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HomeMy WebLinkAboutN2017-0591ewe„ City of Newport Beach . " C 100 Civic Center Drive, Newport Beach, CA 92660 III III II N 2 0 IIIIII III III II 1 7 0 5 IIIIII IIIII III II 0 9 1 Permit Counter Phone (949)644-3311 Online Inspection Request- www.newportbeachea.gov/Online ''�Lrrcint Services Job Address : 1101 MARIAN LN NB Description : 3 CURB CORES PER CITY STD Parcel # : 1176-250-1 - Legal Desc : N TR 3851 LOT 1 Owner: KRALIKJOHN Phone: Address: 1101 MARIAN LN NEWPORT BEACH, CA 92660 Applicant: TODD'S CORE DRILLING Phone: 714-540-5549 [ Address: 3101 SUMATRA PL COSTA MESA CA Special Cond.: PRE -CONSTRUCTION MEETING REQUIRED Permit No: N201'7-0591 Project No : 2218-20 6R NNE , Inspection Requests Phone (949)644-3255 Thomas:Guide: 889C5 }} tp�g Contractor: TODD'S CORE DRILLING it Phone: 714-540-5549 4444 .`��,y� Address : 3101 SUMATRA PL COSTA MESA CA Permit Processing Fee : $241.00 Sewer Connection: $0.00 Agreement Fee: $0.00 4TT Box Cover: $0.00 Traffic control Plan Check : $0.00 Total Water Meters : $0.00 Inspection Fee : $165.00 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 Contractor State Lic: 544897 License Expire : 11 30, 2018 Business License: BT97021594 Business Expire : 06 30, 2018 Workers' Compensation Insurance - - Carrier : EXEMPT Policy No: W. C. Expire: Total Fee : $406.00 Paid : $406.00 Balance: $0.00 Receipt No: Other Department : Date : /_/_ Permit Denied Date : Issued Permit : - Date d 20/7 COMPLETE THE BELOW INFORMATION PROJECT ADDRESS: DETAILED DESCRIPTION OF PROPOSED WORK: APPLICANT: c r a 1 'V Phone: 6l J ` Ctr /fir' all Address: o kek \Asti' 1+v Mailing A dre s: Ci /State/Zip OWNER: ,L,V� Phone: n2. -L(q'C fcl Email Address: bL2��•_,� U�w.- C i— Mailing Ad�esc City/ tatelZip: c{ , y CONTRACTOR: ' , tit-7 Office Phone: Company (if different : (�LL a Phone: Other Phone: Email Address: Mailing Address: City/StatelZip: State License Number & Class: Expires: City Business License Number: Expires: ORKERS COMPENSATION INSURANCE - Certificate of Insurance (Section 3800 Labor Code) Company: Policy No. Ex Tres: Munici ato eratiuns: 90-644-3066 Utilities: 949444.3011 '? Urban Forestry: 949-644-3083 Special Conditions of Permit: l IL .4;W- RORI i '� _ w4vE+=»L Utilities: Traffic: 0 Fire: 0 Municipal Operations Other: Engineering Technician: Per ecialist Date: a` Permit No. IN2017- 7010 Public Works Department 949-644-3311 100 Civic Center Drive, Newport Beach, CA 92660 Permit Processing Fee: Public Works Only $241.00 Other Department $275.00 [M Agreement Fee: Preparation of Report/Agreement $817.00 Document Recordation Fee $192.00 Monitoring Wells $502.00 StreeVAlley/Walk Closure: $65.000 Traffic Control Plan Check x 11" $65.00� 24" x 2436" $143.00 Additional Certificate of Compliance Fee (+100% of hrly over 3 hrs) Development Services Fee (Plan check hourly) Final Tract Map Checking Fee Final Parcel Map Checking Fee - Moderate Lot Line Adjustment Fee Park Dedication Fee Zone _ Street Easement[Vacation Fee (+100% of My over 4 hrs) Street Tree Fee ($700 Planting Fee) ------------------------------- Inspection Fee: Public Works Field Inspection $165. Utilities Field Inspection $121. General Services Inspection $165.00 Water Quality/Artificial Turf Inspection $108.00 Refundable Deposit: Improvements Newspaper Rack Inspection Sewer Connection Fee 4TT Box & Cover TBDE]TBD $108.00 0 $250.00 P $64.00 $288.00 $155.00 $2,488.00 $2,488.00 $1,079.00 TBD $1,022.00 TBDI Certificate of Compliance Fee (+100% of hrly over 3 hrs) Development Services Fee (Plan check hourly) Final Tract Map Checking Fee Final Parcel Map Checking Fee - Moderate Lot Line Adjustment Fee Park Dedication Fee Zone _ Street Easement[Vacation Fee (+100% of My over 4 hrs) Street Tree Fee ($700 Planting Fee) ------------------------------- Inspection Fee: Public Works Field Inspection $165. Utilities Field Inspection $121. General Services Inspection $165.00 Water Quality/Artificial Turf Inspection $108.00 Refundable Deposit: Improvements Newspaper Rack Inspection Sewer Connection Fee 4TT Box & Cover TBDE]TBD $108.00 0 $250.00 P $64.00 $288.00 $155.00 $2,488.00 $2,488.00 $1,079.00 TBD $1,022.00 TBDI 5200-5029 5200-5015 5200-5026 5200-5027 5200-5028 405-470 5200-5031 030-2284 Engineering Tech: Total Amount Due: q �L�,, 1�1, For Finance use only Permit cialist Receipt No. Vusers/pbw/sharecVenuoach/mesters/ep front and back masters/ Rev. 11/8/2017 epfeesheetAs-revised 11/8/17 2.215- 2�31(� Kill r A' .ra d-r1 s x r t u[rd .& t ���� F r��.�:' T'4 '`i,xss3' a, s`S"h, '=,W, t'" d` Y' t av'• 'ht4 1 t t 3 t x..y :t ' Pt} e= i tff.A'� !! MEN" �E d 4 .re3t,3}t:..rt'Ftatta-J._.aR TERMS AND CONDITIONS OF ENCROACHMENT PERMIT WORKER'S COMPENSATION INSURANCE (Section 3800 Labor Code) 1. Encroachment Permits may be taken out by the owner of benefited property or a licensed contractor. A licensed I certify that I have a Certificate of consent to self-INsure, Certificate of Worker's contractor must provide a "Letter of Authorization' to allow another party to pull a permit. An approved copy of the Co pensation Ins ranee, or a Certified Copy t permit and construction plan shall be kept at the job site at all times. Work, which has been done prior to issuance of ^7 ) 2G a permit, is subject to rejectionifine, City reserves the right to void permit if work does not commence within 30 days Dat j ` Signatur` after date of issuance. CERTIFICATE OF EXEMPTION (Section 3800 Labor Code) 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 I certify that in the performance of the work under this permit, I shall not employ or damage to persons or property occurring as a result of work undertaken under this permit. any person so as to become subject to California Worker's Compensation Laws. If, 3. All work shall be done in accordance with the approved plans, Standard Special Provisions and Standard Drawings after signing this certificate I become subject to the Worker's Compensation of the City of Newport Beach, and in compliance with all applicable State laws and City ordinances. provisions ons of the State Labor Code, I must comply with the provisions of Section 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. 3700 this s permit shall be deemed revoked. 5. A valid State licensed contractor must perform all construction within the public right-of-way, unless waived by the Date: Signature: 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. CONTRACTOR LICENSE EXEMPTION 6. All trenching and/or resurfacing shall conform to City Standard 105-L for parkway/roadway and City Standard 140-L, As the Owner of the benefiting property, I certify I am personally performing all in the alley, where a minimum half -alley width resurfacing shall be provided, unless otherwise directed by the Public work in the Public Right -of -Way. Works Dept. Contractors shall obtain permits to perform excavation or trench work from the California Division of Date: Signature: 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. HOLD HARMLESS STATEMENT 7. The Public Works Department Inspectors must inspect all work in the Public right-of-way. Forms and subgmde must I understand that I am locating minor encroachments within the City Right -of - be inspected and approved before concrete is ordered/poured. Sewer, pipelines, and subgrade construction must be Way/Easement. As property owner it is my responsibility to maintain the inspected and approved before backfilling, or applicant may be required to excavate site. Separate Utilities encroachments. I will be responsible for replacing the improvements if the City Department or General Services Department inspections maybe required depending on scope of work performed. . removes them for maintenance of utilities or other public need. I shall indemnify 8. All trench restoration must be inspected by the Public Works Department. No utility installation(s) shall be allowed and hold the City harmless for any liability associated with the minor over or within 5 feet of any City utilities, unless approved by the Public Works Department. Locate and pothole encroachments. 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 VCR or PVC SDR35 be used with a Date: Signature: 4TT box over the riser. 24-hour notice for Encroachment Permit Inspection is required by calling 9. Properly lighted barricades must be provided and maintained around all trenches, excavations and obstructions. All "Manual signs, flags, lights and other warning and safety devices shall conform to the requirements of the current of Warning Signs, Sights and Other Devices for the Use in Performance of Work Upon Highways", issued by the Public Works at 949-644-3311�� K )___1 California Department of Transportation. If needed,'barricades can be obtained from the City at a charge of $10.00 15. Any above ground utility facilities will require documented approval from the adjacent 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. affected property ownens). 10. Work within or near beach sensitive areas will not be allowed during, City holidays, spring break, Memorial Day 16. Homeowner, contractors, and subcontracotrs may each be liable for violations of Water weekend, summer between June 15 and September 15, and during the holiday season from December 19 to Quality Laws. Best Management Practices will be enforced. It is against the law 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 discharge construction debris into the gutter and storm drain. Felony violations of Water acquire a Temporary Street Closure Permit from -the Public Works Department. Access for fire, police and Quality Laws are punishable by fines up to $25,000 and/or up to three years in State emergency vehicles must be maintained at all times. Traffic Control must be per Work Area Traffic Control prison plus the full cost to clean up an illegal discharge or spill. Handbook (WATCH). No nighttime traffic lane closures, unless prior approval has been granted. Any lane(s) closure 17, If a refundable deposit was paid, applicant must submit a Soils Compaction on a major street will only be allowed between 9:00 a.m. and3:00 p.m. (Monday thru Friday), unless approved by Certificate or Evidence of a Slurried Backfill and request a final inspection from the the Public Works Department. Any work affecting the State Highway's traffic or within the State Highway right-of-way Public Works Department. Monies may be held for six months after final inspection will require a Caltrans Permit. All vehicles shall be lawfully parked. before a refund will be processed. 12. This permit does not authorize the closure of sidewalks, streets, or alleys for construction access, storage of 18. No trees in the public right-of-way shall be planted, removed, trimmed, or relocated materials, or parking of construction vehicles unless detailed on an attached Temporary Street Closure. without approval from the General Services Department. 13, Applicant must notify USA at 1.800-227.2600 2 days before starting any underground construction. Applicant 19. All work in the public right-of-way must meet the approval of the Public Works must notify all affected residents 24 hours in advance of restricted access and any inconveniences. Department or corrections will be required (i.e. removals, exposing connections, 14. Refuse or unused materials shall be removed within 24 hours after completion of the work. If not removed, the City etc.). Additional inspection fees may be required. may remove and bill the applicant. Coordinate alley closures with City's refuse pick-up days by calling 949-644-3066 20. Permit is for standard materials in the public right-of-way only, unless previously for the collection schedule so service is not interrupted. To place a dumpster or materials in the public right-of-way, a approved by Public Works and an Encroachment Agreement has been processed. Temporary Street Closure Permit must be obtained from the Public Works Department. 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. No wip(krelated"'toEhls. pncro'aof+mehtyRermttr h"' I fix t) f(r Ts€3`„`' c " ` .. tFx`""9p o r e nEm n h f ' T_-.' ,`""f +f1`- '; t11.%M ja lfg 1 s,f�r"ter-msx¢art: d ;:t SLtH?rep`i�ea4taInrr ee-�'¢ Pt?ch Fpoenrmdj``f[s7a'f� 2e1d ,y"da 4eesarme' fir,u@ TOWSCORE DRILLING ,r .:: 1 l-17-17 ,J'Dhh �Cajlk'15 ©n behalf d Tvd s 0ore.106AVo? 4o pl-L11 a i erm + �or curb cores a+ I101 MQ(1(3n Lace. N-ewpor+ 1each, Con4roc�cxr> LI G= A� '5LIY997 CAY d4 Ntvjpo(4 Lie, Acc 4- �TR7oZj5q� x�_z� /�� CONCRETE CUTTING v CURB CORE SPECIALIST LICENSED • INSURED 3101 Sumatra Place, Costa Mesa, California 92626 - 714.540.5549 11120/�018 4:30:310M - City of Newport Beach Pagel o12o INSP150 - Daily Inspection Request Report Requested Inspection Date: 01/30/2018 - Inspection Type: ENCROACH Inspection Area : PW Site Address : 1101 MARIAN LN `' Acfivlty N2017-0591 SubType: NEW Status: APPROVED OWNER: KRALIK JOHN Phone: APPLICANT: Description ; TODQS CORE DRILLING Phone: 714-540-5549 -3 CURB CORES PER CITY STD Item: 10250 FINAL - PW Requested Time: 1/30/2018 12:06:00AM Requester: NBIVR Entered By: NBIVR 9493554170 Comments: AM Assigned to: Inspector: Date: Time: AM PM Comments: F:\Users\PBW\Shared\ENCROACH\MASTERS\FORMS\InsoectorSheetdoc REPT131: Run Id: 4018