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Home My WebLink About4501 BRUNSWICK STENCROACHMENT 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 . . 15-30000028 Date 8/03/15 Property Addres9 4501 BRUNSWICK ST Application type description PW - ENCROACHMENT PERMIT Owner Contractor SIMENE2 ROBERT G 6 MARIA E OWNER 9501 BRUNSWICK 8T BAKERSFIELD CA 93307 ( 66) 834-1205 -------------------------------------------------------.-------------------- Permi[ENCROACHMENT PERMIT Additional desc . . Phone. Access Code 1685975 Permit Fee 208.00 Issue Date 8/03/15 Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE --------------------------------------------------------------------------- 208.00 Special NOtes and Comments Construct rod iron fence around front of property at 4501 Brunswick Street. Robert Jimenez 834-1205 --------------------------------------------------------------------------- Fee summary Charged Paid Credited ----------------- Due ------------------------------ Permit Fee Total 208.00 208.00 .00 ---------- .00 Grand Total 208.OD 206.00 .00 .00' Applica acknowledges the right of the City Engineer, pursuant to the Bakersfield Municipal Code Chapter 12.20 to rev e t e plermit at any time. Lo( ee4 �A,'vv.evtez Signature of A V licant (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. 'Z ?� SigrMure of City Engineer If there is no address adjacent to work describe limits of work by distances from nearest existing street intersection. FULL NAME OF APPI COMPLETE ADDRESS: PHONE: V FAX: CELL: 4161— 77�' U� PROJECT INFORMATION DESCRIPTION OF ENCROACHMENT (Example:_nWood or wrought iron fence, concrete block wall, raised planter, etc.): �..�.� ISO UClb`T GV"y T�'2V'IL e, PERIOD OF TIME FOR ENCROACHMENT INDEFINIT or OTHER: lease Circle) c, CONTACT PERSON � e e.�- J( VA2.ot11, PHONE: 715, �3,0 7, 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, orjudicial 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 nronerry 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: $208.00 "PERMITS\ENCROACH\F.ncmachment Petmit Req FormDOC Sept 2013 • B A K E R S F I E L D Public Works Oepartment 1501 Truxlun Avenue Bakersfield, Oalifomia 83301 (661)326-3724 TO WHOM IT MAY CONCERN: We the undersigned, have no objection to the construction of a fence beside the sidewalk within me Public right-of-way. 4501 Brtijsw1c9 '�' ( rrcei ar propom encronc mens Of (Addrees of propomd euvo.a rrvu) 1.) Name: Address 2.) Name: Address 3.) Name: Address 4.) Name. Address 5.) Name: Address Br: a L" -7f j kYt ey)F.7 wners ama rno.a. 661 - 979-.567 .A ,wlfl�)JA�' sI M Date: ALAI 3 - %3= Date: ki4g Z /� Date. �UR ✓._�5�- Date: yamy]] Date: Declaration Number: 002 Eff'e'ctive Date: 07/29/2015 Page 3 Policy Number: XH0211927-4 Robert Jimenez I COVERAGE DECLARATIONS Location Address: 4501 Brunswick Bakersfield, CA 93307 Basic Coverages: Limit Deductible Section I Coverages: This location Does Not Include Earthquake Coverage. Cov A - Dwelling. $ 211,000 $ 1,000 Cov B - Detached Structures $ 21,100 $ 1,000 Cov C - Personal Property $ 147,700 $ 1,000 Cov D - Loss of Use $ 42,200 Form. Section Il Coverages Co, E - Personal Liability $ 300,000 CovF - Medical Payments Each Person $ 1,000 Each Accident $ 25,000 Property Insurance Disclosure: This location Includes Specified Additional Amount of Insurance for Coverage A - Dwelling. This location Does Not Include Earthquake Coverage. This location Includes Building Code Upgrade (Ordinance or Law)Coverage, per Fomt PH0041009. This location Includes an Annual Inflation Guard of 4%. Additional Coverages Form. Limit Premium Personal Property Replacement Cost H004901000 Refer to Form $ 0 Specifed Add'I Amt Insurance Cov'A' PHOO81009 Refer to Form $ 10 H.O. Plus PH0011012 Refer to Form $ 25 Ordinance or Law PHOO41009 $ 211,000 $ 42 Workers Compensation H024900801 $ 100,000 $ 5 Date Printed 07/29/2015 INSURED z T 3� w �s a14�70-7v",7 0 r ►l 01