HomeMy WebLinkAboutN2017-0107City of Newport Beach IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII Permit No: N2017-0107
a' 100 Civic Center Drive, Newport Beach, CA 92660 N 2 0 1 7 0 1 0 7
t:' +, Permit Counter Phone (949)644-3311 Project No : �@ -
u Online Inspection Request- www.newporbeachca.gov/Online SCANNED
�� Services A � @ V
it Inspection Requests Phone (949)6443255
Job Address : 10715TH ST NB Thomas:Guide: 889A6
Description: Install 33 LF of conduit, 1 above ground cabinet and ground bed in West Ocean Front Alley and alley parallel to 15th Street. Alley restoration per
City Standards. (AOONTCP)
Parcel # :
0472-111-3 -
Legal Desc :
NEWPORT BEACH SEC B BLK 15 LOT 4
Owner:
Phone :
VAN ORNUM JOHN W
0
,,//^^
Contractor :
Phone :
VCI CONSTRUCTION
909-949-1350
Address:
1109 MIRABELLA AVE
j
k Address:
1921 W 11TH STREET
NOVATO,CA
UPLAND CA
Applicant: AT&T CALIFORNIA
Phone: 714-618-9132 [
Address: 3939 E. CORONADO ST, 2ND FLOOR
ANAHEIM, CA 92807
Special Cond.: Pre -job inspection required
Traffic control per WATCH
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 :
$1,650.00
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: 765716
License Expire : 07 31, 2017
Business License:
BT30036054
Business Expire :
06 30, 2017
Workers' Compensation
Insurance - -
Carrier:
LIBERTY INSURANCE
Policy No:
WC7631004260044
W. C. Expire:
07 31, 2017
Total Fee
Paid:
Balance
Receipt No:
$1,891.00
$1,891.00
$0.00
Other Department : —Date: _/_/_
Permit Denied : Date : _/_,/
e �f
Issued Permit : Dat7,q2 017
LE(11) AOONTCP **GIGAPOWER**
WORKSHEET FOR ENCROACHMENT PERMIT
CITY OF NEWPORT BEACH
PUBLIC WORKS DEPARTMENT
COMPLETE THE BELOW INFORMATION
PROJECT ADDRESS: NEAR 107 15th StXSTW OCEANFRONT
DETAILED DESCRIPTION OF PROPOSED WORK:
EXCAVATE 15 LIN FT IN CONCRETE, 15 50. FT IN DIRT TO PLACE (1) 432 PFP CABINET, (33.) OF
2-4" CONDUITAND (1) 3-ELECTRODE GROUND BED.
APPLICANT: AT&T CALIFORNIA APhone: (714) 618-9132
Email Address: vk3921@aft.com
Valentina Gipson, AT&T Liaison
Mailing Address:
3939 E. CORONADO ST, 2NI FLOOR
City/State/Zip:
ANAHEIM CA 92807
OWNER: lPhone:
Email Address:
Mailing Address: City/State/Zip:
L
ALL CONTRACTOR INFORMATION IS REQUIRED -PLEASE COMPLETE
CONTRACTOR: i /C�
lOffice Phone:
Company (if different)
lJobsite Phone:
1Other Phone;
Email Address:
Mailing Address:
CitylState/Zip:
State Licensebar & Class: ICIVAuslne7,��re!r
!!bt-71 (10 Expires:
Number'
e0o Expires:
WORKERS COMPENSATION INSURANCE - Certificate of Insurance (Section 3800 Labor Code)
". Company: Policy No: xpIres: _1 141111
.......... ... ... ............ ... ...... ...........
OSITINFORMATIOW(fr .................
RefundTags ...........
............. ...... ...........
........... ........
FOR OFFICE USE ONLY
Special Conditions of Permit: r NWe ycS. mqjce '-,'6va 1, uie
VeA. \1IPVWL4.
ADDITIONAL APPROVAL REQUIRED FROM THE FOLLOWING DEPARTMENTS
Utilities: Traffic: Fire:
General Services: F==� Other:
Engineering Technician:
Public Works Specialist:
Date:
Permit No.
Public Works Department 949-644-3311
' 1=PE WORKSHEET FOR'ENCROAGI�MEN7 PERMIT' ' � � � �' �"�n
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r x „ cat ter Y qe,v t ;, k
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$
PUBLICFWOFIS DEdRNT
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AlfAMNbi-R6fthdible: h/6ssiOth0wis6Staf6aE
PROJECT ADDRESS:
PERMIT
N2016-
a0-i d `c1x ,;;,
NUMBER: --Dirty L
AryPPLICANT: �g
F3�jB�t e
Permit Processing Fee:
Inspection Fee:
Public Works Only
$241.00 j
Public Works Field Inspection
$165.00 p'fia
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 ReporVAgreement
$817.00
Document Recordation Fee
$192.00
Refundable Deposit:
TBD
Monitoring Wells
$502.00P
Improvements
TBD
Street/Alley/Walk Closure:
$65.000
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 8 Cover
$64.00
Additional
IT THE FOLLOVWNti tTEMS12frQUl�tl A��
1LAL.�RA N9' ire venueAnitstpn
F. , ..... REVEtJtlE DfVI§IQN. P:RlOR TO PAYINeIfT OF PeES ......: Approval. :............�
I : ::
[WaterMeteF:
Insiagpfton;Charge •;•
$�28;0(}
;
13l4'':Meier�•;•; :•:•:':::
:':'$50.25
I1"•Meter:�:�:�:`:�:�:�:�:•:•:•:•:•:•:•:•:•$12:1•.S6
.•.•.•.•.•:•:�oiP.arkuJsyB,.SidetvafkArea•(Boz•fCotier=•Cosry;•.;•1
.
-1` Meter .1300+3760
$5000
1
�1 1%2 Ttatbine Mltater
$700
00
2 Meter _'27 00 + 61.26
12"•M1bt2r`;•;•;•;•;•;•;•'•'•'•'•'•'•'•;•;•$425.00
:.:.:.:.::::::::::::::::::::.:::::.::::::::::.:.'.;:;.;.;.;.;.;.,.;.;.;.;.:I
[2,'Turb(neMefet
:' $B45.00
•:
:'FdrTi.alfio:BAIIeY.RFeas(Qox:+:E,oyer=COW
13"Meter
$3310.06.�.�:�.
$SF;Oa
44":Meter
::$4 730.00
......er.....0......
........:
. 2":Meter: ,27 00 + 162 00
$18900�
.1
r6"'Meter.'.
... .'....`........$7:190.00......::
,:`:..`.`.`........::.....:.:.:..'Y
Certificate of Compliance Fee (+too i of hrly over 3 hrs) $288.00
Development Services Fee (Plan check hourly) $155.00
Final Tract Map Checking Fee $2,488.00
Final Parcel Map Checking Fee - Moderate $2,488.00
Lot Line Adjustment Fee $1,079.00
Park Dedication Fee Zone _ TBD
Street Easement[VacationFee (+1o0%ofhrlyover 4hrs) $1,022.00
Street Tree Fee ($700 Planting Fee) TBD
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
Permit Specialist
Receipt No.
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TERMS AND CONDITIONS OF ENCROACHMENT PERMIT
WORKER'S COMPENSATION INSURANCE (Sectio 3800 Labor Code)
1.
Encroachment Permits may be taken out by the owner of benefited property,or a licensed contractor. A licensed
_
I ertify that I have a Certificate of consent to self -ins e, Certifi of Worker's
contractor must provide a "Letter of Authorization' to allow another party to pull a permit. An approved copy of the
ompensation Insurance, or a ied Copy thereof. -
permit and construction plan shall be kept at the job site at all times. Work, which has been done prior to issuance o
..Z �Z% y 2 -
a permit, is subject to rejection/fine. City reserves the right to void permit if work does not commence within 30 days-..
Date: nature:
after date of issuance.
CERTIFICATE OF EXEMPTION (Secfi 3800 Labor Code)
2. The Permitted 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
4.
of the City of Newport Beach, and in compliance with all applicable State laws and City ordinances.
Permitted guarantees all work performed under this permit to be free of hidden and latent defects. Any failures shall
provisions
ons of the State Labor Code, I must comply with the provisions of Section
be corrected within two weeks after notification to the satisfaction of the Public Works Director.
3700 mit
this shall be deemed revoked.
s per
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 sharing system, sloping of the ground, or other equivalent
means. Trenches less than 5 feet in depth shall be guarded whenhazardousground 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 subgrade 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
-Locale
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. and pothole
encroachments.
existing City -owned utilities lie: water, sewer, or street lighting conduits) to verify locations. Maintain a one -foot
clearance over or under existing City -owned utilities. Sewer deanouts require VCP or PVC SDR35 be used with a
Date: Signature:
4TT box over the riser.
4-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 o
Warning Signs, Sights and Other Devices for the Use in Performance of Work Upon Highways', issued by the.
Public Works It 949-6 4-3311.
California Department of Transportation. If needed, barricades can be obtained from the City at a charge of $10.00'
15. ab round utility facilities will require documented
y g Y 9 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.
10.
Work within or near beach sensitive areas will not be allowed during, City holidays, spring break, Memorial Day
affected property owners).
16. Homeowner, contractors, and subconlracotrs 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
11.
January 1, unless approved by the Public Works Department.
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 fromthePublic Works Department. Access for fire, police and
Quality Laws are punishable by fines up to $25,000 and/or up to three years in Stale
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. and 3:00 p.m. (Monday thou 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 daysby 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.
: ,N2i: work relatei ^Yo;thislencroachment permit shall ;be,performed.,untJ the-Pu414c.'µr/grks Dapartment'hds,rssuer( ihzsipermrt A$ ppkCanY"ftereby aCknowledgeg he(she has read and,un s tI t rms and
virDndf4pns'df,#Tlts
permit'andhetshe`agrees #o abrde'"bythenr. Pernirt rs voed rf u,Gbrkisrnaj nommaneedwr$FunQiOrlayfter
SSu ce _£
kaimttfeesate;nonrefundable `. - {':, f= .. .:- ;.. i '; ;ti Date `�%77 iggature: '
# ,;. ., .,
,
AT&T CALIFORNIA JOB#AOONTCP ENGINEER: Doug Galvery
PSA 4103LA, AOONTCP - W OCEANFRONTAVE SOUT SIDE, WEST OF 15TH ST, NEWPORT BEACH
OvL.
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NOTE: EXCAVATION DATA
OR
OIINO RED TO BE PfACEO IN THE awxEp
SAME TRENCH WITH PROPOSED 4" DUCT
cm pr
ND.11 BEALX IS LH,T. 11=I5
Sp.Fi.
DADND RED ERRED, �T
EVE DATA
0 L
p 9p Op' Op'
D.L. JV 31' 14R.
DERAN
DICNAL, HH
1e' 3-a W OCEANFRONT
Ex. l
OI!m/o c/, RAM,
(CNLPEE) (PwrvTEn) �
CONSTRUCTION NOTES
1 WUM L. WI IN..
DRAID
}. ALL SU85IRUCNREpINFUPMAipN SMMN WAS LAREN
BID. RLI. A. FNERE p, 515 WEONHEO PiE.
BEFORE EXCAVATING CALL:
U.G. SERVICE ALERT 811
1,1 uQ,LEH, KRK ARu EIEnmN AND
INALLACUN7
WILL MLIZE DR (.MPNALL REST -
i AS ..All TD ENI.E ED.XLE
WIM SBC PULICY LET2R 65UE5 FEERWRI 21, Y 5
ET�- WATER NAiER
1EIWnoX HL.DNNLANs 1.111a) AND IN
A�=ELI Ns P D D REZ REEEIIREDnE
D, THE .1D x .11 IN IDII,
aAN PmwSa+°oA'..
y
25" Ex.MH 3:s+ O 3 RIE.EDWILA ti
(LpXLRETE) s
o Q
a � a
D ❑
NOLED-
E. EWIMORI (I,O) 889-1201 IIIEELI
3 3I IOI PLAN D.. RD. DALKHv (il9) 618-91]I iCM. BALBVA c. v. AwcA
Wow t61�L 'DILL
HE�e DRAWING TO SCREE .R.s.oE: Es.sNzw DDD. 'FAA'w n,a) z - uav a : sspeleJ E Mom: owns ��.io
en DO NOT REDUCE p
avwc mD wp DURING REPRODUCTION ���� Pc(IUICGnsWWp, LLOe o. PPwwP
California �1..c se ll ma •x wDL Ell 7) AOONTCP
A. 11...I DWG. L-I
3%27/7017 City of Newport Beach Page 4 of 11
4:30:26PM INSP150 - Daily Inspection Request Report
Requested Inspection Date: 03/28/2017
Inspection Type: ENCROACH
Inspection Area : PW
Site Address : 107 15TH SysT
',". a
"'tea. sP ""i 'xy a" y'
MM
& a. ,n � ''
SubType: NEW
Status : APPROVED
OWNER: VAN ORNUM JOHN W Phone: 0
APPLICANT: AT&T CALIFORNIA Phone : 714-618-9132
Description : Install 33 LF of conduit, 1 above ground cabinet and ground bed in West Ocean Front Alley
and allev Darallel to 15th Street. Allev restoration per Citv Standards. (AOONTCP)
Item: 10050 EXCAVATION- PW
Requested Time: 3/28/2017 12:00:OOAM
Requestor:
Entered By: NBIVR
Comments: AM
Assigned to:
Inspector: J Date:
3 Z6
'\A :10
NBIVR
7609106252
Time: /6 AM PM
Comments: ftL —F)
2
PcG 7z:> 607- /0--f�.`f�- i G P5lt
F:\Users\PBW\Shared\ENCROACH\MASTERS\FORMS\InspectorSheet.doc
REPT131 Run Id: 4018
3/ 2812017 City of Newport Beach Page 4 of 24
4:30:30PM INSP150 - Daily Inspection Request Report
Requested Inspection Date : 03/29/2017
Inspection Type: ENCROACH
Inspection Area: PW
Site Address : 107 15TH ST
Activity : N2017-0107
SubType: NEW
Status: APPROVED
OWNER: VAN ORNUM JOHN W Phone: 0
APPLICANT: AT&T CALIFORNIA Phone : 714-618-9132
Description : Install 33 LF of conduit, 1 above ground cabinet and ground bed in West Ocean Front Alley
and allev parallel to 15th Street. Alley restoration per City Standards. (AOONTCP)
Item: 10110 CONCRETE PUBLIC WORKS
Requested Time: 3/29/2017 12:00:OOAM Requestor: NBIVR
Entered By: NBIVR
Comments: AM
Assigned to
Inspector: �� y Date: 3 I7 Time: � A M
VC 1
Comments:
T-M .5T-0 e L - g '.,� Pc�r4 c. `e, lam ^-¢D
Itz.
F:\Users\PBMShared\ENCROACH\MASTERS\FORMS\InspectorSheet.doc
REPT131. Run Id: 4018
3/30/2017 City of Newport Beach Page 6 of 20
6:34:47AM INSP150 - Daily Inspection Request Report
Requested Inspection Date :
03/30/2017
Inspection Type:
ENCROACH
Inspection Area:
PW
Site Address :
107 15TH ST
Activity : N2017-0107
SubType: NEW
Status : APPROVED
OWNER: VAN ORNUM JOHN W Phone: 0
APPLICANT: AT&T CALIFORNIA Phone : 714-618-9132
Description : Install 33 LF of conduit, 1 above ground cabinet and ground bed in West Ocean Front Alley
and allev parallel to 15th Street. Allev restoration per Citv Standards. (AOONTCP)
Item: UTIL 0 z j L,-�i
Requested Time: 3/30/2017 12:00:OOAM Requestor: BIVR
Entered By: NBIVR
Comments: AM
Assigned to:
Inspector: t/ Date: Time:
Comments: YLI-G N✓l6 t /
Logged
e-
Retir
F:\Users\PBW\Shared\ENCROACH\MASTERS\FORMS\InspectorSheel doc
REPT131 Run Id 4018
4/14142017 City of Newport Beach Page 7 of 16
,16:34:27AM INSP150 - Daily Inspection Request Report
Requested Inspection Date : 04/14/2017
Inspection Type: ENCROACH
Inspection Area: PW
Site Address : 107 15TH ST
AfP/D Information:
Activity : N2017-0107
SubType: NEW
Status : APPROVED
OWNER: VAN ORNUM JOHN W Phone: 0
APPLICANT: AT&T CALIFORNIA Phone : 714-618-9132
Description : Install 33 LF of conduit, 1 above ground cabinet and ground bed in West Ocean Front Alley
and alley parallel to 15th Street. Alley restoration per City Standards. (AOONTCP)
Requested Inspection(s)
Item: 10250 FINAL - PW
Requested Time: 4/14/2017 12:00:OOAM Requestor: NBIVR
Entered By: NBIVR
Comments: AM
Assigned to:
Comments:
F:\Users\PBW\Shared\ENCROACHNMASTERS\FORMS\InspectorSheet.doc