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HomeMy WebLinkAboutN2017-0114City of Ne BeaNewpor 1111111111111111111111111111111111ill11Qll1111 Permit No: N2017-0114 1 Center Drive, Bleach, CA92660 Permit Counter Phone (949)644-3311 Online Inspection Request - www.newportbeachca.gov / Online Project No : SCANNED ��� g�Fee o ! ! •"brama`' Services Inspection Requests Phone (949)644-3255 Job Address : 1 PUBLIC ROW NB Thomas:Guide: Description: Remove and replace (25) 17"x30"x24" AT&T handholes with (25) 17"x30"x34" handholes in alley between W. Ocean Front Alley between 14th Street and 19th Street. Alley restoration per City Standards. Parcel # : Legal Desc : Owner: CITY OF NEWPORT BEACH �3 Contractor : S E C C CORPORATION Phone : ✓ Phone: 951-734-3110 Address: Address: 14945 LA PALMA DR CHINO CA Contractor State Lic: 710005 Applicant: AT&T CALIFORNIA License Expire: 07 31, 2019 Phone: 714-618-9132 [ Address : 3939 E CORONADO ST, 2ND FLOOR ANAHEIM, CA 92807 Business License : BT30047172 Business Expire: 05 31, 2018 Special Cond.: Pre job inspection required Workers' Compensation Insurance -- Carrier : TRAVELERS PROPERTY CASUALTY Policy No: DTJUB2F85628 W. C. Expire: 01 01, 2018 Permit Processing Fee : $241.00 Sewer Connection : $0.00 Total Fee $4,366.00 Agreement Fee: $0.00 4TT Box Cover: $0.00 Paid: $4,366.00 Traffic control Plan Check : $0.00 Total Water Meters : $0.00 Balance : $0.00 Inspection Fee: $4,125.00 Water Meter Connection : $0.00 Receipt No: 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 : (77TDate : /�J631 6P-C/ General Services Approval : Date LE(11) AOONVH6 **Gigapower** I vttvtKnantE I I -UK ENCROACHMENT PERMIT CITY OF NEWPORT BEACH PUBLIC WORKS DEPARTMENT <'COMPLE :E T --WE PROJECT ADDRESS: NEAR 114 19th St XST Court Ave DETAILED DESCRIPTION OF PROPOSED WORK: EXCAVATE 33 S FT1N PCC ST EET 99 FT 1N N 17"x30"x24" HANDHOLES WITH (25) 17" x30" xX' HANDHOLES. All Traffic Control shall be in accordance with the latest WATCH Manual and CA MUTCD. APPLICANT: AT&T CALIFORNIA Phone: (714) 618-9132 Email Address: vk3921@att.com Valentina Gipson, AT&T Liaison Mailing Address: City/State/Zip: 3939 E. CORONADO ST, 2ND FLOOR ANAHEIM CA 92807 OWNER: Phone: Email Address: Mailing Address: City/State/Zip: ALL CONTRACTOR INFORMATION IS REQUIRED -PLEASE COMPLETE CONTRACTOR: r Office Phone: /el CilZ- �( y Company (if different): Jobsite Phone % Other Phone: Email Address: _ Mailing Address:. 5' c-J htA State License tuber& Class: �� Expires: 31 CitylStatelZip: Clt Business License umber: _ Expires: WORKERS COMPENSATION INSURANCE - Certificate of Insurance (Section 3800 Labor Code) Com an P y: Policy No: Expires lRef 000AOLErvEPOSM11NFORMATION(/fAppIlca4tej Refund pa :able To It7a/I Refund;To, . FOR OFFICE USE ONLY Special Conditions of Permit: ° �'=a — ADDITIONAL APPROVAL REQUIRED FROM THE FOLLOWING DEPARTMENTS Utilities: Traffic: Fire: General Services: Other: Engineering Technician: Public Works Specialist: Date: Permit No Y� .0 f lusers/ppv/sheretl/ancroatlihnasbrslopwoMshw� tls Public Works Department 949-644-3311 � FEE WORKSFF�ET F012 ENCROC�fMNTyP�RIVII f£ 4> r ,_ _� 2 F :d-,y'xM11 PN.aR it ac4 �( -�. "a d3f..Y Jr a wM5»a�te�x �`�, sS,✓k,'���ti '�^�'1�'�'B 1•,�p lJBI�C'YY�Rf�S1:r A#F.6.4&:;AM fUoi�Refui►aiabfe: friless DtF►erlivisr' St�tecE:::::::::::::: PROJECT ADDRESS: PERMIT i ` \V, NUMBER: N2017- APPLICANT: ( l..x= IS . 1 Permit Processing Fee: Q Inspection Fee: Q Public Works Only $241.00 Public Works Field Inspection $165.00 Z Other Department $275.00 Utilities Field Inspection $121.00 General Services Inspection $165.00 Agreement Fee: Water Quality/Artificial Turf Inspection $108.00 Preparation of ReportlAgreennent $817.00 Document Recordation Fee $192.00 Refundable Deposit: TBD Monitoring Wells $502.00P Improvements TBD Street/Alley/Walk Closure: $65.00= Newspaper Rack Inspection $108.00 Traffic Control Plan Check 8-1/2" x 11" $65.00 Sewer Connection Fee $250.00 24" x 36" $143.00 4TT Box &Cover $64.00 Additional _ THERM VVINGHEMSREQUIR APT 1AL.�RA T�1 RevenueAluisian r'''.,.,.,.,REVENUE.DIVISIO:N.P.RIO�TOPAYMENTOPFEES'....... Aaaruvai; .............r r..,'. [WAterMet@r InstaHdtion:Qhalge.: : $5?8.04. Meter.$oxe§:::.. . :::..... : :::: •::I 11'' Meter :: $121.50 . :pr, i?arkwzy 8 :Sidelvalk Area (9qz t CoveF= Cos1j : l 11"1/2 Meter : $28500 1"Meter .1300+37b0 $5000 [ 114%2 Turbine Meter. ,$70000 2:Meter `2700+61.25 $8825=.'1 .. 12";Meter ......, ;. ...:......`.:..:..',•$425.00 �2' 7j e.bin6 Mete[ Z4$.QO : : •F4rTra(fiF AIIBY RrBas (BoX + C,oYer = C.oSt1 13" Meter "$.,:730.00 .:I 140.Meter .2" Meter .27 00 +.162.00 . - $189 00B .1 iW Meter. ' ::. ... ...:' • •$7:190.00 •' .. .. .` Certificate of Compliance Fee (+100% of hrly over 3 hrs) $288.0( Development Services Fee (Plan check hourly) $155.00 Final Tract Map Checking Fee $2,488.0( Final Parcel Map Checking Fee - Moderate $2,488.0( Lot Line Adjustment Fee $1,079.0( Park Dedication Fee Zone _ TBC Street Easement/VacationFee (+1o0%ofhrlyover 4hrs) $1,022.0( Street Tree Fee ($700 Planting Fee) TBC 5200-5029 5200-5015 5200-5026 5200-5027 5200-5028 405-470 5200-5031 030-2284 Engineering Tech: Total Amount Due: For Finance use only .—`s—'• Permit Specialist Receipt No. f:/users/pbw/shamd/encroeeh/masters/ep front and back masters/ Rev. 10/21/2016 epfeesheet.As-revised 101212016 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 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 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 Slate 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 tie: 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 $10.00 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 limes. 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 lariats) 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 Conlpelisatiolh Insurance, or a Certified Copy tPkreofq / / / -' ' CERTIFICATE OF EXEMPTION (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 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 Jitspepetion is required by calling Public Works at 949-644-3311. 15. Any above ground utility facilities wit quire documented approval from the adjacent affected property owner(s). 16. Homeowner, contractors, and subcontracotrs 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. **DRAWING NOT TO SCALE** 8014 41111�112 i I1� / 1911 FFGG Iz 0 CONSTRUCTION NOTES O ram¢' rn [aµs ra^rwo OW Rt MmxiSOUcin[ qu�crrtw�¢a cxurm. rwrs+x nrrn z you vos xin+calev _ua S. BEFORE EXUVATING CALL: U.G, SERVICE ALERT I-(800) 227-2600 au munc mxrlp+ m wmf ri oreeccoxn+A. mme zm cmlmr x�`ax''"e" m'm Raw G.A.Nryra) 9+e-91n sEx.: +wR-rsGe uii corvaiwuenoN DIAL mu FREE eat&tCalifornia .zsrG.u.+a eaDGO NO GDn"°° , 1 900-]2J-2fi00 CO NOT REDUCE c *° mec B J pPvxaro J°'-"" RL lF4R MYI OwK DURING REPRCOUCTGN FJS p9zO5R P F � �c T� "wo xc r BFFgY IW pC aa,�giEypq• 9LLBW . mP 0 nwa0.T zm sr ... ]rry IT LEG 11I AOONVH6 DWG. ! OF "DRAWING NOT TO SCALE" R CONSTRUCTION NOTES �n 0x u TI mR :o`er sa:"pm -';r` N.o 1 AN AT.I.,E ml. maN. 3. BEFORE EXCAVATING CALL: � O BALBOA BLVp. _ _ U.G. SERVICE ALERT I-(800) 227-2600 rErnox u:o wuu erare�N(zlrt —11IT cei¢r �� mn x — rt x�ALL � — �l .r� — rcxc ary ^ ryvawyPl'Nj x01. IiTT l oL III �� xr fc�m� wusL Iu ixwiwa rt Ie� u Nom Wnl'xILafyn nmr� O I- 6 1 B13 �0 lan 'O 1 i§ I80J� 1619 Q C� \\ 1605 !L j DI- __ ERE. 1^ BO.o-22T-2A00 TL NT me 'I I61a of Rt Imo � leofi 10 ® dt&t California nn i nss i _O __ my � — R r DRANING TO SCALE DO NOT REDUCE DURING REPRODUCTION dwFx.'F 1 C. lE. fWI.NN1 Q,A) 669-II41 STAY. 'uwuac 'R C. AMIN ("A) 6 - 114J6ZCJ6]E vc roR: awav:u G CASTaNEM (71.) 66 - 6 i.6.Y HI J-1 - / 163osN MAP / LAL 9M BLY9 �.A� �uDtl3o 71 C TO TN LT �I "DRAWING NOT TO SCALE" CONSTRUCTION NOTES rawer z. mpi re[m�N.ivwnetAND 0 w-za1'1B1''"ve:"plm N", -1 Nmir�].ussm1T. avIxa° R NT(K iwim� erg xa° un'uirza i't+e'i"r°.xlym � 6. BEFORE EXCAVATING CALL: U.G. SERVICE ALERT I4600) 227-2600 A. t O:N,Im'��w °s'N:x OO N nx.>s.,s IT. Niaim aim":a°u`s.° .m n.".I .„ xm IN #? 6 R FI-11 Fml O FmIl W F- s 6 ! a ! ! ! ! v j• ®! 1M1 d IMI IJI9 I° I I I I „Vy I IOB _r 1_� _ _ _ __ALLEI _ __ __ __ ___ ___ _ __t_______ _ I O O (E]Oanze Ima (?]Ji0 TB T6 JI<1]I3 u.c. uG. R27 i-"B00.P2] FREE -2600 � H'iiME DRAWING G i05 oG xoi RmOCE :.RING pFpRCOVCTIXI �t&t California w ® C nMINMCFI (]10) t CC45TarvEM (]IO)t cvumacv R FJs j 3ezx5 NIL IO 13TN Si 9OA C.O. axon CEI "DRAWING NOT TO SCALE" OAR - O' - reit9ar EDmm E DI N30 rerysr r;=IrD 3. BEFORE EXCAVATING CAUL- U.S. SERVICE ALERT 1-(000) 227-2600 RE —AIR ID.Nrx6w orzED. AND n D-PV N NA A NUDE PREARNFON wDREFs6jAIDEA NADA .a (1.1) AND 60 m I� I� ODI ,fi], i6Q29 ,fi21 w`V 1626 0,+: ® 16Q19 J ,,9 OI6 fiJIB O) I �.....I'Cd�%..... 9�..... ......4 NID ..... I% ryDT 'Y 'o IN DA 40 n 8 1fi28 I 1629 I I6II � 18k0 I 1619 ^^ 16Q14 Ifi12 I Iry 1606 I � 1609 -x 609 r' 102 N € C I� DRANING TO SCALE ry°fO DO NOT REDUCE ODFIN0 REPROOUC➢ON scna r= zo' DBADN➢ RDAHII E NJIMORI (714) 669-2N1 SAME 1 20' NEWI BEACH MIN (J19) 516-9111 SEG 1 el6-J CI"AL.'1S4R.CT/CNE 9 wPYfilry L. CADE. E69 (714) S69-2228 i6p N s eRzezD�F w fn. AN=.. .-"`— ,ew e Cn�ea9 �w m SIT LE(I IAOONVA16 M. 4 OF 6 "DRAWING NOT TO SCALEII Op �n ��,x�iu (aJer OEfli � sai[Ne xzH9n - �`�°wr w. �rv�°grarm'xAl `r Ii � filet III 11\� 15]5 ISfI 1619 'ygtl{p{[f9, 151] 511 .I W J Y W Y`•'Y L 1A 15009 O I yl I I�I -ALLEY - --- J o y' SII _ I I I I 0 BALBOA BLVO CONSTRUCT/ON NOTES ---._ SEE OWG. I BEFORE EXCAVATING�CAU owrzN U.S. SERVI...CE ALERT IN(�OR�2µN 2600 "II. 5W.NXNN NNNNNIIN �w. mrx°�i °x'° .n nsssJ Nm­II. IN X. N. pl .NLL..EE . BOD-P2)-2600 ............. DRAMNO TO SCPIE DO NOT REDUCE WRING REPROWLTON 1� ata California ® .a. Ess a: E wnpRl ow 65 - saEE r- zp News ar ecweN <au Na V L. PMINeOCONSTRVLT/ONE Fa�- 6]e vawav lu G CASTPNEM ()19) 669-3336,vwmre0/1 P vrvwcovrs � FJS/36305 m p c� 2 �e_n 'LL`� WW IO ]m 5I LE(1 11 AOONVH6 DWG. 5 OF 6 "DRAWING NOT TO SCALEF" 9 �uNc M_ QrtcM moRic'Ncau. �Rzifrcx. I II .TVNNimlwNR [tt E, m DPiM0 ALLEY___ _ _ ____ _ i _ �G Hls Hla ulz 0 Iwa 1106 1® DRAWING TO SCALE DO NOT REDUCE DURING REPRODUCTION DIAL RILL NO Ipiaoo-zx�x6ao 96oa6.pl p9 3. p BEFORE EXCAVATING CALL: U.G. SERVICE ALERT I-(900) 227-2600 swi u MJE mw�6�(ENswxaNn ANAI ix.�N— xMEmME U� INFIX n ryms).aw NM IN u. s. ncsis R: E NVINORI (]:1) 669-2N� SCY:E 20' sxcuwucs C KKIN (I1q) 619-9111 SE6: -]6J9 suewav iu C 0.5TPNEOP (]I1) 669-3:36 i.E.p _ _ ' e�xixe'�' e•l�`6"i ro InN 9i ✓'O ]6 A00NVH6 6 CFO 7/ 10/2017 City of Newport Beach Page 7 of 10 4:30:13PM INSP150 - Daily Inspection Request Report Requested Inspection Date : 07/11/2017 Inspection Type: ENCROACH Inspection Area: PW !t±. Site Address: 1 PUBLIC ROW Activity : N2017-0114 SubType : NEW Status: APPROVED OWNER: CITY OF NEWPORT BEAT APPLICANT: AT&T CALIFORNIA C Description : Remove and replace (25 alley between W. Ocean Per Citv Standards. item: 10200 PRE JOB - PW Requested Timer 7/11/2017 12:00:OOAM Entered By: WEBUSER Comments: AM- Phone : 71/ oC 3 (s u Phone : 714-616-9132 T �Z39434 emdhefes in Alley between 14th Street and 19th Street. Alley restoration Requestor: WEBUSER 7 - 34-95 r �� _q : --SO Assigned to : zzzzzzzzzzz* R� D Inspector: J Date; 7l / % Time: •� A PM Comments: ac 3 (: ° //. `e I.. ed Refiie F:\Users\PBVV\Shared\ENCROACH\MASfffkS\FO—RMS\InspectorSheet.doc - — -- REPT131 Run Id: 4018 I THIS IS NOT PTICKET NO ---- -—.. CONTROL ^ R®BERTSoNg ! f NUMBER � q y "i j 1 41 d , Phone 800/834 7557 San Diego 8000//e-7d-'1A22M0 ARIVERSIDE 6120 E0h ST m wsmynCa.COm -• MORFjIOVALLEY 12690DAYSL QPEN7DAYS W3 REOLAl 8353 ALABAMA ST �y A #13 IRWINDALE- 13631 LIVE OAK LANE #4 FONTANA-13792SWVER AVE. #14 PASADENA- 142D N. LINCOLN AVE, ., #28-PARAMOUNT 7277E flOSECgANS AVE #32 UPLANO-19I5 N. BENSON #5 `POMDNA 2476 POMONA BLVD. #15 VERNON-Us ANGELES-3365 L29H ST / MOJAVE-140 E, HWY 58 j #24 RIALTO- ,.#41 �l#6 HEMET/SAN JACINTO-1675 STATE ST #16 ANAHEIM- 2emNALOEfi AVE. #33 MIRAMAR- 5692 EASTGATE DR. #42 VICTORVILLE - 16952 N. DST #7 BEAUMONT- 452 W. LUIS ESTRADA RD. #17 SANTA ANA20i E. COMMERCIAL ST #26 3m Be 905ECPVARER #34 LUCERNE-36555HMIB : #43 BAKER- 56500 BAKER BLVD. 310 N.1UWN5EN0 ST. #8 SUN CITY- THOUSAND #2fi THOUSAND PALMS g24fi0 VARNER flO. #35 BIG BERLAKE- 42025 GARSTIN DR. #44 HE IRWIN- 58825 FORT IRWIN no. 2ID50 WATSON RD. #18 TAKE FOREST- 25931 TOWN CENTRE OR. #27 MURRIETA - 26190 ADAMS AVE. #36 ESCONDIDO-1310 SIMPSON WAY #45 BAgSTOW- #9. ARROWHEAD - 29750 HWy 18 #19 ADELAMO-12203 VIOLET Ed, #28 E. OTAYMESA-7961AIRWAYRD. #37 INDIO- 9000 OSSAVE. #10 SANTA FE SPRINGS - 12311 GREENSIONE AVE. #20 SANCLEMENTE-116RINCONCT. #29 EL CPIIIN- RE1ID FARG INYOKENflD. #47 DAL-CITY-1900MH,DOES. #11 CABAZON- 1399D APACHE TRAIL #21 IRVINE- 540 DYPRBORNS #39 #41 POm OF LONG BFACH 1fi02W PIEROST #31 CORONA- 15405H ST. #125AN BERNARDINO- YWOOD-13132RYNERSWEST PALMDAE-3779] ETST. EAST 1955W 9TH Si #22 NO. HOLLVWOOD-13132 MYMEn ST #31 HESPERN-9fifi1 CAVE. #40 ARTESIA- 13949 E. STAGE ROAD AVE. #40 PALMDALE-3719D ]STI Si. EAST #48 EL CENTRO, 1051 N. P ST PLANT GATE CUSTOMER NO: SOLD TO. MAP PAGE ' ' TICKET NO l / ! ry 7 i;. , III-x.: rthl. r •:L.jr., r t t, 1.L I TX CD DELIVERY ADDRESS &INSTRUCTIONS }i(4j 1d.}i t f. ILL CUSTOMER P.O. j JOB OR LOT # I L 1 I n... I/C r r?r..-..'ii jii:� ORDER NO. METER READING TIME TYPED TRUCK LIC NO: 5GI ...h'.`., .,., .tJti`Y ..'.- r7 LOAD NO. SLUMP TRUCK DRIVER ' 1 '!:f it L ! <:aC.)r ! C! lltl")(ti :i. I I tt DRUM J 0j S 13 1 i` In I r.'' , I/III �J4 tit 4a llP REVS - Job -site Cylinder Test TO JOB I- Yes 1 — TIME ON JOB MIN. CHECK# 1 oN,ioB r C.�% Water added on job at �1) STAND BY ❑ it Customers request' '` MIN. CHECK p T START POUR i t3��% 1 gals t0 Full Ld. RATE OF A. UNi By r PER MIN. CASH ❑ j?(�..'t '"'_ AMOUNT p,^4 BY gals t0 2/3 Ld. FINISH POUR�=""-� �.y1 - {�+Yp— $$o0� gals to 1/3 Ld. (ovEHIIME cnAgGE -: PLANT MG SIG 1 LEAVE doe 4 min, per yd unloading time allowed - ADJ. MeteL,i• Pri a lil Additional unloading time charged. at current hourly truck rate ARRIVE PLANT Additional water added to this concrete will reduce its strength, Any water added exceeding the design water is at Customers o,nd, Signature cerlifVing antler penalty of perjury That the information contained In this written time record Is true and correct. - r,!^5 EMPJu '> (1�,j SIGNPTnnE�Tf ,)(I Customer agrees that the described material has eenche ensOlelyby CDatOlrlat WithoutRobertson's cirectlon' or review of any plans or specifications velatinp [o theprol1e ERMSANe CONDITIONSOF SALE Customer further agrees that it shall be solely responsible for the Oillvery location, and discharge/placement of material on the job site, Init udIng theart-site �rto tine ofpco(s) herethMaterithe Iodation, Customer s r even approval the described malarial shall be eCtinin designused evidenced by Customer's signature and/or placement of the described Material fTjob ated IdOber eratiehicles of the above,Customer releases and agrees to defend, indemnify and hold Robertson'sand Its employees and agents harmless from any and all losses,damages,liabilities, Costs on . mover from (i material being inapproprmte, ihpompatible, improper or inconsistent with etl claims an Corrdpy Customer Or any third �obedson's r1 II movement of arty, and specifications, or with the ground soils or conditions on the land where the material is utilized, and (f) the vehicles upon oWabout the d livery location Solely to the extent Customer fails to timely pa for the described materials, in the event Robertson's retains the services Customer agrees to pay such reasonable afford fees incurred by Robertson's in furtherance t� of an attorney' l0)7" of such COVembin efforts. Robertson's and Customer disclaim attorney's fees arising from any other context. Customer agrees to pay a time price differential of l �A %per month on any amounts owed to Robertson's for more than thirty (30) days. Color Disclaimer Due to irre9ulanhes and/or inconsistency Robertson's is nob responsible forthe results of any concrete where the of materiels coloring agent has been added at the request of the customer, either at our plant or on the job site. LD QTY CUM CITY ORD QT/ PROD CODE MIX AND COMMODITY UOM UNIT PR AMT a i r.! I it N'I Nii I ItII(!< I ll i tll,q.=jL) 'ts :let 10..: DE f ;l It t!,i F ;I t Jfllj I! (4I111 IJ}_�% I 't `'IL 4I WEIGHMASTER CERTIFICATE ' THIS IS TO CERTIFY that the fdllowin described commodity was weighed TAX II{}j1r ljll'I ij(:jJI t r ) I%Ij IFI!r measured, or counted by a weighmaster, whose signature is on this certificate who Is a recognized authority Of accuracy, as prescribed by Chapter 7 I::!. ( 1- (,( (commencing with Section 12700) of Division 5 of the California I Business and PREVIOUS t i ItIL l i i .r : Professlans Code, atlmm;stered by the Division of Measurement Standards of the BALANCE ( ,. CaliforrnaDeparttmentofFood and Agriculture . l i l AG_311 1- S D. ROREgTSON'S SUB rc WEIGHMASTER ] { Cl{�(ii -. L_lt .t !, ft.:; Tip '' - TOTAL ,. 1,4 e3AIl 1.....1.5 Ilri -11-' STANDBY j BYDEPU YY T rtll�M ij) ERdlpft rOY YARD53 #POJIN057 G,LGA•f,ldh FkUNCES CU=METEfl53 KG KILOGRAM L LITERS ML MILLL} B CHARGE I EP ) 1 i( i i t 1 1, 'I. cJ­ 7. TOTAL' tz xF S>I tLCI I<i:,hJt CONCRETE DELIVERY -TICKET ' _ (},)V (.t TO ADOURMILURREIVED B,$: _p5TOMER PO BOX 3800 CQFj©NA, CA 92878 3600 4 ,AGREED ROBERTSON'S ROCK * SAND * BASE MATERIALS READY MIX CONCRETE Q<ZOFESS ��pEt. Oq"iC m � 61055 EXP. 12/31/17 OF Date: 7117117 CA��F Concrete Mix Design #: 62894R Project., 1515 W. Balboa Ave. - Newport Beach Contractor. HAC Construction Description: 3000 psi @ 24 hours Strength (Fc): 6000 psi WIC ratio: 0.34 Slump: 6 " Sack Content: 8.00 sk. Max. Size ofAgg.: 1 Gal/sk.: 3.88 Pump Type: Boom pump Un. Wt: 151.4 ALL CONCRETE IS MIXED AND DELIVERED IN ACCORDANCE WITH ASTM C-94 Aggregate Weights are SSD; Moisture in Aggregates Must be Considered When Determining Total Mix Water MIX DESIGN PROPORTION Batch Wt. %used Sp. Gr. Volume Contents: 752 100 3.15 3.83 Cement (ASTM C-150) Fly Ash -Class F (ASTM C-618) 0 0 2.33 0.00 Sand 1284 42 2.62 7.85 1-1/2"x 314" 0 0 2.67 0.00 1"x#4 1484 48 2.65 8.98 318" x #8 309 10 2.65 1.87 Water 31.0 gal. 258.2 4.14 Entrapped Air 1.25 % 0.34 Wt. = 4087 Vol. = 27.00 ADMIXTURES: Note: Dosage rate of Adva shall be ZYLA 625 (ASTM C-494) 3.0 ozlcwt. 22.6 oz. adjusted to achieve the design slump. Polarset (ASTM C-494) 34.0 w1cm.. 256 oz. Recover (ASTM C-494) 2.0 oz.icwt. 15.0 oz. ADVA (ASTM C-494) 3 to 9 ozlcwt. 122.6 to 67.7 oz. Range Remark: The project engineer should review this mix to ensure compliance to the project specifications AGGREGATE GRADATIONS Size % 1 2" 1 112" 1" 314" 112" 318" No 4 No 8 No 16 No 30 No 50 No 100 No 200 1 112" 0 100 95 33 7 3 1 0 0 0 0 0 0 0 V, 48 100 100 95 70 38 12 1 0 0 0 0 0 0 318" 10 100 100 100 100 100 96 18 2 1 1 0 0 0 WCS 42 100 100 100 100 100 100 99 88 72 49 20 7 2 Combined 100 100 100 98 86 70 57 44 37 30 21 8 3 1 Note: Remember, during cold or heated weather to cure cylinders per ASTM C-31 10.1.2. "The specimens shall be stored up to 48 hours in a temperature range from 60 and 80 °F and in an environment preventing moisture loss from the specimens. Sand Source : Robertson's Redlands Rock Source: Robertson's Corona Aggregates meet ASTM C-33 Cement: Portland Cement Type I11V (951) 685-2200 ext 6381 200 S. Main St., Ste 200, Corona Ca. 92882 Fax (951) 280-1429