HomeMy WebLinkAboutN2017-01470 City of CenterNport Beach Beach, CA 92660 11piIII ill11111�Ir����IIIIIlIIII111111111111111
H Permit Counter Phone (949)644-3311
Online Inspection Request - www.newportbeachea.gov / Online
o Services
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Job Address : 1218 HIGHLAND DR NB Thomas:Guide:
Description: Install curb drain per City Standard #184-L. (Located next to driveway approach)
Parcel # :
1174-612-2 -
Legal Desc :
N TR 3031 LOT 75
Owner:
DAVENPORT LUCILE M
Phone:
0
Address :
1218 HIGHLAND DR
NEWPORT BEACH, CA
Applicant: DON HANSEN
Phone: 714-231-3284 [
Address : 3619 W. PENDLETON AVE
SANTA ANA, CA 92708
Special Cond. :
�.�70. 6J
Permit No: N2017-0147
Project No
Inspection Requests Phone (949)644-3255
889C5
SCANNED
Contractor: HANSEN DON ENTERPRISES
COMPLETED Address : SANTA ANA CA TON
Contractor State Lie: 308978
License Expire : 02 28, 2018
Permit Processing Fee :
$241.00
Sewer Connection :
$0.00
Agreement Fee:
$0.00
4TT Box Cover:
$0.00
Traffic control Plan Check :
$0.00
Total Water Meters :
$0.00
Inspection Fee :
$165.00
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
Date :
Date:
Date:
Date:
Business License:
Business Expire :
Workers' Compensation Insurance - -
Carrier : SECURITY NATIONAL INSURANCE CO
Policy No: SWC1121436
W. C. Expire: 09 12, 2017
Other Department :
Permit Denied :
Issued Permit :
Total Fee
Paid :
Balance
Receipt No
;z _ 1("-
$406.00
$406.00
$0.00
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 Lncroachnienl Permits may be taken out by the owner of benefited property or a licensed contractor A licensed
contractor must provide a Lefler of Authorization 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 times Work which has been done prior to Issuance of
a permit is subject to rejection fine Citti reserves the right to void permit if work does not commence within 30 days
after date of issuance
2 The Permittee agrees to defend indemnify and hold the (,ily, its authorized agent, officers, representatives and
employees harmless from any tesponsibility, 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 St,ind,ire/ Spec ial Piovisinn.s ,Ind Stanrlwd Drowmys
of the City of Newport Leach and in compliance with all applicable State laws and City ordinances
4 Permittee guarantees all work performed under this pernnl 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 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 140-1_
in the alley, where a minimum half-allev 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 feel 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 backfillmg 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 most he inspected by the Public Works Department No utility insiallation(s) shall be allowed
over or within 5 feet of any City utilities, unless approved by the Public Works Department Locale and pothole
existing City -owned utilities tie water sewer or street lighting conduits) to verify locations Maintain a one -fool
clearance over or under existinq 0tv-owned utilities Sewer cleanouls require \rCP or PVC SDR35 he used will) a
,;TT box over the riser
9 Properly lighted barricades must be provided and maintained around all trenches excavaliom, 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 III Performance of Work Upon Highways' issued by the
California Department of Transportation If needed name ades can be obtained from the Cih, at a charge of S10 00
per barricade per day with a minimum chanje of 835 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 heir It sen,,ilive areas will not be allowed during City holidays spurig break Memorial Day
weekend summer hetween June 16 and Septemher 15 and during the holiday season front December 19 to
January 1 unless approved bti The F'uhhc Works Department
I 1 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 niw l be maintained at all tinies Traffic Control must be per Work Area 1 raffic Control
Handbook (WATCH) No nighttime li iffic Ian- c losures unless prior approval has been granted Any lanes) 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 Deprvtruent Any work affectinq the Slate Highways traffic or within the Stale Highway right-of-way
will require a Caltrans Permit All vehicles shall be lawfully parker/
12 This permit does not nithon,-,, the- closure of sidewalks streets or alleys for construction aC(eSS storage of
materials or parking of c onstruction 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 rnatenals shall he removed within 24 hours after completion of the work If not removed the City
may remove and bill the applicant t`oordinale alley closures with i;ity s refuse pick-up days by calling 949-644-3066
lot the collection schedule so service is not interrupted to place a dumpster or materials in the public, night-of-wav, a
Temporary Street ';loswe Permit nnlsl 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 Of
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 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 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 Ins ection is required by calling
Public Works at 949-644-3311. , n �
15 Any above ground utility facilities will mqune documented approval from lire- adlac nnl
affected properly ownerls)
10 Homeowner contractors and subcontiacolrs may ear It be haul/ toe vial ihooi of vr.,iu-r
Ouahty Laws Best Management Prac,tic es will be entorced ;I is again,,l the la�v I
discharge construction debris into the gutter and storm dram f elnny vinl,ition,, of
Ouahty Laws are punishable by tines up to S25 000 and/or rill In three veal, in 'd,ite
prison plus the full cost to clean up an illegal discharge of spill
17 If a refundable deposit was paid applir,ant n11Ist Submit ,i Srnl�, (,unitiai tic"i
Certificate or Evidence of a Slurried Backfill and ti'quest a final nspec lion frnni tl�,
Public Works Department Monies may bo held for Six months after fuml inspec tiori
before a refund will be pooce,,serf
18 No trees III the public right-of-way shall he plantFcl temov(� 1 Irnnmed i i-lo .,hr
without approval from the General Services Department
19 All work in the public right-of-way must meet the approval of the Puhlic, Vlotk
Department or corrections will be required (I e ienlovals oxposinc, c innech -,t,,
etc ) Additional inspection fees may be required
20 Permit is for standard materials in the public right-of-way only unless firevinua,l;
approved by Public Works and an Encroachment Agreement has been pincessed
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 feI-s
No work related to this encroachment permit shall be performed until the Public Works Department has issued this permit. Appplicant hereby acknowledges he/she has read and derstands 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 aftgb&" l Z Permit fees are nonrefundable. Date3;2-1 l7
Signature:R1_)py`
FEE WORKSHEET FOR ENCROACHMENT PERMIT
CITY OF NEWPORT BEACH
PUBLIC WORKS DEPARTMENT
All Fees Are Non -Refundable Unless Otherwise Stated
PROJECT ADDRESS: PERMIT N2017-
-1`5 NUMBER:
PPLICANT:
I- TO BE COMPLETED BY PUBLIC WORKS DEPARTMENT
Permit Processing Fee:
Public Works Only
Other Department
Agreement Fee:
Preparation of Report/Agreement
Document Recordation Fee
Monitoring Wells
Street/Alley/Walk Closure:
Traffic Control Plan Check
Q
Inspection Fee:
$241 00
Public Works Field Inspection
$275 00
Utilities Field Inspection
General Services Inspection
Water Quality/Artificial Turf Inspection
$817.00[J
$192 00
Refundable Deposit:
$502 00
Improvements
$65 00=
Newspaper Rack Inspection
$165 00
$121 00
$165.00
$108.002
8-1/2" x 11" $65.00 Sewer Connection Fee $250 00
24" x 36" $143.00 4TT Box & Cover $64 00
Additional
.-------------------------- ------
( THE FOLLOWING ITEMS REQUIRE APPROVAL FROM THE Revenue Division I
I REVENUE DIVISION PRIOR TO PAYMENT OF FEES Approval:
I
(Water Meter:
13/4" Meter $50.25
11" Meter $121.50
11 1/2" Meter $285.00
11 1/2" Turbine Meter $700.00
12" Meter $425.00
12" Turbine Meter $845 00
13" Meter $3,310,00
14" Meter $4,730.00
6" Meter $7.190,00
Qty.
Qt . I
Installation Charge $528.001
Water Meter Boxes: I
For Parkway & Sidewalk Area (Box + Cover = Cost)
1" Meter. 13.00 + 37.00 $50 00�
2: Meter: 27 00 + 61.25 $88.25
1
For Traffic & Alley Areas (Box + Cover = Cost)
1" Meter 13,00 + 38.00 $51 00
2" Meter: 27.00 + 162.00 $189.00 1
MISCELLANEOUS FEES
Certificate of Compliance Fee (+100 of hry over 3 hrs)
Development Services Fee (Plan check hourly)
Final Tract Map Checking Fee
Final Parcel Map Checking Fee - Moderate
Lot Line Adjustment Fee
Park Dedication Fee Zone
Street Easement/Vacation Fee (+100 io of hrly over 4 hrs)
Street Tree Fee ($700 Planting Fee)
$288 00
$155.00
$2.488 00
$2.488 00
$1.079 00
_ TBD
$1,022 00
TBD
City.
Budget Number
5200-5029
5200-5015
5200-5026
5200-5027
5200-5028
405-470_
5200-5031
030-2284
Engineering Tech:
Total Amount Due:
For Finance Use Only
Permit Specialist
Receipt No.
f lus Wpb lshare e=oa mastwr w from and bad masters
Rev 1 5,2017
epfeasflaet As+ev4e010121 R016
WORKSHEET FOR ENCROACHMENT PERMIT
CITY OF NEWPORT BEACH
PUBLIC WORKS DEPARTMENT
COMPLETE THE BELOW INFORMATION
PROJECT ADDRESS: 1,311 S H Cq Ard �) ✓ I
DETAILED DESCRIPTION OF PROPOSED WORK:
Co e
1 Phone: 71Yail
Address:
[[APPLICANT:
lin�9 Address:
S1tUlcl
City/StatelZip: -7
o f�.r I �7u6
OWNER: ��� o „
Phone:
Email Address:
Mailing Address: City/S at (Zip:
1ZI$
ALL CONTRACTOR INFORMATION IS REQUIRED
-PLEASE COMPLETE
CONTRACTOR: Ibor. rt^S-em L'"mot
Office Phone: 71�{ a31 3�t37
Company (if different):
lJobsite Phone:
Other Phone:
Email Address: -C� 0,x4'1 ,t sla so cal
Mailing Address:
\\
Clty/Stat P.
Sa..
State License urnber & Class:
3D997lb C-V Ex ires:017cZB-)g
City Business License Number:
Expires:
WO K u . COMPENSATION INSURANCE - Certificate of Insurance (Section 3800 Labor Code)
E ER
Company: rri0ua) I 1 4_ Policy No: St c, I1 , Jj 3b Expires: ' 1 - )2- 17
REFUNDABLE DEPOSIT INFORMATION (if Applicable):
Refund Payable To:
Mail Refund To:
FOR OFFICE USE ONLY
Special Conditions of Permit:
ADDITIONAL APPROVAL REQUIRED FROM THE FOLLOWING DEPARTMENTS
Utilities:
General Services:
Traffic: Fire: 0
Other:
Engineering Technician:
Public Works Specialist:
Date:
Permit No.
1 NseisfpE�WslureNenuoa.MnasierLep�wMsnee� .�s
Public Works Department 949-644-3311
3/30/2017 City of Newport Beach Page 18 of 20
6:34:47AM INSP150 - Daily Inspection Request Report
Requested Inspection Date : 03/30/2017
Inspection Type: ENCROACH
Inspection Area: PW
Site Address : 1218 HIGHLAND DR
AY /D nfo ation:,
Activity : N2017-0147
SubType :
Status : APPROVED
OWNER: ROSENCRANS-NINE FAMILY TRUST Phone: 0
APPLICANT: DON HANSEN Phone : 714-231-3284
Description : Install curb drain per City Standard #184-L. (Located next to driveway approach)
Item: 10210 PUBLIC WORKS
Requested Time: 3/30/2017 12:00:OOAM Requestor: WEBUSER
9494666041
Entered By: OWULUSER 5� clo
Comments: PM -
Assigned to: 77777777777*
Inspector: Date: 3 30 Ilt7 Time: /2 - 3OPM
Comments: Z-Z) K:2 t / .
Logged
Reffle
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