0943W.^+4'w .• .W�+w �!1�ii!Cw wu�o'F �.� .r�r � ._ 4. w.q!.��. - ... • an..T•:w�kr��.l.. .� .+,. � _ �.-. .w, w.. M. ww' M
�4
NOTE:
With proper validation
this form constitutes an
encroachment permit
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: November 30, 1990 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION -- -Tract 26016 50th and Park
t f%' (Street,address or Description of Location)
street improvements
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION 6" barrier curb,
6" curb and gutter, 3" AC/4" AB see approved street plans on
file
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF.NEEDED
5 --..__APPROXIMATE TIME WHEN WORK WILL BEGIN 12/4/90
APPROXIMATE TIME OF COMPLETION 3/31/91
ESTIMATED CONSTRUCTION COST $ • 49, 395.00
,(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:
(g1t0S 8WH i4 TOTAL 1049 f 48i . 85 4
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 allapplicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result of this
work.
J.P. Mi.nistrelii Construction 74-900
Name of Applicant (please print)
Business Address
icant M&DtIf
I'm CA 733-9888
Telephone No.
Matich Corportion PO Box 50,000 San Bernardino, CA • 328-7165
Name of Contractor and Job Foreman Business Address Telephone No.
149783 on file
Contractor's License No. City Business License No.
Morgan and Franz LC 20504114647
Applicant's Insurance Company tPolicy Number
FEES: Subdivision Improvement Permit —Class III
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
Received by Date
N2 0943
PERMIT VALIDATION
PERMIT NO. 0943
DATE APPROVED 11/30/90
EXPIRATION DATE 6/30/911
DATE ISSUED—:!:.__, 11/30/90
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
"�'+...-=rt.��fi....,�i-.-,-.�•-.�et�a,.�-n..tu.-...-.,ia'�-m'".,r"t'3'�' it "�r�.-. ti�L.��-i.✓.'d...rh}�t�-S�t.a-^+�+1��t.r�v�.� �,.,�',�..w-, 3hY,,• ,,.
1 �
4�4'•�� +.rF�'!� of e+. � ..+.... w..i... +-9�r..R.,we. a!-..+. +.f_ws ew. Vf. T•� R�.-.��a^f, 9�1�!�.t.w r±.n.. �a e!^,.5._M� :n w w.T. h w ... w en. �
r
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
DATE: November 30, 1990
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Tract 26016 . 50th and Park
(Street address or Description of Location)
--PURPOSE OF CONSTRUCTION street improvements Sketch (attach construction plans if appropriate)
~DESCRIPTION OF CONSTRUCTION 6" barrier curb,
6" curb and gutter, 3" AC/4_" AB see approved street plans on
file
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED 1QAN 1 0TWA, 1461r8$
- " APPROXIMATE TIME WHEN WORK WILL BEGIN 12/4/90
APPROXIMATE TIME OF COMPLETION 3/31/91
ESTIMATED CONSTRUCTION COST $ 49, 395.00
(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.
rSignature of`APp(icant or(Agent r i4%>G�%
J.P. Ministrelli Construction 74-900 H3.afn L� CA 733-9888
Name of Applicant (please print) Business Address Telephone No.
Matich Corportion PO Box 50,000 San Bernardino, CA 328-7165
Name of Contractor and Job Foreman Business Address Telephone No.
149783 on file
Contractor's License No. City Business License No.
Morgan and Franz LC 20504114647
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 $ l4 a/
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
Recorded by
�t
$
Date
U 9'l 3
PERMIT VALIDATION
PERMIT NO. 0943
DATE APPROVED 11/30/90
EXPIRATION DATE 6/30/91
DATE ISSUED- . 11/30/90
By
Administrative Authority
TELEPHONE: (619) 564-2246
• �'
The following General and Special Provisions are attached to and made a part.of Permit No.
'GENERAL PROVISIONS
s
The following shall always apply:
r
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
R secure permission from abutting propertyowners. 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
•,
f
f. ". : paved surface unless fitted with smooth -f aced street pads. All mechanical outriggersshallbefitted with rubber street shoes toprotect -
+
the paving during excavations. Rubber -tired equipment only shall be used in backfill operations in paved areas. If the existing
.pavement is scarred; spelled, or broken during the term of this contract, or if the pavement is marred, City of La Quinta shall request
w •
that these portions of road be resurfaced over their entire width.'Resurfacing shall consist of one coat of two inches (27) of A.C.
surfacing plus appropriate seal coat as specified above. ,
-,PROTECTION OF TRAFFIC: Ali excavations and work areas shall be properly lighted and barricadedasdeemed necessary by the City
f'
Engineer or La Quinta City Public Works Inspectors. Suitable detours and detour signs shall be placed and maintained for the duration
ir
of the project. The City shall be notified 24 Hrs. in advance of any.traff_ic 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
s
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 sha11 be removed from the right of
'we y. AlIpaved surfacesshe IIbebroomedcleanofearthandotherobjectionablemeterialsimmediatelyafterbackfiIIandcompaction. '
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.:
,, l ,•
, 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
t
access for the adjoining property own6rs'and em6rgency'vehicles., In the event it is felt bythe permittee that he must close a street for '
r
any length of time, permittee shall contact this office to obtain the necessary pe. mission.
SPECIAL PROVISIONS, . c
• r
Y ! The follwing shall apply ONLY when indicated: j
//R1 NOTIFICATION: Permittee shall notify the City at 564-2246 at least 48 hours in advance of starting construction.
�
„ lam•--' ".
R2 CASH DEPOSITS OR BONDS:'A cash bond or an approved surety bond in an amount of not less than $
„
= 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 .
41
, R3 UTILITY CLEARANCE: (Su bstructures) Prior to making any excavation within the City of La Quinta right ofwayauthorized
-
_ 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
the permittee. �r
\\of
T' R4 FUTILITY 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
S •' '` surfaced with 'inches of A.C. paving placed on ' inches of class ,aggregate subbase course c
i - ,i • having an ••R"valueof not less than and in conformance with City of La Quinta Road Improvement Standards
and Specifications, Ordinance #461.,
R6 yPARKWAY 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 01•
R7� GRADES & STAKES: jCity of -La Quinta shall establish grades and stakes for the proposed concrete curd and gutter
construction. - _ '
„
_
t Rg ,GRADE CHECKING: City of La Quinta shall check grades upon receipt of plan and pFofileand/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. -
*)culvert
R11 CULVERTS: A inch diameter(shall beinstalled with the invertapproximately I-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 complywith the
manufacturer's specifications. �+ y
,�R14, 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
City of La Quinta forces to preclude delay or interference with State or City of La Quinta projects.
R15• 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
ti es to these mon u ments she I I be f u r nished to th e C ity Engi neer pri or to the remove I of any monu ments. Th is off ice she 11
' -
be notified upon completion of replacement, of all survey monuments for proper project clearance.
R16 Si (MONUMENTS: Prior to excavation or beginning of cons n, all survey monuments shall be tied out by City
of uinta and suitable payment or guarantee of payment st._.. __ 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 LIMIT 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 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 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
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') liftswhere 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 isthe 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 intervalsof 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.
R24-- COMPACTION TESTS: If so required by the inspector, compaction tests shall be made for each crossing or service line.
ne (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 temporary pavement exceed a five (5) day limit.
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.
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 P461.
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 issuanceof 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 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 thefollowing 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.
a
' SPECIAL CON DITIONS-=PERMI T`,NO: 09'43 '
STREET IMPROVEMENTS -TR 26016
The followingi._conditions' shall' be 'met • to the satisfaction -of the
City;;Engineer.
`•4
1.y Permittee shall bey responsible+'for, dust and' erosion control.
2. y -Streets shall be kept" clean. 'They 'shall }'be. be completely '
' cleaned= atr_the• end of -the working 'day' and more frequently AT
` required:, J 1
3. Contractor shall comply;with the local noise ordinance and'
'const'ruction operations `and --'maintenance 'of equipment ''within
ohe half *-mile of ',human 76ccupan6y shall be performed only.,. ;
w' during the time,,periodsl as :fol'lows:- `
�,. October 1st to April 30 Monday -Friday 7:00a..m.-5:30p.m.
Saturday 8:00a.m.-5:00p.m. '
May 1st, to September 30': Monday-Friday.•6:00a.in.-7 00p.m.
Saturday 8':00a.m.-5c00.p.m.
Work shall be ' prohibited anytime on. Sunday- and Federal,
holidays.,,." Y, ,
4. ` Permittee' shall assume; responsibility, for '.repair of. existingt
'pavement breakdown at 'the,ha'1 road,.access to any public or ,t
} private -street and -for. ..any damage o . -other City'- streets or
facilities ,q
{ 5. Any on-site' haultroadshall be' effectively 'destroyed at 'the
VP -conclusio'n' of the •work to prevent use l by,�r•unauthdr'ized vehicles.
t, y, 6: "'Permittee shall furnish, -install, and maintain ,stop 'signs at
+
each, Yaccess, to, , any. : public',. ,s.treet to •stop . construction
traffic. Advance • warning . and, _ traffic control shall ' be
g'. 'installed .'and- maintained in ,accordance with Cal Trans
Standards . and .subject to, the approval of , the City Engineer.
a
7. Permittee shall notify the City' at 5'64.-2246 at least: 24 hours
in advance of ,starti'ng 'construction.',
8 All improvements-shall.be constructed as p.er approved plans.
,- -
won—
.� �� .�. � �� �� �.. �- ice. �����, �.���r�i �•��_
NOTE:
With propervafiduione
this form constiwtn•an CITY OF LA OUINTA.
encroachmenroermir
APPLICATION' FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers', water nuhw-
and other like public works improvements in connection with MINOR.IMPROVEMENTS and APPROVED SUBDIVISIONS=
Subdivision Improvement Permit — Class ill
DATE: u( y, �9�_.. Minor- Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street sadress-or Daxrtption at Loeationlo
PURPOSE OF CONSTRUCTION ��� -� ��JPi�✓�ir/TwTS Sketch (attach construction plans if appropRate}_
DESCRIPTION OF CONSTRUCTION 6'':D
CejAn '? .1"/9C/VfAA?
DIMENSION OF INSTALLATION OR REMOVAL
�I iCiA /v II
i�T
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 11jE v
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST S 9 , 39 ► o c>
(including removal of all obstruction, materials, and debris, badkfiliing, com-
paction and placing permanent resurfacing and/or replacing improvementsl .
�_50, �9erR
1m1QAovr-M S wi
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 agaamt any end all
penalties. liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage to persons or pla" V,
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 12411 hours, in advance of the time when work will be started.
Comoly with all applicable City Ordinances, the terns 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.
Name of Applicant (please print)
w
Name of Contractor and Job Foreman
Signature of Applicant or Agent
Business Address ° Telephone No.
Business Address Telephone No.
/5/97 3
Contractor's License No. City Business License No.
Applicant's insurance Company Policy Number
FEES: Subdivision Imorovement Permit —Class Ill
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs NO
Minor Imorovement Permit — Class IV: See attached schedule
inspection Fee S i �' t) .I PERMIT VALIDATION
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by Date
Recorded�by
?ERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
a
By
Administrative Authority
TELEPHONE: (619) 6641246