HomeMy WebLinkAboutN2017-0180awn,$ City of Newport Beach IIrI�I11�I�II�III������ II
100 Civic Center Drive, Newport reach, CA 92660
Permit Counter Phone (949)644-3311
.0 Online Inspection Request - www.newportbeachca.gov / Online
ertaexu`$ Services
Permit No: N2017-0180 ,
Project No: SCANNED
;
Inspection Requests Phone (949)644-3255
Job Address : 2500 W COAST HWY NB Thomas:Guide: 888116
Description : Hot tap existing 6-inch water main for a 4-inch fire service per STD-507-L. Install new double check detector assembly per STD-517-L. `' EWE #: 4254-715-4 - 1 [�E V I E• E D
Legal Desc : P BK 256 PG 25 PAR 2
Owner:
HUMPHRIES JACQUELINE JOY ®�
6!'9s
Contractor: ROLAND ENGINEERING INC
Phone:
0
Phone:
Address:
1836 GALAXY DR
Address : 13600 PAWNEE ROAD SUITE #1
NEWPORT BEACH, CA
APPLE VALLEY CA
Contractor State Lic: 684737
Applicant:
DOMINGUEZ FIRE PROT
License Expire : 07 31, 2018
Phone:
760-617-9104 [
Address :
22241 KEYENTA RD
APPLE VALLEY CA 92308
Business License : BT30059228
Business Expire : 05 31, 2018
Special Cond.:
CALTRANS PERMIT REQUIRED.
Workers' Compensation Insurance - -
PRECONSTRUCTION MEETING REQUIRED
Carrier: STATE FUND
WITH PUBLIC WORKS AND UTILITIES
Policy No: 9028550
INSPECTORS.
W. C. Expire: 01 01, 2018
Permit Processing Fee :
$241.00
Sewer Connection :
$0.00
Total Fee $648.00
Agreement Fee:
$0.00
4TT Box Cover:
$0.00
Paid: $648.00
Traffic control Plan Check :
$0.00
Total Water Meters:
$0.00
Balance: $0.00
Inspection Fee :
$407.00
Water Meter Connection :
$0.00
Receipt No: F-0_ 1-1g io
Refundable Deposit:
$0.00
Total Water Meter Box:
$0.00
Street Tree Fee :
$0.00
Adjustment:
$0.00
Processed By :
Date :
_/_/_ Other Department:
Date:
Utilities Approval :
Date:
_/_/_ Permit Denied
Date:
Traffic Approval :
Date :
_/_/_ Issued Permit :
—Date: S/ 2a / (1
General Services Approval :
Date:
_/_/_
y
s .1ORWWr FOR ENCROACHMENT T gRMI i
ON 1INUG WORKS DEPARTMENt
COMPLETE T14E BELOW INFORMATION
ROJECT ADDRESS: 25z o o--
DETAILED DESCRIPTION OF PROPOSED WORK:
4" >G� lesw er
—Prrv7 Phone: 7� O_ /7- %/D
ress: �ON. in :� tf u o.' . co,
dress:
Ci /S to/Zip:
L)a ire >9. �0
113hone.
Email Address -
Mailing Address: Cityf itatefZip:
._ GENTftACTOR INFORMATION IS REQUIRED -PLEASE COMPLETE
CONTRACTOR•
lta3 a- ° 10ifice
Phone:
Company (if. different): lJobsite
Phone:
Other Phone:
Email Address: �o
Mailing Add
i fState0p:
Slate License Number & Class:
Expires,
City usiness Licen a Number:
I� o01zt2)2-%Expires: S 31�Ip
ORKER$ COMPENSATION INSURANCE - Certificate of insurance (Section 3800 Labor Code)
ompan . r Policy No: x ires: - -
Manic rattoos: 949- SS __—�"
tilfties:- g49.644301 f
Urban l ates . 949444-3M
.. -, FOR OFFICE USE ONLY
Special Conditions of Permit: C N C-C-A 1� `r 1N W U }BAR S
�'__.. ADDFTft3NAL=APPROVAL REQUIRED FROM TNE FOLLDMNG-DEPARTMENTS
utilities:
Municipal Operations
Traffic: Fire: 0
Other:
Engineering Technician:
1.j
Permit Specialist
I
Date:
I 5/?
IPermit No.
IN2017.0 i'0
t.tusarslpbvwshare&encrbachtmastersldpwar shea[xis
Public Works Department 949-644-3311
100 Civic Center Drive, Newport Beach, CA 92660
IIPROJECT ADDRE55: 2f7d C6�St I''°"`mr r N2017- Q� gV II
T1� NUMBER:
�avr,A
Permit Processing Fee:
Public Works Only $241.00
Other Department $275.00
Agreement Fee:
Preparation of ReporflAgreement $817.00
Document Recordation Fee $192.00�
Monitoring Wells $502.00
Street/AlleylWalk Closure: $65.000
Traffic Control Plan Check
8-1/2" x 11" $65.00
24" x 36" $143.00
Additional
Inspection Fee:
Public Works Field Inspection $165.00 i
Utilities Field Inspection $121.00 2
General Services Inspection $165.00
Water Quality/Artificial Turf Inspection $108.00
Refundable Deposit:
Improvements
Newspaper Rack Inspection
Sewer Connection Fee
4TT Box & Cover
TBDBTBD
$108.00
$.00
$6464.00
Certificate of Compliance Fee (+100% of hrly over a hrs)
Inspection Fee:
Public Works Field Inspection $165.00 i
Utilities Field Inspection $121.00 2
General Services Inspection $165.00
Water Quality/Artificial Turf Inspection $108.00
Refundable Deposit:
Improvements
Newspaper Rack Inspection
Sewer Connection Fee
4TT Box & Cover
TBDBTBD
$108.00
$.00
$6464.00
Certificate of Compliance Fee (+100% of hrly over a 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 EasemenWacationFee (+100%ofhrlyover 4hrs)
$1,022.00
5200-5031
Street Tree Fee ($700 Planting Fee)
TBDI
030-2284
Engineering Tech:
Total Amount Due:
For Finance use only
Permit Specialist
Receipt No.
f./users/pbw/sharedlencroach/masters/ep front and back mastersl
Rev. 1/5/2017
epfeesheet.xls-revised 10/21/2016
5/22/2017 Authorization for Permit
Reply 'Reply All Forward
Authorization for Permit
Sheryl Roland [sherylreinc@live.com]
To: Cho, Kathryne
Tuesday, May 09, 2017 2:20 PM
You replied on 5/9/2017 2:29 PM.
Roland Engineering Inc.
General Engineering Contractor
13600 Pawnee Rd Ste# 1 Apple Valley, Ca 92308
Ph# (760) 247-8533 Fax# (760) 247-9814
Ca Lic# 684737
05/09/17
To:City of Newport Beach Permit Dept
Attn: Kathryne Cho
We Authorize Dominguez Fire Protection to pull a permit for a hot tap in the City right of way under our
contractor license # 684737.
We will be represented during the course of this project located at 2500 W. Coast Hwy, Newport Beach and
permit is for hot tap in the City Right of Way. Onsite to be done by others.
Thank You, Don Roland
https://webmail.newportbeachca.gov/owal?ae=Item&a=Open&t=IPM.Note&id=RgAAAABnugpZjvU hR4nTiloGEm%2b7BwCdvLH°/u2bNX2U R5yTxR5rDQGPA... 1/1
TERMS AND CONDITIONS OF ENCROACHMENT PERMIT
1. Encroachment Pennits 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 the
permit and construction plan shall be kept at the job site at all times. Work, which has been done prior to issuance of
a permit, is subject to rejection/fine, City reserves the right to void permit if work does not commence within 2 js
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 (ie: 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 $1, ..Q0
per barricade per day, with a minimum charge of $35.00. It is the responsibility of the applicant to place barricades to
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.
WORKER'S COMPENSATION INSURANCE (Section 3800 Labor Code) , -:
I certify that I have a Certificate of consent to self -insure, Certificate of Worker's
Compen anon Insurance, or a Certified Copy thereof. -
Date: '—�� Signature: �O�r
CERTIFICATE OF EXEMPTION (Section 3800 Labor Code)
I certify that in the performance of the work under this permit, 1 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.
Pate: 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
I 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:
24-hour notice for Encroachment Permit Inspection is required by calling
;Public Works at 949-644-3311. L
15, Any above ground utility facilities will require documented approval from the adjacent
affected property owner(s):
16. Homeowner, contractors, and subconbacotrs 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.
STATE,QF CALIFORNIA - DEPARTMENT OF TRANSPORTATION
ENCROACHMENT PERMIT
7
In compliance with:
® Your application of
❑ Utility Notice No.
❑ Agreement No.
❑ R/W Contract No.
TO: Dominguez Fire Protection
22241 Kayenta Rd.
Apple Valley CA
Attn: Dominguez Fire
1112 / ORA / 1 / 19.4 1
March 20, 2017 04/04/2017
Fee Paid Deposit
of $ $ 820
Performance Bond Amount (1) Payment I
of $ 0.00 $ 0.00
Of
Protection 760-617-9104
and subject to the following, PERMISSION IS HEREBY GRANTED to:
Number (1)
PERMITTEE
Number (2)
Perform 8"x4" hot top gate value, 121 of C-900 4" pipe to double check for fire sprinkler
riser, within the State R/W on 2500 West Coast Highway at Tustin Ave in the City of Newport
Beach.
All performed work shall be in accordance with current Caltrans Standard Specifications
and Standard Plans, Section 500 (Specific Permits) of the Encroachment Permits Manual,
California MUTCD latest edition, the attached Provisions and Permit Plans stamped dated
March 17, 2017.
Permittee shall contact MAJID BANIHASHEMI, State Permit Inspector, at 657-328-6557 a
minimum of five working days prior to the date of the pre -construction meeting. Failure to
comply with this requirement will result in suspension of this permit.
The following attachments are also included as part of this permit (Check applicable):
® Yes
❑ No
General Provisions
In addition to fee, the permittee will
❑Yes
®No
Utility Maintenance Provisions
be billed actual costs for:
❑ Yes
®No
Storm Water Special Provisions
®Yes ❑ No Review
®Yes
❑ No
Special Provisions
® Yes ❑ No Inspection
❑ Yes
® No
A Cal -OSHA permit, if required: Permit No.
® Yes ❑ No Field Work
❑ Yes
®No
As -Built Plans Submittal Route Slip for Locally Advertised Projects
❑ Yes
®No
Storm Water Pollution Prevention Plan / Water Pollution Control Plan
(if any Caltrans effort expended)
❑ Yes ® No The information in the environmental documentation has been reviewed and considered prior to
approval of this permit.
This permit is void unless the work is completed before July 31, 2017
This permit is to be strictly construed and no other work other than specifically mentioned is hereby authorized.
No project work shall be commenced until all the other necessary permits and the environmental clearances have been obtained.
PERMIT ENGINEER:MASOOD OMAR APPROVED:
COPIES TO:
Pernittee
Fite: 17-0191
H.Shakeri Ryan Chamberlain, District Director
Maintenance BY:
P.E., District Permit
FM 91 1436 (012 Permit App.)
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51130120,17
City of Newport Beach Page 3 of 7
.s:34:06AM
INSP150 - Daily Inspection Request Report
Requested Inspection Date: 05/30/2017
Inspection Type: ENCROACH
Inspection Area: PW
Site Address: 2500 COAST HWY W
Activity :
N2017-0180
SubType:
Status :
APPROVED
APPLICANT:
DOMINGUEZ FIRE PROT Phone : 760-617-9104
OWNER:
HUMPHRIES JACQUELINE JOY 'Phone: 0
Description :
Hot tap existing 6-inch water main for a 4-inch fire service per STD-507-L Install new
double checkdetector assembl ; er STD-517-L
Item:
10200 PRE JOB - PW
Requested Time:
5/30/2017 '12:00:OOAM Requestor WEBUSER
760-617-9104 -- r't L-I i<
Enteredts:
Comments:
AM-8:30 am apt. with Matt B.
i
Assigned to:,
z»»�»
Inspector: Date: I& t-7 Time: 9.1i0 PM
Comments:
s'rkii�
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�PC�rpp Q� q
3A-.�E71 0 t0'.V 1 32,'U—:(n-Lt,lq.� tii9W5
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F:\Users\PBW\Shamd\ENCROACH\MASTERS\FORMSXinspectorSheet.doc
•5131/2017 City of Newport Beach
4:30:16PM INSP150 - Daily Inspection Request Report
Requested Inspection Date :
06/01/2017
Inspection Type:
ENCROACH
Inspection Area :
PW
Site Address :
2500 COAST HWY W
Activity : N2017-0180
SubType :
Status: APPROVED
Page 5 of 19
APPLICANT: DOMINGUEZ FIRE PROT Phone : 760-617-9104
OWNER: HUMPHRIES JACQUELINE JOY Phone: 0
Description: Hot tap existing 6-inch water main for a 4-inch fire service per STD-507-L. Install new
double check detector assembly per STD-517-L.
0200 PRE JOB -
Requested Time:
Entered By: WEBUSER
Comments: AM-9:00 am
Assigned to :. zzzzzzz/uzzz"
Inspector: �� �/
Comments:
0 /IJ
Requestor:
WEBUSER
760-617-9104
Date: lZTime: A M
"`?�c-r6p Atc� A- GPe Y' dl� <,�p - %ice - Z .
Logged
Reffle
ALC-x I& '4`0 -133b
F:\Users\PBVV\Shared\ENCROACH\MASTERS\FORMS\InspectorSheet.doc
REPT131
Run Id: 4018