452r3u�9-9�5
,VOTE
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
DATE: Sent. 29. 1989
Subdivision Improvement Permit — Class III
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION On Fred Waring Dr. and ,Adams Street
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
to install new gas main
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED 2126' x 2' open
trench earth
APPROXIMATE TIME WHEN WORK WILL BEGIN asap
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)
Sketch (attach construction plans if appropriate)
To install 408' of 3" plastic
medium pressure gas main 22' N/SPL
of Fred Waring Dr., beginning 24'
E/centerline of Adams St.,
proceeding east. To install 1698'
of 4" plastic medium pressure gas
main 20' N/SPL of Fred. Waring Dr.,
beginning 22' N/SPL of Fred Waring
drive., proceeding north and then
east. To install 20' of 2" plastic
medium pressure gas main 19' W/
centerline of Galaxy Dr., beginninc
20' S/NPL of`Fred Waring Dr.,
proceeding north. SEE SKETCH
mn_n Bann r, _C
In consideration of the granting of this permit, the applicant hereby agrees to: CUT EARTH
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.
Signature of Applicant or Agent
Southern California Gas Co. PO Box 3003 Redlands. CA 92373 (71.4) 798-374/2
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 jk
Minor Improvement Permit — Class IV: See attached schedule T ` ° 452
Inspection Fee $ n/a
Permit Fee n/a
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by ._
Date
PERMIT NO
PERMIT VALIDATION
452
DATE APPROVED 10/4/09
EXPIRATION DATE 4/1/90
DATE ISSUED ,10/4/89 s9
By
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
,gff
'NOTE:
With proper validation Y Q'
O •
this form constitutes an CITY OF LA QUINTA • . ��
encroachment permit j t'
` APPLICATION FOR PERMIT
PUBLIC 'WORKS.♦ CONSTRUCTION (ENCROACHMENT)���wSw
a r OF TIC
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:, ep;t. 29, '' 1989 Minor Improvement Permit Class IV '
LOCATION OF CONSTRUCTION On .Fred .Waring Dr. and Adams Street
(Street address or Description of Location)
to 'install.,new new gas main
PURPOSE OF CONSTRUCTION Sketch.(attach construction plans if appropriate)-
. _ ,
To install •,408' of 3" plastic
DESCRIPTION OF,CONSTRUCTION medium pressure gas main,'.22' N/SPLr
fi of 'Fred ,Waring, Dr. , beginning 24'
'E/centerline of Adams St. , •.
DIMENSION OF'INSTALLATION OR'REMOVAL` t proceeding east. To install '1698'
of 4" plastic medium pressure gas
_ y main. 20' S/SPL .of 'Fred. Waring, Dr.,
SIZE OF EXCAVATION,I-IF NEEDED 2126' x 21' .open beginning 22' N/SPL;^.of Fred Waring
trench earth drive., proceeding north and•then
APPROXIMATE TIME WHEN`WORK WILL BEGIN • as east. To install, 2'0' of•, 2" plastic
medium pressure gas main.l9' W/
APPROXIMATE TIME OF COMPLETION centerline of Galaxy• Dr. , beginninc
ESTIMATED CONSTRUCTION COST $ �20' •,S/NPL of, Fred Waring•'Dr": , r
(including removal of all obstruction, materials, and debris, backfilling, com- proceeding north.' SEE SKETCH-
paction.and placing permanent resurfacing,and/or replacing improvements)
In consideration of the, granting'of,this permit, the, applicant hereby agrees.to: 'CUT EARTH,`
Indemnify, defend and save.the.City, its authorized agents; officers,'reprgsentatives, 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.' `
r
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.
- t Signature of Applicant or Agent
'-Southern•,California Gas4Co. PO Box 3003 Redlands,_'C& 92373 (714L 798-7742'
Name of Applicant (please print) ,% ' , ABusiness Addreis , * Telephone No. '
Name of Contractor and Job Foreman •Business Address Telephone No:
Contractor's License No. ,r "" City Business License No: i
'Applicant's Insurance Company, Policy Number,
' FEES: Subdivision Improvement Permit - Class I I I
Public -improvements; 3% of estimated construction costs
Private improvements: 3% of estimated construction costs.' `
•No 145,2 s
Minor Improvement Permit = Class IV: See attached schedule
• Inipection Fee' $ nL� �* PERMIT VALIDATION
•n a ` ti
Permit Fee PERMIT NO. -452'
. i r
Penalty
10/.4/89 ;
, , � - • ' .. ., w
Cash Deposit -Surety Bond DATE APPROVED
if required �' 4 / 1./ 9 0 -
. 7 • EXPIRATION DATE
TOTAL:' $ ;-0— - DATE ISSUED 0 4 89
` Receipt No.-
f
Received by. - Date Administrative Authority- r
Recorded by ' TELEPHONE: (619) 564 2246'
• •
`
e ,
The following I and Special Provisions are attached to and made a pa�Permit No.
GENERAL PROVISIONS
The following shall always apply: ••1 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
secure permission from abutting property owners. Such authorisation 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
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, spalled, 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.
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
Engineer or La Quinta City Public Works Inspectors. Suitable detours and detour signs shall be placed and maintained for the duration
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 at all times for proper drainage.
RIGHT OF WAY CLEANUP: Any surplus material resulting from excavation and backfill operations shall be removed from the rightof
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
immediate) after backfill. . - L
Y `�
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
access for the adjoining property owners and emergency vehicles. In the event it is felt bythe permittee that he must close a street for
any. length of time, permittee shall contact this office to obtain the necessary permission.
• SPECIAL PROVISIONS The follwing shall apply ONLY when indicated:
R1 NOTIFICATION: 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 9
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 . :1
' r TILITY CLEARANCE: (Substructures) Prior to making any excavation within the City of La Quinta right of way authorized
C� by permit, the permittee shall contact all concerned utility companies relative to the location of existing substructures.
r Damage to existing substructures resulting from operationsIconducted 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 are clear of the
proposed work site. The permittee shall notify all concerned utility companies of the proposed work...
r
,R5 'PAVEMENT WIDENING: Area between.the proposed concrete gutter line and the existing road pavement shall be
t surfaced with inches of A.C. paving placed on - inches of class aggregate subbase course .•
r having an "R"value of not less than and in conformancewith City of La Quinta Road Improvement Standards
and Specifications, Ordinance #461. + h
R6 PARKWAY GRADING: Area between the property line and top of the proposed concrete curb shall be graded to a slope of
+ 1 /4 inch to one foot (1').
R7 GRADES & STAKES: City of La Quinta shall establish grades and stakes for the proposed concrete curb and gutter
construction.` is
'* R8 GRADE CHECKING: Cityof La•Quinta shall check grades upon relceiptof plan and PFOf ile and/or grades as established by
a licensed engineer. ,
.R9 t 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
r concrete driveway approach shall be constructed in conformance with City of La Quinta Standard M7.
R10 DRIVEWAYS, A.C.: Driveways shall be constructed as not to alter existing drainage pattern. Surfacing between the
Y " property line and the existing road paving shall be 2-1 /2 inches of A.C. paving placed on ( ") of class
t aggregate base. Driveway construction shall conform to attached drawing. r
-• R 11 CULVERTS:A inch diameter ( )culvert shall be installed with the invert approximately 1-1 /2
inches below and in line with the existing flow line. Culvert installation shall conform to the attached drawing.
1 SIGHT CLEARANCE: Sight clearance of 600 feet in either direction shall be assured and maintained.
a 13 SOIL STERILIZER: The area to be surfaced shall be treated with soil sterilizer. Rate of application shall comply with 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.
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 the may be readily andcorrectl
Y V- Y Y
be'replaced by a licensed civil engineer or surveyor at the expense ofthe permittee.'A complete set of notes showing the
r._ ties to these monuments shall be furnished to the City Engineer prior to the removal of any monuments. Thisoffice shall
be notified upon completion of replacement of all survey monuments for proper project clearance.
RD-31
R16 :Y MONUMENTS: Prior to excavation or beginning of c on, all survey monuments shall be tied out by City
__ luinta and suitable payment or guarantee of payment siidii ue 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
0R1pavement straight edge shall be corrected.
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 suitabilityof excavation barricading in each case. No
excavation shall remain open for a period exceeding five (5) days. No excavation shall be made unless the construction
material is actually on the work site.
R20 BACKFILL MATERIAL: Backfill shall be free ofbrush, roots or other organic substance detrimental to its usefor 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 (31 and vibrated using vibrotamper or equivalent equipment. Alternate methods may be substituted, but in any
C;�case a relative compaction of 95 percent shall be attained within the structural section of the roadway.
DBACKFILL 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 percent or equivalent tothe surrounding ground, whichever is the greater
compaction. Where ponding or flooding is used for a maximum settlement, adequate dikes will be constructed to retain
the water. Where jetting is used, the jets shall be of sufficient length to reach the bottom of each layer and the water
supply shall be continuous.
R2 COMPACTION TESTS: If so required bythe inspector, compaction tests shall be made at intervals of not more than 1,000
feet and a minimum of one (1) test on each road. One (1) copy of each test shall be forwarded to the City Engineer for
approval 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.
C4 COMPACTION TESTS: If so required by the inspector, compaction tests shall be made for each crossing or service line.
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 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 3,000lineal 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.
226 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 lass base shall be placed no later than days after completion of
temporary road repair. 7, ,Oh Lfs—
R27 PAVEMENT REPAIR: F.A.S.: Upon compietibn of backfill and compaction, a lemporarypatch consisting of twoinches (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 safelywithout interference or hazard tothe traveling public.
It shall be the responsibility of the permittee to maintain the tree in a vigorous growing condition at its new location.
Trees to be removed shall be removed in sections which can be handled safelywithout interferenceor hazard to highway
traffic. The entire width of the tree stump shall be removed and disposed of so that no debris remains in view of the
highway. The stump hole shall be backfilled and thoroughly compacted as specified in the following paragraph. Where it
becomes necessary to restrict traffic, the work shall be restricted to a maximum of 500 feet at any one time. Adequate
signs, flagmen and/or barricades shall be provided to protect the traveling public at all times.
Large holes resulting from tree removal shall be backfilled and compacted to not less than 90 percent or equivalent tothe
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 toa maximum of 500feet at any one time.
Adequate signs, flagmen, and/or barricades shall be provided to protect the traveling public at all times.
c. If tree trunks are partially outside of the City of La Quinta road right of way, permittee shall make his own
arrangements with adjoining property owners for consent to the trimming in addition to the authorization provided
by this permit.
d. All tree trimming on EVERGREEN TREES, PALM TREES, and other ORNAMENTAL TREES shall be accomplished to
the satisfaction of the City Public Works Inspector.
e. Abutting property owners shall be contacted, in all instances, prior to trimming or topping trees.
I. Pruning shall, in all instances, be at the shoulder of the crotch to insure even, fast healing in all cuts of two inches
(2") and above in size. Sealant shall be applied to all cut sections as directed by the City Public Works Inspector.
Y• < r
ADDITION WENCROACHMENT PERMIT NO.40--=CONDITIONS ".
R33 ': ;
Survey monuments ` shall be -protected in place or,
'
re-established pursuant to City standards and -the. -State of..
' •
California Land Surveyor's.Act.
R34.
Work .shall7 be coordinated with -the -City of La Quinta' s
•
-forces to preclude delay or interference with •,the City of La
Quintal's. projects.
R35
Contractor,shall comply with the local noise ordinance and
-construction•operations and maintenance, -of equipment within
one half mile-of•human occupancy.shall bewperformed'only
.during -the time -periods as follows: r.
October 1st to Apri130: Monday-Friday-7-00a.m.-5:30p.m.
'
t Saturday 8:00a.m.-5:00p.m.
F
lst,to'September 30:. Monday -Friday 6:00a.m.-7:00p.m.
,May
;Saturday 8:00A.m.=5:00p.m:
Work shall be,prohibited anytime on Sunday and Federal
holiday. A,
R36
Traffic coritrol"shall' be as. per Cal Trans Traffic Manual. -
Field - adjustments - in detouring shall be accomplished as,_'
t
directed in-order`to adjust..to actual field conditions. It.
shall be the.contractor's•responsibility'to adequately
'barricade and< detour: this• 'site.
}
R37 '
All excavation ate .or near the. travel way shall •be .backfilled' ..
at the end of - the' work- day, for ,the protection of the
traveling public.- ,
R38
Street closures_,shall not be allowed at'any time.
-
F
R39.
A minimum of one travel lane shall be maintained at all:
Ytimes with flag men'during,working hours.
R40
All. work ,to be performed within .the existing •paved- section -
` ;
shall be.temporary,'paved-and maintained by the`Permittee,
permanent pavement shall.be placed.no later than=15 days
after completion of the temporary road repair.
R41
Ingress and egress -for local-properties,shall be maintained
at all times.
R42
Prior to -work starting, Underground`Service Alert shall be
'contacted at'17800-422-4133 and an'"inquiry number. !''shall be .
provided,'to th'e,�City Public 'works' Inspector.
R43
Pavement shall be sawcut prior to removal. t ;
R44
All backfill subgrade soil shall be compacted to nothing
less than 90 o relative dry density,.all 'backfill soil within,F 'w
the -top 21-of finish pavement surface shall be compacted.to {
nothing less than',95o.,relative dry density, all base '
material, shall be -compacted . to nothing less. than,-95 0
relative -'dry density.
R45 ..
Replacement' -' pavement• section shall, -be 4" AC. over 8" Class II
-
aggregate base.. r r
53449-955
NOTE:
With proper validation
this form constitutes an CITY OF LA GUINTA
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
Subdivision Improvement Permit —Class III
DATE: SEPT. 29, 1989 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION nn Frari 14arin q nr anei Arlamc S+
(Stron address or Description of Loeationi
PURPOSE OF CONSTRUCTION To install nave gag main Sketch (attach construction plans if appropriate)
To install 408' of 3" plastic medium
DESCRIPTION OF CONSTRUCTION pressure gas main 22' N/SPL of Fred Way -
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED 2126' X 2' nPFN TRFNr.H
EARTH
APPROXIMATE TIME WHEN WORK WILL BEGIN ASAP
in
_
Dr., beginning 24") E/centerline of Adams g
St., proceeding east. To install 1698' of
4" plastic medium pressure gas main 20'
S/NPI_ of Fred Waring•Dr., beginning 22'
N/SPL of Fred Waring Dr., proceeding north
and then east. To install 20' of 2" i,
plastic medium pressure gas main 19' W/
centerline of Galaxy Dr., beginning 20'
S/MPL of
APPROXIMATE TIME OF COMPLETION 3-31-89 Fred Waring Dr., proceeding north
'ESTIMATED CONSTRUCTION COST $ SEE SKETCH TO 204; E-6 , CUT EARTH
(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 rewlting from claims or court action and arising out of any accident, loss or damage to persons or property
happening or occurring as a proximate remit of any work undertaken under the permit granted pursuant to this application.
Notify the Administrative Authority at lean twenty -,four (24) hours in advance of the time when work will be started.
Comply with all applicable:CityrOrdinances ; tta affmsand `conditions of,the permit and all applicable rules and regulations of the City of
>. y ,� •� �.` � s . �,aY�.�=.� ,} 1i r,� sr..?•.?e,-^' t?�` ., t ''+� ,.�`d 4r .r..., ....�e r
I.rGui andw pay for any addctanMErtpboantenttnrnawry as tM rMul chi work j �' �° �5 tQ,�., r,+
� H�����.� � ti�� 3 ",r ° �?.a A*>� w r � �u.wt � �:� 'd' �`S � 4,�E+��' ✓�'S`. / ��/.� �,tia. i.t, t .Y x - t ���
'S•• at�t r��`�'i��� e�"xr�`�j�et{'.3-dc �'j=rs��sr `�;f',� %'% xm�r.'i, ��'*"cw,>f ' �'s���t: + � ���N , �'�s1 �" sS
[ .v �, i .°' x ..a iie r t i `4� L��Y.kf � � )-,..s �...; ..;. r . •. s # , �`e •Y :^w4�' n .
, `1. :.�.?J. "' �" �. z. r-,: a �?s:.... ;^. � a. i.`+. ♦.. F_-: 1 '. 'iI �"t,..� f ,: '; '_:%'....M!'Q.��... v �f::A.�-.I.��.'�� -A��. .+ s ;. -. 3 -..,. �..wr.._ r.,....'�`' :i:!4.• r - H, `iRt.
SOUTHERN; CALIEOR13Iei iGAS C'O"_ P-` n. gOx� �nn�'; izt?nT ntvn:G r`n s977_� (71`4) "798-7742 #
Nance of Applicant (plei
„i,se print) r ;fir' x 3, x� '� ' rf ^j 8uiirnls Addnst� s �' *,' Telephone No
t
:`wr } � r ,',. �� �• •� � �� ' :.r ;�l ,, ?'!i � • a, "'�,. �t k 4 '� t.• i'�., i - . � �-w� U+fK. �±i :, { ,
Nant� of Contractor anq Job Foreman, .. ; i. >y , :: Businou Address " r Telephone
Contractor's License No. r ', +_ „; v, ;.. City Business License N6i..Y
_ - 4 rj. '�S�r F �ti,# � t ` „n'e .�^. " "�' ...�• .e ` t' r r tf ar,
j ..
Applicant's lnwranoe Company ry ' , Policy Number
�'
FEES: Subdivision Improvement Permit — Class
Public improvements: 3% of estimated. construction costs' t '
'Private improvements: 3% of estimated construction costs.
Minor Improvement Permit — Class IV: See attached sdtedulit Y r
' rV/ r.
Intspection. Fee. _ -�_ _ PERMIT VALIDATION' :
Permit Fee PERMIT NO. 5�
Penalty
Cash DeptuitSurety Bond DATE APPROVED
s
if required EXPIRATION DATE
TOTAL: DATE ISSUED
- - r
Receipt No.
Received by Date
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Administrative Authority
Recorded by I TELEPHONE: 1619) 564-2246