1899A, 77
I
NOTE:'
With proper validation
this form constitutes an CITY OF LA QUINTA
encroach ment'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
September 28, 1993
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
DESCRIPTION OF CONSTRUCTION
53180 Madero
Driveway Approach.
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 9/29/93
Subdivision Improvement Permit — Class I II
Minor Improvement Permit Class IV
Sketch (attach construction plans if appropriate)
APPROXIMATE TIME OF COMPLETION 9/30/93
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 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.
PER RIVERSIDE COUNTY
STD 1207 (ATTACKED)
p°D
8 1993 D
By -g-7
It
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 ofthiswork.
GT
Signature of Applicant or Agent
Synercon Development Corp, 74-940 Hwy, I11, -Indian Wella, CA 92210 564--6929
Name of Applicant (please print) Business Address Telephone No.
SAME
Name of Contractor and Job Foreman ' Business Address Telephone No.
537400 2419
Contractor's License No. City Business License No.
Accord ,�' Q8 38446
Applicant's Insurance Company r 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
t
Inspection Fee $ 20.00
Permit Fee 10*00
Penalty
Cash Deposit -Surety Bond
if required
TOTAL
Receipt No.
$ 30.00
Received by Date
PERMIT VALIDATION
PERMIT NO. 1899
DATE APPROVED 9/28/93
EXPIRATION DATE 9/30/93
DATE ISSUED 9/28/93
By
Administrative Authority
Recorded by II TELEPHONE: (619) 564-2246
:e +Ntl;t,!0Per 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 lou, sewers, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
DATE: Z�5' Subdivision Improvement Permit — Class 111
LOCATION OF CONSTRUCTION O
Mlnor Improvement Permit Class IV
s 3 —
(Serest addrars or Oesenpoon of Loeationl
PURPOSE OF CONSTRUCTION L2P—I 0 I= f 1 A -T kPRaAC;4 _ Sketch (attach co --
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST S
(Including removal of all obstruction, materials, and debris, backfilling, com.
paetion and placing permanent resurfacing and/or replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrees -to:
On plans If appropnate)
!GGS�c&1d�
Indemnify. defend and save the City. its authorised agents, offkare, repraeentatiws and amployess. hartnim from and against any and all
Penalties, liabilities Or loft resulting from claom or court 0CtiOrt and arising Out sl arly•accidaO loarm
happemnq or ooeurrinq d •tiro:irrtsq result of any work undertaken under the permit ranted se- Of damages p icsitiPwwe a prOpaRy
9 pursuant to this appliotien.
Notify the Administrative Authority at Nae twenty-four 1241 hours in advance of the time when work will be starsad,
Comply with all spolicame City ordinanoea. the terms and conditions Of the pannit and all applieable rules and regulations of the City of
La Quints and to pay for any additional replaeanlent necessary as the result Of this work.
Signature of Applicant or Agent
00 W 2216 6-
Name 61 Applicant (please print) Business Address
Telephone No.
Name of Contractor and Job Foreman Business Address
=?� Telephone No.
Contractor's License No.
Applicant's Insurance Company
City Business License No.
G 1- c '�4/f,U/S� /—
Poli N be
cy um r
FEES: Subdivision Improvement Permit — Class 111
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
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED _
EXPIRATION DATE �b
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564.2246
. �' �.
Y_
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