2323NP -T- E:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroach"inent permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit — Class III
DATE: 3-15-95 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION S/S Miles Avenue B/0 Bridgette Way
Tract 26188 Del Ray Norte
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Place Talephoae cable into Sketch (attach construction plans if appropriate)
Tract 26188 Dei Roy Forte
DESCRIPTION OF CONSTRUCTION Y acs 0 oY -
conduit at existing manhola, Lower 2 Manholes b Sao attached conditions
Loner 4' conduits See attached drawing
DIMENSION OF INSTALLATION OR REMOVAL
GTS W.O. 0549-9P408GR-950014
6 ,
SIZE OF EXCAVATION, IF NEEDED W.O. 0549-9P408MS-950020
APPROXIMATE TIME WHEN WORK WILL BEGIN 4-10-95
APPROXIMATE TIME OF COMPLETION 5-15-94
ESTIMATED CONSTRUCTION COST $ 500.00
(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 th rmit and all applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the esult of this work. i
GTE California Inc.
Name of Applicant (please print)
Name of Contractor and Job Foreman
Contractor's License No.
`�Signafure of Applicant or
45-590 Jackson St. Indio, CA
Business Address
Business Address
nt I/
(619) 342-0626
Telephone No.
Telephone No.
City Business License No.
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class 111
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 -0-
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ —0—
Receipt No.
Received by Date
Recorded by
2323
PERMIT VALIDATION
PERMIT NO
DATE APPROVED
EXPIRATION DATE
2323
3-15-95
5-15-95
DATE ISSUED 3 _ q5
By �d 111b) 2A�
Administrative Authority
TELEPHONE: (619) 564-2246
f011ovwne boners' aro Someone earovisiOns are onmenea to one mace a Cart Of Permit NO.
2-; Z �
GENERAL PROVISIONS
-he follow,nq snail aiways aooly'
"ENCROACHMENT ON PRIVATE PROPERTY -hes cermn autnor'zes work to be aeeomCllsnea w,tnin
ONLY. Whenever construction emends wiin,n orlvate crOCemv- it snail be the resconsioulty Of the C,oy Of
secure oermissien from � Quints right of way
abumnq Drooerfv owners. Sucn autnorizateon must De secured ov the oeineg ar for n
TRACKLAYING CON a contraczorsl tr
CONSTRUCTION EQUIPMENT: C;aReotroetlsvi oermihee orfor to starting wore.
osveo surface unless tttteow,tn sit "a conmr-ctivn eduloment small n
:no oavino aurin Cain-reeeostreetoeds-All mef:naniealautn otbeoermnteot
9 excavations. Rubber -urea eduidmem only scall is used
snail De rltteo wiln r oat,,, to mane
oewment Is searrea. Paadill ooeratlons ,n hover great It ins exist n,
soallea. or Proton curing ins term of ones cantroef or if the
that image Cantona of r Cavae area°. If snail
eequa r
oma W resurtaeeo over incl► entire vuwtn. Resurteel Pavement is mania. City of V
suffacln9 plus aocroanate "go coat as soar
above. � small consist o} one Quints snail feauas
COOT of TWO'ncnes t2'1 of A.0
PROTECTION OF TRAFFIC: All excavations aria woek areas snail bnprapmrly Iighteo and barneapm
t
Engineer or to Quint= CiN Public Worcs InsbecfoR. Suitable metacera aria detour goo a small en Ciacco a
at the prole=, rhe esaaamso neGeaYfYbyIng Cit
City shalt be notalgia 24 Hra. in edvann of arty traffic amount" delineations, nornaental
Mdfor trio auratio,
CARE -OF DRAINAGE STRUCTURES: Anv oralnaoe structure including
coteaete structures eneounterso during excavation wneen neegismiestgi cdrrugatea metal olds. conerote
necesaary to memo" tr cut Casting eralnago strueSuros, movM
snail be reotaeeo in ken oil, steel culvert ary
Ofslnage structured and open prions snail bs elect tree of aebte &l �11T small Da notified onor TO commencement
antevsof become,
sat for Craver drainage, o°nierit of tnia wan
RIGHT OF WAY CLEANUP: Any surotus material result, }mom excavation and way. All paved SURar.as snap Oe Drdomed dean of earth and oMex cavatio na01 rtlaterfala'mm
oammeaL snail ft removed tram the ngnt c
Existing putter line and drainage ditches snail be reatacea to their original stanaaro Or Cener.�u eWanerbaextille
Prior to paving. Water tante► snail be usaa. as ftaeaeroeCPan
immediately anal Cacitill. f°Oulf9c. to scr'nkie the excess material Cnall be remawr
loo Lte t0 kM0 down dugt CoflaltlOna amp ahaY De Ufac
OE -WATER OPERATIONS: If irse I antrnneg a taretlens are required and bumps ars lorclnq water on City of
that respanyouity OI iris Oafmmegi Ieatltrofson to cOrltrOt this water Orta IO Ofovoe off,
Li Quints mean. It snail b,
CLOSING STREETS: No street snarl be etosmo. A minimum at one Iee'gi oft meat oarneapet vwien riabgiaaen
aSesa for tree naeClmng Orownv awnmro ono • traffic snail be maintained at all tlmgia o0
anylenginOfilrtle•lxrmmeesnaueontaedOmes gee avenits. In inssventhisfaltbvthepermmsamatnamu or'ONasumner
Potain Ins neeessary permission. RetOaeanersat to
l The foltwlng snail aopty ONLY when ifldlCatea: SPECIAL PROVISIONS
lR NOTIFICATION: Permmegi shalt nctlty the City at 7-77-7075
R2 CASH DEPOSITS OR BONDS: A caste bona Gran ao at 10821 ,48 hours In advance at starting tonevuetoon.
Shall be lurnlsnees In ins name of City at V Craves surety bona In an amountof not less than s
roads aria survey monuments. This Dona small be to cco"T Oil
a�te involved
1e1 do ins restoration of that vgi
poste° onor to eomn+enesmem of a by the City Engineer. T1tls�a u Quints
�) ny work on thea proles Dorm must be
�R UntmCLEARANCE. 1Substruaufa3IPriortomatin
by permit. trio eerrhmtes snail comact all concernedg aniexeatlauonwetnintneQirydtLA QYlmongtrtof
Oatnage to existing vAuzvu=ures resultin him utility romaanus roost., to trig IOCapprt Of existing e�euatare
ted
of the Derreentas. g iterations eondiectad unc9r tats Demenn
mail at eche bN ructures.
�, re monel ll,mr
KRy UTILITY CLEARANCE. ISurfsee structur°st No
PfacCseo work site. The pOfmmee snail nota wort shall be cone unow this
ty all concerned ullll 0°^^h uncal all utilities ars seer of the
R5 PAVEMENT WIDENING: Area between the preposee N Campantes of the proposed wort
surfaced wan inches at A.C. pavan music !info► line end the ekisi'ng road Cave
hsvengen••A'value ofnotleaatnan caving Placed inehesp}ctass ^Ont snail be
_ and Speemcariona. at not less xan_ ono in conformance Ci aggregate subbess course
) tyof la Quints Road Improvement Stanostal
R8./PARKWAY GRADING. Area Detween trio orooenv line end loo of the brOcOsea concrete curd snail berat
1/4 ,nen to ane loot 11 I,
g dgidto • atone of
R7 GRADES o STAKES: City of La Quint= snail egtabtish rades and states mar tris aropoaea concrete cum and goner
R
GRADE KING:City ofLaQwntesnaueheetgraaea
a leeenseansea engineer. uoonreeefptofmu
clan graces°°esblished
R9 CURBREMOVALFORORIrtoon DY
CURB ea Curb and/orcura DRIVE p YS: A=eau be saw at the existing concrete euro and/or euro and gutter I f
concrete o Curb
B y a cut prior to removal. OacfeOsa Curb. matching ccn=eee liter one De
oproarn snail be constru=ed in conformance with City of La Quints Standard 9207, gutter and
RIO DRIVEWAYS- A.C.: Orivewny small be constructed as not to alter existing Drainage Pattern. Surfacing orooenv line dna the existing roan Caving small be 2-1/2 inches of A.C.g
aggregate case. Onvewev eonstrU=ion shalt conform to inches Drawing. cwrt g ttgitween one
9 placed on 1 "1 of Ga"7-
R11 CULVERTS..:
.nen diameter t
��: Culvert snail tie Installed w,tn the invert acurOxirnat n, 1. 1,2
flow
acnes oe,ow and in line worn the existing line. Culvert installation snail conform to tris attaenea drawing
R1 SIGHT CLEARANCE. Sight clearance of 600 feet in seiner Direction snail be assured and maintained.
R13 SOIL STERILIZER: That area to be surlaeea snail be treatea Wein soil sterilizer. Rate of °polieatmn Small Com
msnutaRurer•g soeeetfeanons.
COORDINATE ptywltn ine
WORK. Tits cel in
is avert snag tis suoordiofthi to any operation which ins State of California or
City of La Quints may ept>Dyet Pte tats area curing ins pOflOp del this Dermot Wort snail be con minstea wftn ins State or
City of La Qui U forces to preclude delay or interference witn State or City of La Quints projects.
R15 URVEY MONUMENTS: pear to e
camerftne of all streets or orxcsvabonooenv ones when iI oegenning of eonRructron. all survey monuments wnieft ext
bs ndfeeed by a IiCanap Hyfl a vea snau bocci., latefv tiea out so mtry may OarmemhRon Ina
nvol
rrw•w ...�____. _ nglnae/Or eleevev0►atfn� _.� rmMrw..__...
o - river "ONUMENTS P--nr To excavanan or neelimmne at construction. au survev monuments snail ba N
:r U Uurnta ono suilaals osvmem or Guarantee of G,,vrrient Snail as meas as rermoursemem for an
our by C
(R:17 '4VEMENT CUTTING. Pavement wool be maenanioily wt to a Groan warm Involve.
CuntnO snail 01 aODrOVe!O 1nrOUan fns orrice Of the City Ent sneer 'Under edQa flrlOr TO excavation. Method at °,,,Omen•
On use,, t0 excavate artor to cu1tInG Or oavemrmt qia ria circumstances be cl cea i snail excavating
caving
operaiontions
material Ghali be OIaClO in SUCn a g Oaulamen•
iaeuuate the General now or tramc. ?trot to tonal oavino ooeranons. env aamaae to pavement
position as to Pes:
:arrectec. straight edge snail DE
R18 -'4VEMENT CUTTING. Pavement snail be saw colt orror to removal Prior to renal caving Pavement nrargnt cage snail be eorreaea. q opersteons any damage tc
R19 " UMITOFEXCAVATIONS: Excavations snail belomiteoto1-0001ineafreetorooenirenenoetorecacktilld
begin. All ng Puanc. T snail Public
O orfs inspector Darricsn it ith
ca Irgmts overnlgnt. on VireekenOs dna nOliOiVS TOr Tn
pennons mus.
e xca alio ns ail re. The Public ar a oelouxain aeferminethe sololaP111tyeemenexcavationridn0rcilvis n i
ekCaV7I10n snail remain ooen rot a OeflOp @xta,,Omq Lve l'„11 as of a acn case. O'
material is actually on the wore site. w• No excavation snail be maae unlessq ri earn wee. Nr
R2 BACKFILL the construcuor
MATERIAL Baaddl shall be tree of brusn. roots or °trier organic substance aetrimenta.. ,
Of Producing to i aewnecnv encountered
boattill. Any msnnel venom tris City of La Quinta deems unsuitablelspO pose?
-
saturated meterrefl which Is eneounterea Gunn 's U24 tar
►aptaaxa g excavation snail not oe used tar bacidill, but snail be sol
Cry an approved sane or grave.
R21 BACKFILL SAND: fiai*till shall be aslt.fnry supplemented of
throe feet 13.1 and Vitrtrod using vobrot°Qi�frlbep/ p equivalent ne or equivalent and shall be placed in lifts Of
Casa a rotative compaction of 95 percent shall be attained wilnin rime t. Alternate ise ^atgroatertrier
ops maybe substmrted, but in am
R22 BACKFILL PLACEMENT: Baeldrll snail bb spoiled in lavers of not more tnan 50 percent at the rota dn at the ayav
beforelftiapingoramasamumoffive-cops 151 lifts wharetrencheseradteiicasaneaeptns.Gn es t oe
ba°tttll material is not SYblaQed t0 extreme tvYelf by f1 Orn the [►crier.
rosultln ming Operations. Backfill material shall be lace so tnatine
Tousling eomosaton snail be not teas than 90coream er eOulvalent to the surrouncin pflCap a0 that the
ccmoaction. Where dancing or flooding Is used for a mailmum Sattlemem. ap q ground. wnicn
equate dikes will be co swucl tine greater
the water. Where letting is used. the lets shall be of suttcieht length to ream �tns bottom of cern :a
supply snap be COrmmious. atrtl4md to ratter
R23 COMPACTION TESTS: If so required Yer,,nd the wafer
by the Inspector, Compaction tests snail be mace at Imervals of not m
feat and a minimum of one I I I test on earn roan. One l 11 copy of earn test snarl be rorwaraea to fns City
mare own
1'�C
Standard S 9 Dat Highway,.
repel,,. Ccmpacuan tests snail De maae as Oulllnep o Seat Engonsw for
Daaticatlons Oiviuon of Higttvww. State of Calitomlm. dated January 1973. on &3.01 of the
Q_!_24,i COMPACTION TEM' It so reduerea by the ins,,
On,, l I I c actor. cott+oaalon tests snap be mace tin each crossing COY of esrntest snail betorwaraeetp tris City Engmewforaponralandtile,,orror earn crn rig dl sarsevs fine.
Canaaaeon taaa sn,,ll be maae as ou[Iimeo in Section ti.3 01 of the Starwaro Soae+td prior t malting
of M' anent recalra.
d Caldomem. aabrd January 1973
R25 TEMPORARY PA ghweym. State
ion at
consisting of 2 inixieaAafNll and compaction on
SC 800 Small be placed on atpreoarec s�pl tae. The orations. a SC. 1300 temporary paving
eih0armry pater
atter a maximum of 3.000 lineal feet of trenen nas been excavated and cacttfin an bill
COh1p10te0. but in no case snilt
the placement of the tempora to no t>• a scat
temporary pavement exceed a five 151 day lintel.
R26 PERMANENT PAVEMENT REPAIR: After backfill ano compaction operations have Dean completed. a temporary
pater.
COfgesting at two oncnes 12*l of SC.800 small be placed immstanOlsO v a permanent ba cpm
surfacing placed on a inch class inches A.0
tttltipOrary road reamer. Due shall be placed no later than
days atte►ODmpinion o:
R27 PAVEMENT REPAIR: F.A.S.. Upon completion Ofbacktilland comoacteon,atemooraryoatcnepnsis[ingp}tyveineheal2'
Of coo mix paving ISC•8001 snap be pesceo immeao[ety. A permanent patch at three 31cm c nsi of A.C. bell place,, on six inrnaa l6"1 concrete bass
as arreaed, Dolt not later than fifteen t 151 days atter '1 ofComA. . sl
surtjanq snail
Paying.
Concrete case snail be at five-sant mix and shall conform to the Ciry of La Quints Rosa unorovem tmntpOrary
amid Spaaticauans. Ordinance aa61. eht Stsnaara,
FOG SEAL A fo seal coat consisting at an ac"catiOn Of i naltic emulsion snap be appllad over all
9 9
hetet peas as
dmtemm�so try the City Engineer.
R29 SEAL ARMOR COAT: A seat coat con313ting of an apblicauon binder and screenings small be applied on Olt 09trn areas
where Surn sari costs existed orror to issuance of this permit. Seal Or srmcr coats snail be appliesss sceedisd In Seaton
37. Standard Speay alicen State of California. Division of Hignways, dated January 1973. Work of pavem
be accomplished by a licensed contractor engaged In the business of pavement repair. repair ic
R ) STREET RESTRIPING. Where street striping is still voslaie an streets to be excavated, sucn striping snail be replaced upon
completion of permanent repairs.
R31 TREE RELOCATION OR REMOVAL. Tree relocation witnin Ione City Of La Quinta road right of way shall be as omallshe0
by a licensed. Panama and ensured tree service. and hanalad sately without niterterence or nalaro to ins ans"ling public.
It shall be the responsibility of the permittee to maintain the tree in a vigorous growing condition at its new location
Trees to oe removed shalj be remove,, in sernons won ich can be handled mately W Itnavt a ntenerence ar nazeiM to hrgnwav
traffic. The entire wooth of the tree slump snail be removed and disposed of so trial no debris remains In view of the
hlgrtwav The stuma hole snail be dZicktillea and tnaraugntyccmoactea assoomfled in the following paragraten. Where it
becomes necessary to remcf, traffic. the work shall be restricted to a maximum of 500 feet at anyone pita, Adequate
signs, flagmen mn
and/or barricades shall be prded to protect the, traveling public at all times.
Large notes resulting from tree removal shall be backfilled and Compacted to not less tnan 90 percent er equivalent to Ine
surrounding ground. whichever is the greater compaction as determined by the Impact or field metnae. Compaction
tests snail comply with Season 6.3.01 of the Standard Sauciftcallons.
January 1973, pivesion of Highways. State of California. Galea
R32 TREE TRIMMING:
a. Only the necessary trimming snail be acCprrlolisnea to provide clearance of the facility for one calendar year
All broken or weak secttOns within the trimming shall be removed.
a Where it pecomes necessary to resin t traffic. the work shall be restrfctea to a maximum of 500feet st anyone time.
Adequate signs. Ilagmen, and/or barricades small be provided to protea the traveling public at all times.
C. It tree trunks are partially cutstde of the Ciry at La Quintile road right of wsv. permmes shall make his own
by this meet toinln,,d101fllrig prp0etty owners for consent t0 the trlmmeng Itt aamtldn t0 the,,utnorfaL[On OrOvraea
by this permit.
d All tree trimming on EVERGREEN TREES. PALM TREES- and atner ORNAMENTAL TREES shall be accomoleshea to
the smustaction of the City Public Works Inspector.
e. Abumns nrnnw.tir--- ..._.. � _
SPECIAL CONDITIONS --PERMIT NO. 2323
--- GTE CALIFORNIA INC. ---
In addition to the standard permit conditions, the following shall apply:
1. All work shall be performed in accordance with the latest edition of the Standard Specifications
For Public Works Construction.
I Permittee shall be responsible for providing continuous dust and erosion control..
3. Streets shall be kept clean. They shall be completely cleaned at the end of each working day
and more frequently if required.
4. Contractor shall comply with the local noise ordinance. - Operation and maintenance of
equipment within one half mile of human occupancy shall be performed only during the
following time periods:
October 1st to April 30: Monday -Friday 7:00 a.m. to 5:30p. m.
Saturday 8:00 a.m. to 5:00p. m.
May 1st to September 30: Monday -Friday 6:00 a.m. to 7:00p. m.
Saturday 8:00 a.m. to 5:00p. m.
Work shall be prohibited on legal holidays including Sundays.
5. Permittee/contractor shall assume responsibility for repair of any pavement damage to any public
or private street and for any damage to other City streets or facilities as a result of work
performed under this permit.
6. Advance warning signs and traffic control shall be installed and maintained in accordance with
Cal Trans Standards or the Work Area Traffic Control Handbook (WATCH Manual). It shall
be the permittee's responsibility to detour and barricade this site.
7. Street closures shall not be permitted. A minimum of one travel lane on paved surface shall be
maintained with flagmen at all times.
8. Prior to excavating, the permittee shall contact Underground Service Alert at 1(800) 422-4133.
9. Should additional work, materials, or modifications of the work be required in order to meet city
standards, safety requirements, signage requirements, or to fit actual field conditions, the work
shall be performed by the permittee as directed by and to the satisfaction of the City Engineer
at no cost .to the City of La Quinta.
Special Conditions - Permit No. 2323 Page 1 of 2
SPECIAL CONDITIONS ---PERMIT NO. 2323
continued
10. All work shall be coordinated with the City's contractor and others working within the area as
directed by and to the satisfaction of the City Engineer.
11. All backfill and subgrade soil shall be compacted to 90% relative dry density, all backfill soil
within the top 2' of finish pavement surface shall be compacted to 95% relative dry density, all
base material shall be compacted to 95% relative dry density.
12. All excavations at or near the travel way shall be backfilled and paved at the end of every work
day as directed by and to the satisfaction of the City Engineer for the protection of the traveling
public. I .
13. All landscaping, irrigation, decorative rock, decorative concrete, lighting etc. shall be replaced
to its original condition.
14. Access and egress to all local properties shall be maintained at all times.
15. Permanent pavement replacement section shall be .one inch greater than existing, but not less
than 3" of A.C. over 4.5" of A.B.
16. If the work is to be performed by forces other than that of the utility company the contracting
company shall be required to apply for an additional, encroachment permit and pay the
appropriate fee.
Special Conditions - Permit No. 2323 Page 2 of 2-
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CITY OF LA Z_i `.7. 'TA
NOTE:
With proper validation MAR U 7 1995
this form constitutes an
encroachment permit CITY OF LA QUINTA PUBLIC WORKS
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: MARCH 6, 1995 Sop!hdivision Improvantent Permit —Clan III
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION S/S MILES AVENUE E/0 BRIDGETTE WAY
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION TO BE ABLE TO PLACE TELEPHONE
CABLE INTO TRACT 2618 Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION PLACE 10 FEET 2-4" A�,rrara C.r��c�,7cor`dS
CONDUIT AT EXISTING MANHOLE.
DIMENSION OF INSTALLATION OR REMOVAL'
vel D _
OTIME WHEN WORK WILL BEGIN 04/10/95 V4- "t- q90
SIZE OF EXCAVATION, IF NEEDED G(- ���J(%
APPROXIMATEQ WI��,I" n 4 D6gq � �PgPb
�!� YU
APPROXIMATE TIME OF COMPLETION 05/15/95
ESTIMATED CONSTRUCTION COST $ 500.00
(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 1241 hours in advance of the time when work will be started.
Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City of
La Quints and to pay for any additional replacement necessary
Signature of Applicant or Agent
GTE CALIFORNIA, INC. 45-590 JACKSON STREET INDIO, CA 92201 619/342-0626
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 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
'ermit Fee
"enalty
:ash Deposit -Surety Bond
f required
TOTAL:
ieceipt No.
ieceived by
iecorded by
S
r D
O
$
Date
PERMIT VALIDATION
PERMIT NO. % 2
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: 16191564.2246
!R
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