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CIP2017-0003a, 4 uhda, See below for Finance Revenue Codes ENCROACHMENT PERMIT PUBLIC WORKS CONSTRUCTION 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: 6/8/2017 LOCATION OF CONSTRUCTION(Street address or Description): 78060 FRANCIS HACK PURPOSE OF CONSTRUCTION: TENNIS AND PICKLEBALL COURT CONVERSION DESCRIPTION OF CONSTRUCTION: CIP2016-04 FRITZ BURNS PARK TENNIS AND PICKLEBALL COURT CONV OF INSTALLATION OR REMOVAL: APPROVED PLAN MATE TIME WHEN WORK WILL BEGIN: 6/19/2017 TIME OF COMPLETION: 10/3/2017 ESTIMATED CONSTRUCTION COST: S387.859.00 (Including removal of all obstruction, materials, and debris, backfllling, compaction and placing permanent resurfacing and/or replacing Improvements) COMMENTS: SEE PROJECT CONTRACT AND SPECIFICATIONS FOR CIP 2016-04 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 ru1 n gulation of the City of and to pay for any additional replacement necessary as the result of this work. Signature of Applicant or Agent PACIFIC TENNIS COURTS, INC. CAROLINE CARTER 530 LOS ANGELES AVE., SUITE 115-320 MOORPARK, CA 93021 (818)991-7445 Name of Applicant (please print) Business Address Telephone No. PACIFIC TENNIS COURTS INC 530 LOS ANGELES AVE., SUITE 115-320 MOORPARK, CA 93021 (818)991-7445 Name of Contractor and Job Foreman Business Address Telephone No. 980738 764890 Contractor's License No. NAUTILUS INSURANCE Applicant's Insurance Company Finance Revenue Code TOTAL. $0.00 City Business License No. 1146861 Policy Number PERMIT NO: CIP2017-0003 DATE ISSUED: EXPIRATION DATE-44/.Y//.s BY: INSPECTED BY: IT COMPLETION DATE: 1f the work is covered by a Subdivision Improvement Agreement, Subdivider shall request final acceptance of improvements from the City Council. T4.hf 4 a 0 49 Wei PUBLIC WORKS DEPARTMENT APPLICATION FOR PERMIT uate: . Tract No: N/A Project Name: FritzBurnsPark Tennis and PickleballCourb Vicinity: Fritz Burns Park Purpose of Construction (i.e.: Rough Grading, Offsite Street, etc.)_________________ Two new tennis court _slabs_over existing _tennis _cot rt_ slabs _and _new concrete _walkways Description of Construction (i.e.: See Plan Set No. 01234) Constructingtwonew tenniscourtsover existing tennis courts, walkways, _and fencing. Dimension of Installation or Removal: 120'x120' Approximate Construction Start Date: 6/19/2017 Approximate Construction Completion Date: 10/3/2017 Estimated Construction Cost: $ 387,859.00 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: CarolineCarter Phone Number: (818)991-7445 Name of Applicant/Owner: Caroline Carter Applicant Address: 530Los Angeles Ave.,Suite115-320,Moorpark,CA93021 Applicant Telephone Number: (818)991-7445 Applicant E-mail Address: caroline@pacifictenniscourts.com Name of Contractor: Pacific TennisCourts,Inc. Contractor Address: 530Los Angeles Ave.,Suite115-320,Moorpark,CA93021 Contractor Telephone Number: (818)991-7445 Contractor State License Number: 980738 Contractor City Business License Number: 764890 Contractor E-mail Address: caroline©pacifictenniscourts.com 110- A COPY OF THE CURRENT INSURANCE CERTIFICATE MUST BE PROVIDED '4 Applicant or Contractor General Liability Insurance Company: Nautilus Insurance Applicant or Contractor General Liability Insurance Policy Number: NN649824 Office Use Only: Inspection Fee: Permit Fee: As-Built Deposit: Dust Control Deposit: Credit Amount: TOTAL FEE DUE: OfficeUseOnly: As ned Permit Number: 'P2_cfl- OOO Approval Date: Expiration Date: Issue Date: Administrative Authority: