HomeMy WebLinkAboutN2017-06191.2p..2Z.
City of Newport Beach IppIIIII II III IIIIIIIIIIIIIIIIIIIII III II Permit No: N2017-n619
100 Civic Center Drive, Newport Beach, CA 92660 III N 2 0 1 7 0 6 1 9 III
Permit Counter Phone (949)644-3311 Project No
Online Inspection Request - www newportbeachca.gov / Online '
Services
Inspection Requests Phone (949)644-3255
Job Address: 1 PUBLIC ROW NB Thomas:Guide:
Description : Conduct 5-inch cores through existing pavement section. 5 cores on Marguerite Avenue between San Joaquin Hills Road and Fifth Avenue and 4 cores on
Hospital Road between Placentia Avenue and Superior Avenue.
Parcel # :
Legal Desc :
Owner: CITY OF NEWPORT BEACH
Phone:
Address
Applicant: GEOCON WEST
Phone: 650-208-0992 [
Address : 15520 ROCKFIELD BLVD, SUITE J
IRVINE, CA 92618
Special Cond.: NO FEE PERMIT- CITY PAVING PROJECT
Permit Processing Fee :
$0.00
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 :
$0.00
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 : GEOCON CONSULTANTS INC
Phone:
Address : 6970 FLANDERS DRIVE
SAN DIEGO CA
Contractor State Lic: 716050
License Expire : 12 31, 2019
Business License :
BT30060078
Business Expire:
07 31, 2018
Workers' Compensation Insurance - -
Carrier :
TRAVELERS PROPERTY CASUALTY
Policy No:
UB3373T787
W. C. Expire:
01 01, 2018
Total Fee $0.00
Paid : $0.00
Balance : $0.00
Receipt No
Other Department : Date : _/_/.
Permit Denied Date : / /
Issued Permit : -y Date: i21 12/ 1-1
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 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 date 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 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 State 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 parkwav/roadway and City Standard 140-L,
in the alley, where a minimum half -alley width resurfacing shall be provided, unless otherwise directed y 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 installations) 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 lie 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 obtained 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 times
10 Work within or near beach sensitive areas will not be allowed during, City holidays spring 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 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 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 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
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 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 Perml 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 owners)
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 State
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 Compaction
Certificate or Evidence of a Slurried Backfill and request a final inspection from the
Public 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, er relocated
without approval from the General Services Department
19 All work in the public right-of-way must meet the approval of the Public Work,
Department or corrections will be required (i.e. removals, exposing connections,
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
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 rdlil aill understands 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.
Permit fees are nonrefundable. Date:J12J_t"� Signature:
WORKSHEET FOR ENCROACHMENT PERMIT
CITY OF NEWPORT BEACH
PUBLIC WORKS DEPARTMENT
COMPLETE THE BELOW INFORMATION
PROJECT ADDRESS: Marguerite Ave, btw 5th St & SanJoaquinHills Rd, & Hospital Rd, btw Superior Ave
DETAILED DESCRIPTION OF PROPOSED WORK:
Conduct 5 inch -diameter cores through existing pavement section (asphalt and base layers). 9 core
locations in total. 5 on Marguerite and 4 on Hospital.
APPLICANT: Geocon West, Inc
Phone: 949 491-6570
Email Address: jelisa@geocininc.com
Mailing Address: City/StatelZip:
15520 Rockfield Boulevard, Suite J Irvine, CA 92618
OWNER: Phone:
Email Address:
Mailing Address:
City/State/Zip:
ALL CONTRACTOR INFORMATION IS REQUIRED
-PLEASE COMPLETE
CONTRACTOR: Geocon West, Inc
Office Phone: 949 491 6570
Company (if different):
Jobsite Phone: 650 208-0992
Other Phone:
Email Address: lelisa@geoconinc.com
Mailing Address:15520 Rockfield Boulevard, Suite J
City/StatelZip: Irvine, CA 92618
State License Number & Class:
Expires:
City Business License Number:
BT30060078 Expires: 07/31/18
WORKERS COMPENSATION INSURANCE - Certificate of Insurance (Section 3800 Labor Code)
Company: Cavignac & Associates Policy No: UB3373T787 Expires: 1/1/2018
REFUNDABLE DEPOSIT INFORMATION (if Applicable):
Refund Payable To:
Mail Refund To:
FOR OFFICE USE ONLY
Special Conditions of Permit: • No Fct- �- - G m'ec*__
ADDITIONAL APPROVAL REQUIRED FROM THE FOLLOWING DEPARTMENTS
Utilities:
General Services:
Traffic: Fire: 0
Other:
Engineering Technician:
2odi
Public Works Specialist:
soda
Date:
f2-►2-"I
Permit No.
NWI-L-0101
f /users/pb,�/shared/encroach masters/epworksheet xls
; Placentia Ave
Public Works Department 949-644-3311
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PROFILE SCALE
..IZ 1" = 40'RT 1" = 4'
I(
VE
12+00 13+00 14+00 15+00 16+00 17+00 18+00 19+00
1 i
� III �, Ill
-- ------ — — — —
------------------------- --------------------
HOSPITAL ROAD
,,_—_------------------------- ---- -- _ —
I I
CONSTRUCTION NOTES DISPOSITION NOTE
DMs
CONSULTANTS, INC.
C 1 V 1 L E N G 1 N rE E R S
SCALE 1"=40'
' 12/01 /17
wiecnocR � ocw,w •¢ xss! cn ! so �!
20+00
\
C-
REHEWED
STREET PLAN do PROFILE
HOSPITAL ROAD
From Supenor Avenue to Placentlal Avenue
MAL ENGINEER
DESIGNED SD DRANK NC CITY OF NEWPORT BEACH R-
CHECKED DATE PUBLIC WOKS MENT 1 OF SHEET
SD n/16/17 RDEPART—_--- 1
• • 12i14/2017
City of Newport Beach Page 2 of 7
4:30:12PM
INSP150 - Daily Inspection Request Report
Requested Inspection Date: 12/15/2017
Inspection Type : ENCROACH
•
Inspection Area : PW
Site Address : 1 PUBLIC ROW
_ - ° �_'tif b.
wi'x]'-: i.�' 4:•.` _4-r T,. •'� rI!j1j{ M[jq' t."i: .urc. 'Y�'"i;i Y'l'+; '�y ::*:.+.: Aa.. ;. _
Activity :
N2017-0619
SubType :
Status :
APPROVED
OWNER:
CITY OF NEWPORT BEACH Phone:
APPLICANT:
GEOCON WEST Phone : 650-208-0992
Description :
Conduct 5-inch cores through existing pavement section. 5 cores on Marguerite Avenue
between San Joaquin Hills Road and Fifth Avenue and 4 cores on Hospital Road between
Placentia Avenue and Superior Avenue.
- _ _ - i,•.
- _
-Y .:y,` ;r.F .Y��t.'� S"..: - _ �j�P("4 +.y +a � . .f'.r n , ^4": A` r_. 'v .yys. 1.'N -.
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4
Item:
10010 BACKFILL / COMPACTION- PW
Requested Time:
12/15/2017 12:00:OOAM Requestor: WEBUSER
626-818-1993
Entered By:
WEBUSER
Comments:
AM-
Assigned to:
777777ZZZZZ
Inspector:
')� Date: ( -7'r/S— Time: j. A PM
Comments: Z,�9eV
- A;?l T7
G /U g4 u r 7
Logged
F:\Users\PBW\Shared\ENCROACH\MASTERS\FORMS\InspectorSheet.doc
REPT131 Run Id: 4018
1/19/2022 City of Newport Beach Page 8 of 21
` 4:30:22PM INSP150 - Daily Inspection Request Report
Requested Inspection Date : 01/20/2022
Inspection Type: ENCROACH
Inspection Area : PW
Site Address: 1 PUBLIC ROW
A/P/D Information:
Activity : N2017-0619
SubType :
Status : APPROVED
OWNER: CITY OF NEWPORT BEACH Phone:
APPLICANT: GEOCON WEST Phone : 650-208-0992
Description : Conduct 5-inch cores through existing pavement section. 5 cores on Marguerite Avenue
between San Joaquin Hills Road and Fifth Avenue and 4 cores on Hospital Road between
Placentia Avenue and Superior Avenue.
Requested Inspection(s)
Item: 10250 FINAL - PW
Requested Time: 1/20/2022 12:00:OOAM Requestor: WEBUSER
Entered By: WEBUSER
Comments: 'ANY-'
Assigned to:
zz
fl VIA I-P