0308' ,arc .. :''�� - • r �-. r
NOTE:'
With p#per validation Q•
' this form constitutes an
encroachment permit CITY OF 'LA, QUINTA
r APPLICATION FOR PERMIT --
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT),..
OF
.4
For the construction of public or private curbs". driveways, `pavements, sidewalks, parking lots, sewers, water mains r'
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit —Class III -
DATE:_ May 2, 1988 ' Minor Improvement Permit Class IV `
LOCATION OF CONSTRUCTION Avenida Martinez
(Street address or Description'of Location) *;
PURPOSE OF CONSTRUCTION TO install rieW gaS s�ryiee Sketch,(attach construction,plans if appropriate) '
DESCRIPTION OF CONSTRUCTION Install 50' of .2" U.'S.A. .
plastic medium 'pressure gas main, .10' •W EPL of .
Martinez.. See Sketch TW 224, . D1 Cut Earth Date
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF.NEEDED `
APPROXIMATE TIME WHEN WORK WILL BEGIN May 16,E 1988
APPROXIMATE TIME OF COMPLETION. '
ESTIMATED CONSTRUCTION COST$
(Including removal of ill: 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.
Signature of Applicant,or Agent '
SOUTHERN CALIF'., GAS CO'.., -P. 0.. BOX 220'0, RIVERSIDE, ;CA 9-2516-714-369-4512
Name•of Applicant (please print) - s Business Address Telephone No.
Name of Contractor and Job Foreman Business. Address Telephone No.
Contractor's License No. City Business License No.'
Applicant's`lnsurance Company a Policy Number
FEES: . Subdivision Improvement Permit =Class Ill
Public improvements: 3% of estimated construction costs '
Private improvem ts:'3% of estimated construction costs a
Minor Improvement Permit— Class IV: See attached schedule
Inspection Fee $` PERMIT VALIDATION
Permit Fee
-PERMIT NO.`
Penalty /
Cash Deposit -Surety Bond w DATE APPROVED / 0
f P .if required EXPIRATION DATE ' 3 O h9 �
-0-
TOTAL:- $ DATE ISSUED
Receipt No.
By
Received b
Y Date a V AdmKistrative Authority a
Recorded by x TELEPHONE: (619) 564-2246-, '
PLAN FILE NO ROR K
BABE BETON CNSTSETCH COMPL. SKETCH
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Isolation Area Affected Yes ❑ No ❑
ssure District Affected Yes ❑ No ❑
. I • ' ••SLC. • . f '•.
iness District Affected Yes ❑ No ❑ _s S/- 97S
Supply Line Affected Yes ❑ No ❑ `
Valve(s) Required Yes ❑ No ❑
Reviewed By:
C.P. Reviewed By:
.�• �' TOTAL FEET fNST`D -
INSTALL MAIN WITH AT LEAST ------r' COVER BELOW— /s� TOTAL FEET RETIRED '
` V•J M RETIREMENT /"'• C.�
L � PERMIT ISSUED BY PERMIT NO. DATE MOVED DATE MOVED DATE OF
COUNTY V ON JOB OFF JOB OPER.
��11
DI -5 STRICT -.D EKT REASON - CREW FOREMAN
TRACTy PLANNED BY COMPANY
S AKED ❑ COMPANY FACILITY: SO: CAL. P.L.S. ❑
ATLAS
I)\I I YEAR C.P. _ r
INSTALLED REVI ED BY STORG.
STAKING REO•D ❑ L— AST EP,
DIVISION
CATHODICALLY YES C1 NO C1 OPER. 20% OR OVER ❑ 8.M.Y.S. •� • ; � �
PROTECTED AT LESS THAN 20% 0 ISTRICT SUPERVI O NO STAKES NEEDED W.O� S �Ii CODE
4,
78-105-CALLE. ESTAQO =,_LA QUI,NTA, CALIFORNIA 92253 (619) -564-2246
ADDITIONAL CONDITIONS,
ENCROACHMENT PERMIT NO. 308
R33 Survey monuments shall,be protected in place or..re-established
pursuant to City standards and the State -of California Land
Surveyor's Act.
R34 Contractor 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: -
October 1st -to April -30: Monday -Friday -7:00 a.m. = 5:30 -p.m..
Saturday,. 8:00 a.m. -,5:00-p.m.
Work shall be prohibited anytime on Sunday or Federal holidays.
R35 Traffic control shall be as per Cal Trans -Traffic Manual.
Field adjustments in detouring shall be accomplished as direct-
ed in order to adjust to actual field conditions. It shall be
the contractors responsibility .to adequately barricade and
detour this site. `
R361 All excavation at or near the travel way shall be backfilled.at
the end of the work day, for the" protection of the traveling
public. _ -
R37 This permit is only --for- work within public -street -.,right-of-way.,
R38 Ingress and egreee for local properties shall be maintained at
all times.
R39 This permit is not valid unless the USA Inquiry Number is noted
on the City copy of this permit.
R40 Replacement- pavement shall -be existing asphalt -thickness plus,
one inch, but not less than 3 inches of- AC pavement shall be
placed. Class 2 aggregate base shall be as per existing or 4"
minimum (whichever is greater).
BJ/FORM.1AILING ADDRESS P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253
L
M
N
The following General and Special Provisions are attached to and made a part.of Permit No.
GENERAL PROVISIONS
The following shall always apply:
3o
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 equ ipment shall not be permittedto operate on any
paved surface unless"fittedwith:smooth-faced street pads. All mechanical outriggers shall be fittedwith rubber street shoes to protect
the paving during ''excavations. Rubber -tired equipment only shall be'used in backfill operations in paved areas. If the existing
pavement is scarred, spalled, or•broken during the term of this contract, or if the pavement is marred, City of La Quinta shall request
that these portions of road be resurfaced over their entire width. Resurfacing shall consist of one coat of two inches (2") of A.C.
surfacing plus appropriate seal coat as specified above.
PROTECTION OF TRAFFIC: All excavations and work areas shall be properly lighted and barricaded as deemed necessary by the City
Engineer or La Quinta City Public Works Inspectors. Suitable detours and detour signsshall 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.
CARE OF DRAINAGE STRUCTURES:' Any drainage structure including corrugated metal pipe, concrete pipe, steel culvert and
concrete structures encountered during excavation which necessitate removal shall be replaced in kind'. In the event -it becomes
necessary to remove or cut existing drainage structures, City of La Quinta shall be notified prior to commencement'of this work.
Drainage. structures and open drains shall be kept free of debris at all times for proper drainage.
RIGHT OF.WAY CLEANUP: Any surplus material resulting from excavation and backfill operations shall be removed from the right of
way. All paved surfaces shall be broomed clean of earth and other objectionable materials immediately after backfill and compaction.
Existing gutter line and drainage ditches shall be replaced to their original standard or better. All excess material shall be removed
prior to paving. Water tanker shall be used, as required, to sprinkle the job site to keep down dust conditions and.shall be -used
immediately after backfill.
DE -WATER OPERATIONS: If de -watering operations are required and pumps are forcing wateron City of La Quinta roads, it shall be
the responsibility of the permittee (contractor) to control this water and to provide off-street barricades when necessary.
CLOSING 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.
SPECIAL, PROVISIONS
The follwing shall.apply ONLY when indicated:
R1 NOTIFICATION: Permittee shall notify the City at 564-2246 at least 48 hours in advance of starting construction. ,.
R2 . CASH DEPOSITS OR BONDS: A cash bond or an approved surety bond in an arnountof not Iessthan $
shall be furnished in .the name of City of La Quinta to coverall 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 work on this project .
OR3 UTILITY CLEARANCE: (Substructures) Priorto making any'excavation withinthe City of La.Quinta rightof wayauthorized
' 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.
R4 UTILITY CLEARANCE: (Surface structures) No work shall be done under this permit until all utilities an 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 less than and in conformance with City of La Quinta Road Improvement Standards
and 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 Quinta shall establish grades and stakes for the proposed concrete curb and gutter
construction.
R8 GRADE CHECKING: City of`La Quinta shall check grades 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
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 DRIVEWAYS, A.C.: Driveways shall be constructed as not to alter existing drainage pattern. Surfacing between the
property line and the existing road paving shall be 2-1/2 inches of A.C. paving. placed on ( ") of class
aggregate base. Driveway construction shall conform to attached drawing.
R11 CULVERTS: A inch diameter( ) culvert shall be,installed 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.
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 coinplywith the
manufacturer's specifications.
R14 COORDINATE WORK: The proposed work shall be subordinated to any operation -which the State of California or
City of L" Quinta may conduct in'this area during the period of this permit. Work shall be coordinated with the State or
City of La Quinta forces to preclude delay or interference with State or City of La Quinta projects.
91centerline
SURVEY• MONUMENTS: Prior to excavation or beginning of construction, all survey monuments which exist on the of all streets or property lines when involved shall be completely tied out's o* 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. Th is off icesha11
be notified -upon, completion of 'replacement of all survey.,monuments for proper project clearance.
R16 SURVEY MONUMENTS: Pri ftavation or beginning of construction, all s"onuments shall betied out byCity
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.
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.
R19 LIMITOF EXCAVATIONS: Excavations shall be limitedto 1,000 linealfeetof opentrench before backf ill 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.
R20 BACKFILL MATERIAL: Backfill shall be free of brush, roots or other organic substance detrimentalto its use for purposes
of producing an adequately consolidated backfill. Any material which the City of La Quinta deems unsuitable (spongyor
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 lifts of 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.
R22 BACKFILL PLACEMENT: Backfill shall be applied in layers of not more than 50 percent of the total depth of the trench
before flooding or a maximum of five-foot (5') lifts where trenches are of excessive depths. Care isto be exercised thatthe
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 i ntervals 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.
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 asoutlined 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
consisting of 2 inches of SC -800 shall be placed on a prepared subgrade. The SC -800 temporary paving shall be placed
after a maximum of 3,000 lineal feet of trench has been excavated and backfill operations completed, but in no case shall
the placement of the temporary pavement exceed a five (5) day limit.
26 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. �j,5G Gp "0/ %/O,v /Z �/O
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 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 it
becomes necessary to restrict traffic, the work shall be restricted to a maximum of 500 feet at anyone 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 to a 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.
51'248'22,9(
'NOTE: ~� - ---
.
With. proper validation
this form constitutes an
encroachment permit
MAY _ 41988
_ • .:... CITY ®F LAQU-INTA
PELANNING & DEVELOPMENT DEPT.
CITY OF 'LA QUIN A
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)\—�_
. C`�•'11 nr •ntF.��
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
i
Subdivision Improvement Permit -Class III
DATE: May 2, 1988 Minor Improvement'Permit Class (V
LOCATION OF CONSTRUCTION AVENIDA MARTINEZ
(Street address or Description of Location)
'PURPOSE OF CONSTRUCTION To install new gas tervirP- Sketch (attach construction plans if appropriate)
. 1
DESCRIPTION OF CONSTRUCTION To install 50' of 2" 1� �stic
medium pressure gas main, 10' W/EPL of Avenida Martinez.
SEE SKETCH TGP 224; D1 CUT-FART(
DIMENSION, CF-!^�1ST,.LLATION OR REMOVAL 12A--79 ;
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN May 16, 198
APPROXIMATE TIME OF COMPLETION
• ESTIMATED CONSTRUCTION COSTS
(Including removal of all obstruction, materials, and clef ris, 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...
Sign ure of Ap licant o ATTgenlIt obifl-4 vvIISS
. BO 2 Jk:M::aSD f EC -, DIS2Rj.B� I?RfflRT#E-�i"' , -
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 -
S"
Public improvements: 390of estimated construction costs
Private improvements: 3% of estimated construction costs*
Minor Improvement Permit - Class IV:.See attached schedule
Inspection Fee S - — PERMIT VALIDATION
Permit Fee$•.PERP.IIT NO. 3 •
'Penalty DATE APPROVED 4
Cash Deposit -Surety Bond r .
if required-- ; EXPIRATION DATE
S
TOTAL: —. i
• DATE ISSUED
Receipt No. B -
y
Re.-ived by .Date - Administrative Autho:
Recorded by -- TELEPHONE: (619) 564.2246: '
,
NOTE:' "
With proper validation
this form constitutes an
encroachment permit
r
r
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 II I
DATE: May 2. 1988 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION' Avenida Martinez
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION To install new gas service Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION. Install 50' of 2" U.S.A.. #
plastic medium pressure gas main, 10' W EPL. of
Martinez. See Sketch TGP 224, Dl Cut Earth Date.:.
DIMENSION OF INSTALLATION OR. REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN May 16, 1988
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(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.
Signature of Applicant or Agent
SOUTHERN CALIF. GAS CO:, P. 0. BOX 2200, RIVERSIDE, CA 92516.714-369-4512
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 ND 308
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
-0-
TOTAL: $
Receipt No
Received by Date
PERMIT VALIDATION
PERMIT NO. :2 yff
DATE APPROVED
EXPIRATION DATE 903 O 9H_
DATE ISSUED
r By
AdniWistrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
N+