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Home My WebLink About710 Crossway Road - PW23-0100 - Standard501 PRIMROSE ROAD, BURLINGAME, CA 94010 CITY OF BURLINGAME Public Works Department STREET AND PUBLIC RIGHT-OF-WAY ENCROACHMENT PERMIT WORK LOCATION ADDRESS: 710 CROSSWAY RD OWNER: SFARD BENJAMIN B & POLINA APPLICANT'S NAME Lindsay Breithaupt ADDRESS 859 Clayton Street #1 CITY/STATE/ZIP San Francisco/CA/940117 PHONE (404)388-9120 CONTRACTOR'S NAME ADDRESS CITY/STATE/ZIP // PHONE CALIFORNIA CONTRACTOR LICENSE BURLINGAME BUSINESS LICENSE NO.U.S.A. (800-227-2600) REFERENCE NO. REFUND BOND TO: □ CURB 558-7230 □ FIRELINE 558-7600 □ STORMDRAIN 558-7230 □ CURB/GUTTER 558-7230 □ SEWER 558-7670 □ WATER SERVICE 558-7676 □ DRIVEWAY 558-7230 □ SIDEWALK 558-7230 □ OTHER 558-7676 Parking for a move - 2 Space 1 Day - 04/01/2023 ALL TRAFFIC LANE CLOSURES MUST BE APPROVED BY THE PUBLIC WORKS DEPT. PEAK HOUR RESTRICTION WILL APPLY TO MAJOR ROADWAYS. CONSULT WITH PARK DEPT. BEFORE CUTTING ROOTS OVER 2" IN DIAMETER -650/558-7330. NO EXCAVATIONS OVER 5' WITHOUT OSHA PERMIT. WORK IN ACCORDANCE WITH STD DRAWING # □ BUILDING PLANS □ SPECIAL PERMIT □ PARKING STRIP PAVING PERMIT. CITY BUSINESS LICENSE AND STATE LICENSE IS REQUIRED FOR ALL WORK DONE BY A CONTRACTOR. I AGREE THAT CONSTRUCTION WORK SHALL BE DONE IN ACCORDANCE WITH CURRENT BURLINGAME CITY STANDARDS, WITH 24 HOURS MINIMUM NOTICE TO THE CITY PRIOR TO START OF WORK AND 24 HOURS PRIOR TO EACH REQUIRED INSPECTION. FINAL SURFACE REPLACEMENT SHALL BE COMPLETED WITHIN 10 DAYS OF OPENING. REFUND OF DEPOST WILL BE MADE AFTER FINAL INSPECTION APPROVAL. CALL 650/558-7230 IF DEPOSIT REFUND NOT RECEIVED IN 30 DAYS. PERMIT INVALID 30 DAYS AFTER EST. COMPLETION DATE. EST. START DATE EST. COMPLETION DATE SIGNATURE (OWNER/AGENT)TITLE REPRESENTING DATE PRINT NAME AS WRITTEN DO NOT WRITE BELOW THIS LINE - FOR USE OF CITY STAFF ONLY PERMIT FEE: □ BOND IS REQUIRED □ BOND IS NOT REQUIRED $59.00 □ EXCAVATION IN UNIMPROVED STREET OR EASEMENT □ EXCAVATION IN IMPROVED STREET OR EASEMENT FUND & RECEIPT NO. REQUIRED RESTORATION APPROVED BY:AREA OF EXCAVATION: LENGTH 0 X WIDTH 0 =0 S.F. LC BOND AMOUNT: FUND & RECEIPT NO. DATE: 03/13/2023 □ BOND NO. □ INSPECTIONS REQUIRED BY: OTHER INSPECTED BY DATE BOND REFUNDED BY AMOUNT $0.00 DATE PERMIT NO: PW23-0100 3/23/2023Lindsay Breithaupt Cash Register Receipt City of Burlingame Receipt Number B41915 DESCRIPTION ACCOUNT QTY PAID PermitTRAK $59.00 PW23-0100 PW-PARKING Address: 710 CROSSWAY RD APN: 029051210 $59.00 Owner: SFARD BENJAMIN B & POLINA Applicant: Lindsay Breithaupt Construction Cost: $0 Job Description: Parking for a move - 2 Space on 04/01/2023 ENCROACHMENT PERMITS $59.00 PARKING PERMIT PW0301 101310 43301 91 0 $59.00 TOTAL FEES PAID BY RECEIPT: B41915 $59.00 Printed: Thursday, March 23, 2023 10:16 AM Date Paid: Thursday, March 23, 2023 Paid By: Lindsay Breithaupt Pay Method: ONLINE CC 03795C 1 of 1 Cashier: LC 3/23/23, 3:21 PM PW Reviews Application https://burweblink.burlingame.org/Forms/form/submission/history/7799/17198?hideHeader=true 1/4 City of Burlingame Street and Public Rightof Way Encroachment Permit Application Permit fees will be assessed according to the master fee schedule in effect at the time the permit is issued. Review Public Works Procedures Initial* Check All that Apply*(?) Description of work: How many parking spaces do you need? Initial below after you have reviewed the Public Works Encroachment Permit Procedures, Conditions for Issuance, and Standards for Insurance. LBB What kind of work are you seeking to perform in the public right of way? Parking Sewer Test Sewer Lateral Replacement Remove and Replace Utilites for new residence or construction Sidewalk/Curb & Gutter/Driveway Curb Drain Water Service PG&E Permit Telecommunications Utility Permit Fire Service Sidewalk Closure Traffic Control Other Temporarily reserve parking spaces for a moving truck (Moving from San Francisco to Burlingame) All construction work shall be done in accordance with the most current City of Burlingame Municipal Codes, City Standard Details and Specifications, APWA-AGC Standard Specifications for Public Works Construction, and the California Stormwater Quality Association’s Stormwater Best Management Practice Handbook. (each space is 25 ft.) 2 3/23/23, 3:21 PM PW Reviews Application https://burweblink.burlingame.org/Forms/form/submission/history/7799/17198?hideHeader=true 2/4 Start Date End Date Work Location Street Number * Work Location Street Name * Applicant's Name* Is the work address the same as your home address? Applicant's Address Applicant's Email * Applicant Phone Number* Timeline 4/1/2023 4/1/2023 Work Information 710 Crossway Road Lindsay Yes No City San Francisco State / Province / Region CA Postal / Zip Code 94117 Country USA Street Address 859 Clayton Street Address Line 2 Apartment #1 lindsay.breithaupt@gmail.com 4043889120 3/23/23, 3:21 PM PW Reviews Application https://burweblink.burlingame.org/Forms/form/submission/history/7799/17198?hideHeader=true 3/4 Is a contractor is working on your project? Is there sidewalk work on your project? Provide drawing(s), traffic control plans or approved plans of proposed work including, but not limited to location and dimensions of all affected area within the public right-of-way per the requirements outlined in encroachment permit procedures and conditions for issuance. Please upload proof of insurance. Insurance Who shall we refund the bond to if needed? Signature Yes No Yes No Uploads Insurance Upload Public Works staff may require additional documentation such as a certificate of insurance prior to the issuance of an encroachment permit. Click here for the standards of insurance. Refunds and Signatures Lindsay Breithaupt In Submitting This Application, I/We Agree To Accept And Comply With All Procedures And Conditions Set Forth In This Permit Application, And Agree That Said Procedures And Conditions Shall Be Binding On Permittee(S), Contractors And Subcontractors Performing The Work, Co- Owners, Heirs, Assigns, Transferees And Successors Of Interest Of Every Nature. I/We Agree To Save, Keep, And Hold Harmless, Indemnify And Defend The City Of Burlingame, Its Officers, Employees, Authorized Agents From Any And All Damages, Claims, Liabilities, Penalties, Cost, Or Expense In Law Or Equality That May At Any Time Arise, Result From, Related To, Or Be Set Up Because Of Damages To Property Or Personal Injury Received By Reason Of, In Whole Or In Part, The Negligence, Recklessness, Or Willful Misconduct Of My/Our Officers, Employees, Contractor, Subcontractor, Or Agents. I/We Hereby Affirm Under Penalty Of Perjury That The Above Information Is True To The Best Of My Knowledge. 3/23/23, 3:21 PM PW Reviews Application https://burweblink.burlingame.org/Forms/form/submission/history/7799/17198?hideHeader=true 4/4 Date * Date Permit Issued APN Number PW Permit Number Bond Refunded Date-finaled 3/13/2023 3/23/2023 029051210 PW23-0100