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HomeMy WebLinkAboutN2017-0172-nrr u City of Newport Beach 11IIIIII111111111111111111111111111111111111111111I 100 Civic Center Drive, Newport Beach, CA 92660 N 2 9 1 7 Permit Counter Phone (949)644-3311 Online Inspection Request - www.newportbeachca.gov / Online Services 0 1 7 2 II Permit No: N2017-017` Project No Inspection Requests Phone (949)644-3255 Job Address: 660 KINGS RD NB Thomas:Guide: 889A7 Description : Install 46 LF of 3" SCE conduit across Signal Road adjacent to address. Pavement restoration per City Standards. Parcel # : Legal Desc : 0492-012-7 - N TR 1219 BILK H LOT 1 B'- ED Owner: PEDERSEN JONATHAN T & KELLY gab Contractor : DICKENS JOHN INCORPORATED Phone: 0 Phone: 949-795-0995 Address: 660 KINGS RD Address : P O BOX 1882 NEWPORT BEACH, CA COSTA MESA CA 92628 Contractor State Lie: 355981 Applicant: JOHN DICKENS INC License Expire : 07 31, 2017 Phone: 949-645-8345 [ Address: PO BOX 1882 COSTA MESA, CA 92628 Business License : BT00002899 Business Expire : 07 31, 2017 Special Cond.: Pre -job inspection required Workers' Compensation Insurance - - Traffic control per WATCH Carrier: EVEREST NATIONAL INSURANCE COM Policy No: 7600015590 W. C. Expire: 10 01, 2017 Permit Processing Fee : $241.00 Sewer Connection : $0.00 Total Fee $736.00 Agreement Fee : $0.00 4TT Box Cover: $0.00 Paid : $736.00 Traffic control Plan Check : $0.00 Total Water Meters : $0.00 Balance : $0.00 Inspection Fee : $495.00 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 : Date : y /it/ 17 General Services Approval : Date 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 o'f,' a permit, is subject to rejection/fine. City reserves the right to void permit if work does not commence withini ay5`' 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 backflling, 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 $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 limes. 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 pennit 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. I,T,tGe',(NRr4jrXGa9/aL[i)nIIU-WY4Y4 F3.},. •. WORKER'S COMPENSATION INSURANCE (Section 3800 Labor Cade) I certify that I have a Certificate of consent to self -insure, Certi " ate f W 's Compensation Insurance, or a Certified Copy eof. Date: / 7 Signature: CERTIFICATE OF EXEMPTION ( ion 3800 Labor Code) 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 Encroach t Perm' sp Is red b ailing Public Works at 949-644-331 15. Any above ground utility facilities ill require 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 $25,000 and/or up to three years in State prison plus the full cost to clean up an illegal discharge or spill. 17. If a refundable deposit was paid, applicant must submit a Soils Compaction Certificate or Evidence of a Slurried Backfill and request a final inspection from the Public Works Department. Monies may be held for six months after final inspection before a refund will be processed. 18. No trees in the public right-of-way shall be planted, removed, trimmed, or relocated without approval from the General Services Department. 19. All work in the public right-of-way must meet the approval of the Public Works Department or corrections will be required (i.e. removals, exposing connections, etc.). Additional inspection fees may be required. 20, Permit is for standard materials in the public right-of-way only, unless previously approved by Public Works and an Encroachment Agreement has been processed. 21. Permit is valid for "description' of work noted on front only. Additional work performed may require issuance of a separate permit and/or additional fees. 71111111,Y�� COMPLETE'; THE BELOW INFORMATION PROJECT ADDRESS: lobo K e RA DETAILED DESCRIPTION OF PROPOSED WORK: APPLICANT: Email Address: r ?� l Cv Mailing dress: City/State/Zip: OWNER: Phone: Email Address: Mailing Address: City/State/Zip: (s C I 77, r 7!1LMPRITRAC70R RI,OWNT,1Q , :;I$}`t Et U ki CONTRACTOR:-76 o l� t C- K �T 5 lOffice Phone: Company (if different): lJobsite Phone: Other Phone: Email Address: Mailing Address: City/State/Zip: State License Number & Class: Expires: City Business License Number: Expires: WORKERS COMPENSATION INSURANCE - Certificate of Insurance (Section 3800 Labor Code) Company: Policy No: Expires: Municipal Oerations: 949-644.3056 Utilities: 949-644-3011 Urban Forestry: 949-644-3083 Special Conditions of Permit: 'Pre -jab inepechovt r uirsd- 'Prolrfic esw�ol pa.+• Wq,'(Ctl A00ITIdMAL"AP.pRVALRE0UIREb.F.fMH�FIIL,OWING�MEBAIiTMNT&:`7 Utilities: Municipal Operations Traffic: 0 Fire: 0 Other: Engineering Technician: Roa,; Permit Specialist I Date: Permit No. N2017- 01'12 f./users/pbw/shamdtencroach/mestem/epworksheet.xls Public Works Department 949-644-3311 100 Civic Center Drive, Newport Beach, CA 92660 !v's� �t �l�� d T s �f" �' '� x 7 �}},' � �a °�p�i$�, �y/�� � "'S Sry� .xu33-4 q��✓ °� ` ((��ttP'^ (y � Aft Fees Are Tarr -Refundable Unt"s Qtherwfte Mated PROJECT ADDRESS: PERMIT N2017- o172. (ptpO V;AoJS R� NUMBER: APPLICANT: 5bhn F7tckonS �L44C .�., -C .� 4d Permit Processing Fee: O* Inspection Fee: O Public Works Only $241.00 1 I Public Works Field Inspection $165.00 Other Department $275.00 Utilities Field Inspection $121.00 General Services Inspection $165.00 Agreement Fee: Water Quality/Artificial Turf Inspection $108.00 1fl Preparation of Report/Agreement $817.00 Document Recordation Fee $192.00 Refundable Deposit: TBDP Monitoring Wells $502.00 Improvements TBD Street/AlleylWalk 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 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 EasementlVacation Fee (+100% of hrly over 4 hrs) $1 022.00 5200-5031 Street Tree Fee ($700 Planting Fee) TBDI 030-2284 Engineering Tech: Total Amount Due: For Finance use only ?0aA s7311P• j6 ?ArlD 4—It-I"D Permit Specialist Receipt No. 30a v � Rev. 1/5/2017 o 2� f./users/pbw/shared/encmach/masters/ep front and back masters! epfeesheetAs-revised 10/21/2016 1; 'X30"X24" ,ST FOR BD/PAD/PB/PME/SB/SOE T DUTY #8-350 iP 4-WAy !OB TO H680C) EXCAVATION T CLP (H680B TO H680C) B TO H680A) YCAVATION (H68013 TO H680A) H680B TO H680A IN: 7' 1/0 CLP T :LP )A) H68OBTO H680C IN: 46' #350 CLP 680E TO H6808 IN: 36' #350 CLP CZ-117F DR H680C TO H680D IN: 78' #350 CLP ** EASEMENT REQ'D ** I KINGS RID I I r t4/1212017 City of Newport Beach Pagel of6 ,6.34:416AM INSPI50'- Daily inspection Request Report Requested, Inspection Date : 04/12/2017 Inspection Type: ENCROACH Inspeetion'Area : ,PW' Site Address : 660'' KI NGS RD Activity : N2017-0172 SubType: ' Status : APPROVED- OWNER: PEDERSEN JONATHAN T & KELLY Phone: 0 APPLICANT: JOHN"DICKENS INC i. Phone: 949-645-8345 Description : Install 46 LF of 3" SCE conduit across Signal Road adjacent to address. Pavement restoration "et CU Standards. Item: Requested Time. 4/12/2017 12: 00 OOAM: NBIV Requestor: R " 9497950995 -10 A?4 Entered By: NBIVR ----- —" Comments: AM Assigned to: 2 Inspector: l7 , Dater 4111 Time: a 66 I PM Comments: CA4/ru yz> "t/7g--Z,-/ se4>wg- Pl' t_� N 4rt> O Pv/7J p-e-G— r7,0*7�- i �A ©t?� Toris�u s ` rat— 'r1�1�S Z F:\Users\PBW\SharedXENCROACH\MASTERS\FORMS\InspectorSheet.doc 4/13/2017 City of Newport Beach Pagel of 4:30:25PM INSPI50 - Daily Inspection Request Report Requested Inspection Date : 04/1412017 Inspection Type: ENCROACH Inspection Area: PW Site Address : 660 KINGS RD Activity : N2017-0172 SubType : Status : APPROVED OWNER: PEDERSEN JONATHAN T & KELLY Phone: 0 APPLICANT: JOHN DICKENS INC Phone : 949-645-8345 Description : Install 46 LF of 3" SCE conduit across Signal Road adjacent to address. Pavement restoration Der Citv Standards. Item: 10060 PIPE INSTALLATION - UTIL Requested Time: 4/14/2017 12:00:OOAM Requestor: NBIVR 9497950995 Entered By: NBIVR Comments: AM Assigned to7: Inspector: Date: �'% /7 b Time: /a3o AM PM Comments: F:\Users\PBW\Shared\ENCROACH\MASTERS\FORMS\InspectorSheet.do REPT131. Run Id: 4018