CIP2016-0005fo 4uii
ENCROACHMENT PERMIT
UBLIC WORKS CONSTRUCTION
See below for Finance Revenue Codes
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains and other like public
works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS.
DATE: 9/22/2016
LOCATION OF CONSTRUCTION(Street address or Description): VELASCO. EISENHOWER. & SAGUARO PARKS
PURPOSE OF CONSTRUCTION: PLAYGROUND EQUIPMENT INSTALLATION
DESCRIPTION OF CONSTRUCTION: CIP 2013-02A PLAYGROUND EQUIPMENT INSTALLATION PROJECT
DIMENSION OF INSTALLATION OR REMOVAL:
APPROXIMATE TIME WHEN WORK WILL BEGIN: 9/26/2016 Time of Completion: 10/26/2016
ESTIMATED CONSTRUCTION COST: ._..... (Including removal of all obstruction, materials, and debris, backfilling, compaction and placing
permanent resurfacing and/or replacing improvements)
COMMENTS: SEE PROJECT CONTRACT AND SPECIFICATIONS FOR CIP 2013-02A FOR PERMIT CONDITIONS
In consideration of the granting of this permit, the applicant hereby agrees to:
Indemnify, defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and all
penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage to persons or property
happening or occurring as a proximate result of any work undertaken under the permit granted pursuant to this application.
Notify the Administrative Authority at least twenty-four (24) hours in advance of the time when work will be started at (760) 777-7097. To
submit an inspection request, leave a message on the Inspection Request Hotline at (760) 777-7097 prior to 1:30 P.M. at least twenty-four
(24) hours prior to the anticipated inspection.
Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City of and
to pay for any additional replacement necessary as the result of this work.
Slgnatur..oLà ,llcant or Agent
R.E. SCHULTZ CONSTRUCTION - DOUG
LEWIS 2914 E KATELLA AVE #102 ORANGE, CA 92867
Name of Applicant-(please print) Business Address
R E SCHULTZ CONSTRUCTION INC P 0 BOX 6 SILVERADO, CA 92676
Name of Contractor and Job Foreman Business Address
1007195 . LIC-764051
(760)703-3706
Telephone No.
(714)649-2627
Telephone No.
Contractor's License No. City Business License No.
WESTERN HERITAGE INSURANCE CO. SCP1017392
Applicant's Insurance Company Policy Number
Finance Revenue Code
TOTAL: $0.00
PERMIT NO: ClP2016-0005
DATE ISSUED: /1 4.
EXPIRATION DATE: Jkt. JIi
BY-_/_5_
WORK INSPECTED BY*:
PERMIT.COMPLETION DATE:
r
P
1f the work is covered by a Subdivision Improvement Agreement,
Subdivider shall request final acceptance of improvements from the
City Council.
Tit~p 4 4 Qawfij
PUBLIC WORKS DEPARTMENT
APPLICATION FOR PERMIT
Date: September 21, 2016
Tract No: Project Name: Playground Equipment Installation, #2013-02
Vicinity: Eisenhower Park, Valasco Park, & Saguaro Park
Purpose of Construction (i.e.: Rough Grading, Offsite Street, etc.)_________________
Playground Equipment Installation
Description of Construction (i.e.: See Plan Set No. 01234) See Site Plan #C16035CH
#C16004PM, & #C16037CHR1
Dimension of Installation or Removal: 3333 SQ FT, 450 SQ FT, 2650S0 FT
Approximate Construction Start Date: 9/26/2016
Approximate Construction Completion Date: 10/26/2016
Estimated Construction Cost: $ 62,736.00
Estimated Construction Cost shall include the removal of all obstructions, materials, and debris, back-filling, compaction and
placing permanent resurfacing and or replacing improvements
Contact Name: Doug Lewis Phone Number: 760-703-3706
Name of Applicant/Owner: R.E. Schultz Construction, Inc.
Applicant Address: 2914 E Katella Ave. #102, Orange, CA 92867
Applicant Telephone Number: 714-649-2627
Applicant E-mail Address: chelsea@reschultzconstruction.com
Name of Contractor: R.E. Schultz Construction, Inc.
Contractor Address: 2914 E Katella Ave. #102, Orange, CA 92867
Contractor Telephone Number: 714-649-2627
Contractor State License Number: 1007195
Contractor City Business License Number: LlC-764051
Contractor E-mail Address: chelsea@reschuuzconstruction.com
'A COPY OF THE CURRENT INSURANCE CERTIFICATE MUST BE PROVIDED
Applicant or Contractor General Liability Insurance Company:
Western Heritage Insurance Co.
Applicant or Contractor General Liability Insurance Policy Number:
5CP1017392
Office Use Only:
Inspection Fee:
Permit Fee:
As-Built
Deposit:
Dust Control
Deposit:
Credit
Amount:
TOTAL FEE DUE: 417
Office Use Only:
Assigned Permit NumbcrCI PZoi
Approval Date: 4
Expiration
Issue
Date:
Administrative Authority:
California MUTCD 2014 Edition Page 1139
(FHWA's MUTCD 2009 Edition, including Revisions I & 2, as amended for use in California)
Figure 6H-1. Work Beyond the Shoulder (TA-I)
J4OR •
W20-1 W21-1
Note: See Tables 6H-2 and 61-1-3 for the meaning
of the symbols and/or letter codes used in
this figure.
Typical Application I
Chapter 6H - Typical Applications November 7, 2014
Part 6— Temporary Traffic Control
California MUTCD 2014 Edition
(FHWA's MUTCD 2009 Edition, including Revisions 1 & 2, as amended for use in California)
Page 1143
Figure 61-1-3. Work on the Shoulders (TA-3)
G20-
IS31lM XX IXJN
4lOM OYOi
or
r
<
A8 0M\
W21-5
4—
END
4 t ROAD WORK
(optional)
Shoulder taper
/ (see Note 7)
/L
1/3 L
SHOULDER
WORK
/LJN
1
4—
Shoulder taper
Shoulder taper
(see Note 7)
(see Note 7)
Note: See Tables 6H-2 and 6H-3
for the meaning of the
symbols and/or letter
codes used in this figure.
1/3 L
J6 SHOULDER
WORK
4 f J [ROAD WORK
[NEXT XX MILES
Typical Application 3
Chapter 6H - Typical Applications November 7, 2014
Part 6— Temporary Traffic Control
California MUTCD 2014 Edition Page 1150
(FHWA's MUTCD 2009 Edition, including Revisions I & 2, as amended for use in California)
Figure 61-1-6. Shoulder Work with Minor Encroachment (TA-6)
ML
F
END
ROAD JWORK
optonai
4t
Note: See Tables 6H-2 and
6H-3 for the meaning
of the symbols and/or
letter codes used in
this figure.
I Work vehicle
Truck-mounted
- attenuator
(optional)
G20-2
itJOM OVOd
ON] ] •U•
(Optional)
Buffer space
(optional)
1/3 L
A
W20-1
ROAD
_____ WORK
AHEAD
Chapter 6H - Typical Applications November 7, 2014
Part 6— Temporary Traffic Control
California MUTCD 2014 Edition
(FHWA's MUTCD 2009 Edition, including Revisions I & 2 as amended for use in California)
Page 1162
Figure 61-1-II. Lane Closure on a Two-Lane Road
with Low Traffic Volumes (TA-1 I)
or ( MOM
avo /
(optional
(optional)
I Hd _YI I T
Md
(optiona . >
' I -
16,
4 t E L ROADWORK
G20-2
OPtiOnal
I
50 to 100 ft
Buffer space (optional)
WI-4
Bufferspace (optional)
(optional)
M8OM avo
ON]
'9
50 to 100 ft
TC
.FONCTOOMING' RI -2aP
A FK
.16 I W3-2
B (optional)
.1.1 ON E
(
LANE
ROAD ) W20-4
AHEAD
4t C
UL
_
[xxi
[MPH]
optlollal)
(optional)
ROAD ( WORK ) W20-I
AHEAD
Note: See Tables 6H-2 and 6H-3
for the meaning of the
symbols and/or letter
codes used in this figure
(optional)
(see Section 3B16)
Typical Application II
Chapter 6H - Typical Applications November 7, 2014
Part 6 - Temporary Traffic Control