1491NOTE:
With proper validation
this form constitutes an
encroachment permit
CITY. OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)� _9wi
OF
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:. July 23, 1992 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 52-416 Avenida Villa La Quinta, CA
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Driveway approach
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN _7.111.199
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)
PER RIVERSIDE COUNTY STD., NO. 207
ATTACHED.
In consideration of the granting of this permit, the applicant hereby agrees to:
iSS SWA 146TAL~j3-92 30.00 0
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 (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 ry, as the result of this�?vork, h
Signature of Applicant or Agent
Expectation Const P.O Box 1847 1 a Quints CA 564-0793
Name of Applicant (please print) Business Address Telephone No.
Jim Snellenborg 77-836 Ave Montesuma La Quinta, CA 664-0893
Name of Contractor and Job Foreman Business Address Telephone No.
613406
Contractor's License No.
1858
City Business License No.
State Fund 1242686-92
Applicant's Insurance Company Policy Number
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
$ 20.00
10.00
$ 30.00
Received by Date
PERMIT VALIDATION
PERMIT NO. 1491
DATE APPROVED 7/23/92
EXPIRATION DATE
7/27/92
14'1
DATE IS UE7/23/92
gy�—_Q§tMVAA
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
NOTE:
With 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:.114
LOCATION OF CONSTRUCTION 1 �—
Subdivision Improvement Permit —Class II I
Minor Improvement PeCmit Gass IV—
(Street address or Description of Location)
P POSE OF CONSTRU TIONL�7N Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRU16TION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN
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) _
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 (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 les and regulations of the City of
Le Quints and to pay for any additional replacement necessary as the result of this %prk. , '
Name of Contractor and Job Foreman Business Address elephoneo��- b
Contractor's License No. City Business License No.
L�(
Cdtiv. b � — 1
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 1236
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
Date
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564-22464,
Signature of Applicant or A nt
Name of Applicant(please print) a
Business Address
tatenhen
Name of Contractor and Job Foreman Business Address elephoneo��- b
Contractor's License No. City Business License No.
L�(
Cdtiv. b � — 1
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 1236
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
Date
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564-22464,