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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 ~\(} ~'1-12-' 2- 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 ~,tC-( 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. ' .~ Signature of City E~er Additional Terms on the Back it ; J. 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 - ----- ... ~ . - It-fA ~V ~p 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. S:\PERMITS\ENCROACH\5404 Panorama Dr..doc -#--05 - / DLj. i' ~ . - 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. 4t>7!t;J 1 rr'l9ffff , ~ 5 ~c4 ~(~[1-( ~ r-Ilf1< (t~,(}/) c,utA 4erI S:\PERMITS\ENCROACH\TRAFFIC\5404 Panorama Dr..doc ~ . - 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. ~~ S:\PERMITS\ENCROACH\INSURANC\5404 Panorama Dr..doc ." .. . ,;. , 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: . ~ tJr ~-r fD~ (" () ~ 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. ../e . ::; -;~ rji CITY OF:. BAKERSFIELD DEPARTMENT OF PUBLIC WORKS .' , 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: /dP1,.. f1J--9'7 Z I SIGNED: 1}Name: ~;( 71LtAIJ--f~ . Address: !?Yt!1J ~a4t.M~UA/<'.1 AJ~ ....' . -.,- 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: Date: {;,- Iv CJ~.- . - . /' Date: ? .- //3 -- G> $ , Date: (p. ;;Z 1'-0.5- Date: f/-lldfL.fMI<!J If, &.H fl/ti yl&4 f\AJ IhJ ~fl.AI1b~ Avi, _ r,M Date: 5) Name: Address: 6) Name: Address: Date: .~.. ....~..- .....-- ,/ ~r 'e fflOTr.c..l'~ .1..331 t:% Fl' fu\l~E.. &,/ILbEIe.; bAlI/~ ;$t.A'd..J,;,I.U~..S" W~\r 1'01.11 e",(ff"cfi,,tf l.-,aMf~ :d. r.;(,"J"'10C-. ',AW,S:-: "'S:jO~,','P/tfJ~lllll^ MI ve n.lU""Ue: f.j",1.f12~'IDB~ [;Ut.MI: r{: 'TiIoMH j(6d~Y ~,...' " cl . 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CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDtYYYY) ACORD~ OP 10 B2/ WESTC01 03/31/05 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Hunter Insurance Services, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency Lic# OD94594 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR POBox 756 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. La Mesa, CA 91942 I I NAIC# Phone: 888-815-7639 Fax:619-465-1926 I ! INSURERS AFFORDING COVERAGE INSURED i INSURER A: Lincoln General Insurance Co. I : INSURER B: I West Coast Constructors : INSURER C: ! David Blackhurst 2801 University Avenue , INSURER D: , Bakersfield CA 93306 I i INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE 8EEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY 8E ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE 8EEN REDUCED BY PAID CLAIMS. LTRINSRC TYPE OF INSURANCE POLICY NUMBER i PD9N~1ri~fJ~~E I Pgk!fll~~bRifJgN I LI MITS GENERAL LIABILITY I ' EACH OCCURRENCE S 1000000 - , UAMA{jt: I U Kt:N I t:u A X X COMMERCIAL GENERAL LIABILITY 632002340900 i 03/09/05 03/09/06 ; PREMISES (Ea occurence) S 100000 i CLAIMS MADE ~ OCCUR I I MED EXP (Anyone person) S 5000 X Owner/Cont Proto I PERSONAL & ADV INJURY S 1000000 ~ i GENERAL AGGREGATE S 2000000 - , PRODUCTS - COMP/OP AGG . S Included I GEN'L AGGREGATE LIMIT APPLIES PER: - nPRO nLOC i X I POLICY I JECr i I AUTOMOBILE LIABILITY i I - , I COM81NED SINGLE LIMIT i$ 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 . .-"<-- :;- .} {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