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City of Newport Beach
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Permit No: N2018-0320
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100 Civic Center Drive, Newport Beach, CA 92660 01
03
20
Permit Counter Phone (949)644-3311
Project No
o k..
Online Inspection Request - www.newportbeachca.gov,
/ Online
�LII'U4T,`
Services
Inspection Requests Phone (949)644-3255
Job Address:
1845 PORT BARMOUTH PL NB
Thomas:Guide:
889G6
Description :
Install artificial turf in parkway area.
Parcel #:
Legal Desc
4581-350-8 -
N TR 6622 LOT 97
SCANNED
:
Owner:
MIROWITZ HOWARD D
Contractor :
BLACK PETE CONSTRUCTION INC
Phone:
0
Phone:
714-612-7678
Address :
1845 PORT BARMOUTH PL
Address :
1788 MONROVIA AVENUE
NEWPORT BEACH, CA
'J
A 92627
r�
Contractor State
LOSTA 69 8MESA
3
Applicant:
PETE BLACK CONSTRUCTION INC.
License Expire :
08 31, 2018
Phone:
714-612-7678 [
Address :
1788 MONROVIA AVENUE
COSTA MESA, CA 92627
Business License
: BT00003226
Business Expire
: 04 30, 2019
Special Cond.:
Workers' Compensation Insurance - -
Carrier:
STATE COMP. INS
Policy No:
9042053
W. C. Expire:
02 11, 2019
Permit Processing Fee : $0.00
Sewer Connection :
$0.00
Total Fee $108.00
Agreement Fee :
$0.00
4TT Box Cover:
$0.00
Paid : $108.00
Traffic control Plan Check : $0.00
Total Water Meters :
$0.00
Balance : $0.00
Inspection Fee :
$108.00
Water Meter Connection :
$0.00
Receipt No: 2 g$ 33b
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: to / i3 / t 19
General Services
Approval :
Date:
I _ ALL UNDERGROUND. WORK SHALL BE PERFORMED BY A LICE NSEU.CONTRACTOR` I
Contact "Underground Service Alert" At Least 48-Hours,in Adyancb of -Any -Excavation at 800-422-4133
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 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 Will days
after date of issuance.
2. The Permiltee 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 Slate laws and City ordinances.
4. Permitted 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 Stale licensed contractor must perform all construction within the public right-of-way, unless waived by the
Public Works Director.. A valid Slate 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 born the California Division of
Industrial Safely 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.
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 tie: water, sewer, or street lighting conduits) to verify locations. Maintain a one -foot
clearance over or under existing City -owned utilities. Sewer cleanouts require VCR or PVC SOR35 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 Differ 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 al all limes.
10, Work within or near beach sensitive areas will not be allowed during, City holidays. spring break, Memorial Day
weekend, eunnmer between June 15 and September 15, and during the holiday season from December 19 to
January 1, unless approved by the Public Works Department.
1 L 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 pun. (Monday thru Friday), unless approved by
the Public Works Department. Any work affecting the State Highway's traffic or within the Stale Highwav right-of-way
will require a Callrans Permit. All vehicles shall be lawfully parked.
12_ This permit does riot authorize the closure of sidewalks, streets, at 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 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
Compensation Insurance, or a Certified Copy thereof.
Date: �!3,11C 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, 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-
WaylEasement. 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 Encroachment Permit Inspection is required by calling_
Public Works at 949-644-3311.
i
15. Any above ground utility facilities will require documented approval from the adjacent
affected property owneds),
16. Homeowner, contractors, and subcontracolrs 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 $25,000 and/or up to three years in State
prison plus the full cast to clean up an illegal discharge or spill.
17. If a refundable deposit was paid, applicant must submit a Soils Compaction
Certificate or Evidence of a Slurried Backfill and request a final inspection from the
Public Works Department. Monies may be held for six months after final inspection
before a refund will be processed.
18. No trees in the public right-of-way shall be planted, removed trimmed, or relocated
without approval from the General Services Department.
19. All work in the public right-of-way must meet the approval of the Public Workc
Department or corrections will be required (i.e. removals, exposing connections,
etc.). Additional inspection fees may be required.
20. Permit is for standard materials in the public right-of-way only, unless previously
approved by Public Works and an Encroachment Agreement has been processed.
21. Permit is valid for 'description" of work noted on front only. Additional work
performed may require issuance of a separate permit and/or additional fees.
No work related to this encroachment permitshall be performed until the Public Works Department has issued this permit.'. Applicant hereby acknowledges he/she has.read d understands the terms and'
I conditions of this permit and helshetagrees to abrde,by them. Permit is void If work is not commenced wrthrn-30 days'afte Ise�nce.
Permit fees nonrefundable..Date; �`/+'Signature:
:
PRKSHEET FOR ENCROACHMENT PERMIT
`P- CITY OF NEINPORT BEACH
faPUBLICNYORK$ DEPARTMENT,-,
COMPLETE THE BELOW INFORMATION
PROJECT ADDRESS: 0 "Z M a
DETAILED DESCRIPTION OF PROPOSED WORK:
APPLICANT: GCE
Phone: V 12-%
Email Address:67 cob."
Mailin Address:
►7 ho>j4jUI✓i C' dam'
City/ to a/Zip:
CYAI-V}
OWNER: rL,,L
jPhone: 9 rU-7 M
Email Address: f Pti 00
Mailing Address: City/St t Zip:
,P� r r��rH�u� 1668
ALL CONTRACTOR INFORMATION IS REQUIRED-PLEASE'COMPLETE
CONTRACTOR: lC ,
t � GCi� �[ / .w� .�
Office Phone:
Company (if different):
Jobsite Phone:
Other Phone: W
Email Address: i Cp --Oy,
Mailing Address:
1761 r„-A/ U-V W'4 R�
City/State/Zip:
cM cat 9Ze�, /
State License Number & Class:
Z�� Expires:
City Business License Number:
Expires:
WORKERS COMPENSATION INSURANCE - Certificate of Insurance (Section 3800 Labor Code)
Company: Policy No: Expires:
Municipal Oerations: 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: 0 Fire:
Other:
Engineering Technician:
2-A,
Permit Specialist
Rod:
Date:
f,-M - I
Permit No.
IN2018- 0320
FluserLpb lSH8m /en=aWimaslelslepw Sheet xl5
Public Works Department 949-644-3311
100 Civic Center Drive, Newport Beach, CA 92660
FEE WORKSHEET FOR ENCROACHMENT PERMIT
'CITY OF NEWPORT BEACH
,PUBLIC WORKS DEPARTMENT
All Fees Are Non -Refundable Unless Otherwise Stated
PROJECT ADDRESS: PERMIT
l`s45 ?o NUMBER:
- S.-Yn ", �I. N2018- 03�A
PPLICANT:
t�etc lock C6ns`hv�iidYt �+G,
TO BE!! WOKKS 01:PAKTMF-NT
Permit Processing Fee:
Public Works Only
Other Department
Agreement Fee:
Preparation of Report/Agreement
Document Recordation Fee
Monitoring Wells
Street/Alley/Walk Closure:
Traffic Control Plan Check
Q Inspection Fee:
$241.00Public Works Field Inspection
$275.00 Utilities Field Inspection
General Services Inspection
Water Quality/Artificial Turf Inspection
$.00
$192192.00 Refundable Deposit:
$502.00 Improvements
$65.000 Newspaper Rack Inspection
8-1/2" x 11" S65.00= 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 T
Q .
$165.00
$121.00
$165.00
$108.00
TBDBTBD
$108.00
$250.00 B
$64.00
aenue Division
[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
4" Meter $4,730.00
6' Meter $7.190.00
Installation Charge $528.00"
Water Meter Boxes:
1" DFW Meter Box $96.66
2" DFW Meter Box $203.24
Certificate of Compliance Fee (+100% of My 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/Vacation Fee (+100i of hrly over 4 hrs) $1,022.00
Street Tree Fee ($700 Planting Fee) TBD
Qty.
Budget Number
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
tea:
.6 to-6.
'?ariP
to-i3_ IV
Permit Specialist
Receipt No.
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Rev. 12/1812017
epfeesneet �ls+evisaa 11017
7/2/2016 City of Newport Beach Page 3 of 4
6:34:16AM INSP150 - Daily Inspection Request Report
Activity
SubType :
Status :
OWNER:
APPLICANT:
Description :
Item:
Requested Time:
Requested Inspection Date :
07/02/2018
Inspection Type:
ENCROACH
Inspection Area :
PW
Site Address :
1845 PORT BARMOUTH PL
A/P/D Information:
N2018-0320--
APPROVED
MIROWITZ HOWARD D
PETE BLACK CONSTRUCTION INC.
Install artificial turf in parkway area.
Requested Inspection(s)_
10240 WATER QLTY/ARTIFICIAL TURF
7/2/2018 12:00:OOAM Requestor:
Entered By: WEBUSER
Comments: AM -Please call with approx time
Assigned to : zzzzzzzzzzz* 9: 7/ Z
BLS (uv`A-
Phone: 0
Phone : 714-612-7678
WEBUSER
9496897228
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