HomeMy WebLinkAboutN2017-0590,�wNrn4�T oo City cNeWenter �pOrt Beach ort Bach, CA92660 I11pilIII11111111111111111111111111111111111111111111111 Permit No: N2017-0590
Permit Counter Phone (949)644-3311 Project No : 1620-2016
yam, t� Online Inspection Request - www.newportbeachca.gov / Online
Services
0411A.�' Inspection Requests Phone (949)644-3255
Job Address: 2815 PEBBLE DR NB Thomas:Guide: 919F1
Description : R/R FOR DRIVEWAY APPROACH, SIDEWALK, CURB AND GUTTER PER CITY STANDARDS
Parcel # : 4586-620-5 -
Legal Desc : N TR 3660 LOT 39
Owner: ERIC AND ADRIANA OLSEN TRUST
Contractor : MATA'S CONSTRUCTION CO
Phone:
Phone: 714-393-6358
Address: 2815 PEBBLE DR
Address : P.O. BOX 3749
CORONA DEL MAR CA 92625
SANTA ANA CA 92703
Contractor State Lic: 861880
Applicant: JOSE MATA
License Expire: 07 31, 2018
Phone: 714-393-6358 [
Address
Business License: BT30015664
Business Expire: 04 30, 2018
Special Cond.: PRE CON MEETING REQUIRED WITH
Workers' Compensation Insurance - -
PW INSPECTOR
Carrier: WESCO INS CO
Policy No: WWC3251945
W. C. Expire: 02 01, 2018
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:
1
2/c
General Services Approval :
Date
PROJECT ADDRESS:
DETAILED DESCRIPTION OF PROPOSEDalkwA WORK:
' Ur
APPLICANT: a Phone:
Email Address:
Mailing Add ess: L�
•l-XaLU
Ci Stat ip•
� 2 O t
OWNER: Phone: 7- W56-
Email Address:
Mailin Add r s
Ci State/Zip:
Y LL+EOR-RACTOR �N OItAA �O t JS_° iEQt1 l EiWl''EI SEV-,WJ,*T1WW:;
CONTRACTOR
Office Phone:
Company (if different):
Jobsite Phone: ^�s3
Other Phone:
Email Address:
ss: CI /Stat Zi O
Mailing Lip k
State License Number S Class: City Business License Number:
0 Expires: Expires:
WORKERS COMPENSATION INSURANCE - Certificate of Insurance (Section 3800 Labor Code)
Company: No: Expires:
—Policy
.......... ......................................................................:......:..................:.....................
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..............
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Mail:Retiind iFo::::::::::::::::::::::::: ::::::::::::::::::::::::::::::::::::::::::::::....:::....: :::....:........:..:....:::::....:....:.:.:....:::....
FOR OFFICE USE.ONLY
Special Conditions of Permit:
ADDITIONAL APPROVAL REQUIRED FROM THE FOLLOWING DEPAR'MENTS
Utilities:
General Services:
Traffic: Fire: 0
Other:
Engineering Technician:
s Specialist:
Publ!a;
Date: 7fPVjah-65q0
rmit No.
ffwersVbvvhharftWncroactVMS SMp-rWmeUk
if
Public Works Department 949-644-3311
Permit Processing Fee:
Public Works Only $241.00
Other Department $275.00
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: $65.000 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 A
TBD
TBD
$108.00 0
$.00 $64e
64.00
----------
venue Division I
I
city.
[Water Meter:
Installation Charge
$528.00
13/4" Meter
$50.25
[
11" Meter
$121.50
Water Meter Boxes:
11 1/2" Meter
$285.00
1" DFW Meter Box
$96.66
11 1/2" Turbine Meter
$700.00
2" DFW Meter Box
$203.24
12" Meter
$425.00
12" Turbine Meter
$845.00
13" Meter
$3,310.00
14" Meter
$4,730.00
6' Meter
$7,190.00
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 hry over 4 hrs)
$1,022.00
5200-5031
Street Tree Fee ($700 Planting Fee)
TBD
...
030-2284
_.. ...._....
Engineering Tech: Total Amount Due: For Finance Use only
V73�
Permit Spea/1'alist Receipt No.
Qom& / /users/pbw/shared/encroadVrnasterslep front and pack masters/
%-Q A Rev. 11 /8/2017 epfeesheetAs-revised 1 ven 7
I ALL UNDERGROUND WORK SHALL BE PERFORMED BY A LICENSED CONTRACTOR I
Contact "Underground Service Alert" At Least 48-Hours in Advance of Any Excavation at 800-422-4133
2.
10.
12
13
14
TERMS AND CONDITIONS OF ENCROACHMENT PERMIT
Encroachment Pernik 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 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 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.
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.
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 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.
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.
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.
All trench restoration must be inspected by the Public Works Department. No utility installation(s) 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 (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 SOR35 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 limes.
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 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 Stale Highway's traffic or within the Stale Highway right-of-way
will require a Caltrans 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 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.
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.
certifWORKER'S COMPENSATION INSURANCE (Section 3800 Labor Code)
y that 1 have a Certificate of consent to self -insure, Certificate of Worker's
Compens tion Insurance, or a Certified Copy t
Date: Signat�Y
CERTIFICATE OF EXEMP,FffdN (Section 3800 Labor Code)
I certify that in the performance of ffe 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. 1 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
encroachme%ts,.,
Date: / 2� Signatuj. � /I
-hour notice for Encroachment
blic Works at 949-644-3311.
is required by calling
15 Any above ground utility facilities will 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 Work;
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.
INo work related to this encroachment permit $hall be performed until the Public Works Department has Issued this permit &p plicant hereby a kno edges helshe has r �dst s 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 I ytCo.
Permit fees are nonrefundable. VVV 1111 Date: / !Z Signatur .
(I) C'ONSTRUC7ON-SLIT? C'ONCRI3'['1. PATIO/WALKWAY, SET, LANDSCAPE ARCI I. PI-ANti
FOR DESIGN PA1 ERNS.
C C'ONS'l'RU(-I' ON-SI'1"'1' I)RIVI. WAY. 5fa.; ARCTI. PLANS FOR MA'I'I?RIAL `I'YPF,,
SlJB(lRADF SMALL. IW PT R SOIL I N(iINF.EN'S RFC'OMMENDATIONS.
" CONSI RI C1' 6" DfA. AREA DRAIN INI UT (DOMFID GRA I I:). NDS MODEL 80.
�4) C ONS`I'111-10' 4" DIA 1 E CK DRAIN
5, ('()NSi'ltE)(:"T 127" SQC.)A1.tt1iR()t)KS I:'k(:II:)EIC"(.;S N(). 1212 ()Vf'f{.f'L()'W C"A"I'C'II i3A:titN,
OR APPROVED EQUAL. f`OR WA }'F:R QUAI_ TV,
6. (ONSTRIA-7 4" DIA. P.V.C. DRAIN PIPE, AT I '7v MIN. SLOPE, PIPF. SI IALL BE
w�
SC'IlEll.). 40 OR SDR- 35.
(` ('()NN1?C"I' ROOD DU'WNSF'O(Il"l'C) UNTE.ROROUND DRAIN SYSTEM PI R I:)I'TAIL IfF:RE()N
0 CONSTRUCT CURB DRAIN Pf?R CITY STDS. 184-L.
(SEPARATE PUBLIC WORKS PERMIT REs"QUIRI,D).
G INSTALL SINGLE ROW OF (TRAVEL, BAGS (2 BAGS HIGH) FOR EROSION CONTROL (BMP SI:,-6)
I() INSTALL NEW Sl:-'W1 R CLE.ANOUT WI'I:If "tT2.Al l'I(:' RA`FE I) COVEIR. ON FWIS'TINCI SEWER
LATERAL 11I R CITY STD 406-L,
C1 C'ONST1xU(74" DIA. 1'.V.0 ..NI::.Rt ()RAT} I) DRAIN PlIT Al' I"A• MIN, SLOPE, PIPE;
SEfAL1 33I S(:'I fF3I). 40 t)1.2 Sf)R tS SF;L' 1)E?'PAIL F1k;RI;t)N-
t "2.. Ri�ME}V1:,1 XtST, DRIVE; APPROACH AN[) CONSTRUCT NI:W DRIVES APPROACH PF,R C'f'I'Y
STD. 162-L AND CONSTRUCU I' WIDE; A.C. PATCFIBACK PF'R CITY Sf'DS. (W=1 T, X : V )
cl 1) C'ONSTRUC"T Y WIDE, BIORl'I'I:NTTl:)N BASIN,
14 CONSTRUCT LOW CURBIN(i WALL. (TO ALLOW FOR ELl?VATION DIFFER1 N(T*S)
Willi WOOL) FENCT ON'TOP
0 CONSTRUC T ON-S1'I'l PF.AN7'E;It WALL
8 PR(YIU.71N PLACE
1'7 PROVI.DE SILTFE,NCf, ALONG PROPER"i'Y LINE: PI`R BMI' SE l
88, (X)NSl?lJ(:'T 4" DIA. P.V.C. PF?RFORA'l E.D S.IBDRAEN DRAIN PIPE? AT VY(( MIN. SLOPU', PIPE
SHALL BE. SCIIE?D. 40 OR. SDR-35, SUE DFITAIL FEIRI ON.
G REMOVE' AND :REL (WATF ONTO PRIVATE PROPERTY.
20. REMOVE. ALL NON-STANDARD IMPROVEMF;NTS WIT'fFIN'I"FfFi PUBLIC; RIGI F-OF-WAY
AND REPLACE WITH CITY APPROVI 1) PARKWAY LANF:)SC'APIN(►
21. BORE PIT FOR DOWN SLOPE; DRAIN PIPI:
C2) CONSTRUCT 6" DIA. P.V.C. DRAIN I'll' -?(BORED DOWN SLOPF0, Pl1'F, SHALL BI'
SCHE'D. 40 OR SDR-35..
NOTES:
AN APPROVED ENC..:ROAC HMFNT PERMIT IS REQUIR D FOR ALL WORK AC"l'IVl'I'1I:S
WITIEN THE PUBLICRIGFIT-OF-WAY.
A PUBLIC WORKS DEiPAR'TMEN'F' ENC'ROAC'I-IMEN'1' F'F?RMI'i' INSPE ("TFON IS REOUIRE1)
BEFnRI.: TlIE, BUILDING DEPARTMENT' PE3RMIT FINAL CAN BE ISSUED. A'T THF. 'TI:ME OF PUBLIC
WORKS DEPARTMENT INSPECTION. Il' ANY OFTHE EXISTING PUBLIC IMPROVI.;ME NTS
SCIRROI.TNDINCI THE SITE IS DAMAGED, NEW CONCRI 'TE SIDEWALK, ('[JR13 AND GU'T'TI?R,
AND ALL:F?Y/STRF.I'I' PAVIIMF3N'I' WILL BE Rf QUIR.I D. ADDITIONALLY, IF EXISTING [1TILIT[F?S
I:NFRASTRUC"TURE ARE. DEEMED SUBSTANDARD. A NEW I -INCI I WATER SFRVIC E, WATER
MITER BOX, SEWER LATERAL AND/OR CLE ANC)UT WITH BOX AND LED WTLI., BE Rl QUIR"FI).
100% OF THE COST SHALL BE BORNE BY THE; PROI'E R"I'Y OWNER (MUNICIPAL ('OL)F? 14.24JY20
AND 14.08.030). SAID Dii-iT :RMINATION AND T11F l X ICI NI' OF I'l 1E Rl PAIR. WORK SI IALL BEMADE
AT TUF.:DISC'RE71ON OF TILE PCIEILIC WORKS INSPI (.70R.
AN ENCROACUME:NT AGRFEI'ME MU IS RE'QU1RED FOR ALL NON-STANDARD PRIVATL
IMPROVEMFNTS WTI'Ifi.N TIFF: PUBLIC.` RIGHT-OF-WAY. ALL NON-STANDARD IMPROVI .MENT:S
SHALL. COMPLY WITH. CCTV COUNCIL POLICY L-6 AND L-18.
ALL WORK RELATED TO WATER [NTH PUBLICRIGHT-OF-WAY SHALL BE
PERFORMED BY A C-34 LICI NSL.L) PEl'f?LINI (.'()N'CRAC"I'(.)R OR AN "A" LIC ENSI D
6F.NI RAL F?NGINEE?RINCi CON'rRAC.'TOR.
ALL WORK RELATED TO WASTEWATER IN TI IE PUBUC.' RIMIT-OF-WAY SHALL. Ill'
PERFORMED BY A C-42 LICENSED SANE'TATION SF-WER CONT'RAC7'O 'R OR AN "A" LTCENSL D
CeF?NERAL. ENGINEERING RING (:'.(:)N'IRACI'OR.
NEW CONCRETE SIDEWALK, CURB AND CCU rI'ER, ('[ IR B ACC t'.SS RAMP, AND
ALLEY/Sl'RI I l' PAVEMEN'T MAY BE REQUIRED BY THE CITY TY AT T'FiE TIME
OF CONSI'RIX17ION. SAID DfiTERMLNATION SHALE. BE MA DF AT" I'IEi?
DISC'R11TION OF TIfE PUBLIC WORKS INSPF?(:'f'OR.
A SEPARATE PERMIT I:S RE Qtt1REI) FOR SPA,
l NCE, WALL AND DETACHED Slit IJ("l'CIRF.S
r FUGSHZD GRADE A
J SM.- 232.60
P OF WALL
3, DRAIN PIPE
PLANT yfiffolUMANT
--' 2' DEEP AMENDED SOILS
f DEEP CLEAN 3/4" GRAVEL
FILTER CLOTH HETIIEEN- / 4" PERFORATED PVC PIPE
SOILS AND GRAVEL 2" ABOVE B{)T1'OH OF RAM
BIORF.7ENTEON BASIN
I MCA[
RPa'AMING
rr WAI.I
yS _-lfl f NOW 011I•:SWL
ORANiII.AR RACKI'II.I
MfI'OPWALI
CAVA ON
ARRU'LAP(S"r
'IIt mi i v v 4AItUl
c.3
NEW RESIDENCE
FILTER CLOTH BRr
SOILS AND GRAVEL
I i 1
t ( )N`e Iv4
`;)IAI:t B
S UI ). 162
I }
C`ON STR l
I)NSTRI
W ITI I W(
t'C1N`TRI
�IX)
(_:0NS'IVl
SHAI J, 131
l�`>}
ItI MOVl:
0u.
RE;MOV�l:zl
AND 1411
�21)
BORi; VIT
L ` Z"
COIN `i I'R l
SC"EIE?l). 4(
NOTES.
AN APPROVED f:N('R(.)
WITHIN THE PUBLIC R
A PUBLIC WORKS DliT
BEFORE '111F BUII..l)IN(
WORKS DEPARTMENT
SURROUNDING THE: SI
A N [:)
INFRASTRII(7111RI AR
METER BOX, SU I= ft L
Rx)Ik (W-11flF.. COST sill
AND 14,08.030). SAID I
AT I-1ES DISCR.I?`110N ()
AN I:NCR.(.)A(.`UMI,NT /
IMPROVEi.MENTS wrru
SHALL COMPLY WI7111-I
ALL WORK RELATED]
ED ]
PF,RFORMED BY A C-3e
GE;NI?RA.L FNGINEF?RIl
ALL WORK RILATED1
PURFORME3D BY A C-4:
GENERAL E;NGINE;I3RO
NF,W ('0N( RF' l'E SIDFV
AI,L.I'.YCSTRf?Is`I' I'AVEM
OF CONS'I'RIA-110N, S/
DIS('RFTI()N OF THE' Pt
A SEPARXIT PERMIT V
FF'NO.T., WALL AND f)lri
LCI.Ev.�
iTc
3C��'
'
4' PIERFORATED
2" MM Wfi"I'Q
IIIOREA'E NTIOP
• 11/20/2017 City of Newport Beach Page 16 of 16
4:30:51PM INSP150 - Daily Inspection Request Report
Requested Inspection Date: 11/21/2017
Inspection Type : ENCROACH
Inspection Area: PW
Site Address: 2815 PEBBLE DR
"f h
Activity : N2017-0590
SubType : NEW
Status : APPROVED
OWNER: ERIC AND ADRIANA OLSEN TRUST Phone •
APPLICANT: JOSE MATA Phone : 714-393-6358
Description : R/R FOR DRIVEWAY APPROACH, SIDEWALK, CURB AND GUTTER PER CITY
STANDARDS
Item: 10200 PRE JOB - PW
Requested Time: 11/21/2017 12:00:OOAM Requestor: WEBUSER
714-393-6358 — J
Entered By: WEBUSER
Comments: AM -
Assigned to: 77777 7777 -
Ac.l4-T-4
ii �
Inspector: V V Date: Time: ;,-AM AM PM
Comments:
S
s4-7
/8�z -Z
F:\Users\PBW\Shared\ENCROACH\MASTERS\FORMS\InsoectorSheet.doc
F'A
REPT131 Run Id: 4018
1H7;2018
• '6:34:17AM
City of Newport Beach Page 8 of 8
INSP150 - Daily Inspection Request Report
Requested Inspection Date: 01/17/2018
Inspection Type: ENCROACH
Inspection Area: PW
Site Address : 2815 PEBBLE DR
Activity :
N2017-0590
SubType :
NEW
Status :
APPROVED
OWNER:
ERIC AND ADRIANA OLSEN TRUST Phone:
APPLICANT:
JOSE MATA Phone : 714-393-6358
Description :
R/R FOR DRIVEWAY APPROACH, SIDEWALK, CURB AND GU PER CITY
STANDARDS
hNal
Item:
10100 FORMS WITH COMPACTION - PW
Requested Time:
1/17/2018 12:00:OOAM Requestor: R
714-393-6358
Entered By:
WEBUSER
Comments:
ANY -
Assigned to:
77777777777*
V �I Date: 17 18 Time: 1 � AiM AM PM
Inspector:
p
tv0-L-30-
Loggeo
Reffle
F:\Users\PBMShared\ENCROACH\MASTERS\FORMS\InsnectorSheet.doc
REPT131 Run Id: 4018
4/30/2018 City of Newport Beach Page 6 of 10
4:30:14PM INSP150 - Daily Inspection Request Report
Requested Inspection Date: 05/01/2018
Inspection Type : ENCROACH
Inspection Area: PW
Site Address: 2815 PEBBLE DR
Activity : N2017-0590
SubType : NEW
Status : APPROVED
OWNER: ERIC AND ADRIANA OLSEN TRUST Phone
APPLICANT: JOSE MATA Phone : 714-393-6358
Description : R/R FOR DRIVEWAY APPROACH, SIDEWALK, CURB AND GUTTER PER CITY
STANDARDS
Item: 10250 FINAL - PW
Requested Time: 5/1/2018 12:00:OOAM Requestor: WEBUSER
714-393-6358
Entered By: WEBUSER
Comments: ANY -
Assigned to: 77777777777*
Inspector:. Date: �� Time: AM PM
Comments:
F. !
a .
F:\UserskPBW\Shared\ENCROACH\MASTERS\FORMS\InspectorSheet.doc
REPT131 Run Id: 4018