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Permit No: N2018-0092
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Dport
oityvo CenterNewportham. cnszsso
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Permit Counter Phone (949)644-3311
Project No: 1947-2016
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Online Inspection Request- www.newportbeachca.gov/Online
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Services
Inspection Requests Phone (949)644-3255
Job Address:
119 41 ST ST NB
Thomas:Guide:
Description :
NEW CURB, GUTTER AND SIDEWALK PER CITY STD, 2 NEW CURB DRAINS
PER
CITY STD.
Parcel # :
Legal Desc :
Owner:
METRO 41 ST STREET LLC
Contractor :
KEEGAN'S CONCRETE
Phone:
Phone:
949-650-6991 949-290-8615
Address :
227 20TH ST #100
Address :
788 W 16TH STREET
NEWPORT BEACH CA 92263
COSTA MESA CA 92627
Applicant:
SEAN VANDENRAADT
AVIDContractor
State
License Expire :
Lic: 632315
05 31, 2019
Phone:
949-456-4301 [
Address
Business License: BT98041837
Business Expire
: 04 30, 2018
Special Cond.:
PRE CON MEETING REQUIRED WITH
Workers' Compensation Insurance - -
PW INSPECTOR
Carrier:
NORGUARD INS
Policy No:
KEWC631922
W. C. Expire:
03 19, 2018
Permit Processing Fee: $241.00
Sewer Connection:
$0.00
Total Fee $571.00
Agreement Fee:
$0.00
4TT Box Cover:
$0.00
Paid : $571.00
Traffic control Plan Check : $0.00
Total Water Meters:
$0.00
Balance : $0.00
Inspection Fee :
$330.00
Water Meter Connection :
$0.00
Receipt No:
Refundable Deposit: $0.00
Total Water Meter Box:
$0.00
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Street Tree Fee :
$0.00
Adjustment :
$0.00
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Processed By:
Date : _/ /
Other Department :
Date
Utilities Approval
:
Date: _/_/
Permit Denied :
Date : _/ /
Traffic Approval :
Date: _/_/
Issued Permit :
Date: 2 / 22/ 113
General Services
Approval :
Date: _/_/
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PROJECT ADDRESSt
DETAILED DESCRIPTION OF PROPOSED WORK:
APPLICANT: `� c a
Phone: qq' �S 3 v
Email Address:
Mailing Address:
City/Sta BIZip
Phone:
OWNER:
Email Address:
Mailing Address: City/State/Zip:
rE!3 L ONTRAC,YOR INFOI2IVIAT QN fS REQU(RED4PLFEA-
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CONTRACTOR: (CeQC2L
Office Phone: I Li`4`1
Company (if different):
JobsitePhone:��(
Other Phone:
EmaifAddressS'.e � 15 ere •LG•
Mailing Address:
City/Stato/Zip
State License Number & Class:
a 5 G` Expires:
City Business License Number:
BTci8o4i 0 3-� Expires:
WORKERS COMPENSATION INSURANCE -Certificate of Insurance (Section 3800 Labor Code)
Company: Policy No: Expires:
RmREFUwgt.DeF0$1T)NFORMATIQRSE ..........
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FQR OFFCCE USE,O,NLY;,
Special Conditions of Permit: _ R—cm nup4lP
ADDITIONAL'APPROVAL REQUIRED FROM THE FQLLOWING}DEPARTMENTS ,,•; ,
Utilities:
General Services:
Traffic: Fire:
Other:
Engineering Technician:
Public Work Specialist:
Date:
2 za �a
Permit No.
N-M)-o0a2__
F.Nsers/pMv/sharetllencraachlmasiers/epwotksheel�Js
Public Works Department 949-644-3311
Permit Processing Fee:
$241.00
inspection ree:
Public Works Field Inspection
$165.00 2
Public Works Only
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 Report/Agreement
Document Recordation Fee
$817.00[
$192.00
Refundable Deposit:
TBD
Monitoring Wells
$502.00
Improvements
Street/Alley/Walk Closure:
$65.00 =
Newspaper Rack inspection
r-�
$108.00 u
Traffic Control Plan Check
8-1/2" x 11"
$65.00�
Sewer Connection Fee
$250.00
$64 00
24' x 36"
$1'. 00
4TT Box & Cover
Additional �� — — — — —
—
THE FC?LLOWI1rIG ITEMS REQUIRE APPROI/EtL FROIF HE Revenue Division
DIVISION PRIOR TO PAYMENT OF FEES AppravaF.
I REVENUE
Qty`
my.
1
IWaterMeter:
Installation Charge
$528.001
I
13I4" Meter
$50.25
1
hemeter
$121.50'
Water Meter Boxes:
$96.66
11 1/2" Meter,
$285,00
1" DFW Meter Box
[1. 1/2" Turbine Meter
$700.00
2" DFW Meter Box
$2 ]3.24P
12" Meter
$425.00'
I
12.n Turbine Meter
$845.00
1
IT Meter
$3,314 00'
f4" Meter
$4,730,00'
6"' Meter
$7 190.OQ
MISCELF I NEQUS FEES z
"����'
Qty.Budget Number
Certificate of Compliance Fee (+1 00% 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/Vacation Fee (+100%of
hriy over hrs)
$1,022.00
5200-5031
Street Tree Fee ($700 Planting Fee)
TBD
---------------------------
030-2284
Engineering Tech*
Total Amount Due:
For Finance use only
5,111b6
Permit Specialist
Receipt No.
XV 5 "I
fluserslpbw/sharetllenaoachlmasterslep front and back masters/
Rev. 12/18/2017
/
'
epfeesheet.xls-revised11/8117
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 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 sharing 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 Ile: 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 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 -in e, Certificate of Worker's
mpensation Ins rance, or a Certified Copy thereof.
D te: Signature:
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, 1 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:
9our notice for Encroachment Permit Inspection is required by calling
IPblic Works at 949.644-3311. /
.15, Any above ground utility facilities above ground utility facilities will require documented approval from the adjacent documented approval from the adjacent
affected property owner(s).
16. Homeowner, contractors, and subcontrecotrs 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.
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