PROPOSED CONSTRUCTION:
(Describe and attach sketch if appropriate)
LOCATION OF WORK:
DURATION OF WORK:
Signature of Applicant
Date
Name of Applicant (Print)
Contractor & License Number
Address, City, Zip Code
Address, City, Zip Code
Telephone (Office & 24 hr. Emergency Numbers)
Email
Telephone (Office & 24 hr. Emergency Numbers)
Email
BELOW FOR CITY USE
PERMIT NO: DATE ISSUED:
TOTAL FEE: PROCESSED BY:
EMAIL CITY INSPECTOR (JFuentes@DiamondBarCA.Gov) AT LEAST 48 HOURS BEFORE STARTING WORK.
WORK INITIATED BEFORE REQUESTING FOR INSPECTION UNDER THIS PERMIT IS SUBJECT TO REMOVAL AND
RECONSTRUCTION. NOTE THE ATTACHED TRENCH REPLACEMENT DETAIL AND STREET CUT MORATORIUM POLICY.
The undersigned hereby makes application to construct specific improvements on public streets at the location
described below with the understanding all work is subject to the provisions of the City of Diamond Bar Municipal Code
and an approved Street Construction Permit.
Permittee shall indemnify and hold harmless City (including of its officers, employees and agents) from and against
all claims, causes of action, liabilities, losses and damages for injuries to persons and property, including reasonable costs
of defense and attorney and expert fees, arising from Permittee’s work described in and undertaken under and pursuant
to this Permit. Permittee shall promptly pay the amount of any judgement rendered against City (including its officers,
employees and agents) for any such indemnified claims, and reasonable costs and attorney and expert fees incurred by
City in the defense if such claims. For Engineering questions please call 909-839-7040.
Traffic Control devices shall be installed per MUTCD and W.A.T.C.H. Handbook before start of construction.
This permit shall expire Ninety (90) days after the date of issuance unless otherwise indicated below.
A 30 day extension may be obtained at the discretion of the City Engineer with payment of an extension fee or any other
fee that may be required. The City Engineer reserves the right to terminate any permit.
ENCROACHMENT PERMIT APPLICATION
Public Works Department
21810 Copley Drive, Diamond Bar California 91765
E-mail: pwpermit@diamondbarca.gov
IMPORTANT NOTICE
Section 4216/4217 of the Government Code requires a
DigAlert Identification Number be issued before a
“Permit to Excavate” will be valid. For your DigAlert
I.D. Number Call Underground Service Alert TOLL FREE 1
800-422-4133
Two working days before you dig.
TRAFFIC SIGNAL CONDUITS ARE NOT A PART OF
CONTRACTOR TO CONFIRM LOCATION WITH CITY
click to sign
signature
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