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Home My WebLink About2008-124 4- - PUBLIC PROPERTY ENCROACHMENT PERMIT INSPECTION PHONE: CITY OF LAKE ELSINORE Permit No: 2008-124 909-772-5979 - Marc Laroche Public Works Department Effective Date: or 951-674-1344 - message # 130 S. MAIN STREET 7/29/2008 INSPECTION OFFICE SHALL BE NOTIFIED LAKE ELSINORE CA 92530 AT LEAST TWO(2)WORK DAYS PRIOR TO 124 Expiration Date: 951 COMMENCING PERMITTED USE. FAILURE ) 674-3 8/4/2008 TO OBTAIN INSPECTION SHALL VOID THIS PERMIT. Permittee: Edmondson Constr. Contact: Chance Edmondson Address: 581 Birch St, Ste G Contact Phone: i CA 92530 Work Description: Use of City property is hereby authorized as follows,subject to provisions on reverse hereof and attached hereto. Install Drive Approach modified City Std per KAS to match existing condition. Additional Conditions-Restrictions: Traffic Control per W.A.T.C.H Manual/MUTCD or as directed in field by City staff. Existing City sign, tree&sidewalk to remain. Coordinate constr. activityw/PW Inspector. Location: 201 W. Graham (The Chimes) Other ID: Contr.641518ICity 1715 Administrative Fee: 340-20-28 AD (Admin Fee) Account No: 320-30-20 EP (Other) Permit Type: Encroachment Fees: Permit Type: Encroachment Fees: Admin Fee $100.00 $0.00 Driveway-Commercial $110.00 $0.00 $0.00 $0.00 Total Fees: $210.00 Engineer: _ Date: 'z 0( THIS IS YOUR RECEIPT WHEN PERMIT AND APPROVED PLANS SHALL BE MAINTAINED ON JOB SITE. MACHINE VALIDATED PERMITTEES SHALL COMPLY WITH REGULATIONS PRINTED ON REVERSE SIDE OF PERMIT AND ATTACHMENTS. ALL UNDERGROUND WORK REQUIRES PRIOR'UNDERGROUND SERVICE ALERT' COMPLIANCE. CALL USA AT 1-800-422-4133 AT LEAST 48 HOURS PRIOR 70 EXCAVATING. THIS PERM171$Ik LL BE NO(V,-,} r. i OpEr: colfl r_R� Tv.De: PF Drawer: 1 TRANSFERABLE. kpr, --i U�Te, 7i-�l 13 Lb I"=elr no: Hj hL Tii,z ,..If J LYloifday,J :yELLO 2008 -r_ WHITE-PERMITTEE Tr3 [Li�('-FINANCE � `hW-JOB F1L YELLO� INSPECT JRI ryECV 00 Time: h: Trans date: Ti airs :I C1SC. CITY OF^rse—�Rkl. ENGINEERING DIVISION LPL LS1110RE ENCROACHMENT PERMIT APPLICATION DREAM EXTR£ME 130 SOUTH MAIN STREET, LAKE ELSINORE, CA 92530 Phone:951-674-3124, Fax 951-674-8761 CONTRACTOR/ PERMITTEE: c o josoc,� tJS—C COMPANY: �t3 MAILING ADDRESSICITYIZIP: �gr t 2 C.t.ti lJk I Gr �ff 64 2!j 5,C3 TELEPHONE: FAX: ��/ �-- EMAIL: CITY BS. LIC.#: CONTRACTOR'S LIC.#&CLASS: — 24 HOUR CONTACT: PU-CJeC,- 6-• 24 HR CONTACT PHONE. OWNER/DEVELOPER: �Tj/�v�gs� yn MAILING ADDRESSICITYIZIP: TELEPHONE: FAX: EMAIL: � APPLICANT: (If different from owner or contractor) '( �'� MAILING ADDRESSICITY/ZIP: ' TELEPHONE: EMAIL: JOBSITE DETAILS SITE ADDRESS or CROSS STREETS: CZp( G✓ . aa4W" PARCEL/TRACT MAP PROJECT NAME/UTILITY NO.: 3 7 .t ( --7 W.O.#: TL Ci(',i"wk-es ASSESSOR'S PARCEL NO(S): 37- t7 2- 4- 7 Estimated Start Date: `� �j�C ' Estimated Completion Date: Curb LF Paving LF Road/ Lane Closure TYPE OF WORK: Curb Core Qty Sidewalk LF Utility Maintenance Check all that apply&fill Driveway LF Streets LF Traffic Signal in linear feet(LF)/Quantity (Qty)where Gutter LF Storm Drn LF applicable Newsrack Qty Irrigation Pedestal Qty Sewer Lateral LF =Engineer's Estimate:$ DESCRIPTION OF WORK: WengfformslEngineering FormsWPLICATIONMEP APPLICATION.3.08.xIs Page 1 of 2 z y oGb N N Z W N � P 00 C I TY OF 1~4 is 1± ELS:IAiGAE BUSTNFS�""�"T! NT:.: 0 1.30 .`.S• KA•IN STREET till LAKE EL.SIN REj. CA 97,530 LOC AIDOR z 581' BIRCH ST #A- BUS INESS LICENSE ReNEWAL NOTTCL YOUR 5USINESS' LICENSE WILL EXPIRE ON 01/31/08 PAYIMENT MUST BE RECEIVED PRIOR TO 06/15/08 TO AVOTQ Al .Y SE. PR-Qv.ItaE-. A-NY. ! Ct4A iC N`; fN;E S 1 1 h YOUR- AY�.�t�T� ., Irk I ;.Li �YTI: NS. 6EIS •:PE A.. 1Rl~*�';'8U'Si:il`S5 I:IC 'SE.� LF YD ARC 151C�:'LL�f GR 1,t 8I15,iNESS ftASE 14: Tl Dl�l,, Al a � N THIS. �T CE `B1ISI # •, LIIS;E :PRONE ..X2I. : PENALTY j .00 TOTAL 08 tltl001171-� ,, . A� =DMONDSON CONSTRUCTION 22147 Dam 07/1ILJS Amount: x******$133.00 Vendor. CITY OF LAKE ELSINORE Invoice# Job/Description Balance Retain Discount This Check 1715 Business License #1 133. 00 133 . 00 &DEW%E BUSINESS FOAMS 1+800.328.0304 w Aehumtorme.eom CITY OF , LAI-E LSMOPE 130 SOUTH MAIN STREET LAKE ELSINORE,CA 92530 BUSINESS LICENSE CERTIFICATE BUSINESS NAME • : EDMONDSON CONSTRUCTION CTL NBR 1715 PHONE NUMBER • : (951) 674-5589 LOCATION ADDR • 561 BIRCH ST #A LIC NBR/GLASS • 08 00001715 GENERAL ENGINEERING CONTRACTOR ISSUE DATE : 7/20/07 EXPIRATION DATE = 7/30/08 LIC FEE • = 133.00 PENALTY • •00 TOTAL • • : 133.00 EDMONDSON CONSTRUCTION P•0• BOX 101 LAKE ELSINORE CA 92531 POST IN A CONSPICUOUS PLACE i State Of California n. ,CONTRACTORS STATE LICENSE BOARD NA --� ACTIVE LICENSE CO-UCKC Aesim c - EKE CORP ROBERT EDMONDSON INC DBA 5 EDMONDSON CONSTRUCTION CO C12 A —p--a• 04/30/2010 t FROM FAX NO. Jul. 25 2008 01:09PM P1 ACW CERTIFICATE OF LIABILITY INSURANCE DATE(MMMUN"" 07125/2008 PRODUCEk (951)735-Z552 FAX (951)272-9183 TKO CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION! Williams & Franks Insurance Brokers Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Coro S. R 928 Ave. #212 HOLDALTETHE Oy R.THIS AGICATE DOES NOT EAFFORDED BY HEEPOOLIC ES BELOow. Corona, CA 92$79 Horace Williams INSURERS AFFORDING COVERAGE NAIC# INSUPw Ldmon son Construction CO, IN9uRERA Delos Insurance Co. 581 Birch Street #G II�URER B: Lake Elsinore, CA 92530 IN�,RFRc RJSURCR INSURER E: OVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATEa,N4TV1flTHSTANp1NG ANY REQUIREMENT,TERM OR CONDLTION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESpECTTO WHICH THIS CERTIFICATE MAY BE ISSUED A MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AG,REGATE LIMIT$SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSPt D 'L TYPE OF INSURANCE POLICYNUMBER POLI YEFFECTIVE MOWN LlMfrlt 7GEKR LMILITY DPA550115$ 02/05/2008 12/03/2009 EAACHOCCURRENCE $ 1 00(),()001 �( COh'Jf�E RC44L CiENET2/+L LIABI:.ITV DAMAG ,0001 E 6 50 CLAIMS MADE OCCUR MED EXP(Any one person) $ 5 D A PERSONAL&AQV INJURY $ �,.0Q0 0 GEafERAL AGGREGATE $ 2.00D DQ L AGGREGATE LIMITnF'PLIES PER: PRODUCTS•CQMPlOP AGG $ 1 ODO OO S X POLICY PAP LOC ALTMMOScE LIABILMY DPA5501158 12/03/7007 12J03/2008 EaMeccid&l) GLE LIMIT $ X ANY Al,,7o ]. 000 00 ALL UAIZD AUT05 5CHEDULEDAI.TOG BODILY INJURY $ A (Per pewrl) HIRED AUT05 LY INJURY $ NON-OVJNEO ALIPOS BODI{Par ecclderd) f PROPERTY DAMAGE $ fPvr eccldeml OARA4E LIABILRY AUTO ONE Y-EA ACCIDENT $ ANY AUTO OTHER TT PN EA ACC $ AUTO ONLY: AGG $ E%CEU=MBRELLA LIABILrry EACH OCCURRENCE $ OL'CLR CLAIMS.MADE AGGREGATE $ 3 DEDUCTIBLE 117L-NTION $ WORKHtSCOiNPENBATIONAND WC TATII 0 EMPLOYERS'L"ILTTY ANY PROPF.IETORj A57 NER1E>eECUTIVE E.L.EACH ACCIDENT $ OFPICORIMSVOER EXCLLDED? If yyp;,0ewDe Und9r E.L.DISEASE-EA EMPLOYE 3 9PE •CIAL PROVISION5 Delow F.I.DIqEA -POLICY LIMIT $ OTHER DESCFU DNOFO RA 0 I LOC4MW I VEHICLES I EXC UgfGNS ADDED BY ENDO EMENTl9PECIALPROVISIO 9 erti icate o�der, its agents, o fzcers and employees are naMT additional insured. SHOULD ANY OF THE ABOVI<nE$CRIBED POLICIES BE CANCaLLED BEFORE THE EXPIRATION DATE THEREOF,TTE(SSLHNG INSURER WILL ENDEAVOR TO MAIL 30 DAY$WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THL LEFT, City of Lake El S i nOre BUT FAILURE TO MAIL SUCH NOTICE SMALL IMPOSE No osUoAnoN oR UASIL.ITy 130 South Main St r"t OF ANY KIND UPON THE INSURER,ITS AGENTg OR REPREBENTATpMS Lake Ll sinore, CA 92530 AUTHORIZED REPRESENTAYIVE Horace Williams acoRp25(200iros) FAX: (909)674-3I24 ®ACORDCORPORATION I FROM FAX NO. Jul. 25 2008 01:10PM P2 IMPORTANT If the certificate holder is an ADDITIONAL,INSURED,the poiicy(ies)must be endorsed.A statement an this certificate does not confer rights to the certificate holder in lieu of such endorsement(s)- If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement,A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s), DISCLAIMER The Certificate of Insurance on the reverse side of#his farm does not constitute a contract between the issuing insurer(s),authorized representative or producer,and the certificate holder, nor does It affirmatively or negatively amend,mdend or alter the coverage afforded by the policies listed thereon. ACORD 25(2001100) FROM FAX NO. Jul. 25 2008 01:13PM P3 POLICY NUMBER' DPA5501158 COMMERCIAL GENERAL LIABILITY AC 20 37 0707(Blanket) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following. COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) or O anization s : Location And DesCri tion of Com leted Q erattons Blanket as required by written contract. Blanket as required by written contract and Primary Insurance applies: It is agreed that such effective during the policy period as stated in the insurance as is afforded by this policy for the benefit of policy declarations_ the Additional Insured shown shall be primary insurance,and any other insurance maintained by the City of Lake Elsinore, its agents,officers and Additional Insured(s)shall be excess and employees. noncontributory as respects any claim, loss or liability allegedly arising out of the operations of the named insured, provided however that this insurance will not apply to any claim loss or liability which is determined to be solely the result of the Additional Insured's negligence or solely the Additional Insured's responsibility. This insurance also does not apply to any structure with an intended occupancy of a private residence, not including apartments. Information required to complete this Schedule, if not shown above will be shown in the Declarations. Section II-Who Is An Insured is amended to include as an Additional Insured the person or organization shown in the Schedule, but only with respect to liability for"bodily injury"or"property damage"caused, in whole or in part, by"your work"at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the"products-completed operations hazard" AC 20 37 0707(Blanket) 80 Properties, Inc., 2004 Page 1 of 1