HomeMy WebLinkAboutN2017-0372oCity
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oport Bea rive,ehNewporta�h, CA s2sso IIII�III�IIIIIIIInIII�III�IIIIIIIIIIIIIIINIg1III Permit No: N2017-0372
Permit Counter Phone (949)644-3311 Project No:
'i Online Inspection Request - www.newportbeachca.gov / Online
Services
Inspection Requests Phone (949)644-3255
Job Address: 1 PUBLIC ROW NB Thomas:Guide:
Description : Pothole existing 16-inch high pressure gas main for testing on Bristol Street between Cypress Street and Bayview Place. (Gas main located in
landscaped area) Emergency work due to gas main leak. Landscape restoration to match existing. Updated 07-31-17 - Install 720 LF of 16-inch gas main.
Parcel tf :
Legal Desc :
Owner: CITY OF NEWPORT BEACH
Phone :
Address
Applicant: SOUTHERN CALIFORNIA GAS COMPANY
Phone : 714-634-7298 [
Address : 1919 S STATE COLLEGE BLVD
ANAHEIM, CA 92806
Special Cond.: Pre -job inspection required.
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 :
$59,400.00
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
Contractor : S E PIPE LINE CONSTRUCTION COMPANY
Phone :
Address : 11832 SO BLOOMFIELD AVE
SANTA FIE SPRINGS CA
Contractor State Lic: 122218
License Expire: 10 31, 2018
Business License
Business Expire:
Workers' Compensation Insurance - -
Carrier : TRAVELERS INDEMNITY
Policy No: VTC2JUB5642B676
W. C. Expire: 05 30, 2018
Total Fee
Paid .
Balance
Receipt No:
$59,641.00
$0.00
$59,641.00
Date : _/_/ Other Department : -Date:
Date : _/_/ Permit Denied Date:
Date : _/_/ Issued Permit: Date:
Date
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City of Newport Beach IIII�IIIIIIIIIIIIIIIIIIIIIIIIIIII�IIIIIIIIIIIIIIIIIIIIIIII Permit No: N2017M72
• ~� % 100 Civic Center Drive, Newport Beach, CA 92660
n Permit Counter Phone (949)644-3311 Project No
-:i: Online Inspection Request - www.newportbeachca.gov / Online SCANNED
N
Services
Inspection Requests Phone (949)644-3255
Job Address: 1 PUBLIC ROW NB Thomas:Guide:
Description : Pothole existing 16-inch high pressure gas main for testing on Bristol Street between Cypress Street and Bayview Place. (Gas main located in
landscaped area) Emergency work due to gas main leak. Landscape restoration to match existing.
Parcel # :
Legal Desc :
Owner: CITY OF NEWPORT BEACH
Phone :
Address
Applicant: SOUTHERN CALIFORNIA GAS COMPANY
Phone: 714-634-7298 [
Address : 1919 S STATE COLLEGE BLVD
ANAHEIM, CA 92806
Special Cond.: EMERGENCY WORK -FEES TO BE COLLECTED
AT A LATER DATE
Permit Processing Fee :
$0.00
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 :
$0.00
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
Contractor : S E PIPE LINE CONSTRUCTION COMPANY
Phone:
Address : 11832 SO BLOOMFIELD AVE
SANTA FE SPRINGS CA
Contractor State Lic: 122218
License Expire : 10 31, 2018
Business License:
Business Expire :
Workers' Compensation Insurance - -
Carrier : TRAVELERS INDEMNITY
Policy No: VTC2JUB5642B676
W. C. Expire: 05 30, 2018
Total Fee $0.00
Paid : $0.00
Balance : $0.00
Receipt No:
Date :
—/—/
Other Department : Date:
Date:
/ /
Permit Denied Date:
Date:
/ /
Issued Permit: Date : /
Date :
—/—/
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 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
2 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.
3 All work shall be done in accordance with the approved plans. Standard Special Provisions anrd Standard Drawings
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 Slate Contractor License Class C-34 is required. For construction or
connection to sewer lines a valid Stale 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 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 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 (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 SDR35 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 other 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 at all times
10. 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.
1 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 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 Slate Highway's 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 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.
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 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
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 CopyAhyreo�� ,,,
Dater / fc-i- / / 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-
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:
24-hour notice for Encroachme Permit Inspecti In required by calling
Public Works at 949-644-331 .
15 Any above ground utility facilities will require clented approval r 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 vears in Stale
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 I
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. er relocated
without approval from the General Services Department.
19. All work in the public right-of-way must meet the approval of the Public VIo-I
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 shall be performed until the Public Works Department has issued this permit. Applicant hereby acknowledges helshe has read and understan s the terms 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 issuance. Da11p�:/ f � �ignatur ��
Permit fees are nonrefundable.
-
COMPLETE THE BELOW INFORMATION
PROJECT ADDRESS: Across 2322 & 2424 SE Bristol St. XSt: Spruce Ave. TG: 889-F1
DETAILED DESCRIPTION OF PROPOSED WORK (include measurements):
Pot Hole 16" HP Main
(2) 5'x5' Earth Cut
NOT#: 2040713404 MCU# 5190659 CC# 2200-0565
APPLICANT: SoCalGas Phone: 714-634-7298 Linh Do (Permit Clerk)
Email Address: Ldo@semprautilities.com
Mailing Address: 1919 S. State College Blvd.
City/State/Zip:Anaheim, CA 92806
Phone:
ss:
E
ress:
City/State/Zip:
c_*O FN� <i_► _:.Y
CONTRACTOR:
Office Phone:
Company (if different):
Jobsite Phone:
Other Phone: Z 1 �% 7
Email Address:
Mailing Address:
City/State/Zip:
State License Number & Class: _
L, '1-2 k S Expires: ;13
City Business License Number:
Expires:
ORKERS COMPENSATION INSURANCE - Certificate of Insurance (Section 3800 Labor Code)
Com an : Policy No: Ex ires:
REFUNDABLE DEPOSIT INFORMATION (/f A plicab/e ):
Refund Payable To:
Mail Refund To:
Special Conditions of Permit:
ADDITIONAL APPROVAL REQUIRED FROM THE FOLLOWING DEPARTMENTS
Utilities: Traffic: L.__ .� Fire:
General Services: Other:
Engineer:
PWS:
Date:
Permit No. N2007-
:nrsempb-shared. `.
Public Works Department 949-644-3311
3300 Newport boulevard, Newport Beach, CA 92663
FEE WORKSHEET FOR ENCROACHMENT PERMIT
CITY OF NEWPORT BEACH
PUBLIC WORKS DEPARTMENT
All Fees Are Non -Refundable Unless Otherwise Stated
PROJECT ADDRESS:
?,,bloc Row
PERMIT N2017- o 3"12
NUMBER:
A APPLICNT-
so� e c01; 4 rv,n c► C,03 y
Permit Processing Fee:
Q
Public Works Only
$241.00 i
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
Utilities Field Inspection
General Services Inspection
Water Quality/Artificial Turf Inspection
Refundable Deposit:
Improvements
Qtv.
$165.00 959,400
$121.00
$165.00
$108.00
TBD
TBD
Street/Alley/Walk Closure: $65.00Newspaper 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 El 4TT Box & Cover $64.00
Additional
- - - - - - - - - - - - - - - - - - --------- ----
1 THE FOLLOWING ITEMS REQUIRE APPROVAL FROM THE Revenue Division 1
REVENUE DIVISION PRIOR TO PAYMENT OF FEES Approval:
Qty
(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
Turbine Meter
$425.00
12"
13" Meter
$845.00
$3,310.00
For Traffic & Alley Areas (Box + Cover = Cost)
1" Meter: 13.00 + 38.00 $51.00�
14" Meter
$4,730.00
1
2" Meter: 27.00 + 162.00 $189.00
16" Meter
$7,190.00
uty.
tsuaget Numder
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:
Total Amount Due:
For Finance use only
zod,%
0 s9, (041. r.
Permit Specialist
Receipt No.
riuserypt)visharedlencroachtmasters/ep front and back masters/
Rev. 1/5/20171
lepfeeSheet as -revised 10/21/2016
FEE WORKSHEET FOR-WROACH.MENT PERMIT
CITY NLWPOfT _
PUBUIDWORD DEPART MEW
All Fees Are Non -Refundable Unless Otherwise Stated
PROJECT ADDRESS: <�
PERMIT N2017-
NUMBER:
APPLICANT:
IV DIE COWL
Permit Processing Fee: Q
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
TBDeTBD
$108.00 0
$250.00
$64.00
----- ----
venue Division
1
Qty.
aty. 1
,
1Water Meter:
Installation Charge $528.00,
13/4" Meter
$50.25
Water Meter Boxes:
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
11 1 /2" Turbine Meter
$700.00
2: Meter: 27.00 + 61.25 $88.25 1
12" Meter
$425.00
12" Turbine Meter
$845.00
For Traffic & Alley Areas (Box + Cover = Cost) 1
13" Meter
$3,310.00
1" Meter: 13.00 + 38.00 $51.00
14" Meter
$4,730.00
2" Meter: 27.00 + 162.00 $189.00e
16" Meter
$7,190.00
Certificate of Compliance Fee (+100% of hry 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 EasementtVacation Fee (+100% of hrly over 4 hrs)
$1,022.00
5200-5031
Street Tree Fee ($700 Planting Fee)
TBD
030-2284
---
---
Engineering Tech::
Tot Amount Due:
For Finance Use Only
Permit S ialist
Receipt No.
f:/userslpbw/shared/encroach/masters/ep front and back masters/
1
Rev. 1/5/2017
epreesheet-As-revised 10121n016
Page 1 of
Print Permit
S,AIEOFCALIFORNIA DtPARTMENTOF rRANSPORTAIION
ENCROACHMENT PERMIT
1 R-0120 (REV 6/2012)
In compliance with
123 Your application of July 27, 2017
U Utility Notice No. of
CI Agreement No of
t 1 R/W Contract No. of
TO: SO CAL GAS COMPANY
1919 S. STATE COLLEGE BLVD.
ANAHEIM, CA 92806
Attn: RICKARD TYRIE 714-634-3039
and subject to the following, PERMISSION IS HEREBY GRANTED to
'ermit No
12-17-6-TK-0528
iist/Co/Rte/PM
12 / ORA / 73 / 25.097
late
08/01/2017
erformance Bond Amount (1) � aymenl Bond Amount (2)
0.00 IW` 0.00
and Company
and Number (1) Bond Number (2)
, PERMITTEE
INSTALL, MAINTAIN, AND REMOVE TEMPORARY TRAFFIC CONTROL DEVICES WITHIN STATE RIGHT OF WAY
ON BRISTOL STREET AT SR-73 AND CLOSE OFF -RAMP 15 IN THE CITY OF NEWPORT BEACH TO PERFORM
EMERGENCY COSNTRUCTION TO REPLACE 16" HP MAIN GAS LEAK OUTSIDE OF THE STATE RIGHT OF WAY.
All performed work shall be in accordance with current Caltrans Standard Specifications
and Standard Plans, Section 500 (Specific Permits) of the Encroachment Permits Manual,
California MUTCD latest edition, the attached Provisions and Permit Plans stamp -dated JULY
26, 2017.
Permittee shall contact State Permit Inspector SHAHRYAR DERAVI at 651-328-6403 between
10:30 AM and 1:30 PM, a minimum of five working days prior to the start of work and a pre -
job meeting will be scheduled at the earliest mutually agreeable time. Failure to comply
with this requirement will result in suspension of this permit.
THIS PERMIT IS NOT A PROPERTY RIGHT AND DOES NOT TRANSFER WITH THE PROPERTY TO A NEW OWNER
The following attachments are also included as part of this permit (Check applicable):
0 Yes
0 No
General Provisions
In addition to fee, the permittee will
El Yes
M No
Utility Maintenance Provisions
be billed actual costs for:
n Yes
M No
Storm Water Special Provisions
IN Yes ❑ No Review
0 Yes
Cl No
Special Provisions
® Yes ❑ No Inspection
• Yes
M No
A Cal -OSHA permit, if required Permit No.
® Yes ❑ No Field Work
❑ Yes
(M No
As -Built Plans Submittal Route Slip for Locally Advertised Projects
LJ Yes
D9 No
Storm Water Pollution Prevention Plan / Water Pollution Control Plan
(if any Caltrans effort expended)
M Yes S No The information in the environmental documentation has been reviewed and considered prior to
approval of this permit.
This permit is void unless the work is completed before _October 31 L 2017_
This permit is to be strictly construed and no other work other than specifically mentioned is hereby authorized.
No project work shall be commenced until all the other necessary permits and the environmental clearances have been obtained.
PERMIT ENGINEER Rai Gohil APPROVED
COPIES TO
Permittee
FIle.17-528 Ryan Chamberlain, District Director
S fleravl
Maintenance BY �^ ^ n �> e
R BIIATT . P E . District Permit
FM 91 1436 (012 Permit App )
SO CAL GAS COMPANY
1217- 6TK-0528
-tUt;U:; i I :ill i
WORK SHALL BE PERFORMED AT NIGHT TIME ONLY.
In addition to the attached General Provisions (TR-0045), the following Special Provisions are applicable:
Tile following advance notification procedure shall be followed for permitted work activities
requiring Traffic Control within the State Right of Way:
By Noon Monday, permittee shall submit a completed copy of the attached District 12
Closure Schedule Form to the assigned Permit Inspector by email (as shown on the Closure
Schedule Form) or by Fax (949-724-2265) for the following week period, defined as Saturday
through the following Friday. If Monday is a designated holiday, the schedule shall be
submitted on Tuesday. Incomplete, illegible or inaccurate information will be returned for
correction and resubmittal. Permittee/Permittee's contractor will be notified of disapproved
closures or closures that require coordination with other parties as a condition of approval. If
email or fax is unavailable, the schedule may he called in by calling the assigned Permit
Inspector, and the completed Form be submitted to the Permit Inspector during the pre job
meeting.
• AI)A Compliance requirements shall be met at all times. (DIB 82-05)
• Permittee shall contact the LOCAL LAW ENFORCEMENT JURISDICTION at least 48 hours prior to implementing traffic
control measures. All closures shall conform to State standards and shall follow Chapter 8 of the Safety Manual.
• Except for installing, maintaining and removing traffic control devices, any work encroaching within 3 feet of the edge of a
travel lane for areas with a posted speed limit below 45mph, or 6 feet of the edge of a travel lane, for areas with a speed limit
posted at 45mph or higher, shall require closing of that travel lane. Any work encroaching within 6 feet of the edge of the
shoulder, shall require closing of that shoulder. Permittee shall notify the Department's Representative, and obtain approval of,
all traffic control, lane closures or detours, at least seven (7) WORKING DAYS prior to setting up of any traffic control."
Orange vests and hard hats shall be worn at all times while working within State right-of-way.
• By acceptance of this permit, the permittee understands and agrees to reimburse the State for all costs incurred for performing
corrective work in the event that the permittee or permittee's representatives fail to install, replace, repair, restore, or remove
facilities to state specifications for the immediate safe operation of the highway and satisfactory completion of all permit work.
State forces may perform corrective work or it may be contracted out. Understood is that the above charges are in addition to
permit fees, and an invoice will be sent to permittee for said charges after satisfactory completion of all work. The issuance of
the permit shall not set as precedence for other permits approved in the future.
• It is the responsibility of the permittee, permittee's agents, or contractors to comply with all provisions of this permit and
instructions from the State permit inspector. Permittee shall keep the permit package or copies thereof, at the work site at all
times and show it upon request to any Department representative or law enforcement officer. When the permit package is not
available, then immediate suspension of permit will occur.
• Permittee shall furnish the necessary inspection to provide for public safety and to insure that all work within or affecting the
State's right of way pursuant to this permit is in accordance with State Standards and requirements. The State permit inspectors
will monitor the work authorized under this permit and the work is subject to the approval of the State permit inspectors.
• Permittee shall remain solely responsible for compliance with all requirements of this permit.
• Prior to performing any work pursuant to this permit, the permittee shall obtain all necessary permits and authorizations
required of other governmental agencies and by law. The permittee shall make the necessary arrangements with the appropriate
agencies to monitor and test performed work to ensure accordance with requirements of those agencies.
• American National Standards Institute (ANSI) compliant Class If vests and hard hats shall be worn while working within
State's right-of-way. Workers working at night will be required to wear ANSI Class III warning garments. Class III compliance
can be achieved by combining ANSI Class E pants worn with an ANSI Class II vest.
• The State permit inspector must ascertain and agree to all work details and all aspects of traffic control or no work shall begin
on this permit.
• if a safe passage way cannot he provided, appropriate signs and barricades shall be installed at the
limits and in advance of construction at the nearest Crosswalk or Intersection to detour pedestrians to
facilities across the street.
• When the work area encroaches upon a sidewalk, walkway, or crosswalk area, special consideration
must be given to pedestrian safety. Protective barricades, fencing, handrails and bridges, together with
warning and guidance devices and signs must be utilized so that the passageway for pedestrians,
especially blind and other physically handicapped is safe and well defined and shown on the approved
permit plan.
• Personal vehicles of the Contractor's employees shall not be parked on paved shoulders or traveled way within the limits of this
work.
• Unless otherwise approved by the State Permit Inspector no work that interferes with public traffic shall be performed on
weekdays between 6:00 AM and 9:00 AM, and between 3:00 PM and 6:30 PM.
• The full width of traveled way shall be open for use by public traffic on Saturdays, and designated legal holidays, after 3:00 PM
on Fridays and on the day preceding designated legal holidays, and when construction operations are not actively in progress.
• Except as specifically provided herein, all requirements of the Vehicle Code and other applicable laws
must be complied with in all particulars.
• No lane may be closed or obstructed at any time unless specifically allowed per the encroachment
permit, shown in approved traffic control plans, and/or as directed by the Department's Representative.
• 'the Permittee's work shall be subordinated to any operations which the Department may conduct and
shall not delay, nor interfere with the Department's Forces or Department's Contractors.
• Should any deviation from these procedures or conditions be observed, all work shall be suspended until
satisfactory steps have been taken to ensure compliance.
• In the event of any discrepancy between Permittee's Permit Plans and these Permit Special Provisions, these Special Provisions
shall prevail.
Immediately following completion of the work permitted herein, Permittee shall fill out and fax the
attached Work Completion Notice to 949-724-2265 to initiate final permit processing.
J 1 A i F OF GAi iFCjRNiA • LIEPAk I MEN I OF 'I HANSF'ORIAI ION
STANDARD ENCROACHMENT PERMIT APPLICATION
TR-0100 (REV.03/2015)
Plcod ,. ri,gw (.I lnru! I hrnrly yl+t.r I null/o, 1 ia... 'NA' N m,r :,lrl,l;, A-!,
This application is not complete until all requirements have been approved.
Permission is requested to encroach on the State Highway right-of-way as follows:
Page 1 of 3
PERMIT NY.
SIMPLEX STAMP
il," (.•i�%r r• � i� .j i((O 1j(j. Ir iE
1. COUNTY
2. ROUTE
3. POSTMILE j -) >
ORANGE
73
-15
4. ADDRESS OR STREET NAME
5. CITY
BRISTOL ST
NEWPORT BEACH
6. CROSS STREET (Distance and direction from project site)
7. PORTION OF RIGHT-OF-WAY
DATE OF SIMPLEX STAMP
_SPRUCE AVE-WITHIN SITE
NONE
B. WORK TO BE PERFORMED BY
_
9. ESTIMATED START DATE
10. ESTIMATED COMPLETION DATE
❑ OWN FORCES CONTRACTOR
8-7-201 7
9-22-2017
11.
MAX. DEPTH
AVG. DEPTH
AVG. WIDTH
LENGTH
SURFACE TYPE
EXCAVATION
70""
60"
24"
662'
ASPHALT
ff-2 ESTIMATED COST WITHIN STATE HIGHWAY RIGHT-OF-WAY
FUNDING SOURCE(S)
$ 0.00
FEDERAL STATE LOCAL PRIVATE
13.
PRODUCT TYPE
DIAMETER
VOLTAGE / PSIG
14. CALTRANS' PROJECT CODE (ID)
PIPES
STEEL
16'
465 PSIG
15. (30ouble Permit Parent Permit Number NEWPORT BEACH N2_017-0372
Applicant's Reference Number I Utility Work Order Number MCU 5190659
16. Have your plans been reviewed by another Caltrans branch? [E]NO YES (If "YES") Who?
17. Completely describe work to be done within STATE Highway right-of-way:
Attach 6 complete sets of plans (folded to 8.5" x 11") and any applicable specifications, calculations, maps, etc.
NO WORK WILL BE DONE IN CALTRANS RIGHT OF WAY. SO. CAL. GAS CO. JUST NEEDS
TRAFFIC CONTROL PERMIT TO CLOSE CALIFORNIA STATE ROUTE 73 OFF RAMP 15 FOR
PART OF EMERGENCY CONSTRUCTION PROJECT TO REPLACE 16" HP MAIN GAS LEAK.
ALL WORK WILL BE ON SE BRISTOL ST. AND THE CLOSURE OF OFF RAMP 15 WILL ONLY
TAKE PLACE AT NIGHT BETWEEN 8:OOPM TO 6:00 AM.
18. IS a City, County or other public agency involved in the approval of this project?
❑ YES (If "YES", check type of project AND attach environmental documentation and conditions of approval)
❑ COMMERCIAL DEVELOPMENT ❑ BUILDING ❑ GRADING ❑ OTHER
❑ CATEGORICALLY EXEMPT ❑ NEGATIVE DECLARATION ❑ ENVIRONMENTAI IMPACT REPORT ❑ OTHER
❑ NO (If "NO", please check the category below which best describes the project AND answer questions A - K on page 21
El DRIVEWAY OR ROAD APPROACH, RECONSI RUCTION, MAINTENANCE OR RESURFACING ❑ FENCE
❑ PUBLIC UTILITY MODIFICATIONS, EXTENSIONS, HOOKUPS ❑ MAILBOX
❑ FLAGS, SIGNS, BANNERS, DECORATIONS, PARADES AND CELEBRATIONS ❑ EROSION CONTROL
❑ OTHER _ - _ ❑ LANDSCAPING
ADA NOTICE: For individuals with sensory disabilities, this document is available in alternate formals. For infunnallon, call (916) 445-1233, 1 fY 711, or write to Records
and Forms Management, 1120 N Street, MS b9, Sacramento, CA 95814.
5 1 A 1 L OF CALIF-ORNIA • DEPARI MEN i OF TRANSPORTATION Page 3 of 3
STANDARD ENCROACHMENT PERMIT APPLICATION
TR-0100 (REV.03/2015) -- PERMIT NO.
PLEASE RFAD'14IE' FOLLOWING OWING CLAUSES PRI R TO SIGNING THIS FNC'ROAC HME'N'r PERMIT APPLICATION.
The applicant, understands and herein agrees that an encroachment permit can be denied, and/or a bond required for non-payment of prior or
present encroachment permit fees. Encroachment Permit fees may still be due when an application is withdrawn or denied, and that a denial
may be appealed, in accordance with the California Streets and Highways Code, Section 671.5. All work shall be done in accordance with the
California Department of Transportation's (Department) rules and regulations subject to inspection and approval.
The applicant, understands and herein agrees to the general provisions, special provisions and conditions of the encroachment permit, and to
indemnify and hold harmless the State, its officers, directors, agents, employees and each of them (Indemnitees) from and against any and all
claims, demands, causes of action, damages, costs, expenses, actual attorneys' fees, judgments, losses and liabilities of every kind and nature
whatsoever (Claims) arising out of or in connection with the issuance and/or use of this encroachment permit and the placement and subse-
quent operation and maintenance of said encroachment for: 1) bodily injury and/or death to persons including but not limited to the Applicant,
the State and its officers, directors, agents and employees, the Indemnities, and the public; and 2) damage to property of anyone. Except as
provided by law, the indemnification provisions stated above shall apply regardless of the existence or degree of fault of Indemnities. The Ap-
plicant, however, shall not be obligated to indemnify Indemnities for Claims arising from the sole negligence and willful misconduct of State, its
officers, directors, agents or employees.
An encroachment permit is not a property right and does not transfer with the property to a new owner.
COMPLIANCE WITH THE AMERICANS WITH DISABILITIES ACT (ADAI OF 1990: All work within State Highway right-of-way shall be conducted in
compliance with all applicable Federal, State and Local Access laws, regulations and guidelines including but not limited to the Americans with
Disabilities Act Accessibility Guidelines (ADAAG), the Public Rights -of -Way Guidelines (PROWG), the Department's current Design Information
Bulletin 82, "Pedestrian Accessibility Guidelines for Highway Projects", the Department's Encroachment Permits Manual and encroachment permit.
DISCHARGES OF STORM WATER AND NON -STORM WATER: All work within State Highway right-of-way shall be conducted in compliance with
all applicable requirements of the National Pollutant Discharge Elimination System (NPDES) permit issued to the Department, to govern the
discharge of storm water and non -storm water from its properties. Work shall also be in compliance with all other applicable Federal, State and
Local laws and regulations, and with the Department's Encroachment Permits Manual and encroachment permit. Compliance with the Depart-
ment's NPDES permit requires amongst other things, the preparation and submission of a Storm Water Pollution Protection Plan (SWPPP),
or a Water Pollution Control Program (WPCP), and the approval of same by the appropriate reviewing authority prior to the start of any work.
Information on the requirements may also be reviewed on the Department's Construction Website at:
Igtg_l/www clo c:" 4wv(licyl :an tni<:/�lnrSllwer
25. NAME OF APPLICANT OR ORGANIZATION
RICHARD TYRIE-SO. CAL. GAS CO.
ADDRESS OF APPLICANT OR ORGANIZATION WHERE PERMIT IS TO BE MAILED (Include City and Zip Code)
1919 S STATE COLLEGE BLVD, ANAHEIM 92806
RTYRIE@SEMPRAUTILITIES.COM 1714-634-3039
26. NAME OF AUTHORIZED AGENT / ENGINEER (A "Letter of authorization" is required if different from #25) IS A LETTER OF AUTHORIZATION ATTACHED?
SAME ❑ YES ❑ NO
ADDRESS OF AUTI IORIZEn AGENT / ENGINEER (Include City and Zip Code)
SAME
E-MAIL ADDRESS PHONE NUMBER FAX NUMBER
SAME
27. NAME OF BILLING CONTACT (Same as #25EI Same as #26 ❑ )
BILLING ADDRESS WHERE INVOICE(S) ISIARE TO BE MAILED (Include City and Zip Code)
E-MAIL ADDRESS PHONE NUMBER FAX NUMBER
28. SIGNAT OF P T OR AUTHORI"LED AGENT 29. PRINT OR TYPE NAME 30.TITLE 31. DATE
-, _ RICHARD TYRIE IPLANNER6-17
JIHTE OF CALIFUKNIA" DEPAkIMEN -I OF TRANSPORTATION
STANDARD ENCROACHMENT PERMIT APPLICATION
TR-0100 (REV 03/2015)
The following questions must be completed when a City, County or other public agency IS NOT involved in the approval of this project.
Page 2 of 3
Your answers to these questions will assist Departmental staff in identifying any physical, biological, social or economic resources that may be affected by your proposed
project within Slate highway right-of-way and to determine which type of environmental studies may be required to approve your application for an encroachment permit.
It is the applicant's responsibility for the production of all required environmental documentation and supporting studies and in some cases this may be costly and time
consuming. If possible, attach photographs of the location of the proposed project Please answer these questions to the best of your ability. Provide a description of
any "YES" answers (type, name, number, etc.)
A. Will any existing vegetation and/or landscaping within Slate Highway rightaf-way be disturbed?
NO
8. Are there waterways (e.g. river, creek, pond, natural pool or dry slreambed) adjacent to or within the limits of the project or State Highway right-of-way?
NO
C. Is the proposed project located within five miles of the coast line?
NO
D. Will the proposed project generate construction noise levels greater than 86 d8A (e g jack -hammering, pile driving)?
YES, CONCRETE SAW, JACK HAMMER
E. Will the proposed project incorporate land from a public park, recreation area or wildlife refuge open to the public?
NO
F. Are Ihew any recreational trails or palhs within the limits of the proposed project or State Highway dghtof-way?
NO
G. Will the proposed project impact any structures, buildings, rail lines or bridges within Slate Highway right Of -way?
NO
H. Will the proposed project impact access to any businesses or residences?
NO
I. Will the proposed project impact any existing public utilities nr public services?
NO
J. Will the proposed project impact existing pedestrian facilities, such as sidewalks, crosswalks or overcrossings?
NO
K. Will new lighting be constructed within or adjacent to Slate Highway right-of-way?
NO
19. Will this project cause a substantial change in the significance of a historical resource (45 years or older), or cultural resource? YES ✓ NO
(If "YES", provide a description)
20. Is this project on an existing State Highway or street where the activity involves removal of a scenic resource including a significant tree or stand of trees, a
rock outcropping or a historic building? []YES Q✓ NO (If "YES", provide a description)
21. Is work being done on the applicant's property?
Q YES ✓❑ NO (If "YES", attach 6 complete sets of site and grading plans.)
22. Will the proposed project require the disturbance of soil? 0 YES Q NO
If "YES", estimate (tie area wjtjhin Slate Highway right -of way in square feel AND acres. 6 _ __ __ (tt') ANU 0 _ (acres)
estimate the area outside of Slate Highway right-of-way in square feet ANO acres: 16,320 (h') ANU.374656 — (acres)
23. Will the proposed project require dewalering? Q YES Q✓ NO
If "YES", estimate total gallons AND gallons/month. _ (gallons) AND (gallonshnor4h)
SOURCE': ❑STORM WATER ANON -STORM WATER
('See Caltrans SWMP for definitions of non -storm water discharge: http://www Jut ca gov/hq/env/sturrnwater/irhdex.htm )
24. 1 low will any storm water or ground water be disposed of from within or near the limits of the proposed project?
Q✓ Storm Drain System Q Combined Sewer / Storm System Q Storm Water Retention Fusin
Other (explain):
CAI E OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
NCROACHMENT PERMIT FEE CALCULATION SHEET
i 0406 (NEWO 2015) PERMIT�RLRE�FERENCE
TI i1S PAGE IS FOR CALTRANS USE ONLY WORK NUMBER
DEFERRED BILLING (Utility) EXEMPT PROJECT CODE am
— ----
FEES
—
REVIEW .............
— ---
INSPECTION.............................................................
...........
hours@
$82.00 /hour= $
............................................................
FIELDWORK ...................................................
hours @
$ 62.00 /hour = $
UIPMEN'1"AND MATERIALS.............
.............
hours @
$
$ 82.00 / hour =..................................................................................... —'—
`--__ CALCULATED BY:
DATE:
AMOUNT:$
REVIEW......................................................"-....
INSPECTION.....................................
................................I...............
hours @
$ 82.00 /hour = $
.............
FIELDWORK ...................................................
hours @
$ 82.00 /hour = $
................................................
EQIJIPMENTANDMATERIALS..................
hours @
$ 82.00 / hour= $...............
_ CALCULATED BY; —
DATE:
..........................
................
.
AMOUNT: $
REVIEW......................................
.............................................
...........................
.—_hours @
$ 82.00 / hour = $
INSPECTION .................................
---
.................................................
FIELD WORK ......................
...........
.
hours @
$ _
$ 82.00 / hour =.................................................................................................
EQUIPMENT AND MATERIAIS .......................................................
hours @
$ 82.00 / hour = $
CALCULATED BY:
.
O�TE:
AMOUNT: $
REVIEW ......................
—
..............................................................
............................:
�.� !......
hours @
$ 82.00 /hour = $
INSPECTION .................................................
...............................
.................
hours
FIELD WORK ............................
EC UIPMEN'I AND MATERIALS........ .......................................................
.; ....................
hours @
$ 82.00 / hour = $
CALCULATED BY:
..............I.....................
DATE:
......
AMOUNT.
TOTAL FEES: $
DEPOSITS
CHECK NUMBER NAME ON CARDICHECK
CREDIT CARD PHONE NUMBER
LI CASH CASHIER'S INITftALS
DATE: AMOUNT:
CHECK NUMBER
NAME ON PARD/CHECK
CREDIT CARD
PHONE NUMBER
CASH
CASHIER'S INITITALS
CHECK NUMBER—
NAME ON CARD/CHECK
CREDIT CARD
PHONE NUMBER
CASH
CASHIER'S INITTTALS
DATE: AMOUNT:
DATE: AMOUNT:
CHECK NUMBER NAME ON CARD/CHECK-
CREDIT CARD PHONE NUMBER
CASH CASHIER'S MITITALS
-----_—___ DATE: AMOUNT.
TOTAL DEPOSITS;
;I1 DEPOSIT IN UEU OF BOIJD El DATE AMOUNT
BOND
DATE $ :FORM: JVCE; AMOUNT
MENT BOND DATE AMOUNT $
IABILITY INSURANCE REQUIRED? — $
_ — YES NO AMOUNT
N
OTICE; Fur indMdualswi1 r senwry disahiliNoa
DISTRICT 12 LANE/SHOULDER CLOSURE REQUEST FORM
THIS FORM MUST:: BE SUBMITTED BY NOON ON MONDAY PRIOR TO THE WEEK OF THE PLANNED RESTRICTION.
COMPLETE FORM AND SUBMIT BY EMAIL TO THE EMAIL ADDRESSES INDICATED AT THE BOTTOM OF THE PAGE
OR BY FAXING IT TO (949) 724-2265.
Today's Date:,_ Time:
Contractor:
Req uestor:
Field Contact
Office Phone #•
Cell
Cell Phone #.
_
Office
EA # /Permit #
Pager
Caltrans Inspector:
FAX
LOCATION & DATE OF CLOSURE. FOR THE WEEK OF:
Direction: NB SB EB WB Reporting Week begins on Saturday
Days(s): O Saturday ❑ Sunday ❑ Monda
y ❑Tuesday ❑Wednesday ❑ Thursday
n Friday
Types of Closure, Closure Characteristics (check all of the following that apply):
❑ One -Way ❑ Complete Closure ❑ 24— Hour /7 Day —closure
❑ Detour info available
❑ No detour available ❑ Ramp Closures ❑ COZEEP/MAZEEP
❑ Shoulder
[] Closure conforms to the FHWA's Manual of Uniform Traffic Control Devices (MUTCD) 2o14 EDITION, copies of
which are wrailable online at http./Avww.dotca-gov/hgttraffops/engineering/mutcd/ca—mutcd20l4.htm
Estimated Delay. Minutes Reason for Restriction:
"REAL-TIME" STATUS INSTRUCTIONS PLEASE MAKE YOUR FIELD PERSONNEL AWARE & RESPONSIBLE!
Permittee shail STATUS (call) scheduled work DAILY via District's 24-Hour Communication Center (DCC) at 949 936 3600 and
text the 10-97. 10 98 or 10-22 status o the rnit i eotor named on the errnit Ins ctors cell pgone numberwill be provided
during the ore -lob meebric Status (call) using Closure ID No(s) when work begins (first cone down, 1( 97), and again when
work is finished for the day (last cone removed, 1 0-W). If the work is cancelled on any scheduled day, Permittee shall call
Caltrans DCC at 949 936 3600 and relay, "(Closure ID fi) is 10-22" (cancelled). The cancellation cell shall be made before the
scheduled 10-97 time, but no later than 1 hour prior to the scheduled 10-98 time. Any delay in picking up your closure must be
reported immediately to DCC at 949-936-3600 and Permit Inspector.
PERMIITEE.SHALL EMAIL OR FAX THE COMPLETED FORM TO THE ASSIGNED PERMIT INSPECTOR, AND SUBMIT
THE SIGNED ORIGINAL COPY AT THE PRE -JOB MEETING. Permit Inspectors Email Addresses are as follows:
shakeri.hossein(a�dgtca aov, iavid iraj a)dotca pov, banihashemi maiidC of ca gov
Name: Signature
Date
S'I'ATE OF CALIFOkNIA, DEPARTMENT' OF TRANSPORTATION
ENCROACHMENT PERMIT GENERAL PROVISIONS
TR-0045 (REV.05/2007)
g.
9.
10.
r All
T'IiOR'IV: The Department's authority to issue encroachment
Permits is provided under, Div. 1, Chpt. 3, Art. 1, Sect. 660 to 734 of
the Streets and Highways Code.
2• REVOCATION: Encroachment permits are revocable on five days
notice unless otherwise stated on the permit and except as provided by
law for public corporations, franchise holders, and utilities. These
General Provisions and the Encroachment Permit Utility Provisions
are subject to modification or abrogation at any time. Pennittees' joint
use agreements, franchise rights, reserved rights or any other
agreements for operating purposes in State highway right of way are
exceptions to this revocation.
3- DENIAL. FOR NONPAYMENT OF FEES: Failure to pay permit
fees when due can result in rejection of firttrre applications and denial
of permits.
4• ASSIGNMENT. No party other than the permittee or permittee's
authorized agent is allowed to work under this permit.
5. ACCEPTANCE OF PROVISIONS: Permittee understands and
agrees to accept these General Provisions and all attachments to this
Permit, for any work to he performed under this permit.
6• BEGINNING OF WORK: When traffic is not impacted (see
Number 35), the permittee shall notify the Department's
representative, two (2) days before the intent to start permitted work.
Perntittee shall notify the Department's Representative if the work is
to be interrupted for a period of five (5) days or more, unless
otherwise agreed upon. All work shall be performed out weekdays
during regular work hours, excluding holidays, unless otherwise
specified in this permit.
STANDARDS OF CONSTRUCTION: All work performed within
highway right of way shall conform to recognized construction
standards and clurent Department Standard Specifications,
i.)epartment Standard Plans High and Low Risk Facility
Specifications, and Utility Special Provisions. Where reference is
made to "Contractor and Engineer," these are amended to be read as
"Permittee and Department representative."
PLAN CHANGES: Changes to plans, specifications, and permit
provisions are riot allowed without prior approval from the State
representative.
INSPECTION AND APPROVAL. All work is subiect to
monitoring and inspection. Upon completion of work, penrrittee shall
request a final inspection for acceptance and approval by the
Department. The local agency pemrittee shall not give final
construction approval to its contracto until final acceptance and
approval by the Department is obtained.'
PERMIT AT WORKSITE: Pennittey shall keep the permit package
or a copy thereof, at the work site and show it upon request to any
Department representative or law enforcement officer. if the permit
package is not kept and made available.at the work site, the work shall
be suspended.
CONFLICTING ENCROACHMENtfS: Permittee shall vfield start
of work to ongoing, prior authorized, work adjacent to or within the
limits of the project site. When existing encroachments conflict with
new work, the permittee shall bear all cost for rearrangements, (e g ,
relocation, alteration, removal, etc.).
PERMITS FROM OTHER AGENCIES: This permit is i:tvalidated
if the permittee has not obtained all permits necessary and required by
law, from the Public Utilities Commission of the State of California
(PUC), California Occupational Safety and Health Administration
(Cal -OSHA), or any other public agency having jurisdiction.
13. PEDESTRIAN AND BICYCLIST SAFETY: A safe minimum
Passageway of 4' shall be maintained through the work area at existing
pedestrian or bicycle facilities. At no time shall pedestrians be
diverted onto a portion of the street used for vehicular traffic. At
locations where safe alternate passageways cannot be provided,
appropriate signs and barricades shall be installed at the limits of
construction and in advance of the limits of construction at the nearest
crosswalk or intersection to detour pedestrians to facilities across the
street. Attention is directed to Section 7-1.09 Public Safety of the
Department Standard Specifications.
14. PUBLIC TRAFFIC CONTROL: As required by law, the permittee
shall provide traffic control protection warning signs, lights, safety
devices, etc., and take all other measures necessary for traveling
Public's safety. While providing traffic control, the needs and control
of all road users [motorists, bicyclists and pedestrians, including
Persons with disabilities in accordance with the Americans with
Disabilities Act of 1990 (ADA)] shall be an essential part of the work
activity.
Day and night time lame closures shall comply with the California
Manual on Uniform Traffic Control Devices (Part 6, Temporary
Traffic Control), Standard Plans, and Standard Specifications for
traffic control systems. These General Provisions are not intended to
impose upon the permittee, by third parties, any duty or standard of
care, greater than or different from, as required by law.
15. MINIMUM INTERFERENCE WITH TRAFFIC: Permittee shall
plan and conduct work so as to create the least possible inconvenience
to the traveling public; traffic shall not be unreasonably delayed. On
conventional highways, permittee shall place properly attired
flagger(s) CO stop or warn the traveling public in compliance with the
California Manual on Uniform Traffic Control Devices (Chapter 6E,
Flagger Control).
16. STORAGE OF EQUIPMENT AND MATERIALS: The storage of
equipment or materials is not allowed within State highway right-of-
way, unless specified within the Special Provisions of this specific
encroachment permit. If Encroaclunent Permit Special Provisions allow
for the storage of equipment or materials within the State right of way,
the equipment and material storage shall comply with Standard
Specifications, Standard Plans, Special Provisions, and the Highway
Design Manual. The clear recovery zone widths must be followed and
are the minimum desirable for the type of facility indicated. below.
freeways and expressways - 30', conventional highways (no curbs) - 20'
conventional highways (with curbs) — 1.5'. if a fixed object cannot be
eliminated, moved outside the clear recovery zone, or modified to be
made yielding, it should be shielded by a guardrai! or a crash cushion.
17. CARE OF DRAINAGE: Permittee shall provide alternate drainage
for any work interfering with an existing drainage facility in
compliance with the Standard Specifications, Standard Plans and/or as
directed by the Department's representative.
IS- RESTORATION AND REPAIRS IN RIGHT OF WAY: Permittee
is responsible for restoration and repair of State highway right of way
resulting from permitted work (State Streets and Highways Code,
Sections 670 et. seq.).
23.
24.
I9: 'RIGHT OF WAY CLEAN UP: Upon completion of work,
pemuttee shall remove and dispose of all scraps, brush, timber,
materials, etc. off the right of way. The aesthetics of the highway
shall be as it was before work started.
20. COST OF WORK: Unless stated in the pennit, or a separate written
agreement, the permittee shall bear all costs incurred for work within
the State right of way and waives all claims for indemnification or
contribution from the State.
21. ACTUAL COST BILLING: When specified in the permit, the
Department will bill the permittee actual costs at the cun-ently set
hourly rate for encroachment permits.
22 AS -BUILT PLANS. When required, permittee shall submit one (1)
set of folded as -built plans within thirty.(30) days after completion 25.
and approval of work in compliance with requirements listed as
follows:
I. Upon completion of. the work provided herein, the permittee
shall send one vellum or paper set of As -Built plans, to the
State representative. Mylar or paper sepia plans are not
acceptable.
2. All changes in the work will be shown on the plans, as issued
with the permit, including changes approved by Encroachment
Permit Rider.
3. The plats are to be stamped or otherwise noted AS -BUILT" by
the permittee's representative who was responsible for
overseeing the work. Any original plan that was approved with
a State stamp, or Caltrans representative signature, shall be
used for producing the As -Built plans.
4. If As -Built plans include signing or striping, the dates of
signing or striping removal, relocation, or installation shall be
shown oil the plans when required as a condition of the permit.
When the construction plans show signing and striping for
staged construction on separate sheets, the sheet for each stage
shall show the removal, relocation or installation dates of the
appropriate staged striping and signing.
5. As -Built plans shall contain the Permit Number, County, Route,
and Post Mile on each sheet.
6. Disclaimer statement of any kind that differ from the
obligations and protections provided by Sections 6735 through
6735.6 of the California Business and Professions Code, shall
not be included on the As -Built plans. Such statements
constitute non-compliance with Encroachment Permit
requirements, and may result in the Department of
Transportation retaining Performance Bonds or deposits until
proper plans are submitted. Failure to comply may also result in
denial of future permits, or a provision requiring a public
agency to supply additional bonding.
PERMITS FOR RECORD PURPOSES ONLY: When work in the
right of way is withiman area under a Joint Use Agreement (JUA) or a
Consent to Common Use Agreement (CCUA), a The exempt permit is
issued to the pennit.ee for the purpose of providing a notice and
record of work. The Permittec's prior rights shall be preserved
without the intention of creating new or different rights or obligations.
"Notice and Record Purposes Only" shall be stamped across the face
of the permit.
BONDING: The permittee shall file bond(s), in advance, in the
amount set by the Department. Failure to maintain bond(s) in full
force and effect will result in the Department stopping of all work and
revoking pennit(s). Bonds are not required of public corporations or
privately owned utilities, unless permittee failed to comply with the
provision and conditions under a prior permit The surety company is
responsible for any latent defects as provided in California Code of
Civil Procedures, Section 337.15. Local agency permittee shall
comply with requirements established as follows: In recognition that
project wnsimcdon work done on State -property will not be directly
funded and paid by State, for the purpose of protecting stop notice
claimants and the interests of State relative to successful project
completion, the local agency permittee agrees to require the
construction contractor furnish both a payment and performance bond
in the local agency's name with both bonds coinplying with the
requirements set forth fit Section 3-1.02 of State's current Standard
Specifications before performing any project construction work. The
local agency permittee shall defend, indemnify, and hold harmless (tic
State, its officers and employees from all project construction related
claims by contractors and all stop notice or mechanic's lien claimants.
The local agency also agrees to remedy, in a timely manner and to
State's satisfaction, any latent defects occurring as a result of the
project construction work.
FUTURE MOVING OF INSTALLATIONS. Permittee understands
and agrees to relocate a permitted installation upon notice by the
Department. Unless under prior property right or agreement, the
permittee shall comply with said notice at his sole expense.
26. ARCHAEOLOGICAL/HISTORICAL: If any archaeological or
historical resources are revealed in the work vicinity, the permittee
shall immediately stop work, notify the Department's representative,
retain a qualified archaeologist who shall evaluate the site, and make
recommendations to the Department representative regarding the
continuance of work.
27. PREVAILING WAGES: Work performed by or tinder a permit may
require permittee's contractors and subcontractors to pay appropriate
prevailing wages as set by the Department of industrial Relations.
Inquiries or requests for interpretations relative to enforcement of
prevailing wage requirements are directed to State of California
Department of Industrial Relations, 525 Golden Gate Avenue, San
Francisco, California 94102.
28. RESPONSIBILITY FOR DAMAGE: The State of California and
all officers and employees thereof, including but not limited to the
Director of Transportation and the Deputy Director, shall not be
answerable or accountable in any manner for injury to or death of any
person, including but not limited to the permittee, persons employed
by the permittce, persons acting in behalf of the permittee, or for
damage to property from any cause. The permittee shall be
responsible for any liability imposed by law and for injuries to or
death of any person, including but not limited to the permittee,
Persons employed by the permittee, persons acting in behalf of the
permittee, or for damage to property arising out of work, or other
activity permitted and done by the permittee under a permit, or arising
out of the failure on the permittee's part to perform his obligations
under any permit in respect to maintenance or any other obligations,
or resulting from defects or obstructions, or from any cause
whatsoever during the progress of the work, or other activity or at any
subsequent time, work or other,activity is being performed tinder the
obligations provided by and contemplated by the permit
i
The permittee shall indemnify and save harmless the State of
California, all officers, employees, and State's contractors, thereof,
including but not limited to die Director of Transportation and the
Deputy Director, from all claims, suits or actions of every name, kind
and description brought for or on account of injuries to or death of any
person, including but not limited to the permittee, persons employed
by the permittee, persons acting in behalf of the permittee and the
public, or damage to property resulting from the performance of work
or other activity under the permit, or arising out of the failure on the
permittee's part to perform his obligations under any permit in respect
to maintenance or any other obligations, or resulting from defects or
obstructions, or from any cause whatsoever during the progress of the
work, or other activity or at any subsequent time, work or other
activity is being performed tinder the obligations provided by and
contemplated by the permit, except as otherwise provided by statute.
t he duty of the permittce to indemnify and save harmless includes the
dirties to defend as set forth in Section 2778 of the Civil Code. The
Permittee waives any and all rights to any type of expressed or
implied indemnity against the State, its officers, employees, and State
contractors. It is the intent of the parties that the permittee will
indemnify and hold harmless the State, its officers, employees, and
Slate's contractors, from any and all claims, suits or actions as set
forth above regardless of the existence or degree of fault or
negligence, whether active or passive, primary or secondary, on the
part of the State, the permittee, Persons employed by the permittee, or
acting oil behalfofthe permittee.
For the purpose of this section, "State'$ contractors" shall include
contractors and their subcontractors under contract to the State of
California performing work within the limits of this permit.
The gifting of public property use and therefore public funds is
prohibited under the California Constitution, Article 16.
34. FIELD .WORK REIMBURSEMENT: Permittee shall reimburse
State for field work performed on permittee's behalf to correct or
remedy hazards or damaged facilities, or clear debris not attended to
by the permittee.
35.
29. NO PRECEDENT ESTABLISHED: This permit is issued with the
understanding that it does not establish a precedent.
36.
30. FEDERAL CIVIL RIGHTS REQUIREMENTS FOR PUBLIC
ACCOMMODATION:
A. The permittee, for himself, his personal representative, successors
in interest, and assigns as part of the consideration hereof, does her
covenant and agree that:
I . No person on the grounds of race, color, or national origin shall be
excluded from participation in, be denied the benefits of, or be
otherwise subjected to discrimination in the use of said facilities.
2. That in connection with the construction of any improvements on
said lands and the fitrnishings of services thereon, no discrimination
shall be practiced in the selection and retention of first -tier
subcontractors in the selection of second -tier subcontractors.
3. 11rat such discrimination shall not be practiced against the public in
their access to and use of the facilities and services provided for
public accommodations (such as eating, sleeping, rest, recreation), and
operation on, over, or tinder the space of the right of way.
4. 1"hat the permittee shall use the premises in compliance with all
other requirements imposed pursuant to Title 15, Code of Federal
Regulations, Commerce and Foreign Trade, Subtitle A. Office of the
Secretary of Commerce, Part 8 (15 C.F.R. Part 8) and as said
Regulations may be amended.
5. That in the event of breach of any of the above nondiscrimination
covenants, the State shall have the right to terminate the permit and to
re-enter and repossess said land and the land and the facilities thereon,
and hold the same as if said permit had never been made or issued.
31. MAINTENANCE OF IIIGHWAYS: The Permittee agrees, by
acceptance of a permit, to properly maintain any encroachment. This
assurance requires the pecmitwe to Provide inspection and repair any
damage, at permittee's expense, to State facilities resulting from the
encroachment.
32. SPECIAL EVENTS: III accordance with subdivision (a) of Streets
and highways Code Section 682.5, the Department of Transportation
shall not be responsible for ate conduct or operation of the permitted
activity, and the applicant agrees to defend, indemnify, and hold
harmless the State and the city or county against any and all claiitis
arising out of ally activity for which the permit is issued.
The permittee understands and agrees to comply with the obligations
of Titles If and III of the Americans with Disabilities Act of 1990 in
the conduct of the event, and further agrees to indemnify and save
harrtiless the State of California, all otTicers and employees thereof,
including but not limited to the Director of Transportation, from any
c.lafms or liability arising oirr of or by virtue of said Act.
13. PRIVATE USE OF RIGHT OF WAY: Highway right of way shall
not be used for private purposes without compensation to the State.
NOTIFICATION OF DEPARTMENT AND TMC: The permittee
Shall notify the Department's representative and the Transportation
Management Center (TMC) at least 7 days before initiating a lane
Closure or conducting act activity that may cause a traffic impact. A
confirmation notification should occur 3 days before closure or other
potential traffic impacts. In emergency situations when the corrective
work or the emergency itself may affect traffic, TMC and the
Department's representative shall be notified as soon as possible.
SUSPENSION OF TRAFFIC CONTROL OPERATION: The
Permittee, upon notification by the Department's representative, shall
immediately suspend all lane closure operations and any operation
that impedes the flow of traffic. All costs associated with this
suspension shall be borne by the pennittee.
37. UNDERGROUND SERVICE ALERT (USA) NOTIFICATION:
Any excavation requires compliance with the provisions of
Government Code Section 4216 et. seq., includirig, but trot limited to
notice to a regional notification center, such as Underground Service
Alert (USA). The pennittee shall provide notification at least 48 hours
before performing ally excavation work within the right of way.
Al,
�,EwPogre Newport 0
Beach
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Disclaimer: Every reasonable effort has been made to assure the accuracy of the data
100 200 provided, however, The City of Newport Beach and its employees and
agents disclaim any and all responsibility from or relating to any results
Feet obtained in its use.
Imagery: 2009-2013 photos provided by Eagle Imaging wwv .sagleaerial.com
8/81/2C
-
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BY:R.TYRIE DATE:7/7/17
BY. C.SLAKE
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BY: C.BLAKE DATE:7/21/17
BY:
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DATE: 7/7/17 S H E ET ; d F
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DATE: I cmblake 7/21/2017
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ELECTRICAL TEST STATION
ATTACHING WIRE TO PIPE "
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-CONCRETE CASING & COVER
GROUND LEVEL —
COPPER WIRE-----"
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CADWELO MMI
NO, 5 CHARGE
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UNDERGROUND WIRE PLASTIC TAPE
IF PIPE IS FULLY EXPOSED
FIGURE I
PROFILE VIEW
I. MIRE SMALLER THAN #8 REOUTRES COPPER SLEEVE.
2. COAT ALL EXPOSED METAL ON PIPE. CADWELD AND WIRE.
3. ON PIPELINES GREATER THAN 125 PSI OR CABLE LARGER THAN #4.
WIRE SHALL BRAZED TO A SOCKET WELD OR DEAD END PLATE.
4. WIRES ARE TO BE LONG ENOUGH TO EXTEND A MINIMUM OF 3ON
ABOVE GROUND LEVEL,
5. IDENTIFY WIRE WITH A BRASS OR PLASTIC TAG.
I- 720' OF 16"H .375 X60 PUB. PROP.
A - 657' OF 16"H PUB. PROP.
A - 607' OF 20" CASING PUB. PROP.
SOT INFO: 7/21/2017 1:29:27 PM
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PIPE PRESSURE TEST
GAS STD GAS STO
MEDIUM HIGH',-�
-' #184.0160 - #782.017C
LOCATION " A " TO LOCATION " B
TEST PRESSURE:
MINIMUM: 785 PSIG / MAXIMUM: 1401 PSIG
ACTUAL TEST PRESSURE:_ PSIG
TEST MEDIUM:
AIR L4� NITROGEN [YJ OTHER:
DURATION: 1 HRS. ANO/OR U MIN,
SIGN: DATE:
PRINT NAME:
PRINT TITLE:
INSTALL MAIN WITH AT LEAST: 42" RETIREMENT
COVER BELOW GUTTERFLOW REASON:
VVBS #
NBMS # WA
SDCaIGas DREAMS#
�+ DESIGN #
Cal8flbefm ymc4 ORDER OP.'
PRE CONSTRUCTION MEETING: �(
YES O! NO ❑
feellply\'1
!. J PCB - MEGARULE
NIA PCB FREE AREA ❑ HOT SPOT ❑ HOT DISTRICT my
L i ANNUAL / BUSINESS LEAK SURVEY AREA:
_I (POST LIMITS ON SKETCH IF APPLICABLE) YES LIJ NO IJ
I CATHODICALLY PROTECTED: YES NOD
L1 BRIDGE OR SPAN INVOLVED: YES ❑ NO d
WILLANY PIPE BE LEFT EXPOSED: YES ❑ NO
I(IF YES ROUTE AS -BUILT COPY TO SP SUPERVISORI
ENVIRONMENTAL CLEARANCE REQUIRED'
YES ❑ NOW
STORM WATER: BMPS ONLY Cljl' SCG SWPPP ❑
APPLICANT SWPPP ❑
SPECIAL ENVIRONMENTAL CONSIDERATIONS:
YES ❑ NO[
AV VFR RFF pp2ln1J CLIVIVIIYYGYTAI An.nenm
PIPELINE MARKERS
DAT-
Nz
PA /
ABANDON PIPELINE SAMPLING REQUIRED
(PER GAS STANDARD ID4.0042) YES ❑ NO ❑
BY: DATE:
(CHANGE LABOR TO MWO# 99300.000)
CROSSING SEWER LATERALS: YES ❑ NO❑
NUMBER OF LATERALS CLEARED:
METHOD(S) USED TO VERIFY LOCATION(S):
OPENTRENCH ❑ CAMERA ❑ POTHOLE ❑
EXPOSED BY EXCAVATION ❑ (GAS STD #184.0170)
OTHER ❑ METHOD: 'z
_;O
IF A POSITIVE LOCATION COULD NOT BE
FOS I FS:
DATE:`
DESIGN CHANGES
WERE CHANGES MADE TO THE
YES ❑ NO
DESIGNED PIPE OR COMPONENT:
(IF YES TECHNICAL SERVICES APPROVAL IS REQUIRED)
REGION ENG:
DATE:
UPDATED TO RER #
TSS:
DATE:
USED MECHANICAL COMPACTION: YES U NOII
GAS HANDLING
REVIEWED AND PERFORMED AS
PLANNED PER GAS STD 9194.06 : YES ❑ NO ❑
OF NO PLEASE PROVIDE EXPLANATION ON SKETCH)
SIGN: DATE:
FEET DATE MOVED
LED: I ON JOB:
WORK CENTER #
WOT PARCEL # 14
RNV # N/A
DESIGN NAME:
.KET# I I NOTIFICATION # 002040713404
DATE OF
OPERATION:
DATE MOVE
OFF JOB:
iA
PLAN FILE#21
RER # N/A
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TAX #
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