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HomeMy WebLinkAbout12319 Jacksonville AveENCROACHMENT PERMIT CITY OF BAKERSFIELD PUBLIC WORKS DEPARTMENT 1501 TRUXTUN AVE BAKERSFIELD CA 93301 (661) 326 -3724 Iq 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- 30000022 Date 10/05/18 Property Address . . . . . . 12319 JACKSONVILLE AVE Application type description PW - ENCROACHMENT PERMIT Owner ------------------------ EZELL SHANNON D 12319 JACKSONVILLE AV BAKERSFIELD CA 93312 Contractor ------------------ - - - - -- OWNER ---------------------------------------------------------------------------- Permit . . . . . . ENCROACHMENT PERMIT Additional desc . . Phone Access Code 2257251 Permit Fee . . . 420.00 Issue Date . . . . 10/05/18 Valuation . . . . 0 Qty Unit Charge Per Extension 1.00 420.0000 EA PW ENCROACHMENT ---------------------------------------------------------------------------- 420.00 Special Notes and Comments October 5, 2018 4:42:40 PM mmendenhal. Install 6' block wall at back of sidewalk on side of house (Shadow Rider Way). Will follow City Line of Sight Standard T11, keeping the line of sight clear. Contact person: Gerardo Maya 979 -7070 ---------------------------------------------------------------------------- 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. c��5f Si ature of Applicant (Owner gent) 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) (DENIEDISaid 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. l av ad and acknowledge the above. M4 � r Applicants Initials ,-,pi 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): If there is no address adjacent to work describe limits of work by distances from nearest existing street intersection. FULL NA COMPLE' APPLICANT INFORMATION CELL: W • 3 -78 - b. -:!) C6 S- PROJECT INFORMATION DESCRIPTION OF ENCROACHMENT (Example: Wood or wrought iron fence, concrete block wall, raised planter, etc.): B LUCK W A L L PERIOD OF TIME FOR ENCROACHMENT: 6INIT0pr OTHER: (P ease trc e) CONTACT PERSON G 15 R AR DO MAYA PHONE: CI) c/ - 70 7 6 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 upgn the 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 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 :IPERMITSIENCROACH\Encroachment Permit Req Form.DOC Aug. 2017 To whom it may concern: I Shannon Ezell owner of the residential property located 12319 Jacksonville ave. Bakersfield Ca. Give Gerardo Maya of G.M. Construction permission to obtain permits for repairs, construction of Pool, concrete wall, Outdoor kitchen and BBQ and Patio cover for pending construction work located at 12319 Jacksonville Ave. If there are any questions please feel free to contact me. Cell- 661 - 378 -8385 Work- 661 - 758 -8400 ext. 6113 Mustbezy03 @yahoo.com �NMON D. EIELL -� i-\L K Sb N V I L 1_L NU E", bNKERSr i EL D M A �) Z C-OR ER LOT PROPERTY t iN E EXISTING 1- 10US>✓ 1 I i i h W :,, :,,!SID--WALK CURB And GUrrER _ PRVOStD BLCL. MALL L -'12 H »N PRrjME :D WALL I J 3 � It- N V x —4 u K) CL < I� I 1 J. 21 �J 4.I �I ;=J xl w� i ! PItOP056 PROPOSE:p WALL siiiTiu6woou TrXN -V I� cs ICD oc D O JACIK50WVILLE AVE STREGT CEN3EKL10F, l� 'y 2 LV WW o�c T 3 cz I V/ 12319 Jacksonville Ave - Google Maps Page 1 of 4 Go gle Maps 12319 Jacksonville Ave Imagery 02018 Google, Map data 02018 Google 10 ft 12319 Jacksonville Ave Bakersfield, CA 93312 https: / /www.google.comlmaps /place/ 12319 +Jacksonville +Ave, +Bakersfield, +CA +93312... 10/19/2018 Shadow Rider Way - Google Maps Go gle Maps 401, . * Shadow Rider Way 12319 Jacksonville Page 1 of 3 Image capture: Jan 2012 ® 2018 Google Bakersfield, California Google, Inc. Street View - Jan 2012 12319 Jac Avenue https: / /www.google.com/maps /place/ 12319 +Jacksonville +Ave, +Bakersfield, +CA +93312... 10/19/2018 BAKE RS FIELD Public Works Department 1501 Truxtun Avenue Bakersfield, California 93301 (661) 326 -3724 TO WHOM IT MAY CONCERN: We the undersigned, have no objection to the construction of a fence beside the sidewalk within the public right -of -way. L)�nc i Nei \Nna bko ny oo D Ewe d (Street for proposed encroachment) 111A Jac. Oy)v, Ile Ave (Owners Name) ']y�.l� Phone• FWJI - 3 (V - 8 38S (Address of proposed encroachment) SIGNED: 1.) Name: Address: 2.) Name: ✓`^ Address: P" )N �ftz't/-Sor —qf 3.) Name:, Address: 4.) Name: x , Address: j c►L. ,,Jt - ' 5.) Name: Date: Ct Date: �' vZ�' 1 r�1 Date: % - Date: Date: -ter Address: 6.) Name: Date: 1 „Z Address: • See Signatures needed for approval page 400000�� $AKERSFIELD Public Works Department 1501 Truxtun Avenue Bakersfield, California 93301 (661) 326 -3724 TO WHOM IT MAY CONCERN: We the undersigned, have no objection to the construction of a fence beside the sidewalk within the public right -of -way. (street for proposed encroachment) (Address of proposed encroachment) SIGNED: \ 1.) Name: i 1�lU Address: / 2906 J f �ri ((il L (rr %}'v- 2.) Name: � •( �-- t-k- C�_Ajl k1(-) By: (Owners Name) Phone. Address: 124-01 kLI , 3.) Name: Address: 4.) Name: Address: 5.) Name: Address: 6.) Name: Address: • See Signatures needed for approval page Date: /6)/3/18 Date: /�,- lb Ile Date: Date: Date: Date: -f� U L cu T.1 _r _ 15` a _ ry O N " Z V Z OC v - c a 3 p� O O 0 0 v N O 0 0 0 o O ° 0 O O OD O N 01 m O U v� S E N o � a v E E s Y q m� uo t a° 8Z S o $o .f a 0 Uv po a0 e o U A FF a o a E nt ao 5 w E Y 0 D 6 b Y E 0 m California HOMEOWNER DECLARATION PAGE California Capital Insurance Company - NAIC Code 13544 Capital A CIG Company Insurance Co. a CIG Company Homeowners Policy - HO -3 - Special Form INSURED COPY Name and Address of Insured Servicing Agency - 58190 Ezell, Shannon DiBuduo & DeFendis Insurance 12319 Jacksonville Ave P.O. Box 9548 Bakersfield, CA 93312 Bakersfield, CA 93389 For Customer Service, Contact: (866) 430 -0372 Policy #: 2- HOC -1- 1635570 Declaration Type: Endorsement Effective Date: 02/07/2018 Policy Period: From 02/18/2018 To 02/18/2019 12:01 a.m. standard time at the address of the Named Insured as stated herein. Property Location: 12319 Jacksonville Ave, Bakersfield, CA 93312 This is Declaration #: 10 and when attached to the applicable forms, it completes the policy. Transaction Description: Change Mortgagee Endorsement Summary Endorsement Premium Total Policy Summary $0.00 Current Policy Term Premium $1,413.00 $0.00 This is not a Bill. The premium will be billed to your mortgage company. This is a replacement Declaration, counter signature is not required. TO REPORT A CLAIM, CONTACT THE CLAIM SERVICE CENTER (800) 986 -9974 Process date: 07/26/2018 Named Insured: Ezell, Shannon Homeowner Declaration Policy #: 2- HOC -1- 1635570 Declaration Type: Endorsement Effective: 02/07/2018 Coverage Form — 3 Property Location: 12319 Jacksonville Ave, Bakersfield, CA 93312 Description: Construction: Frame; Year Built: 2005; Square Feet: 2862: Territory: 1003, Protection Class: 2 Basic Coverage Limits and Premium Limit Premium A Dwelling $505,924 $1,351.00 B Other Structures 50,592 C Unscheduled Personal Property 354,146 D Additional Living Expense 101,185 E Personal Liability 300,000 25.00 F Medical Payments Each Person 1,000 Each Accident 25,000 The limit of liability for this structure (Coverage A) is based on an estimate for the cost to rebuild your home, including an approximate cost for labor and materials in your area, and specific information that you have provided about your home. As a Company, we will make property valuations from information you provide to estimate the cost to rebuild your home. However, the valuation is an estimate and your home may cost more to rebuild. Optional Coverages & Mandatory Fees Extended Dwelling Replacement Cost Coverage (Up to 200% of Coverage A — Dwelling limit) 10.00 Contents Replacement Cost Included Cal -Pak Coverage (Includes $50,592, 10% limit for Ordinance or Law Coverage) Included Identity Fraud Expense Coverage Included Home Appliance and Electronics Breakdown Endorsement ($500 Deductible Applies) 27.00 Worker's Compensation (Mandatory) Included Premium Credits and Surcharges Applied Renewal Credit Total Annual Premium $1,413.00 This policy contains a $500 Deductible. This policy does not provide Earthquake Coverage. Policy Coverage Forms: Mortgagee — Form 438BFU NS: HO -3 (04/84) 03 -037 (11 -14) HO -350 (06 -14) HO -300 (11 -14) HO -325 (12185) HO 90 (09/84) HO -322 (09/87) HO -243 (04/84) 03-347 (05/01) 03 -331 (01/02) 03 -760 (07 -14) 02 -083 (06/06) 03 -486 (07/M) HO -52 (04/84) 03 -304 (09/99) 03 -016 (07 -14) Mortgagee #1 Wells Fargo Bank NA #936 ISAOA, P O Box 100515, Florence, SC 29502 Loan No: 0510696446 Process date: 07/26/2018 03 -390 (07/09) 02 -304 (07 -11) HO -52 (04/84) 03 -304 (09/99) 03 -016 (07 -14) Mortgagee #1 Wells Fargo Bank NA #936 ISAOA, P O Box 100515, Florence, SC 29502 Loan No: 0510696446 Process date: 07/26/2018 ©CIGD Capital Insurance Group California Capital Insurance Company Evidence of Property Insurance Additional Interest: Insured: Wells Fargo Bank NA #936 ISAOA Ezell, Shannon P O Box 100515 12319 Jacksonville Ave Florence, SC 29502 Bakersfield, CA 93312 Loan No: 0510696446 $101,185 Additional Interest Type: Mortgagee Policy Number: 2- HOC -1- 1635570 Term Effective Date: 02/18/2018 Expiration Date: 02/18/2019 Legal Text: Property Location: 12319 Jacksonville Ave, Bakersfield, CA 93312 Property Description: Construction: Frame; Year Built: 2005; Territory: 1003; Protection Class: 2 Basic Coverage Limits Limit Dwelling (Coverage A) $505,924 Other Structures (Coverage B) $50,592 Unscheduled Personal Property (Coverage C) $354,146 Additional Living Expense (Coverage D) $101,185 Personal Liability (Coverage E) $300,000 Medical Payments Each Person $1,000 Each Accident $25,000 Policy Deductible: $500 Additional /Optional Coverages Extended Replacement Cost Coverage Up to 200% of Coverage A I Total Annual Premium $1,413.00 1 This is evidence that insurance is in force for the above insured effective 02/18/2018 and will remain in force until the policy is cancelled or until the end of the policy term. The policy is subject to the premiums, forms and company rules in affect as of the term effective date. Should coverage be cancelled for any reason, the company will give the Additional Interest identified above the same advance written notice of cancellation as the named insured. Servicing Agency: DiBuduo & DeFendis Insurance - 58190 P.O. Box 9548 Bakersfield, CA 93389 For Customer Service, Contact: (866) 430 -0372 Process date: 07/26/2018 L A h E I:'_ � F I E L Z) PUBLIC WORKS DEPARTMENT MEMORANDUM TO: Jena Covey, Risk Manager � FROM: Michelle Mendenhall, Engineering Technician DATE: October 19, 2018 SUBJECT: Encroachment Permit Application for: 12319 Jacksonville Avenue Name of Applicant: Shannon Ezell Description of Encroachment: 6' high block wall at back of sidewalk on side of house (Shadow Rider Way) Please review the insurance certificate with the attached encroachment permit and return to me at your earliest convenience. S \ PERMITS \ENCROACH \INSURANCE \12319 JACKSONVILLE AVE.doc f h F 11 F I E I_ T PUBLIC WORKS DEPARTMENT MEMORANDUM TO: Ed Murphy, Engineer III FROM: Michelle Mendenhall, Engineering Tech \ DATE: October 19, 2018 SUBJECT: Encroachment Permit Application for 12319 Jacksonville Avenue Name of Applicant: Shannon Ezell Description of Encroachment: 6' block wall at back of sidewalk on side of house (Shadow Rider Way) Please review the attached encroachment permit and return to me at your earliest convenience. S: \PERMITS \ENCROACH \TRAFFIC \12319 JACKSONVILLE AVE.doc