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Home My WebLink About03-30000014 i' 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 ofthe 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 . . 03-30000014 Date 1/31/03 Property Address . . . 6205 DISTRICT BLVD Application description . PW - ENCROACHMENT PERMIT Owner Contractor SMALL KEN 5024 AIRPORT DR BAKERSFIELD BAKERSFIELD (661) 393-6678 CA 93308 UHALT CONST CO 524 NO STINE RD BAKERSFIELD (805) 322-7777 CA 93309 Permit . . . . . Additional desc . Phone Access Code Permit Fee . . . Issue Date . . . ENCROACHMENT PERMIT 51763 145.00 1/31/03 Valuation o Qty Unit Charge Per 1. 00 14 5 . 0000 EA PW ENCROACHMENT Extension 145.00 Special Notes and Comments INSTALL 160' OF 2" CONDUIT FOR FIBER OPTIC CABLE AND 85' OF 11/2" NATURAL GAS PIPE LINE Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 145.00 145.00 .00 .00 Grand Total 145.00 145.00 .00 .00 City Engineer, pursuant to the Bakersfield Municipal Code Chapter 12.20 to revoke the GAB Y U/ML. { 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 (I) WILL (NOT) SUBSTANTIALLY INTERFERE WITH THE USE OF THE PLACE WHERE THE SAME IS TO BE LOCATEP AND (2) WILL (NOT) CONSTITUTE A HAZARD TO PERSONS USING SAID PUBLIC PLACE; SAID APPLICATION IS THEREFORE ~) (DENIED). Said permit shall expire on date stated above. 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 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. I have read and acknowledge the above. _ Applicant's Initials .. I' 4 . l s-' C / ~I v'~ aoz7 - BAKERSFIELD PUBLIC WORKS DEPARTMENT MEMORANDUM TO: Raul M. Rojas, Public Works Director FROM: Marian P. Shaw, Civil Engineer IV, Subdivisions DATE: April 18, 2003 SUBJECT: Encroachment Permit Application for Installation of 2" (() fiber optic & 1.5" natural gas line under District Blvd Ken Small Construction 6205 District Blvd.. Engineering and Traffic staff has reviewed the attached encroachment permit to allow the installation of a 2" fiber optics and 1.5" natural gas line. The site is located at-2?2Q tfaftit8~a)'. , LI rz05 D\, fZ-1OJ {:::Lv .D. 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\2003 Permits\6205 District Blvd.doc 3 ' If APPLICATION FOR ENCROACHMENT PERMIT TO THE CITY ENGINEER' OF THE CITY OF BAKERSFIELD, CALIFORNIA: Pursuant to the provision~ of Chapter 12.20 of the Bakersfield Municipal Code, the undersisned applies for a permit to place, erect, use and maintain an encroachment on public property or right-of-way as therem defmed. 1. Full name of applicant and complete address including phone number: ~U~IM-t'-....~Q1~bf'}J:.~t ~DZJl. AtQ.\bcz..\ DQ4 ~~~f\~LO )(p~ 't~3()S ?:>C(3-bb~ 2. Nature or description of the encroachment for which this application is made: 7b 'N ~ 7IIu.:. /4:,0 4F t!)~ 'Z II ~ c.t9AJPtJ/T r~ F"IB€,e oP77C CA 0l.&' A-AJ P 85' LP cF J Y?,-" M+7lJ,('/Jl t qA~ PIPe l../JJti. ~~ f/16~ . /~ 3. Location of the proposed encroachment: Kt5# ~LL COAl~uc.71DN } ~Z05 OJt>TRlCT /BLVD. /'3AI<Et<S~/ELD CA. 933/3 J ' 4. Period of time for which the encroachment is to be maintained: / - z.. 7 .. ~ B 16 2 - / ~ - tJ 3> Applicant agrees that if this application is granted, applicant shall indemnify, defend and hold harmless City, its officers, agents and employees against .~y an~ allliabil~ty, ~l,,:uns, ac~io~s! cau~es 01 action or de~ands, whatsoever ~ainst them, or any of them, before admmIstratIve, quasi-JudICial, or JudICial tnbunals of any kmd whatsoever, ansmg 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 fermit for which this application is made, if granted, or upon the revocation thereofbv the City engineer. aoolicant wil at his own cost and expense remove the same from the oublic prooertv 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 keel? allliabili~y insurance reCJ.uired by ~he qty Engineer in ~ll force ~nd effect for however long the encroachment. remams. Apphcant shall funnsh the City Risk Manager WIth a Certificate of Insurance evidencing sufficient coverage for bodily mjury or property damage liability or both and required endorsements evidencing the insurance required. The type(s) and amount(s) of insurance coverage is: PERMIT 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 PUBLIC 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 . 61'1 Il L/UA L1 Representative) - Applican~ acknow~edges the right of the City Engineer, pursuant to Bakersfield Municin the penmt at any tune. Date: l- Z't. D~ Date: Signature of City Engineer No. G:\GROUPDA 1\Fonns\EncroachmentPennilApp.wpd ... , ~! CATHODIC PROTECTION: INSTALL CATHODIC PROTECTION: YES 0 ANODE: NONE l2f MAG 0 ZINC AMP FITTINGS INSTALLED AT: l:Y1'NONE NO g o SIZE o RISER' LB CPA NO. ANODE 0 } . .-/ BONDED TO: LOC. WIRE M RISER 0 MAIN 0 VALVE o J 9 ~J. OTEE SKETCH 7~o' .--.----.. . ~. l-lP -l~l__h " o OTHER (MUST SHOW ON SKETCH) --r V _11_ [) t ~ \{2...\ C-, ...c \\} '1 \J' 4 b-rf?\...\c..('!\I"'~tr""l- c' ('J '. ( ;;; ,1. ~'1' "'~'.,:.:;...." (' R "L i,k..~ \...... ~.\..f.- r::'!. .~~, ,.. ~ ' .\-:.7.~,.;:-" \. "/ . t 1 I IIp}.., <1Y \ '--r ~ \.-Vt>. ': 4l'Dff:p L-______, I I I I I I I I <.&>"Z-o? -- . \ vtCf'\(. ,..w\ .t '"l f) ~::;)04.:.t.~;.:.. N ?;; 0 'Z-fb'?:.>-.l-; .:/:-) 7- MAP NO. t:')Q7_'<,'" GAS SERVICE RECORD PLAT NO. ~-,\ - (@rT. -l.p BLOCK LOCATION tbp..:\U'::"'L-<SF-~~Ll:> ADDRESS APPLICANT OR TRACTK..~.... ~t..L.,? L-o....."'::>n~-J'-...I.o,..l BLOCK LOT EXISTING FACILITY: MAIN Gt ~'\-\p PL. &' OFF: SERVICE D SIZE & PRESS. C.!. D ON ND'L:lt-\ SIDE t> \"':,\12-\'--\ TRENCH OCCUPIED WITH: NONE 0 ELECTRIC D ST L. D CU. D '0.) \-\1 't) PHONE D INSERTED IN CASING: CATV D OTHER PROPOSED SERVICE: SERV ICE ON ~OVI>-t \ " PL. if SIZE USA TICKET NO. NUMBER Le-z....:.oS Q \-<-).-:-,C.L..tL:-r DATE ISSUED \ \ - \ 1.~ -.0 Z- \7:;>L,/r>. r:.../I, BY_ YES D NO d CASING SIZE t I OUT PL. D C.!. D STL. D CU. D JOB ORDER 0' NEW SERVICE D REPLACEMENT D STUB SERVICE' D STUB COMPLETION o BRANCH SERVICE REF. NO. D ALTER '/INSPECTION D TRANSFER D CUT OFF (C/O) D MANIFOLD Q \"""'2-1'-,,,\ e:.LvD. I'::::"r LOCATION G"./ --ro f-.-oC.",-tr.!=:. 12-.t:> . SIDE CU. D CASING SIZE TRENCH OCCUPIED WITH: NONE g ELECT. D PHONE D CATV D OTHER INSERT: NO &i YES D STL. D STL.D RISER: CU. 0 NON.CORRODIBLE d CURB VALVE NO g YES D JOB/ACCT. NO. NO. OF OUTLETS C/O DATA:' TRANSFER FROM INSTRUCTIONS AND CAUTIONS D&C NO. METER SIZE PERMIT NO. REG. SIZE I ...( If l- 'z.... Mo...II-rQ2-. \-'fz- \ , . S 1'--"\ FT.OF SIZE YR. INSTALL. TYPE REASON: LEAKAGE 0 OTHER D MAIN ON_SIDE OUT .if ~,jell...C;'L.:.J;"Jj It' -'7t,;'~~, ~f"':;l-";";;:'" M~V'~ ,~~ ;~~;;,:;".;t .~;~ r (eet E:. 1-:"'.,.."" 'C ~"'I-.t WORK DONE (SHOW CORRECTIONS TO SERVICE AND MAIN DATA ABOVl:): FT. MAIN TO ptL " ?-;Jo 2-1C> ?-;'/.. ?-;?... FT.P/LTOEND ,17~.oA-17~ TOTAL FT. FT. EXCESS SERVICE TEST DATA: (SEE GAS STD. A-34) INITIAL/DATE BELOW FOR SERVICES OFF DISTRIBUTION SYSTEMS (UP TO 60 PSIG MAOP) TESTED TO MINIMUM OF 100 PSIG FOR 5 MINUTES 0 / FOR SERVICES OFF MAINS WITH A MAOP OF OVER 60 PSIG TESTED AT PSIG FOR ' MINUTES COVER ON MAIN REMARKS *DATESTUBINSTALLED DATE COMPLETED , ',,', ;";''''''?;~'J~''':T7;;' ~'i~~--' FOREMAN FOREMAN PG~E 62-4183 Rev 4/80 P~~'"""""""':;f.'~''''-' ".',;1',.'''''''~H ,_ __~.._ ___u._______:- ...--:-~,....-..-.--.----: . . Of-29-2003 10:29 FROM-WALTER MORTENSEN INSURANCE ACORD' ,",c.n.llrl'-'~ I c vr ....."'P....I. 1"1 ~ROouCER (661)h4-6Z22 FAX (661)834-6662 Wal'ter Morte'llsen Insurance, Inc. license '90257 4701 Stockda. I e Awy. Bakersfield,"eA 93309 INSIJRf'-P KS IndListries, LP Ken Sm<lll Constructi on. Inc. 5024 Ailrport Dr. Bakersfield, CA 93308 661-834-6662 T-315 I 1l'~U''U''''\'''v,- P001/003 F-175 01/24/2003 ONLY AND COtllFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR At..TER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURER A; INSuRER t: INSURi=R C: INSURER P; lfllSUFU:R 10: American Home Assurance Nat;onal Union Fire Ins. Company State COmPensation Ins. Fund I COVeftAGES . Trle POL.ICIES OF' INSURANCE L.ISiED BEt-OW HAVE BEeN IssuED TO Tl-lE INSURED NAMED ABOVE FOR THE POliCY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMEr iT TERM OR CONDITION OF ~y CONTRACT OR OTriE.R DOCUMENT WITH RESpg:r TO Wl'iICH THIS CERl1flCA TE MAY BE ISSUED OR MAY PeRTAIN. Tl- POl.ICIES. AGGR! Ci ty <; 1501 .1 Baker:; J;; iNSURANCE AFf'OROED BY THE POLICieS DESCRIBED HEREIN IS SUBJECT TO ALL THE: TERMS. EXCl.USIONS AND CONDITIONS O~ SUCH : GA iE I.IMITS SHOWN MAY HAVE seEN REDUCED BY PAID C~MS. IINSURAhCe; POUCY NUMBER DATf IMMlDP/YYl cOATI" IMMlCorm' L.IMITS I. In- 5442546 07/01/2002 07/0l/2003 t:ACI'i OCCuP,RENCE S 1.000 ODD h ,L 'GENERAL LIASIL1l1 FIRE DAMAGE (Any 009 n,9) $ 100,000 : MADE lX]'OCCUR McC Ex? (Any On~ ",,~C.n) ~ 5 00( P~ONAL " AOV INJURY S 1,000 OQl: - GENJ:RAI-AGGREGATE $ 2.000,000 'I"E I-IMrr APPLIE5 PE~ PRODUCTS. COMPJOP AGe s 2 . 000 , OOC 'l~ nLOC _,BIUTY 7203426 07/01/2002 07/01/2003 COMBINEO SINGLE LIMIT lEa 8CCOOnl) S 1,OaO,OOl] : AUTOS BODILY INJL1RY (Per PC~nJ $ I J AUTOS IlS BOOIl_ Y INJURY S ;JAUTOS Iper ~ceiQel1t) PROPI<P.TY OA),lAGE S IPe' 8~,aent) .TV AuTO ONLY. EA ,A.CCIDENT $ OitiER THAN E.....CC $ AUrO ONL. y, AGG S lry BEI393344 07/01/2002 07/01/2003 t:ACH OCCLJRREiNCe S 9.000 000 D C~iMS MAP~ AGGRE<:;Are $ 9,000 000 S IE S I S $ ~ENSAT10N AI'<D ~-40020751 10/01/2002 10/01/2003 X I TOR{L;'MN.s I I"'~R' >.BlllTY E.~. EACIi ,~CCIOENT S 1. 000 .OOC E-L OISEAse . EA EiMf'L.OyEE S 1.000.000 E.L DISEASE" POLICY liMIT S 1. 000 ,OOC ~10 day cancellation will apply for non-payment of p remi urn'" RATIO!'iSJLOCATIONSNI'HlCL.lOSiEXCLlJSIOl'l~ ADPED BY 1'l'lDOfl:leM!;l'l1'ISI'!;C1AL PRCIII:>I !'is & volunteers ;akersfield, its mayor, council, officers, agents, employees are named lsured per the attached endorsement. )LDER I I AcpmOIlAl. iNsuRED; INSURER Lml'R CANCEL-LA nON Sl-fOULD A1'IY OF THE A80Vl; ilESCFUSEO poucles ee. CANCE\..I-EP BEl'ORE TI-lE j':)(PlflATlON DATE ThEREOF. TIlE ISSUING COMPA.NY WILL ENOEAVOR TO MAIl. JO- DA~ wRITTErl NOllC'" TO TIiE CE!l.TlFlCATE HOL.CE;R NAMED TO TH~ Le;FT. f Bakersfield auT PAll.tJRE TO MAIL SUCH NO.ICE SHAL.L.IMPOSE NO oaL1CATION OR LIASILITV ruxtun Avenue OF AAY KINO UPON THE COMPANY. rrs AGeNTS OR REPRE;SENTATIVES. field, CA 93301 AuTHOI<lZl'O REPRe;SE~T A nVf; 0:" ~~ pi" Michael Moore AAI/MTM If',~-t;l..< - #Ic~-v?... .7} " JUN l:lUll I.TR TYPSO GENEIU\1- LlA51 X COr.AMERC CLAIM A A e;xCESS UA!illL X OCCiJR B OEOUCTIB RETENTIOr Y'I0R~RS COM e;MPI,.OVERS' 1-1 CI OlHER lJ~R1I'TION OF o~ll he City of i dditional i, CERTIFICATE Hi ~l-29-~3 l~:2l RECEIVED FROM:66l 834 6662 P.Ol :- 01~29-2003 10: 29 FROM-WALTER MORTENSEN INSURANCE 661-834-6662 T-315 P.002/003 F-175 IMPORTANT f the certificate holder is an ADDIT10NAL INSURED, the policy(ies) must be endorsed. A statement .m this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). f SUBROGATION tS WAIVED, subject to the terms and conditions 'oftha policy, certain policies may 'squire an endorsement. A statement on this certmcate does not confer rights to the certificate 10lder in lieu af such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively ar negadvely amend, extend or alt€:r the coverage afforded by the policies listed thereon. fH-29-03 10:21 RECEIVED FROM:551 834 6652 P.El2 . " 0,"-29-2003 10: 30 FROM-WALTER MORTENSEN INSURANCE 661-834-6662 T-315 P.003/003 F-175 .. ~ . f Policy Nunlber: 5442546 Endorsement Effective: 7/1/2002 THIS ENDORSEMENT CHANGES THE POlley. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED--DESIGNATED PERSON OR ORGANIZATION This endor:: ement modifies insurance provided under the following: . COMMERCLA.L GENERAL LIABILITY CO\i'ER.A..GE PARt. SCffiOUlE Name of Pt:rson or Organization: City of Bak~rsfield, its mayor, council, officers, agents, employees & volunteers Who is an insured (Section II) is amended to include as an insured the person or organization shown in the Schedule as an IDSUJ' ~d but only with respect to liability arising out of your operations or premises o"WIled bior rented to . you. CG20261! 85 f>1-29-03 10:21 RECEIVED FROM:551 834 5552 P.El3 ; .0 ~ . - BAKERSFIELD PUBLIC WORKS DEPARTMENT MEMORANDUM TO: Pat Flaherty, Risk Manager FROM: Marian P. Shaw, Civil Engineer IV, Subdivisions DATE: February 28, 2003 SUBJECT: Encroachment Permit Application for 6205 District Blvd. Ken Small 2" conduit for fiber optics line. Please review the insurance certificate with the attached encroachment permit and return to me at your earliest convenience. {IV S:\PERMITS\ENCROACH\INSURANC\6205 District Blvd.doc