1737s;
- ;NOTE'
"With'pr 'per validation
tHis..form'const'itutes an
':.encroachment,,permit
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
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
Subdivision Improvement Permit — Class II I
DATE: '5/11193.1 • Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION . 51-665 'Carranza
:(Streetaddress or Description of Location)
{'Driveway Approach
:,PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate)
DESCRIPTION OF -CONSTRUCTION PER RIVERSIDE COUNTY STD #-207'
_ (ATTACHED)
DIMENSION OF INSTALLATION OR REMOVAL
"SIZE OF, EXCAVATION, IF NEEDED
a APPROXIMATE TIME WHEN WORK WILL BEGIN 5/11/93
`APPROXIMATE TIME OF COMPLETION 5/12/93
'. ESTIMATED CONSTRUCTION COST $
(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 resultin from claims or court action and arising out of an 4'
g g +.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 alrapplicable 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 DEV. CORP.. 7.4-940 Hwy 111 Indian Wells 9221.0 564-6929
Name of. Applicant (please print) Business Address Telephone No..
'SAME
Name
Name of Contractor and Job Foreman Business Address Telephone No.
`-'- 337400 2419
Contract'or's License No.City Business License No.
ACCORD .. CLS 348446(:
Applicant's Insurance Company. Policy Number
~+FEES:, {.Subdiyision,Improvement Permit —.Class III.
Public improvements:'.3% of estimated construction costsAt k17,9
3;: i0
Private improvements: 3% of estimated construction costs . -
Minor Improvement Permit = Class IV: See attached schedule '
Inspection Fee $ 20.00 PERMIT VALIDATION
r
10.00
,Permit FeePERMIT NO. ``' 1737
Penalty : S/11/93
"'Cash' Deposit -Surety Bond DATE APPROVED
if required EXPIRATION DATE ' 3/14/93
TOTAL:
Receipt No.
Received• by Date
Rec'o'rded, by
DATE SU D 5/11/93
By .
Administrative Authority
TELEPHONE: (619)56.4-2246 ,.
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
DATE s" / �.� Subdivision Improvement Permit — Class 111
Minor. Improvement Permit Class IV
LOCATION OF CONSTRUCTION 5 ` G 5:—. (f A f Z
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION (-U !' bl% Oe//Kketch (attach constructiontans if appropriate)
ppropriate)
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
�(IV 6I'SIGe,
Coa ►j� sTb Z6 7
APPROXIMATE TIME OF COMPLETION / 2.9,3
ESTIMATED CONSTRUCTION COST $
(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 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 Cof
La Quint@ and to pay for any additional replacement necessary as the result of this work. ity
Name of Applicant (please print)
Name of Contractor and Job Foreman
337Y -a6'
Contractor's License No.
Signature of Applicant or Agent
Id., f/a. Il. // e"'1_11_ - - . /A%,. - -
Business
Telephone No.
Business Address Telephone No.
a If,
City Business License No.
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 $ Z�
Permit Fee j V II
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by Date ;;
Recorded by
PERMIT VALIDATION
PERMIT NO. ( 7 3
DATE APPROVED —9 5
EXPIRATION DATE
DATE ISSUED
By
TELEPHONE:.(619). 564-2246
1 v86
Administrative Authority
W