HomeMy WebLinkAboutN2017-0170t�,�.►�.,,� City of Newport Beach
G� 100 Civic Center Drive Newport Beach CA 92660
A. Permit Counter Phone (949)644-3311
y� Online Inspection Request - www newportbeachca gov / Online
Services
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Job Address 217 VIA DIJON NB Thomas:Guide
Description Remove existing rolled curb to install new driveway (W=16') and final inspection of public right-of-way.
Parcel# 4231-431-6 -
Legial Desc : N TR 907 LOT 1032
Owner: LOFTIN CAROL F A
Phone: 0
Address : 22041 JONESPORT LN
HUNTINGTON BEACH, CA
Applicant: MASONRY PLUS
Phone : 714-381-5997 [
Address : 1079 CORONA LANE
COSTA MESA, CA 92626
Special Cond.: Pre -job inspection required
Permit No: N2017-0170'"*
Project No
Inspection Requests Phone (949)644-3255
888H7
Contractor: MASONRY PLUS
COMPLETED Address : 1079 COS AOMEOSA CLANE
A 9 626
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
$495 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
Contractor State Lic: 553711
License Expire : 01 31, 2019
Business License: BT00016674
Business Expire :
11 30, 2017
Workers' Compensation
Insurance - -
Carrier :
STATE COMP
Policy No :
9027621
W. C. Expire:
10 01, 2017
Other Department
Permit Denied
Issued Permit
ACAN K)
Total Fee
$736.00
Paid :
$736.00
Balance:
$0.00
Receipt No
r2 --1 lolo t -;�—
Date
f �— r
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 lateen out by the owner of benefited property or a licensed contractor A licensed
contractor must provide a I Pile of Authorizationto allow another party to pull a permit An approved cop'yef the
permit and conshuclion 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 City reserves the right to void permit if work does not commence within 30 days
after dale of issuaw e
2 The Permitfee agrees to defend indemnify and hold the Aty its authorized agent officers representatives and
employees harmless from any iesponsibility, liability, suit or auction 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 Stand,vd Drawu,tlti
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 Talent 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 Imes a valid Slate Contractor License Class C-42 is required
6 All trenching and/or resurfacing shall conform to City Standard 105-L for parkwayrroadway and City Standard 140-L
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 feet in depth shall be protected by a shoring system sloping of the ground or other equivalent
means Trenches less than 5 feel 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 backfdhng 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 he 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 Locale and pothole
existing City -owned utilities tie water sewer or street lighting conduits) to verify location,, Maintain a one -foot
clearance over or under existing City -awned utilities Sewer cleanouts require VCP or PVC SDR35 be used with a
4T f 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 narninq and safety devir,es shall conform to the requirements of the current "Manual of
Warning Signs Sights and Other Devices for the Use in Performance of Work Upon Highways , issued by the
California Department of Transportation If needed 'barricades can be obtained from the City at a charge of $$10 00
pet harricade per day, with a minimum charge of $35 00 It is the responsibility of the applicant to place barricades to
protect the general public Ac ces,, to fire hvrirants mw l be maintained at all tinter
10 Work within or near heach sensitive areas will not be allowed during City holidays spnnq hieak Meniorial Day
weekend summer hetween June 15 and September 15 and during the holiday season from December 19 to
January 1, unless approved by the Public Vforks Department
11 Anv work that extPnds into tial'i w parking lanes and impedes the normal flow of Traffic requires the applicant to
acquire a lempoiaw Street Closure Permit tiom the Public Works Department Access for I police and
emergency vehicles must be maintained at all tunes I raffic Control must be pet Work Area Traffic Control
Handbook (WAT(,H) No nighttime lra(fic lane closures unle,,s prior approval has been granted Any lanes) closure
on a major street will only he allowed hetween 9 00 a m. and 3 00 p.m. (Monday thru Friday) unless approved by
the Public Works Department Any work affecting the Stale Highway s traffic or within the Stale Highway nght-of-way
will require a i :alh.ins Permit All vehirles shall be lawfullv parked
11 1his permit dnes, not mlhonze the closute of sidewalfs streets or alleys for conslruc,lion access, storage of
materials or parking of constiucfion vehicles unless detailed on an attached Jemporary Street Closure
13 Applicant mist notify USA at 1-800-227-2600 2 days before starting any underground construction. Applicant
must notify all affected residents 74 hours in advance of restricted access and any inconveniences
14 Refuse or unused maleuals ,,hall he temoved within 24 hours after completion of the work If not removed file City
may remove and bill the apphc aril Coordinate alley closures with Citv's refuse pick-up days by calling 949-644-3066
for the collection schedule so service is not interrupted To place a dunipster or materials in the public right-of-way a
Temporary Street ',losure I'ernul 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 the oof
Date: J9` (Q- 17 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 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. Y),b
15 Any above ground utility facilities will requnP dominienled approval from the ,idla(e•nl
affected properly owners)
16 Homeowner contractors and subc.onlracotrs may eau li be liable lot violation,, nl r,V,uc•r
C)ualli Laws Best klanagement Practices will he enforced l is aciain,,l the la-, to
discharge construction debris into the puller ,and slonu drain I Plony violations of "V.irc r
Quality Laws are punishable by lines up to 525 0()0 and of tip to Ihn•n ;r•ar , i ` k l<
prison plus the full cost to clean up an illegal discharge or spill
17 If a refundable deposit v,as pain applicant rinks( Submit ,i Sins Crbnil,ar li-i
Certificate or Evidence of a Slurried Backfill and request a final inspection lion, the
Public Works Department Monies may be held for six month,, after fin.il iusj,echo'i
before a refund will be processed
18 No trees in the public right-of-way shall he planted tenuivcd hininiecl 1"I", Ot-i
without approval from the General Services Department
19 All work in the public right-of-way must meet the apptnval of the Pi,bli( \,d,,rk.
Department or corrections will be requited It e removals expo,,inq c.nnnr'r tmos
etc ) Additional inspection fees may be required
20 Permit is for standard materials in the publu right-of-way only, unless pir•viowdv
approved by Public Works and an Encroachment Aqreement has been pn)(a ,sed
21 Permit is valid for "description' of work noted on front only Additional vvnlk
performed may require issuance of a separate perniit and or additional fees
INo work related to this encroachment permit shall be performed until the Public Works Department has issued this fligmilillill Applicant hereby acknowledges he/she has read and understands the ter s 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. Date: 4110117 Signature:
COMPLETE THE BELOW INFORMATION
PROJECT ADDRESS: I
DETAILED DESCRIPTION OF PROPOSED W K:
e 2-3 1%r. -V+" cry c-o r a
r n 3- 2
APPLICANT: v�d
Phone:
Email Address: rS ,
Mailing Address:
Iola �'o r 2 ✓1
City/State/zip:
Ca z a. � � `�
OWNER: 1 —Ig-r-rij G t--ir\ Phone: 947 464 -0160
Email Address:
Mailing Address:
City/State/Zip:
:x'�►L1:'CONT1tAC�OR T1t`�N-18" E 1 MPL:EI►�SE COMPLETE
CONTRACTOR: A'-O
Office Phone: 71 ` f 54 (o - Z'7 '5
Company (if different):
e r
Jobsite Phone:
Other Phone: `7 3& ( " 5q
Email Address: Iasoo S . COPY -I
Mailing Address:
103 Co corms
Ci tate/Zip:
os-ta M a Ca 2-4
State License Number & Class:
2-1 Expires: 35b
City Business License umber:
/ Ex ires: ��
WORKERS COMPENSATION INSURANCE
Com an ZAe h(A
- Certificate of Insurance (Section 3800 Labor Code)
Policy No: Ex ires: b /17
Municipal Orations: 949-644-3055
Utilities: 949-644-3011
Urban Forestry: 949-644-3083
' '--• �� ;.S`, .fir. - ,.x'zt,-.°'ai�• - t,�s""- i n--^-'y.". - _ '
Special Conditions of Permit: p�e/'ob ',ns �+sv+ ra uircb
i - DNA �19'A►iii11�N'Ei ` :. .,
Utilities:
Municipal Operations
Traffic: Fire:
Other:
Engineering Technician:
l
Permit Specialist
r`�d ;
Date:
j4- I,0 -i7
Permit No.
IN2017- or'1-D
f/users/pbw/shared/enaoach/masters/epworksheet As
Public Works Department 949-644-3311
100 Civic Center Drive, Newport Beach, CA 92660
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All Fees Are Non -Refundable Unless Otherwise Stated
PROJECT ADDRESS:
N2017- 0110
Z 1,7 V;o T); ro n __]PERMIT
NUMBER:
APPLICANT:
nlloso» ?I uS
Permit Processing Fee:
Public Works Only
Other Department
Agreement Fee:
Preparation of Report/Agreement
Document Recordation Fee
Monitoring Wells
Q Inspection Fee: Qty.
$241.00 Public Works Field Inspection $165.00 3
$275.00 Utilities Field Inspection $121.00
General Services Inspection $165.00
Water Quality/Artificial Turf Inspection $108.00
$817.00
$192.00 Refundable Deposit:
$502.00 Improvements
Street/Alley/Walk Closure: $65.00Newspaper Rack Inspection
Traffic Control Plan Check
8-1/2" x 11" $65.00 Sewer Connection Fee
24" x 36" $143.00 4TT Box & Cover
Additional
_ _ _
THE FOLLOWING ITEMS REQUIRE APPROVAL FROM THE
1 REVENUE DIVISION PRIOR TO PAYMENT OF FEES
TBDBTBD
$108.00
$.001 $6464.00
---
Revenue Division I
Qty.
Qt • 1
(Water Meter:
Installation Charge $528.00 1
13/4" Meter
$50.25
Water Meter Boxes:
11" Meter
$121.50
For Parkway & Sidewalk Area (Box + Cover = Cost)1
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
12" Meter
$425.00
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
14" Meter
$4,730.00
2" Meter: 27.00 + 162.00 $189.00�
6" Meter
$7,190.00
Qty.
Budget Number
Certificate of Compliance Fee (+100% of hrly 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
41-VO-tl
Permit Specialist
Receipt No.
Rev 1/5/2017
Q
f lusers/pbw/shared/encroach/masters/ep front and back masters/
epfeesheetxls-revised 10/21/2016
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12'
2' ROLLED CURB
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ATERAL
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SPEC
4/11/2017 City of Newport Beach Page 10 of 10
6:34:20AM INSP150 - Daily Inspection Request Report
717 - 'Iqg Requested Inspection Date: 04/11/2017
rLrf1 7 Inspection Type: ENCROACH
Inspection Area : PW
Ve C4 4 Site Address : 217 VIA DIJON
AIP/D Information:
Activity :
N2017-0170
SubType :
Status :
APPROVED
OWNER:
LOFTIN CAROL F A Phone: 0
APPLICANT:
MASONRY PLUS Phone : 714-381-5997
Description :
Remove existing rolled curb to install new driveway (W=16') and final inspection of public
right-of-way.
Requested Inspections)
Item:
10200
PRE JOB - PW
Requested Time:
4/11/2017
12:00:OOAM
Requestor:
WEBUSER
714 381-5997
Entered By:
WEBUSER
Comments:
ANY -
Assigned to:
77777777777*
Inspector:
J
Date:
���/ �-7
Time: / Z ' 06
AMV P�
Comments: t-t'E
_ 4T
�-�sv��
sP�n
� sue- c
Z 4- .
F:\Users\PBW\Shared\ENCROACH\MASTERS\FORMS\Ins ectorSheet.doc
REPT131 Run Id: 4018
4/13/2017 City of Newport Beach Page 9 of 9
6:34:10AM INSP150 - Daily Inspection Request Report
Requested Inspection Date: 04/13/2017
Inspection Type: ENCROACH
Inspection Area: PW
Site Address: 217 VIA DIJON
Activity : N2017-0170
SubType :
Status : APPROVED
OWNER: LOFTIN CAROL F A Phone: p
APPLICANT: MASONRY PLUS Phone : 714-381-5997
Description : Remove existing rolled curb to install new driveway (W=16') and final inspection of public
right-of-way.
Item: 10100 FORMS WITH COMPACTION - PW
Requested Time: 4/13/2017 12:00:OOAM Requestor: WEBUSER
Entered By: WEBUSER
Comments: AM -ready to qo, come early if possible
Assigned to: 77777777777*
Inspector: � j 3 Date:
714 381-5997
Time: AM PM
Comments: C41Z G A5�2 16 ✓Z- -
F:\Users\PBW\Shared\ENCROACH\MASTERS\FORMS\InspectorSheet.doc
5/3/2017 City of Newport Beach Page 4 of 25
6:34:35AM INSP15O - Daily Inspection Request Report
Requested Inspection Date: 05/03/2017
Inspection Type: ENCROACH
Inspection Area: PW
Site Address : 107 15TH ST
Activity : N2017-0107
SubType : NEW
Status : APPROVED
OWNER: VAN ORNUM JOHN W Phone: p
APPLICANT: AT&T CALIFORNIA Phone : 714-618-9132
Description : Install 33 LF of conduit, 1 above ground cabinet and ground bed in West Ocean Front Alley
and alley parallel to 15th Street. Alley restoration per City Standards. (AOONTCP)
.. ,-Vie:;x;?sz x�-.: <: ��• - •
Item: 10205 GENERAL SERVICE V �'
Requested Time: 5/3/2017 12:00:OOAM Requestor: NBIVR
Entered By: NBIVR
Comments: AM
Assigned to:
Inspector: "N Date: / Time: 0' �c �Ag-PM
Comments: CO'e X-f;: iur,li 4 1.4 S'd
Refire
F:\Users\PBW\Shared\ENCROACH\MASTERS\FORMS\InspectorSheet.doc
REPT131 Run Id: 4018