1830NOTE:
';4ith 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
DATE
August 5, 1993
Subdivision Improvement Permit — Class II I
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION M1100Juarez s3- 07 4 D Aticz,
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Driveway Approach Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION J1 Per Riverside Co. Std. No. 207
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 8/6/93
APPROXIMATE TIME OF COMPLETION 8/10/'93
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
j
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 Developmett Corporation 74-y940 Hwy 111, Indian Wells, CA 92210
Name of Applicant (please print) Business Address Telephone No.
Sww
Name of Contractor and Job Foreman Business Address Telephone No.
337400
219
Contractor's License No. City Business License No.
Accord GLS348 L6
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 $ 20
Permit Fee 10
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 30
Receipt No.
Received by Date
AUG 0
I" P_�11
,.� •:
PERMIT VALIDATION
PERMIT NO. 1830
DATE APPROVED
EXPIRATION DATE
8/5/93
8/10/93
DATE ISSUED 8/5/93
By \ r
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
DATE: �'I Subdivision Improvement Permit - Class III
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTIONPJAiA-14�flyIN)4-C�L— Sketch (attach constructionlans if appropriate)
PPropriate)
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN -'72
APPROXIMATE TIME OF COMPLETION- a' -
ESTIMATED CONSTRUCTION COST S _ 2:� en
(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
happening or occurring as a proximate result of env worse undertaken under the permit granted Pursuant to tlt�epplicato ca ti O My
Notify the Administrative Authority at tam twenty-four (24) hours in advance of the time when work will be stared.
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 replacannent necessary as the result of this work.
S
Signature of Applicant or Agent
9507 lka /// , Gy tel' Z Z l
Name of Ap 'cant (tease print) 8uslness Address Telephone No.
Name of Contractor and Job Foreman Business Address
Telephone No.
Contractor's License No.
iJ _ City Business License No.
Applicant's Insurance Company
FEES: Subalvlslon 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: $
Receipt No.
Received by Date
Recorded by
Policy Number
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564-2246