HomeMy WebLinkAboutN2017-0184♦t,$��,�,4T City of Newport Beach �111111 1111111111111 ill 111111111111111111111111 111
100 Civic Center Drive, Newport Beach, CA 92660 N 2 0 1 7 0 1 8 4
r Permit Counter Phone (949)644-3311
� Online Inspection Request - www.newportbeachca.gov / Online
Services
Job Address:
200 E BALBOA BLVD NB
Description :
INSTALL SEWER CLEAN OUT PER STD 406-L.
Parcel # :
0480-911-6 -
Legal Desc :
NEWPORT BAY TR BILK 4 LOT 1
Owner:
GRIMM STEVEN
Phone:
Address :
18514 SANTA CRUZ CIR
ri
FOUTAIN VALLEY CA 92708
Applicant: POWER ONE ENGINEERING, INC
Phone : 714-462-8339 [
Address : 600 N TUSTIN AVE STE 250
SANTA ANA, CA 92705
Special Cond.: PRE -CONSTRUCTION MEETING REQUIRED
Permit No: N2017-0184
Project No : 2696-2015 !;
Inspection Requests Phone (949)644-3255
Thomas:Guide: 91982
Contractor : POWER ONE ENGINEERING, INC
Phone : 714-231-2027
Address : 12601 ENRAMADA
TUSTIN
Contractor State Lic: 992648
License Expire : 05 31, 2018
Business License : BT30050912
Business Expire :
04 30, 2017
Workers' Compensation
Insurance - -
Carrier :
STATE COMP
Policy No :
1957938
W. C. Expire:
01 17, 2018
Permit Processing Fee :
$241.00
Sewer Connection :
$0.00
Total Fee
$635.00
Agreement Fee :
$0.00
4TT Box Cover:
$64.00
Paid :
$635.00
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
Street Tree Fee :
$0.00
Adjustment :
$0.00
Processed By :
Date : / /
Other Department :
Date
Utilities Approval :
Date : / /
Permit Denied
Date
6Y—)
Traffic Approval :
Date : / /
Issued Permit :
Date :4
General Services Approval : Date: / /
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COMPLETE THE BELOW INFORMATION
PROJECT ADDRESS: , a G
DETAILED DESCRIPTION OF PROPOSED WORK: _
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APPLICANT: NiLd LccxLatA jPhone:
Email Address: n ti ap ,
Mailing Address:
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City/State/Zip:
rorn"- C14
OWNER:
y
Phone:
Email Address: etciTI C 0"),
Mailing-7Address: Ci /S te/zijpx
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ALL CONTRACTOR INFORMATION IS REQUIRED -PLEASE COMPLETE
CONTRACTOR: l �tv, nk-p n
Office Phone: -/LiL/ - `a 32
Company (if different):
Jobsite Phone: !'S - / s- to .
Other Phone:
Email Address: C1 I Q 0
Nvlev � vi e2v, I , Cm -
Mail ing A
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doss:
Cityl§tatel ip: CA � �O
SSI��YI
State License Number & Class:
9'q Expires: 5-3) -1
City Business License Number:
Ex Tres:
WORKERS COMPENSATION INSURANCE - Certificate of Insurance (Section 3800 Labor Code)
Company: Policy No: Expires:
Municipal Orations: 949-644-3055
Utilities: 949-644-3011
Urban Forestry: 949-644-3083
FOR OFFICE USE ONLY
Special Conditions of Permit:
ADDITIONAL APPROVAL REQUIRED FROM THE FOLLOWING DEPARTMENTS
Utilities:
Municipal Operations
Traffic: Fire:
Other:
Engineering Technician:
Permit Specia '
I (h2
Date:
Permit No.
N2017-
flu sers/pbwlshared/encroach/masterslepworksheet. xf s
Public Works Department 949444-3311
100 Civic Center Drive, Newport Beach, CA 92660
All Fees Are Non -Refundable Unless Otherwise Stated
PROJECT ADDRESS:
�GG�C
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ERMIT N2017-
4JCa
UMBER:
APPLICANT:
C►w y-
r � .,.
Permit Processing Fee:
Public Works Only
$241.0
Other Department
$275.0
Agreement Fee:
Preparation of Report/Agreement
$817.00
Document Recordation Fee
$192.00
Monitoring Wells
$502.00
Inspection Fee:
Public Works Field Inspection $165.00
Utilities Field Inspection $121.00
General Services Inspection $165.00
Water Quality/Artificial Turf Inspection $108.00
Refundable Deposit:
Improvements
Street/Alley/Walk Closure: $65.00Newspaper Rack Inspection
Traffic Control Plan Check
TBD
TBD
$108.00
8-1/2" x 11" $65.00 Sewer Connection Fee $250.00
24" x 36" $143.00 4TT Box & Cover $64.0
Additional
THE FOLLOWING ITEMS REQUIRE APPROVAL FROM THE Revenue Division
1 I
REVENUE DIVISION PRIOR TO PAYMENT OF FEES Approval: I
I
9• 1
(Water Meter:
Installation Charge
$528.00. .1
13/4" Meter
$50.25
Water Meter Boxes:
1
11" Meter
$121.50
For Parkway & Sidewalk Area (Box + Cover = Cost)
11 1/2" Meter
$285.00
1" Meter: 13.00 + 37.00
$50.00 1
11 1/2" Turbine Meter
$700.00
2: Meter: 27.00 + 61.25
$88.25[ 1
12" Meter
$425.00
12" Turbine Meter
Meter
$845.00
$3,310.00
For Traffic & Alley Areas (Box + Cover = Cost) 1
1" Meter: 13.00 + 38.00 $51.00
�13"
4" Meter
$4,730.00
2" Meter: 27.00 + 162.00
$189.00B 1
1
6! „ Meter
$7,190.00
Qty.
Budget Number
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 Easement/Vacation Fee (+100% of hrly over 4 hrs)
$1,022.00
5200-5031
Street Tree Fee ($700 Planting Fee)
TBD
030-2284
Engineering Tech: T1 Amount Due: For Finance Use Only
Perm(Talist Receipt No.
f/users/pbw/shared/encroach/masters/ep front and back masters!
Rev. 1/5/2017 epfeesheet.xls-revised 10/21/2016
Ll l lei 6o -V in/s- tG q
ALL UNDERGROUND WORK SHALL BE PERFORMED BY A LICENSED CONTRACTOR
Contact "Underground Service Alert" At Least 48-Hours in Advance of Any Excavation at 800-422-4133
TERMS AND CONDITIONS OF ENCROACHMENT PERMIT
1 Encroachment Permits inay be Laken out by the owner of benefited property or a licensed contractor A licensed
contractor must provide a I tiller of Authonzatonto .!flow another party to pull a permit An approved copy of the
permit and construction pl ran sh�rll he kept at the job site at all times Work, which has been done prior to issuance of
a permit, is subject to re)ecliondine 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 laity its authorized agent officersrepresentatives 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 shal! be done in accordance with the approved plans. Strrrrrlartl Special Provisions ,rod Sfwul�ird Dnrwin(Is
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 Stale 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 mminwm 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 most 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 nee 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
47T 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 safely 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 S10.00
per harricade per day, will) 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 area,; will not be allowed during City holidays- sprang 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.
I 1 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 VVorks 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 Highways traffic or within the Slate Highway right-of-way
will require a Caltrans Permit All vehicles shall be lawfully parked.
12 This permit does not authorize file 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 ?4 hours after completion of the work If not removed. the City
may remove and bill the applicant Coordinate alley closures with City 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 orker's
C ate.
mpensation Insurance, or a Ce ified Copy tf eof
Si
a9 nature:
CERTIFICATE 01 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:
�4-hour notice for Encroachment Perm, Inspection is required by calling
Public Works at 949-644-3311.
1-1
15 Any above ground utility facilities will require documented approval from the adla('enl
affected property owners)
16 110meowner, contractors. and subcontr<ncotrs niay each be liable lot violations of vV,rler
Quality Laws Best Management Practices will be enforced It is against the law In
discharge construction debris into the gutter and storm drain_ Felony violrilions of Wa!er
Quality Laws are punishable by fines rip to S25 000 and/or t-ru to three goats n Stn(e
prison plus the full cost to clean up an illegal discharge or spill
17. If a refundable deposit was paid, applicant must subunit a Soils Comprwho+r
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, rernoved, trimmed, r;r mla:pled
without approval from the General Services Department.
19. All work in the public right-of-way must meet the approval of the PA)lic Vwk,-
Department or corrections will be required (i.e. removals, exposing cnnnoctirns,
etc.). Additional inspection fees may be required
20. Permit is for standard materials in the public right-of-way only. unless prevow lv
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 andror additional fees.
No work related to this encroachment permit shall be performed until the Public Works Department has issued this permit. Applicant hereby acknowledges he/she has r d a7d�nclerstands the rms and
conditions of this permit and he/she agrees to abide by them. Permit is void if work is not commenced within 30 days after issyaryCe. �,�� / A (/ _ n
Permit fees are nonrefundable. \�[/ Date: ignature: �(GIiAL
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Comments:
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F:\Users\PBW\Shared\ENCROACH\MASTERS\FORMS\InsoectorSheet.doc
REPT131 Run Id: 4018
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Date: I 7-Zi7 Time: I I I w AM PM
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Run Id: 4018
4/17/2017 City of Newport Beach Page 10 of 16
6:34:28AM INSP150 - Daily Inspection Request Report
Requested Inspection Date : 04/17/2017
Inspection Type: ENCROACH
Inspection Area : PW
Site Address : 200 BALBOA BLVD E
A/P/D Information:
Activity : N2017-0184
SubType : NEW
Status : APPROVED
OWNER: GRIMM STEVEN
APPLICANT: POWER ONE ENGINEERING, INC
Description : INSTALL SEWER CLEAN OUT PER STD 406-L.
Requested Inspection(s)
Item: 10200 PRE JOB - PW
Requested Time: 4/17/2017 12:00MAM Requestor:
Entered By: WEBUSER
Comments: AM-8am preferred
Assigned to: zzzzzzzzzzz* -
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L 0CAJ,
Kafue
Phone:
Phone : 714-462-8339
WEBUSER
951-515-4284
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04
4/19/2017 City of Newport Beach Page 10 of 11
4:31:OOPM INSP150 - Daily Inspection Request Report
Requested Inspection Date: 04/20/2017
Inspection Type: ENCROACH
Inspection Area: PW
Site Address : 200 BALBOA BLVD E
ts
: �...
Activity : N2017-0184
SubType : NEW
Status : APPROVED
OWNER: GRIMM STEVEN Phone:
APPLICANT: POWER ONE ENGINEERING, INC Phone : 714-462-8339
Description : INSTALL SEWER CLEAN OUT PER STD 406-L.
Item: 10010 BACKFILL / COMPACTION- PW
Requested Time: 4/20/2017 12:00:OOAM Requestor: WEBUSER
Entered By: WEBUSER 9515154284
Comments: AM-10am preferred
Assigned to: 77777777777*
Inspector: J� Date: yL 7 Time: 1 Z ' (' A PM
Comments: C l�liT7Z/9GT-mi2 !S pt�� <<i L —L — 3 ZS-0
5c,0 2 PF Fte-6 vYl lei- PI L
F:\Users\PB W\Shared\ENCROACH\MASTERS\FORMS\Insoectorsheet.doc
REPT131 Run Id: 4018