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Home My WebLink About2620 CHESTER AVEENCROACHMENT PERMIT CITY OF BAKERSFIELD PUBLIC WORKS DEPARTMENT 1501 TRUXTUN AVE BAKERSFIELD CA 93301 (661) 326-3724 TO THE CITY ENGINEER OF THE CITY OF BAKERSFIELD CALIFORNIA: Pursuant to the provisions of Chapter 12.20 of the Bakersfield Municipal Code, the undersigned applies for a permit to place, erect, use and maintain an encroachment on public property or right of way as therein defined. Application Number . . . . . 11-30000018 Date 8/05/11 Property Address 2620 CHESTER AVE Application type description PW - ENCROACHMENT PERMIT Owner Contractor ________________________--_-____________________ ITANI INVESTMENTS LLC OWNER PO .Box 2615 BAKERSFIELD CA 93303 A DIVISION OF SAN JOAQUIN COMMUNITY HOSPITAL __________________________________________________________________________ Permit . . ENCROACFPhNT PERMIT Additional desc . . Phone Access Code . 1120189 Permit Fee . . . . 208.00 Issue Date . . . . 8/05/11 Valuation . . . . 0 Qty Unit Charge Per Extension EASE FEE 208.00 __________________________________________________________________________ Speeial Notes and Comments Allow footing of new building to encroach into R/W along 'K` Street as per approved building plana. __________________________________________________________________________ Fee us maty Charged Paid Credited Due ----------------- __________ ____________________ _ ______ Permit Fee Total 208.00 208.00 .00 .00 Grand Total 208.00 208.00. .00 .DO Applicant ackn tgqledges the right of the City Engineer, pursuant to the Bakersfield Municipal Code Chapter 12.20 to revoke the permit at,yy�p�tfi,e. a[ Applicant (Owner/Agent) Print Name I HEREBY CERTIFY THAT I HAVE MADE AN INVESTIGATION OF THE FACTS STATED IN THE FOREGOING APPLICATION AND FIND THAT THE MAINTENANCE OF SAID ENCROACHMENT (1) WILL (NOT) SUBSTANTIALLY INTERFERE WITH THE USE OF THE PLACE WHERE THE SAME IS TO BE LOCATED AND (2) WILL (NOT) CON STIT TfE A HAZARD TO PERSONS USING SAID PUBLIC PLACE; SAID APPLICATION IS THEREFORE GRA ) (DENIED). Said pennit shall expire on date stated above. 4;; L SignanikIlif City Engineer Additional Terms on the Back 2 B A K E R S F I E L D Public Works Department 1501 Truxlun Avenue Bakersfield, California 93301 (661)326-3724 APPLICATION FOR ENCROACHMENT PERMIT Permit Fee $208.00 To the City Engineer of the City of Bakersfield, California: Pursuant to the provisions of Chapter 12.20 of the Bakersfield Municipal Code, the undersigned applies for a permit to place, erect, use and maintain an encroachment on public property or right-of-way as therein defined. 1. Full name of applicant and complete addre s including phone number: sr o "e ,tri ®S i 2. Nature or description of the encroachment for which this application is made: (Expmple: Wood or wrought iron fence, concrete block wall, raised planter, etc...) K Q.OrC/e 79FOoTisr r J .P i C rY !/l1IDEif G/OR/i UC_�� <TSiPFL KS% L.✓EFr Z4' 3. Location of proposed encroachment: (Example: Side yard at back of sidewalk or front yard at back of sidewalk) t �T & r i r�i% 4?4� V`27:5 7- 4. Period of time for which the encroachment is to be maintainnrre r Other. lease Circle) 5. Is property part of a Homeowner's Association Yes Z No Applicant agrees that if this application is granted, applicant shall indemnify, defend and hold harmless the City, its officers agents and employees against any and all liability, claims, actions, causes of action or demands, whatsoever against them, or any of them, before administrative, quasi-judicial, or judicial tribunals of any kind whatsoever, arising out of, connected with, or caused by applicant's placement, erection, use (by applicant or any other person or entity) or maintenance of said encroachment. The applicant further agrees to maintain the aforesaid encroachment during the life ofsaidencroachment or until such time that this permit is revoked. Applicant further agrees that upon the expiration of the permit for which this application is made, if granted or upon the Property or right of way where the same is located, and restored said public property or right of way to the condition as nearly as that in which it was before the placing, erection, maintenance or existence of said encroachment. Applicant further agrees to obtain and keep all liability insurance required by the City Engineer in full force and effect for however long the encroachment remains. Applicant shall furnish the City Risk Manager with a Certificate of Insurance evidencing sufficient coverage for bodily injury or property damage liability or both and required endorsements evidenc- ing the Insurance required. The type(s) and amount(s) of insurance coverage is: Applicant acknowledges the right of the City Engineer, pursuant to Bakersfield Municipal Code Chapter 12.20 to revoke the permit at anytime. S 9EncroachmentPemilsl pplicationforEncroachmenl CERTIFICATE OF COVERAGE IN THE EVENT OF TERMINATION OF THE PROGRAMS dventist DESIGNATED BELOW, IT IS THE INTENT OF ADVENTIST HEALTH Health SYSTEMIWEST RISK MANAGEMENT TO MAIL THIRTY (30) DAYS PRIOR NOTICE THEREOF TO CERTIFICATE HOLDER: PARTICIPANT: San Joaquin Community Hospital City of Bakersfield 2615 Chester Avenue 1601 Truxton Avenue Bakersfield, CA 93301 Bakersfield, CA 93301 AHS/WEST RISK MANAGEMENT CERTIFIES THAT THE FOLLOWING PROGRAMS ARE IN FORCE: TYPE OF COVERAGE COMPANY& TRUST/TRUST NOXIRUSTEE PERIOD OF COVERAGE AMOUNT OF COVERAGE OCCURRENCE AGGREGATE* AHS/WEST TRUST 01-01-2011 COMPREHENSIVE GENERAL LIABILITY NO. 14969200 WELLS FARGO to $1,000,000 $3,000,000 TRUST 01-01-2012 'THE COVERAGE PROGRAM LISTED ABOVE HAS BEEN ISSUED TO THE ADVENTIST HEALTH PARTICIPANT INDICATED ABOVE FOR THE PERIOD. OF COVERAGE STATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE COVERAGE AFFORDED BY THE PROGRAM DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH COVERAGE DOCUMENTS. AGGREGATE LIMITS ARE SHARED BY ALL ADVENTIST HEALTH PARTICIPANTS AND MAY HAVE BEEN REDUCED BY PAID CLAIMS. DISCLAIMER This Certificate of Coverage does not constitute a contract between the AHS[West HPUGL Trust and the cer ificale holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the coverage documents listed hereon. DESCRIPTION OF OPERATIONS/LOCATIONS: All occurrences subject to the terms and conditions of the above Trust as respectsthe liability of San Joaquin Community Hospital directly resulting from its encroachment on the "K" Street east side sidewalk between 26th and 27th Street, Bakersfield, CA during the months of August and September, 2011. Effective: August 01; 2011 THIS CERTIFICATE IS NOT VALID UNLESS SIGNED BY AN AUTHORIZED REPRESENTATIVE. OF ADVENTIST HEALTH SYSTEM/WEST RISK MANAGEMENT. ADVENTIST HEALTH SYSTEMIWEST Risk Management 2100 Douglas Boulevard,. PO Box 619002, Roseville, CA 95661-9002. Phone 916-7814620, Fax 916-781-2804 August 02 2011 DATE AUTHORIZED REPRESENTATIVE ADVENTIST HEALTH SYSTEMIWEST Risk Management 2100 Douglas Boulevard,. PO Box 619002, Roseville, CA 95661-9002. Phone 916-7814620, Fax 916-781-2804 Endorsement No. 2011-WO208 Adventist Health This endorsement modifies such coverage as is afforded by the provisions of the trust relating to the following coverage partfs): COMPREHENSIVE GENERAL LIABILITY This endorsement effective August 01, 2011 (12:01 A.M., Standard time) forms a part of Trust Document No. 14969200 issued by Adventist Health System[West Risk Management. It is agreed that City of Bakersfield, its mayor, council, officers, agents, employees and volunteers are added as Additional Participants of this Trust but only to the extent that Additional Participant is held liable for the acts, errors or omissions of San Joaquin Community Hospital. directly resulting from its encroachment on the "K" Street east side sidewalk between 26th and 27th Street. This Endorsement does not extend coverage for the acts, errors or omissions of City of Bakersfield its mayor, council, officers,. agents, employees and volunteers. As respects the acts, errors and omissions of San Joaquin Community Hospital this coverage shall be primary to and not contributing with any other insurance maintained by the City of Bakersfield. All other terms, conditions and exclusions remain unchanged. In the event of termination of this program of coverage it is the intent of Adventist Health System/West Risk Management to mail thirty (30) days prior notice thereof to: City of Bakersfield 1601 Truxton Bakersfield, CA 93301 AUTHORIZED REPRESENTATIVE ADVENTIST HEALTH SYSTEMMEST Risk Management 2100 Douglas Boulevard, PO Box 619002, Roseville, CA 95661-9002. Phone 916-7814620, Fax 916-761-2804 CITY OF BAKERSFIELD - PERMIT RIDER PUBLIC WORKS DEPARMENT 1501 TRUXTUN AVENUE, BAKERSFIELD, CA 93301 (661)326-3724 INSPECTION 326-3049 To be attached to and made part of: DATE i j �� '20 / �S IIY;Street Permit No. ❑ Transportation Permit No. I APPLICANT N V>✓�:v_ IIt PHONE LOCATION ��-% i_��C w�(��. 4O In response to your request of f::� ° -7 20 we hereby amend the above numbered permit as follows: Date of expiration extended to Description ofwork changed to: /, l Except as amended, all other terms and provisions of the original permit shall remain in effect. This rider must be attached to the original permit. APPROVED BY Raw Rojas Rider Fee $. CITY ENG EER DEPUTY Other Fee $ Total $ White -Applicant. Yellow - Public. Warks Pink -Construction PP 12101 • B _-1 I� E R S F I E L D PUBLIC WORKS DEPARTMENT MEMORANDUM TO: Ralph Korn, Risk Manager .V FROM: Bob Wilson, Supervisor II, Subdivisions DATE: August 9, 2011 SUBJECT: Encroachment Permit Application for: 2620 Chester Ave Name of Applicant. San Joaquin Community Hospital Description of Encroachment Allow footing of new building to encroach into RNV along `K' Street as per approved building plans. Please review the insurance certificate with the attached encroachment permit and return to me at your earliest convenience. Chester Ave.doc /L S A h E R S F I E L D PUBLIC WORKS DEPARTMENT MEMORANDUM TO: John Ussery, Engineer II FROM: Bob Wilson, Supervisor II, Subdivisions DATE: August 9, 2011 SUBJECT: Encroachment Permit Application for: 2620 Chester Ave Name of Applicant: San Joaquin Community Hospital Description of Encroachment: Allow footing of new building to encroach into RAN along `K' Street as per approved building plans. Please review the attached encroachment permit and return to me at your earliest convenience. fy�u-c�19 Zoll �i� tdj9p Chester Ave.doc