2327NOTE:
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: 3-15-95
Subdivision Improvement Permit — Class I II
Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 51800 Avenida Montezuma
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Provide Temp. Pover Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Install Temp. power pole
in R/W Permittee shall install
reflective devices on or around
DIMENSION OF INSTALLATION OR REMOVAL 12" diameter pole the tamp pole for visibility
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 3-15-95
APPROXIMATE TIME OF COMPLETION 9-15-95
ESTIMATED CONSTRUCTION COST $ 100.00
(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
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.
Dan Beatheringill
Signature of Applicant or Agent
DoDco Construction Services P.O. Box 1012 La Quinta, CA 92253 360-7792
Name of Applicant (please print) Business Address Telephone No.
Dan Beatheringill
Name of Contractor and Job Foreman Business Address Telephone No.
397830
Contractor's License No.
Reico Insurance
1375
City Business License No.
14L 420426
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 II
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
10
$ 30
Received by Date
Recorded by
�:p q-) C
2321
PERMIT NO.
PERMIT VALIDATION
2327
DATE APPROVED 3-16-95
EXPIRATION DATE 9-30-95 r4
DATESSU —16-95
By
Administrative Authority
TELEPHONE: (619) 564-2246
NOTE:
With proper validation
this form constitutes an
encroachment permit CITY OF LA OUINTA
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
03/15/95 Subdivision Improvement Permit — Class Ill
DATE: Minor Improvement Permit Clan IV
LOCATION OF CONSTRUCTION 51-800.Avenida Montezuma
PURPOSE OF CONSTRUCTION temp. power
Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION temp, Dower po =e
DIMENSION OF INSTALLATION OR REMOVAL iameter
SIZE OF EXCAVATION, IF NEEDED one
APPROXIMATE TIME WHEN WORK WILL BEGIN — —
APPROXIMATE TIME OF COMPLETION & pie.
ESTIMATED CONSTRUCTION COST S
(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:
Indamnify,.deland and save the Ciry, its authorized pants, officers, representatives and emplovaes, harmless from and sp um any and all
Penalties. iiab Imes or on resulting from dsirs or hurt action and arising out of arty aCCldent, lose or damage to persons or prop"
happen:
ine or P=urring as a proximate result of any wort undWIM un under the par it pnnvad Durtwant to tris appllotion.
Notify the Administrative Authariry K least fwanry•four (24) hours in advance of the time when wort[ will be star W,
Comely with all aPO Cable City Ordkutwa. the terns and conditions of the permit arta ell applicable rile and retpdations of the Chy M
La Quints and to pay far any additional reptaeameM nedastary as the result of this worn,
f
Signature
X DoDco Construction Services- of Applicant or Agem
P.p. Box 1012, La Quinta, 619-3.60-7792
Name of Applicant ( lease print) Business Address
X Dan FeMeringili
Same Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
X 397830 1375
Contractor's License No. City Business License No.
� Reico Insurance ,X MBI. 420426
APPllcant s Insurance Company G1CV. L.IAB1Lt'Ty Policy Number
FEES: SuWivision Improvement Permit —Class 111
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction Costs 1 v 8 6
Minor Improvement Permit — Class IV: See attached schedule
Inspeetion,Fee S PERMIT VALIDATION \
Permit -Fee 23 Z�
PERMIT N0. \
Penalty _
Cash Deposit -Surety Bond DATE APPROVED
if required S
EXPIRATION OATS
TOTAL. $ �j — [ Lo —Q
Receipt No.
DATE- ISSUED
By /
Received by Date---.Adminisuab" Authority
Recorded by 777-7075
TELEPHONE: (619) 5'.
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