1738With proper `validation
,this form constitutes an
'encroachment permit CITY OF LA QUINTA*
APPLICATION. FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT).
OF
For. the construction of public' or private curbs,driveways, pavements, sidewalks, parking" lots, sewers, -,water mains
and other like publicworksimprovements in connecti6n'With MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit Class. III
DATE--. 5/11/93 Minor Improvement Permit Class:IV.
7
LOCATION OF CONSTRUCTION 52-040 Cortez
.(Street address. or Deicription of Location)
,..;PURPOSE OF CONSTRUCTION Driveway Approach Sketch (attach construction plans -if appropriate)
DESCRIPTION OF CONSTRUCTION
PER RIVERSIDE COUNTY STD # 207
(ATTACHED)
DIMENSION OF INSTALLATION'OR'REMOVAL
J-
* S I IZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN /11/93
APPROXIMATE TIME OF COMPLETION .5/12/93
..ESTIMATED CONSTRUCTION COST $
(Including. removal of all obstruction, materials, and debris, backfillinig, co.m-
paction'and placing permanent •resurfacing and/or replacing improvements)
"in consideration of *thegrantin g -of this permit, the a'pplicant' hefeby.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.i -
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.an.d to*pay for any additional replacement necessary as the result of this Work.
17L
Signature of Applicant or Agent..
SYNERCON DEV. CORP 74-940 14WY 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 24-15
License No. City Business License No. -
ACCORD GLS348446`
Applicant's Insurance Company Policy Number
t -'FEE& Subdivision Improvement Permit'— Class III
io
Public improvements: 3% of,estimated construction costs
Private improvements: 3% -:Of estimated construction costs
Minor Improvement Permit = Class IV: See attached sch6du 1'e
Inspection Fee $ 20.00
Permit Fee 10.00
it Penalty
Cash Deposit -Surety Bond
;:if required
TOTAL: $ 30.00
_Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO. 1738-
1,-
DATE APPROVED S/11/93
EXPIRATION DATE 5/14/93'..
DATE IS UE 15/11/93
By
Administrative Authority
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
y -
S".—��� Cj 3 Subdivision Improvement Permit — Class III
DATE:- Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION Z— 0 O ,�) 02 7—C— Z
(Street address or Description of Location) �y
PURPOSE OF CONSTRUCTION ` 4 I�A,1l .Q-4 Sketch (attach construed 1 'f
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 5"--// = 93
on p ans I appropriate)
APPROXIMATE TIME OF COMPLETION— S —/7 —A?,
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:
Indemnitv,.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
Le Quinta and to.pay for any additional replacement necessary as the result of this work.
Name of Applicant (please print)
3.4-W F, -
Name of Contractor and Job Foreman
3.3 7 -elo to
Contractor's License No.
Applicant's Insurance Company
Signature of Applicant or Agent
Business Address
2,l d
Telephone No.
Business Address Telephone No.
Business License No.
Policy Number
FEES: Subdivision improvement Permit —Class III
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Pea*
r�mit — Class IV: See attached schedule
Inspection Fee $ dD0
Permit Fee I () , ®U I1
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
$
PERMIT VALIDATION
PERMIT NO. 7 S
DATE APPROVED 5
EXPIRATION DATE 2 I L`
DATE ISSUED
Received by . Date By
Administrative Authority
Recorded by '
TELEPHONE: (619) 564-2246