HomeMy WebLinkAboutN2017-0274City of Newport Beach IIIIIIIIIIIIII�I[' pI II
4¢ ' 100 Civic Center Drive, Newport Beach, CA 92660 II N 2 0IIII III I IIIII IIIII IIIII4 II
H Permit Counter Phone (949)644-3311
4 Online Inspection Request- www.newportbeachea.gov/Online
Services
Job Address : 18 CANYON FAIRWAY DR NB Thomas:Guide:
Description: INSTALL SEWER CLEAN OUT PER STD 406-L.
Parcel # :
4423-910-8 -
Legal Desc :
N TR 10814 LOT 8
Owner:
DEGRAZIER CAROL & ANTHONY
Phone:
858-527-5661
Address:
18 CANYON FAIRWAY DR
NEWPORT BEACH, CA 92660
Applicant:
WESTERN PACIFIC DEV INC
Phone:
949-278-8937 [
Address :
18552 MACARTHUR BLVD #102
IRVINE CA 92612
Special Cond.: PRE -CONSTRUCTION MEETING REQUIRED
Permit Processing Fee :
$241.00
Sewer Connection :
$0.00
Agreement Fee:
$0.00
4TT Box Cover:
$64.00
Traffic control Plan Check :
$0.00
Total Water Meters :
$0.00
Inspection Fee :
$330.00
Water Meter Connection :
$0.00
Refundable Deposit:
$0.00
Total Water Meter Box:
$0.00
Street Tree Fee :
$0.00
Adjustment :
$0.00
Processed By:
Utilities Approval
Traffic Approval:
General Services Approval
Date:
Date
Date
Date :
_/
/_
Permit No: N2017-0274
Project No : 2639-2015 SGA N N EQ. -
Inspection Requests Phone (949)644-3255
889E6
Contractor: WESTERN PACIFIC DEV INC
Phone: 949-278-8937
Address: 18552 MACARTHUR BLVD #102
IRVINE CA 92612
Contractor State Lic: 882643
License Expire: 08 31, 2018
Business License: BT30038827
Business Expire: 04 30, 2018
Workers' Compensation Insurance - -
Carrier : EXEMPTION ON FILE
Policy No:
W. C. Expire:
MT
Total Fee $635.00
Paid: $635.00
Balance : $0.00
Receipt No:
Other Department: Date : _/ /
Permit Denied gm= Date : _/ /22_
Issued Permit : Date : 6/07
VVUi KbHtC I 1-UK tNUKUA1.n1YIIZN I I MKIVtl I
CITY OF NEWP.ORT•BEAC3H
PUBLIC WoAKS iDEPAkTMENT
_
tman Aaaress: SQ a.n W Vs l �M qC % A -IL cLed- Co e"
Mailing Address: CitylStatelZip:
y so rl a. r,4_ CLni�r I)2. 41 tG o a r+ r k- 8eac,lx, CA
OWNER: a j-"`. I?C- rCa � Phone:
Email Address:
Mailing Address: CitylStatelZip:
�0 c; ovl �� " (� l5e4r_l+ Ot �2tifo O
ALL CONTRACTOR INFORMATION IS REQUIRED -PLEASE COMPLETE
(if different):
Other Phone:
Email Address: eAn 01wGsler rt Pot 'C Af- V • Co r-n
Mailing Address: y CitylStatelZip:
r56 i /�
State Lic ns fV, ber &Cass: City Busines License Number:
rr 4 Expires: I Expires:
WORKERS COMPENSATION INSURANCE - Certificate of Insurance (Section 3800 Labor Code)
Comnanv: Slam 1Fin.oi . Policv No: 01014511 Expires: 201-4-
FOR OFFICE USE ONLY
Special Conditions of Permit:
Utilities: Traffic:
General Services: Other:
Engineering Technician: Public Wo cs cialist:
22 t/userslpbw/sharetllencraachlmasletslepwoMsheelxl / 6 —
Fire: I
31 Permit No.
Public Works Department 949.644-33 '1
r RVJCIi 1 muumcao- �(`�� -, rCR1Y111
O rff)n `;/ n 1 Arm i ([A �Ikf � D`IUMBER: N2017-
Permit Processing Fee:
Public Works Only
Other Department
Agreement Fee:
Preparation of ReporUAgreement
Document Recordation Fee
Monitoring Wells
Street/AlleyNValk Closure:
Traffic Control Plan Check
8-1/2" x 11"
24" x 36"
Additional
$241.00
Inspection Fee:
Public Works Field Inspection
$165.00
$275.00M
Utilities Field Inspection
$121.00
General Services Inspection
$165.00
Water Quality/Artificial Turf Inspection
$108.00
$817.00fEJ
$192.00
Refundable Deposit:
TBD
$502.00
Improvements
TBD
$65.000
Newspaper Rack Inspection
$108.00
$65.00=
Sewer Connection Fee
$250.00
$143.00
4TT Box & Cover
$64.00
Certificate of Compliance Fee (+100%of hrly over 3 hrs)
$288.00
5200-5029
Development Services Fee (Plan check hourly)
$155.00
5200-5015
Final Tract Map Checking Fee
$2,488.00
5200-5026
Final Parcel Map Checking Fee - Moderate
$2,488.00
5200-5027
Lot Line Adjustment Fee
$1.079.00
5200-5028
Park Dedication Fee Zone _
TBD
405-470_
Street Easement/VacationFee (+10o%ofhrlyover 4hrs)
$1,022.00
5200-5031
Street Tree Fee ($700 Planting Fee)
TBDI
030-2284
Engineering Tech:
Tota Amount Due:
For Finance Use only
Per S`pbralist
Receipt No.
f:/users/pbw/shemd/encroech/masters/ep front and back masters/
Rev. 1/5/2017
epfeesheet.xls- evised 10/21/2016
TERMS AND CONDITIONS OF ENCROACHMENT PERMIT
1. Encroachment Permits may be taken out by the owner of benefited property or a licensed contractor. A licensed
contractor must provide a "Letter of Authorization' to allow another party to pull a permit. An approved copy of tljp-
permit and construction plan shall be kept at the job site at all times. Work, which has been done prior to issuance or
a permit, is subject to rejection/fine. City reserves the right to void permit if work does not commence within 30 days
after date of issuance.
2. The Permittee agrees to defend, indemnify and hold the City, its authorized agent, officers, representatives and
employees harmless from any responsibility, liability, suit or action of any description arising out of any accident, loss
or damage to persons or property occurring as a result of work undertaken under this permit.
3. All work shall be done in accordance with the approved plans, Standard Special Provisions and Standard Drawings
of the City of Newport Beach, and in compliance with all applicable State laws and City ordinances.
4. Permittee guarantees all work performed under this permit to be free of hidden and latent defects. Any failures shall
be corrected within two weeks after notification to the satisfaction of the Public Works Director.
5. A valid State licensed contractor must perform all construction within the public right-of-way, unless waived by the
Public Works Director. A valid State Contractor License Class A can perform any work in the public right-of-way. For
construction or connection to water lines a valid State Contractor License Class C-34 is required. For construction or
connection to sewer lines a valid State Contractor License Class C-42 is required.
6. All trenching and/or resurfacing shall conform to City Standard 105-L for parkway/roadway and City Standard 140-L,
in the alley, where a minimum half -alley width resurfacing shall be provided, unless otherwise directed by the Public
Works Dept. Contractors shall obtain permits to perform excavation or trench work from the California Division of
Industrial Safety prior to commencing underground construction as required by State law. Walls and faces of all
excavations over 5 feet in depth shall be protected by a shoring system, sloping of the ground, or other equivalent
means. Trenches less than 5 feet in depth shall be guarded when hazardous ground movement may be expected.
7. The Public Works Department Inspectors must inspect all work in the Public right-of-way. Forms and subgrade must
be inspected and approved before concrete is ordered/poured. Sewer, pipelines, and subgrade construction must be
inspected and approved before backfilling, or applicant may be required to excavate site. Separate Utilities
Department or General Services Department inspections may be required depending on scope of work performed.
8. All trench restoration must be inspected by the Public Works Department. No utility installation(s) shall be allowed
over or within 5 feet of any City utilities, unless approved by the Public Works Department. Locate and pothole
existing City -owned utilities (is: water, sewer, or street lighting conduits) to verify locations. Maintain a one -foot
clearance over or under existing City -owned utilities. Sewer cleanouts require VCP or PVC SDR35 be used with a
4TT box, over the riser.
9. Properly lighted barricades must be provided and maintained around all trenches, excavations and obstructions. All
signs, flags, lights and other warning and safety devices shall conform to the requirements of the current "Manual of
Warning Signs, Sights and Other Devices for the Use in Performance of Work Upon Highways", issued by the
California Department of Transportation. If needed, barricades can be obtained from the City at a charge of $10.Op.
per barricade per day, with a minimum charge of $35.00. It is the responsibility of the applicant to place barricades t
protect the general public. Access to fire hydrants must be maintained at all times.
10, Work within or near beach sensitive areas will not be allowed during, City holidays, spring break, Memorial Day
weekend, summer between June 15 and September 15, and during the holiday season from December 19 to
January 1, unless approved by the Public Works Department.
11. Any work that extends into traffic or parking lanes and impedes the normal flow of traffic requires the applicant to
acquire a Temporary Street Closure Permit from -the Public Works Department. Access for fire, police and
emergency vehicles must be maintained at all times. Traffic Control must be per Work Area Traffic Control
Handbook (WATCH). No nighttime traffic lane closures, unless prior approval has been granted. Any lane(s) closure
on a major street will only be allowed between 9:00 a.m. and 3:00 p.m. (Monday thru Friday), unless approved by
the Public Works Department. Any work affecting the State Highway's traffic or within the State Highway right-of-way
will require a Caltrans Permit. All vehicles shall be lawfully parked.
12. This permit does not authorize the closure of sidewalks, streets, or alleys for construction access, storage of
materials, or parking of construction vehicles unless detailed on an attached Temporary Street Closure.
13, Applicant must notify USA at 1-800-227-2600 2 days before starting any underground construction. Applicant
must notify all affected residents 24 hours in advance of restricted access and any inconveniences.
14, Refuse or unused materials shall be removed within 24 hours after completion of the work. If not removed, the City
may remove and bill the applicant. Coordinate alley closures with City's refuse pick-up days by calling 949-644-3066
for the collection schedule so service is not interrupted. To place a dumpster or materials in the public right-of-way, a
Temporary Street Closure Permit must be obtained from the Public Works Department.
D BYR;-A,4tJC
U4,CONTRACTOR�
ante ofrgr , leo ' O£ t n t 860-4,224413
WORKER'S COMPENSATION INSURANCE (Section 3800 Labor Code)
I certify that I have a Certificate of consent to self -insure i if cat o orkars
om Peri ion I surance, or a Cent led Copy thereof.
ate: �' 2 1.9- i Signature:
CERTIFICATE OF EMPTION (Section 3800 Labor Code)
I certify that in the performance of the work under this permit, I shall not employ
any person so as to become subject to California Worker's Compensation Laws. If,
after signing this certificate I become subject to the Worker's Compensation
provisions of the State Labor Code, I must comply with the provisions of Section
3700 or this permit shall be deemed revoked.
Date: Signature:
CONTRACTOR LICENSE EXEMPTION
As the Owner of the benefiting property, I certify I am personally performing all
work in the Public Right -of -Way.
Date: Signature:
HOLD HARMLESS STATEMENT
1 understand that I am locating minor encroachments within the City Right-of-
Way/Easement. As property owner it is my responsibility to maintain the
encroachments. I will be responsible for replacing the improvements if the City
removes them for maintenance of utilities or other public need. I shall indemnify
and hold the City harmless for any liability associated with the minor
encroachments.
Date: Signature:
?4-hour notice for Encroachment Permit Inspection is required by calling
I Public Works at 949-644-3311. tA.sS�
15. Any above ground utility facilities will require documented approval from the adjacent
affected property owner(s).
l6-, Homeowner, contractors, and subconlracolrs may each be liable for violations of Water
Quality Laws. Best Management Practices will be enforced. It is against the law to
discharge construction debris into the gutter and storm drain. Felony violations of Water
Quality Laws are punishable by fines up to $25,000 and/or up to three years in State
prison plus the full cost to clean up an illegal discharge or spill.
17, If a refundable deposit was paid, applicant must submit a Soils Compaction
Certificate or Evidence of a Slurried Backfill and request a final inspection from the
Public Works Department. Monies may be held for six months after final inspection
before a refund will be processed.
18. No trees in the public right-of-way shall be planted, removed, trimmed, or relocated
without approval from the General Services Department.
19. All work in the public right-of-way must meet the approval of the Public Works
Department or corrections will be required (i.e. removals, exposing connections,
etc.). Additional inspection fees may be required.
20. Permit is for standard materials in the public right-of-way only, unless previously
approved by Public Works and an Encroachment Agreement has been processed.
21. Permit is valid for "description' of work noted on front only. Additional work
performed may require issuance of a separate permit and/or additional fees.
♦
6/24/2017
City of Newport Beach
Page 3 of 15
6:34:08AM
INSP160 - Daily Inspection Request Report
Requested Inspection Date: 05/24/2017
Inspection, Type: ENCROACH
Inspection Area: PW
Site Address : 18 CANYON FAIRWAY DR
Activity :
N2017-0274
SubType:
NEW
Status:
APPROVED
OWNER:
-DEGRAZIER CAROL & ANTHONY
Phone: 858-527-5661'
raroldegrazier@grnaii.com'
APPLICANT:
WESTERN PACIFIC DEV INC
Phone : 949-278-8937
Description :
INSTALL SEWER CLEAN OUT PER STD 406-L
Item:
10200 PRE JOB - PW
Requested Time:
5/24/2017 12:00:OOAM Requestor:
NBIVR
9493503442
Entered By:
NBIVR
Comments:
AM
Assigned to:
Inspector:
�/ l/ Dater S`� 2 7��
Time: lv<'nd A PM
Comments:
�I
,Y,-1-- w�
Logged
Y
efile.
I
F:\UsemIPBWkSharedkENCROACH\MASTERS\FORMS\inspectorSheet.do
6/30/2017
City of Newport Beach Page z of 12
4:30:48PM
INSP1`50- Daily Inspection Request Report
Requested Inspection Date : 05/31/2017
Inspection Type : ENCROACH
Inspection Area : PW
Site Address : 1.8 CANYON FAIRWAY DR
Activity :
N2017-0274
SubType:
NEW
Status :
APPROVED'
OWNER:
DU L&ANIHONY Phone : 858-527-5661
caroldegrazier@gmail.com
APPLICANT:
WESTERN PACIFIC DEV INC s Phone : 949-278-8937
Description :
INSTALL SEWER CLEAN OUT PER STD 406-L.
Item:
10050 EXCAVATION- PW
Requested Time:
5/31/2017 12:00:OOAM Requestor: NBIVR
L%Jgge� 9493503442
Entered By:
NBIVR e�FF
Comments:
PM Ria1IIV
Assigned to
Inspector.
V Dater 3 ! 117. Time: /b. AM M
Comments: A9_A-'
I I%eP is=/ uD TA4&-r cv y gC
�/!.�>i11•EGTB/i
t''3�` Gs4-13D.�I d-O C� �f- ®y/�] ' , ®i"- 9�
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5/31/2017 City of Newport Beach Page 1 or 19
4:30:16PM INSP150 - Daily Inspection Request Report
Requested Inspection Date: 0610112017
Inspection Type : ENCROACH
Inspection Area : PW
Site Address : 18 CANYON FAIRWAY DR
Activity : N2017-0274
SubType : NEW
Status: APPROVED
OWNER: DEGRAZIER CAROL & ANTHONY Phone: 858-527-5661
caroldegrazier@gmaii.com
Entered By: NBIVR
Comments: AM
Assigned to:
Inspector: 'A `I Date: 64l Time: SSA PM
�e
Comments: &QIV'PX-�9�`r76 EL
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y k
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F:\Users\PBW\ShaFed\ENCROACH\MASTERS\FORMS\InspectorSheet.do
REPT131
Run Id: 4018
w;
—`—' THIS IS NOT A TICKET NO.
- CONTROL 2 932724
5y'�� - NUMBER
f9 #2 MORENOVALLEYZ12896DAYST.
ROEMTS ON"S
Phone 800/834-7557 San Diego 800/870-1220
www.rrmca.com
OPEN 7 DAYS
`
t
1 :#3 REDLANDS - 8353 AMAMA ST.
#4 FONTANA - 13792 SOONER AVE.
#131RUN DALE -13631 LIVE OAK ME
#14 PAMIDEN#'- 1420 N. LINCOLN AVE.
#23.PARAMOUNIT - 7277 E. FOR ECMNBAVE,
#5 POMONA- 2470 POMONA BLVD.
#15 VERNON-LOS ANGELES-336 E. 26TH ST
#24 RNLTD- 2601 N. ALDER AVE.
.i #6 HEMET/SAN JACIMO-1Are FATE ST.
#16 ANAHEIM- 201 E. COMMERCIAL ST
#25 GARDENA-301 W ROSECMNS AVE.
F #7 BEAUMONT- 452 W. WIS ESTRADA RD.
#17 SANTA ANA- 3f 0 N. TOWNSEND ST.
#26 THOUSAND PALMS -72460 VARNER RD.
• #8 SUN CITY -27050 WATSUN RD.
#18 LAKE FOREST- 25931 TOWN CENTRE DR.
#27 MURFIRA - 26190 ADAMS AVE.
#9 ARROWHEAD - 29750 HIM 18
• '. #m SANTA RE SPRINGS- 12311 GREENSTONE AVE.
#19 AOEIANTD-12203 VIOLET RD.
#20 SAN CLEMENTE-116 RINCON CT
#28 OTAY MESA -7961 AIRWAY RD.
#29 EL cmall-215 CYPRESS La
CABAZON- 13990 APACHE TRAIL
#21 IRVINE- 16081 CONSTRUCTION CIR. WEST
#30 CORONA- 1540 SHERBORN ST.
it#11
#12 SAN BERNARDINO-1955W 9TH ST
#22 NO. HOLLYWOOD - 13132 RHYMER ST
#31 HESPERIA-9661 CAVE.
PLANT DATE
CUSTOMER NO: SOLD TO:
('L
C2,1. 06/05/1 7
99991cr;'• WESTERN PASIFICC,
TX CD DELIVERY ADDRESS & INSTRUCTIONS
1.F' CANYON FAIR :WAY 1?I'2
( SAN J'Llf1CF!U]:Ii i`IILLS NEt1PC1F2T ItE=AC
Job Phone " (949) 351 3•a tW'
ORDER NO. METER READING TIME TYPED TRUCK LIC N0.
441. 1600.. 001 ESP, Z-•r:1 93T(:iP:iE...I
�tp��{{�� LOAD NO. SLUMP TRUCK DRIVER
t�PtlIN I 1. 4. rZfIZ
r DRUM
TO JOB REVS:
#32 UPIAND-1975 N. BENSON
#41 MOJAVE-140 E. HWY 58
#33 MIFAWR-5692 EASTGATE DR.
#42 VICTORVILLE - 16952 N.09..
#34 LUCERNE-35555HM18
#43 BAKER- 56500 BAKER BLVD.
#35 BIG BEAR LAKE- 42025 GARSTIN OR.
#44 IT IRWIN- 58825 FORT IRWIN RD.
#36 ESCONDIDO - 1310 SIMPSON WAY
#45 BARSTOW-2700 E. MAIN 81
#37 INDIO 55110 FARGO CANYON RD.
#46 CAL-CITY-7900 MOSS AVE.
#38 RIDGECREST-21571NYOKERN RD.
#47 PONT OF LONG OMCH, 1602 W PIER D ST
#39 PALMDALE- 3719075TH ST. EAST
#48 EL CENTRO, 1051 W P ST
#40 ARTESIA - 13949 E. STAGE ROAD
MAP PAGE TICKET NO,
CUSTOMER P.O. / JOB OR LOT #
LAST IIKS T,r'
1478 7539 GARCIA, I..UIS (R'1') CITY SIDEWALKS
Job -site Cylinder TeMOB GEDR'RT 9 E 00 1
TI ME ON JOB MIN CHECK# _
11011
1>
JOB—'
( START POUR
FINISH POUR
qo
( �LEAVEJOB
1
1
i
( C
C
F
i,
PLANT
under penalty of perjury
LD CITY
1. QI0
1.00
1. Owl
CITY ORD CITY
Water added On fob at STAND BY MIN. CHECK ❑ k i.
Cu$tomef s request: AMOUNT BY '-.t ;.-,
gals to Full Ld. RATE OFX$ PER MIN. CASH ❑ 1
AMOUNT BY
gals to 2/3 Ld.
$ PLANT MGR SIG
gals to 1/3 Ld. OVERTIME CHARGE
y 4 min. per yd. unloading time allowed.
f ADJ. Meter ; Additional unloading time charged at current hourly truck'rate:
&, Additionalliter�'sll I�6 concrete will reduce its strength. Anywateradded exceeding the design water is atcusta ner's Own nsk
N1 n contained in this written time record is true and correct.
coloring agent has been added at the request of the customer, either at our
CODE MIX AND COMMODITY'' 1
E„ A0 1.01-71 QC;MAB31
I I " 00 'r::i`:1. 11.
1.00 1 00 rc1'1 13
WATI-AR At LOWED :38.OGAL..
WATER BATCHED 25.513AL
M01S'TURE. WATER 12.0L3A1....
MAX ADD WATER . 5GAI_.
; (-.*,1 lt'..:s` °'ri7t..-REVSD ORNGE YD
ENVIRONMENTAL FEE PL
ENE.Rl[3Y SURCHARGE PJL
CEMENT TYPE II/V
WEICIDII aF�ttFl�Ni
TERMS AND CONDITIONS OF SALEl
to the prol'ect(s) where the material Is to be used.
action of Robertson s vehicles to the designotetl M nn K�p54� pp
obsite. Inconsideration oftheabove,Customer "'pp pt.pt,
I claims asserted by Customer or any thud party N WW NY9
e land where the material is utilizetl, and Hit the
1 Robertson's retains the services of an attorney'
n attomey's fees arising from any other context
to irregpularities and/or inconsistency of mStand s
the job site.
UNIT PR AMT
1.061" 1710 106. 00
30.00 70".00
THIS IS TO CERTIFY that the following described commodity Was weighed,
measured, or counted by a weighmaster, whose signature is on this certificate,
who is a recognized authority of accuracy, as prescribed by Chapter 7
(commencing with Section 12700) of Division 5 of the California Business and
Professions Code, administered by the Oivisibn,of Measurement Standards of the
CEMENT 1' LB 150 ✓' WE WWS Ef
16-0
I A013 I 1E100
r yyi' ������ ff}}`�'�Et''}} j qq..,,�� 7/1 er oEpury
) ' BOM tlO-I4VERA93SAN-'VAR053 4=POUN�S'GL GALLONSr`Fo1'OLN�ES CU-METERS3 KG -KILOGRAM L-LITERS ML=MILLILITERS _
..• RL:^I-Ic�t"IJ I^'aersc}n
CONCRETE DELIVERY TICKET
AGREED TO AND RECEIVED BY CUSTOMER PO BOX 3600 CORONA, CA 92878 3600
TAX
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PREVIOUS
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