0732NOTE`
With proper validation
this form constitutes an
encroachment permit
53440-667
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 III
DATE: .1111 Qq(1 Minor Improvement Permit Class.IV
LOCATION OF CONSTRUCTION Avenida. Velasco
(Street address or Description of Location) '
PURPOSE OF CONSTRUCTION to install new as r .main • Sketch (attach constructions plans if appropriate)
DESCRIPTION OF CONSTRUCTION to install 121.' of 2"
plastic' medium nressurP aas main' 13"~ W/VPI of "
Ave.. Velasco,beaiinnincr 3271.!;/RPT. of ral 1 e Ensenada," proceeding, south.
DIMENSION OF INSTALLATION OR REMOVAL
SEE SKETCH•TGP 224'FC-1 cutearth
SIZEOF EXCAVATION, IF NEEDED acid jet oil.and gradel 20' 'drive
way
APPROXIMATE TIME WHEN WORK,WILL BEGIN 7 /13/9(1 '
APPROXIMATE TIME OF COMPLETION' 1-0113 190 ,
ESTIMATED CONSTRUCTION COST $ t
(Including removal of all obstruciion,'materials, and debris, backfilling, corn ,.
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 orproperty
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.
J.M. Snyder..Distribtition
Signature of Applicant or Agent `
'Southern Califrona Gas Co. -PO-Box 3003 Redlands, CA'92373 (714)335-7742
Name,of Applicant (please print) Business Address Telephone No. '
Name of Contractor and Job Foreman Business Address , -Telephone No.. -
i
Contractor's License No. City Business License No.
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class 11.1
Public"improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached scdule ®7 3 2
he .
Inspection Fee $ PERMIT VALIDATION "
Permit Fee -0- II .
0732
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $
Receipt No.
' Received by ' Date
Recorded by
PERMIT NO.
DATE APPROVED', -7/5/90 ,
EXPIRATION DATE 12/31/90
DATE ISSUEED7/,�/90
By
V Administrative Authority
TELEPHONE: (619) 564-2246
o
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NOTE:
With proper validation
this form constitutes an
encroachment permit CITY --,OF LA QUINTA
APPLICATION FOR PERMIT
53440-667 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
, ( f
Subdivision Improvement Permit— Class III
DATE: •Tttl v R, 1 QQn Minor Improvement Permit Class IV
'--,-.LOCATION OF CONSTRUCTION Avenida Velasco•
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION -to install new gas main Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION to install 1211 of 21
"`"'151astic medium pressure aas main 13t1 W/EP1 of
Ave.. Velasco,beainnina 32.71 S/SPL of Calls Ensenada, proceeding south
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 7/13/90
APPROXIMATE TIME OF COMPLETION 10/13/90
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
SEE SKETCH TGP 224TC-1 cut earth
and jet oil and gravel 201 drive
way
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
l.a Quinta .and to pay for any additional replacement necessary as the result of this work.
i J.M. Snyder, Distribution SuAervisor
Signature of Applicant or Agent
Southern Califronia Gas Co PO Box 3003 Redlands, CA 92373 ('714)335--7742
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 I
Public, improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs -
Minor Improvement Permit — Class IV: See attached schedule N2 ;0732
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
-0-
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO. 0732
DATE APPROVED 7/5/90
12/31/90
EXPIRATION DATE
DATE ISSUE7/`5/90
By
Administrative Authority
TELEPHONE: (619) 564-2246
NO.' ADDITION ----ENCROACHMENT PERMIT`2=---CONDITIONS 4_f
R33
Survey,-nPirrits . shall w:be ; pro`tected,� in -,place v ori
re=established -'pursuant -yto� City standards 'and .they State; of
California Land Surveyor's, Act.
R34' •
Work•: shal•l` be coordinated :with -,the -!City of La- Quinta-.'s ,
forces to preclude delay or interference with the'City of.La'
Quinta:!.s projects..
-' _R35
Contractor• shall 'comply with `the -'local 'noise ordinance. and:-
`
construction, -operations ,and maintenance of 'equipment within i.. .
one . half. mile, of human occu anc V shall be.-performeid.;onlyl
• :F
during., the• time periods .as ,follows:
t=
;,•• _
October 1st to Apri1,30i Monday=Friday 7:00a.m.-5:30p.m.
-. 'Saturday.', , 8:OO'a.m:-;S:OOp.m �.
`
May�lstrto..September-30s Monday -Friday 6:OOa.m:-7:OOp:m,
Saturday.-; 8 OOa.m.; 5:00p:m.. ;
-
Workx'shall ..be; •proliibited, 'anyt-imeKon Sunday, "and:w Federal': r
holiday:, -
R3 6
Traffic control shall be as - per . Cal. Trans -Traffic Manual.".
•
Field adjustments in -detouring shall.be accomplished as.
directed in* order . toy adjust to• actual, field: conditions., •It
shall be,,.the contractor !'s responsibility;:to adequately '
'
bar.ricade :and detour this;.%site:�.A Traffic: -control plan .shall
be submitted, = for approvalby the. Ci.ty,,Engineer'.. `
' �'•R37
All excavation at or near•the travel way shall be•backfilled
at, the • end. of 'the work -day, for the protection -of the
travelin"g 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 working hours... ,
R4.0
. All .work ; to be performed .within the existing paved section:
shall! be . temporary 'paved' and maintained,'by the Permittee',
permanent -pavement shall.. be placed': no later. than- .15 days, �
after com letion• of the tem oras+ roa repair `
P P Y. d P
•
. R41
Ingress and egress for local properties shall be maintained
at - all times.
R42
to work ..,starting; Und6rground Service Alert shall be
-Prior
contacted':at 1-800-422-41.33t•and an.. "inquiry number" .shall' be
J
provided to' .t.he City Public Works' Inspector ., -
R43
Pavement shall be'sawcut prior•:to.removal. Z
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The following General and Special Provisions are attached to.and made a part of,Permft No. __L1 7�7�
e
AL =.
GENERfPROVISIONS
1
• ` "
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. -
'
TRAGKLAYING CONSTRUCTION EQUIPMENT:' Cleated tracklaying construction equipment shall not be permittedtooperate on any
s -
;paved surface.unless fitted with.smooth-faced street pads. All mechanical outriggers shall be fitted with rubber street shoes to protect
�- T.•
the paving,during excavations: Rubber -tired equipment, only, shall be used in backfill operations in paved areas..lf.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,
' t
that these portions of road be. resurfaced;over their entire width `Resurfacing shall consist of one coat of two inches (2") of A.C.
y.f •J .. Y
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surfacing plus appropriate seal'coat as specified above.. '- r • �,,t ,- cep^'
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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 Inipiictors'Suitable detours and detour signs shall be placed and maintained for the duration,.
' t
of the project The hal
City sl be notified 24 His. in advartce'of anj traffic detours or delineations- ; "' "
•
CARE OF DRAINAGE STRUCTURES: Any drainage structure,includingcorrugated metal pipe, concrete pipe„steel •culvert and
V. 1 ..- -
. concrete structures encountered during excavation which necessitate removal shall be replaced in kind. -In the'event.it becomes
' , .`„• t ;'4 •.��
•necessary.to remove,or cut existing drainage structures;` City of La Quinta shall be notified prior to commencement of this work.,.
i ''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 fromthe rightof'
-,,"t t '.'. t i1
n way.Allpa4edsurfacesshallbebroomedclean ofearth and otherobjection nablematerialsimmediately after backfill and compaction. ;
t ” ”
Existing gutter line and drainage ditches shall be replaced io thenoriginal standard or better. All excess material shall be removed
prior,to paving. Water tanker shall be: used, as required'tosprinkle the job site to keep'down dust conditions and shall be used
immedietelyafterbackfill.,,, T,:, t ''
DE -WATER OPERATIONS:If de-v"atering operations are required and pumps are forcing water on City of La Quints roads, it shall be
the responsibility of„the permittee (contractor) to control this water and to provide off-street barricades when necessary.
M`,i+ • • .�
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 owner -and emergency vehicles. In the event it isfe'lt bythe permittee that he mustclose a street for
,7
any length of time, permittee shall contact this office to obtain the necessary permission., ,
`
,, '..,• +' SPECIAL PROVISIONS + !•
i
The follwing shall apply ONLY when indicated: r r
`
•'
R1 OTIFICATION: Permittee shall notify the City at 564-2246 at least 48 hours in advance.of starting construction.
CASH DEPOSITS OR BONDS: A cash bond or an approved surety bond in an amount of not less than $,
” y 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
l�posted prior to commencement of any work on this project.
<,. R3 UTILITY CLEARANCE:(Substructures) Prior to making any excavationwithin the City ofLaQuinta right ofway authorized .
by permit, the permittee shall contact all concerned utility companies relative to the location of existing substructures.
a . Gyl ;.
i • , : Damage to existing substructures resulting from operations conducted under this permit shall be the sole responsibility
•
of the permittee.
R 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
r
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 r1461. •;;.- ,t r
v
R6 PARKWAY GRADING: Area between the property line and top of the proposed concrete-cwb shall be graded to a slope of
1 /4 inch to one foot (1').
i R7. GRADES & STAKES:`City of La Quinta shall establish grades and stakes for the proposed concrete curb and gutter
_
construction. - • - . - , t i •. • . „•
�R8 RADE CHECKING: City of La Quinta shall check grades upon receipt of plan and pFofile and/or grades asestablished by
a licensed engineer.
` R9 CURB REMOVAL FOR DRIVEWAYS: A portion of the existing concrete curb and/or curb and gutter { feet) shall be
f
+. removed. Curb and/or curb and gutter shall be saw cut prior to removal. Depressed curb, matching concrete gutter and ,
i
- concrete driveway approach shall be constructed in conformance with City of La Quinta Standard it207.
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.
Fill 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.
M
R1 SIG HT• CLEARANCE. Sight clearance of 600 feet in eitherdirection be and maintained.
f• shall assured
R13 SOIL STERILIZER: The area to be surfaced shall be treated with soil sterilizer. Rate of application shall complywith the
manufacturer's specifications.'
+;
R14 OORDINATE 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
r •
0 City of La Quinta forces to preclude delay or interference with State or City of La Quinta projects. .
R15 URVEY 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 maybe 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
Z'r ties to these mo numents shall be furnished to the City Engineer prior to the removal of any monuments. This office shall
r. be notified upon completion of replacement of all survey monuments for proper project clearance.
R16 St MONUMENTS: Prior to excavation or beginning of const n, all survey monuments shall be tied out by City
of — uuinta and suitable payment or guarantee of payment sha„ „. 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.
19 LIMIT OF EXCAVATIONS: Excavations shall be limited to 1,000 lineal feet of open 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 determinethe 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 (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 may be substituted, but in any
a relative compaction of 95 percent shall be attained within thestructural section of the roadway.
,case
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 that the
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 andfiled priorto making permanent repairs. Compaction testsshallbe made asoutlined in Section 6.3.01 of the
Standard Specifications, Division of Highways, State of California, dated January 1973.
R24 AOMPACTION TESTS: It 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 as outlined in Section 6.3.01 of the Standard Specifications, Division of Highways, State
of California, dated January 1973.
R25 EMPORARY 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
he placement of the temporary paveme.,i exceed a five (5i day :imit.
1126 P RMANENT PAVEMENT REPAIR: After backfill and compaction operations have been completed, a temporary patch
onsisting of two inches (2") of SC-800 shall be placed immediately. A permanent patch of inches A.C.
surfacing placed ona inch lass ba shall bepl cednolaterthan days after completion of
temporary road repai
R27 PAVEMENT REPAIR: F.A.S.: Upon com letionofbackfilan� a t�atemporary
p ppatchconsistingoftwoinches(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 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 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 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.
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.
NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
ewoschment permit
APPLICATION FOR PERMIT
53440-667 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
JUNE 29 , 1990 Subdivision Improvement Permit — Clan III
DATE: Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Avenida Velasco
it wt ettlaret+ or Dowiption of Location)
PURPOSE OF CONSTRUCTION TO install new teas main Sketch (attach construction plans if appropriate).
DESCRIPTION OF CONSTRUCTION
Avenida Velasco. beoinninc
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 7-13-90
'=nla tic medium pressure gas main 13' W/EP1 of
Ensenada, proceeding south.
R�A
APPROXIMATE TIME OF COMPLETION 10-13-90
ESTIMATED CONSTRUCTION COSTS SEE SKETCH TGP 224, C-1 CUT EARTH AND
(Including removal of all obstruction, materials, and debris, bectfilling, com- JET OIL AND GRAVEL 20' DRIVEWAY
paction and placing permanent resurfacing and/or replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrees to:
Sr
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,
.Neste of ApOkwt (Please Printf _ Businss Adds Teltpton. No.
Noble of Contractor and Job Forman' • Ausiness Address Telephone No.
Contractor's License No. City'Businin Liosrne No.
Applicants Insurance Company Policy Number
FEES: Subdivision Improvemint Permit — Chis III
Public improvements: 3% of estimated construction costs ,
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Clue IV: See attached schedule
Inspection Fee $
Permit Fee
Penalty
Cash DepcWtSurety Bond
if required
TOTAL:
Rewipt No.
Received by ate
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
Recorded by l TELEPHONE: (619) 564-2246
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