1464yy t'
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, 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: June 17, 1992 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION_ 54-561 and 54-581 Avenida Alvarado La Quints
(Street address or Description of Location) .
PURPOSE OF CONSTRUCTION Driveway approach Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
PER RIVERSIDE COUNTY STD. NO. 207,
ATTACHED. '
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 6/17/92
APPROXIMATE TIME OF COMPLETION 6/18/92
ESTIMATED CONSTRUCTION COST $
700.00
(Including removal of all obstruction, materials, and debris, backfilling, com
t' d ` I
pac on an p acing 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. g
�w 4�
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
David Dietrick 45-325 Driftwood Dr. Palm Desert, CA 92260 564-6929
Name of Applicant (please print) r Business Address Telephone No.
Synercon Development Corp. 74-940 Hwy 111 Indian We##s, CA 564-6979
Name of Contractor and Job Foreman Business Address Telephone No.
337400
Coritractor's License No.
,-
Accord
2279
City Business License No.
GLS 398446
Applicant's Insurance Company Policy Number
FEESSubdivision Improvement Permit — Class I II 1 _1
Public improvements: 3% of estimated construction costs i�5S8CA TSTA 57-9` 50,0010
Private improvements: 3% of estimated construction costs 1 464
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ 40.00 1I
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
Recorded by
10.00
$ 50.00
1
Date
PERMIT VALIDATION
PERMIT NO. 1464
DATE APPROVED 6/17/92
EXPIRATION DATE 6/22/92
DATE ISSUED 6/17/92
By
TELEPHONE: (619) 564-2246
Administrative Authority
--------- -------------
NOTE:
With proper validation
this form constitutes an CITY 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
DgTE:�Q /7- Z Subdivision Improvement Permit — Class I I I
` _ Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION "f-57 S4 `S8/ 4VAit4 n 11,A, QVI L7-4
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN Ullt
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)
In consideration of the granting of this permit, the applicant hereby agrees to:
,9/ 1/4,,eS7GI_ Go S't) ep i
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
LT1� ��eco e� 9
Name �-9--
of Applicant (please print) Business Address Telephone No.
- S•4'����� � � Gale � -- ��-�Q����yii .�';u/ .sx�-6���
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. / City Business License No.
Applicant's Insurance Company IPolicy 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 $ ``/ V
Permit Fee /
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
Recorded by
Date
1236
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED .
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564-2246. -•v