HomeMy WebLinkAboutN2017-0133„�,wr•�,4� City of Newport Beach 11111111111111 111111111111111
o� = G� 100 Civic Center Drive Newport Beach CA 92660 N 2 0 1 7 0 1 3 3
:. Permit Counter Phone (949)644-3311
Online Inspection Request - www newportbeachca gov / Online
” Services
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Permit No: N2017-0133
Project No • 2494-20 tGANNED
Inspection Requests Phone (949)644-3255
Job Address .
1915 KEWAMEE DR NB
Thomas:Guide: 919E1
Description
EP TO REMOVE FICUS RUBIGINOSA
Parcel # •
0503-460-6 -
Legal Desc :
N TR 2813 LOT 64
Owner:
MICHAEL WALKER
Contractor
Phone:
Phone:
Address :
1915 KEWAMEE DR
Address
CORONA DEL MAR, CA 92625
ETEDCOMA
Contractor State Lic:
Applicant:
CHILDS CYNTHIA
License Expire
Phone:
949-718-3528 [
Address :
2732 E COAST HWY #B
CORONA DEL MAR CA 92625
Business License
Business Expire :
Special Cond.:
PRE -CONSTRUCTION MEETING REQ'D
Workers' Compensation Insurance - -
Carrier :
Policy No
W. C. Expire:
Permit Processing Fee : $0 00
Sewer Connection $0.00
Total Fee
Agreement Fee
$0 00
4TT Box Cover, $0 00
Paid :
Traffic control Plan Check $0 00
Total Water Meters $0 00
Balance:
Inspection Fee :
$165 00
Water Meter Connection : $0 00
Receipt No:
Refundable Deposit $0 00
Total Water Meter Box $0 00
Street Tree Fee •
$413 64
Adjustment $0.00
Processed By
Utilities Approval
Traffic Approval :
General Services Approval
Date
Date
Date
Date
$578.64
$578.64
$0.00
Other Department Date
Permit Denied Date
Issued Permit Date ac�)� f J
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COMPLETE THE BELOW INFORMATION
PROJECT ADDRESS: �W
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1
DETAILED DESCRIPTION OF PROPOSED WORK:
APPLICANT: l
Phone: - 3.
Email Address: /j;)t jo
Mailing A�re�� / � �
City/State/zip:
OWNER: Vh1 � - 70
Phone:
Email Address: tt
Mailing Address: tI
rity/StatelZip:
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:
Munici aIOperations: 949-644-3055
Utilities: 949-644-3011
Urban Forestry: 949-644-3083
FOR OFFICE USE ONLY
Special Conditions of Permit:
ADDITIONAL APPROVAL REQUIRED FROM THE FOLLOWING DEPARTMENTS
Utilities:
Municipal Operations
Traffic:
Other:
Fire:
Engineering Technician:
Perm! alist
Date:
�j C'
Permit No.
IN2017-
f /users/pbw/shared/encroach/masters/epworksheet As
Public Works Department 949-644-3311
100 Civic Center Drive, Newport Beach, CA 92660
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 I-ncroachment Permits may be taken out by the owner of benefited property or a licensed contractor A licensed
contractor must provide a I elter of Aulhouzation" to allow another party to pull a permit An approved copy of the
permit and construction plan shall be kept at the lob site at all limes Work, which has been done pilot to issuance of
a permit IS subject to iejectionlfine City reserves the right to void permit if work does not commence within 30 days
after dale of issuance
2 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
3 All work shall be done in accordance with the approved plans Standard Special Provisumti ,iod Stomlard Driwuul.",
of the City of Newport Beach and in compliance with all applicable Slate laws and City ordinances
4 Permrttee 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 most 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 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-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 CitV-owned utilities (ie water sewer or street lighting conduitSr 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 user
9 Properly lighted barricades must be provided and maintained around all trenches, excavations and obstructions All
signs, flags lights and other warning and salety devices shall conform to the requirements of the current "Manual of
Warning Sigris Sights and Other Device,, for the Use in Performance of Work Upon Highways" issued by the
California Department of iransporiation It needed oarricades can be obtained from the City at a charge of $10 00
per barricade per day with a minimum charge of 535 00 It is the responsibility of the applicant to place barricades to
protect the general public Ar.cess to lire hvdiantS must be maintained at all times
10 Work within or near beach sensilivP areas will not be allowed dunnq City holidays sponq 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 parkinq lanes and impedes the normal flow of traffic requires the applicant to
acquire a Temporary Street Closure Penmil bona the Public Works Department Access for fit(- police and
emergency vehicles must be maintained at all times Traffic control must be pet Work Area Traffic Control
Handbook (WA P :11 r No nighttime traffir Ian -closures unless prior approval has been granted AnV lanes) closure
on a major street will onl,, he .allowed between 9 00 a.m. and 3.00 p m (Monday thru Friday) unless approved by
the Public b1'orks Depailmenl 4nv wrnk uffectinq the State Highway s traffic, or within the Slate Highway right-of-way
will require a Caltrnns Permit All vehicles shall be IJWfUlk, parked
12 This permit dines not aulhoti7e the r Iosute of sidewalks streets or alleys for consli-w.tion au ess, storage of
materials or paikinq of c crostiuctton 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 houis in advance of restricted access and any inconveniences
14 Refuse or unused matenals shall be removed within 24 hours after c,onipletion of the work If riot removed the Carty
may remove and hill the applicant Cooidinate alley closures with City s refuse pick-up days by callinq 949-644-3066
for the collection schPdulP so service is not intenupled To place a dumpsler or materials in the public right-of-wav a
Temporary Street ''Iosure 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 -insure, Certificate of Worker's
Compensation Insurance, or a Certified Copy thereof
Date:
Signature -
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 certif I prin ers nally rf g all
ork in th Publi Right-of-Wa '
Date. ignature _
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 adla(enl
affected properly ownen s )
16 Homeowner contractors and subcontracolrs may each be liable for viuLitiouS of .'Jaier
Quality Laws Best Management Practices will be enforced It r, against the la,a to
discharge construction debris into the qulter and storm drain I elony violation~ of ^J.iior
Quality Laws ate punishable by fines up to S25 000 and/or uii It, thr , year., iii Slate
prison plus the full cost to clean up an illeq,il discharge or spill
17 If a refundable deposit was paid applicant must ,uhniit a Soils Conipm he •i
Certificate or Evidence of a Slurried Backfill and request ,i final iispecticui fton, It,,,
Public Works Department I'donies may be held for six mrnith, after final nispectinn
before a refund will be processed
18 No trees in the public right-of-way shall be plantec; renuiverl trinnnr d
without approval from the General Services Department
19 All work in the public right-of-way must meef the approval of the Public \V,rk .
Department or corrections will be required (I e removals oxpo,,inq connecbr,i�
etc I Additional inspection fees may be requited
20 Permit is for standard materials in the public right-of-way only unk-'S prr-Vlciut,ly
approved by Public Works and an Encroachment Agreement has been processed
21 Permit is valid for description of work noted on front only Additional voil,
performed may require Issuance of a separate permit and or additional fees
I 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 st7"nd
conditions of this permit and he/she agrees to abide by them. Permit is void if work is not commenced within 30 days after i` suance. 4/M
/Permit fees are nonrefundable. Date. rolgnatUre:
}y,�:_h ^`.':•r rw w y .:''i r f '
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All Fees Are Non -Refundable Unless Otherwise Stated
PROJECT ADDRESS:
PERMIT N2017- 22
NUMBER: C�`J
APPLICANT:
TO HE COMPLETEE) BY PUB _11C WORKS DEPARTMENT
Permit Processing Fee: QtV
Public Works Only $241.00
Other Department $275.00
Agreement Fee:
Preparation of Report/Agreement $817.00
Document Recordation Fee $192.00
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
THLLOWING ITEMS REQUIRE APP
E FOROVAL FROM THE Revenue Division
REVENUE DIVISION PRIOR TO PAYMENT OF FEES ]Approval:
_ 1
1
Qty.
. Q�• ,
iWater Meter:
Installation Charge $528.00
13/4" Meter
$50.25
Water Meter Boxes: 1
11" Meter
$121.50
For Parkway & Sidewalk Area (Box + Cover = Cost)
11 1/2" Meter
$285.00
1" Meter: 13.00 + 37.00 $50.00�
11 1/2" Turbine Meter
$700.00
2: Meter: 27.00 + 61.25 $88.25 1
12" Meter
$425.00
1
12" Turbine Meter
$845.00
For Traffic & Alley Areas (Box + Cover = Cost)
13" Meter
$3,310.00
1" Meter: 13.00 + 38.00 $51.00
1
4 " Meter
1
$4,730.00
2" Meter: 27.00 + 162.00 $189.00
I
!6" Meter
$7,190.00
Qty.
Budget Number
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
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 Sp a 1
Receipt No.
f /users/pbw/sharedlencroach/masters/ep front and back masters/
/ L Rev. 1 /5/2017
epfeesheet As -revised 10/21 /2016
-9(1",IL/ - .? tic:;
3/20/2017 City of Newport Beach Page 3 of 8
•4:30_43PM INSP150 - Daily Inspection Request Report
Requested Inspection Date: 03/21/2017
Inspection Type: ENCROACH
Inspection Area: PW / `y 7"2-
Site Address: KEWAMEE DR
Activity : N2017-0133
SubType : NEW
Status : APPROVED
OWNER: MICHAEL WALKER
APPLICANT: CHILDS CYNTHIA
Descrilption : EP TO REMOVE FICUS RUBIGINOSA.
Item: 10210 PUBLIC WORKS
Requested Time: 3/21/2017 12:00:OOAM
Entered By: WEBUSER
Comments: PM -
Phone :
Phone : 949-718-3528
cchilds@accarchitect.com
Requestor: WEBUSER
949-2906843
Assigned to: 77777777777*
Inspector: Date: 3 /-Z1 7 Time: f�- �M) PM
Comments:
-
Refite
F:\Users\PBW\Shared\ENCROACH\MASTERS\FORMS\InspectorSheet.doc
REPT131 Run Id: 4018