HomeMy WebLinkAboutN2017-0111'�,aw,•o� tyocNe Newport
Beach
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ooit acn, CA 92660 1111111
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Permit Counter Phone (949)644-3311
u 0 Online Inspection Request - www.newportbeachca.gov / Online
n , Services
Permit No: N2017-01- 11; .'-
Project No:
Inspection Requests Phone (949)644-3255
Job Address: 1 PUBLIC ROW NB Thomas:Guide:
Description : Bore 2,122 LF of 4-inch conduit and (4) 17"x30" vaults for Level 3 Communications on the west side of Jamboree Road between Eastbluff/University to
approximately 700-feet south of Bison Avenue. Sidewalk restoration per City Standards.
Parcel # :
Legal Desc :
Owner: CITY OF NEWPORT BEACH
Phone :
Address
Applicant: THE FISHEL COMPANY
Phone : 714-668-9268 [
Address : 647 YOUNG STREET
SANTA ANA, CA 92705
Special Cond.: Pre -job inspection required.
SCANNED
: FISHEL COMPANY THE
COMPLETED AddresPhone sor 951-685-9482
MC GAW AV 51 254-8095
IRVINE, CA
Permit Processing Fee:
$241.00
Sewer Connection :
$0.00
Agreement Fee:
$0.00
4TT Box Cover:
$0.00
Traffic control Plan Check:
$351.00
Total Water Meters:
$0.00
Inspection Fee:
$3,300.00
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 State Lic: 678942
License Expire: 10 31, 2017
Business License: BT00014042
Business Expire:
09 30, 2017
Workers' Compensation
Insurance - -
Carrier :
ARCH INSURANCE COMPANY
Policy No:
31 WC18940400
W. C. Expire:
08 01, 2017
Total Fee $3,892.00
Paid : $3,892.00
Balance : $0.00
Receipt No: R0_-1StdQA
Date:.
/_/
Other Department: -Date:
Date :
/_/
Permit Denied Date
Date:
/
/
Issued Permit: Cam^' Date :
3 / / 11
Date:
/
/
FEE WORKSHEET FOR ENCROACHMENT PERMIT
CITY 0F:NEWP0 T,4 BEACH
;PUBLIC WORKS ;DEPARTMENT
Aff fees: Are lVoiRefitdabie: Unless
Ditierwise S>��tecf
PROJECT ADDRESS:
PERMIT N204-6-
I Pw;c. ROW
NUMBER: mon —Oiii
APPLICANT:
T4aa. F'; s�e1 cow► o"
Permit Processing Fee:
Public Works Only
Other Department
Agreement Fee:
Preparation of Report/Agreement
Document Recordation Fee
Monitoring Wells
Q Inspection Fee:
$241.00 I Public Works Field Inspection
$275.00 Utilities Field Inspection
General Services Inspection
Water Ouality/Artificial Turf Inspection
$81'
$192.00 Refundable Deposit:
$502.00 Improvements
StreeVAlley/Walk Closure: $65.00® Newspaper Rack Inspection
Traffic Control Plan Check
8-1/2" x 11" $65.00 Sewer Connection Fee
24" x 36" $143.00 3. 4TT Box & Cover
Additional
� .. HE•�bLLOYWN(i MEMSWQUIRE:AP� 01[At FROM {I E SIR
f.'.'.'.'.'.'.'REVENt1EDIWSIC>tPIP.RIOR'TOPAYMEfItT'OF'PEfS'.'.'.'.'•'•'.IA
Qty.
$165.00 2O
$121.00
$165.00
$108.00
TBDeTBD
$108.00 Q
$00
$64..00
64
.Venue. Division. :I
Doroval. • . . . . . . • .I
.:.:.:..:.:.:. ,cam. :.:.:.:.:.:.:.:.:.:.:.:.:
[Water Nlextz�:
;Irjs.4H00Qn Cfia.ge' ' $$28:0�'l :
13/4'':MeJO : • $50.25
: �Wxec•M6tei BOX04:: :I
I1'y •Meter, • $421.M
�1'1/2":Meter: :$....
.
:For. Pa/iiuvAk 9 .SidetvA Area •tEoz • t Cover,
:"I":Meter:....0. .... '$50.$Q' :I
'
�1.1/2"'Turbin*e eter.' '$7.00.00
•
'.2; Meter;':'27.00 } t31�25 ' $88.�5
12"•Meter'•'•'•'•' ' •$425;0Q'
..:.:.:.:.:.:.:.........:...............:....:.. ..
12"T•urbineM:e(et ' :$845.Q0
�4".Meter : .:$4,.73d.d0
: FOF.TtaTrtpi&:RiOy.Rree(slOdx:+:Cover-'Cost) .I
$5X'0 1
: '2":Meier.::27.00• � :t62.a0: ' : $189.,d .I
'
.��� Mptp�:..............: •t7 "M nn
.. .
Certificate of Compliance Fee (+100% of hny 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
$1,079100
5200-5028
Park Dedication Fee Zone
TBD
405-470
Street Easement/Vacation Fee (+100% of My over 4 hrs)
$1,022.00
5200-5031
Street Tree Fee ($700 Planting Fee)
..........
TBD
..................................
030-2284
Engineering Tech:
Total Amount Due:
For Finance Use Only
?06;
63.-M.
Permit Specialist
Receipt No.
f 1UwWpWsharWen=ad*m3terWep fmnt and back masters)
Rev. 10/21/20161
1epfeesh.td.,.W.W 10121,2016
I ALL UNDERGROUND WORK SHALL BE PERFORMED BY A LICENSED.CONTRACTOR I
Contact "Underground Service Alert" A$ 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 off
a permit, is subject to rejection/fine. City reserves the right to void permit if work does not commence within ft'sysj
after date of issuance.
2. The Permiltee agrees to defend, indemnify and hold the City, its authorized agent, officers, representatives and
employees harmless from any responsibility, liabiUly, 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 and 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 Slate 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.
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 rl--
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.
11. 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 "it 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.
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-insur Certi ' ate *of Worker's -
Compensation Insurance, or a Certified Co f.
Date: 3 = 1 + l i Signatur _ .
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 1 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:
24-hour notice for Encroachment Permit Inspection is required by calling
(Public Works at 949-644-3311. I:>'A
15. Any above ground utility facilities will require documented approval from the adjacent
affected property owner(s).
16. Homeowner, contractors, and subcontracotrs may each be liable for violations of Water
Ouality Laws. Best Management Practices will be enforced. It is against the law to
discharge construction debris into the gutter and storm drain. Felony violations of Water
Quality Laws are punishable by fines up to $25,000 and/or up to three years in State
prison plus the full cost to clean up an illegal discharge or spill.
17. If a refundable deposit was paid, applicant must submit a Soils Compaction
Certificate or Evidence of a Slurried Backfill and request a final inspection from the
Public Works Department. Monies may be held for six months after final inspection
before a refund will be processed.
18. No trees in the public right-of-way shall be planted, removed, trimmed, or relocated
without approval from the General Services Department.
19. All work in the public right-of-way must meet the approval of the Public 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.
No work related to this encroachment permit shall be performed until the Public Works Department has issued this permit. Applicant hereby -acknowledges he/she has read and ndeFsfa ds 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.
Permit fees are nonrefundable. I , aw"Whii, Date: 3 -1 - 11 Signat
LOCATION: Jamboree Road to Camelback Street
CITY: Newport Beach, CA
-acre _'y�Oro: �' VKto Oef G•oJVcj1' —J/ •4 / `a ,; -_` • ��
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Estimated linear Construction Feet
I -*I.. a I nroffnm a een!
MH-3088
Vault-1
5
Vault-1
Vault-2
802
Vault-2
Vault-3
655
Vault-3
Vault-4
655
Vault-4
MH-1083
5
Total Linear feet) 2'M 1
SITE LOCATION
SCOPE OF WORK
LEVEL(3) IS TO PLACE (4) NEW 1rX30' FLUSH MOUNT VAULTS. TRENCH S' FROM
EXISTING MH-3038 TO NEW VAULT AND PLACE 4' CONDUIT. BORE APPROXIMATE
2.127 IN SIDEWALK FROM NEW VAULT TO EXISTING MH-1083 AND PLACE 3
VAULTS POTHOLE AT (2) AREAS AND RAR CONCRETE PER CITY STANDARDS
BORE IN THE CITY OF NEWPORT BEACH
REMOVE& RESTORE SIDEWALKPANLES: (11)1O'xI&=1.100SQ.FT.
EXCAVATION IN SIDEWALK: 10 SQ.FT.
BORE IN SIDEWALK: Z122 SQ.FT.
CONTACT
LC nttw Information
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City of Newport Beach
Newport Beach Police Dispatch Public Works Department
Phone:949-644-3717 Phone:949-644-3311 Fax:949-644-3318
WAP.121111 ATION F,OR TiEMPOR RY SEENTTFDALK�OR
City of Newport Beach Municipal Code 1 Z 6Z010 Permit for Temporary Street Closure
• APPLICANT INFORMATION
Name: TA'K r t.S Wc- L LO ,-A %0 Wuy
Company Name�� �VD City o Newport each Business License No.
: N �G L i"10
Address: 4 47 16T 000 1404 Z
City2ip: 4 ,nr 9Z`l V V Phone: 11 `f —6 6 Y - QTG email: o K o S e
Exact Location of Encroachment CLA Un a d--,o tQd -%+VUCf:
(Use street address or approximate number of feet from nearest ,nters ction)
Reason for Encroachment: l3o�r4,0. - CA'AM"Is ,
Franchised Hauler or
Dumpster Company Name: Size:
Date Use to Begin: 3 t '3 -1-1 Date Use to End: 3 -3 1- 1 1
(Ma)imum 14 Days) Time of Closure: 9 % Oo CIM to 3.13 0 P" -
DIAGRAM LOCATION OF ENCROACHMENT BELOW: I Newport Beach Police Department 949 44-37 7
Sep -bra t.0
A copy of this permit must be visible on the dash of each vehicle authorized to Tark in reserved parking spots.
The applicant is responsible for notifying Police Dispatch of any road closure, detour, or reserved parking.
See reverse side of this permit for regulations covering use of this permit.
ADDITIONAL CONDITIONS OF APPROVAL FOR THIS PERMIT ARE AS FOLLOWS:
I, (Permitee) hereby certify the information provided is true and correct, and I agree to comply with the terms and
conditions on the front and bad
f this permit. Permitee guarantees to indemnify and hold the City of Newport
Bea less ag nst any i �Iiability,ments for damages arising out of permitee's activities.
x / r • Date:
Reviewed by: VA Date:
Approved by: t<c Date: S 1 11
Permit Fee: $ - - J 9C K201-7 -0 (11 Receipt No:
F:WursW8WWWredNMSTERS%STREET CLOSURE MASTERSrf Temp Steel Gown App0colonidslSneell
w CAD"
` e�
TRAFFIC CONTROL GENERAL NOTES
1. ALL TRAFFIC CONTROL WORK FOR CONSTRUCTION SHALL CONFORM TO THE LATEST EDITION OF:
THE CALIFORNIA MANUAL ON UNIFORM TRAFFIC CONTROL DEVICES FOR STREETS AND HIGHWAYS (CA MUrCOL
WORK AREA TRAFFIC CONTROL HANDBOOK DBOOK (WAT C.H. MANUAL) .
ALLO.S KA REQUIREMENTS.
2 ALL SIONING AND STRIPING SMALL CONFORM TO THE LATEST CALTRANS STANDARO PLANS AN SPECIFICATIONS AND THE CITY OF NEWPORT BFACH S LATEST'SIGNING AND STRIPING
GENERAL NOTES. r
1 NO WORK SHALL BEGIN BEFORE 0 00 AM OR CONTINUE AFTER O DO PM ON ARTERIAL STREETS.
4. NO WORK IS PERMITTED ON SUNDAYS OR HOLIDAYS UNLESS APPROVED BY THE CITY
S. DURING NON .VWRIGNG HOURS OR WHEN WORK IS NOT SCHEDULED, ALL ROADWAYS LANES SMALL BE RETURNED TO THEIR FULL TRAFFIC USAGE ON THE SAME DAY BY PLATING OR
BACKFIRING THE OPEN TRENCHES, AND CONTRACTOR SMALL REMOVE ALL TRAFFIC CONTROL DEVICES USED FOR TRAFFIC CONTROL OR DETOUR.
6. CONTRACTOR SHALL MAINTAIN ACCESS TO ALL AQ=ENT PROPERTIES. ,
T. ALL SIGNS $HALL BE REFLECTORIZEO AND STANDARD SIZE
S CONTRACTOR SHALL NAVE ALL SIGNS. OEUNEATORS, BARRICADES. ETC. PROPERLY INSTALLED PROP TO COMMENCING CONSTRUCTION
0 ALL TUBULAR DELINEATORS SHALL BE Or MINIMUM KEIGHT AND CONES SMALL BE Zr MINIMUM HEIGHT AND SWILL INCLUDE A r AND P NIGH INTENSITY REFLECTORMED SLEEVES.
10 CONTRACTOR SMALL BE RESPONSIBLE FOR THE PLACEMENT OF ANY ADDITIONAL TRAFFIC CONTROL DEVICES REQUIRED BY THE CITY TO ASSURE SAFETY TO THE PUBLIC AT ALL TIMES
DURING CONSTRUCTION
11. CONTRACTOR SWILL RESTORE ANY AND ALL STRIPING, PAVEMENT MARKINGS. AND TRAFFIC SIGNAL LOOPS OAMAGED OR REMOVED OURNG CONSTRUCTION TO THE SATISFACTION OF THE
CITY EFDINEER.
12 CONTRACTOR SNAIL TELEPHONE THE CITY OF NEWPORT BEACH (9401644.3311 AT LEAST TWO WORKING DAYS (46 HOURS) PRIOR TO THE STARTING TRAFFIC CONTROL DELINEATION.
17 ARROW BOARDS SHALL BE USED ON ANY LANE CLOSURES ON ARTERIAL STREETS.
14 THE CONTRACTOR SHALL MAINTAIN TY40-WAY TRAFFIC DURING CONSTRUCTION. THE CONTRACTOR SHALL REPLACE ANY TRAFFIC SIGNAL LOOPS DAMAGED WITHIN Tz HOURS
w+eaeo rea..N -
NOTE-
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t3i� 3za�a. City -of Newport Beach Page 7 of 14
4:30:19PM ' INSP150 - Daily Inspection Request Report
Requested Inspection Date : 03/14/2017
Inspection Type : ENCROACH
Inspection Area: PW
Site Address : 1 PUBLIC ROW
A/P/D InTo- rmation•
Activity : N2017-0111
----SubType : - --
Status : APPROVED
OWNER: CITY OF NEWPORT BEACH Phone :
APPLICANT: THE FISHEL COMPANY Phone : 714-668-9268
Description : Bore 2,122 LF of 4-inch conduit and (4) 17"x30" vaults for Level 3 Communications on the
west side of Jamboree Road between Eastbluff/University to approximately 700-feet south
of Bison Avenue. Sidewalk Ke_sto'ation per City Standards.
Item: 10200 PRE JOB - PW . a : 30AM
Requested Time: 3/14/2017 12:00:OOAM Requestor: WEBUSER
G 49-254-8306
Entered By: WEBUSER JU4N 01C,40,4
Comments: AM -
Assigned to: 77777777777` -
Inspector: Date: ZI 7 Time: : 3o AM M
Comments: fiae�-c- L4-47
iZ-
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F:\Users\PBW\Shared\ENCROACH\MASTERS\FORMS\I nsoectorSheet.doc
REPT131. Run Id: 401,8
� _ _ .• .. •..,. _... _ia ..... a., J •-n . �_ i.4 • •.'.:..�e?,�iGitus : .`f S . �YJI�� _'_s:. ss: i..Y' �....� i .t. va,.� • ..�a=f.ur _.. _4 iYc+l��'.iIFC:.'JLit1.. �e.�.�.._�e !� �. .> >_ _
3ria2o7 City of Newport Beach Page 14 of 21
•4:30:43PM INSP150 - Daily Inspection Request Report
Requested Inspection Date: 03/15/2017
Inspection Type: ENCROACH
Inspection Area: PW
Site Address: 1 PUBLIC ROW
A/P/D Information•
Activity : N2017-0111
SubType:
Status : APPROVED
OWNER: CITY OF NEWPORT BEACH Phone.:
APPLICANT: THE FISHEL COMPANY Phone • 714-668-9268
Description : Bore 2,122 LF of 4-inch conduit and (4) 17" x30" vaults for Level 3 Communications on the
west side of Jamboree Road between Eastbluff/University to approximately 700-feet south
of Bison Avenue. Sidewalk restoration per City Standards.
Item: 10000 EXCAVATION & PIPE INSTALL-UTIL
Requested Time: 3/15/2017 12:00:OOAM Requestor: WEBUSER
Juan Ochoa
Entered By: WEBUSER Jaw 44�0
Comments: AM -Star work 3/15/2047 at 9:00 am . ,40 pwl►"� G����
Assigned to : 77777777777`
Inspector: k )` Date: 3 Time: PM
Comments: 60411VIA- T-D2 SPW-2r&D .J,%,-tL if /30r_� o�i�•�--r-�ti
Oil/ 5 . �K,✓/.� Sf •., o P .//�►�»iJ�•�t'6. �is S � �l.,t+2.aoy yr�-r� -
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F:\Users\PBW\Shared\ENCROACH\MASTERS\FORMS\I nsnectorSheel.doc
REPT131. Run Id: 4018
� A'�'1►� �� � TG✓� ���St�i3 is t Pr-
10 OCO eXe-AVA-r / o1V + f / PF,
Inspector: �_1 V Date: 1, (P 7 Time: 9 '/ A PM
Comments:
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F:\Users\PBW\Shared\ENCROACH\MASTERS\FORMS\InsoectorSheet.doc
REPT131.
Run Id: 4018
. '. Ili 61261i City of Newport Beach Page 2 of 6
4:30:07PM INSP150 - Daily Inspection Request Report
Requested Inspection Date:
03/17/2017
Inspection Type:
ENCROACH
Inspection Area:
PW
Site Address:
1 PUBLIC ROW
Information-
- -- -- -- --Activity-:--N2017:01-1-1- --- -- --_ _ - __- --
------ - - -- -- - --- - — --- --
SubType:
Status : APPROVED
OWNER: CITY OF NEWPORT BEACH Phone :
APPLICANT: THE FISHEL COMPANY Phone : 714-668-9268
Description : Bore 2,122 LF of 4-inch conduit and (4) 17"x3O" vaults for Level 3 Communications on the
west side of Jamboree Road between Eastbluff/University to approximately 700-feet south
of Bison Avenue. Sidewalk restoration per City Standards.
Item: 10000 EXCAVATION & PIPE INSTALL-UTIL
Requested Time: 3/17/2017 12:00:OOAM Requester: WEBUSER
9492548306
Entered By: WEBUSER
Comments: ANY -
Assigned to
Inspector: �-1� Date: 3 / / Time:M
Comments: 4 04 y " j( r., Tube's
wo 447yZ %-G r
Log 9-W
R
3ZU J�-o3
F:\Users\PBW\Shared\ENCROACH\MASTERS\FORMS\InsoectorSheel.doc
REPT131. Run Id: 4018
311612iT17 City of Newport Beach Page 8 of 8
4:30:43PM INSP150 - Daily Inspection Request Report
Requested Inspection Date: 03/21/2017
Inspection Type: ENCROACH
Inspection Area: PW
Site Address: 1 PUBLIC ROW
Activity: N2017-0111
SubType:
Status : APPROVED
OWNER: CITY OF NEWPORT BEACH Phone:
APPLICANT: THE FISHEL COMPANY Phone : 714-668-9268
Description : Bore 2,122 LF of 4-inch conduit and (4) 1 T'x3O" vaults for Level 3 Communications on the
west side of Jamboree Road between Eastbluff/University to approximately 700-feet south
of Bison Avenue. Sidewalk restoration per City Standards.
Item: 10000 EXCAVATION & PIPE INSTALL-UTIL
Requested Time: 3/21/2017 12:00:OOAM Requestor: WEBUSER
9492548306
Entered By: WEBUSER
Comments: ANY -
Assigned to • ,
Inspector: —3 V Date: / /-7 Time: �-"M
Comments:
Corsi
J--
S /w ) .
D Tm-yam 4D O,) s� CA/0 A0�t-D (-VV4& �� 511 A) '9 07-
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F:1Users\PBWXShared\ENCROACH\MASTERS\FORMS\InsnectorSheet.doc
16
sew
REPT131.
Run Id: 4018
:'��Ti'�1.•r•�,A" s . -, � �r °••mil' �. -•'�W'y►;;�. ��: � ;�.' �'�-.s�.i''aa,.
3127/2017 City of. Newport Beach Page 5 of 8
6:34:50AM IN-SP1.50--:0aily Inspection•Request.Report
-Requesteddnspection.Date : 03727/2017
fnspection -.Type : ENCROACH
Inspection,Area : PW
Sire -Address : 1 PUBLIC ROW
Information:
Activity : N2017-0111
SubType :
Status: APPROVED
OWNER: CITY --OF NEWPORT BEACH Phone:
APPLICANT: THE FISHEL COMPANY Phone : 714-668-9268
Description : Bore 2,122 LF of 4-inch conduit and•(4) 17'x3O" vaults for Level 3 Communications on the
west-side:of.Jamberee Road between Eastbluff/University to approximately 700-feet south
of3Bison•Avenue.••-Sidewalk restoriation•per'City•Standards.
11111111111111111111IReb Inspections)
Item: 10000 EXCAVATION & PIPE INSTALL=UTIL
Requested Time: 3/27/2017 12-:OO:OOAM Requestor: WEBUSER %pf/ GCS ,01
Entered By: WEBUSER
Comments: ANY -
Assigned to: 7777zzz="
Inspector: �l
Vis 0014
Comments:/
9492548306 imEaddAsaw
9s1-61��"�-�Zo ,
Date: 3 2 Time: &O A PM
1441
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F:\Users\PB\N\Shared\ENCROACH\MASTERS\FORMS\InsoectorSheet.doc Ref IYV
REPT131. Run Id: 4018
'. 3/2712017. City of Newport Beach Page 6 of it
4:30:26PM INSP150 - Daily Inspection Request Report
Requested Inspection Date: 03/28/2017
Inspection Type : ENCROACH
Inspection Area: PW
Site Address: 1 PUBLIC ROW
A/P/D Information:
SubType :
Status : APPROVED
OWNER: CITY OF NEWPORT BEACH Phone :
APPLICANT: THE FISHEL COMPANY Phone : 714-668-9268
Description : Bore 2,122 LF of 4-inch conduit and (4) 1 T'x3O" vaults for Level 3 Communications on the
west side of Jamboree Road between Eastbluff/University to approximately 700-feet south
of Bison Avenue. Sidewalk restoration per City Standards.
Item: 10000 EXCAVATION & PIPE INSTALL-UTIL
Requested Time: 3/28/2017 12:00:OOAM Requestor:
Entered By: WEBUSER
Comments: ANY -
Assigned to: 77777777777*
Inspector: Date: 4, , %
,e L'O.q-A;-f-
Comments:
Refle
F:1UserslPBW\Shared%E NCROACH%MASTERS%FORMSU nsoectorSheet.doc
110
WEBUSER
9492548306
Time: _;�PM
_614- y2-63
REPT131. Run Id: 4018
City of Newport- Beach Page 17 of 24
se�;�d[ttT.3iiPfat: INSP150 -Daily Inspection, Request Report
"oil Date Requested Inspection F,3, e:: 03/29/2017
hen 1 ypl' : r , Inspec4Cma Type : ENCROACH
Inspection Area : PW
_::a,t�;r�'..• . Simt+eA��ddr¢os : 1 PUBLIC ROW
�I�i tfl�fl6}I�lF. LA �SIi.n wY. Su. :.�. ••Afw�
Activity : N2017-0111
SubType:
Status : APPROVED
OWNER: CITY OF NEWPORT BEACH Phone:
APPLICANT: THE FISHEL COMPANY Phone: 714-668-9268'
c;r,cik::t arc Description : Bore 2,122 LF of 4-inch cn-I uii irld (4)A7?'x30'',vaults for Level-3 Communications on the
Cie!`!Ic en west side of Jamboree Road between Eastbluff/University to approximately j,99-feet south
:;k °LQ: xancr of Bison Avenue. Sidewaik rastor2tinn oer City Standards.
P'USUC. V40: Item:
10110 CONCRETE PU&IC i/V0A S ~'''
R"@a!eiited•Time:
3/29/2017 12:00:00AM Requester:
WEBUSER
..9492548306.
• .
Entered By:
WEBUSER
Comments:
ANY-
.'
Assigned to:
Inspector:
77777777777*
J X
Date: 2 Y I% Time: T PM
/LL�C o �i,?
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Comments:
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,cam9 77w
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F:\Users\PBW\Shared\ENCROACH\MASTERS\FORMS\InsoectorSheet doc
c
REPT131. Run Id: 4018
_ ;; r.Y�..: - ,- 's•, i, 'j`,vY7I�:`,i ;mil[ '.T.'. "s^r: 1., !:�- ':.r *' ;• �.- n x w-. :_y - -,
3/30/2017 City of Newport Beach Page 17 of 20
6:34:47AM INSP15O - Daily Inspection Request Report
Requested Inspection Date : 03/30/2017
Inspection Type: ENCROACH
Inspection Area: PW
Site Address : 1 PUBLIC ROW
A/P/D Information:
Activity : N2017-0111
SubType :
Status : APPROVED
OWNER: CITY OF NEWPORT BEACH Phone :
APPLICANT: THE FISHEL COMPANY Phone : 714-668-9268
Description : Bore 2,122 LF of 4-inch conduit and (4) 17"x30" vaults for Level 3 Communications on the
west side of Jamboree Road between Eastbluff/University to approximately 700-feet south
of Bison Avenue. Sidewalk restoration per Citv Standards.
Item: 10110 CONCRETE PUBLIC WORKS
Requested Time: 3/30/2017 12:00:OOAM Requestor: WEBUSER
9492548306
Entered By: WEBUSER
Comments: ANY -
Assigned to: z777777777�- %
Inspector: 'i V Date: Time: / : QSA PM
Comments:
t
G—
Gm
Refile
F:\Users\PBW\Shared\ENCROACHIMASTERS\FORMS\Inspectorsheet.doc
z
REPT131. Run Id: 4018
_VjIff 7 *,pI .iqnU City of Newport Beach
'•.4'r31--06PM -- --.---INSP150-= Daily -I nspection-Request -Report
- --
T E FE4dg*f 13
Requested Inspection Date : 03/31/2017
Inspection Area: PW
• • ► ��••:
APPLICANT: THE FISHEL COMPANY
Phone : 714-668-9268
" the
west side of Jamboree Road between Eastbluff/University to approximately 700-feet south
Requested Time: 3/31/2017 12:00:OOAM Requestor: WEBUSER
9492548306
Entered By: WEBUSER
Comments: ANY-
Wd WV :awil
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-
:aiea
Logged
Rofde
:sluawwoa
:aoloadsul
'-4/4/20W . City of Newport Beach Page I of 3
4:30:42PM INSP150 - Daily Inspection Request Report
Activity :
SubType:
Status :
Requested Inspection Date: 04/05/2017
Inspection Type: ENCROACH
Inspection Area: PW
Site Address: 1 PUBLIC ROW
N2017-0111
APPROVED
OWNER: CITY OF NEWPORT BEACH Phone :
APPLICANT: THE FISHEL COMPANY Phone : 714-668-9268
Description : Bore 2,122 LF of 4-inch conduit and (4) 1 T'x3O" vaults for Level 3 Communications on the
west side of Jamboree Road between Eastbluff/University to approximately 700-feet south
of Bison Avenue. Sidewalk restoration per City Standards.
Item: 10110 CONCRETE PUBLIC WORKS .
Requested Time: 4/5/2017 12:00:OOAM Requestor: NBIVR
7146689268
Entered By: NBIVR
Comments: AM
Assigned to:
Inspector: t 1\ Date: &11 Time: AM M
Comments: ,e
F:NUsers%PBMShared%E NCROACHIMASTERS%FORMS\InsoectorSheet.doc
REPT131.
Run Id: 4018
.'.4/512017 City of Newport Beach Page» of 11
4:30:58PM INSP150 - Daily Inspection Request Report
Activity :
SubType:
Status :
Requested Inspection Date: 04/06/2017
Inspection Type: ENCROACH
Inspection Area: PW
Site Address: 1 PUBLIC ROW
N2017-0111
APPROVED
OWNER: CITY OF NEWPORT BEACH Phone :
APPLICANT: THE FISHEL COMPANY Phone : 714-668-9268
Description : Bore 2,122 LF of 4-inch conduit and (4) 17'x3O" vaults for Level 3 Communications on the
west side of Jamboree Road between Eastbluff/University to approximately 700-feet south
of Bison Avenue. Sidewalk restoration per City Standards.
Item: �00 Z 4' MOW
Requested Time: 4/6/2017 12:00:OOAM Requestor: WEBUSER
714-668-9268
Entered By: WEBUSER
Comments: ANY -
Assigned to: 77777777777*
Inspector: I V Date: 7 / Time: PM
Comments: IV"
F:\Users\PBW\Shared\ENCROACH\MASTERS\FORMS\InsoectorSheet.doc
REPT131. Run Id: 4018
-4/612017 City of Newport Beach Page 6 of 7
4:30:28PM INSP150 - Daily Inspection Request Report
Requested Inspection Date:
04/07/2017
Inspection Type:
ENCROACH
Inspection Area:
PW
Site Address:
1 PUBLIC ROW
WA- /PID Information:
Activity : N2017-0111
SubType :
Status : APPROVED
OWNER: CITY OF NEWPORT BEACH Phone :
APPLICANT: THE FISHEL COMPANY Phone : 714-668-9268
Description : Bore 2,122 LF of 4-inch conduit and (4) 17"x3O" vaults for Level 3 Communications on the
west side of Jamboree Road between Eastbluff/University to approximately 700-feet south
of Bison Avenue. Sidewalk restoration Per Citv Standards.
Item: 10110 CONCRETE PUBLIC WORKS
Requested Time: 4/7/2017 12:00:OOAM Requestor:
Entered By: WEBUSER
Comments: AM -
Assigned to: 77777777777;
Inspe or: :_
Comments:
Date: -7
WEBUSER
714-668-9268
21
Time: PM
Z:a/!/"7-
eq v,�tJl� �-JA Yl,e3��2�C .677•�J / u�vlG S�7
F:\Users\PBW\Shared\ENCROACH\MASTERS\FORMS\InsoectorSheet doc
REPT131. Run Id: 4018
• .'. 41111201'7 City of Newport Beach Page 3 of 10
6:34:20AIM INSPI-50 - Daily Inspection Request Report
Requested Inspection Date : 04/11/2017
Inspection Type: ENCROACH
Inspection Area: PW
Site Address: 1 PUBLIC ROW
Activity : N2017-0111
Subtype :
Status : APPROVED
OWNER: CITY OF NEWPORT BEACH Phone:
APPLICANT: THE FISHEL COMPANY Phone : 714-668-9268
Description : Bore 2,122 LF of 4-inch conduit and (4) 17"x30" vaults for Level 3 Communications on the
west side of Jamboree Road between Eastbluff/University to approximately 700-feet south
of Bison Avenue. Sidewalk restoration per City Standards.
Item: 10110 CONCRETE PUBLIC WORKS
Requested Time: 4/11/2017 12:00:OOAM Requestor: WEBUSER
714-668-9268
Entered By: WEBUSER
Comments: AM -
Assigned to: 77777777777�
Inspector:
Comments: vV/ r A l
Date: el `/ / 7 Time: 0. 3 o AM PM
P
mac. s
iry sG I-1 T-
7r 5
F:1Users\PBW1SharedIENCROACHIMASTERSIF0RMSIInsoectorSheet doc
RE;PT'131. Run Id: 4018
4/1712017. i City of Newport Beach Page 3 of 16
s:34:2sAM INSP150 - Daily Inspection Request Report
Requested Inspection Date: 04/17/2017
Inspection Type: ENCROACH
Inspection Area: PW
Site Address : 1 PUBLIC ROW
Activity : N2017-0111
SubType :
Status : APPROVED
OWNER: CITY OF NEWPORT BEACH Phone:
APPLICANT: THE FISHEL COMPANY Phone : 714-668-9268
Description : Bore 2,122 LF of 4-inch conduit and (4) 17"x3O" vaults for Level 3 Communications on the
west side of Jamboree Road between Eastbluff/University to approximately 700-feet south
of Bison Avenue. Sidewalk restoration per City Standards.
Item: 10110 CONCRETE PUBLIC WORKS
Requested Time: 4/17/2017 12:00:OOAM Requestor: WEBUSER
714-668-9268
Entered By: WEBUSER
Comments: AM -
Assigned to: 77777777777't ToM
71 IWOW }
4/24/2017 City' of Ne.Wpoi it b ach Page 10 of 14
6:34:39Ann INSP150 - D'a'ily Ins'pec'tio'n Raquest Report
Requested Inspection Date : 04/24/2017
1'nspection T3 - : ENCROACH
1ntpection Area : PW_
'Site Address : 1 PUBLIC ROW
17-0111
SubType :
Status : APPROVED
OWNER: CITY OF NEWPORT BEACH Phone :
APPLICANT: THE FISHEL COMPANY Phone : 714-668-9268
Description : Bore 2,122 LF of 4-inch conduit and (4) 17"x30" vaults for Level 3 Communications on the
west side- of Jamboree Road between Eastbluff/University to approximately 700-feet south
of..Bison Avenue. Sidewalk restof-ation per City Standards.
Item: 10020 PERMANENT PAVING- PW
Requested Time: 4/24/2017 12:00:OOAM Requestor: WEBUSER
714-668-9268
Entered By: WEBUSER
Comments: AM-
Assigned to: 77777777777*
Inspector: ,� l� Date: ql-LL1117 Time: 10 A PM
Comments: Gdi1�Ti/�t7►2 Gcw�t /1 +.e /'LGct
0*7--ez,5-
LogWd
'vie
F:\Users\PBW\Shared\ENCROACH\MASTERS\FORMS\I nspectorSheet.doc
RE PT 131-------...--- -'- . - ..... _ ....---..........._.........----'--............. _ ._.._..-_........_ .. _— Run . Id':
_....4 _o i:s. ;
r..he. M...�"_ac."1n,7ri.NL'k�a,1►.i:'a•1,._. ::.vf:s�'Y�l:c�si.]-iir�.__ ,Aa�'.� ti .. �L.. •� � � N - v:! 4.-."Ei
- 'ice'. :..:�;�.' ~i:....�aa._...._ . y'.'i�lc..t.irtaa:cl,...n��... :sa. ."i��ta�i4W�9�s161�.C1nt i�Mia lv'' ems:. •i
8,
'Status : APPROVED,'
2
OWNER: CIW OF NE-.VVPqff.'BE-ACH
APPLIC ANT, -THE.F[SkE.L COMPANY
boscriA0,tib'ri Bid"re 1.fF9i'LO'�-:6"f- 4-incsh, condui
t and (4) 17:
west
Phone
Pfibne 7147668-9268
vaults for -Level 3 Cdmtnunicbtions on the
JniV,ersi-ty.td'dppr6xiwjteIV 7004ee0so'dh
I - .12
3tand'ards.
tl
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7114-668'64'268-
Er*4r6.d',jB.y: WE-BUSER
COM, AM -A
'e# S,
Inspector Dtime: 0
77,7.7-7-777.777
Date: 7 �-rpm
Comments:. `-V.
K
4Vdob
f
511/2017 City of Newport Beach Page 16 of 17
6:34:14AM INSP150 - Daily Inspection "Request Report
Requested nspection Date : 0b/U'W1
•Inspection Type : EN, CROACH
[nspection-Area : PW
Site Address : 1.PUBLIC ROW
Activity : N2017-0111
SubType :
Status : APPROVED
OWNER: CITY OF NEWPORT BEACH Phone:
APPLICANT: THE FISHEL COMPANY Phone : 714-668-9268
Description: Bore 2,122 LF of 4-inch conduit and (4) 1 T'x3O" vaults for Level 3 Communications on the
west side of Jamboree Road between Eastbluff/University to approximately 700-feet south
of Bison Avenue. Sidewalk restoration ver City Standards.
Item: 10020 PERMANENT PAVING- PW
Requested Time: 5/1/2017 12:00:OOAM Requestor: WEBUSER
7146689268
Entered By: WEBUSER 141-2l
Comments: AM-
Inspelk igned to : zz777777777•Date: ( (_7 Time: PM
Alt NO-5-
• - �7 A-cltit _
PO y- J*A) 4,1� S *)OP0s6194y", 44r��
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F:\UserslPBlMShared%ENCROACH\MASTERS\FORMS%InsoectorSheel doc
RE-PT131.
tea._ r!A1 ..� ._i.. k.N:c .FJ �... •R•.t �.L•r: .v � :� ,
Run Id.: 4.018
- CONTROL THIS IS NOT 9 TICKET NO. • RO�ERTSON'S
NUMBER .�
2 5 2 14 2 0 g
.Phone 800/834-7557 San Diego 800/870-1220
r I RIVERSIDE • 5120 20M ST W Ww rrmca.com
r2 MORENOVAU.EY-12690DAYST OPEN 7 DAYS
03 •REDLANOS - SM ALABAMA $T
IF 13 RMNOALE .13631 LIVE OAK LANE
rA EaNiTANA • 13M ROVER AVE.
# IA PASAOENA - f A20 N UNCOLN AVE.
023 PARAMOUNT • 7277 E ROSECRANS AVE.
r5 POMONA • 2410 POMOHA BLVO
r 15 VENNON•l05 ANGELES - 3365 E 26TH Si
r24 RIALTO .2501 N. ALDER AVE.
06 HEMEUSAN 4ACINTO.1675 STATE Si
r16 ANAHEIM • 201 E. COMMERCIAL ST
025 GARDENA • 301 W ROSECRANS AVE
r7 BEAUMONT • 452 W LUIS ESTRADA RD
017 SANTA ANA • 310 N. TOWNSEND ST.
r26 THOUSAND PALMS • 72460 VARNER RD
re SUN CITY • 27050 WATSON NO
rle LAKE FOREST - 25931 TOWN CENTRE OK
027 MURFUETA • 26190 ADAAS AVE
09 ARROWHEAD. 29750 HWY IS
019 ADELANTO.122M VIOLET RD
028 OTAY MESA • 7961 AIRWAY NO.
010 SANTA FE SPRINGS -12311 GREENSTONE AVE
r20 SAN CLEMENTE -116 RRCON CT
029 EL CASON - 215 CYPRESS I.H.
r11 CABAZON -13M APACHE TRAIL
r21 IRVINE -16001 CONSTRUCTION ON WEST
r30 CORONA - 1540 SHERSORN ST.
012 SAN BERNARD= -1955 W.9TH ST.
r22 NO HOLLYWOOD - 13132 RAYMER ST
r31 HESPERIA - 9561 CAVE.
PLANT DATE CUSTOMER NO: SOLD TO:
21 05/08/17 6930 FISHEL
TX CO DELIVERY ADDRESS 6 INSTRUCTIONS
JAMBOREE RD & BISON AVE
032UPLAND .1975N.SENIOR`.,
041MOJAVE•140EHWY 50 -
033 MRAMAR - 5692 EASTGATE 00. • • '
042 VICTORV41E -16952 N DST '
034 LUCERNE - 36555 HWY 10 _:
rtl BAKER - 56500 BAKER BLVD
035 BIG BEAR LAKE -'.a2025 GARSTR OR. '
ru FT IRWIN - 50e25 FORT RVAN NO
036 ESCONDIDO.1310 SIMPSON WAY
r45 9ANSTOW - 2700 E. MAR ST.
037 INOIO - Bar 10 FARM CANYON NO
046 CAL -CITY - 7900 MOSS AVE.
03e R10GECREST .2157 RYOKERN RD
047 FORT OF LONG SEACK IOU W. PER 0 St '
039 PALMDALE - 37190 75TH ST EAST.
00 EL CENTRO,1051 N. P ST.
040 ARTESIA -139a9 E. STAGE ROAD
,•
r
MAP PAGE
.
TICKET NO
COMPANY, THE 889E4 2521420,'
CUSTOMER P.O / JOB OR LOT di
25F 1112185 25170449 •' . • .
NEWPORT BEAC ( 58-0830LAST TKS
Job Phone : (714)549-2475
ORDER NO METER READING TIME TYPED TRUCK LIC NO.
586 1600.00 10:43 93769L1
LOAD NO SLUMP TRUCK DRIVER
1 4.00 1476 7325 LARA, R I CHARD— (DL) CITY SIDEWALKS - ., nt
f� REEVUS:: Job -site Cylinder TdOB ED]RAT • 1 1 : 00 � �(r�
TO JOB h . C3 V Q TIME ON JOB MIN CHECK #
ON JOB j A ' Of) 1 C Water added on job at STAND BY MIN. CHECK ❑ ` .
+ ` Customers request: AMOUNT
START POUR' • , �� gals to Full Ld. RATE OF X a PER MIN CASH ❑
AMOUNT 6Y
FINISH POUR �to 2/3 Ld. $ PLANT MGR SIG
gals to 1/3 Ld. OVERTIME CHARGE
LEAVE JOB r1 4 min. per yd unloading time allowed
ADJ. Meter M►�T Additional unloading time charged at current hourly truck rate.
ARRIVE PLANT Additional 100fITd blin concrete will reduce Its seergOL Any water added eveednng the design water is S customer's own risk .
Signature certifying under penalty of perjury that the information contained In this written time record Is true and correct.
EYPl1 Sir
Customer agrees that the described
Customer further agrees that it shall
location Customer s review and apt
releases and agrees to defend, nnde
arising from (1 material bem Inapg
movement of Robertson S Verlides I
Customer agrees to pay such reasc
Customer agrees to pay a time prICE
Robertson's a not responsible for tl
LD OTY j CUM OTY
r
has been
ns relating to the pro eCl(s) where the material is
I on -site drectan of bertson's vehicles to the
erial on the job site. In consideration of the above
1 costs and claims asserted by Customer or airy
litions on the land where the material is utilized,
in the event Robertson's retains the services of
mer disclaim attomey's fees arising from any 00
I Yi % per month on arty amounts owed to Robertson's for more than thirty (30) days. Color Disclaimer Due
y concrete where the Co" agent tiers been added at the request of the customer, either at our plant or an
I OTY PROD CODE MIX AND COMMODITY UOM
i r
or
or
or with the ground Sods or
2.00 2.00
12.00 0056,0133
56OC3250—REVSD ORNGE YD3
CEMENT TYPE TI/V
WATER ALLOWED
74
OGAL
,
WEIGHINASTERCERTW&ATE
WATER BATCHED
52. 5GAL
•
CERTIFY that the 101bwing1O Countedbya weng5MOISTURE
WATER
14.OGAL
L11.S
ecognized authoritof awith Sedan 12700) of Omsian 5 of the Caldwnia Business and
MAX ADD 'WATER
9. 5GAL
°de admirnisteredbytne°"�sr"'ofMeas"reme"'s ardsot'he
CaVfomis Department of Food and Agriculture.
CEMENT LB
1:350
ROBERTSON'S
3/8 AGG LB
4��
WEIGHMASTER
I" AGG LB
38800
W SAND LB
2800
BYOEFVTY
UOM CONVERSION CY.YAROS3 #.POUNDS GL.GALLONS FO-0UNCES CU.METERSi K6•aLOGRAM L.UTERS "t. 111116 111SR i
iC chard Pierson
a -
CONCRETE DELIVERY TICKET
AGREED TO AND RECEIVED ""CUSTOMER
PO BOX 3600 CORONA, CA 92878.3600
9rities and/or
ate.
UNIT PR
TAX
PREVIOUS
BALANCE
SUB
TOTAL
STAND BY
'�- CHARGE
TOTAL
ti
AMT
5/4/2017
4:30:30PM
City of Newport Beach
INSP150 - Daily Inspection Request Report
Page 7 of 12
Requested Inspection Date: 05/05/2017
Inspection Type: ENCROACH
Inspection Area: PW
Site Address: 1 PUBLIC ROW
A/P/D Information•
Activity: N2017-0111
SubType:
Status : APPROVED
OWNER: CITY OF NEWPORT BEACH Phone:
APPLICANT: THE FISHEL COMPANY Phone • 714-668-9268
Description : Bore 2,122 LF of 4-inch conduit and (4) 1 T'x3O" vaults for Level 3 Communications on the
west side of Jamboree Road between Eastbluff/University to approximately 700-feet south
of Bison Avenue. Sidewalk restoration per Citv Standards.
Item: 10020 PERMANENT PAVING- PW
Requested Time: 5/5/2017 12:00:OOAM Requestor:
Entered By: WEBUSER
Comments: AM -
Ass' ned to: 77777777777*
Inspector: Date: T- 67/
WEBUSER
714-668-9268
Time: 8 = —4-T AM PM
Comments: 6-04" rnZ.�c'zvA Gflti 2 r - �f�v 2 �• -Tzo
F:\Users\PBW\Shared\ENCROACH\MASTERS\FORMS\InsoectorSheet.doc
REPT131.
Run Id: 4018
• 7
wgodes.�Psge'•14 of 1S
f :s:3a2oAnn'* `�
INSPf150' -iy�i speycn'a�)R�]egestFteP.ort.
-
'Reque6ted-.Inspectioq@ate• : 05/08/201'7..
InspecfionpwT�ype- ENCROACfi
i?�W .
„ - + •2,
='!Ste,.Address,: 1:�PU,BLICJROIIV
4•
A/P/D Information•
_
rACt vity .
SutiT pe,:
N201a7,'-U1-11 •;: -
ARPROVED
OWNER :
CITY OF NEWPORT BEACH r Phone:
APPL''ICAN, :
THE FISHEL COMPANY , Phone : 714-668-9268
Description :
B}ore 2,1221R-0f:4-inch.conduit�and (4) 1.7. x30" vaults for•.Le'vel 3 Communications on the
west side of Jamboree -Road• between: Eastbluff/University`to. approximately 700-feet south
of .8isonAvenue, _Sidewalk. resW,ation;peP City Standards.
Requested Inspe_ ction(s•�
1.0020 PERMANENT PAVING- P.1N
� � ,; ..
Requested Time:
5/8/2017 12:00:00AM Requestor: WEBUSER
'
714-668-9268
Entered By:
WEBUSER
Comments:
AM -
Assigned to
77777777777�j
�J
Inspector:
y Date: Time: AM PM
,. 'Comments: 649/`r AA &Z2 CO/l 't PG& Sv�-
/WPX-0yVni 'T - %oC .
iii
1
1 F:\Wse?s\PBVMhared\ENCROACH\MASTERS\F•ORMS\IrisoectdrSheet.doc
.i
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d-•hi��^sdri!» - -_ _ i• ti a 13(�tJi�/il ice'' _ '=^.ai�##4f
TY11s is NOT A ncNAET No. 'RO�ERIMON'S
t '' 11t CONTROL
.
7NUMBER 5 21 5 Phone 800/834-7557 San Diego 800/870.1220 '
II• RIVERSIDE-612p/•7ST
12 MORENOVALL(V, 12a900AY$T
W7WW.r(mCa.COm
OPEN 7 DAYS
03 REOIANDS -111M AIABAMA ST
I13 IRWINDALE -13631 LIVE OAK LANE '
04 �FONIANA • 13M STOVER AVE.
I14 PASADENA . 1420 N. LNCOLN AVE #23 PARAMOUNT • 7277 E ROSECRANS AVE.
IS POMONA•:L 2Q0 POMONA BLVD
06 •HEMETFAM O=TO.1675 STATE ST
015 VERNON{OS ANGELES - 3365 E 26TH ST 024 RIALTO . MI N. ALDER AVE.
015 ANAHEIM - 201 E. COMMERCIAL ST + 125 GWENA • 301 W. ROSECRANS AVE
IIeEAi1MONT - 452 W. UJIS ESTRADA RD
017 SANTA ANA . 310 N. TOWNSEND 51 026 THOUSAND PALMS - 72460 VARNER RD
:a- m SUN C• 27050 WATSON RD.
016 LAKE FOREST • 25931 TOWN CENTRE OR IAMt 027 MURRIETA - 26190 NS AVE -
.. ARROWNW - 29750 HWY IB
fig AOEIANTO.12203 VIOLET RD. %• 028 0UY MESA - 7961 AIRWAY RD. '
Ii0 SANTA FE SPRINGS; 12311 GREENSTONE AVE.
020 SAN CLEMENTE • 116 RNCON CT 029 EL CAJON : 215 CYPRESS LN.
III CABA20il • 139M APACHE TRAIL
012 SAN dAlIM10IN0 ;1955 W 9TH ST
021 HIM • 16081 CONSTRUCTION CIR WEST 030 CORONA • 1S40 SHFAeORN ST•.
022 NO HOl1YW000.13132 RAYMER ST 031 HESPEAIA • 9651 C AVE
PLANT DATE CUSTOMER NO' SOLD TO: +,'1•� • ' +: r^
21• 05/09/17
6930 J FISHEL COMPANY, TH
TX CO DELIVERY ADDRESS 8 INSTRUCTIONS
r
JAMBOREE
RD & BISON AVE �'•
1,. NEWPORT BEAC
Job Phone
: (714) 549-2475 . • t• ' •
ORDER NP.. METER READING
TIME TYPED TRUCK LIC NO.""'
rP"' 555 1600.00
10:28 2550i4LI .
'LOAD'NO. SLUMP
TRUCK DRIVER ti '
1 *%,4.00
"C DRUM
r REVS:
TO JOB v
ON JOB 'I(Y
START POUR. L /��'►
FINISH POUR TJ
1 ,
LEAVE JOB'
J
ARRIVE PLANT
Signature codifying under penalty of perli
lt,EMPJS ' C 7 I '' SIGNATURi
Customer agrees that thellescribed malei
Customer further agrees that It Shall be sole
location. Customer s review and approval it
releases and agrees to defend. indemnify a
arising from Cl material being inappropriate
movement Of bertson's ve des upon or
• Customer agrees to pay such reasonable a
Customer agrees to pay a time (ram differei
Robertson's is riot responsible IW the resull
LD OTY CUM OTY
2. 00 -•2. 00
4
032 UPLAND -J975 N. BENSON 041 MOJAVE -140 E. HWY S5 • v
033 MIRAMAR - 5692 EASTGATE OR 042 VICTORV41E-16952.0. 0 ST. . y
,'
03e LUCERNE .36555HWV 1S 043 BAKER `56S00OAKS BLVD,
035 BIG BEAR LAKE • 42025 GARSTIN OR IM FT. IRwiN - 5a625 FORT am RD. t
035 ESCONDIDO.1310 SIMPSON WAY 045 BARSTOW 4700 E. MAIN ST \ •
. 037 Wool - flat 10 FARGO CANYON RD 046 CAL -Cm' 4900 MOSS AVE, •� •;, ,
,
036 RIDGECREST - 21S7 NltDORN RD. 047 PORT OF LONG BEACH, 1602 W. PIER 0 ST •
139 PALMDALE • 37M 75TH ST EAST I/a EL CENTRIf 1051 N. P ST. •- x •
_ A74
/Ao ARTESIA -13949 E STAGE ROAD .
,
MAP PAGE TICKET NO.
889F4 21r5533'
CUSTOMER P.O / J08 OR TAT 8 _
>t'
25F 111310 25170449
(858) 658- tZ183@LAST TKS
1347 4413 FU.jTD'.MATT- (RP. N. PC I TY SIDEWALKS
T
r s Job site Cylinder Ted 7P tQF� Ps �11 : 00 A
TIME ON JOB MIN. -CHECK M
Water added Tin loti at,,
/ STAND BY MIN. CHECK 0
Customer ' request: " • �-� AMOUNT EiY _ i :. 7
gals Ito FUII Ld. RATE OF X $ J PER MIN. CASH ❑AMOUM rBy
'
gals 16 2/3 Ld. t
$ PLANT MGRISIG � � • • •'
gals to 1/3 Ld. OVERTIME C11AFIGE
4 min. per yd. unloading time allowed.
ADJ. Meter,,,r, {{ Additional unloading time charged at current hourly truck rate.
;• i Additiorelv}ater P((TT P1s wr,oete will redlKe d5 soagUl. Aril' water added aaceedirp the design water is at tUSIOrrNJ'S Own risk �
that the Inlfirmatien contained In this written time record Is true and correct. :
has
I Shall bl
and its
OW or
lbout the delivery location. Solely to the extent CUSH
lomey's fees incurred by Robertson's in furtherance
Gal of 1 h % per month on any amounts owed to Rot
I of any concrete where the coloring agent has been
ORD OTY PROD CODE MIX
TERMS AND CONDITIONS OF SALE _
rection. or review of any plans or specifications relating to the proi'ect(s) where the material is to be usbd.
nest of material on the job site, irir g the on•sne irecUon of H�obertson's vehicles to the designated -
lure and/or placemen�of the described lnalenal on the pti s1te. In oonslderation 01 the above, Customer
from any and all l0 damages, IiatlOwes, costs and claims asserted by Customer or arry thud party, tfJT ►i `
ClfiCalKJr151, On with the round Sod. W COnId i. On the land where the material i5 UIIIi2ed. 8rld (i) the
IS to time pay Or
the bed nrlale(in N the QYenit Robert5W1'S (elein5 lh@ ServICe9 OI art 8tt0mey
Collection efforts. Robertson's and Customer diSCWun attorney'S tees arising from any other context' ,
;for more than thvty (W) days. Color Oleelafiner Due to irregulanues and/or irrcorrsiStenCy of materials ^
at the request of the customer, either at our plant or on the job site J..:
COMMODITY UOM UNIT PR AMT _ ;.•: c
2.00 00560831 560d3250-REVSD ORNGE YD3'
CEh8NT TYPE I I / V
�
r
WATER ALLOWED
76. OGAL
or-
- wEIOHWAISTERC NTIFICATIE
= WATER BATCHED
49. 0GA1_
D-IIS IS TO CERTIFY that the following -described commodity was weighed.
TAX
measured, or coiAed by a weighmaster, whose signature is on this Certificate,
MOISTURE• WATER
i
18. OGAL
who is a recognized authority.of accuracy, as prescribed by Chapter 7
e
(comm with Section 12700) of Division 5 of the California Business and
PREVIOUS
MAX ADD WATER
9. OGAL
Professodered erect w One oirti0r, of Measurement standards of the
•Ca6lamia Oep�ent d Food and Agriculture.
BALANCE
CEMENT LB
1340 '
RoefearsoN s
'
'
3/8 AGG ` LB
320
WEIGHMASTER
i
TOTAL
111 AGG LB
3160
STAND BY
W SAND LB
2840
( BY DEPUTY
CHARGE
UOM CONVERSION CY.YAROS3 #.POUNDS GL.GALLONS Fo-0UNCES CU.METE0. 3 g;�(1LOGFAM LdnENS ML.MILUUTER i ch a r d Pierson
!j 1
C&.
CONCRETE DELIVERY -TICKET
TOTAL -
AGREED TO AND RECEIVED BY CUSTOMER
^, 0 BOX 3600'CORONA, CA 92878-3600
a
51812017f" City of Newport Beach Page 6 of 17
• 47:30:18PM INSP150 - Daily Inspection Request Report
Requested Inspection Date: 05/09/2017
Inspection Type: ENCROACH
Inspection Area: PW
Site Address : 1 PUBLIC ROW
Activity : N2017-0111
SubType:
Status : APPROVED
OWNER: CITY OF NEWPORT BEACH Phone :
APPLICANT: THE FISHEL COMPANY Phone : 714-668-9268
Description : Bore 2,122 LF of 4-inch conduit and (4) 17"x30" vaults for Level 3 Communications on the
west side of Jamboree Road between Eastbluff/University to approximately 700-feet south
of Bison Avenue. Sidewalk restoration per Citv Standards.
Item: 10020 PERMANENT PAVING- PW
Requested Time: 5/9/2017 12:00:OOAM Requestor: WEBUSER
Entered By: WEBUSER
Comments: AM -
Assigned to:
Inspector:
77777777777*
v
714-668-9268
Date: $'- Time: / Z ,J0A S
Comments: LPL(/ S�w � 2�¢-7' "V
PD O
Pew 7—c— P s ,
� �iN4-1_ w ><
-ttf i Li-�y PG 7-7 c '' f'C5,� S .
Logged
F:%Users%PBMShared%ENCROACH%MASTERS\FORMS%InsnectorSheet doc
REPT131.
Run Id: 4018
1/4/2022 City of Newport Beach Page 11 of 19
.4:30:56PM INSP150 - Daily Inspection Request Report
Requested Inspection Date: 01/05/2022
Inspection Type: ENCROACH
Inspection Area: PW
Site Address : 1 PUBLIC ROW
Activity
SubType :
Status :
17-0111
APPROVED
OWNER: CITY OF NEWPORT BEACH Phone :
APPLICANT: THE FISHEL COMPANY Phone : 714-668-9268
Description : Bore 2,122 LF of 4-inch conduit and (4) 17"x3O" vaults for Level 3 Communications on the
west side of Jamboree Road between Eastbluff/University to approximately 700-feet south
of Bison Avenue. Sidewalk restoration per City Standards.
Item: 10250 FINAL - PW
Requested Time: 1/5/2022 12:00:OOAM Requestor: WEBUSER
If
Entered By: WEBUSER
Comments: 'ANY-'
Assigned to:
qmwp WOO&
77777777777*
i9�
��Valew
115:4
p'Ptirl CP�p�'�