0784}` 'r� � a'z7r- ,:�:^ yi. ..W, � t' y. 'r:ysr � .ri t. �"sew^.tti ie+P �:.a.; , ^r• ,:i`. � .ice.-Y....y :-:�.,-..rx . j�� �w :._ N.-,";- �� v` �!'"R' � �'Vti
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NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
54440-904 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
DATE
August 10, 1990
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
Fiesta Dr. e/ Roadrunner Lane
PURPOSE OF CONSTRUCTION to install new cras main
.z,
DESCRIPTION OF CONSTRUCTION to install 157' of 21'
plastic medium pressure aas.main 11' s/nnl of
Firesta Dr, becrinnina 427' e/eDl of Roadrunner
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 8/13/90
APPROXIMATE TIME OF COMPLETION 11/13/90
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, com-
action andlacin e�manent resurfacin and/or replacing improvements)
Sketch (attach. construction plans if appropriate)
see attached sketch
Cut earth and jet con.
P P 9 P 9
In consideration of the granting of this permit, the applicant hereby agrees to:
a
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.M.. Snyder, Distribution Supervisor
Signature of Applicant or Agent_
Southern California Gas 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 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
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
$ -0-
$ -0-
Received by Date
Recorded by
PERMIT NO
0784
PERMIT VALIDATION
0784
DATE APPROVED 8/10/90
EXPIRATION DATE 12/32/ 90
DATE ISSUED r 8/10/90
By
Administrative Authority
TELEPHONE: (619) 564-2246
r
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,* w-ti•aY�-'SY Ile
NOTE:
With proper validation
this form constitutes an CITY OF LA ' QUINTA
encroachment permit
APPLICATION FOR PERMIT
54.440-904 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
DA7E:�, August 10, 1990
LOCATION OF CONSTRUCTION
Subdivision Improvement Permit — Class II I
Minor Improvement Permit Class IV
Fiesta Dr. e/ Roadrunner Lane
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION to install new eras main Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
�` to install 1571 of 2"
plastic medium pressuregas main 111's/nol of
Firesta Dr", beginning 427' a/e-ol of Roadrunner see attached sketch
DIMENSION OF INSTALLATION OR REMOVAL Cut earth and jet con.
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE.TIME WHEN WORK WILL BEGIN 8/13/90
APPROXIMATE TIME OF COMPLETION 11/13/90
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.
J.M. Snyder, Distribution Supervisor
Signature of Applicant or Agent,. --
Southern California Gas PO Box 3003 Redlands, CA 92373 714/335-7742
Name of Applicant (please print) Business Address Telephone.No.
I+
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 II
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $
Receipt No. _
0
Received by Date
Recorded by
0784
PERMIT VALIDATION
0784
PERMIT NO.
DATE APPROVED 8/10/90
EXPIRATION DATE 12/32/ 90
DATE ISSUED 8/10/90
By
Administrative Authority
TELEPHONE: (619) 564-2246
'
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The following General and Special Provisions are attached to and made a part of Permit No. I7
y'GENERAL,
x �`
.. - PROVISIONS '
The following, shall alwaysapply:
"
ENCROACHMENT ON PRIVATE PROPERTY:' Thispermit authorizes work to be accomplished within City of La Quints rightof way
4
. - ONLY-. Whenever construction extends within private property: itshall be the responsibility of the permittee for his contractors) to
secure permission from abutting property owners. Such authorization must be secured by the permittee prior to starting work.
TRACKLAYING CONSTRUCTION EQUIPMENT: - Cleatedtracklaying construction equipment shall not be permitted to operate on any
•.
paved surface unless fitted with smooth-facedstreetpads. All- mechanicaloutriggers shall befitted with rubber street shoes toprotect
g yr .y
' t the paving. during excavations. Rubber -tired equipment Ionlyi shall be used in backfill operations in paved areas. of the existing
•
pavement is scarred, spilled, or broken during the term of this contract, or if the pavement is marred. City of La Quints -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.,+`
r "
PROTECTION OF TRAFFIC: All excavations and work areas shall be properly lighted and barricaded as deemed necessarybythe City
Engineer or La Quints City Public Works Inspectors,. -Suitable detours and detour signs shall be placed and maintained for the duration
f'r
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
t
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 Quints 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 sha11 be removed from the right of
_ . z
. • r' way'All paved surfaces shall be broomed clean of earth and other objectionable materials immediatelyafterbackfill 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
' .
3 immediately after backfill.'
f
t" DE -WATER OPERATIONS-* If de -watering operations are required and pumps are forcing water on City of La Quinti roads, it shah be
the responsibility of the permittee (contractor) to control'this water and to provide off-street barricades when necessary.
x+
CLOSING STREETS: No street shall be closed. A minimum of one lane of traffic shall be maintained at all times to provide limited
J ,.
access for the adjoining' property owners and emergency vehicles. In the event it is felt bythe'permittee that he must close a street for
length of time. permittee shall contact this office to'obtain the.necessary permission. {
SPECIAL PROVISIONS +-
* J "r .r,_
The follwing shall applyONLY when indicated: '
• ' '
r1�OTIFICATION: 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 amount of not less than s "
shall be furnished in the name of City of La Quints to cover all work involved in the restoration of the various La Quints
'
- 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 . • r,
0.
R3 UTILITYCLEARANCE: (Substructures) Prior to mikiriYany enavation'within the City of La Quints right of way authorized.
" [
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
r
r;..t
[ of the permittee.
.. ,.
s ,/^R4TILITY CLEARANCE: (Surface structures) No work shall be done under this permit until all utilities are clear of the
i�proposed work site. The permittee shall notify all concerned utility companies of the proposed work.
a
t • R5 PAVEMENT WIDENING: Area between the proposed concretergutter, line and the existing road pavement shall be
surfaced with inches of A.C. paving placed on inches of class " "aggregate subbase course
a
t having an "R" value of not less than and in conformance with City of La Quints Road Improvement Standards
t • 1 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'). + ,
tR7-I,GRADES & STAKES: City of,La Quints shall establish grades and stakes for the proposed concrete curb and gutter
•a�
.g.
. r 1 .. ! ,.
-construction.
CREr �RAIDE CHEC'KING: City of La Quints shall check grades upon receipt of.plan'and PFOfile and./or grades as established by
;,tea lirensed engineer.
-F Mrd .. [,•t -.
R9 CURB REMOVAL FOR DRIVEWAYS: A portion of the existing concrete curb and/or curb and gutter( feet)shall be
i
removed. Curb and/or curb and gutter shall be saw cut prior to removal f Depressed curb, matching concrete gutter and
x
' concrete driveway approach shall be constructed in conformance with City of La Quints Standard #207.' +
J
R10 DRIVEWAYS, A.C.: Driveways shall -be constructed as not to alter existing drainage pattern. Surfacing between the
_ -t
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.
• 911 CULVERTS:A inch diameter(_) culvert shall be installed with the invert approximately 1- 1 /2'
inches below and in line with the existing flow lined Culvert installation shall conform to the attached drawing.
"
R1 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 sha11 comply with the
r
manufacturer's specifications. !'
R14 COORDINATE WORK: The'proposed work shall be"subordinated to any operation which the State of California or
City of La Quints may conduct in this area during the period of this permit. Work shall be coordinated with the State or
r`
• Citv of La Quints forces to preclude delay or interference with State or City of La Quints projects.
RVEY MONUMENTS: Prior to excavation or.beginning of construction, all survey monuments which exist on the
r _• ' y
t y centerline of all streets or property lines,when involved shall be completely tied out so they may be readily andcorrectly
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. '
.. 1 L
R16 JEY MONUMENTS: Prior to excavation or beqinninq of c_..___ _ction, all survey monuments shall be tied out by City
u. 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 IMIT OF EXCAVATIONS: Excavations shall be limited to 1.000 lineal feetof 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 suitabilityof 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
pmaterial is actually on the work site.
):ACKFILL MATERIAL: Backfill shall be free of brush, roots or other organic substance detrimental to its use for purposes
0f 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 lifts of notgreaterthan
three feet (3') and vibrated using vibrotamperor 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 offive-foot (5') liftswhere trenchesareof excessive depths. Care isto 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, compactiontests 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 andfiled 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. 1
R24 OMPACTION TESTS: If so required by the inspector, compaction tests shall be made for each crossing or service line.
�`-"' ne J 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
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 temporal, p varaani exceeu a ii.ra ;5j day limit.
i' 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. �J
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 It 5) 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 Standirds
and Specifications, Ordinance i#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. I.
R30 STREET RESTRIPIN G: Where street striping is still visible on streets to be excavated, such striping shall be replaced upon
completion of permanent repairs. I
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 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 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.
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.
I. 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.0784-- --- CONDITIONS `
R33,
Survey- monuments shall. be.protected.in'plafe: or.
`
re-established pursuant to City standards and the'State of-
California Land. Surveyor's Act:_'• `
R34
.Work shall be coordinated with the City of La
Quintals-forces
to preclude,delay or interference.with,the.City of La
Quintals projects. .
R35
"'Contractor shall..comply'with_ the'. •local noise-ordinance,and.
construction•operations•and maintenance of equipment within,
one half mile 'of human occupancyshall' be performed ,only.
during the time•,periods.as'.follows:- '
October lst,to April 30: Monday-Friday 7:0.0a-:m.-5:30p.m.. ;
Saturday 8:00a.m.-5:00p.m.
May Jst to'-September X30: Monday-Friday 6: 00a.m. -7: 00p.m. '
3 Saturday 8:00a.m.-5:00p,:m'. ' '
,_
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 . responsibili.ty to- adequately r -
barricade';and detour this 'site. A Traffic control plan shall
be submittedtfor•'approval,by the City Engineer.
nor
" R37
_-� -Allexcavation at .near thetravel way' shall be backfilled -
at .the end of the work day, for the protection' of the
traveling public. ,
- R38
Street',closures shall not-be allowed',,at any time.. F`
R39*1
-*A minimum, of one-travel'-lane-shall be maintained-at all'
times. with flagmen during ,wor' king hours. * .
-.R40
All work to be.-performed within -:the existing paved section- '
..
shall be temporary paved and maintained by'rthe Permittee,•
permanent, pavement shall.-be-placed no•later than 15°days
after completion of the temporary-road repair':
R41
Ingress and egress for local properties shall be maintained
'
at All-times. f
R42
Prior to work starting,, Underground. Service Alert shall be
`
contacted 'at. 1-800-422-4133, and an. '"inquiry number"• shall be
" provided•to'the City Public Works, Inspector.
R43
Pavement shall be sawcut prior,,to rermoval. ,
Additional. Conditions - Encroachment'' Permit No..'�' 07AC, s
`Page
2
x R44.
All backfill subgrade soil" 'shall be. compacted nothing
,to-
` less 'than 90%. relative dry density; all_ backfill soil within
the t6pv2' of ,finish pavement surface,shall be -compacted to'
`z
nothing 'less .than 95 % - relative. dry .density. all. base
material shall 'be,compacted, to, nothing, less than, 95%
'relative -:dry density..
�x
IR45
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 µ
.
the utility company,:the contracti'ng',company will be s
. required to ' apply for an additional,'.encroachment° permit
,
and pay •the 'appropriate fee:.
I
e.
i
NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
53440-904 PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
C�'71, C -A rv.4114Tp
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mins
and other like public works improvements in connecstion with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
JULY 23 1990 Subdivision Imprownent Permit — Class III
DATE: Minor Improvement Permit Clan IV
LOCATION OF CONSTRUCTION - Fi eSta Dr. , E/ Roadrunner Ln.
(Suess addrtss or Description of Location)
PURPOSE.OF CONSTRUCTION To install new gas main Sketch lam construction plans if appropriate)
OWRIPTION OF CONSTRUCTION To install 157' of 2" elastic mddium_ pressure gas main 11' S/NPL of
Fiesta Dr.., beginni'ng 427' E/EPL of Roadrunner Ln__ proceeding east.-
DIMENSION
ast:
CUT EARTH AND JET CONC.
DIMENSION OF INSTALLATION OR _REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 8-13-90
APPROXIMATE TIME OF COMPLETION 11-13-90
ESTIMATED CONSTRUCTION COST $ '
Ilncluding removal of all obstruction, materials, and debris, backfilling, corn -
pactlon an pacing permanent acing 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, harmles from and against any and all
penalties, liabilities or loos resulting from claims or court action and arising out of any accident, los 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 tM Administrative Authority at least twenty-four (241 hours in advance of the time when work will be started.
Comply acitll all applicable City Ordinances. the terms and conditions of the permit and NI applicable rules and regulations of the City of
Li twins and to pay for any additional reVI neoeseery as the 1 of this
- r
S. IQ. SUPERVISOR ^
. _ ftlettlne of Ilppliorit.ar Againt ,
SOUTHERN Qa1=RN
_. za`GAS"Co_'•' p_naOx rn `42 -4'7'i (714) 335_7742
Nana of Applinnt (plem.print) < Business Address . Telephone No.
Nims of Contractor and Job Foremeft. • :. Businteais Address. TNsphone No.
Contractor's Lioilnw No. City Business Lida No. .
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit —Class 111
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimeted construction costs
Minor Improvement Permit — Claw IV: See attertwd schedule
Inspection Fee $
Permit Fee
Pwwty
Cash Deposit -Surety Bond
if required
TOTAL: "' S
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: 1619) 564-2246