HomeMy WebLinkAboutN2017-0519U 6.9.18
wv,i•,,{� City of Newport Beach IIIIII�IIIIIIIIIII IIIII�IIIIII IIIIIIII Permit No: N2017-0519 -
:` •` �' 100 Civic Center Drive, Newport Beach, CA 92660 II N 2 0 1 7 0 5 1 9
1 `� Permit Counter Phone (949)644-3311 Project No : 1522-2016 ,;, i
x Online Inspection Request www newportbeachca gov /Online S " f
Services
Inspection Requests Phone (949)644-3255
Job Address : 441 OLD NEWPORT BLVD NB
Thomas:Guide: 888H5
Description : INSTALLATION OF 1" WATER SERVICE,
1" AND 2" REDUCE PRESSURE BACKFLOW DEVICE, DOUBLE CHECK DETECTOR BACKFLOW DEVICE AND
CATCH BASIN. SIDEWALK, CURB
AND GUTTER REPAIR PER CITY STANDARDS.
Parcel # : 4252-711-2 -
Legal Desc : P BK 163 PG 31 PAR 1
Owner: OCEAN VIEW MEDICAL
Contractor : 4 WEST PIPELINE INC
Phone: 0
Phone:
Address : #560
COMPL
: ZETA HOT SPRINGS
RVINEAIN CAST
I MDAddress
MURR ETA CA
Contractor State Lic: 863590
Applicant: 4 WEST PIPELINE INC
License Expire : 01 31, 2019
Phone: 951-722-6392 951-741-3959[
Address : PO BOX 3277
QUAIL VALLEY, CA 92587
Business License : BT30060612
Business Expire : 09 30, 2018
Special Cond.: PRE -CONSTRUCTION MEETING REQUIRED
Workers' Compensation Insurance - -
Carrier : STATE COMP INS FUND
Policy No: 9161122
W. C. Expire: 06 18, 2018
Permit Processing Fee : $241 00
Sewer Connection :
$0.00
Total Fee
$1,930.50
Agreement Fee - $0.00
4TT Box Cover.
$0.00
Paid :
$1,930.50
Traffic control Plan Check : $0.00
Total Water Meters :
$649.50
Balance :
$0.00
Inspection Fee : $990.00
Water Meter Connection :
$528.00
Receipt No
Refundable Deposit: $0.00
Total Water Meter Box :
$50.00
Street Tree Fee $0.00
Adjustment :
$0.00
Processed By :
Date: _/_/
Other Department : Date,
Utilities Approval :
Date: _/_/
Permit Denied Date:
J_/_/
` 1 U 7
Traffic Approval -
Date : _/_/
Issued Permit : Date
General Services Approval : Date _/_/
WORKSHEET FOR ENCROACHMENT PERMIT
CITY OF NEWPORT BEACH
PUBLIC WORKS DEPARTMENT
COMPLETE THE BELOWINFORMATION
PROJECT ADDRESS: 441 Old Newport Blvd, New ort Beach, CA 92663
DETAILED DESCRIPTION OF PROPOSED WORK:
Work shall consist of demolition to the public sidewalk, curb, and asphalt street. Once demolition is complete the
installation of a 1 inch water service, 1 inch and 2 inch reduce pressure backlow device, double check detecor backlow
device, and catch basin. All devices will be city approved. Once installation is complete the sidewalk, curb, and
asphalt street shall be repaired to city standards.
APPLICANT: Garrett Weaver Phone: (949) 355-5789
Email Address: garrettweaverl23@gmail.com
Mailing Address:18632 Topanga Cyn Rd
City/State/Zip: Silverado, CA 92655
OWNER: Barry Beitler
Phone: (310) 820-2955
Email Address: bbeitler@beitler.com
Mailing Address:825 S. Barrington Ave
City/State/Zip: Los Angeles, CA 90049
ALL CONTRACTOR INFORMATION IS REQUIRED
-PLEASE COMPLETE
CONTRACTOR: 4 WEST PIPELINE
Office Phone: 951-722-6392
Company (if different):
NA
Jobsite Phone: 951-741-3959
Other Phone: NA
Email Address: PAUL 4WESTPIPELINE.COM
Mailing Address:
P.O.BOX 3277
City/State/Zip:
QUAIL VALLEY 92587
State License Number & Class: City Business License Number:
Expires: Expires:
WORKERS COMPENSATION INSURANCE - Certificate of Insurance (Section 3800 Labor Code)
Company: STATE COMPENSATION INSURANCE FUND Policy NO: 35076 Expires: 06/18/2018
REFUNQA13LE QEPOSIT INFORMATION (If Applicable): .
Refund Payable To:
Mail Refund To:
FOR OFFICE USE ONLY
Special Conditions of Pe�'t:
ADDITIONAL APPROVAL REQUIRED FROM THE FOLLOWING DEPARTMENTS
Utilities:
General Services:
Traffic: Fire:
Other:
Engineering Technician:
Publ' rks Specialist:
Date:
c
Permit No.
X 11
1 tusers/pbw(sharedlencroachtrnasters/epworksheet xis
Public Works Department 949-644-3311
All Fees Are Non -Refundable Unless Otherwise Stated
PROJECT ADDRESS: / I �1 [NUMBER:
ERMIT N2017-1
`4411 C)I �N K �i� v>7f-
Permit Processing Fee:
Inspection Fee:
Public Works Only
$241.0
Public Works Field Inspection
$165. 0
Other Department
$275.0
Utilities Field Inspection
General Services Inspection
$121.0
$165.00
Agreement Fee:
Preparation of Report/Agreement
$817.00
Water Quality/Artificial Turf Inspection
$108.00
Document Recordation Fee
$192.00
Refundable Deposit:
TBDB
Monitoring Wells
$502.00
Improvements
TBD
Street/AlleylWalk 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
I REVENUE DIVISION PRIOR TO PAYMENT OF FEES
$108.00 0
$250.00
64 $64.00
Revenue Division I
1►•
1
(Water Meter:
Installation Charge $528.00 1
13/4" Meter
$50.25
Water Meter Boxes: 1
11" Meter
$121.5
For Parkway & Sidewalk Area (Box + Cover = so
11 1/2" Meter
$285.00
1" Meter: 13.00 + 37.00 $50.0 1
11 1/2" Turbine Meter
$700.00
2: Meter. 27.00 + 61.25 $88.2
12" Meter
$425.00
12" Turbine Meter
$845.00
For Traffic & Alley Areas (Box + Cover = Cost) 1
13" Meter
$3,310.00
1" Meter: 13.00 + 38.00 $51.00 1
`4" Meter
$4,730.00
2" Meter: 27.00 + 162.00 $189.00P
16" Meter
$7,190.00
Certificate of Compliance Fee (+100% of hdy 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)
$1,02.2.00
5200-5031
Street Tree Fee ($700 Planting Fee)
TBD
030-2284
Engineering Tech:
To I Amount Due:
For Finance use only
ft�
Permit Specialist
Recei No.
f /userslpbwlshared/encroach/masters/ep front and back masters/
Rev. 1/5/2017
epfeesheet xis -revised 10/21/2016
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
WORKER'S COMPENSATION INSURANCE (Section 3800 Labor Code)
1
Encroachment Permits may be taken out by the owner of benefited property or a licensed contractor A licensed
I certify t t I have a Certificate of consent to s nsure, Certificate of Worker's
contractor must provide a Letter of Authorization' to allow another party to pull a permit An approved copy of the
Compe tion Insurance, or a Certified Copy t of
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 refection/fine City reserves the right to void permit if work does not commence within 30 days
Date: Signature:
after date of issuance
CERTIFICATE OF EXEMPTION (Section 3800 Labor Code)
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
I certify that in the performance of the work under this permit, I shall not employ
or damage to persons or property occurring as a result of work undertaken under this permit
any person so as to become subject to California Worker's Compensation Laws. If,
3
All work shall be done in accordance with the approved plans, Standard Special Provisions and Standard Drawings
after signing this certificate I become subject to the Worker's Compensation
of the City of Newport Beach, and in compliance with all applicable State laws and City ordinances
provisions of the State Labor Code, I must comply with the provisions of Section
4
Permittee guarantees all work performed under this permit to be free of hidden and latent defects Any failures shall
3700 or this permit shall be deemed revoked.
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
Date: Signature:
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
CONTRACTOR LICENSE EXEMPTION
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,
As the Owner of the benefiting property, I certify I am personally performing all
in the alley, where a minimum half -alley width resurfacing shall be provided, unless otherwise directed by the Public
work in the Public Right -of -Way.
Works Dept Contractors shall obtain permits to perform excavation or trench work from the California Division of
Date: Signature:
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
HOLD HARMLESS STATEMENT
7
The Public Works Department Inspectors must inspect all work in the Public right-of-way Forms and subgrade must
I understand that I am locating minor encroachments within the City Right -of -
be inspected and approved before concrete is ordered/poured Sewer, pipelines and subgrade construction must be
Way/Easement. As property owner it is my responsibility to maintain the
inspected and approved before backfilling, or applicant may be required to excavate site Separate Utilities
encroachments. I will be responsible for replacing the improvements if the City
Department or General Services Department inspections may be required depending on scope of work performed
removes them for maintenance of utilities or other public need. I shall indemnify
8
All trench restoration must be inspected by the Public Works Department No utility installation(s) shall be allowed
and hold the City harmless for any liability associated with the minor
over or within 5 feet of any City utilities, unless approved by the Public Works Department Locate and pothole
encroachments.
existing City -owned utilities 0e 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
Date: Signature:
4TT box over the riser
24-hour notice for Encroachment Per It Irlspecti n is required by calling
9 Properly lighted barricades must be provided and maintained around all trenches, excavations and obstructions All
"Manual
signs, flags, lights and other warning and safety devices shall conform to the requirements of the current of
Public Works at 949-644-331 r
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
15 Any above ground utility facih es wi require documen d approval from the adjacent
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
affected property owner(s)
10
Work within or near beach sensitive areas will not be allowed during, City holidays, spring break, Memorial Day
Water
16 Homeowner, contractors, and subcontracotrs may each be liable for violations of Water
Homey
weekend, summer between June 15 and September 15, and during the holiday season from December 19 to
Laws Best Management Practices will be enforced It is against the law to
1 t
January 1, unless approved by the Public Works Department
Any work that extends into traffic or parking lanes and impedes the normal flow of traffic requires the applicant to
discharge construction debris into the gutter and storm drain Felony violations of Water
acquire a Temporary Street Closure Permit from the Public Works Department Access for fire, police and
s up to $25,000 and/or up to three years in State
fines
prison plus the full cost to clean Quality Laws are punishable by fneup an illegal discharge or spill
emergency vehicles must be maintained at all times Traffic Control must be per Work Area Traffic Control
17 If a refundable deposit was paid, applicant must submit a Soils Compaction
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
Certificate or Evidence of a Slurried Backfill and request a final inspection from the
the Public Works Department Any work affecting the State Highway's traffic or within the State Highway right-of-way
Public Works Department. Monies may be held for six months after final inspection
will require a Caltrans Permit All vehicles shall be lawfully parked
before a refund will be processed
12
This permit does not authorize the closure of sidewalks, streets, or alleys for construction access, storage of
18 No trees in the public right-of-way shall be planted, removed, trimmed, or relocated
materials, or parking of construction vehicles unless detailed on an attached Temporary Street Closure
without approval from the General Services Department
13
Applicant must notify USA at 1-800-227-2600 2 days before starting any underground construction. Applicant
19 All work in the public right-of-way must meet the approval of the Public Works
must notify all affected residents 24 hours in advance of restricted access and any inconveniences
Department or corrections will be required (i e removals, exposing connections,
14
Refuse or unused materials shall be removed within 24 hours after completion of the work If not removed, the City
etc.) Additional inspection fees may be required
may remove and bill the applicant Coordinate alley closures with City's refuse pick-up days by calling 949-644-3066
20 Permit is for standard materials in the public right-of-way only, unless previously
for the collection schedule so service is not interrupted To place a dumpster or materials in the public right-of-way, a
approved by Public Works and an Encroachment Agreement has been processed
Temporary Street Closure Permit must be obtained from the Public Works Department
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 $hall be performed until the Public Works Department has issued this permit. Applicant hereby acknowledges he/she has rea d understa s 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.
Dat LL ,;
Permit
fees are nonrefundable.
_Signature: _ __
10/26/2017 City of Newport Beach Page 2 of 8
4:30:20PM INSP150 - Daily Inspection Request Report
Requested Inspection Date: 10/26/2017
Inspection Type: ENCROACH
Inspection Area: PW
Site Address : 441 OLD NEWPORT BLVD
NOUN —
Activity : N2017-0519
SubType : NEW
Status: APPROVED
OWNER: OCEAN VIEW MEDICAL Phone : p
APPLICANT: 4 WEST PIPELINE INC Phone : 951-722-6392
951-741-3959
OWNER: ROGER'S REALTY LLC Phone :
Description : INSTALLATION OF 1" WATER SERVICE, 1" AND 2" REDUCE PRESSURE BACKFLOW
DEVICE, DOUBLE CHECK DETECTOR BACKFLOW DEVICE AND CATCH BASIN.
SIDEWALK, CURB AND GUTTER REPAIR PER CITY STANDARDS.
Item: 10200 PRE JOB - PW
Requested Time: 10/26/2017 12:00:OOAM
Entered By: WEBUSER
Comments: AM-
InsAm ft led to : zzzzzzzzzzz* J V
Comments:
Requestor: WEBUSER
949-355-5789!/
Date: %V� /7 Time: AM PM
C " � - /
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F:\Users\PBW\Shared\ENCROACH\MASTERS\FORMS\InspectorSheet.doc
REPT131 Run Id: 4018
;10/30/7017 City of Newport Beach Page 1 of 13
'6:34:40AM INSP150 - Daily Inspection Request Report
Requested Inspection Date : 10/30/2017
Inspection Type: ENCROACH
Inspection Area: PW
Site Address: 441 OLD NEWPORT BLVD
Activity : N2017-0519
SubType : NEW
Status : APPROVED
OWNER: OCEAN VIEW MEDICAL Phone: 0
APPLICANT: 4 WEST PIPELINE INC Phone : 951-722-6392
951-741-3959
OWNER: ROGER'S REALTY LLC Phone
Description : INSTALLATION OF 1" WATER SERVICE, 1" AND 2" REDUCE PRESSURE BACKFLOW
DEVICE, DOUBLE CHECK DETECTOR BACKFLOW DEVICE AND CATCH BASIN.
SIDEWALK, CURB AND GUTTER REPAIR PER CITY STANDARDS.
Item: 10010 BACKFILL / COMPACTION- PW
Requested Time: 10/30/2017 12:00:OOAM Requestor:
Entered By: NBIVR
Comments: AM
Inspector:
Assigne d to : m
Comments: 1,e
� D,ate:
1 -7
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F \Users\PBW\Shared\ENCROACH\MASTERS\FORMS\InsaectorSheet doc
NBIVR
9493555789
Time: SnAM PM
:1 . 0/31/2017 City of Newport Beach Page 3 of 12
-6:34,08AM INSPI50 - Daily Inspection Request Report
Requested Inspection Date: 10/31/2017
Inspection Type: ENCROACH
Inspection Area : PW
Site Address: 441 OLD NEWPORT BLVD
fit,
Activity N2017-0519
SubType: NEW
Status : APPROVED
OWNER: OCEAN VIEW MEDICAL
APPLICANT: 4 WEST PIPELINE INC
Phone : 0
Phone : 951-722-6392
951-741-3959
OWNER: ROGER'S REALTY LLC Phone
Description: INSTALLATION OF 1" WATER SERVICE, 1" AND 2" REDUCE PRESSURE BACKFLOW
DEVICE, DOUBLE CHECK DETECTOR BACKFLOW DEVICE AND CATCH BASIN.
SIDEWALK, CURB AND GUTTER REPAIR PER CITY STANDARDS.
0t PAN
Item: 10060 PIPE INSTALLATION - UTIL
Requested Time: 10/31/2017 12:00:OOAM Requestor: NBIVR
9493555789
Entered By: NBIVR
Comments: AM
Inspector: �j Date: Time: D = vv�;PIVI
Assigned to:
Comments:
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0/2— i-14-
F.\Users\PBW\Shared\ENCROACH\MASTERS\FORMS\InspectorSheet.doc
' 11/2/2017 City of Newport Beach Page 2 of 13
• 6:34:53AM INSP150 - Daily Inspection Request Report
Requested Inspection Date: 11/02/2017
Inspection Type: ENCROACH
Inspection Area : PW
Site Address : 441 OLD NEWPORT BLVD
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Activity : N2017-0519
SubType : NEW
Status : APPROVED
OWNER: OCEAN VIEW MEDICAL Phone : 0
APPLICANT: 4 WEST PIPELINE INC Phone : 951-722-6392
951-741-3959
OWNER: ROGER'S REALTY LLC Phone :
Description : INSTALLATION OF 1" WATER SERVICE, 1" AND 2" REDUCE PRESSURE BACKFLOW
DEVICE, DOUBLE CHECK DETECTOR BACKFLOW DEVICE AND CATCH BASIN.
.y SIDEWALK, CURB AND GUTTER REPAIR PER CITY STANDARDS.
vp.. .se,• �fi5�' � . :,r^ra+c .r ✓a s.• a.v' .. -
Item: 10085 BACKFLOW DEVICE INSTALL - UTIL
Requested Time: 11/2/2017 12:00:OOAM Requestor: NBIVR
9493555789
Entered By: NBIVR
Comments: AM —7
Inspector: Date: (� / Time: /v ` 1 AW PM
Assigned to:
Comments: � � le���' c��'� �'' lf� ' i Z— U�l
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F:\Users\PBW\Shared\ENCROACH\MASTERS\FORMS\InSoectorSheet doc
11/6/2017 City of Newport Beach Page 1 of 11
6:34:07AM INSP150 - Daily Inspection Request Report
Requested Inspection Date: 11/06/2017
Inspection Type: ENCROACH
Inspection Area : PW
Site Address: 441 OLD NEWPORT BLVD
Activity : N2017-0519
SubType : NEW
Status : APPROVED
OWNER: OCEAN VIEW MEDICAL Phone : 0
APPLICANT: 4 WEST PIPELINE INC Phone : 951-722-6392
951-741-3959
OWNER: ROGER'S REALTY LLC Phone
Description: INSTALLATION OF 1" WATER SERVICE, 1" AND 2" REDUCE PRESSURE BACKFLOW
DEVICE, DOUBLE CHECK DETECTOR BACKFLOW DEVICE AND CATCH BASIN.
y SIDEWALK, CURB AND GUTTER REPAIR PER CITY STANDARDS.
Item: 10255 FINAL - Utilities
Requested Time: 11/6/2017 12:00:OOAM Requestor: NBIVR
9493555789
Entered l3
ACQInspector: P Date: < <7 Time: � A M
Assigned to:
Comments: L4M G• i5ij. D
NOT
Logged
F:\Users\PBW\Shared\ENCROACH\MASTERS\FORMS\InsoectorSheet doc