0273 (2)With propervalidation`• atw S?t"•fu, ire moj t ra Jitt t1., ;.t -;its;,.
this form constitutes an CIT fOF' t°.`A '`a I A ' '� �'
encroachment permit! ; '7777S. ttt. t t Yu s ; 4 - >�ju IN Y ., ' ;. u� �Y
t�attrsv�i!„g.-Q!ttsit,at><v��;i� f� , r, APPLICATION'*FqR :PERM%IT�e`
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PUBLIC
y WORKS CONSTRUCTION (ENCROACHMENT)
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Cenit_Y, Vv{tePave tt wnz sucsior, to tati t '»tFt,s,�r;tr:EaY }tt,y� tty, tt tl 11, apt timet t ; #rrt tisi{ity.yf tttu� pofmi* ett (04 i
UlCtirA {}OTttlf$'iiiQt. 'f On"dtbWatria; T.Yi'/ 41iiY CtVitltdfh ^V' -'a 4itr2t i)rl3iiti.i!r llitd 1 tr 'N^ =+`t.d:by the (ya nt t, , prt.sr in rlllftii)Q�:V7rk
For the construction of public or private 'curbs, driveways pavements, sidewalks, parking lots, sewers, water mains
'
Ind, a ptibl c works`improvements iri"conliectidri'wi h MINOR`IMPROVEMMENTSjarid�`APPROVED SUBDIVISIONVY t '
pavla sui Att'l Un usSS atttkd wttr; i;rnowh .fit .1 ntt Ott p r Ali m�;c tar+a�ei utrig Ars+ sht�il lab fittl c►wig t rubber strata t:tto.a� tri u; otsr�i
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PO diiririiJ,tkclvt+tiarle. ixrtia'>�+r'strer! tr �,ius �z�t txrzly fi'init SQL ttS<cCf lfl.lt;aCkfiil:opertatirtol5 +s1'oAvfi:: €fdoae. it t:ie 4risllnca
;t3'avtsnidnt s5 sQurre4t sPalied or. I;r'P. a i ::;artcu7lilc t�rtq o1 ihis ^rtrstr'aGt, ii if the nt�vtnst;;�t is atiarraci, Cily tij La Cil:nts 5hri i•;:ac)au3:t
RFfstt;'i:otii�rz;;'of ra.*W"La rc,ufjccoi.'j tiyttr'Okit tLq'l,tialwid,01. 4i*0ta0ktSubdi4isionrlmprovemen;,.Permiv� Class '.Illf,'a,,,T A
DATE. -`4 '11k1 x . c.. > �'= ` •! �t ��a.,�: Minor Improvement Permit'Class IV
LOCATION, OFXONSTRUCTION,,' 01; ,FAAASt 104140-0-,Aoude1�, T04-nfrrk�crt�+. ,�;1r.;n^rt. ±,:•r ,,.-. ;� t r-,1•
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- (Streef address or Description
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PURPOSE GF O TR C11 N SkQt co str clic plansif appropriate)
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9ESCRIPTIONOF,CONST;R.UCTIQN
7777=7-47;AY4 y 2t{ly Oi_;allt'FtJl4 'u iitc�,rs,.;wsFil,l t+d-r'4rC, <;�.,,•, :,r tit" .-I( �a nt.
To f1'Abtall 13,7 oP 2 medium`
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[�I,M �ISIO�y OFrIfV TALLATI�I�¢t R REI QVS44 pieta, a p, ;astir rg�s maid, 5.'
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SIDE OF XCAVATIQN,_aF (�EEDED' ” ' SEE - SKETC r TGP. 214, F-2 CUT EARTH
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?,.APPROXIMATE TIME IIVI-IEN WO!�'K WILL.BEGIN t �r=j � �; `� t`' vfUSA xlnquirrl ,'NC:`te' t "��'t2`3 j
R-27—
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IN 6P. STA 1:471 f i 1) it Cl;ly,+
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APPROXIMATE iTIMEtiOF'COMPLETION'r''*gener.al=�andti�8pecial
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ESTIMATED CONSTRUCTION COST,$ �provieiona" are included. and made
.(Including removal of all obstruction, materials, and detiris backfilling; comb r : a part ' Of, this permit
( C,, �.q d�plaCinq y�nangr�t egs�urif�tG g?n l/or replacing;improvementS.
'In consideration of the graniing,of' this' permit;:the.applicant hereby agrees to:
Oji i} !i t ri.1i t•�,..q IT itc,+, �lii�tl r.., indemnify, -defend asave the City Its authorized, a(g'e,•n.t. s,'I t`f>'tr i r . .�',.•''w
all, , nd ttay
penalties,,:iJ�bilitjes'or lossr4esthtiRgtyfro4sl_cl�im tp�j�ourt,a>+�jion,and.aa! ing.auj3ofacci�en�s,loss:orl,darnagg;Jtito person;or property
.' happeningjorxocc)rrrlr�$ ast�➢prQiae�reult iof�an�yworik.tuderta,en tndruthe perrlytrarduRursyprn�t t�iawls:}app�ll�cationact.t�,sirrka
Notify;the;,ARiministrative Authority t,;least,,.twenty-.four,•(24)thours`In�advancei,oftthe,tirtl )Yyh@�;woi�C wlls•.,be @tatted. )r, ,� s ,, w '
Comply with all--ipplicable`tCity' �Ordmarices, the'terms- and condition§'of the permit and all applicable rules and.•r_egulations of the City of .
Q mita` nd,to pay for,any ad%iti?nal replacement. necessary as the•result of,t,)is wor
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tN S � , o `-Signatureof Applicant orAgent
Soi&th'ernE''Californ� a Gas "Co a 1tiiP, " O.'�Bl'a
:. Namp,9f APPiicantt(please print).t'v,p�rtritEat; 44411 nssll!`v
sf17` .`12�Telephone No..•64
'AlieANT.tiIEJtxistio:t?3-N.
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- :.Name. of Contr'ectoi iti Job'Foreman. ,, .: Business Address. :. -
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Contractor; kart • ,°'sfMt)i'ylt,; ,, tta be tura>sr) the r=� r ' if9ts iand pf tr3e r' _,, tttrrd c u ws ,uL e e N
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Applicr�t's.Ins,�trance Cgrppnyfrity•ial E.ri'Cs,f;ts s;1t.t r3tit:tiY{i fl r�ttade� ��t.i slic€ss,f{f Pp�i�y�,N•ymbesacttstu �t�t3r alit? gsxt,as
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FEES:-, SubdivisionImprgvementPermit .Class;Ill;{ ,ac race si;; tr�erc:islo:p,aaa rlctgtrofiittanifirar'tar arc:asa }wi�.sa,:; t>,
' tPublic•improvements: 3% of estimated construction cost;.
Ptilyate;irnproveme!)h5,j9,E, Qf,.estirtatgd con;trug>;pcEscosts;,Nt�c+ ,tet 1 tirta arldlvr cifrt7T�a.t+r j, g1�tty,ii tie
Minor lmprtivement Pe?mitr'—� Class IV See attached schedtilef ?p+?rr+wrr{�1 •Ct parssarlt rig i est=rs 4alid:�;f!�,. {;rpt: islri
GJrx,;t; irk ,r •vv y., , ia., ; tur4'3Et>rtttS:ts c� t11 cutiicn'm4tlita vu?tji'` ity sal (,ttlitIla $to =+'�z d ii207—
Inspq El n Feawit . tt1,N�i. ��$4—rtrrrr� �rctt'ain;RVIMIT;,VALIDATION.,
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Permit Fee ttapf"ik't'titara sara^ tilt axlsit{no fDoi imVOW-gf•t.[:,oik -i'xy JrYJW') ''r! 1,C, ;};+tJil:r� j;(4ot-4t+Z.�
I;- ;wtrri>rrwt s Vuct wm soog
Penalty t t t � 7 • A r: s �t'-�:Yt DATEtAPP,ROVEDu tt, /{t•,.� '7+,..s, , ? . t
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Cos6e' posit -Surety Bond • "�"
if required int; }S ai IQtv,, r1Ci in ltrw tri;^tgl7 ts,e•!YfSFata +;l')xr� i�d �c � fir. n e', :., ltatrUrl:,rt,,:i f•�i"ti%t. Yt t0 gtlti! 4S fi/'ti' iCtfylm�.
ti EXPIRATION DATE �"i�� �f 7
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t . .L,Z. , t ii ;` ` s "G bct, "� ,aat ,rF =DATE, IUP�t
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Receipt �..-
r+ {f' , +k. t�tiall tom, �a hl'v�r ..Ori 414 ny pu, �s s v qty a • e
Received 0Y._7,,,1.Date ti ' mi �afi�e Authority
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Recorded byt.- �r»t+ '' `TELEPHONE':.(61'9) 564-2246.1!''
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' is Cli'nt::rijltHrr9i3t{.tlr�au+st�r,�tt�t',!#'r.�+'t+:tit&tNia+�n4ilVUti.l:�:�'rL,r"',�r-r,;�'�'� �ti,i`1f7t�1i`rttii3?Cl{;1(ii�t}t6�+'ilairel.1.itiri�c�i,T{<}!�a1•E,!�,tjatktf;r:{+J
bojrer,lacit: Wva#.g —is ed6itsi'n+4b-tr-*4 ar'suttb%lotus4W;;t,1 6,oWitlixti .,'col,,01 eq* Sat ofrittt:ct:��Iw.ki*irvtth4,,.
ties to these monuments"shall be furnished to the City Engineer prior to the removal of any4monu'ments. This office shall
be notified upon completion,ofrreplacement of- all- survey'monuments for'proper projectsclearance:r
RD -31 t •,: QOOVv In 5 t7c : l"+tom`?. till -Ill tw eig,lit- 1 Jk