TC2015-0053ctI ,4 ,
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: 8/13/2015
S
LOCATION OF CONSTRUCtIO.N(Streetaddress or Description): 52ND @ JEFFERSON ST
PURPOSE OF CONSTRUCTION: TRAFFIC CALMONG REMOVAL AND INSTALLATION OF STRIPING.
'DESCRIPTION OF CONSTRUCTION: CIP 2014-02 STRIPING, SIGNAGE AND SLURRY SEAL AT ROUNDABOUT
DIMENSION OF INSTALLATION OR REMOVAL:N/A
MATE TIME WHEN WORK WILL BEGIN:8/10/2015 TIME OF COMPLETION: 9/4/2015
ESTIMATED CONSTRUCTION COST: S290.361.10 (Including removal of all obstruction, materials, and debris, backfilling, compaction and
placing permanent resurfacing and/or replacing improvements)
COMMENTS:
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 thepermit and all applicable rules and regulations of the City of and
to pay for any additional replacement necessary as the result of this work.
Signature of"AAlicant or Agent
KENNY SMITH -SUPERIOR PAVEMEN 650 E. FIRST STREET BEAUMONT, CA 92223 (909)844-7518
Name of Applicant (please print) Business Address Telephone No.
SUPERIOR PAVEMENT MARKINGS INC 5312 CYPRESS ST CYPRESS, CA 90630 (714)995-9100
Name of Contractor and Job Foreman Business Address Telephone No.
776306 111794
Contractor's License No. City Business License No.
IRONSHORE SPECIALITY INSURANCE COMPANY AGSOO78000
Applicant's Insurance Company Policy Number
Finance Revenue Code
TOTAL $0.00
PERMIT NO: TC2015-0053
DATE ISSUED:____
EXPIRATION DATE:''
BY:-Z. 5
WORK INSPECTED BY*:
PERMIT COMPLETION DATE*:
1f the work is covered by a Subdivision Improvement Agreement,
Subdivider shall request final acceptance of improvements from the
City Council.
Office Use Only:
Inspection Fee:
Permit Fee:
As-Built
Deposit:_
Dust Control
Deposit:
Credit
Amount:
TOTAL FEE DUE:
1 I'.Ii :p.r•1t,19 -
Office Use Only:
Assigned Permit Number: Tc z 0 / 0 0 S
Approval Date:
Expiration
Issue
Dale:
Administrative Authority:
T"af 4 4 a"
PUBLIC WORKS DEPARTMENT
APPLICATION FOR PERMIT
Date: August 6, 2015
Tract No: Proj. 2014-02 Project Name: Ave. 52 @ Jefferson Street
Vicinity: Roundabout
Purpose of Construction (i.e.: Rough Grading, Offsite Street. etc.) Traffic
Calming Removal and Installation of Striping
ription of Construction (i.e.: See Plan Set No. 01234) Striping, Signage and Slurry
Dimension )f Installation or Removal: .
Approximale Construction Start Date: i\ugust1u,u10
Approximate Construction Completion Date: September 4, 2015
Estimated Construction Cost: $ 290,361.10
Estimated Ctinsinuctitrn Cost shall include the removal of all obstructions, materials, and debris. back-filling, compaction and
placing permanent resurfacing and or replacing improvements
Contact Name: Kenny Smith Phone Number: 909844;7518
Name of Applicant/Owner: Superior Pavement Markings, Inc. mL .
Applicant Address: 650 E. i-irst Street Beaumont, Ca 92223
Applicant Telephone Number: 951.8452799 ..
Applicant E-mail Address: dalesuperiorpavementmarkings.com
Name of Contractor: Superior Pavement. Markings, Inc.
Contractor Address 650 E -irst Street Beaumont a 9ILi
Contractor Telephone Number: 951845.2799,,:.
Contractor State License Number: 776306 '
Contractor City Business License Number: -.. .'
Contractor E-mail Address: dalesuperiorpavernentmarkings.com
10- A COPY OF THE CURRENT INSURANCE CERTIFICATE MUST BE PROVIDED I
Applicant or Contractor general Liability Insurance Company:
lrol-tshore Specialty ins. Co.
. .. ..
Applicant or Contractor General Liability Insurance Policy Number:
AGS0078000