HomeMy WebLinkAbout2515 CHURCH AVE1"�C RPORA ENCROACHMENT PERMIT
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dCITY OF BAKERSFIELD
PUBLIC WORKS DEPARTMENT
1501 TRUXTUN AVE
)A�ARY 1L�4+ BAKERSFIELD CA 93301 5 a
41_IFOR (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
Owner
------------------------
UNIVERSITY BAPTIST CHURCH
2515 CHURCH AV
BAKERSFIELD CA 93306
08- 30000084 Date 11/06/08
2515 CHURCH AVE
PW - ENCROACHMENT PERMIT
Contractor
------------------ - - - - --
OWNER
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Permit . . . . . . ENCROACHMENT PERMIT
Additional desc .
Phone Access Code 859710
Permit Fee . . 208.00
Issue Date . . . . 11/06/08 Valuation . . . . 0
Qty Unit Charge Per
1.00 208.0000 EA PW ENCROACHMENT
Extension
208.00
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Special Notes and Comments
Build 51 wrought iron fence approx
75' long, mid block on Church Ave.
Fence will be set in 12" mow strip and
is on the side yard of the church.
12' removeable gate can be added.
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Fee summary Charged Paid Credited Due
- ---- ------ - - - - -- ---- - - - - -- -- -- -- - - -- ---- - - -- -- - -- --- - - --
Permit Fee Total 208.00 208.00 .00 .00
Grand Total 208.00 208.00 .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.
Arl� 0av2 Busse
Signature of Applicant (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) E A HAZARD TO PERSONS USING SAID PUBLIC PLACE; SAID APPLICATION IS
THEREFO (GRANTED) DENIED). Said permit shall expire on date stated above.
Signature f City Engineer
Additional Terms on the Back
S A K E R S F I E L D
PUBLIC WORKS DEPARTMENT
MEMORANDUM
TO: Raul M. Rojas, Public Works Director
FROM: Marian P. Shaw, Civil Engineer IV, Subdivisions
DATE: May 19, 2009
SUBJECT: Encroachment Permit Application for: 2515 Church Ave.
Name of Applicant. University Baptist Church
Description of Encroachment: Build wrought iron fence behind sidewalk,
this fence is a side yard fence and will be 5'
high.
Engineering and Traff ic staff has reviewed the attached encroachment permit to allow the
applicant to build wrought iron fence behind sidewalk, not over 5' high.
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.
SAPERMIMENCROACH\2515 Church Ave..doc
1 A I� E R S F I E L I
PUBLIC WORKS DEPARTMENT
MEMORANDUM
TO: Ryan Starbuck, Civil Engineer III
FROM: Marian P. Shaw, Civil Engineer IV, Subdivisions
DATE: February 12, 2009
SUBJECT: Encroachment Permit Application for: 2515 Church Ave.
Name of Applicant: University Baptist Church
Description of Encroachment: Build 5' wrought iron fence approx. 75' long,
mid block on Church Ave. Fence will be set
in 12' mow strip and is on the side yard of
the church. 12'removeable gate may be
added.
Please review the attached encroachment permit and return to meat your earliest convenience.
-7 /Z 06;
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S: \PERMITS \ENCROACH \TRAFFIC\2515 Church Ave..doc
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B A K E R S F I E L I)
PUBLIC WORKS DEPARTMENT
MEMORANDUM
TO: Ralph Korn, Risk Manager
FROM: Marian P. Shaw, Civil Engineer IV, Subdivisions
DATE: December 9, 2008
SUBJECT: Encroachment Permit Application for: 2515 Church Ave.
Name of Applicant. University Baptist Church
Description of Encroachment: Build 5' wrought iron.fence approx. 75' long,
mid block on Church Ave. Fence will be set
In 12' mow strip and is on the side yard of
the church. A 12' removeable gate may be
added.
Please review the insurance certificate with the attached encroachment permit and return
to me at your earliest convenience.
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S: \PERMITS \ENCROACH \INSURANC\2515 Church Ave..doc
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M,
B A K E R S F I E L D
Public Works Department
1501 Truxtun Avenue
Bakersfield, California 93301
(661) 326 -3724
APPLICATION FOR ENCROACHMENT PERMIT
Permit Fee $208.00
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.
1. Full name of applicant and complete address including phone number: dlwe✓s r
2. Nature or description of the encroachment for which this application is made: (Example: Wood or wrought iron
fence, concrete block wall, raised planter, etc...)
3.
Location of proposed encroachment: (Example: Side yard at back of sidewalk or front yard at back of sidewalk)
15/,/,t- yClra✓ cr dkyYeL a r 6aek_ at 14
4. Period of time for which the encroachment is to be maintained. IndefiniPircle) or Other.
ease
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 upon 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 restored 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 evidenc-
ing the insurance required. The type(s) and amount(s) of insurance coverage is:
Applicant acknowledges the right of the City Engineer, pursuant to Bakersfield Municipal Code Chapter 12.20 to revoke the permit at
any time.
S:\EncroachmentPermits\ApplicationforEncroachment
C)$- 30000084
B A K E R S F I E L D
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.
By:
(Street for proposed encroachment ) (Owners Name)
Of Phone*
(Address of proposed encroachment)
SIGNED:
1.) Name: Date:
Address:
2.) Name: Date:
Address:
3.) Name: Date:
Address:
4.) Name: Date:
Address:
5.) Name: Date:
Address:
6.) Name: Date:
Address:,
r w6v. VVG
ACORD. CERTIFICATE OF LIABILITY INSURANCE
ioiisi2008
PRODUCER (800) 995 -7525 FAX: (800) 995 -7521
Church &Casualty Insurance Agency Inc
3440 Irvine Ave suite 150
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
NmTort Beach CA 92660
INSURERS AFFORDING COVERAGE
NAIC #
INSURED Fratima Romero FAX: (661) 871 -0924
INSURERA Church Mutual Insurance
18767
UNIVERSITY BAPTIST CHURCH OF BAKERSFIEID
INSURER B.
2515 CHURCH AVE
INSURER C:
INSURER D:
BAxzReF2Em CA 93306 -1099
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN 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 BE 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 BEEN REDUCED BY PAID CLAIMS.
INSR
ADD'L
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MMIDDIYY
POLICY EXPIRATION
DATE MMIDDIYY
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
A
X
X COMMERCIAL GENERAL LLABILITY
I CLAIMS MAOE aOCCUR
0089455 -02- 970267
9/16/2008
9/16/2011
RR MISES Ee o rice
$
MEDEXP IAny one person)
$ 10,000
PERSONAL &ADV IN,AIRY
$ 1,000,000
GENERAL AGGREGATE
3,000,000
GE AGGREGATE LIMIT APPLIES PER:
POLICY JEC LOC
1, 000 , 000
AUTOMOBILE LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
(Ea accident)
$
ALL OWIJED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per person)
$
HIREDAUTOS
NON- OVYNEDAUTOS
BODILY INJJRY
(Peraccident)
$
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EAACCIDENT
$
OTHER THAN EA ACC
ANY AUTO
$
AUTO ONLY: AGG
EXCESSIUMBRELLA LIABILITY
OCCUR FI CLAIMSMADE
EACH OCCURRENCE
$
AGGREGATE
$
DEDUCTIBLE
$
$
RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
TVO'CR T O R
E.L. EACH ACCIDENT
$
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. DISEASE - EA EMPLOYEE .$
OFFICER/MEMBER EXCLUDED?
If yes, describe under
—
,
E.L. DISEASE -POLICY LIMIT
$
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONSILOCATI ONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECUIL PROVISIONS
Evidence of insurance for installation of wrought iron fence at 2515 Church Avenue, Bakersfield, CA beginning
approximately in the first week of November and for about a three weeks time frame.. The City of Bakersfield, its
mayor, council, employees, agents and volunteers are added as additional insureds only with respect to installation of
the wrought iron fence on the above described premises. All activities /operations not specifically run /or conducted
by the Named Insured are excluded.
CERTIFICATE HOLDER CANCELLATION
(661) 852 -2132 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City of Bakersfield EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
Attn : Building Dept. 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
1501 Truxtun Avenue FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
Bakersfield, CA 93301
4CORD 25 (20(
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AUTHORIZED REPRESENTATIVE
Shelley Zertuche, -4
0 ACORD CORPORATION 1988
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