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2326• NOTE c With proper validation this form constitutes an C1TY 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: 3-15-95 LOCATION OF CONSTRUCTION _ (Street address or Description of Location) Subdivision Improvement Permit — Class I I I Minor Improvement Permit Class IV Porth side of Intersection of Eisenhower Dr. 5 Ave 50 PURPOSE OF CONSTRUCTION Repair storm drain Sketch (attach construction plans if appropriate) pressure line DESCRIPTION OF CONSTRUCTION Excavate, repair line 8 Backfill See attached conditions DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED x APPROXIMATE TIME WHEN WORK WILL BEGIN 3-16-95 APPROXIMATE TIME OF COMPLETION 3-16-95 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. Signatur f Applicant or Agent SouUy Unlimited 52-275 Avenida Vallejo La Quint& , CA 564-3535 Name of Applicant (please print) Business Address Telephone No. Mike Bartlett Name of Contractor and Job Foreman Business Address Telephone No. 184099 Contractor's License No. City Business License No. Sfingi & Hannon 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 _ Penalty Cash Deposit -Surety Bond if required TOTAL Receipt No. Received by _. Recorded by 160 10 $ 170 Date PERMIT NO 2326 PERMIT VALIDATION 2326 DATE APPROVED 3-15-95 EXPIRATION DATE 3-31-95 DATE SSU D 3-15-95 By Administrative Authority TELEPHONE: (619) 564-2246 -he fo,ldwlno ciene►al and Soecta, Nrovutans ars aMcnaa to aro naiad n - a oiR Of P!►tnK No. GENERAL PROVISIONS -he following snail always acciv- ENCROACHMENT ON PRIVATE PROPERTY 'h,s oermrtautnorizes wars to be adeomollsneo wilnin ONLY. Whenever construction extends witnin orivate orooenv. it small be ins re Citv of secure permission from aouhin la Quina rlgnt of wa soonsiowty or tme oermmee for nR eantraaorn t. g prodern owners. Such autnorizatlon must oe secweo ttv lila oermitfeD ontir to TRACKLAYING COYSTAUCTION EQUIPMENT: C:astsa tratifav,nD Oaveo furtace unleaa trttUCT" iEQU" feces street Dads. All meenan elf niMton eculoment small n , elastin. worn. :ns bavina curing excavations. Rubber -urea eaulomanT only small be OtasOarmmeG,Dooersteoman, Dave -ant is scarred. scailea or orotenduringthetermoftnis snail contract. in Oa snail o nrteo s nrubberstreetshoestoorates used in bacictul operations m oayso areas. If the exlalln thR [made canton a m rasa be resurraced over tneir entire or m the Oavemem is maned' Ci surfacing plus acoraonate foal coat at f00f911eG aodve. wwtn. Aeaurtacing Snell cona1R a} one Not La Quints snail raouar Dost of two inenes 12"1 of Ax PROTECTION OF TRAFFIC: All excavations and wort areas snail bacrooenv ugmtea aro bameaaeo Engineer or La Quinta City Public works insoectors. Suitable oetoura aria detour sI at the project. Tho Ci ssndemeo neeesaart a the Cil City mall be notified 24 Hrs. In aavanp of a 9rla small be olaeaa drip rnalntaf CARE OF DRAINAGE any traffic detours or delineations. ^eorortnedwatio GE STRUCTURES. Any ara,nage structure including whets structures encountered during excavation wnicn necess,tate rrnavel snaicarruqateal metal alas. in kinds nodeseary to remove or cut existing drainage structures. City of La m anau be sola nice.atNl culvert an, Otslnage structures and Doan drains snail be tact tree or debris at Quints for be notffleo eco in kind' In the eYsrtt.it become ttnor to commencement of tnis won RIGHT OF WAY CLEANUP; orooer drainage, Any surplus maleriu resulting from excavation way. AlloavedSurfacesShall bebroolnealcfeanofSarin and atnerebjectio so ma,ensUSlmmeoiaevNerbaekrations snail be t'1e Existing gutter line and Drainagerom the ngnt c aiiCnea snail be laOtacEG to Inalr original slanoaro Dr Oaner. All excess rd cor,tGacOOr Onor di paving. Water tamer snau be used. as redutrec. to sonnkie ins in,meaiateb ertar p u material Nau to remove. eletfill. Iro site to keep down oust eonanlans OE -WATER OPERATIONS. If de -watering operations are re and Nae be use the resoonsioanv or the permittee (contractor, to control tnul water erom0s are rarcing water an City at V Quints rocas. it anau b CLOSING STILE broyme Oft-atroet Oam"cadas "an rra0eamrv. Earn No street small ba closed. e a minimum or one lane of traffic Small be maintained at all times to aSearorinssatoiningprOOefff,owneraaroemergencyvenKys.Intneevent,,,sfeltb�ms arm am lerlgtn df nine. Dertmnes snau contact tris office [o O,GMae unite cocain ins ° rttaetnatnalnuRcloarastrestrc necessary DerftltaflOfl. SPECIAL PROVISIONS The follwing shall a0ob ONLY when Indicated: Rl NOTIFICATION: Permmee snail nobly the City CASH OEPOSTTS OR BONDS: A ease Dona or an sot least 48 hours in advance of starting eonmualon. Shall be lurnisnea in the name of City of V surely Oona of a amount g not lets than s roads and survey monuments. Thio bona stall be continuous tti cer all wors �wle1 involved in the restoration of the va Posted odor to commencement of any work on the by the City Engineer. Thbneua LA Quints 0.I... bores must to R3 IUTILITY CLEARANCE:ISubstructurea, Prtarto matin by Permit- ins Certmttss snail contact all cancer ned cat ly ration Witnln the City of 1.d' Quints ngmtot Damage 10 axlshng aYbRRJcturea resunm from O panes Mathis to the wub aYmarita0 9 oenticnsco location at Of the permmee.=>a4Ged unoermptlertnrt anallbefne sale d'4/1 unLrrY �r+aoility CLEARANCE. (Surface structures, No wart small be Gore unaer trill oermrt until all utilities are clear of the Oradassc work site. The parrttmas snail notlty all concerned utility companies at the prDOOMa wan. R5 PAVEMENT WIDENING. Area between the Proposed m surfacedw,ln _�;r+crtea of A.0 pavin ate gutter line and the existing road Dew having an A'valueotnotlees Of A gPlawoDn incheaatctasa rtent snail be and Soecrticatichs. �anainconterman aggre0a[aaubaasecDurse Ordinaries x481. cevwln Cib of la Quints Road' In+ordvement Standards R6 PARKWAY GRADING: Area between lila property line end too of the 1/4 incn to one toot I11. orcooseoconcrete curb sMail berd' g daotoauooeot R7 GRADES. STAKES: City at La Quints construction. snau eslablish graces and stakes for the pro00360 concrete cora and purser RB GRADE CHE rCiryotLaQulntisnallcneC[graasauoon a licensed engineer. recerototclanandprdtileand/or graces aeaetablishedby R9 CURB REMOVALFOR DRIVEWAYS: A Portion of the existing concrete euro and/ or curb dna gutter 1 he,lenell Os fafncvsO. Curb ana/or curia and guner snail be saw cut prier t0 removal. curb anchor Curb. matchinggutter cc concrete concrete onvewav approaert snail be constructed in Conformance wile City at (,a gutter and Quints Stanaara 0207. RIO DRIVEWAYS. A.C.: Orivewevs snail be constructac as not to alter extsting.drama a pattern. Surfacing Procanplaced an I "1 of efa� v line and the existing road Caving snail be 2-1 /2 inches of A. C. Payingg aggregate base. Driveway construction snail conform to attached drawina. betyveen ane � R 11 CULVERTS..:_ ncn diameter i inches Deiow and In line wi,n the existing I,OW Pine. Culvert snail be installed w,in ins i PIG,��t?�� Culvert installation snail conform to the a[tacneart iatoowmtery g t 2 SIGHT CLEARANCE: Signt clearance at 600 lest In either direction snail be assured and maintained' R13 . SOIL STERIUZER: The area to os surfaced shall be Treated with sou sterilizer. Ran of ao0llcatlon snail complyvvith ins manufacturers soeeitieatlons. k4 -')COORDINATE WORK: The proposed ,,,,Drs snatl be suoordlnatea to any adoration which the State dW of La Qulms may conduct In this area during the period of this permit. Wont sCalifornia or mall be eoadinatat@ Of at me Stale or City at La Quina tcrcm to prectude delay or interference with State or City of Lf Quints tuoleets. PC R15 SURVEY MONUMENTS. Prior in e centerline or all kces whom, or beginning at construction, all survey monuments wnlcn exist an ins streeo or oroosr,v fines when lltvofyDD analat ,, reaacso ov a lf� cry,, engmser dr s camofetet tfso out sG to ,,,,,�----. tayeyerKtrle �� evrnavbereaoiheryrrw..__... - i o - _nvr r •npNUMENTS. P --m To excavation or", "ntneor Construction. all survev monuments small be r,,,00yt ov t :r u uuints and sultaole oavmem or cuaranere tit cavetent small as mace as relTOurseTem for au trots Vt OIL R17 24VEMENT CUTTING. Pavement will W meatarwaliv Qrt to a etroegm edge prior to est aava^on. MaSU of Oawmen cutttno small Os epp►dved Lnrouon the orteee or the City Engine fir- 'Under no circumstances snail a:cause^ oe used to excavate erect to cuttino or oavememt Excavation material snail be o'acec in sucn a tacnnate the oenerai now or traffic. Prior to final oavind Operations. anv oamaae to oavem tic g women• oosltion as to Desi 'orrectec. straight eggs snail of. R18 '4VEMENT CUTTING. Pavement small be saw Cut or'or to removal. Prior co renal caving operations, dery pavement Straight edge snail be corrected. R1 LIMIT damage u EXCAVATIONS: Excavations snail De limited to 1.000 lineal feet or Coen trencn Delete oacktill operations mus: begin. All excavations snail be cronerry Oarricadee wim itdnts Overnlgnt. On weeKends and hdltdivS TOrthe OrOtea'On O: Ins tiavettrtg pusuc. The Public Worss lnsoaaor snail oetermine the suetacilery or excavation carricaoing in Seen case: Nc excavationteniais scall remain Oben for i OBfIOq exceeding TIVe 171 sous. NO sxravatlon snail be made unless the construalor Tiitl/Ial is aaYa11V On I"e WOtK SIi6. R JO BACX ILL MATERIAL Samfillsmall be from ofcrusn. facts orotnerorgante suastancedetr'mama.,..:suytar purposes Of Producing an scadttt unte v consolidated yatll. Anv Tatem' w"lcn Ins City of Lal QYinta teems unswtsbta purposes Sa[uraiea meteriall Wnicn is encountered During excavation small not 00 used tar cacktill. but snail be supplemented at roptac'm ov an approved sand or gravel. R21 BACKFILL SANG: 81110111,111 Shall be avordyed frarvrt-mx rano or equivalent and shall be placed in lips of throe teei 13'1 ano vetlrated using vecrO1%moer or ecurvatem equipment. Alternate TetmOds may oe sub case a relative compaaton at 95 Dercem shall be.ettaineo wrrnin the a:rueturat seats" of tine roagwsy d. but i anv stittited. but in anv 22 BACKFILL PLACEMENT: Baeldill snarl be aopfied in lavers of not more tnan'50 percent of the total dsvM at the Ironer. befOraitpppingOrsnots urtdtfive-fact(51liftswnereCanneserectaxcessrvedeptns.Careestobeexerciseddratthe bid[IIII Tuinal i$ mai SUbleQee to extreme wvell by flaming Opefations. 8acktill material small be Gleam so that the resulting ccmoaatcn snail be not less tnan 90 oereem or ecurvatent to the surrounding ground, wnIenaver is t CCMDBct'Cn. Where dancing or flooding is used for a maximum she greaser ettlemem. adequate dikes will be cp^atruaetl to retain Ins water. Where Letting is used. the Lets shall be of sufficient length to reach the variant of Caen ;aver fine the water sltppty snau be conenucus. COMPACTION TESTS: If so required bythe inspector, c flat and a minimum at'ane 11) test on seen road. One I liwpydn tows or Caen testabe sna oesat I ntervals of rorwaraed to tnetGaetrian 1,ppC aoprovaiand filed prior tomakingPermanent room irs-Compaction tests snau be madeaaoutlined'nSe Engineer for Staodaro Slleutieapprty Oiveuon m Highwave. State of Califomee, mtsd January 42Ou a+on &3.01 of the R2 1973. COMPACTION TESTS. If so required bvthe inspsaor. compaction tests snau be made for Coat craning Ons 111 copy of esen test Snail be torwara" to the City Engmeer tar sparovaaill be Lem e f or seen cMakingg or ssrx em, e. Ctlmoaaton fain small be msae as oialtnso in Seaton ti.3.Ol of the Stanpana Salmd,aticns, 0ivraion of t1' trent reoslra. 01 Calif—M. oared January 1973 ghwepe, State R25 TEMPORARY PAVEMENT REPAIRS: After compleilon of bactilll and eotftoaaeon Operations, a temporary pater. consisting of 2 inates of SC -800 shall be places on a precarea $upgrade. The SC -800 temporary pave^ after a maximum of 3.0001ineet feet or trencn nas peen excavates ano baettill operations In "pas•small ry the Placement of the temporapavement exceed a five 151 day Ilmlt. completed. but R26 PERMANENT PAVEMENT REPAIR: After oacatill and compaction operations nave Coen completed. a tentparory peter. Consisting at two inches (2-) at SC -800 small be Graced Immeeiatety A permanent patch of surfacing placed dna inch class inches A. C. twnpdrary rasp reastr. base snail be placed no latertnan days atfer completion ar R27 PAVEMENT REPAIR- F.A.S..Uooncompletion otbandlllandcdmoacttan.a[emporarypatchcsnsisting Ottwoonenes(2-. at Cold mix paving (SC -800) snail be pieced Immedutety. A Germanent paten of three Tcrtes 131 DIAZ- surfscang snail be placed on six inches to-) concrete base as directed. but not later tnan fifteen Iletnng.Concrete sa ete ossinal be 6lseek mix and shall can 115) days aper comoletian of temporary WA Soauficanona. Ordinance ma81. form Im to trio City of La Qwnta Road Improvement Standards R28% FOG SEAL: A fog seal coat consisting of an application Of aspnaiti determines by the City Engineer. c emulsion scala be apailad Over all patch &r ams as R29 SEAL ARMOR COAT: A seal coat consisting of an acalicaudn bender and screenings small be applied on all Osit7t areas where sucn sant Caata Gxlsttions. Sprier f iSSwneeott" parmrt. Seal or armor coats snail be applied asspeafied in Seaton 37. Standard Soeelt'eations. Stats of Calilarnia. D• accomplished by a IIeeR$,O contractor engagedoivi ion at Hignwey, dated January 1973. work at pavemem repair to R3 STREET RESTRIPING, Where street striping Is stes o e on streets in tne s o C a as Of ve tea ent •such striping snail be re t completion at permanent repairs. 0 aced YOOn R31 TREE RELOCATION OR REMOVAL. Tree relocation within Imo Citv of La Quinta road regnt of way snail be aaomplcsnec by a licensed. Conceal and insured tree service, and haneled sately Witnoul rtltert,rence or maxara to the trayeling public. It shall be the responsibility at the germ ttee to maintain the tree in a vigorous growing conortidn at Its new location. Trees to oe removed shall be removed In seafons Wrtich can be he naiad safely wrtnout inlemorenceor naaara to hlgmwev traffic. The entire width at the tree stump snail be removed and disposed at s0 that no debrIS remains in view at the hlgnway. rhes[umphatesnailbebacktelledandthorougntycOmpactecasspeelfledentrlefollowrngparagropn.Whereit becomes necessery to resmet traffic. the work snap be restricted to s maximum of 500 le signs. flagmen end/or barricades at env one time. Adequate cades shall be provided to protea tis traveling public at all et at a Large males resulting from tree removal shall be backfilled and compacted to not less than 90 percent or equivalent t0 the surrounding ground. whichever is the greater compaction as dalarminea tri trio Impact or field method. Compaction tears sriall comply with Section 6.3.01 of the Standard Specifications. January 1973. Oivesesn of Hignwevs. State of California.aliaateC R32 TREE TRIMMING: a. Only trio necessary trimming small be acCgmotisned to proved, clearance of the facllty for one calendar veer All broken or weak sections witnrn the trimming snail be removed. a Where it oetomes nad restart traffic. Adequate segos, flagmgmen.n. andtathe work shall be restrtaedto a maximum of 500feet atanyons time. ior parricides snail be provided to protea trio traveling punbc at all times. G If tree ifunka are paRfaliv outside at the City Of L a QuimS road right of way. permmae small mak, fila own bw this erm"fillfrM wets ad)Otriing prOOe� Owners tar consent 10 tri, [rimming In addition t0 the snail ucrt hisprao an W this oermrt. d. All tree trimming on EVERGREEN TREES, PALM TREES. and other ORNAMENTAL TREES shall be accM., iyhna to the aatmfactlpn of the City Public Works insp�or. e. Abumne nriinw... __ - - SPECIAL CONDITIONS --PERMIT NO. 2326 --- SONRAY UNLIMITED --- 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. 2. 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 S:OOp. m. Work shall be prohibited on legal holidays including Sundays. 5. Permittee/contractor shall as 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. 2326 Page 1 of 2 SPECIAL CONDITIONS ---PERMIT NO. 2326 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 asdirected by and to the satisfaction of the City Engineer for the protection of the traveling public. 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. Existing .pavement section on Eisenhower Dr. is 4" of A.C. Over 6" 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. 2326 Page 2 of 2 M, 0 C18 or C23 See Chart A B DELINEATORS HIGH LEVEL WARNING DEVICE HIGH LEVEL WARNING DEVICE C30 BARRICADES FLASHERS OPTIONAL C30 R18 +' z (Rt.. B p r �... ¢� p 0' CC � r 0 s 0 0 V nJill CHART A -`Z� MINIMUM RECOMMENDED DELINEATOR AND SIGN PLACEMENT 9 SIGN SPACING i O TRAFFIC SPEED TAPER LENGTH DELINEATOR SPACING (Advance of Taper 9 (Each '9N (+ +e) (T@W (brgwd) A BNw«n Slans) 25 MPH 150 FL 25 FL SO Ft 150 Fl 30YPH 200 FL 30 FL 60 FL 200 Ft. 35 MPH 250 FL 35 FL 70 FL 250 FL 40 MPH 350 FL 40 FL 60 FL 350 FL •t5 MPH 650 FL 45 FL 60 FL 550 FL •50 YPH 600 FL ' 50 FL 100 FL 600FI. •55+MPH 1000 FL 50 FL 100 FL 1000 Ft. ' Sm 6Wd A •Note: See Section 6 1« h1mid .NNumm WORK BEYOND INTERSECTION See Chart A FLASHING ARROW SIGN ... OR / HIGH LEVEL r WARNING DEVICE i- —C30 C20 (Rt.) C18 or C23 X X 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, pavemems, sidewalks, parking lou, sewers, water mains and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS DATE: - /` S �7 S Subdivision Improvement Permit - Class III pq Minor ImprovemeJ,rceermit Class IV LOCATION OF CONSTRUCTION _ l= % SC2J C7 br.�c e_Y x ltt�� 11 ,•,co (Sunk address Of Om,nPticn of Location) PU POSEOF-CONSTR ON L2el�r7r✓ , S"/(�f, /�-� fi-eS uv Sketch (attach construction plans if appropriate) DE {'IPTIO()f�I- OF CONSTRUCTION 7 \ cao �c t� pTj a c�lS DIMENSION OF INSTALLATION OR REMOVAL SIZE OF EXCAVATION, IF NEEDED APPROZC 4A�T�IME�EN WORAll KWILL BE N` APPROXIMATE TIME OF COMPLETON_ ESTIMATED CONSTRUCTION COST S (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: Indernnifv, defend and save the City, its authorized agents, a offimm, rtpn:•nptlw and ampleygs hannlesf from and ogeinst ny any all penalties, liabilities a Ion restating from china p Court action and wising out of eery oxidant, log of damage happening or occurring as a proximate rasun of @"Ywort undertaken under the permit grantee Ourwent to this ao arsons O► propeity pplkation. NotifV the Administrative Authority In lean twenty-four (241 hours in advance of the time when v,,*ft sill be stwad Comply with all apptieaU@ City Ordinances, the terms and conditions of the permit and 911 aWleable rules and regulations of of La Quints and to P8Y for Wry addltkwa reptacvnem necatmv, es the result of this wort. the Gly n / �Signature of Applicant or A .g ✓2 _7J qY Names of Applicant (please print)/ �{ Business Address Telephone N0. 7 Name of Contractor and Job X. igry©gC� Contractor's License No. I C—V Business Address Telephone No. x City Business License No. Applicant's Insurai6 Company GiCV, LI.og1LITY Policy Number FEES: Subdivision Improvement Permit -Class 111 Public improvements: 3% of estimated construction cont Private improvements: 3% Of estimated construction costs Minor Improvement Permit - Class IV: See attached schedule Inspection Fee S Permit Fee Penalty Cash Deposit -Surety Bond if required TOTAL: $ Receipt No. Received by Data Recorded by 1 %386 PERMIT VALIDATION PERMIT NO. DATE APPROVED EXPIRATION DATE DATE ISSUED 3� S _C By / Administrative Authority TELEPHONE: (619)77 5' Y: