0544NOTE:
�+ 'With proper validation
this form constitutes an
.encroachment permit
1
CITY OF .LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION. (ENCROACHMENT)
y
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
DATE: March, 22; 1990
LOCATION OF CONSTRUCTION -QTR 24
Subdivision Improvement Permit— Class III x
Minor Improvement Permit Class IV
R. +
290
and Adams Street
(Street address or Description of Location) 4
PURPOSE OF CONSTRUCTION watex' little Sketch (attach construction pans if appropriate)
DESCRIPTION OF'CONSTRUCTION j CVWD Drawing '164-16. -16425
Ara�.�i �1
n,r n
DIMENSION OF INSTALLATION OR REMOVAL 601x131 sewer
204' x 4' water
SIZE OF EXCAVATION, IF NEEDED 13' sewer, 4'water
•APPROXIMATE,TiME.WHEN WORK WILL BEGIN 4/5/90
A
APPROXIMATE TIME OF COMPLETION 5 Aavq• f
ESTIMATED CONSTRUCTION COST $ 1 A nnn `
.(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
4/ In consideration of the granting of this permit, the applicant hereby agrees to: l'
Indemnify,•defend'and save the City, its authorized agents, officers,. representatives and employees, harmless from and against anyland 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
E.G_._ .William Ca.� 42600 Cook Street Ste.135\'halm Desert 345-7541
Name of Applicant (pl'ease print) Business AddressTelephone'No.
i E.G. Williams Co same \T'
Name of.Contractor and Job Foreman ,` Business Address Telephone No.
477423 1231
Contractor's License No. ":� City Business License No. r
tAMI BINDER 4.201 r •tet i
Applicant's Insurance Company r Policy Number
"° Inspection 5 heoaus
FEES: Subdivision'Improvement Permit —Class III � P /$40.00• per/hr.
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs r f
E ' d 's.Al.— . A l�
Minor Improvement Permit — Class IV: See"attached schedule 0 518 Q 03—?8-90 10
s LAS i TAL 210.00
Inspection Fee $ 200.00 II PERMIT VALIDATION
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL
10.00
$ •�lin_no
Receipt No. '
Received by Date
Recorded by
PERMIT NO. 0544
DATE APPROVED a 3/22/90
EXPIRATION DATE 6/30/90
DATE ISSU ED 3/22/90
By `
Administrative Authority
TELEPHONE: (619) 564-2246
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
Subdivision Improvement Permit — Class II I X
DATE: March 22, 1990 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION TR 24517 and TR 25290.
Fred 14arincx Drive and Adams Street.
(Street address or Description of Lobation) *,
PURPOSE OF CONSTRUCTION water service line Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION CVWD Drawing 16416=1642'5
. •. e�.aa � rat"t� ��_
" DIMENSION OF INSTALLATION OR REMOVAL 601X131 sewer
20,.41 x 41 water
SIZE OF EXCAVATION, IF NEEDED 131 sewer, 4 1 Water
APPROXIMATE TIME WHEN•WORK WILL BEGIN 4/5/90
APPROXIMATE TIME OF COMPLETION 5 days
ESTIMATED CONSTRUCTION COST $ 14, nnn
(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.
f) (J � � r-
lSignature of Applicant or Agent
E.G. Williams Co. 42600 Cook Street Ste. 135sPalm Desert 345-7541
Name of Applicant (please print) Business Address Telephone No.
E.G..Williams Co same.
Name of Contractor and Job Foreman
r' Business Address.
Telephone No.
477423 1231
Contractor's License No. City Business License No.
-AMI BINDER 4201
Applicant's Insurance Company Policy Number
FEES: . Subdivision Improvement Permit — Class III Inspection 5 heaus/$40.00 per/hr
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ 200.00
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 210.00
Receipt No.
Received by Date
Recorded by
•rkR:;o
%To
. 0"448' ' 0,3 SF -9q 14 5CA� , fTALx,
20.00
PERMIT VALIDATION
0544
PERMIT NO
DATE APPROVED 3/22/90
EXPIRATION DATE 6/30/90
DATE ISSUED 3/22/90
ByM�—�
Administrative Authority
TELEPHONE: (619) 564-2246
'The following General and Special Provisions are attached to and made a part of Permit No.
' Y GENERAL.PROVISIONS
The following shall always apply`
.ENCROACHMENT ON PRIVATE PROPERTY: This permit authorizes work to be accomplished within City of La Quinta right of 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
tpaved surface unless fittedwithsmooth-faced street pads. All mechanical outriggers shall befittedwith rubber street shoestoprotect
the paving during excavations. Rubber -tired equipment only shall be used in backfill operations in paved areas. If.the existing
j pavement is scarred, spelled; or broken during the term of this contract, or if the pavement is marred, City of. La Quinta shall request
that these portions of road be resurfaced over their entire width: Resurfacing shall consist of one coat of two inches (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 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.'
CARE OF DRAINAGE' STRUCTURES: Anydrainage 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,
c 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:
t. ^ 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
t immediately after backfill.-
DE-WATER
ackfill:DE-WATER OPERATIONS: If de -watering operations are required and pumps are forcing water on 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 itis felt by the permittee that he must close a street for
any length of time, permittee shall contact this office to obtain the necessary permission. • „p.,•
;.
SPECIAL PROVISIONS.
t The follwing shall apply ONLY,when indicated: , f
.NUTIFir-ATiON: Permittee shall notify the City at 564-2246 at least 48 hours in advance of starting construction.
:I-
2. CASH DEPOSITS OR BONDS: A cash bond or an approved surety bond in an amount of not less than S
i 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
prior, to commencement of anywork on this project,posted
UTILITY CLEARANCE: (Substructures) Prior to making any excavation withi-the.CityofLaQuintaright ofway authorized
by permit, the permittee shall contact all concerned utility companies relative to the location of existing substructures.
^r Damage to existing substructures resulting from operations conducted under this permit shall be the sole responsibility
of the permittee. �'•
R4 TILITY CLEARANCE: (Surface structures) No work shall be done under this permit until all utilities are clear of the
roposed 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
t construction. ,
(PRADE CHECKING: City of La Quinta shall check grades upon receipt of plan andpFofileand/or grades as established by
a licensed engineer. { •-, .
w 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
s * 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
r;,inches below and in line with the existing flow line. Culvert installation shall conform to the attached drawing.
11 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 complywith the
manufacturer's specifications.
14 COORDINATE WORK: The proposed work shall be subordinated to any operation which the State of California or
City of La Quinta may conduct in this area during the period of.this permit: Work shall be coordinated with the State or '
Citv of La Quinta forces to preclude delay or interference with State or City of La Quinta projects.
8R15 SURVEY MONUMENTS: Prior to excavation or beginning of construction, all survey monuments which exist on the
centerline 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. ;
R16 -Y MONUMENTS: Prior to excavation or beginning of coi._-. __:ion, 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.
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.
9 LIMIT OF EXCAVATIONS: Excavations shall be limited tot,000lineal feet ofopen trench before backfill operations must
begin. All excavations shall be properly barricaded with lights overnight, on weekends and holidays for the protection of
the traveling public. The Public Works inspector shall determine the suitability of excavation barricading in each case. No
excavation shall remain open for a period exceeding five (5) days. No excavation shall be made unless the construction
material is actually on the work site.
R20 BACKFILL MATERIAL: Backfill shall be free of brush, roots or otherorganic substance detrimental to its usefor 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. 0
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 is to 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 atintervalsof 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 andfiled prior to making permanent repairs. Compaction tests shall be made as outlined in Section 6.3.01 of the
Specifications, Division of Highways, State of California, dated January 1973,Standard
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 beforwarded 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, Divisionof Highways, State
of California, dated January 1973.
�aftera..maximurn
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
of 3,000 lineal feet of trench has been excavated and backfill operations completed, but in nocase shall
—e plac::i 'e„t of the temporary pavement exceed a.five (5) day limit.
R26 RMANENT PAVEMENT REPAIR: After backfill and compaction operations have been completed, a temporary patch
nsisting of two inches (2"1 of SC -800 shall be placed immediately. A permanent patch of inches A.C.
surfacing placed on a inch class base shall be ped rip )aterthan days aftercompletion of
temporary road repair. �A � QQ� 5
R27 PAVEMENTREPAIR:F.A.S.:Upb"drfSpTetibnobackfiIand action,atemporarypatchconsistingoftwoinches(2'1
of cold mix paving (SC -800) shall be placed immediately. A permanent patch of three inches (3'1 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 hazardto 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 to amaximumof500feetatany onetime.
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 accomplishedto
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
IQ"1 and above in ei7o P -1—t chill 1. o....';e -- _n __ I-- 1:— 0..4r_ ,n ........ .-------
'ADDITION-- ENCROACHMENT PERMIT yNO.'05 ----CONDITIONS^
R33
Survey "monuments shall be protected in place -or '
re-established.'pu'rsuant to -City standar_ ds , and, the 'State.. of ,
California 'Land ,Surveyor's Act s `
?; R3'4
Work• shall be coordinated; with the -City of -.La Quintals-
uintals-forces
forcesto ' preclude ,delay.' or 'interference with. the City of `.La"
Quintals projects . �� • �. ,
R35
Cbntractor^shall comply with the local. noise ordinance and. --
y
construction"operations,and,Maintenancd of.equipment•within, '
one half mile of -human occupancy shall be performed only
during' -the time' .}periods as. follows.
October ls.t"to April 30: Monday -Friday 7:OOa.m.'-5"r30p.m:
Saturday. 8:0.0a.m.-5:OOp.m.;
-May'lst'to September 30: Monday -Friday 6:OOa.m.-7:00p.m. `
Saturday. `"' 8: Oa.m.-5 OOp..m:
•
Work shall be prohibited anytime on'Sunday `and. Federal.
'
holiday
.;
` R36
Traffic' control shall. be as per- Cal, Trans. Traffic Manual....- *}
'
Fi_eld. adjustments in detouring 'shall. be accomplished.. as
directed -in order to 'adjust to actual field. condition's.
-
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.
c, a
R37
All excavation at. or. near the travel• way `shall 'be ,backf.illed.
' r
at the end of the work day,, for the protection of` the
-traveling .public.
• R38
Street closures. shall not +be' allowed at any , time . "• ' '' a
R39
A minimum of one travel lane. 'shall be.' maintained at all,
.times.-with flagmen'during working hours. ,
R40
;All work :to' be performed within 'the existing paved. `section a '
tem
shall ,be temporary y paved and_ 'maintained by the -Permittee, `
-,'
ays•-
permanent pavement shall,be placed no later than' -15 days.-
after
after completion of the temporary road r repair. : . .
,R4.1-
Ingress and egress for local properties shall be maintained.
at all times.. y 4 ,
R42•.
Prior to work starting, 'Underground Service Alert""shall be. '
,contacted at 1-8007-422-4133 and.an "inquiry number" shall be,
provided to the•City•Public Works. Inspector.
R43
Pavement shall be sawcut.prior�`tb removal.
Tv
0
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
Subdivision Improvement Permit — Class I I I
1
DATE: '3 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 11�/1 `t' Z 5!7 Z r Z le
(Street address or Description of Location) `
PURPOSE OF CONSTRUCTION .7 :� 1�/�T Sketch (attach construction plans if appropriate►
DESCRIPTION OF CONSTRUCTFN IiNs
DIMENSION OF INSTALLATION OR REMOVAL 410"Kf?6"
SIZE OF EXCAVATION, IF NEEDED j!V sew=,
APPROXIMATE TIME WHEN WORK VN(L BEGIN y" S " Yrs
APPROXIMATE TIME OF COMPLETION "S"Aws'f U
ESTIMATED CONSTRUCTION COST 4k
1
(!n.C!! ding 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 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 necessary as the result of this work.
Signatur6rof Applicant or Agent
PAW, 'intG E& Lock .tZ 4taiM /35 7379/
Name of Applicant (please print) Business Address Telephone No.
�'6. G�i�/i��riS D 4�tGoo Gs ,t ST` iwa 73�/
Name of Contractor and Job Foreman Business Address Telephone No.
1/77 163 f 3l
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 NO
Minor Improvement Permit — Class IV: See attached schedule lr
Inspection Fee $ VI PERMIT VALIDATION
Permit Fee
Penalty
Cash Deposit -Surety Bond '
if required
TOTAL: $
Receipt No.
Received by Date
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
Recorded by II TELEPHONE: (619) 564-2246