mited to 1,000 Ii nea I feet of open trench befo;-e backfill operations rn ust
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.
R20 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.
R21 .BACKFILL SAND: Backfill shall be approved transit -mix sand or equivalent and shall be placed in liftsof notgreaterthan
three feet (3') and vibrated using vibrotamper or equivalent equipment. Alternate methods maybe substituted, but in any
case a relative compaction of 95 percent shall be attained within the structural section of the roadway.
j R22 BACKFILL PLACEMENT: Backfill shall be applied in layers of not more than 50 percent of the total depth of the trench
6eforefloodingdramaximum offive-foot(5')liftswheretrenches are ofexcessive depths. Care istobeexercisedthatthe
backfill material is not subjected to extreme swell by flooding operations. Backfill material shall be placed so that the
resulting compaction shall be not less than 90 percent or equivalent to the surrounding ground, whichever is the greater
compaction. Where ponding or flooding is used for a maximum settlement, adequate dikes will be constructed to retain
the water. Where jetting is used, the jets shall be of sufficient length to reach the bottom of each layer and the water
supply shall be continuous.
R23 COMPACTION TESTS: If so required bythe inspector, compaction tests shall be made at intervals of not more than 1,000
feet and a minimum of one (1) test on each road. One (1) copy of each test shall be forwarded to the City Engineer for
approval and filed prior to making permanent repairs. Compaction tests shall be made as outlined in Section 6.3.01 of the
/ "-Standard Specifications, Division of Highways, State of California, dated January 1973.
R24 COMPACTION TESTS: If so required by the inspector, compaction tests shall be made for each crossing or service line.
'-bne (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.
R25 TEMPORARY PAVEMENT REPAIRS: After completion of backfill and compaction operations, a temporary patch
�'after
consisting of 2 inches of SC -800 shall be placed on a prepared subgrade. The SC -800 temnorary paving shall be placed a maximum of 3,000 lineal feet of trench has been excavated and t:ac:<`Ilape,atcoii5cornp,atad,Iut in no case siiaii
the placement of the temporary pavement exceed a five (5) day limit.
( R26 PERMANENT PAVEMENT REPAIR: After backfill and compaction operations have been completed, a temporary patch
consisting of two inches (2") of SC -800 shall be placed immediately. A permanent patch of inches A.C.
surfacing placed on a inch class base shall be placed no later than days after completion of
temporary road repair.
R27 PAVEMENT REPAIR: F.A.S.: Upon completion of backfill and compaction, a temporary patch consisting of two inches (2")
of cold mix paving (SC -800) shall be placed immediately. A permanent patch of three inches (3") of A.C. surfacing shall
be placed on six inches (6") concrete base as directed, but not later than fifteen (15) days after completion of temporary
paving. Concrete base shall be of five -sack mix and shall conform to the City of La Quinta Road Improvement Standards
and Specifications, Ordinance #461.
R28 FOG SEAL: A fog seal coat consisting of an application of asphaltic emulsion shall be applied over all patch areas as
determined by the City Engineer.
R29 SEAL ARMOR COAT: A seal coat consisting of an application binder and screenings shall be applied on all patch areas
where such seal coats existed prior to issuance of this permit. Seal or armor coats shall be applied as specified in Section
37, Standard Specifications, State of California, Division of Highways, dated January 1973. Work of pavement repair to
be accomplished by a licensed contractor engaged in the business of pavement repair.
R30 STREET RESTRIPING: Where street striping is still visible on streets to be excavated, such striping shall be replaced upon
completion of permanent repairs.
R31 TREE RELOCATION OR REMOVAL: Tree relocation within the City of La Quinta road right of way shall be accomplished
by a licensed, bonded and insured tree service, and handled safely without interference or hazard to the traveling public.
It shall be the responsibility of the permittee to maintain the tree in a vigorous growing condition at its new location.
Trees to be removed shall be removed in sectionswhich can be handled safelywithout interferenceor hazard to highway
traffic. The entire width of the tree stump shall be removed and disposed of so that no debris remains in view of the
highway. The stump hole shall be backfilled and thoroughly compacted as specified in the following paragraph. Where it
becomes necessary to restrict traffic, the work shall be restricted to a maximum of 500 feet at any one time. Adequate
signs, flagmen and/or barricades shall be provided to protect the traveling ,public at all times.
Large holes resulting from tree 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.
R32 TREE TRIMMING:
a. Only the necessary trimming shall be accomplished to provide clearance of the facility for one calendar year.
All broken or weak sections within the trimming shall be removed.
b. Where it becomes necessary to restrict traffic, the work shall be restricted toa maximum of 500feet at anyone time.
Adequate signs, flagmen, and/or barricades shall be provided to protect the traveling public at all times.
c. If tree trunks are partially outside of the City of La Quinta road right of way, permittee shall make his own
arrangements with adjoining property owners for consent to the trimming in addition to the authorization provided
by this permit.
d. All tree trimming on EVERGREEN TREES, PALM TREES, and other ORNAMENTAL TREES shall be accomplished to
the satisfaction of the City Public Works Inspector.
e. Abutting property owners shall be contacted, in all instances, prior to trimming or topping trees.
f. Pruning shall, in all instances, be at the shoulder of the crotch to insure even, fast healing in all cuts of two inches
(2") and above in size. Sealant shall be applied to all cut sections as directed by the City Public Works Inspector.
ADDITION-ENCROACHMENT.PERMIT NO. 4 ----CONDITIONS.
R33:7 Survey monuments shall be protected in place,or
•`„ ,_. re-established pursuant to,City standards and the State of
California Land'Surveyor's`Act.
R3.4 `Work shall.be coordinated.with the City of La,Quinta's
' forces.to preclude'delayor interference with the City.of La
Quintals projects. ;
R35� tContractor shall comply with the local.noise ordinance and
construction`operations and maintenance of equipment within,
one ' half. mile' of human%occupancy shall`' be performed only.
during the'time periods.as follows:
iOctober''lst to April 30: Monday-Friday.7:00a.rri.-5:30p.m. _G
Saturday 8:00a.m.=5:00p.m.
May 1st to September 30: Monday -Friday. 6: 00a.m.-7:00p.m__
Saturday 8:00a.m.-5:00p.m.
r Work'shall be prohibited anytime on -Sunday and Federal.
` holiday.,. ,
R36 Traffic control shall be as-per•Cal.Trans'Traffic Manual.,-^,
•, Field adjustments.in detouring shall'be accomplished:as'
directed''in':order to adjust to actual field conditions. It
shall be the contractor.'s responsibility to adequately
barricade and detour.this_site. A Traffic control plan shall
be submitted for approval by the City,Engineer. !
I.' _R37 All excavation'at'or near the travel way shall.be backfilled',
at the end -of -the work day, For the protecti^n of -the
traveling- public. '-
R38' Street closures shall.not`be allowed at. any time. `
R39' .-A minimum of 'one -travel lane -shall be maintained at all
times with`flagmen during'work_ing.hours. '•
z R40t All,work to be performed within the existing paved section_
..;shall be tempo' y`, paved and maintained -by the Permittee
permanent pavement "shall be.placed no later than 15..days
after• completion of'the temporary road .repair., {
,1. t -
R41. Ingress and egress.fortlocal properties shall be maintained
at all times • _
R42' Prior. to work starting, Underground.ServicelAlert shall be:
. contacted at,17800-422-4133 and an "inquiry -number" shall be
provided to'the City Public Works'Inspector.
R43 Pavement• shah be sawcut ^prior to removal.;
F " ` • • s t F
, l
17
Additional -Conditions -; Encroachment'Permit.No. 061.4+
_
Page 2
R44,'
A11.1backfill subgrade soil shall+`be." compacted to^ nothing
..'lessAthan
'90 o+relative dry density; all backfill within
-soil
Lhe top:.2', of, finish pavement„ surface shall, .be,,'.compacted
`
nothing' -less than- 95% relative dry density;,- all base `
material -shall be compacted to nothing less,than 950.
•.
relative dry density,. ,
R45
Replacement pavement sections'. shall'be 3" AC"over-411-Class•
II -aggregate base. ,
R46"
If the work is to be` performed by forces other ••than that .of, ,
the' utility the contracting' company will be: • 1,
_company', 4 1.
required- to apply for an,•.additional- encroachment permit
and pay the appropriate fee.., '
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
Subdivision Improvement Permit — Class I Il
DATE: 4-30-90 Minor Improvement Permit Class rV
LOCATION OF CONSTRUCTION Calle Barcelona .between Aver) i da Bermudas and Desert Club Drive in
La Quinta.
(Sarm address or Description of Laotian) ,
PURPOSE OF CONSTRUCTION To provide f.i re protection` Sketch (attach construction plans if appropriate)
to 78-071 Calle Barcelona Mario's El Gardena RestaulaiiT
DESCRIPTION OF CONSTRUCTION -Install 1 -6" fire hydrant,
assembly aoprox— 260' East of Bermudas on Calle
Barcelona. South side of street.
DIMENSIOc; CF !";ST,'.LLATION OR REMOVAL 6 x 6 SEE ATTACHED DISTRICT PLAT,
SHEET NO. 6-7. -3
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN @1aT1990
APPROXIMATE TIME OF COMPLETION lzla.T 1 qan
ESTIMATED'CONSTRUCTION COST S T^n
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing ,improvements) t
In consideration'of, the granting of this permit, the applicant hereby agrees to:
' Indemnity, defend and saw the City, its authorized apnts, officers, representatives and employees, harmless from and against any and all
penalties, liabilities or'loss resulting from clainu 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.
Notity the' Administrative Authority at least twenty-four 124) hours in advance of the time when work will be started.
Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City of
La Quints and to pay for any additional replacement•nocesssry as the,result'of this work.
• Rober.t A. Fordo—�"
Signature of Applicant or Agent
COACHELLA VALLEY WATER DISTRICT P.O. BOX 1058 COACHELLA, CA. (619)398-2651 x265
Name of Applicant (please print) Business Address Telephone No.
SAME AS ABOVE
Name of Contractor and Job Foreman Business Address Telephone
;No.
Contractor's License No.
City Business License No.
Applicant's Insurance Company Policy Number
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