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• Cityof Lodi Public Works Department Permit Address 301 West Kettleman Lane - Chevron ENCROACHME�� PERMIT �•. Applicant's Name'Address Gettler-Rvan Inc /Joe Valera (925) 3164 Gold Camp Drive, #240, Rancho Coroova, CA Starting Date 06/07/2000 Completion Date Contractor Norm Porges 06/23/2000 Address License No COL 9960 Date 06/05/2000 Phone (925) 551-7555 Cellular E(916) 631-1316 Phone Exp Cellular Exp Pursuant tp the provisions of the Lodi Municipal Cole the undefsigned apples for permission to exca vale construct andlor otherwise encroach an City SVeel Righl-of Way or Easement by performing the following NOTIFY USA (800) 227-2600 48 HOURS PRIOR TO ANY EXCAVATION Work Description The work consists of on-site work pera raved plans, Building Permit # B2038 traffic control shall be ger approved submitted clans. Installation of SS pipe shall be prior to -proposed off ite imQrovements backfill fine h in sidewalk area shall be 2" AC finish bore b neath curb and-guttert curb r t rn match existing gradt. sidewalk to be closed during installation. "Sidewalk closed" signs required at nearest crosswalks, rr. /V Abandonment of 4"SS shall be per the approved attached correspondence and commp,nce no lat .r than 60 days after the approval of the Regional Water Quality Control Board Applicant will provide City with a cosy of RWQCB approval. Prof f SAI m m r ht re tred(Ticket #0145245) Insurance rtifi to r n w t r vide prior -expiration date irate n of pQIiQ will void the CmE (Sketch) Permit void if work not started within 6 months of permit date Licensed Contractor required for this work Certificate of insurance in the owner's name which names the "City of Lodi its elected and appointed Boards Commissions, Officers, Agents and Employees" as an Additional Named Insured is required for Comprehensive General Aggregate 1n the amount of 51,000 000 per occurrence and Automobile Liability Insurance in the amount of $1 000 000 combined single limit The undersigned does hereby agree to indemnify and save the City of Lodi free and harmless from any liability in accordance with the provisions of See 12 04 040 of the Lodi Municipal Code Pemutlee is spearicalty aware of Sec 12 04 290 thereof relating to me felcrauon or removal of said encroachment of future construction requires such relocation It the work for which this encroachment permit has been issued has not been completed by 0 612 312 00 0 the City of Lodi shall have the right to complete the work and to file a cause of Action to recoup the Citys elope n es m ompleting the work and for ail other costs and fees in accordance vnih t provision c 12 04 120 of the Lodi Murncipal Code Date (2 EL0C,D Signed Required Improvement Security Certification of Insurance Arthur J Gallagher 8r Co Comp Gen Policy No PECO001987 Exp Automotive Policy No PPP043160802 Exp Other Policy Exp Referred to Tom Hathaway 333-6773—,, Date Inspected _ Date Completed Date Reviewed Date This permit is granted sublect to all provisions of Chapter 12 04 of the Lodi Municipal Code and to all general provisions and applicable special provisions as Show on the attached sheet Permit Approved CI 01+ LODI By ❑ P lc Above Ground Date ❑ Public Underground JPrivateto be maintained or relocated by owner as required ❑ other Permit No 20103 f Inspector Copy r- File Copy ❑ Permittee Copy Pee $24100 PWD 002 (Rev 6157)