HomeMy WebLinkAboutN2017-0375�wN,.
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City of Newport Beach
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Permit No: N2017-0375
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100 Civic Center Drive, Newport Beach, CA 92660
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Permit Counter Phone (949)644-3311
Project No
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Online Inspection Request - www newportbeachca
gov / Online
Services
Inspection Requests Phone (949)644-3255
Job Address
1 PUBLIC ROW NB
Thomas:Guide:
Description :
BLUETOOTH WIRELESS DEVICE SYSTEM
ON COAST HWY AT IRVINE TER
AND COAST HWY AT AVOCADO AVE.
Parcel # .
Legal Desc :
Owner:
CALTRANS
Contractor : St? rv11'te�- - oo(whclrks
Phone:
Phone:
Address :
COMPLETED
Address
Contractor State Lic: Q-1 (o( 4-3
Applicant:
CALTRANS
License Expire :
Phone:
949-279-8838
Address :
6533 MARINE WAY
IRVINE, CA
Business License: j /A
Business Expire:
Special Cond.:
NO FEE ENCROACHMENT PERMIT (BS)
Workers' Compensation Insurance - -
Carrier :
Policy No: -rr�V�� P„U�i�►„ /,
W. C. Expire:
Permit Processing Fee : $0.00
Sewer Connection :
$0.00
Total Fee $0.00
Agreement Fee -
$0.00
4TT Box Cover:
$0.00
Paid : $0.00
Traffic control Plan Check . $0.00
Total Water Meters :
$0.00
Balance : $0.00
Inspection Fee :
$0.00
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 :
Traffic Approval :
Sc
Date : /2-q/(I
Issued Permit : <C— Date : / 'Z-q 7
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 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 limes Work, which has been done prior to issuan
a permit, is subject to rejection/fine City reserves the right to void permit if work does not commence within 30 day
after date of issuance
2 The Permitlee agrees to defend indemnify and hold the City, its authorized agent, officers, representatives and
employees harmless from any responsibility liability suit or action of any description arising out of any accident, loss
or damage to persons or property occurring as a result of work undertaken under this permit
3 All work shall be done in accordance with the approved plans Standard Specral 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 State Contractor License Class A can perform any work in the public right-of-way For
construction or connection to water lines a valid Slate Contractor License Class C-34 is required For construction or
connection to sewer lines a valid 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 by the
California Department of Transportation If needed barricades can be obtamed 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 limes
10 Work within or near beach sensitive areas will not be allowed during City holidays spring break MemonaI 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 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
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
No work related to this encroachment permit shall be performed until the Public Works Department has issued this
conditions of this permit and he/she agrees to abide by them. Permit is void if work is not commenced within 30 days
Permit fees are nonrefundable.
WORKER'S COMPENSATION INSURANCE (Section 3800 Labor Code)
I certify that I have a Certificate of consent to self -insure, Certificate of Wor-ker's
G�mpensati Insu ance, or a Certified Copy thereo .
Gate: 2 / Signature: tVT Z / Signature: t
CERTIFICATE OF EXEMPTION (Section 3800 Labor Code)
I certify that in the performance of the work under this permit, I shall not employ
any person so as to become subject to California Worker's Compensation Laws. If,
after signing this certificate I become subject to the Worker's Compensation
provisions of the State Labor Code, I must comply with the provisions of Section
3700 or this permit shall be deemed revoked
Date: Signature:
CONTRACTOR LICENSE EXEMPTION
As the Owner of the benefiting property, I certify I am personally performing all
work in the Public Right -of -Way.
Date: Signature:
HOLD HARMLESS STATEMENT
I understand that I am locating minor encroachments within the City Right-of-
Way/Easement. As property owner it is my responsibility to maintain the
encroachments. I will be responsible for replacing the improvements if the City
removes them for maintenance of utilities or other public need. I shall indemnify
and hold the City harmless for any liability associated with the minor
encroachments.
Date: Signature:
24-hour notice for Encroachment Permit Inspection is required by calling
Public Works at 949-644-3311.
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
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 Stale
prison plus the full cost to clean up an illegal discharge or spill
17 If a refundable deposit was paid, applicant must submit a Soils Compache'i
Certificate or Evidence of a Slurried Backfill and request a final inspection from thr-
Pubhc 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 Mork,
Department or corrections will be required (i e removals exposing connectinns.
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
licant hereby acknowledges he/she has read and understands the terms and
a uance. Date:!lQ
7.2Y 'JSiynature:
DETAILED DESCRIPTION OF PROPOSED WORK:
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APPLICANT: Phone: q 2 r
Email Address: 5. t t O
Mailing Address: n City/State/Zip:
UWNEK: Phone:
Email Address:
Mailing Address: City/State/Zip:
GUNTKAUTUK:
,S' S Office Phone:
Company (if different): Jobsite Phone: 26 ^ 2 —
Other Phone:
Email Address:
Mailing Address: City/State2ip:
c :rW Lk
State License Number & Class: City Yusiness License Number:
C Expires: Expires:
WORKERS COMPENSATION INSURANCE - Certificate of Insurance (Section 3800 Labor Code)
Com an : Policy No: Expires:
Municipal Orations: 949-644-3055
Utilities: 949-644-3011
Urban Forest : 949-644-3083
Special Conditions of Permit:
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Utilities: Traffic: Fire: 0
Municipal Operations Other:
Engineering Technician: Permit Specialist Date: Permit No.
St% I 1 -7 �� N2017- d3�55
f /users/pb w/shared/encroach/masters/epworksheet As
Public Works Department 949-644-3311
100 Civic Center Drive, Newport Beach, CA 92660
Encroachment Permit N2017-0375
Conditions of Approval
• Emergency Contact
Caltrans Maintenance: Jason Gonsman (949) 517-8265
Contractor: Sam Saldivar (949) 279-8838
• Traffic control per latest edition of WATCH
• Notify the Public Works Department 48 hours in advance of installation for inspection.
• Bluetooth Device Locations:
Coast Hwy at Irvine Terrace and at Avocado Ave
• Do not install a Bluetooth devices at Coast Hwy at Newport Coast and Coast Hwy at Marguerite.
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CONTRACTORS STATE LICENSE BOARD GO
Contractor's License Detail for Lic tfr
# 976173
)ISCLAIMER: A license status check provides information takeense database. Before relying on this
nformation, you should be aware of the following limitations.
CSLB complaint disclosure is restricted by law (B&P 7124 6) If this entity is subject to public complaint disclosure, a link for complaint disclosure will appear below. Click on the
link or button to obtain complaint and/or legal action information.
Per B&P 7071 17 , only construction related civil judgments reported to the CSLB are disclosed.
Arbitrations are not listed unless the contractor fails to comply with the terms of the arbitration.
Due to workload, there may be relevant information that has not yet been entered onto the Board's license database.
(This liceryge is current and active
All information below should be reviewed.
!C10 - ELECTRICAL
Data current as of 7/24/2017 10:36:41 AN
Business Information
SERVITEK SOLUTIONS INC
618 BREA CANYON ROAD
SUITE J
CITY OF INDUSTRY, CA 91789
Business Phone Number:(626) 227-1650
Entity Corporation
Issue Date 08/25/2012
Expire Date 08/31/2018
License Status
Classifications
Bonding Information
Contractor's Bond
This license filed a Contractor's Bond with SURETEC INDEMNITY COMPANY.
Bond Number: 115401
Bond Amount: $15,000
Effective Date: 07/22/2016
(Contractor's Bond History
Bond of Qualifying Individual
The qualifying individual GEOFFREY BRIAN REYES certified that he/she owns 10 percent or more of the voting stock/membership
interest of this company; therefore, the Bond of Qualifying Individual is not required.
;Effective Date: 08/25/2012
Workers' Compensation
This license has workers compensation insurance v%ith the TRAVELERS P�f1P-�RT�CASUALTY COMPANY OF AMERICA
,Policy Number: UB3F06039
'Effective Date: 02/01 /2015
Expire Date: 02/01/2018
Workers' Compensation History
1/11/20.22 City of Newport Beach Page 6 of 12
4:30:44PM INSP150 - Daily Inspection Request Report
Requested Inspection Date : 01/12/2022
Inspection Type : ENCROACH
Inspection Area : PW
Site Address : 1 PUBLIC ROW
A/P/D Information:
Activity : N2017-0375
SubType :
Status : APPROVED
APPLICANT: CALTRANS Phone : 949-279-8838
Description : BLUETOOTH WIRELESS DEVICE SYSTEM ON COAST HWY AT IRVINE TER AND
COAST HWY AT AVOCADO AVE.
Requested Inspection(s)
Item: 10250 FINAL - PW
Requested Time: 1/12/2022 12:00:OOAM Requestor: WEBUSER
1.
Entered By: WEBUSER
Comments: 'ANY-'
Assigned to : z zz zzzz*