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• <br />City of Lodiv <br />n .r <br />�tixol~�'Public Works••. <br />ENCROACHME10O <br />PERMITc <br />Permit Address 301 West Kettleman Lane - Chevron Date <br />Applicant's Name Address Address Phone <br />Gettler-Ryan Inc /Jose Najera (925) 3164 Gold Camp Drive, #240, Rancho Coroova, CA Cellular <br />Starting Date 06/07/2000 Completion Date 06/23/2000 License No COL 9960 <br />Phone <br />Contractor Norm Porges <br />Address <br />Cellular <br />06/05/2000 <br />(925)551-7555 <br />E(916)631-1316 <br />Pursuant to the provisions of the Lodi Municipal Cede the undersigned applies for permission to excavate construct andlor ethermse encroach on City Street Rrght-0f Way or Easement by <br />performing the fDllUwrng <br />NOTIFY USA (800) 227-2600 48 HOURS PRIOR TO ANY EXCAVATION <br />Work Description <br />The work consists of on-site work Der approved plans. Building Permit #_B2038..traffc control shall be per approved submitted plans. <br />Installation of SS moe shall be Drior to DroDosed off-site Imorovements..backfill <br />finish in sidewalk area shall be 2" AC finish, bore beneath curb and gutter at <br />curb return match existing grade—sidewalk to be closed during installation, <br />"Sidewalk Closed" signs required at nearest crosswalks,- <br />(1.412 <br />rosswalks,_(r.412 <br />Abandonment of 4"SS shall be per the approved attached correspondence and <br />crmmmence_no later than 60 days after the approval of the Regional Water <br />Qualitv Control Board AoDlicant will orovide Qtv with a coDyof RWQCB <br />approval, <br />• Proof of USAlert membership required Jicket #0145245) Insurance certificate <br />renewal to be provided prior to expiration date Expiration of policy will void this <br />permit, <br />(Sketch) <br />Permit void if work not started within 6 months of permit date <br />Z Licensed Contractor required for this work <br />Certificate of insurance in the owner's name which names the `City of Lodi, its elected and appointed Boards, Commissions, Officers, <br />Agents and Employees' as an Additional Named Insured is required for Comprehensive General Aggregate In the amount of $1 000 000 per <br />occurrence and Automobile Liability Insurance to the amount of 51,000 000 combined single limit <br />The undersigned does hereby agree to Indemnify and save the City of Lodi free and harmless born any liability in accordance with the provisions of Sec 12 04 040 of the Lodi Murippal Code <br />Permittee is specifically aware of Sec 12 04 290 thereof relating to the relocation or removal of said encroachment d future construction requires such reloCahOn <br />If the work for which this encroachment perw has been issued has not been completed by 0612312000 the Cly of Lodi shall have the nghi to complete the work and to rile a Cause of <br />Action 10 reCoup the Clys expen sin imp*ting the work and for all 01hef tosM and lees in accordance mth I provision c 12 04 120 of the Lodi Munrapal Code <br />Date F1,7 C� Signed { {/l i <br />i <br />Required Improvement Security <br />Certification of Insurance <br />Arthur J Gallagher & Co <br />Comp Gen Policy No PEC0001987 Exp <br />Automotive Policy No PPP043160802 <br />Other Policy <br />Referred to <br />Inspected <br />Completed <br />Reviewed <br />Tom Hathaway 333-6773\ <br />Exp <br />Exp <br />Date <br />Date <br />Date <br />Date <br />This pem9t u granted subject to all provisions of chapter 12 04 of the Lodi Munidpal Code <br />and to all general provisions and applicable specal pronasions as show on the attached sheet <br />Permit Approved CI OF LODI <br />By <br />- r <br />P tc Above Ground Date <br />Public Underground f <br />Private to De maurirained or reiocafed by owner as requved <br />Other Permit No 20103 <br />Fee $241 00 _ <br />7 Inspector Copy — File Copy (D Permittee Copy PYM.002 (Rev 6197s <br />