1749iNOTE:
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
Subdivision Improvement Permit — Class III
DATE: 5/24/93 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 54-800 & 54-810 Juarez
W_
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Driveway A»yroa(sh Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
Per Riverside County STD # 207
(Attached)
DIMENSION OF INSTALLATION OR REMOVAL q�Y'5'4-3 50.0014
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 5/24/93
APPROXIMATE TIME OF COMPLETION 5/25/93
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
t- 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. �.
`h
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 Dev. 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
Contractor's License No.
2419
City Business License No.
Accord Q8348446
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit —Class I II
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:
Receipt No.
Received by
Recorded by
$ 40.00
10.00
$ 50.00
Date
147
PERMIT VALIDATION
PERMIT NO. 1749
DATE APPROVED 5/24/93
EXPIRATION DATE5/28/93
DATE I,$,S,UE, 5/24/93
By t� 11*4Q
Administrative Authority
TELEPHONE: (619) 564-2246
0 frob- i
NOTE:
With proper validation
this form constitutes an
encroachment permit CITY OF LA QUINTA
a e<4 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: - Z L�' �3 Subdivision Improvement Permit — Class III
_ Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION -.5 Y-Sl0 0 - S `{ � �lO "6:z
wu auwlva yr ua3crlpilon or Location)
PURPOSE OF CONSTRUCTION' U-1 U6 -WA I?
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 3
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
Sketch (attach construction plans if appropriate)
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 City of
La Ouinta and to pay for any additional replacement necessary as the result of this work.
Signature of Applicant or Agent
V, qP291,6
Name of Applicant (please print)
Name of Contractor and Job Foreman
337'/0 o
Contractor's License No.
Business Address
Telephone No.
Business Address Telephone No.
2419
City Business License No.
&Q -C620 GCS -wAV446
Applicants Insurance Company Policy Number
FEES: Subolvision 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 $ 7%
Permit Fee b
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
$ 5v
Receipt No.
Received by . Date
Recorded by
PERMIT VALIDATION
PERMIT NO. / 7 LIy
DATE APPROVED 5-2"1-13
EXPIRATION DATE
DATE ISSUED 5 - Zq_93
By
Administrative Authority
TELEPHONE: (619) 564-2246