HomeMy WebLinkAbout05-30000104
11
ENCROACHMENT 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 . . . . .
Property Address . . . . . .
Application type description
05-30000104 Date 10/27/05
5309 PANORAMA DR
PW - ENCROACHMENT PERMIT
Owner
Contractor
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DAVID BLACKHURST
5404 PANORAMA DR
BAKERSFIELD, CA
BAKERSFIELD
(661) 87-9721
OWNER/BUILDER
BAKERSFIELD
CA 93301
CA 93306
Permit . . . . .
Additional desc .
Phone Access Code
Permit Fee . . .
Issue Date . . .
ENCROACHMENT PERMIT
462846
150.00
10/27/05
Valuation
o
Qty Unit Charge Per
1.00 150.0000 EA PW ENCROACHMENT
Extension
150.00
Special Notes and Comments
ENCROACHMENT REQUESTED ON CHARGER AVE
FOR PLACEMENT OF 6' HIGH BLOCK WALL
( NON-RETAINING ) IN PUBLIC RIGHT OF
WAY AT SIDEWALK.
CONTACT NUMBER (661) 872-9721 DAVID
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 150.00 150.00 .00 .00
Grand Total 150.00 150.00 .00 .00
Applicant acknowledges the right of the City Engineer, pursuant to the Bakersfield Municipal Code Chapter 12.20 to revoke the
pe 'at any tim .
PAvIlJ
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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)
SUBSTANTIALL ERFERE WITH THE USE OF THE PLACE WHERE THE SAME IS TO BE LOCATED AND (2)
WILL (NOT) NST E A HAZARD TO PERSONS USING SAID PUBLIC PLACE; ,SAID APPLICATION IS
THEREFO (GRANT ) (DENIED). Said permit shall expire on date stated above. '
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Signature of City E~er
Additional Terms on the Back
it
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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 provisions 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 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 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.
IcJl;ve read and acknowledge the above.
Applicant's Initials
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B A K E R S
FIELD
PUBLIC WORKS DEPARTMENT
MEMORANDUM
TO: Raul M. Rojas, Public Works Director
FROM: Marian P. Shaw, Civil Engineer IV, Subdivisions
DATE: November 22, 2005
SUBJECT: Encroachment Permit Application for 5404 Panorama Dr.
Name of Applicant David Blackhurst
Description of encroachment. 6' high block wall behind sidewalk on
Charger Ave.
Engineering and Traffic staff has reviewed the attached encroachment permit to allow the
installation of description of encroachment. The site is located at address of encroachment.
The applicant has provided proof of appropriate insurance coverage to Risk Management, and
has provided signatures of all immediate neighbors stating that they have no objection to the
proposed construction.
Based on their review, staff recommends approval of the permit.
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BA...KERSFIELD
PUBLIC WORKS DEPARTMENT
MEMORANDUM
TO: Ryan Starbuck, Civil Engineer III
FROM: Marian P. Shaw, Civil Engineer IV, Subdivisions
DATE: November 2, 2005
SUBJECT: Encroachment Permit Application for 5404 Panorama Dr.
Name of Applicant David Blackhurst
Description of encroachment 6' high block wall behind sidewalk on
Charger Ave
Please review the attached encroachment permit and return to me at your earliest convenience.
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BAKERSFIELD
PUBLIC WORKS DEPARTMENT
MEMORANDUM
TO:
Pat Flaherty, Risk Manager
RECEIVED
OCT, 2 7 2005
R\SK MGMT.
FROM: Marian P. Shaw, Civil Engineer IV, Subdivisions
DATE: October 27,2005
SUBJECT: Encroachment Permit Application for 5404 Panorama Dr.
Name of Applicant David Blackhurst
Description of encroachment. 6' high block wall behind sidewalk on
Charger Ave.
Please review the insurance certificate with the attached encroachment permit and return to me
at your earliest convenience.
~~
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APPLICATION FOR ENCROACHMENT PER.J.\1IT
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 defmed.
1. Full name of applicant and complete address including phone number: MiI/b 7Jl.A-L~iJLlftSL-
5'?JOtj fh-NO~A- fbeo(L ~'/~ f1;L-Cj'12J
2. Nature or description of the encroachment for which this application is made: h rt.. 'Mt.,L
f:JlDt1<. WA-LL {hvL-€-
3. Location of the proposed encroachment: .
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~ 4, Period of time for which the encroachment is to be mamtained:
Applicant agrees that if this application is granted, applicant shall indemnify, defend and hold harmless City, its
officers, agents and employees against any and allliabihty, 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.
.' "4 . .
Applicant further agrees that upon the expiration of the permit for which this application is made, if granted, or !illQ!1
the revocation thereofbv the CIty engineer, apolicant will at his own cost and exoense remove the same from the public
propert~ or right of way where the same is located, and restore said public property or right of way to the condition
as near y as that in which it was before the placing, erection, maintenance or existence or 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 is:
~ :z,O[)(), cDO fB"'--LI /~rf..t1.J. -('I dllj Lf/lUAlcf:r
Applicant acknowledges the right of the City Engineer, pursuant to Bakersfield Municipal Code Chapter 12.20 to
revoke the ht at any time. . t\
Date: /; /~I oS- D .
/ ( Ignature 0
PERi~1T
I HEREBY CERTIFY THAT I HAVE MADE A.~ INVESTIGATION OF THE FACTS STATED IN THE
FOREGOING APPLICATION AND FIND THAT THE MAINTENANCE OF SAID ENCROACHMENT (1) WILL
(NOT) SUBST ANTIALL Y INTERFERE WITH THE USE OF THE PUBLIC PLACE WHERE THE SA.l\1E IS TO
BE LOCATED AND (2) Wll.L (NOT) CONSTITUTE A HAZARD TO PERSONS USING SAID PliBLlC PLACE;
SAID APPLICATION IS THEREFORE (GRANTED) (DENIED), SAID PER~IT SHALL EXPIRE
Date:
SIgnature of City Engmeer
No.
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rji CITY OF:. BAKERSFIELD
DEPARTMENT OF PUBLIC WORKS
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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.
CPA<&"zfZ.... A-tI~ "
(St.reet for puposed encroachment)
Bv: b/+il(iI() T5LAl-Y-tft/l;~~f
(Owners Name)
of' /)301' ~D,e~A- {)/L.
(A~dress of purposed encroachment)
Phone:
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SIGNED:
1}Name: ~;( 71LtAIJ--f~
. Address: !?Yt!1J ~a4t.M~UA/<'.1 AJ~
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2}Name: ~4 t:~L~~~~
Address: z::~ j)/C.
3) Name: __~
Address: . 5.3/;;L ? IE-/l rrA..hI.~ b}-- .
4} Name: /JO jJf,lblft!:tJfl$ tfIV btf-f fil)t.
Address:
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Date:
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5) Name:
Address:
6) Name:
Address:
Date:
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= . CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDtYYYY)
ACORD~ OP 10 B2/
WESTC01 03/31/05
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Hunter Insurance Services, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Agency Lic# OD94594 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
POBox 756 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
La Mesa, CA 91942 I I NAIC#
Phone: 888-815-7639 Fax:619-465-1926 I
! INSURERS AFFORDING COVERAGE
INSURED i INSURER A: Lincoln General Insurance Co. I
: INSURER B: I
West Coast Constructors : INSURER C: !
David Blackhurst
2801 University Avenue , INSURER D: ,
Bakersfield CA 93306 I
i INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE 8EEN 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 8E ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE 8EEN REDUCED BY PAID CLAIMS.
LTRINSRC TYPE OF INSURANCE POLICY NUMBER i PD9N~1ri~fJ~~E I Pgk!fll~~bRifJgN I LI MITS
GENERAL LIABILITY I ' EACH OCCURRENCE S 1000000
- , UAMA{jt: I U Kt:N I t:u
A X X COMMERCIAL GENERAL LIABILITY 632002340900 i 03/09/05 03/09/06 ; PREMISES (Ea occurence) S 100000
i CLAIMS MADE ~ OCCUR I
I MED EXP (Anyone person) S 5000
X Owner/Cont Proto I PERSONAL & ADV INJURY S 1000000
~
i GENERAL AGGREGATE S 2000000
- , PRODUCTS - COMP/OP AGG . S Included
I GEN'L AGGREGATE LIMIT APPLIES PER:
- nPRO nLOC i
X I POLICY I JECr i I
AUTOMOBILE LIABILITY i I
- , I COM81NED SINGLE LIMIT i$
i (Ea accident)
~ ANY AUTO I
~ ALL OWNED AUTOS :
i : BODILY INJURY i$
SCHEDULED AUTOS ' (Per person) I
I , I
! HIRED AUTOS I BODILY INJURY IS
R ",~ow""ur'" ' (Per accident)
PROPERTY DAMAGE Is
(Per accident)
I
I RO' "Am",", AUTO ONLY - EA ACCIDENT is
ANY AUTO OTHER THAN EAACC S
, AUTO ONLY: AGG $
!
i EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
o OCCUR D CLAIMS MADE AGGREGATE is
I s
~ DEDUCTIBLE S
i I i RETENTION S Is
I WORKERS COMPENSATION AND l i TORY L1Mm; ! rU~~-!
EMPLOYERS' LIABILITY E.L. EACH ACCIDENT 1$
I ANY PROPRiETOR/PARTNER/EXECUTiVE
OFFICER/MEM8ER EXCLUDED? i E.L. DISEASE - EA EMPLOYEE! $
if yes, describe under E.L. DISEASE - POLICY LIMIT $
SPECIAL PROVISIONS below
OTHER I
I
I I
,
'I i
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Cancellation: 10 day nonpay 30 day all other
CERTIFICATE HOLDER
CANCELLATION
Proof of Insurance
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
ACORD 25 (2001108)
@ ACORD CORPORATION 1988
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{inaJfn genmu ~ Policy Number
6320023409 00
~ConJxto/ COMMERCIAL GENERAL LIABILITY COVERAGE PART
SUPPLEMENTAL DECLARATIONS
LINCOLN GENERAL INSURANCE COMPANY
Named Insured DAVID BLACKHURST Effective Date: 03-09-2005
12:01 A.M., Standard Time
Agent Name HUNTER INSURANCE SERVICES INC Agent No. 041446
Item 1, Business Description:
Item 2. Limits of Insurance
Coverage Limit of Liability
Aggregate Limits of Liability Prod ucts / Completed
INCLUDED Operations Aggregate
General Aggregate (other than
$ 2,000,000 Products/Completed Operations)
Coverage A - Bodily Injury and anyone occurrence subject to
Property Damage Liability the Products/Completed
Operations and General
$ 1,000,000 Aggregate Limits of Liability
anyone premises subject to the
Damage To Premises Coverage A occurrence and the
Rented To You General Aggregate Limits of
$ 100,000 Liability
Coverage B - Personal and anyone person or organization
Advertising Injury subject to the General Aggregate
Liability $ 1,000,000 Limits of Liabilitv
Coverage C - Medical Payments anyone person subject to the
Coverage A occurrence and the
General Aggregate Limits of
5,000 Liability
Item 3, Retroactive Date
This Insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" which occurs
before the Retroactive Date, if any, shown here:
(Enter Date or "None" if no Retroactive Date applies)
Item 4, Form of Business and Location of Premises
Forms of Business: INDIVIDUAL
Location of All Premises You Own, Rent or Occupy:
See Schedule of Locations
ItemS. Forms and Endorsements I
Form(s) and Endorsement(s) made a part of this policy at time of issue:
See Schedule of Forms and Endorsements
Item 6. Premiums
Coverage Part Premium: $ 1,641.00
Other Premium:
Total Premium: $ 1,641. 00
I
THESE DECLARATIONS ARE PART OFTHE POLICY DECLARATIONS CONTAINING THE NAME OFTHE INSURED AND THE POLICY PERIOD.
GL-DEC (12/01)
Insured Copy