Costa Mesa Municipal Code § 15-27 Form of application

Applications for permits required by this chapter shall be filed with the city engineer upon printed forms to be prescribed and supplied by him. The application shall be signed by the applicant and shall state:

(a) The name and address of the applicant.

(b) The location, nature, purpose and extent of the proposed obstruction.

(c) The time during which it is estimated that the excavation, fill or obstruction will exist.

(d) That the applicant, if his permit is granted agrees to indemnify, protect, defend and hold harmless the city, its elective and appointive boards, officers, agents and employees from any and all claims, liabilities, expenses or damages of any nature, including attorney fees, for injury to, or death of, any person, and for injury to any property, including consequential damages of any nature resulting therefrom, arising out of or in any way connected with the performance of the work for which the permit is obtained by, or on behalf of, the applicant, including damages resulting or allegedly resulting (1) from concurrent, but not sole, negligence by act or omission by the city, its elective or appointive boards, officers, agents or employees in connection with supervision or direction of the work, and (2) from violation of any statute, law, regulation or other legal requirement concerning a safe and healthful place of employment for workers.

(e) That the applicant agrees that if any tank, pipe, conduit, duct, tunnel or other installation of any nature or kind placed in the excavation, fill or obstruction for which the permit is issued shall at any time in the future interfere with the use, repair, improvement, widening or change of grade of the street, the applicant, or his successors or assignees, within 10 days after receipt of a written notice from the city engineer to do so, will, at his own cost, either remove such tank, pipe, conduit, duct, tunnel or other installation, or, subject to the approval of the city engineer, relocate them to a site which may be designated by the city engineer.

(f) That the applicant has read, understands and will comply with the city standard specification manual of warning signs, lights and devices for use in work upon highways.

(g) Any additional information which the street superintendent may deem necessary for the proper disposition of the application.

(Code 1960, § 7202; Ord. No. 66-9, 3-7-66; Ord. No. 80-2, § 2, 2-4-80)

(a) The applicant shall maintain at all times when performing work in the city right-of-way, appropriate insurance policies, as stipulated in section 15-27.1(b) and (c), covering workers' compensation and public liability and property damage.

(b) To perform Class B permit work the applicant shall comply with the liability insurance requirements described in section 7.3 of the current edition of "Standard Specifications for Public Works Construction." (See section 15-2.) In addition, the insurance coverage provided to the city shall be primary and not contributing with any insurance maintained by the city. Certificates of insurance and any other requested evidence shall be provided to the city for its approval to show compliance with these insurance requirements. No public liability and property damage insurance is required for a Class A permit.

(c) To perform either Class A or Class B permit work, the applicant shall submit a certificate of insurance to verify workers' compensation insurance coverage.

(Ord. No. 80-2, § 2, 2-4-80)