1478NOfiE•
With proper validation
th s�form co t-Mes�an,,,,. CITY OF LA QUINTA �o
•,.'-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
l' ?
• Subdivision Improvement Perm t`a— Class III
DATE. June 29, 1992 Minor Improvement Permit°Class IVB
LOCATION'OF CONSTRUCTION — 53-605 Madero La Quinta ` ti • ;
(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 y $5se q A ? 8r �"�g-q� 30.00 ,
APPROXIMATE -TIME WHEN WORK.WILL BEGIN 6/29/92 {
APPROXIMATE TIME OF COMPLETION 6/30/92 ,
ESTIMATED CONSTRUCTION COST $ 350.00
(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 actiori 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 andregulations of
the City of
+ La Quinta and to pay for any additional replacement necessary as the result of this work.. f '
` Signature of Applicant or Agent `.
Synercon Development: Corp 74"940,Hwy 111 Indian Wells, CA �'`' _ 564-6929,
Name of.Applicant (please print) Business Address . Telephone No.
David Detrick 45-325 Driftwood Palsy Desertt,CA 92260, 564-6929
Name of Contractor and Job Foreman _ Business Address Telephone No.
337500 2279
r Contractor's License No: - City Business License No.
.Accord GLS 328 446
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
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
$ 20.00
10.00
$ 30.00
Date
ij
PERMIT VALIDATION
PERMIT NO. 1478
DATE APPROVED -.6/29/92
EXPIRATION DATE
7/5/92
DATEIS UED 6/29/92
By _
E �1.
Adminlstrative.Authority
TELEPHONE: (619) 564-2246
---
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
Subdivision Improvement Permit —Class III
DATE: � — 2, 1 g 2 _ Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION —c�.3 — �6 5 � .��' n `d 6201A)r
(Street address or Description of Location) /� v //�
PURPOSE OF CONSTRUCTION 7)e X11 e -w i+ I Aa2bul
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN — Z
Sketch (attach construction plans if appropriate)
APPROXIMATE TIME OF COMPLETION 120—�So— l Iz'
ESTIMATED CONSTRUCTION COST $ '� 5 C�
(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 Quints and to pay for any additional replacement necessary as the result `of this work.
Signature of YA
Applicant or Agent Gdto GJ�V l J�N� 7� --QU/) /-I(�)I( �il�in
Name of Applicant (please print)
Business Address
Telephone No.
Name of Contractor and Job Foreman Business Address o.
Telephone N
A3 -7c do
n ? 3G
Contractor's License No. City Business LiSense No.
AQ01aRD GLS 329
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
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No. _
Received by _Date
Recorded by
r 1236
PERMIT VALIDATION
PERMIT NO..
DATE APPROVED
EXPIRATION DATE
DATE ISSUED ` Y
By _
Administrative Authority
TELEPHONE: (619► 564-2246=...: