HomeMy WebLinkAbout801 PINE AVE; ; 11174; PermitI
DEVELOPMENT PROCESSING SERVICES DIVISION
2075 LAS PALMAS DRIVE
CARLSBAD, CA 92009 -4 859
(619) 438-1161
RIGHT OF WAY PERMIT ·1 1 1 7 4
THIS PERMIT MUST BE
11CA°Rls~HESEN!OP. ~Ef'/7E.i<.!'
App li cant Please Print and Fill I n Shaded Area
JO B
ADDRESS
NEAREST
CROSS STR EET
PROJECT
NUMBER
ASSESSOR 'S PARCEL NO.
APN
PERMITTEE SHALL IND EMN I FY, HOLD HARMLESS, AND DEFEND THE C ITY
OF CARLSBAD OR ITS OFF ICERS OR EMPLOYEES FROM ALL CLA I MS,
DAMAGE OR LIA BILI TY TO PERSONS OR PROPERTY AR ISING FROM OR
CA USED BY ANY ACT IVI TY OR WORK DONE PURS UANT TO TH IS PERMIT
UNL ESS THE DAMAGE OR LIA BILITY WAS CA USED BY THE S OL E ACT IV E
NEG LIG ENCE OF THE CITY OR ITS OFFICERS OR EMPLOYEES.
ISS UED BY -1.0-
EXP IR ES
24 HOUR NOT ICE REQU I RED FOR
IN SPECTION AND PR IOR TO START OF WORK.
CALL 438 -3101
YOU MUST CALL UND ERGRO UND SERVIC E
1-------.,..,.s --=-n -,-Gc,-~....,.-t:_....--,-___ -,-______ ---j ALERT (1 -8 00 -4 22-4133) TWO
CONTRACTOR'S 53 15 ·Aven a ncinas WORKING DAYS PRIOR TO WORK.
MAILING • C arlsbad, CA 92 002_ 4 38-{cDB;).. 1
ADDRESS . -; O 4 ~-/.dJ4&i ...
• 24 HO~R.A ./Jl_34 CITY Z IP TEL.~ :Y-1'"-W ~
STATE
LICENSE
NUMBER
DESCRIPTION
OF WORK
BUSINESS
LICENSE
NUMBER
UNDERGROUND SERVICE ALERT NO. _____ _
THIS PERMIT IS INVALID WITHOUT THIS NUMBER
IF ANY EXCAVATION OR BORING IS DONE.
VALIDATION AR EA
INITIALS
) ,{, q TRAFFIC CONTROL PLAN APPROVED
AND ATTACHED
. cs~
::;IC 1/
ESTIMATED
COMPLETION DATE
LIABILITY INSURANCE VERIFIED
PAID THE UNDERSIGNED ACKNOWLEDGES THAT ALL WORK
SHALL BE PERFORMED PER CITY CODES, STANDARD
SPECIFICATIONS, CITY APPROVED PLANS AND FEE: --=2~5=-'-' o-a ____ BILLED
STANDARDS.
RESTORATION SECURITY
TRAFFIC CONTROL DEPOSIT
INSPECTOR'S
SIGNATURE
J , BLUE -F ILE: YELLOW -IN SPEC T0_.:9 ; GR EEN_-UTILITIE S; PIN K -FINANCE ; WHIT E -CO NTf~ACTO R
IA 11 ::#,== /) r"J 9 a4 Q c-; ;7 740--1-3 /) ~ l/t J ,..fat cl~ Cl -J J ~ l....-' !....-/._?,. 1 (_./
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DATE