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0946� gym. +>,...,•��tREri�%:Y��`�'�'�'�of'�.'•`�".�r'�'S�i�''y�i:ls,,'(I,`�' y'�. L � "'�. -a •�, ". +• , �, , •• ,.. y+ •, � � -�� , } - k'e���y,��-.^}-•-.7� °yiy,wfv >E.:e''--c..L•�� .in:rr,+',r'�'anew.+`�ka�..:.;,,v.,..r..ti.•;«!.Y«+..a�y�,v>�,'+r''J.,i'j'y��'�'..';'ii•.""'^S..Z"�'"' *•� aC �- �y!"�F�c ° .. ' mfr• �,�+✓, y `�• w .� r. r + s r„�'` .. 7 NOTE:. With';proper validation this form constitutes an-,' ` s 04 :�. CITY OF LA QUINTA encroachment permit APPLICATION' FOR PERMIT PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) 0F -BLANKET PERMIT • 19 91 For the construction_ of public or private. curbs, driveways; pavements, sidewalks, parking slots," sewers, water mains ' sand other like public works,improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS . ' . 'Subdivision Improvement Permit -Class II I DATE: `November'. 30 i 1990 » °, , Minor Improvement Permit la r f .s A. t C ss'IV , LOCATION OF. CONSTRUCTION ` " Various locatioris *ithinr.the City ;Limits `r ;(Street'address or. Description of Location) toll install •new gas services PURPOSE OF CONSTRUCTION Sketch,(attach constructiori plans if:appropriate) *�' �E� T'ic�?17f=nnar►na 'nrt Fta� ,,. a, F ."DESCRIPTION OF CONSTRUCTION - •fac -1 ; ti "Q' =THIS AUTHORIZATION DOES NOT INCLUDE j ��*tit;'�„ i EXCAVATIONS. OF FAS' ROADS (Major 'It k Y- Roads) , t ; ,. , DIMENSION,01`4NSt LLfATION OR REMOVAL X ' } .,�. PERMITTEE SHALL NOTIFY CITY-'HALL t ". - r ,: �' A MINIMUM OF 24 HOURS `PRIOR TO �' THE START OF CONSTRUCTION ` SIZE'OF EXCAVATION,,IF NEEDEDrl • t , Er {•.'APPROXIMATE TIME WHEN WORK WILL BEGIN 1 /1 J91 -•' 11' SEPARAEE PERMITS ARE. REQUIRED•' FOR FAS ROADS APPROXIMATE TIME OF. COMPLETION- 1 94 'A '1 /91 � = iM � " •• ,' `" � f 'ESTIMATED CONSTRUCTION COST $- (Including removalof all 'obstruction;;materials' and debris; backfilli�ngrcom ,, r f '' ;•� '` } ' « ` paction-and placing p7'rmanent resurfacing and/or replacing improvements) In -consideration of; the: granting of this permit, the applicant .,he' reby agrees to: "r Indemnify; defend and.save the City, its autF orized agents, officers, representatives employees, harmless from and against any and all penalties, liabilities.'or?lossiresulting 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 pui�suant`to this application. -`i' Notify3the. Administrative Authority at least twenty-four'(24) hours in advance of the time when work will be started s•, t 1Comply,,with all applicablepCity 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. if JM 'Snyder, Distribution Supervisor i` ' s • �*„' ,� ?"k. 'Signature of Applicant or'Agent Cn»+ho .(;alIfnrnin apig Vn_ Pn ROx' 3003 Redlands,, CA'. 92373 714/3.35-7742 Name of Applicant (please'print). `` Business Address ' t �` Telephone No. ,.� Narime of Contractor and 'Job Forema`ri r Business Address - Telephone No: + Contractor'sLicense No., 1. "r, City Business License.No. r. Applicant's•Insurance Company. .' ' _> + �, Policy Numbert FEES: ' Subdivision Improvement Permit•— Class 11 1' Public improvements: 3% of estimated construction costs ' Private impr6vements:'3% of estimated construction costs . +' j Minor Improvement Permit — Class IV: See attached schedule Inspection Fee $ - ` PERMIT- VALIDATION T Permit Fee _ PERMIT NO. th M - r y a + Cash lDepo'sit-Surety Bond eta DATE'APPROVED � -/a/ zFo if required .. { ' . ' 7i l 1 _ EXPIRATION DATE TOTAL:' J $ DATE ISSUED ! do Receipt No. / By i4 Received by Date `J v Administrative Authority Recorded by TELEPHONE: (619) 564-2246 _ SOUTHERN.'CAIIFORNI'A GAS CO' '. EXCAVATION REPORT t. May 9, 1991 V8® d . AY p � Page .1 City of La Quinta 199f ';P.O. Box 1504 La Quinta, CA '92253 Below are 'the•excavati-on data reports you require. -for -completing permits and billing' purposes. Please- return the pink copy�with Fyour invoice; to insure correct payment:.. Pamela, H. Minor Paving Clerk ( 7,.14) 335-7;7.31 v _PERM.IT LOCATION ACCOUNT ORDER• SIZE OF CU FEE #, +� # # &..KIND t • 0 0946 L'ot 199 Villeta Dr 53418.:996 KA J25316 3' x2'' - N%side, 43' 2" Mac , 0,502 48.775'A'venida E1' Nido 53400.996KA 2'x2' E/si•de. 105'' N/E1 Nido 3" ' Mac + t. j -�- yp. .r' �,;,;RZ49,*�1,�.�°-=':�-t�'✓^✓Y*..�`'r""•�..aY'�..r-'�,.""�+1tY`-tK..s-i1'',�-•v,,rv..�tw...i=..t-.:....�„'�.-�Sy,�.�;%�--,-.-.r+Lr.:±}�'�:i�`t�'x ��' !t: �f• '��_...-,���s. �j/�a��Rr�.Y�!A !M M!f�i F. �'�+. aYr Y�, �. �' 9..�!O,,MF�-.f!L IN•.M� lir. q'. N.l►�'P_ �S� kf-9.A.Iww ,t tN.M �w 'r f NOTE: With proper validation this form constitutes an CITY OF LA QUINTA encroachment permit APPLICATION FOR PERMIT PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) BLANKET -PERMIT 1991 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 Various locations *ithin the City Limits (Street address or -Description of Location) PURPOSE OF CONSTRUCTION t0 install. new gas service aSketch (attach construction plans if appropriate) "'c s -q 4^ '"v^ ti r� �, =a4" ma4 n*Amnann,o an gar, DESCRIPTION OF CONSTRUCTION fa 44 14 t4 Ana 2 eakzi; mom - DIMENSION OF INSTALLATION OR REMOVAL X 4 SIZE OF EXCAVATION, IF NEEDED APPROXIMATE TIME WHEN WORK WILL BEGIN THIS AUTHORIZATION DOES NOT INCL 'EXCAVATIONS OF FAS ROADS(Major -Roads) PERMITTEE SHALL NOTIFY CITY HALL A MINIMUM OF 24 HOURS PRIOR TO THE START OF CONSTRUCTION SEPARAEE PERMITS ARE REQUIRED FOR FAS ROADS APPROXIMATE.TIME OF COMPLETION ESTIMATED CONSTRUCTION COST $ (Including removal"of all obstruction, materials, and debris, backfilling, com- paction and placing permanent resurfacing and/or replacing improvements) In consideration of the grantingof 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. JM Snyder. Distribution Supervisor Signature of Applicant or Agent Cntithoalrn ral 4 $nrni a naa caPO Rox 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 x 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 Recorded by $ Date N3 099 4- 6 PERMIT VALIDATION PERMIT NO. �� C7 { DATE APPROVED / EXPIRATION DATE 17 - DATE ISSUED / rz TELEPHONE: (619) 564-2246 Administrative Authority ADDITIONAL CONDITIONS - SOUTHERN"CALIFORNIA GAS, -BLANKET PERMIT 'PERMIT NO.'0946 4 _ .,January. 1, 1991,: = December 31,'" 1991 R33 Survey monuments shall be .protected in place -or. re-established pursuant,to City standards and -the State of California *,La,nd Surveyor's 'Act . ' R34• Contractor shall comply with the`.local noise.'ordinance and,construction operations and maintenance'of equipment ' within one half.mile*of_human occupancy shall. be performed .only during the time periods as follows: ' .October 1st to April 30: Monday -Friday 7:OOam - 5:30 pm , Saturday.,,, 8:00am.- 5:00 pm May_1st to Sept. 30: ;'',Monday=Friday 6:OOam.- 7:00 ­pm : Saturday 8:OOam -5:00 pm Work shall 'be -prohibited anytime on Sunday and Federal ' holidays. R35 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 responsiblity to,adequately barricade and detour this,site. R36 All excavations at or near the travel way shall be. � backfilled at the end of the work day, ,for the, protection. of the traveling.public. " R37 This permit is only for work within public street -right -of= , way. _ ... , R38 Ingress and egress for local properties shall be maintained " at all time. --R39 Prior'to work starting, Underground Service Alert shall be - contracted at 1-800-422=3155 and an."inquiry number" shall be -provided., -to the City; Public Works, Inspector'. , R40 Pavement shal,l,be•sawcut,•prior to removal: R41 Replacement pavement shall be"existing asphalt thickness' plus one inch, but not'fess•than.3 inches of AC pavement shall be placed. Class 2 aggregate base shall be as per 4 existing or, '4" minimum (whichever is' greater..) .. , R42 If work is to.'be performed by forces other than the utility company, the contracting company -will be.. -required to apply for an additional encroachment permit and'' pay the ,appropriate .fee:. The following General and Special Provisions are attached to and made a part. of Permit No. ;� ,.r;{. r• GENERAL PROVISIONS " The following shall always apply: _ 't 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 v " secure permission from abutting property owners. Such authorization must be secured by the permittee prior to starting work. ' a?_'. • ' TRACKLAYING CONSTRUCTION EQUIPMENT: +Cleated tracklaying construction equipment shall not be permitted to operate on any - o paved surface unless fitted with smooth -faced street pads. All mechanical outriggers shall be fitted with rubber street shoes to protect the paving during excavations. Rubber -tired equipment only shall be used in backfill operations in paved areas. If the existing pavement is scarred, s'palled, 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. A 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 r Engineer or La Quinta City Public Works Inspectors: Suitable detours and detour signs shall be placed and maintained for the duration s of the project. The City shall be notified 24 Hrs. in advance of any traffic detours or delineations. CARE OF DRAINAGE STRUCTURES: Any drainage structure including corrugated metal pipe, concrete pipe, steel culvert and concrete structures encountered during excavation which necessitate removal shall be replaced in kind. In -the event.it becomes necessary to remove or cut existing drainage structures, City of La Quinta shall be notified prior to commencement of this work. Drainage structures and open drains shall be kept free of debris it all times for proper drainage. i RIGHT OF WAY CLEANUP: Any surplus material resulting from excavation and backfill operations shall be removed from the right of t F, way. All paved surfaces shall be broomed clean of earth and other objectionable materials immediately after backfill and compaction. Existing gutter line and drainage ditches shall be replaced to their original standard or better. All excess material shall be removed prior to paving. Water tanker shall be used, as required,"to sprinkle the job site to keep down dust conditions and shall be used ^ immediately after backfill. DE -WATER OPERATIONS: If de -watering operations are required and pumps are forcing 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 " taccess for the adjoining property owners and emergency vehicles. In the event it isfelt bythe permitteethat he must close a street for any length of time, permittee stiall contact this office to obtain the necessary permission. SPECIAL PROVISIONS w, r The follwing shall apply ONLY when indicated:. IA1 �fVOTIFICATION: Permittee shall notify the City at 564-2246 at least 48 hours in advance of starting construction. R2 CASH DEPOSITS OR BONDS: A cash bond or an approved surety bond in an amount of not less than $ 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 ' posted prior to commencement of any work on this project PbR3TILITYCLEARANCE:(Substructures) Prior to making any excavation within the City of LaQuintarightofwayauthorized y permit, the permittee shall contact all concerned utility companies relative to the locatiori of existing substructures. amage to existing substructures resulting from operations conducted under this permit shall be the sole responsibility of the permittee. !" R4 UTILITY CLEARANCE: (Surface structures) No work shall be done under.this permit until all utilities ere 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 rsurfaced with inches of A.C. paving placed on inches of class aggregate subbase course ' having an "R"valueof not less than - and in conformance with Cityof La Quinta Road Improvement Standards ' " and Specifications, Ordinance #461. r - `'- R6 PARKWAY GRADING:Area between the propertyline 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 shallestablish grades and stakes for the proposed concrete curb and gutter construction. (qg RADE CHECKING: City of La Quinta shall check grades upon receipt of plan and profile and/or grades as established by . / a licensed engineer. R9 CURB REMOVAL FOR DRIVEWAYS: A portion of the existing concrete curb and/or curb and gutter ( feet)shall be t removed. Curb and/or curb and gutter shall be saw cut prior to removal. Depresseq curb, matching concrete gutter and, . concrete driveway approach shall be constructed in conformance with City of La Quinta Standard #207. R10 DRIVEWAYS, A.C.: Driveways shall be constructed as not to alter existing drainage pattern. Surfacing between the property line and the existing road paving shall be 2-1/2 inches of A.C. paving placed on ( ") of class aggregate base., Driveway construction shall conform to attached drawing. R11 CULVERTS: A inch diameter( )culvert shall be installed with the invert approximately) -1/2 inches below and in line with the existing flow line. Culvert installation shall conform to the attached drawing. a R12 ' IGHT CLEARANCE: Sight clearance of 600 feet in either direction shall be assured and maintained. OIL STERILIZER: The area to be surfaced shall be treated with soil sterilizer. Rate of application shall comply with the manufacturer's specifications. i 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 • City of La Quinta forces to preclude delay or interference with State or City of La Quinta projects. R15 RVEY 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 ties to these monuments shall be furnished to the City Engineer prior to the removal of any monuments. This office shall ibe notified upon completion of replacement of all survey monuments for proper project clearance. RD -31 R16 SL 'MONUMENTS: Prior to excavation or beginning of const i, all survey monuments shall be tiedout by City of _.—_ iinta and suitable payment or guarantee of payment sh..,, .,. made as reimbursement for a`i wbrk irkolved. 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 tc pavement straight edge shall be corrected. R19 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 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 )ACKFILL material is actually on the work site. MATERIAL: Backfill shall be free ofbrush, roots or other organic substance detrimentaI to its useforpurposes f 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 vibrotamper or equivalent equipment. Alternate methods maybe substituted, but in any case a relative compaction of 95 percent shall be attained within the structural section of the roadway. `, R22,/ BACKFILL PLACEMENT: Backfill shall be applied in layers of not more than 50 percent of the total depth of the trench before flooding or a maximum of five-foot (5') lifts where trenches are of excessive depths. Care 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 percentor 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 and filed prior to making permanent repairs. Compaction tests shall be made asoutlined in Section 6.3.01 of the cl_,�ridard Specifications, Division of Highways, State of California, dated January 1973. _�Ocine OMPACTION TESTS: If so required by the inspector, compaction tests shall be made for each crossing or service line. (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 T MPORARY PAVEMENT REPAIRS: After completion of backfill and compaction operations, a temporary patch �� �Eonsisting 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 ERMANENT 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 15 days after completion of temporary road repair. /"A+_ f� J R27 PAVEMENT REPAIR: F.A.S.: Upon completion o backfill and colinpaction, a temporary patch consisting of two inches (2") of cold mix paving (SC -800) shall be placed immediately. A permanent patch of three inches (3") of A.C. surfacing shall be placed on six inches (6") concrete base as directed, but not later than fifteen (15) days after completion of temporary paving: Concrete base shall be of five -sack mix and shall conform to the City of La Quinta Road Improvement Standards and Specifications, Ordinance #461. R28 FOG SEAL: A fog seal coat consisting of an application of asphaltic emulsion shall be applied over all patch areas as determined by the City Engineer. R29 SEAL ARMOR COAT: A seal coat consisting of an application binder and screenings shall be applied on all patch areas where such seal coats existed prior to issuance of this permit. Seal or armor coats shall be applied as specified in Section 37, Standard Specifications, State of California, Division of Highways, dated January 1973. Work of pavement repair to be accomplished by a licensed contractor engaged in the business of pavement repair. R30 STREET RESTRIPING: Where street striping is still visible on streets to be excavated, such striping shall be replaced upon completion of permanent repairs. R31 TREE RELOCATION OR REMOVAL: Tree relocation within the City of La Quinta road right of way shall be accomplished by a licensed, bonded and insured tree service, and handled safely without interference or hazard to the traveling public. It shall be the responsibility of the permittee to maintain the tree in a vigorous growing condition at its new location. Trees to be removed shall be removed in sectionswhich 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 restrictedtoa maximum of 500feet at anyonetime. 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. BLANKET 199T NOTE: OY With proper velidation this form constitutes an CITY OF LA OUINTA encroachment permit APPLICATION FOR PERMIT PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) For the construction of public or private curbs, driveways, pavements, sidewalks, puking lots, sewers, water .mains and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS Subdivision Improvement Permit — Class 111 DATE: NOV. 26,' 1990 Minor lemww t Permit Chas IV LOCATION OF CONSTRUCTION VARIOUS LOCATIONS WITHIN THF CITY I.TMTTS (Street addraes or Description of Location) To install new gas services p appropriate) PURPOSE OF CONSTRUCTION Sketch (attach construction lens if and to do routine main maintenance on gas facilities DESCRIPTION OF CONSTRUCTION excavation DIMENSION OF INSTALLATION OWREMOVAL SIZE OF EXCAVATION, IF NEEDED 4 x a APPROXIMATE TIME WHEN WORK WILL BEGIN 1-1-91 APPROXIMATE TIME OF COMPLETION 12-�1-91 ESTIMATED CONSTRUCTION COST S (Induding removal of all obstruction, materials, and debris, backfilling. Dom• paction and piecing permanent resurfacing and/or replacing improvements) In consideration of the granting of this permit. the applicant hereby agrees to: Indemnify, defend and saw the City, its authorized agents, officers, reprountatives and employees, harmlen from and against any and all penalties. liabilities or loss 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 the Administrative Authority at hest twenty-four (241 haus in advance of the time when work will be started. Comply with all applicable City Ordinances, the terms and conditions of the it and NI rules and regulations of "the City of V t�iiirtta ant to pay for any additional spleoernent naoaeaery es the nwrlt J. SN DIS PF.RVZSOR '- _P�nnnrAAPPl�ior�ni. or Ao(ant 4)357742-OUTHERN AL FORN"A'rAs _ ?' Name of Applkwd (plem print) YuainLa Address Telephone No. Nenhe of Contractor and .lob Foremen = Busirtma. Address. Telephone No. AContractora Lioww No. City Business LWww 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 Minor Improvement Permit - Class IV: See attactad schedule Inspection Fee $ Permit Fee Pwwty Cash Deposit -Surety Bond if required TOTAL: Remipt No. Received by Date'' Recorded by PERMIT VALIDATION PERMIT NO. DATE APPROVED EXPIRATION DATE DATE ISSUED By Administrative Authority TELEPHONE: (619) 564-2246