HomeMy WebLinkAboutN2017-0498City 00 Ciao Center
Beach Bach. CA 92660 IIII�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII
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Permit Counter Phone (949)644-3311
s Online Inspection Request - www.newportbeachca.gov / Online
._` Services
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Job Address: 4701 DORCHESTER RD NB
Description : INSTALL NEW CURB DRAIN PER STD 184-L.
Parcel # : 4750-660-4 -
Legal Desc : N TR 3519 LOT 28
Owner: SMITH KEVIN/SMITH FAM TRUST
Phone: 949-230-2871
Address : 4701 DORCHESTER RD 1
CORONA DEL MAR CA 92625
Applicant: DIANE/MR CARLOS POOLS
Phone : 626-332-8731
Address : 978 N AMELIA AVE
SAN DIMAS CA 91773
Permit No: N2017-0498
Project No : 0842-2017
Inspection Requests Phone (949)644-3255
Thomas:Guide: 919G3
Contractor : MR CARLOS POOLS & CONST
Phone: 626-332-8731
Address : 978 NORTH AMEILA AVE
SAN DIMAS CA 91773
Contractor State Lic: 385622
License Expire : 05 31, 2019
Business License: BT30054942
Business Expire : 05 31, 2017
Special Cond.: PRE -CONSTRUCTION
Workers' Compensation Insurance - -
Carrier : STATE COMP INS
Policy No: 1960918
W. C. Expire: 06 01, 2018
Permit Processing Fee :
$241.00
Sewer Connection :
$0.00
Total Fee
$406.00
Agreement Fee:
$0.00
4TT Box Cover:
$0.00
Paid :
$0.00
Traffic control Plan Check :
$0.00
Total Water Meters:
$0.00
Balance:
$406.00
Inspection Fee :
$165.00
Water Meter Connection :
$0.00
Receipt No:
Refundable Deposit:
$0.00
Total Water Meter Box:
$0.00
Street Tree Fee :
$0.00
Adjustment :
$0.00
Processed By:
Date : _/ /
Other Department :
Date:
Utilities Approval :
Date : _/_/
Permit Denied
Date
1 n
Date c7L:
Traffic Approval :
Date: _/_/
Issued Permit :
:�
General Services Approval :
Date
COMPLETE THE BELOW INFORMATION
PROJECT ADDRESS: 17,01 kill C'1 zs
DETAILED DESCRIPTION OF PROPOSED WORK:
APPLICANT: �2 L �n o
Phone: 6 Z (, _ 3L
Email Address: ,�/ e SS i c4 - Me-, 9R-IA-IaS
Mailin Address:
Ci t ip:
OWNER: V,�,sm ,
Phone:
Email Address: S`jy�,' //?' - 'Corn
Mail in Address: ` Aw
City/St ip•
W. i . roR ....
CONTRACTOR: /7fqj. �J o p
Office Phone: 6z6 - 3 az • F I N
Company (if different):
Jobsite Phone:
Other Phone:
Email Address: &/2
Mailing Address:
City/StatelZip:
State License Number & Class:
Expires:
City Business License Number:
Expires:
WORKERS COMPENSATION INSURANCE - Certificate of Insurance (Section 3800 Labor Code)
Company: PolicyNo: Expires:
Municipal Operations: 949-644-3055
Utilities: $49-644-3011
Urban Forestry: 949-644-3083
Special Conditions of Permit:
_ ONN
tl
Utilities:
Municipal Operations
Traffic: 0 Fire: t�J
Other:
Engineering Technician:
Permit Sp
Date:
LJL
Permit No.
N2017- Q
riuserWpbwWsear"encmadVmasftVepwork9t,eat.bs
Public Works Department 949-644-3311
100 Civic Center Drive, Newport Beach, CA 92660
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PROJECT/ -
4-701
1
Permit Processing Fee:
Public Works Only $241.00
Other Department $275.00
[M
Agreement Fee:
Preparation of Report/Agreement $81' .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: TBD
Improvements TBD
Street/Alley/Walk Closure: $65.000 Newspaper Rack Inspection $108.00 0
Traffic Control Plan Check
8-1/2" x 11" $65.00 Sewer Connection Fee $250.00
24" x 36" $143.00 4TT Box & Cover $64.00
Additional
1 THE FOLLOWING ITEMS REQUIRE APPROVAL FROM THE Revenue Division 1
1 REVENUE DIVISION PRIOR TO PAYMENT OF FEES Approval: I
1
Qty-
1
(Water Meter:
Installation Charge $528.00
13/4" Meter
$50.25
Water Meter Boxes:
11" Meter
$121.50
For Parkway & Sidewalk Area (Box + Cover = Cost) 1
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
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 1
I4" Meter
$4,730.00
2" Meter: 27.00 + 162.00 $189.00D
16" Meter
$7,190.00
1
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 hry over 4 hrs)
$1,02.2.00
5200-5031
Street Tree Fee ($700 Planting Fee)
_.._.. ............... ....
TBD
030-2284
Engineering Tech: Total Amount Due: For Finance Use Only
o/ 'L
Permi cialist Receipt N .
f-/users/pbw/sharedlen=acNmasters/ep front and track masters!
Rev. 1/5/2017 epreesheet.As{evised 10/21/2016
v942-, 2x-)r-I P1F-3op 54<?4 2
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
WORKER'S COMP NSATION INSURANCE (Section 3660 abor Code)
1
Encroachment Permits may be taken out by the owner of benefited property or a licensed contractor. A licensed
ave a C ific to of consent to self -ins e, a ific to f Worker's
I certifyAalnsura
contractor must provide a "letter of Authorization" to allow another party to pull a permit An approved copy of the
Compen -Certified Copy 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 (tie right to void permit if work does not commence within 30 days
Da Signature:
after date of issuance
CERTIFICATE OF EXEMPTION (Sectio 3800 Labor Code)
2. The Perrnittee 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
I certify that in the performance of the work under this permit, I shall not employ
or damage to persons or property occurring as a result of work undertaken under this permit.
any person so as to become subject to California Worker's Compensation Laws. If,
3
All work shall be done in accordance with the approved plans, Standard Special Provisions and Standard Drawings
after signing this certificate 1 become subject to the Worker's Compensation
of the City of Newport Beach, and compliance with all applicable State laws and City ordinances.
provisions of the State Labor Code, I must comply with the provisions of Section
4.
Permittee guarantees all work performed under this permit to be free of hidden and latent defects. Any failures shall
3700 or this permit shall be deemed revoked.
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
Date: Signature:
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
CONTRACTOR LICENSE EXEMPTION
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,
As the Owner of the benefiting property, I certify I am personally performing all
in the alley, where a minimum half -alley width resurfacing shall be provided, unless otherwise directed by the Public
work in the Public Right -of -Way.
Works Dept. Contractors shall obtain permits to perform excavation or trench work from the California Division of
Date: Signature:
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.
HOLD HARMLESS STATEMENT
7.
The Public Works Department Inspectors must inspect all work in the Public right-of-way. Forms and subgrade must
I understand that 1 am locating minor encroachments within the City Right -of -
be inspected and approved before concrete is ordered/poured. Sewer, pipelines, and subgrade construction must be
Way/Easement. As property owner it is my responsibility to maintain the
inspected and approved before backfilling, or applicant may be required to excavate site. Separate Utilities
encroachments. I will be responsible for replacing the improvements if the City
Department or General Services Department inspections may be required depending on scope of work performed.
removes them for maintenance of utilities or other public need. I shall indemnify
8.
All trench restoration must be inspected by the Public Works Department. No utility installation(s) shall be allowed
and hold the City harmless for any liability associated with the minor
over or within 5 feet of any City utilities, unless approved by the Public Works Department. Locate and pothole
encroachments.
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
Date: Signature:
4TT box over the riser.
24-hour notice for Encroachment P it In sp� ion ' tequired by calling
9 Properly lighted barricades must be provided and maintained around all trenches, excavations and obstructions. All
"Manual
signs, flags, lights and other warning and safety devices shall conform to the requirements of the current of
Warning Signs, Sights and Other Devices for the Use in Performance of Work Upon Highways", issued by the
Public Works at 949-644-3311.
California Department of Transportation. If needed, barricades can be obtained from the City at a charge of $10.00
15. Any above ground utility facilities will rere documented approval from the adjacent
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.
affected property owners,
10.
Work within or near beach sensitive areas will not be allowed during.. City holidays, spring break. Memorial Day
16. Homeowner, contractors, and rs may each be liable for violations of Water
weekend, summer between June 15 and September 15, and during the holiday season from December 19 to
Quality Laws. Best Management Practices will be enforced. It is against the lawto
ent Practices
11.
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
discharge construction debris into the gutter and storm drain. Felony violations of Water
acquire a Temporary Street Closure Permit from the Public Works Department. Access for fire. police and
Quality Laws are punishable by fines eg l $charge and/or up to three years in State
prison plus the full cost to clean up an illegal discharge or spill
emergency vehicles must be maintained at all times. Traffic Control must be per Work Area Traffic Control
17. If a refundable deposit was paid, applicant must Submit a Soils Compaction
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
Certificate or Evidence of a Slurried Backfill and request a final inspection from the
the Public Works Department. Any work affecting the State Highway's traffic or within the State Highway right-of-way
Public Works Department. Monies may be held for six months after final inspection
will require a Caltrans Permit. All vehicles shall be lawfully parked.
before a refund will be processed.
12.
This permit does not authorize the closure of sidewalks, streets, or alleys for construction access, storage of
18. No trees in the public right-of-way shall be planted, removed, trimmed, or relocated
materials, or parking of construction vehicles unless detailed on an attached Temporary Street Closure.
without approval from the General Services Department.
13.
Applicant must notify USA at 1-800-227-2600 2 days before starting any underground construction. Applicant
19. All work in the public right-of-way must meet the approval of the Public Works
must notify all affected residents 24 hours in advance of restricted access and any inconveniences.
Department or corrections will be required (i.e. removals, exposing connections,
14
Refuse or unused materials shall be removed within 24 hours after completion of the work. If not removed, the City
etc.). Additional inspection fees may be required.
may remove and bill the applicant Coordinate alley closures with City's refuse pick-up days by calling 949-644-3066
20. Permit is for standard materials in the public right-of-way only, unless previously
for the collection schedule so service is not interrupted. To place a dumpster or materials in the public right-of-way, a
approved by Public Works and an Encroachment Agreement has been processed.
Temporary Street Closure Permit must be obtained from the Public Works Department.
21. Permit is valid for "description" of work noted on front only. Additional work
performed may require issuance of a separate permit and/or addititJ�ial fees.
No work related to this encroachment permit ghall be performed until the Public Works Department has Issued this permit. Applicant hereby c ow dpaa helshe has rea a d unders d 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.
Permit
fees are nonrefundable.
.
pat ? Signature: _,_ _,___
7Jt,.4, ����V� �L9'�i.W �.���f✓f�ctL�c�c. /i•''it.
978 N AMELIA AVE, SAN DIMAS CA 91773
Jessica.mrcarlospools@gmaii.com Lic:385622
FOR CUSTOMERS:
Kevin Smith
4701 Dorchester Rd.
Corona Del Mar Ca 92625
Mr. Carlos Pools Inc. (The Contractor) gives Kevin Smith (The Customer) permission to pay and sign for
a supplemental permit for a curb core as an addition to existing Swimming Pool Permit S2017-0066
on September 27. 2017
Gary Gunderson
Contractor
�Z� 09/27/17
jonctoes Signature Date
912712017 City of Newport Beach Page 18 of 19
4:31:04PM INSP1S0 - Daily Inspection Request Report
Requested Inspection Date: 09/28/2017
Inspection Type: ENCROACH
Inspection Area: PW
Site Address : 4701 DORCHESTER RD
Activity : N2017-0498
SubType : NEW
Status : APPROVED
OWNER: SMITH KEVIN/SMITH FAM TRUST Phone : 949-230-2871
APPLICANT: DIANE/MR CARLOS POOLS Phone : 626-332-8731
DIANE. MRCARLOSPOOLS(,
Description: INSTALL NEW CURB DRAIN PER STD 184-L.
Item: 10200 PRE JOB - PW
Requested Time: 9/28/2017 12:00:OOAM Requestor: WEBUSER
6263328731
Entered By: WEBUSER
Comments: ANY -Approval of pre -curb core %06& SrD 184 L
Assigned to: 77777777777` (
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01v4 r e q u i r e m e-vj- s . Vl u E
t�o �
3/27/2018 City of Newport Beach Page 3 of 9
4:30:46PM INSP150 - Daily Inspection Request Report
Requested Inspection Date: 03/28/2018
Inspection Type: ENCROACH
Inspection Area: PW
Site Address: 4701 DORCHESTER RD
4 Activity : N2017-0498
SubType : NEW
Status : APPROVED
OWNER: SMITH KEVIN/SMITH FAM TRUST Phone : 949-230-2871
APPLICANT: DIANE/MR CARLOS POOLS Phone : 626-332-8731
DIANE. MRCARLOSPOOLS(
Description: INSTALL NEW CURB DRAIN PER STD 184-L.
�X
Item: 10110 CON�:O
E KS
Requested Time: 3/28/2018 12: 0AM Requestor: WEBUSER
6263328731
Entered By: WEBUSER �
Comments: ANY -
Assigned to: 77777777777*
Inspector:`'l, � Date: Time: AM
Comments:
F:\Users\PBMShared\ENCROACH\MASTERS\FORMS\InsoectorSheet.doc
REPT131 Run Id: 4018
3/27/2018 City of Newport Beach Page 4 of 9
4:30:46PM INSP160 - Daily Inspection Request Report
Requested Inspection Date: 03/28/2018
Inspection Type: ENCROACH
Inspection Area: PW
Site Address: 4701 DORCHESTER RD
Activity : N2017-0498
SubType : NEW
Status : APPROVED
OWNER: SMITH KEVIN/SMITH FAM TRUST Phone : 949-230-2871
APPLICANT: DIANE/MR CARLOS POOLS Phone : 626-332-8731
DIAN E. M RCAR LOSPOOLS(
Description : INSTALL NEW CURB DRAIN PER STD 184-L.
s
Item: 10250 FINAL - PW
Requested Time: 3/28/2018 12:00:OOAM
Entered By: WEBUSER
Comments: ANY-
Assigned to: 77777777777`
Requestor: WEBUSER
6263328731
Inspector: C� Date: Time: A PM
Comments: ! l�
F:\Users\PBW\Shared\ENCROACHIMASTERS\FORMSUnspectorsheet.doc
r
REPT131 Run Id: 4018