1692t i
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 II I
DATE: 3/16/93 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 53-995 Cortes La Quint&
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Drivamy Approach
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 3/1.7/93
Sketch (attach construction plans if appropriate)
Per Riverside CO.Std #I 207
(Attached)
APPROXIMATE TIME OF COMPLETION
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 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
Synercon Development Corp 74940 Hwy 1i1 Yudiau Wells 92210 564-+6929
Name of Applicant (please print) Business Address Telephone No.
SA1m
Name of Contractor and Job Foreman Business Address Telephone No.
337400
Contractor's License No.
2419
City Business License No.
Accord GLS 348446
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit —Class Ill
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:
Receipt No.
$ 30.00
Received by Date
PERMIT NO
f0'"C'49 INTAN6-93 30,00i0
1692
PERMIT VALIDATION
1692
DATE APPROVED 3/16/93
EXPIRATION DATE 3/19/93
D6TE-ISSUED 3/1I16/93
di46d a__t.[.:
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
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
� s^
GATE:
A . / 15 Subdivision Improvement Permit — Class III
/� Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 9 _ (/'I _M G�7
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION 1 9A'y pp, Sketch (attach construction plans if approP rinte)
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
C
APPROXIMATE TIME WHEN WORK WILL BEGIN '—% 7—
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $�ti
(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:
Indemnity, 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, lou 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 124) 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 Applicant or Agent
-1,V- 9q0 9'Z2l o S��920
Name of Applicant (please print) Business Address
�. Telephone No. /
Name of Contractor and Job Foreman
83 74-0 0
Contractor's License No.
Applicant's Insurance Company
Business Address Telephone No.
2-f/9
City Business License No.
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:
$ -D
Receipt No.
Received by Date
Recorded by
Policy Number
1C,CFi
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE > Cl— (7-15
DATE ISSUED 9-f
By
TELEPHONE: (619) 564-2246
Administrative Authority
9
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