1730NOTE
• With proper validation
' this form constitutes an CITY OF LA QUINTA
encroachment permit.
APPLICATION . FOR PERMIT
PUBLIC WORKS.. CONSTRUCTIONENCROACHMEN
( T)
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: 5/5/93 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 54-840 Juarez
(Street address or Description of Location)
r'..PURPOSE OF CONSTRUCTION Driveway ADproaeh. Sketch (attach construction plans if appropriate)
r A, DESCRIPTION OF CONSTRUCTION PER RIVERSIDE COUNTRY STA # 207
"DIMENSION OF INSTALLATION -OR REMOVAL
SIZE'OF EXCAVATION -,-,IF NEEDED
!',,APPROXIMATE TIME W�HWN,WORK WILL.BEGIN 5/6/93 -
Ilk :
•'APPROXIMATE. TIME OF,COMPLETION
ESTIMATED CONSTRUCTION COST $.
'
,',',(.Including removal of a)1 obstruction, niaterials, and debris, backfilling, com
•paction and placing permanent: resurfacing and/or replacing improvements) 3
In -consideration of the granting of this permit, the applicant hereby agrees to:.
Indemnify,.deferid 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 CityOrljminces, .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.
r
Signature of Applicant•or Agent
'Sgnercon Development Corp 74-940 Hwy 111 Indian Wells 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 348446
Applicant's Insurance Company Policy Number
i FEES! +Subdivision Improvement Permit ='Class III
io
93
- Public improvemerits: 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 VALIDATION' '
Permit Fee 10.00 1730
PERMIT NO.
Penalty -5'/5/93 .
Cash Deposit -Surety. Bond DATE APPROVED'
if-requiredEXPIRATION DATE'S./10/93
,A
TOTAL: . $. 30:00 5/5/93 .
D® SSUED
Receipt No. B 0_Q, .
By
Received by _ Date Administrative Authority
<' Recorded by TELEPHONE: (619) 564-2246