TC2016-00694 ee •oeiow Tor iinance ilevenue LOcies
4. jJ l
ENCROACHMENT PERMIT 0.
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: 9/26/2016
LOCATION OF CONSTRUCTION (Street address or Description): EISENHOWER DR & AVENIDA BERMUDAS
PURPOSE OF CONSTRUCTION: SLURRY SEAL AND STRIPING IMPROVEMENTS
S
DESCRIPTION OF CONSTRUCTION: C1P2012-07D EISENHOWER DR & AVE BERMUDAS SLURRY & STRIPING
DIMENSION OF INSTALLATION OR REMOVAL:
TE TIME WHEN WORK WILL BEGIN: 10/3/2016 TIME OF COMPLETION:12/19/2016
ESTIMATED CONSTRUCTION COST: $401,830.00 (Including removal of all* obstruction, materials, and debris, backfilling, compaction
and placing permanent resurfacing and/or replacing Improvements)
ENTS: SEE PROJECT CONTRACT AND SPECIFICATIONS FOR CIP 2012-07D 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 ordamage 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 ofjbe'C[ty of and
to pay for any additional replacement necessary as the result of this work. /1
of Applicant or Agent
ALL AMERICAN ASPHALT- BRIAN
ANSELM P 0 BOX 2229 CORONA, CA 92878 (909)917-9207
Name of Applicant (please print) Business Address Telephone No.
ALL AMERICAN ASPHALT P 0 BOX 2229 CORONA, CA 92878 (951)736-7625
Name of Contractor and Job Foreman Business Address
267073
Contractor's License No.
ARCH SPECIALTY INS CO
Applicant's Insurance Company
Finance Revenue Code
TOTAL: $0.00
Telephone No.
764057
City Business License No.
DPC100585600
Policy Number
PERMIT NO: TC2016-0069
DATE ISSUED:
EX
DATE: DATE:
BY:2
W(K INSPECTED 6Y:
PERMIT COMPLETION DATE*:
*,f the work is covered by a Subdivision Improvement Agreement,
Subdivider shall request final acceptance of improvements from the
City Council.
a
PUBLIC WORKS DEPARTMENT
APPLICATION FOR PERMIT
Date L9 -7
Tract No TeQI2bO1P1Project Name 1W C641J11
Vicini'f I
Purpose of Constniction (i.e.: Rough Grading, Offsite Street, etc.)
~1 r Imp 777777,
iI
,, -•.. .,. ..-- ----..-, .
Description of Construction i 'e.': See Plan Set No 01234) ltflP!9L
of Installation or Removal
----- -_-.T-. - -
Dimension , 1
Approximate Consttuction Start Date:
Approximate Construction Completion Date 2l19I16'T
Estimated Construction Cost. $9i1130tOOL i]
Estimated Constnsction Cost shall include thc smoval of all obslzuclions, matenals, and dthris, back-filling, compaction and . .
placing pannanimt isuefacmg and or n!ptacug unpiovemcnls
Contact Name 1WAise .ilPhone Number 9)971, I
Name of AppliCaht/Owner. hait TD
Applicant Address:'—fo1IV
Applicant Telephone Number 9jiT36i625T -
Applicant E-mail Addrdss:Er S
:
Name of Contractor All jnencan Ahalt .-
-
- -
Contractor Address rP'E SutthStlPO B6 2229
Contractor Telephone Number.
Contractor State License Numbec[267,0Z3: • •: -
Contractor City Business License Number b57 3
Contractor E-mail Addreis:á WItioW"tT. -.-
A COPY OF THE CURRENT INS
Applicant or Contractor General Lu
.
Ayplicant or Contractor General Lu
O88
Office Use Only:
Permit Fee:
Inspection Fee
-
As-Built Dcpcsh:______
Dust Cóntmi
Dcposil ._. • •
•Citdii. • •
Amount:._______
TOTAL FEE DUEl' 0
Uflveit.necK115ts - 1-orms a #pplica1iori
E CERTIFICATE MUST BE PROVIDED 4 •
bsurance Policy Number • . •
,;y]
0111cc Use Only:
AssiwdPenditNumbr7(é_Ot)b1
Approval Date: • • '.
Expiration' • • • . • ••
• Date: •
bsuc
• Date,
•••
• Admnis*ntive Aulhmity.'.