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HomeMy WebLinkAboutN2017-0090U l . 4, 2y . port Beach City ofvic IIII�Ii;II"IIIIIIIIIIIIIIIIIIIIIIIIIII�III^III�IIIYIIII Permit No: N2017-0090' cNewenter 100 each, CA s2sso a' Permit Counter Phone (949)644-3311 Project No: Online Inspection Request - www.newportbeachea.gov / Online - ey, Services Inspection Requests Phone (949)644-3255 Job Address: 1 PUBLIC ROW NB Thomas:Guide: Description : Bore approximately 40 LF of 2-inch CATV conduit across 15th Street in front of 286 and 288 15th Street (Costa Mesa) and pothole existing utilities. Pavement restoration per City Standards. A Parcel # : Legal Desc SCANNED Owner: CITY OF NEWPORT BEACH Contractor : COAST WATER & POWER Phone : Phone : 949-548-0106 Address : : P O BOX 3341 OVIETVAddress NEWPORT BEACH CA 92659 Contractor State Lic: 738400 Applicant: MIKE KILBRIDE License Expire: 07 31, 2017 Phone : 949-548-0106 [ Address : PO BOX 3341 NEWPORT BEACH, CA 92659 Business License: BT96014951 Business Expire: 12 31, 2017 Special Cond.: Pre -job inspection required. Workers' Compensation Insurance - - Traffic control per WATCH. Carrier : STATE COMP INS FUND City limit at centerline of 15th St Policy No: 9087110 W. C. Expire: 10 01, 2017 Permit Processing Fee: $241.00 Sewer Connection : $0.00 Total Fee $736.00 Agreement Fee: $0.00 4TT Box Cover: $0.00 Paid : $736.00 Traffic control Plan Check: $0.00 Total Water Meters: $0.00 Balance: $0.00 Inspection Fee : $495.00 Water Meter Connection : $0.00 Receipt No: ? —'1 S39 5 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 : L /1j4 / t� General Services Approval : Date: _/ / TERMS AND CONDITIONS OF ENCROACHMENT PERMIT 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 isauance4df a permit, is subject to rejection/fine. City reserves the right to void permit if work does not commence within 30 days after date of issuance. The Permittee agrees to defend, indemnify and hold the City, its authorized agent, officers, representatives and employees harmless from any responsibility, liability, suit or action of any description arising out of any accident, loss or damage to persons or property occurring as a result of work undertaken under this permit. All work shall be done in accordance with the approved plans, Standard Special Provisions and Standard Drawings of the City of Newport Beach, and in compliance with all applicable State laws and City ordinances. Pernittee guarantees all work performed under this permit to be free of hidden and latent defects. Any failures shall be corrected within two weeks after notification to the satisfaction of the Public Works Director. A valid State licensed contractor must perform all construction within the public right-of-way, unless waived by the Public Works Director. A valid State Contractor License Class A can perform any work in the public right-of-way. For construction or connection to water lines a valid State Contractor License Class C-34 is required. For construction or connection to sewer lines a valid State Contractor License Class C-42 is required. All trenching and/or resurfacing shall conform to City Standard 105-L for parkway/roadway and City Standard 140-L, in the alley, where a minimum half -alley width resurfacing shall be provided, unless otherwise directed by the Public Works Dept. Contractors shall obtain permits to perform excavation or trench work from the California Division of Industrial Safety prior to commencing underground construction as required by State law. Walls and faces of all excavations over 5 feet In depth shall be protected by a shoring system, sloping of the ground, or other equivalent means. Trenches less than 5 feet in depth shall be guarded when hazardous ground movement may be expected. The Public Works Department Inspectors must Inspect all work in the Public right-of-way. Forms and subgrade must be inspected and approved before concrete is ordered/poured. Sewer, pipelines, and subgrade construction must be Inspected and approved before backfilling, or applicant may be required to excavate site. Separate inspections by the Municipal Operations Department may be required depending on scope of work performed. All trench restoration must be inspected by the Public Works Department. No utility installation(s) shall be allowed over or within 5 feet of any City utilities, unless approved by the Public Works Department. Locate and pothole existing City -owned utilities (is: water, sewer, or street lighting conduits) to verity 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. Property 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 $36.00. 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. Work within or near beach sensitive areas will not be allowed during, City holidays, spring break, Memorial Day weekend, summer between June 15 and September 15, and during the holiday season from December 19 to January 1, unless approved by the Public Works Department. Any work that extends into traffic or parking lanes and impedes the normal flow of traffic requires the applicant to acquire a Temporary Street Closure Permit from the Public Works Department. Access for fire, police and emergency vehicles must be maintained at all times. Traffic Control must be per Work Area Traffic Control Handbook (WATCH). No nighttime traffic lane closures, unless prior approval has been granted. Any lane(s) closure on a major street will only be allowed between 9:00 a.m. and 3:00 p.m. (Monday thru Friday), unless approved by the Public Works Department. Any work affecting the State Highway's traffic or within the State Highway right-of-way will require a Caltrans Permit. All vehicles shall be lawfully parked. This permit does not authorize the closure of sidewalks, streets, or alleys for construction access, storage of materials, or parking of construction vehicles unless detailed on an attached Temporary Street Closure. Applicant must notify USA at 1-800-227-2600 2 days before starting any underground construction. Applicant must notify all affected residents 24 hours in advance of restricted access and any inconveniences. All USA marks shall be removed prior to Final Public Works Inspection. 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 949-644-3088 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) 1 certify that I have a Certificate of consent to self -insure, Certificate of Worker's Compensation Insurance, or a Certified Copy thereoff/� Q� Date: a- 2- ` -17 Signature: C1 yt)r.�/1,. CERTIFICATE OF EXEMPTION (Section 3800 Labor Code) I certify that In the performance of the worts 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 1 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: Inepeotlonti should' tis roqueeted_by selling the iib Ic Worki`1n`e ep �tlor�' Reausat Line at: 949-644-3255J INITIALS: ILA X 15. All above ground facilities shall comply with the Municipal Code, including but not limited to Chapter 13.20. 16. Homeowner, contractors, and subcontractors may each be liable for violations of Water Quality Laws. Best Management Practices will be enforced. It is against the law to discharge construction debris Into the gutter and storm drain. Felony violations of Water Quality Laws are punishable by fines up to $25,000 and/or up to three years in State prison plus the full cost to clean up an illegal discharge or spill. 17. If a refundable deposit was paid, applicant must submit a Soils Compaction Certificate or Evidence of a Slurried Backfill and request a final inspection from the Public Works Department. Monies may be held for six months after final inspection before a refund will be processed. 18. No trees In the public right-of-way shall be planted, removed, trimmed, or relocated without approval from the Municipal Operations Department, Parks and Street Trees Division. 19. All work in the public right-of-way must meet the approval of the Public Works 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. Permit Processing Fee: Public Works Only Other Department Agreement Fee: Preparation of Report/Agreement Document Recordation Fee Monitoring Wells Inspection Fee: $241.00 Public Works Field Inspection $275.00 Utilities Field Inspection General Services Inspection Water Quality/Artificial Turf Inspection $817.00 $192.00 Refundable Deposit: $502.00 Improvements Street/Alley/Walk Closure: $65.00Newspaper Rack Inspection Traffic Control Plan Check 8-12" x 11" $65.00 Sewer Connection Fee 24" x 36" $143.00 4TT Box & Cover Additional FliE F�+LLOV�f iNt3 iC MS SEQUIlZE/tPPR01[At FltUM TI�E� SIR r . • ..... • •REVENUE. OtvllSt4�L fPRtOF[ i`O PhYMEtsfC•OF` FEES . • . • : ... $165.00 $ . $121.00 $165.00 $108.00 TBD TBDI $108.00 Q $.00 $64e 64.00 r~ue ofth ion. ;1 aaiaval:... . . . . ... . . .� IWai4FVeter•.' • ;kjsiaB Qe Ctiai+ge....-$f28.. 1 E34•':Me2er: $50:2 . V1f ec Metes $Qx�s:. :1 I1"ifAeter. • $ 1 ]5 • :for. �'aricway & ,SideiareNc Area jBnx i-Cover= : •1 Nl')f2":Meter: .$285A .-1'.Meter.:•:13M+37:00•.•.'.-.•. •$s0o :I I1-117-'Turbinb Meter.' . ' . -$700.0 •2; Meter: - - •27.oa a, 61.26 -' W.2 1 12"aVletr::::::-$423.D. :.:..::...:.:..:::::::......... a Iz"Turbin4Mefes : :$84$.QO : I�grTraft;&. 114 j A i66X:*:few=:�Ost1 ' - • 1 F " ISAetec : "Meter : : •2'.Meter.: • .271W *, :t62.09. - . - :5189AOQ 1 :•Meter ;$7:ti�0.00 .. ---•_ �:'r•'��;"F �rr;:w" _ X�'�� C-.yip`_ . ,. - - - - - - - —. _ ..,._ _ '. .. , t9'�. _ _ . _ . Certificate of Compliance Fee (+100% of My 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 405470 Street Easement/Vocation Fee (+100% of " over 4 hrs) $1,022.00 5200-5031 Street Tree Fee ($700 Planting Fee) TBD 030-2284 Engineering Tech: Total Amount Due: For Finance Use Dory ;Zod. e'13(o. — ?4-11) Permit Specialist Receipt No. Z „ Z" rwn NO back masmrs� _ 15 Rev. 1021/2016 3 �7 epeeWesAe 43- lorrra e VORKS�iEET. FOR ENCROACHMENT PERM1T .., : _ CITY'OF NEWPORT 6EACH = ' ' PUBUC WORKS DEPARTMENT CO L•ET •H LOW 1 FORMAf O PROJECT ADDRESS: DETAILED DESCRIPTION OF PROPOSED WORK: J PLICANT: G.T.L� Phone: . s Q Email Address: �,' 7" Mailing Address: CL~3LAI City/Statoop: WNER: Phone Email Address: Mailing Address: City/State0p: :AA, 1CTOEt RVORMATIONE IS` REMAREI LEASE •OOM . " ONTRACTOR: YA Cr 6 Office Phone: ompany (if different): Jobsite Phone: OAAOther Phone Email Address: ' 4T� , L,p lM ailing Address: v City/Stateop: State License Number & Class: p ires• 7. 3(• /'7 City Business Ucensb Number: I NExpires: 1231.11 WORKERS COMPENSATION INSURANCE - Certificate of Insurance (Section 3800 Labor Code) Company:0.wi& PolicyNo: O$ %/ /O• %o fires uirac` 'Boris= • 5+ts:-64�3d55 •'Goes:: •949-6d+4.0:t'I • ..................................................... liitian Fones • �49+644,30$3.... .. ..; .. .. . - - ` - - - FOR-40F ICE EiSE ONE.Y Special Conditions of Permit: �:,,1H�.0 ice. �G9' �1i.�%:f,%. pr�'►'�ii.. y i�•� �+d1tIT Al'+" G.ifl4°lr.:f1(?. Oj• i.>�''� i:C_• REQUIRED FROM THE FOLLOWING DEPOTS Utilities: Traffic: Fire: Municipal Operations Other: Engineering Technician: Permit Specialist Date: °a Permit No. Public Works Department 949.6443311 100 Civic Center Drive, Newport Beach, CA 92660 i Cif V / (p �.)411 FS� •--"��r.�.-s--`---.-T--'---.--� •-��...-�..w....w-� --ram+--:f----�*-;- •.,.T-.r---- .--�--- -.. .. _. .-- ,- :•'7 2/27/2017 City of Newport Beach Page 6 of 8 6:35:01AM INSP150 - Daily Inspection Request Report Requested Inspection Date: 02/27/2017 Inspection Type: ENCROACH Inspection Area: PW Site Address: 1 PUBLIC ROW Activity : N2017-0090 SubType : Status : APPROVED OWNER: CITY OF NEWPORT BEACH Phone: APPLICANT: MIKE KILBRIDE Phone : 949-548-0106 Description : Bore approximately 40 LF of 2-inch CAN conduit across 15th Street in front of 286 and 281 15th Street (Costa Mesa) and pothole existing utilities. Pavement restoration per City Item: 10215 ROUGH UTIL 3Y Al 6 ; X -ST : Gi¢�Atl/�J�4 Requested Time: 2/27/2017 12:00:OOAM Requestor: WEBUSER Entered By: WEBUSER Comments: AM-R & R CTV handhole in S/W, pothole Assigned to: 77777777777' Inspector: ,i V Date: y?17 Time: Z = 76 AM Comments: ~-r w/ ,tab 6itT rV 4600 /D Ny L or �.✓� 9 Od C� .o r i • � k Refife F:\Users\PBW\Shared\ENCROACH\MASTERS\FORMS\InspectorSheet.do REPT131. Run Id: 4018 1/312022 City of Newport Beach Page 10 of 21 4:30:32PM INSP150 - Daily Inspection Request Report Requested Inspection Date: 01/04/2022 Inspection Type: ENCROACH • Inspection Area: PW Site Address : 1 PUBLIC ROW Activity t N2017-0090 SubType . Status : APPROVED OWNER: CITY OF NEWPORT BEACH Phone: APPLICANT: MIKE KILBRIDE Phone : 949-548-0106 Description : Bore approximately 40 LF of 2-inch CAN conduit across 15th Street in front of 286 and 28i 15th Street (Costa Mesa) and pothole existing utilities. Pavement restoration per City Standards. Item: 10250 FINAL - PW Requested Time: 1/4/2022 12:00:OOAM Entered By: WEBUSER Comments: 'ANY-' Glwavoo Assigned to: 77777777777i ._ IV40^v 0 rr1-S Requestor: WEBUSER 4077, 40000 epp� o7ow.