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Home My WebLink About1800 H StreetENCROACHMENT PERMIT CITY OF BAKERSFIELD ^� PUBLIC WORKS DEPARTMENT 1501 TRUXTUN AVE BAKERSFIELD CA 93301 ELI F 0 til- (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 . . . . . 18- 30000021 Date 10/04/18 Property Address . . . . . . 1800 H ST Application type description PW - ENCROACHMENT PERMIT Owner ------------------------ MAISON ACQUISITIONS LLC 9530 HAGEMAN RD STE B112 BAKERSFIELD CA 93312 Contractor ------------------ - - - - -- OWNER ---------------------------------------------------------------------------- Permit . . . . . . ENCROACHMENT PERMIT Additional desc . . Phone Access Code . 2256303 Permit Fee . . . . 420.00 Issue Date . . . . 10/04/18 valuation . . . . 0 Qty Unit Charge Per Extension 1.00 420.0000 EA PW ENCROACHMENT 420.00 ---------------------------------------------------------------------------- Special Notes and Comments October 4, 2018 4:39:27 PM mmendenhal. Existing stucco on City parking structure - 8'x50'. There is an attached 181, bench /shelf, 1011 of which belongs to City and 8" to property owner. Contact person: Robert Massey 900 -4159 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ------ ----- - - - - -- ---- - - - - -- ---- - - - - -- - --- - - - - -- ---- - - - - -- Permit Fee Total 420.00 420.00 .00 .00 Grand Total 420.00 420.00 .00 .00 Applicant acknowledges the right of the City Engineer, pursuant to the Bakersfield Municipal Code Chapter 12.20 to revoke the permit at any time. Sig a ure of 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) CONSTITUTE A HAZARD TO PERSONS USING SAID PUBLIC PLACE; SAID APPLICATION IS THEREFORE (GRANTED) (DENIED) Said permit shall expire on date stated above. Signature of City Engineer Additional Terms on the Back Applicant agrees that if this application is granted, applicant shall indemnify, defend, and hold harmless 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 or judicial tribunals of any kind whatsoever, arising out of connected with, or caused by applicant, or in any way arising from, the terms and provision of this permit or the placement, use (by applicant or any other person or entity) or maintenance of said encroachment, whether or not caused in part by a party indemnified hereunder, except for CITY's sole active negligence or willful misconduct. The applicant further agrees to maintain the aforesaid encroachment, including, but not limited to, repairing or replacing the encroachment at Applicant's cost even if CITY inadvertently damages or destroys the encroachment in the ordinary course of CITY's business, during the life of the said encroachment 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 revocation thereof by the City Engineer, applicant will at his own cost and expense remove the same from the public property or right of way where the same is located, and restore 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 must contact Dig -Alert at 811 at least 2 full working days prior to all excavating. 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 issuance evidencing sufficient coverage for bodily injury or property damage liability of both and required endorsements evidencing the insurance required. I have read and acknowledge the above. �; t'� Applicant's Initials ENCROACHMENT PERMIT APPLICATION FORM CITY OF BAKERSFIELD PUBLIC WORKS DEPARTMENT 1501 TRUXTUN AVE BAKERSFIELD CA 93301 (661) 326 -3724 Fax: (661) 852-2012 LOCATION OF ENCROACHMENT(Address required where available): ��00 P to _ If there is no address adjacent to work describe limits of work by distances from nearest existing street intersection. APPLICANT INFORMATION FULL NAME OF APPLICANT Rc Ais uu_t-► cc, L6i4io%m LL- COMPLETE ADDRESS: 9 2 U WAa AN R4 (%-111 PHONE: SAl 2N fi It CtA �i33J L FAX: - - - CELL: PROJECT INFORMATION DESCRIPTION OF ENCROACHMENT (Example: Wood or %%rought iron fence, concrete block wall, raised planter. etc.l: yt(,o )}` /uJ\,arQ �l1n�JX D S� PERIOD OF TIME FOR ENCROACHMENT: INDEFINITE o OTHER: ( CONTACT PERSON_ b4 �i PHONE: C�L I " clot) - LOS — .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 of said encroachment 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 revocation thereof by the CitLEngineer, applicant will at his own cost and expense remove the same from the public propeM or right of way where the same is located, and restore 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 evidencing the insurance required. The type(s) and amount(s) of insurance coverage required are: Residences: homeowners General Liability coverage in an amount of at least $300,000.00 Commercial: Commercial Liability coverage in an amount of at least $1,000,000.00 The Commercial Liability policy must identify City and City's mayor, council, officers, agents, employees, and designated volunteers as Additional Insureds. Encroachment Permit Fee: $420.00 S 1PtiRMI'fS1ENCRUACN Fncroa�hmem Permit Req hums lH K' Aug 2017 - Jo > I (.D z CV LU 2, NVI.1 NOIlV(3Nno-J * GNOIIVA]lg v3sv .L;13,SIG A. 0091 II II a a II .... ... . . . . . . . . . III R, 3 u . . . . . . . . . . . . . . . . . . . . . . I IT-1 .... ... ... R .. . ..... .. .. . . . . . . . . . . . . . . ........ .. ..... .. ... . ........... ........... .. . ............ I U U. 2 PIC AR T.Ttm . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . II I II I . . . . - - - I - - - - . . . . . . . . . . . . U.'J.'. A . . ...... ... . . . . . . . . X. I. II ... . ...... .. . ....... ....... HH-H-1-f-H.. . . . . . . . . . . ..... . . . . . . . . . . . . . ... .... .. .... .... ....... ............ I If H-H.-H-HHH: II + XX ...... .. -,c--rJ .W - 4Z- 1 � u I I II �` ,':'i. .all r�� O Ei OD Lk :1 1800 "H* 5TREET Z 4- 1 i"o W C- OUTDOOR BREAK AREA rLOOR PLAN �, 0 ACORD CERTIFICATE OF LIABILITY INSURANCE �� DATE (MWIDDIYYYY) 10/021201 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Saber Insurance Agency CONTAAME: CT Sam Siador PHONE (661)365 -0100 gAixC,No1:(661)365.0070 8120 Rosedale Hwy, Ste 100 Bakersfield, CA 93312 License #: OL73974 E -MAIL Sam saberinsurance.com BDDRESS: INSURERS AFFORDING COVERAGE NAIC 0 INSURERA : Allied GEN'1. AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 INSURED INSURERS: INSURERC: Maison Acquisitions, LLC INSURER D: 9530 Hageman Rd # B -112 INSURERS: AUTOMOBILE LIABILITY Bakersfield, CA 93312 -3969 INSURER F: ANY AUTO BODILY INJURY (Pa. person) $ i+w PCGT,GIPATC d1111UDCo. nnnnnnnn_e2onn REVISION NUMBER 4 .. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. 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 INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ITS SUER MOUDY� MOD) EXP LIMITS TYPE OF INSURANCE IN POLICY NUMBER A X COMMERCIAL GENERAL LIABILITY Y ACP 3008572280 112113/2017 112/13120181 EACH OCCURRENCE s 1000.000 �I PRFMI ' �E3Eoca1 •nee, s 300 ,000 CLAIMS-MADE I X l OCCUR I i i MED EXP (Any one pe ;son) 5 5,000 PERSONAL 4 ADV IN URY S 1,000,000 GEN'1. AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 X POLICY PRO- U LOC ` I I PRODUCTS - COMP /OP AGG s 2,000,000 S OTHER: i COMBINED SINGLE LIMIT , S AUTOMOBILE LIABILITY ,MINED 1 i ANY AUTO BODILY INJURY (Pa. person) $ OWNED SCHECV_EO i BODILY : NJURY (Per acoden:); S AUTOS ONLY AUTOS HIRED NON-OWNED I — I PRJPER7Y DAMAGE S AUTOS ONLY AUTOS ONLY Per aWoent S UMBRELLA UAB OCCUR EACH OCCURRENCE S AGGREGATE S EXCESS UAS H CLAIMS•MADE I DEO I I RETENTIONS I S PEAT WORKERS COMPENSATION E RM AND EMPLOYERS' LIABILITY ANY PROPRiETOR/PARTNERIEXECUTIVE —7 NIA E.L. EACH ACCIDENT $ S OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L DISEASE - EA EMPLOYEE I 5 if yes, describe under DESCRIPTION OF OPERATIONS oelow I E.4 DISEASE - PO'JCY LIMIT A I Building ACP 3008572280 112113120,17 112/13120181 5000 Deductible 1,800,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEKICLES (ACORO 101, Additional Remarks Schedule, may be attached It more space is required) The Commercial Liability policy must identify City and City's mayor, council, officers, agents employees and designated volunteers as Addition Insured Property Address: 1800 H Street, Bakersfield, CA 93301 City of Bakersfield 1600 Truxtun Avenue Bakersfield, CA 93301 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE w IVOO-AV 10 ALIUMU IIUMI-VIR417VP1. 1 11718111.1 roDGlvpu. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Printed by SS3 on October 02, 2018 at 03:54PM • I-,-- H I" I I E T. 1 PUBLIC WORKS DEPARTMENT MEMORANDUM TO: Ed Murphy, Engineer III n FROM: Michelle Mendenhall, Engineering Tech DATE: October 19, 2018 SUBJECT: Encroachment Permit Application for: 1800 H Street Name of Applicant: Masion Acquisitions LLC Description of Encroachment: Existing stucco on City parking structure Please review the attached encroachment permit and return to me at your earliest convenience. S. \PERMITS \ENCROACH \TRAFFIC \1800 H ST.doc 40 I l h F. T,. S F I E L L) PUBLIC WORKS DEPARTMENT MEMORANDUM TO: Jena Covey, Risk Manager j; ti FROM: Michelle Mendenhall, Engineering Technician DATE: October 19, 2018 SUBJECT: Encroachment Permit Application for: 1800 H Street Name of Applicant: Maison Acquisitions LLC Description of Encroachment: Existing stucco on City Parking Structure Please review the insurance certificate with the attached encroachment permit and return to me at your earliest convenience. S: \PERMITS \ENCROACH \INSURANCE \1800 H ST.doc