HomeMy WebLinkAboutN2018-0201yoNe Newport Beach
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OitcDa Bach. CA 92660 111111111
Permit Counter Phone (949)644-3311
Online Inspection Request - www.newportbeachca.gov / Online
Services
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Permit No: N2018-0201.
Project No : 0202-2016
SCANNED
Inspection Requests Phone (949)644-3255
Job Address :
400 JASMINE AVE NB
Thomas:Guide: 919E2
Description :
CURB CORE PER STD 184-L, REPLACE SIDEWALK PANEL PER STD 180-L.
Parcel #:
4591-910-1 -
Legal Desc :
CORONA DEL MAR BLK 337 LOT 2
Owner:
400 JASMINE
1Phone:ry`�+tj��p�pp�O MID
tor : 9 LDING WORX INC
09-373-7461
Addr ss :
1084 CAMINO DEL RItltl1°"
Address01 GLENDORA AVE
SAN DIEGO CA 92108
GLENDORA, CA 91741
Contractor State Lic: 901795
Applicant:
BUILDING WORX INC
License Expire : 08 31, 2018
Phone:
909-373-7461 i
Address :
130 GLENDORA AVE
GLENDORA, CA 91741
Business License : BT30040115
Business Expire : 07 31, 2018
Special Cond.:
PRE -CONSTRUCTION MEETING REQUIRED
Workers' Compensation Insurance - -
Carrier: STATE FUND
Policy No : 9116685
W. C. Expire : 06 01, 2018
Permit Processing Fee :
$241.00
Sewer Connection : $0.00
Total Fee
$406.00
Agreement Fee :
$0.00
4TT Box Cover: $0.00
Paid :
$406.00
Traffic control Plan Check :
$0.00
Total Water Meters : $0.00
Balance:
$0.00
Inspection Fee :
$165.00
Water Meter Connection : $0.00
Receipt No:
Refundable Deposit:
$0.00
Total Water Meter Box : $0.00
Street Tree Fee :
$0.00
Adjustment : $0.00
Processed By:
Date: _/_!_
Other Department:
Date: _/_/
Utilities Approval :
Date:
Permit Denied
Date /_
_/_/_
�/ 7�, / 9
Traffic Approval :
Date: _/_/_
Issued Permit :
Date :
General Services Approval : Date: _/_/
r �/5
WORKSHEET,FOR,ENCROACHMENT�PERMI �a-' fi-..r ..
* + �IiCITY ORNEWPORT+BEACH
.,P.UBLIP,WOPK_§IQEPARTMEN
PROJECT ADDRESS: '-1Oo /)-S�twC— _
DETAILED DESCRIPTION OF PROPOSED WORK:
Phone: 6 H
APPLICANT: �i [t�}C
Email Address:
Mailing Address:
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City/State/Zip:
W
OWNER:
Phone:
Email Address:
Mailing Address: City/State/Zip:
AL_L CONTRACTOR INFORMATION'IS+R_EQUI-RED-PLEAS_ E'COMPL'-E_;TiE_
CONTRACTOR: !��k
Office Phone: %I(Q t{Z d
Company (if different):
Jobsite Phone:
Other Phone:
Email Address:
Mailing Address:
City/State/Zip:
State License Number & Class:
Ex Tres:
City Business License Number:
41Expires:
WORKERS COMPENSATION INSURANCE - Certificate of Insurance (Section 3800 Labor Code)
Company: Policy No: Expires:
...........— ...............:::::::.:.:::::::::.::::::::.::::.:::.:::...:::..:.::::.:.
REFUNOpBLE:DEPO$IT:INFORMAT.ION{/(Apglicabli');:: :»::':;:ii::<:i........:...
- .
Refund:Payable To ....:......
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Mad Refund:To . .: . - ...
--
-FOR OFFICEiUSE ONLY '
Special Conditions of Permit:
ADDITIONAL APPROVAL REQUIRED.FROM THE FOLLOWINGpEPARTMENTS
Utilities:
General Services:
Traffic: Fire: 0
Other:
Engineering Technician:
Public V ks Specialist:_
Date: _
Permit No.
ffuseeLpE�HSIiereNervmacNmaskrslop�wrlalieaWs '—/�//%�j/}//J '
2— 02 — ZQ. ,
Public Works Department 949.644-3311
>'-FEE.WORKSHEET FOR ENCROACHMENT_ PERMIT
CITY OF NEWPORT BEACH
r
PUBLIC WORKS DEPARTMENT
z;
All Fees Are Non -Refundable Unless Otherwise Stated
PROJECT ADDRESS: PERMh L��_ NUMBIER:
N2018- Q�Q
APPLICANT:
Permit Processing Fee:
O
Inspection Fee:
Public Works Only
$241.00
Public Works Field Inspection
Other Department
$275.00
Utilities Field Inspection
General Services Inspection
Agreement Fee:
Water Quality/Artificial Turf Inspection
Preparation of Report/Agreement
$817.00
Document Recordation Fee
$192.00
Refundable Deposit:
Monitoring Wells
$502.00
Improvements
Street/AlleyfWalk Closure: $65.00= Newspaper Rack Inspection
Traffic Control Plan Check
8-1/2" x 11" $65.00= Sewer Connection Fee
24" x 36" $143.00 4TT Box & Cover
Additional THE FOLLOWING ITEMS REQUIRE APPROVAL FROM THE _ R
REVENUE DIVISION PRIOR TO PAYMENT OF FEES AI
(Water Meter:
13/4" Meter $50.25
11" Meter $121.50
11 1/2" Meter $285-00
11 1/2" Turbine Meter $700.00
12" Meter $425.00
12" Turbine Meter $845-00
13" Meter $3,310.00
14" Meter $4,730.00
0" Meter $7.190.00
Installation Charge
Water Meter Boxes:
1" DFW Meter Box
2" DFW Meter Box
TBDBTBD
$108.00
$.00 B $64
$64.00
venue Division
$96.66
$203.24
Certificate of Compliance Fee (+100i. 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 hrs)
$1,022.00
5200-5031
Street Tree Fee ($700 Planting Fee)
TBDI
030-2284
Engineering Tech:
Total Amount Due:
For Finance use only
DL. 00
Permit S ecialist
Receipt No.
huserslpPwtsharea/enn,dac Jmastef eP "nt and bads masters/
Rev. 12/18/2017
epteesheet xlsrevasau 11017
I ALL UNDERGROUND WORK'SHALL BE PERFORMED BY A LICE NSEU.CONT,RACTOR
Contact "Underground Service Alert" At Least 48-Hours.in Advance of Any Excavation of800.422.4133
9.
10
12,
13.
14.
TERMS AND CONDITIONS OF ENCROACHMENT PERMIT
Encroachment Permits may be taken out by the owner of benefited properly 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 limes. 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.
The Perniftee 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.
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 Slate laws and City ordinances.
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.
A valid State licensed contractor must perform all construction within the public right-of-way, unless waived by the
Public Works Director. A valid Stale 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 Stale Contractor License Class C-42 is required.
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 feel in depth shall be guarded when hazardous ground movement may be expected.
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 penorned.
All trench restoration must be inspected by the Public Works Department. No utility installations) shall be allowed
over or within 5 feel of any City utilities, unless approved by the Public Works Department. Locate and pothole
existing City -owned utilities (le: 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.
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 $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.
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.
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 antl
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 lanes) 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 Slate Highway right-of-way
will require a Catlrans Permit. All vehicles shall be lawfully parked.
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.
Applicant must nolily USA at 1-800-227-2600 2 days before starting any underground construction. Applicant
must nolily all affected residents 24 hours in advance of restricted access and any inconveniences.
Refuse or unused materials shall be removed within 24 hours after completion of the work. If riot 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
ComperyAation Insurance, or a Certified Copy there_g4_
/ 3 / j7 Signatu
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.
Dale:
Signature:
24-hour notice for Encroachment Permit Inspection is required by calling
Public Works at 949-644.331.1. /
15. Any above ground utility facilities will require documented approval from the adjacent
affected property owners).
16, Homeowner, contractors, and subcontracons 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 Backflll 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 play require issuance of a separate permit and/or additional fees,
No work related to this encroachment permit shall be performed until the Public Works Department has Issued this permit.: Applicant heieby acknowledges helshe has+read and understands the terms and' -
conditions of this permit and helshe'agrees toabide by them Permit isrvoid if work is not commenced within'30 days after Issuance. J� /�' t s 5I
. .. _ / ��p
Permit feesmre nonrefundable. e _.a - i : - ,j, -,.„ Dater/., -- - JTgnature.F / (�' '
4116/2018 City of Newport Beach Page 10 of 11
4; 30:34PM INSP150 - Daily Inspection Request Report
Requested Inspection Date :
04/17/2018
Inspection Type :
ENCROACH
Inspection Area :
PW
Site Address :
400 JASMINE AVE
Activity : N2018-0201
SubType: NEW
Status : APPROVED
OWNER: 400 JASMINE LLC Phone:
APPLICANT: BUILDING WORX INC Phone : 909-373-7461
rygn@buildingworxinc.net
)escriotion : CURB CORE PER STD 184-L, REPLACE SIDEWALK PANEL PER STD 180-L.
Item: 10200 PRE JOB - PW
Requested Time: 4/17/2018 12:00:OOAM Requestor: WEBUSER
949-842-0636
Entered By: WEBUSER
Comments: ANY -Please call with time of meeting.
Assigned to :uzzzzzuu"
Inspector: - "off Date: L7P/1% Time: AM PM
Comments:
F:\Users\PBW\Shared\ENCROACH\MASTERS\FORMS11ns ectorSheet.doC
REPT131 Run Id: 4018
4/24/2018 City of Newport Beach Page 11 of 16
4:31:OOPM INSP150 - Daily Inspection Request Report
Requested Inspection Date :
04/25/2018
Inspection Type :
ENCROACH
Inspection Area :
PW
Site Address :
400 JASMINE AVE
Activity : N2018-0201
SubType: NEW
Status : APPROVED
OWNER: 400 JASMINE LLC Phone:
APPLICANT: BUILDING WORX INC Phone : 909-373-7461
ryqn@buildingworxinc.net
Description : CURB CORE PER STD 184-L, REPLACE SIDEWALK PANEL PER STD 180-L.
Item: 10100 FORMS WITH COMPACTION - PW
Requested Time: 4/25/2018 12:00:OOAM Requestor: WEBUSER
949-842-0636
Entered By: WEBUSER
Comments: AM -
Assigned to:
zzzzzzzzzzz'
Inspector: %Q Dater Time: [ AM PM
Comments:
Logged
I elffie
F:\Users\PB\N\Shared\ENCROACH\MASTERS\FORMS\InsoectorSheet doc
REPT131. Run Id: 4018
4/25/2018 City of Newport Beach Page 9 of 13
4:30:45PM INSP15O - Daily Inspection Request Report
Requested Inspection Date : 04/26/2018
Inspection Type : ENCROACH
Inspection Area : PW
Site Address : 400 JASMINE AVE
A/P/D
Information:
Activity :
N2018-0201
SubType:
NEW
Status :
APPROVED
OWNER:
400 JASMINE LLC Phone:
APPLICANT:
BUILDING WORX INC Phone : 909-373-7461
ryqn@buildingworxinc.net
Description :
CURB CORE PER STD 184-L, REPLACE SIDEWALK PANEL PER STD 180-L.
Requested Inspections)
Item:
10100 FORMS WITH COMPACTION - PW
Requested Time:
4/26/2018 12:00:OOAM Requestor: WEBUSER
949-842-0636
Entered By: WEBUSER
Comments: AM -
Assigned to : zzzzzzzzzzz`
Inspector: �(�/ Date: 2G Time: AM PM
Comments:
F:\Users\PBW\Shared\ENCROACH\MASTERS\FORMS\InspectorSheet.doc
REPT131. Run Id: 4018
4/26/2018 City of Newport Beach Page a of 13
' 4:30:28PM INSP150 - Daily Inspection Request Report
p- Requested Inspection Date : 04/27/2018
Inspection Type : ENCROACH
Inspection Area : PW
Site Address : 400 JASMINE AVE
AIP/D Information:
Activity : N2018-0201
SubType: NEW
Status : APPROVED
OWNER: 400 JASMINE LLC Phone:
APPLICANT: BUILDING WORX INC Phone : 909-373-7461
ryqn@buildingworxinc.net
Description : CURB CORE PER STD 184-L, REPLACE SIDEWALK PANEL PER STD 180-L.
Item: 10250 FINAL - PW
Requested'Time: 4/27/2018 12:00:OOAM Requestor: WEBUSER
Entered By: WEBUSER 9498420636
Comments: ANY -Please call with an approx. time.
Assigned to : zzzzzzzzzzz'
Inspector: sc, Date: y-Zi- 1 S Time: It: c/o A�VI PM
Comments:
cun's curt � Sty etc cfinec5iE wA%TwG k. S'cQ
SoZ) . ' IVr^ (^I ^rAC.CsJ S- Z- I,?
F:\Users\PBVV\Shared\ENCROACHkMASTERS\FORMS\InspectorSheet.do
REPT131. Run Id: 4018