1535NATE:.'
` 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 II I
DATE: September 5, 1992 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 54-260 Rubio
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Driveway Approach -Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
Par Rlvereide County Std. No. 207
(Atxach�d)
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 9/9/92 ?*51 A i9?jT'L`� -9 30400 14
APPROXIMATE TIME OF COMPLETION 9/11/92 !
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 applic� ant 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 Quinta and to pay for any additional replacement necessary as the result of this work.
Signature of Applicant or Argent
Synercon Development Corporation 74-940 Hwy 111 Indian Walls, CA, 92210 564-6929
Name of Applicant (please print) Business Address Telephone No.
Same
Name of Contractor and Job Foreman Business Address Telephone No.
337400 2419
Contractor's License No. City Business'License No.
Accord GLS 345446
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 $ 20.00
Permit Fee 10.00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 30.00
Receipt No.
Received by Date
Recorded by
1 535
PERMIT VALIDATION '
PERMIT NO. 1335
DATE APPROVED 9/5/92
EXPIRATION DATE 6/11/92
DATE ISSUED 9/5/92
-
Administrative Authority
TELEPHONE: (619) 564-2246