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HomeMy WebLinkAboutLD24-3653Permit Number: LD24-3653 LD - Utilities/ Excavation - Parallel Issued: 10/14/2024 Expired: 04/12/2025 Job Address: 27622 Jefferson Ave Legal Description: City of Temecula - Land Development Division 41000 Main Street - Temecula, CA 92590 Mailing Address: P.O. Box 9033 Temecula, CA 92589-9033 Phone: (951) 308-6395 Fax: (951) 694-6475 Stephen Wade 7337 Central Ave Riverside, CA 92504 Applicant: Veronica Barrozo 2042 S. Grove Ave Ontario, CA 91761 (909) 721-3785 Contractor: Utility Work Order Number: PID_5530551 Description: Charter PID 5530551 WORK HOURS SHALL BE SUNDAY – THURSDAY, NO HOLIDAYS, 9:00pm – 5:00am Location: Jefferson Ave and Overland Dr Proposed work: Tie into vault; rod and rope 8' through existing underground conduit to target location as shown on "SOW MAP, LD24-3653" All facilities shall be installed in accordance with City Standard Drawing 117. Traffic Control shall be in accordance with approved Traffic Control Plan LD24-3653 Permittee shall comply with all applicable Traffic Control General Notes. Safe pedestrian/bicycle traffic and driveway access shall be maintained at all times. Concrete repair shall be in accordance with City Standards and the Greenbook. Trench repair shall be in accordance with City Standard Drawing 407. Final compaction test results shall be provided by a soils engineer. Concrete curbs, walks, gutters, cross gutters and driveway approaches damaged during construction shall be removed from joint to joint and reconstructed in accordance with City Standards and the Greenbook. All disturbed landscaping and other improvements shall be removed/repaired and replaced to the satisfaction of the City Engineer or their designated assignee. Permittee shall contact LDInspections@temeculaca.gov a minimum of two (2) business days prior to any work. Page 1 of 3*****See Page 2 of this Permit for Permittee Responsibilities***** Permit Number: LD24-3653 LD - Utilities/ Excavation - Parallel Permittee must also request a final inspection to verify completion of project. Permittee Responsibilities This Permittee 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. Trench repair shall be pursuant to City of Temecula Standard Drawing No. 407. 3.Traffic control devices shall be utilized to protect and control pedestrian and vehicular traffic in the construction area in accordance with the latest revision of the “Manual of Uniform Traffic Control Devices for Streets and Highways” (MUTCD). The contractor shall submit a specific traffic control plan for review and approval by the City in accordance with City “Traffic Control Plan Guidelines” for all work within Major Circulation Element streets. 2.BEFORE YOU DIG - CALL (TOLL FREE) 800-422-4133 A pre-construction meeting is required two (2) business days prior to any scheduled work. Permittee shall contact LDInspections@TemeculaCA.gov to schedule a meeting. 1. 4. Water Quality: Contractor shall remain in compliance with the City Water Pollution Control Ordinance. Contractor is required to provide protection of the City storm drain system. 5. Work hours shall be limited between 7:30 AM and 4:30 PM, Monday through Friday, unless otherwise noted. No work shall be allowed during City-recognized holidays." 6. THIS PERMIT IS ISSUED AND ACCEPTED SUBJECT TO THE FOLLOWING CONDITIONS AND ANY ATTACHED PROVISIONS: All U.S.A. mark outs shall be removed prior to completion of project.7. 8.All contractors and subcontractors shall have a valid City of Temecula business license and valid Certificate of Liability prior to start of work. 9.Should there be any claim against the City and the property owner with the encroachment being the proximate cause, the property owner shall be notified in writing to remove the encroachment within 30 days or the City will remove and bill the owner. 10.Permission is hereby requested to encroach into public right of way to perform work as set forth above. It is understood that this permit is limited to the work described herein and that all work is to be done in compliance with the provisions attached to this permit and with all other applicable rules. Permittee shall be responsible for said compliance, for acceptability of the work, for repair or replacement thereof if defective, and for repair or replacement of any existing improvement damaged by the doing of the work I hereby certify and agree on behalf of the Permittee that all laws, regulations and ordinances of the City of Temecula and the State of California and the terms and conditions of the Permit shall be complied with whether herein stated or not. 11. 12.I hereby warrant and represent to the City that I am authorized to execute this Permit Application on behalf of the Permittee and bind the Permittee to the agreements contained herein and any conditions of the Permit. ******Contractor and all subcontractors shall be present at the pre-construction meeting; otherwise, the meeting will be rescheduled to a later date****** Any work commencing within the City right-of-way before permit issuance or a pre-construction meeting shall be subject to a 72-Hour suspension of said work and an assessment of double permit fees.13. Permitee Date Page 2 of 3 Permit Number: LD24-3653 LD - Utilities/ Excavation - Parallel City Engineer or Authorized Representative Date 10/14/2024 Page 3 of 3 WORK DURATION: 2 DAYS WORK HOURS: MONDAY-FRIDAY 8:30AM TO 3:30PM TRAFFIC CONTROL CONSTRUCTION NOTE: CONTRACTOR TO MAINTAIN MIN. 4' CLEARANCE IN ORDER TO MEET ADA REQUIREMENTS OR PROVIDE FLAGGER TO ESCORT PEDESTRIANS THROUGH WORK AREA AT ALL TIMES. D DRIVEWAY DELINEATOR DETAIL CONTRACTOR WILL PROVIDE ACCESS TO DRIVEWAYS IN WORK AREA DURING ALL WORK HOURS AS SHOWN. STREET SW UNDERGROUND SERVICE ALERT CA L L B E F O R E YO U D I G ! Call:TOLL FREE 811 www.call811.com TWO WORKING DAYS BEFORE YOU DIG A* 25 30 35 40 45 50 100 250 250 250 350 350 125 180 540 600 65 90 125 160 270 300 45 60 85 110 180 200 160 205 260 315 380 450 SPEED "S" MPH 55 500 660 330 220 520 60 500 720 360 240 600 50 60 70 80 90 25 30 35 40 45 50 50 50 100 100 100 (2) 245 320 TABLE "A" * FOR 12' LANE WIDTH. IF LANE IS WIDER THEN 12', THE L, 1/2L & 1/3L SHALL INCREASE PROPORTIONATELY. RECOMMENDED TAPER, BUFFER AND SIGN SPACING SIGN SPACING FT B* MERGING FT C* SHIFTING FT D* SHOULDER FT E* BUFFER SPACE FT MAXIMUM CHANNELIZER SPACING FT MAXIMUM CHANNELIZER SPACING FT TAPER L TAPER 1/2 L TAPER 1/3 L TAPER TANGENT 65 500 780 390 260 685 50 100 PUBLIC WORKS - TRAFFIC ENGINEERING DIVISION CITY OF TEMECULAENGINEER'S INFORMATIONENGINEER'S SEAL TRAFFIC CONTROL PLANS TEMECULA, CA 92590 CONTRACTOR: PROJECT ID: 5530551 27622 JEFFERSON AVE CHARTERSpectrum LEGEND FACE OF CURB EDGE OF PAVEMENT LANE STRIPING X X X RIGHT OF WAY CENTERLINE FENCE RAILROAD PROPOSED CONDUIT WORK ROAD EX. CONDITIONS LINETYPESDESCRIPTION WORK LOCATION TRAFFIC CONE BARRICADE FLASHING ARROW SIGN DIRECTIONAL ARROW HIGH LEVEL WARNING DEVICE TRUCK LOCATION FLAGGER SYM RECOMMENDED BY: DATE: ACCEPTED BY: DATE: R.T.E. NO. ERICK ESCOBEDO TRAFFIC ENGINEER 2042 S GROVE AVE ONTARIO, CA 91761 PROJECT DESIGN: VICTOR PARRA PHONE 909-393-3322 EMAIL: DG-HHSDESIGN@CONGRUEX.COM HHS CONGRUEXʞ KCUE| TRAFFIC CONTROL PLAN GENERAL NOTES 1. ALL TRAFFIC CONTROL DEVICES SHALL CONFORM TO THE LATEST EDITION OF THE CALIFORNIA MANUAL ON UNIFORM TRAFFIC CONTROL DEVICES (CALIFORNIA MUTCD) AND THE STANDARD SPECIFICATIONS FOR PUBLIC WORKS CONSTRUCTION. 2. THE CITY ENGINEER OR HIS REPRESENTATIVE HAS THE AUTHORITY TO INITIATE FIELD CHANGES TO ASSURE PUBLIC SAFETY. 3. ALL TRAFFIC CONTROL DEVICES SHALL BE REMOVED FROM VIEW WHEN NOT IN USE. 4. WORK HOURS SHALL BE RESTRICTED TO THE PERIOD BETWEEN 8:30 A.M. AND 3:30 P.M., MONDAY THROUGH FRIDAY, UNLESS APPROVED OTHERWISE. WHEN NIGHT WORK IS REQUIRED, WORK HOURS SHALL BE 9 P.M. TO 5 A.M., SUNDAY THROUGH THURSDAY. 5. TRENCHES MUST BE BACK FILLED OR PLATED DURING NON-WORKING HOURS. STEEL PLATES SHALL HAVE ASPHALTIC CONCRETE BERM ON ALL EDGES. ALL DIRT, DUST, AND DEBRIS SHALL BE REMOVED FROM STREET AT END OF EACH DAY AND AT THE END OF THE JOB. THE STREET SHALL BE IN DRIVABLE CONDITION AT ALL TIMES. 6. PEDESTRIAN CONTROLS SHALL BE PROVIDED AS SHOWN ON THE PLANS. 7. TEMPORARY "NO PARKING" SIGNS WILL BE POSTED 24 HOURS PRIOR TO COMMENCING WORK. 8. ACCESS TO DRIVEWAYS WILL BE MAINTAINED AT ALL TIMES UNLESS OTHER ARRANGEMENTS ARE MADE. 9. THE CONTRACTOR SHALL REPLACE WITHIN 72 HOURS, ALL TRAFFIC SIGNAL LOOP DETECTORS DAMAGED DURING CONSTRUCTION. 10. THE CONTRACTOR SHALL REPLACE WITHIN 24 HOURS, ALL STRIPING REMOVED OR DAMAGED BY CONSTRUCTION WORK. (STRIPING MAY BE REPLACED TEMPORARILY WITH TAPE.) 11. ALL WORKERS SHALL BE EQUIPPED WITH AN ORANGE VEST (OR A REFLECTIVE VEST AT NIGHT). ALL FLAGGERS SHALL ALSO BE EQUIPPED WITH A HARD HAT, C28 "STOP/SLOW" PADDLE AND SHALL BE TRAINED IN THE PROPER FUNDAMENTALS OF FLAGGING TRAFFIC. 12. ANY WORK THAT DISTURBS NORMAL TRAFFIC SIGNAL OPERATIONS SHALL BE COORDINATED WITH THE CITY OF TEMECULA’S TRAFFIC DIVISION, 48 HOURS PRIOR TO BEGINNING CONSTRUCTION. CONTACT THE CITY’S TRAFFIC DIVISION AT (951) 694 -6411. 13. THE CONTRACTOR SHALL MAINTAIN ALL TRAFFIC CONTROL DEVICES 24 HOURS PER DAY AND 7 DAYS PER WEEK. 14. A MINIMUM OF TWELVE (12) FOOT TRAVEL LANES MUST BE MAINTAINED UNLESS OTHERWISE APPROVED BY THE DEPARTMENT OF PUBLIC WORKS. 15. ALL NIGHT WORK WILL REQUIRE WRITTEN APPROVAL FROM THE DEPARTMENT OF PUBLIC WORKS. LANE CLOSURES, ROAD DETOURS, ROAD CLOSURES, AND TRAFFIC SIGNAL MODIFICATIONS ASSOCIATED WITH OVERNIGHT CONSTRUCTION ACTIVITIES WILL REQUIRE WARNING SIGNS BE PLACED AT LEAST ONE WEEK IN ADVANCE OF STARTING CONSTRUCTION. 16. A SOLAR POWERED FLASHING ARROW BOARD SHALL BE REQUIRED ON ALL ARTERIAL STREET LANE CLOSURES. 17. IF THE PERMIT APPLICANT DETERMINES THAT CONDUIT INSTALLATION WILL BE BY THE BORING MACHINE METHOD, THE TRENCH PATCH FOR THE UTILITY OBSERVATION EXCAVATION WILL BE THE SAME AS FOR OPEN TRENCH EXCAVATION METHOD. THIS WILL PROVIDE A SINGLE CONTINUOUS SURFACE RESTORATION ELIMINATING THE MULTIPLE PENETRATION INTO THE PUBLIC ROADWAY TO ALL REQUIREMENTS IN CITY STANDARD DRAWING # 407 (ALL SHEETS) FOR TRENCH PATCH. 18. ANY WORK THAT CREATES AN UNDUE SAFETY RISK OR CREATES SEVERE CONGESTION MAY BE SHUT DOWN BY CITY TRAFFIC ENGINEERS, CITY FIELD INSPECTION, OR THE POLICE DEPARTMENT. 19. CONES AND DELINEATORS SHALL HAVE REFLECTORIZED SLEEVES FOR NIGHT WORK. 20. IF PARKING IS ALLOWED IN ADVANCE WARNING AREA, ADVANCE WARNING SIGNS SHALL BE MOUNTED ON HIGH LEVEL DEVICES. AH E AD HIGH LEVEL WARNING DEVICE (HLWD) POST TUBE TRAFFIC CONE CHANGEABLE MESSAGE SIGN TRAILER (TYP.) FLASHING ARROW SIGN TRAILER (TYP.) (FAS)(CMS) MISCELLANEOUS DEVICES SLOW VICINITY MAP N.T.S. N.T.S. WARNING SIGNS MUTCD [FEDERAL HIGHWAY ADMIN.] DESIGNATION (TYP) DETOUR M4-8 C9A(CA) C28A(CA) W1-6L W1-3 TO STOP PREPARED BE W3-4 W4-1L W4-2R W4-2R W5-1 ROAD NARROWS W6-4 W6-3 ENDS W8-3 PAVEMENT SHOULDER W8-4 SOFT GRAVEL W8-7 LOSE ROAD W8-8 ROUGH W9-3 CLOSED CENTER AHEAD LANE W1-8R XX MPH W13-1 W20-3 ROAD CLOSED AHEAD W20-4 ONE LANE ROAD AHEAD W20-5L LEFT LANE CLOSED AHEAD RIGHT W21-1A OIL W21-2 FRESH W21-2 ROAD MACHINERY AHEAD SHOULDER WORK W21-5 SURVEY CREW W21-6 WORK UTILITY AHEAD W21-7 ROAD WORK END G20-2 END DETOUR M4-8A END DETOUR M4-8A DETOUR M4-10R C12(CA) NARROW LANE C27(CA) OPEN TRENCH STOP C28A(CA) SLOW C30(CA) LANE CLOSED W1-4 W20-2 DETOUR AHEADWORK ROAD AHEAD W20-1 W12-1 W1-2 W1-1 R4-7 STOP R3-4 R3-2R3-1 R3-1 R3-18 R3-6 TURN RIGHT M U S T RIGHT LANE R3-7R TURN RIGHT M U S T RIGHT LANE R3-7R R3-17 BIKE LANE ENDS AHEAD R3-17B R3-17A R3-18 R4-1 DO NOT PASS BEGIN RIGHT TURN LANE YIELD TO BIKES R4-4 R4-7A KEEP RIGHT R4-7B KEEP RIGHT R5-6 R9-3 R9-9 CLOSED SIDEWALK USE OTHER SIDE SIDEWALK CLOSED R9-10 CROSS HERE R9-11L SIDEWALK CLOSED AHEAD CROSS HERE SIDEWALK CLOSED R9-11AR ROAD CLOSED R11-2 R11-2 R11-2 ROAD CLOSED LOCAL TRAFFIC ONLY AHEAD ROAD CLOSED TO THRU TRAFFIC REGULATORY SIGNS NOTES TEMP. NO PARKING SIGNS WHERE AFFECTED 72 HOURS PRIOR TO WORK. MAINTAIN DRIVEWAY ACCESS AS CONSTRUCTION ALLOWS. MAINTAIN MINIMUM 12' TRAVEL LANE WIDTH. FLAGGERS ARE TO ASSIST DRIVERS EXITING DRIVEWAYS WHEN WORK ACTIVITY MAY IMPAIR VIEW OF APPROACHING VEHICLES AND PEDESTRIANS THROUGH WORK ZONES WHERE SIDEWALK IS AFFECTED. SW 27622 JEFFERSON AVE SOW ROD & ROPE 8' OF EXISTING UNDERGROUND CATV CONDUIT. WORK AREA 1 2 LD24-3653 300224HR CONTACT: MARTIN GOMEZ 714-356-0859 12/31/2025 DEOFIDE GROUP, INC. PO BOX 722765, San Diego, CA 92172 engineering@deofide.com (858) 603-4881 WORK HOURS SUNDAY - THURSDAY 9:00 PM - 5:00 AM 10/10/24 10/10/20 24 D O V E R L A N D D R 4 0 M . P . H . M E D I A N JEF F E R S O N A V E 40 M . P . H . D O V E R L A N D D R 3 0 M . P . H . 3 2 0 ' T A P E R 3 1 5 ' B U F F E R 250' 5 0 ' W O R K A R E A 250' 2 5 0 ' SIDE W A L K PARK W A Y FOC FOCROW ROW F O C F O C R O W R O W FOC FOCROW ROW PAR K W A Y PARK W A Y P A R K W A Y S I D E W A L K B I K E L N S I D E W A L K S I D E W A L K P A R K W A Y S I D E W A L K B I K E L N M E D I A N V WORK ROAD AHEAD W20-1 ROAD WORK END G20-2 WORK ROAD AHEAD W20-1 ROAD WORK END G20-2 WORK ROAD AHEAD W20-1 ROAD WORK END G20-2 1 0 0 ' O P E N I N G C30(CA) LANE CLOSED C30(CA) LANE CLOSED C30(CA) LANE CLOSED TURN RIGHT M U S T RIGHT LANE R3-7R TURN RIGHT M U S T RIGHT LANE R3-7R W12-1 CLOSED BIKE SC11 (MOD) LANE C30(CA) LANE CLOSED P A I N T E D M E D I A N P A I N T E D M E D I A N P A I N T E D M E D I A N P A I N T E D M E D I A N J E F F E R S O N A V E 4 0 M . P . H . S I D E W A L K B I K E L N S I D E W A L K B I K E L N S I D E W A L K S I D E W A L K B I K E L N S I D E W A L K B I K E L N S I D E W A L K B I K E L N 12' 8' 8'12' 12' 8'10' 14' 12' 8' 12' 12' 18' 1 2 ' M I N 1 2 ' M I N 1 2 ' M I N 1 2 ' M I N D D 3 2 0 ' T A P E R 1 1 0 ' B I K E L A N E T A P E R 2 5 0 ' 2 5 0 ' 2 5 0 ' F O C F O C R O W R O W WORK ROAD AHEAD W20-1 ROAD WORK END G20-2 CLOSED AHEAD C20(RT) RIGHT LANE W4-2R W11-1 W16-1 W11-1 ASSEMBLY SHARE THE ROAD CLOSED AHEAD C20(BIKE) BIKE LANE W1-6L CLOSED BIKE SC11 (MOD) LANE S I D E W A L K B I K E L N S I D E W A L K B I K E L N J E F F E R S O N A V E 4 0 M . P . H . P A I N T E D M E D I A N P A I N T E D M E D I A N P A I N T E D M E D I A N S I D E W A L K B I K E L N S I D E W A L K B I K E L N S I D E W A L K B I K E L N S I D E W A L K B I K E L N 8' 12' 1 2 ' M I N 12' 8' 81 1 2 ' M I N WORK DURATION: 2 DAYS WORK HOURS: MONDAY-FRIDAY 8:30AM TO 3:30PM TRAFFIC CONTROL CONSTRUCTION NOTE: CONTRACTOR TO MAINTAIN MIN. 4' CLEARANCE IN ORDER TO MEET ADA REQUIREMENTS OR PROVIDE FLAGGER TO ESCORT PEDESTRIANS THROUGH WORK AREA AT ALL TIMES. D DRIVEWAY DELINEATOR DETAIL CONTRACTOR WILL PROVIDE ACCESS TO DRIVEWAYS IN WORK AREA DURING ALL WORK HOURS AS SHOWN. STREET SW UNDERGROUND SERVICE ALERT CA L L B E F O R E YO U D I G ! Call:TOLL FREE 811 www.call811.com TWO WORKING DAYS BEFORE YOU DIG PUBLIC WORKS - TRAFFIC ENGINEERING DIVISION CITY OF TEMECULAENGINEER'S INFORMATIONENGINEER'S SEAL TRAFFIC CONTROL PLANS TEMECULA, CA 92590 CONTRACTOR: PROJECT ID: 5530551 27622 JEFFERSON AVE CHARTERSpectrum LEGEND FACE OF CURB EDGE OF PAVEMENT LANE STRIPING X X X RIGHT OF WAY CENTERLINE FENCE RAILROAD PROPOSED CONDUIT WORK ROAD EX. CONDITIONS LINETYPESDESCRIPTION WORK LOCATION TRAFFIC CONE BARRICADE FLASHING ARROW SIGN DIRECTIONAL ARROW HIGH LEVEL WARNING DEVICE TRUCK LOCATION FLAGGER SYM 24HR CONTACT: MARTIN GOMEZ 714-356-0859 RECOMMENDED BY: DATE: ACCEPTED BY: DATE: R.T.E. NO. TRAFFIC ENGINEER 2042 S GROVE AVE ONTARIO, CA 91761 PROJECT DESIGN: VICTOR PARRA PHONE 909-393-3322 EMAIL: DG-HHSDESIGN@CONGRUEX.COM HHS CONGRUEXʞ KCUE| VICINITY MAP N.T.S. N.T.S. NOTES TEMP. NO PARKING SIGNS WHERE AFFECTED 72 HOURS PRIOR TO WORK. MAINTAIN DRIVEWAY ACCESS AS CONSTRUCTION ALLOWS. MAINTAIN MINIMUM 12' TRAVEL LANE WIDTH. FLAGGERS ARE TO ASSIST DRIVERS EXITING DRIVEWAYS WHEN WORK ACTIVITY MAY IMPAIR VIEW OF APPROACHING VEHICLES AND PEDESTRIANS THROUGH WORK ZONES WHERE SIDEWALK IS AFFECTED. SW 27622 JEFFERSON AVE SOW ROD & ROPE 8' OF EXISTING UNDERGROUND CATV CONDUIT. WORK AREA 2 2 SEE A B O V E R I G H T "A" M A T C H L I N E " A " SEE B E L O W L E F T "A" M A T C H L I N E " A " LD24-3653 ERICK ESCOBEDO 3002 12/31/2025 DEOFIDE GROUP, INC. PO BOX 722765, San Diego, CA 92172 engineering@deofide.com (858) 603-4881 WORK HOURS SUNDAY - THURSDAY 9:00 PM - 5:00 AM 10/10/24 10/10/20 24 SOW Map CHARTER COMMUNICATIONS CONSTRUCTION SURVEY Statement of Work (SOW) Map & Details Detail from Right Of Way to Interior MPOE/demarc in or at the premises. Insert SOW Map & Details A SOW must include a detailed map, Google Earth and/or ground level pictures or layout, and a detailed description of what work will be done that can be presented to the owner to detail what work will happen/occur on their property, as in building entry, or any other kind of disturbance to their property, while showing the physical route of Charter's proposed plant. When needed, SOW information is used to help in obtaining an ROE (Right of Entry). SOW MAP TIE IN POINT TARGET LOCATION EXISTING POLE TELCO MAN HOLE PLACE NEW VAULT TELCO VAULT EXISTING PED Y - CAST EXISTING VAULT PID_5530551_27622 JEFFERSON AVE_SOW LD24-3653APPLICANT SHALL COMPLY WITH ALL CITY OF TEMECULA UTILITY PLAN GENERAL NOTES CLEARED BY CITY OF TEMECULA PUBLIC WORKS Tricia.ortega 09/24/2024 09/24/2024 09/24/2024 09/24/20 SOW Map CHARTER COMMUNICATIONS CONSTRUCTION SURVEY Statement of Work (SOW) Description Detail from Right Of Way to Interior MPOE/demarc in or at the premises. *IF MTU, detailed description MUST contain Entire Building Layout, Rack, and Power Locations* SOW DESCRIPTION PID_5530551_27622 JEFFERSON AVE_SOW ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD WVD DATE (MM/DD/YYYY) PRODUCER CONTACT NAME: FAXPHONE (A/C, No):(A/C, No, Ext): E-MAIL ADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGG $JECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person)$ OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ DED RETENTION $$ PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. 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). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE Lockton Companies, LLC 444 W. 47th Street, Suite 900 Kansas City MO 64112-1906 (816) 960-9000 kcasu@lockton.com HHS CONSTRUCTION, LLC 2042 S. GROVE AVE. ONTARIO CA 91761 Arch Insurance Company 11150 Hartford Casualty Insurance Company 29424 Hartford Fire Insurance Company 19682 Twin City Fire Insurance Company 29459 X X 1,000,000 300,000 10,000 1,000,000 2,000,000 2,000,000 X X X X $1,000,000 XXXXXXX XXXXXXX XXXXXXX XXXXXXX X X X X 10,000 10,000,000 10,000,000 XXXXXXX XXXXXXX XXXXXXX XXXXXXX C 37 UENOL5831 9/30/2024 9/30/2025 A 37 ECSOL5825 9/30/2024 9/30/2025 B 37XHUOL5832 9/30/2024 9/30/2025 D UXP3000309-01 9/30/2024 9/30/2025 NOT APPLICABLE 9/30/2025 1451971 N N N N N N 9/13/2024 16271358 16271358 XXXXXXX CITY OF TEMECULA 41000 MAIN STREET TEMECULA CA 92590 RE: ALL OPERATIONS PERFORMED BY THE NAMED INSURED DURING THE CURRENT POLICY PERIOD. EXCEPT 10 DAYS NOTICE OF CANCELLATION OF NON-PAYMENT OF PREMIUM; SHOULD THIS POLICY BE CANCELLED BEFORE THE EXPIRATION DATE, LOCKTON COMPANIES WILL MAIL 30 (THIRTY) DAYS WRITTEN NOTICE TO THOSE CERTIFICATE HOLDERS WHICH REQUIRE SUCH ACTION PER CONTRACT OR AGREEMENT. X X Land Development Encroachment Permit 41000 Main Street Temecula, Ca 92590 Phone: 951-694-6444 www.temeculaca.gov R:\LAND DEVELOPMENT DIVISION\Forms\Permit Applications\Word\Encroachment Permit App.docx Page 1 of 2 Revised: 06/16/2020 APPLICATION INFORMATION PERMIT NO.: Type of Encroachment:  Street/Storm Drain  Sewer/Water  Utility Trenching  Signing & Striping  Traffic Signal  Miscellaneous (SPECIFY BELOW) The undersigned hereby applies to excavate, construct and otherwise encroach on City street right-of-way, as follows: Name(s) of street(s) and/or street address: Utility Work Order #: Start Date: End Date: In consideration of granting this application, all applicants including utility companies hereby agree to: 1. If applicable, submit a set of Construction Drawings, Traffic Control Plans, proof of City Business License for all parties involved, proof of Contractor’s License along with this application at the time of submittal. See the Traffic Control Plan Checklist for details. 2. 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. (See below for specific liability insurance requirements.) 3. Remove/relocate any encroachment installed/maintained under this permit, upon written notice from the City Engineer. 4. Notify the Land Development Inspection Division via email at LDInspections@temeculaca.gov at least two (2) working days prior to commencing construction. Hold a pre-construction meeting prior to the start of construction. The developer/general contractor must be present for the timely request of inspections. 5. Comply with the Standard Specifications, most current Improvement Standard Drawings for Public Works Construction, City of Temecula Municipal Code Chapters 13.04 and 18.12, terms and conditions of the permit and all applicable rules and regulations for the City of Temecula and other public agencies having jurisdiction. LIABILITY INSURANCE REQUIREMENTS PROVIDE PROOF OF INSURANCE COVERAGE MEETING THE REQURIEMENTS STATED BELOW OR A CITY ATTORNEY APPROVED EQUIVALENT WITH THE CITY NAMED AS ADDITIONAL INSURED. IN THE EVENT THAT THE INSURANCE IS PROVIDED BY THE CONTRACTOR, THE CITY AND THE OWNER/DEVELOPER MUST BE NAMED AS ADDITIONAL INSURED. THIS REQUREMENT SHALL BE MET BY EITHER THE APPLICANT (DEVELOPER, OWNER, PUBLIC UTILITY AGENCY OR FRANCHISE) OR BY THE CONTRACTOR PERFORMING THE SUBJECT WORK, PRIOR TO BEGININNG ANY WORK PROPOSED UNDER THE SUBJECT ENCROACHMENT PERMIT. x On the E/s of Jefferson Ave tie into existing CATV vault. Rod and rope 8' through existing underground conduit to target location. 27622 Jefferson Ave PID_5530551 09/21/24 09/23/24 LD24-3653 CLEARED BY CITY OF TEMECULA PUBLIC WORKS Tricia.ortega 09/24/2024 09/24/2024 09/24/2024 09/24/20 Land Development Encroachment Permit 41000 Main Street Temecula, Ca 92590 Phone: 951-694-6444 www.temeculaca.gov R:\LAND DEVELOPMENT DIVISION\Forms\Permit Applications\Word\Encroachment Permit App.docx Page 2 of 2 Revised: 06/16/2020 Proof of coverage shall be by certificate (Accord or equivalent) naming the City of Temecula as certificate holder and the minimum limits of insurance coverage shall be as follows: a. General Liability: One million dollars ($1,000,000) per occurrence for bodily injury, personal injury and property damage. If Commercial General Liability Insurance or other form with a general aggregate limit is used, either the general aggregate lim it shall apply separately to this project/location or the general aggregate limit shall be twice the required occurrence limit. b. Automobile Liability: One million dollars ($1,000,000) per accident for bodily injury and property damage. c. Worker’s Compensation as required by the State of California; Employer’s Liability: One million dollars ($1,000,000) per accident for bodily injury or disease. d. Course of Construction: Completed value of the project. There is a limited exception to this requirement. Owners of single family homes doing work on the home’s driveway approac h located in the public right-of-way, may use their homeowners insurance with public liability and property damage coverage in at least the following minimum limits and which will name the City of Temecula as an additional insured for the duration of the encroachment permit: BODILY INJURY $250,000.00 EACH PERSON $500,000.00 EACH OCCURANCE $500,000.00 AGGREGATE PRODUCTS AND COMPLETED OPERATIONS PROPERTY DAMAGE $100,000.00 EACH OCCURANCE $250,000.00 AGGREGATE PRODUCTS AND COMPLETED OPERATIONS A combined single limit homeowner’s policy with aggregate limits in the amount of $1,000,000.00 will be considered equivalent to the required minimum limits. Homeowners: a copy of the required homeowners insurance and a Certificate of Insurance showing the City named as an additional insured shall be attached to the application. The undersigned applicant and/or contractor states that they have read and agrees to meet all the conditions on this application, including provisions of required liability insurance or a City Attorney approved equivalent, and acknowledges that this application will be made a part of the encroachment permit. APPLICANT’S INFORMATION (THIS SECTION MUST BE COMPLETED) Company Name: Mailing Address: Contact: Phone #: E-mail: I hereby warrant and represent to the City that I am authorized to execute this permit application on behalf of the permittee and bind the permittee to the agreements contained herein and any conditions of the permit. Authorized Signature: Date Applied: CONTRACTOR’S INFORMATION Company Name: Mailing Address: Contact: Phone #: 24-HR Emergency #: State Contractor’s License #: Class: City Business License #: Charter Communications, LLC 7337 Central Ave, Riverside, Ca 92504 Stephen Wade 818-427-4947 stephen.wade@charter.com HHS Construction, LLC 2042 S Grove Ave, Ontario, Ca Jess Pyles 909-519-0476 760-953-2095 818906 049178A, C31, C10, B, C-7