HomeMy WebLinkAboutN2017-0106City
'vof NeWic Center CPOrt Bp a ort BFeach, CA 92660 IIII�III�IIIIIIIIIIIIIIIIII�fII�IIIIIIIIIIIII�III�llll Permit No: N2017-0106 .,.
Permit Counter Phone (949)644-3311 Project No
,�. Online Inspection Request - www.newportbeachca.gov / Online
M_ Services
Inspection Requests Phone (949)644-3255
Job Address: 1917 W BALBOA BLVD NB Thomas:Guide: 918H1
Description : Install 78 LF of conduit, 1 above ground cabinet, 1 fiber barrel, and ground bed on 20th Street south of West Balboa Boulevard. Sidewalk and concrete
pavement restoration per City Standards. (A00H4N1)
Parcel # : 0471-710-1 - SC d
Legal Desc : NEWPORT BEACH SEC A BLK 119 LOT 12
Owner: BALSAMO J AUDRE
Contractor : HORIZON UNDERGROUND INC
Phone : 0
Phone : 951-279-8134
Address : 22862 SAILWIND WAY
Address : P M B 212
LAKE FOREST, CA
2279 EAGLE GLEN PKWY #112
CORONA CA
Contractor State Lic: 802076
Applicant: AT&T CALIFORNIA
License Expire : 12 31, 2017
Phone : 714-618-9132
Address : 3939 E CORONADO ST, 2ND FLOOR
ANAHEIM, CA 92807
Business License: BT30058188
Business Expire : 02 28, 2018
Special Cond.: Pre -job inspection required
Workers' Compensation Insurance - -
Traffic control per WATCH
Carrier : STATE COMPENSATION
Policy No: 9086128
W. C. Expire: 01 16, 2018
Permit Processing Fee :
$241.00
Sewer Connection :
$0.00
Total Fee $1,891.00
Agreement Fee :
$0.00
4TT Box Cover:
$0.00
Paid : $1,891.00
Traffic control Plan Check :
$0.00
Total Water Meters:
$0.00
Balance: $0.00
Inspection Fee :
$1,650.00
Water Meter Connection:
$0.00
Receipt No: 2 _ 7Sv3i'O
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: `f / tO/ 1-1
General Services Approval :
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 Fncroachment Permits may he Liken out by the ownef of henefiled properly or a licensees contractor A licensed
contractor must provide ,! 'Letter of Aulhonzalion to allow another party to pull a permit An approved copy of the
permit and construction plan shall he kept at the job site at all tunes Vfork. which has been done prior to issuance of
a permit is subject to relectiori/fine City reserves the nght to void permit if work does not continence within 30 days
after date of issuance:
2 The Pemnitlee agrees to delend indemnify and hold the City. its authorized agent, officers, representatives and
employees harmless from ariv responsihility, liability, suit or action of any description ansing out of any accident loss
or damage to persons or properly occurring as a result of work undertaken under this permit.
3 All work shall he done in accordance. will) the approved plans. Sfaodard Special Provisions cmcl Sfundard Drtwiogs
of the City of Newport Beach, and in compliance with all applicable Stale 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 nght-of-way unless waived by the
Public Works Director A valid State Contractor License Class A can perform any work in the public righl-of-way. For
construction or connection to water lines a valid Stale Contractor License Class C-34 is required For construction or
connection to sewer lines a valid Slate 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-I..
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 Stale law. Walls and faces of all
excavations over 5 feel in depth shall be protected by a shoring system, sloping of the ground. or other equivalent
means. Trenches less than 5 feel in depth shall be guarded when hazardous ground movement may be expected.
7 The Public Works Department Inspectors must inspect all work in the Public right-of-way Forms and subgrade must
be inspected and approved before concrete is ordered/poured Sewer. pipelines, and subgrade construction must be
inspected and approved before backfilling, or applicant may be required to excavate site Separate Utilities
Department or General Services Department inspections may be required depending on scope of work performed.
8 All trench restoration must be inspected by the Public Works Department. No utility installabon(s) shall be allowed
over or within 5 feet of anv City utilities. unless approved by the Public Works Department Locale and pothole
existing City -owned utilities he water sewer, or street lighting conduits) to verify locations Maintain a one -fool
clearance over or tinder existing 0tv-owned utilities Sewer cleanouts require VCP or PVC SDR35 be used with a
4T1 box over the riser
9 Properly lighted barricades most be provided and maintained around all trenches excavations and obstructions All
signs, flags. lights and other warning and safely devices shall conform to the requirernents of the current "Manual of
Warning Signs. Sights and ether Devices for the Use in Performance of VJork Upon Highways' issued t 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 nunmium charge of S35 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 IJernonal Dav
weekend, summer between June 15 and Septernber 15. and during the holiday season from December 19 to
January 1. unless approved by the Public !"forks Department
I 1 Any work that extends into traffic: or parkmq lanes and impedes the normal flow of traffic requires the applicant to
acquire a lemporary Street Closure Permit from the Public Works Department Access for fire police and
emergency vehicles must be. maintained at all limes Traffic Control must be per Work Area Traffic Control
Handbook iVVATCHi No nighttime traffic: lane closures finless prior approval has been granted Anv 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 Depadnienl Anv work affecting the Slate Highwav'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 aulhonte 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
roust notify all affected residents 24 hours in advance of restricted access, and any inconveniences
14 Refuse or unused matenals 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 riot interrupted To place n dumpsler or materials in the public right-of-way. a
Temporary Streel'aosure Permit most he 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
Compensa on In urance. or a Certified Copy thereof.
✓
Date: 1/ 1 7 Signature: __.__ __
CERTIFICATE OF EXEMPTION (Section 3800 Lairk Code)
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:
I24-hour notice for Encroachment Permit Inspection is required by calling I
Public Works at 949-644-3311.
15 Any above ground utility facilities will require documented approval from the adjacent
affected properly owner(s).
16 Homeowner, contractors and subconlracotrs may each be liable fat viol,rhons of `.-'ale
Ouality Laws Best Management Practices will be enforced II is agamsl the law to
discharge construction debris into the gullet and storm dram I elony violations of
Quality Laws are punishable by fines up to $25,000 and/or up to Ihrec veats !n Slate
prison plus the full cost to clean up an illegal discharge, or spill
17 If a refundable deposit was paid. applicant must suhrnif a Soils Contpac iOn
Certificate or Evidence of a Slurried Backfill and request a iunal 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 he planted. rernovod. loinrned. or rMoc:; tees
without approval from the General Services Department
19. All work in the public right-of-way must rneet the approval of the Public: Vfork
Department or corrections will be. required (i.e. removals. exposing cnnnecf c os.
etc.) Additional inspection fees may be required.
20. Permit is for standard materials m the public right-of-way only, unless I reviously
approved by Public Works and an Encroachment Agreement has been prices-sed
21. Permit is valid for description` of work noted on front Only Additional work
performed may require issuance of a separate permit and/or additional fees
No work related to this encroachment permit shall be performed until the Public Works Department has issued this permit. Applicant hereby kno ledges he/she has read and understands 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 ince. i / f O� 7 I^-��{{�� 1 , Permit fees are nonrefundable. Date: Slgnature:'�y_
FEE WORKSHEET FOR ENCROACHMENT PERMIT
CITY OF NEWPORT BEACH
PUBLIC WORKS DEPARTMENT
All feel ;Are Noh_ftf jhdab1II�: Uhless:OttieilWisia:
Stithd ::::::: :
PROJECT ADDRESS:
PERMIT N2016-
NUMBER:
APPLICANT:
MENT
Permit Processing Fee: Q
Public Works Only $241.00
Other Department $275.00
Agreement Fee:
Preparation of Report/Agreement $81700
Document Recordation Fee $19100
Monitoring Wells $502.00
Inspection Fee:
Qty.
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
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 FOLLOVWNC3ITEMS R QUIRE• APPROVAL. FROM THE ..Mpir6vail.'
f.'..'.'.'.''REVENtitI*ItidPlFikibk'tOPAYMt&t'OF'PEES':' :':':':.... .........I
[Water Meter; • ; ; ; ; ; ; ; ; ; ; ; kistaHaXion: Ch:aige;
13/ ".Meter :::::::::::::::: $5Q.25 ::: - : • : •ft(et.Meter. coxes:..... ......:::::::I
11Meter:: :: : . : : :: : : :.:: : $t21.50 .. .. :: :For. Parkway :Side►valk Area (9ox +Cover = Cost .: 1
11 1/2":Meter. .....:: ::::$285.00 '....:: 1":Meter. 13.00'+37:00'.... .'.'$500
0 ...'..I
[ 1.1 /2"• Turbine Meter ' ' ' ' . ' $700.00 .2: Meter:, ' 27.'00 + 6115 $88:25
12"Miter .• . '•'• .•;•.•$42... ;;•:.:.:::.:.:::::::::::.:.:::.:.:.:.:::.:::::::::::.:.:::::::.:.:.:.:.1
[2''Tl. b(neMetef '046-00 :::: 0r.T ft BAI►eY.QFeas:( ox:+:Foyer:=:CoStJ : ;.a
13" •Meter:: :: : $3;310..Ob . . . : : :1:' Meter:: 3.fl0. + 38:00 : • :: :: • : • : • : •$5.1.0�E1.1
.[4"Meter' :: $4,730.00 ' . ' .. ' . ' :.2":Meter: •.27.00•+.1.62.00 .•.'.'.•.•.$.189A0::1
:�i l►no►o�: : •Cz •Ian nn : : : : : : :
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
Permit Specialist
Receipt No.
t:lusers/pbwlshared/encroach/masters/ep front and back masters/
Rev. 10/21/20161
I.pfeesheet. ids -revised 10/21/2016
LE(11) A00H4N1 **GIGAPOWER**
WORKSHEET FOR ENCROACHMENT PERMIT
CITY OF NEWPORT BEACH
PUBLIC WORKS DEPARTMENT
COMPLETE THE BELOW INFORMATION
PROJECT ADDRESS: NEAR 1917 W BALB A B VD XST 20th STREET
DETAILED DESCRIPTION OF PROPOSED WORK:
EXCAVATE 75 LIN FT + 16 SQ FT IN CONCRETE TO PLACE 1 576-PFP CABINET
(1) 3-ELECTRODE GROUND BED, (1) FIBER BARREL, (78') OF 2-4" CONDUIT
APPLICANT. AT&T CALIFORNIA
Phone: (714) 618-9132
Email Address: vk3921@att.com ;� Valentina Gipson, AT&T Liaison
Mailing Address:
3939 E. CORONADO ST• 2ND FLOOR
City/St to/Zip:
ANAHEIM CA 92807
OWNER: Phone:
Email Address:
Mailing Address:
City/State/Zip:
ALL CONTRACTOR INFORMATION IS REQUIRED -PLEASE COMPLETE
CONTRACTOR:
Office Phone:
Company (if different):
Jobsite Phone:
Other Phone:
Email Address:
Mailing Address:
City/State/Zip:
State License Number & Class:
Expires:
City Business License Number:
Expires:
WORKERS COMPENSATION INSURANCE - Certificate of Insurance (Section 3800 Labor Code)
Company: Policy No: Expires:
REFUNDABLE DEPOSIT INFORMATION.(/f Applicable)::
Refund Payable To:
Mail Refund To:
FOR OFFICE USE ONLY
Special Conditions of Permit.
ADDITIONAL APPROVAL REQUIRED FROM THE FOLLOWING DEPARTMENTS
Utilities:
General Services:
Traffic: Fire:
Other:
Engineering Technician:
Public Works Specialist:
Date:
Permit No.
/U: vtti[C:L�tdr2C!er CrO::ih.'r. d51lf S/Cpaq�NSRar' t•.
Public Works Department 949-644-3311
AT&T CALIFORNIA JOB# A001-141\11
ENGINEER: Doug Galvery
PSA4103LA, A00H4N1-20TH ST, SOUTH OF W BALBOA BLVD
I "IIIf'1�'l�l/1.
�,
"DRAWING NOT TO SCALE"
EXCAVATION DATA
OWNER ASPHALT CONCRETE 01" TUNNEL C k G
25 LN.n.
CITY Or ----
NEWPORT BEACH (FIBER BARREL)
4'X4'-16 so rr
5 .X5 5'
2 '5
y
1
COW. 165
2-4' TO SM
��
\
SPA. CAST
MH l256 PENpNG QQ
ECrY
MSA L OU
O 5TA I0r89 Lt
� O
1
NORM wAU,
a u
c�
LOOK NORM
.
I c
W
E.
•
•'
2
OA`• 6 A
f\
FOa°D CF•PB
A�E�`!
1912 w BALBd1 Bl.w
/� 'hh•1 ry'•V
-A _'7i02 A: `F �,
PFI-516 CABINET
CONCRETE PAO SIZE
66t66Y.'
DIAL TOLL TREE
811
AI UEAST IYID OAK
BEfa[ IOII 00
II.N¢ NOT w fWMTIRI CN•OMA
oil
W �,6, 'BF, �,2�f •'v,, 2 °n•a Fey, aF
F e � Mylt
{
ALV
CURVE DATA
R C L
I .50 6' S2 5 ia.i3—
TIM
12.S0 147 51 531 10.28
12.50 166 24 "1 10.52
DRAWING TO SCALE
DO NOT REDUCE
DURING REPRODUCTION
at&t
California
OAL.
526 PFP CABINET
OPL.
IB' BARE /6 GROUND NIRE
INSTALL !-COPPER GROUND R005
5/8' OIAMEFER. 8' MINIMUM LENGM
NO PM
NOTE:
GROUND BEO TO PLACE IN OPEN TRENCH
OPL.
FIBER BARREL
OPL.
13' 2-4' DUCT
TYPE
4C PM
13' PFP TO FIBER BARREL VERIFY
OPL
10' 2-4' DUCT
TYPE
.COP.
10' FIBER BARREL TO IMF 236. VERIFY
OPL
55' 2-4' OUCr
TYPE
.CO PM
55' FIBER BARREL. TO NN 3256. VERIFY
CONSTRUCTION NOTES
1. AY16L1UM COVER FOR STRUCTURE M, BELOW EXISTING
ONAOE OR 30' BELOW WTRR FLDNLIK.
2. ALL SUBSTRUCTURE INFORMATION SHONN wAS TAKEN
FROM RECORDS AVNUBLf MN IS APPRO-FIT.
VERIFY. LOCATE Aw PROTECT AS REWIRED.
J. BEFORE EXCAVATING CALL-
U.G. SERVICE ALERT 811
.. ALL TRAFFIC CONTROL TO BE IN ACCOROMIA E •IIH
THE wwr.0 H. ANO THE CAUFORNA, MU.rC.O.
TRAFFIC CONTROL MMAIAL.
5. THIS PINMECT REWRES C+GVAnON. CONSTRUCTION
MILL UTILIZE AND IMPLEMENT ALL BEST MANAGfMENr
PRACTICES (BMP'. AS REQUIRED TO ENSURE COMMIANCE
WIM SBC POLICY LETTER ISSUES FEBRUARY 21. 2003
BY ENWRON"AL MWACEMENr CONCERNING
STORM YIAIER PERNITIING AND STORM WATER
POLLUTION PREVENTION PLANS (S.PPP.) .0 IN
ALCOROANCE MIM THE CLEW -TER ACT (1065) AN0
EPA REGUNATIOM "Us' a RI 1990 AS MODIfI[0
81 THE PHASE If RULE IN MS.
Kc= MOIL IBS O bitsIm PUNT, sMR m
RBLECT AC COIBe1INS TOME 01/216 FEIONI.
rBBEO FOBMIOB REOOROL
NOTE ::
DETAIL A O
wLn
Awo
6' 40OUIII,01,10 APPROVED
CLLLI[OMR CONRECTdI
COAFER CLADO STE[t
R
WE I:
wwwM 00- - 12 INCHES
5.00rlB FIBER VAULT II
•!Y
a
SCALE 1'. 20'
CNaE N.EO 20._MWkEIFO_2a— pECYA.Ym
c. OLvIaN LNOINLLN E. rWwOM (214) 669-2241 SCALE 1-- 20' NrH, RT BEACH
N EwA r tl CN C.O. A
0. GALE? (rl.) 618-9131 r.G.M. 918-H1 CONOUIr CONSTRUCTION
SutlWAr�N3PECTOR C. CASTANEOA (rl.) 882-2228 MAP III 4-2-LEI I PRE 11 t2 IL M p
'N'R"L 11R Consulting, LLC APea n
IB45 w. 01.12,- ,1 Aw.. SNI14 300 Aon10V[0
a.19� CA 22M LE( I 1 ) AOOH4N i
(9N) 2'A-000. /FAX (949) 2SO-OW6 OA/ 11O 1 OWG. L- )
I%
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VC
IL
um bwAl
ML
AT&T CALIFORNIA
ENGR: DOUG GALVERY LE(11)AOOH4N1-A
All Traffic Control shall be in accordance with the latest WATCH Manual and CA MUTCD
'41.1212017 . City of Newport Beach Page 5 of 7
4.30:36PM INSP150 - Daily Inspection Request Report
Requested Inspection Date: 04/13/2017
Inspection Type: ENCROACH
Inspection Area : PW
Site Address : 1917 BALBOA BLVDW
. 1
Activity : N2017-0106
SubType:
Status : APPROVED
OWNER: BALSAMO J AUDRE Phone : 0
APPLICANT: AT&T CALIFORNIA Phone : 714-618-9132
Description : Install 78 LF of conduit, 1 above ground cabinet, 1 fiber barrel, and ground bed on 20th
Item:
Requested Time:
Street south of West Balboa Boulevard. Sidewalk and concrete pavement restoration per
City Standards. (A00H4N1)
.r ;?3•F9FW�'1�'�3! 7h bl].Y S., i r,' i
10200 PRE JOB - PW
4/13/2017 12-00:OOAM Requester: WE R
Entered By: WEBUSER
Comments: AM -
Assigned to:
Inspector:
Comments: MC—,r ci,/ F---),
9513474247
�r 17oiv u��i, Iti6
Date: 113 17 Time: /=Z. A� PM
j 4�fS k- MZz, y - Psi 9 s-/ - 3 � 7 - ! f Z �(7 r-v -Ae�l trr--u
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F:\Users\PBW\Shared\ENCROACH\MASTERS\FORMS\InspectorSheet.do
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REPT131'
Run Id: 4018
4i17/2017 City of Newport Beach Page 6 of 16
6:34:28AM INSP150 - Daily Inspection Request Report
Requested Inspection Date : 04/17/2017
Inspection Type: ENCROACH
Inspection Area: PW
Site Address • 1917 BALBOA BLVD W
NP/D Information:
Activity: N2017-0106
SubType :
Status : APPROVED
OWNER: BALSAMO J AUDRE Phone: o
APPLICANT: AT&T CALIFORNIA Phone: 714-618-9132
Description : Install 78 LF of conduit, 1 above ground cabinet, 1 fiber barrel, and ground bed on 20th
Street south of West Balboa Boulevard. Sidewalk and concrete pavement restoration per
City Standards. (A00H4N 1)
Requested Inspection(s)
Item: 10000 EXCAVATION & PIPE INSTALL-UTIL
Requested Time: 4/17/2017 12:00:OOAM Requestor: WEBUSER
9516910969
Entered By: WEBUSER
Comments: ANY -
Assigned to: zzzzzzzzzzz` aV'4
Logged
Ret 7L
"4/1-W2Q17 City of Newport Beach Page 5 of 7
4:33:3413141 INSP150 - Daily Inspection Request Report
Requested Inspection Date: 04/19/2017
Inspection Type: ENCROACH
Inspection Area: PW
Site Address: 1917 BALBOA BLVD W
.. a - ". .. .. s ���V�i'��1!1'v. ,t• +is .. i�5s.,t. .. . s +wr.`..,a.?��"i rY u, , ., �.. . , ..
Activity : N2017-0106
SubType:
Status : APPROVED
OWNER: BALSAMO J AUDRE Phone : 0
APPLICANT: AT&T CALIFORNIA Phone : 714-618-9132
Description : Install 78 LF of conduit, 1 above ground cabinet, 1 fiber barrel, and ground bed on 20th
Street south of West Balboa Boulevard. Sidewalk and concrete pavement restoration per
City Standards (A00H4N1)
Item: 10000 _. EXCAVATION & PIPE INSTALL-UTIL } 0100`" G(J1 r-�
Requested Time: 4/19/2017 12:0O:OOAM Re uestor: WEBUSER
q q
9516910969
Entered By: WEBUSER
Comments: ANY -
Assigned to
Inspector: 1311Date: 2 �?
Comments: P
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7y,!L4
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F:\Users\PBW\Shared\ENCROACH\MASTERS\FORMSMnsoectorSheet.doc
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Time: l A PM
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REPT131 Run Id: 4018
1912017 City of Newport Beach Page 7 of 11
d:31:00PM INSP150 - Daily Inspection Request Report
Requested Inspection Date: 04/20/2017
Inspection Type: ENCROACH
Inspection Area: PW
Site Address: 1917 BALBOA BLVD W
Activity : N2017-0106
SubType:
Status : APPROVED
OWNER: BALSAMO J AUDRE Phone : 0
APPLICANT: AT&TCALIFORNIA Phone : 714-618-9132
Description : Install 78 LF of conduit, 1 above ground cabinet, 1 fiber barrel, and ground bed on 20th
Street south of West Balboa Boulevard. Sidewalk and concrete pavement restoration per
City Standards. (A00H4N1)
Item: 10210 PUBLIC WORKS
Requested Time: 4/20/2017 12:00:OOAM
Entered By: WEBUSER
Comments: ANY-
Requestor: WEBUSER
9516910969
es0-
�
Assigned to: 77777777777'
Inspector: J Date: tz& /rI Time: PM
Comments: Lo ti i2 S err% ly %eO . W
7~O~,2� "-`G 4-L 4
Gl S iy2�xL� rr S ���'L•
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F:\Users\PBW\Shared\ENCROACH\MASTERS\FORMS\InsDectorSheet.doc
REPT131 Run Id: 4018
41i612017 City of Newport Beach Page 10 of 10
4:30:36PM INSP150 - Daily Inspection Request Report
Requested Inspection Date: 04/21/2017
Inspection Type: ENCROACH
Inspection Area: PW
Ske Address:—T9"�BGA B VD W
Activity : N2017-0106
SubType :
Status : APPROVED
OWNER: BALSAMO J AUDRE Phone : 0
APPLICANT: ATU CALIFORNIA Phone : 714-618-9132
Description : Install 78 LF of conduit, 1 above ground cabinet, 1 fiber barrel, and ground bed on 20th
Street south of West Balboa Boulevard. Sidewalk and concrete pavement restoration per
City Standards. (A00H4N1)
Item: Lt9 ZGd
Requested Time: 4/21/2017 12:00:OOAM Requestor: WEBUSER
9516910969
Entered By: WEBUSER
Comments: ANY -
Assigned to: 77777777'
Inspector: *17 Date: q Time: / Z = `% AM
Comments: / 9!/ ;�E u Sr 5 y
L0 Dw d
ROfile
F:\Users\PB\MShared\ENCROACH\MASTERS\FORMSUnsoectorSheet.doc
REPT131 Run Id: 4018
a.
*2412017 City of Newport Beach Page 2 of 11
4:31:OOPM INSP150 - Daily Inspection Request Report
Requested Inspection Date: 04/25/2017
Inspection Type: ENCROACH
Inspection Area: PW
StRe Address
Activity : N2017-0106
SubType :
Status : APPROVED
OWNER: BALSAMO J AUDRE Phone : 0
APPLICANT: AT&TCALIFORNIA Phone : 714-618-9132
Description : Install 78 LF of conduit, 1 above ground cabinet, 1 fiber barrel, and ground bed on 20th
Street south of West Balboa Boulevard. Sidewalk and concrete pavement restoration per
Citv Standards. (A00H4N1)
Item: 10255 FINAL - Utilities
Requested Time: 4/25/2017 12:00:OOAM Requestor: WEBUSER
Entered By: WEBUSER
Comments: ANY -
Assigned to: 777=77777*
Inspector: Date: `�/2 g'/ ! 7 Time: 1 7,5' & PM
Comments: % 446- -r I O/U S 9457-0 w- «4W
Af-57-7 c- S1Tle / /° 4 oti Zo-'. 4
Sf�T ltic�z /A--- 'L�
V0V'a;f?9-C'
F:\Users\PBW\Shared\ENCROACH\MASTERS\FORMSUnsoectorSheet.doc
REPT131
Run Id: 4018