HomeMy WebLinkAboutN2018-0179oityvofcNew�port Bea B ach,CA92660 IIIIII I IIII II (IIIIIIIIII IIIIII II Permit No: N2018-0179
N 2 0 1 8 0 1 7 9
Permit Counter Phone (949)644-3311 Project No
s yam. -t Online Inspection Request - www.newpoitbeachca.gov / Online �• Services S (y V [
Inspection Requests Phone (949)644-3255
Job Address: 1 PUBLIC ROW NB Thomas:Guide:
Description : One 4-inch soil boring for soil sampling for Metropolitan Water District on Bristol Street southeasterly of Irvine Avenue. Pavement restoration per
City Standards.
Parcel # .
Legal Desc :
Owner: CITY OF NEWPORT BEACH
Phone :
Address
Applicant: CLARK SEIF CLARK, INC
Phone : 562-676-7927 [
Address : 4010 WATSON PLAZA DRIVE #170
LAKEWOOD, CA 90712
Special Cond.: Pre -job inspection required.
Contractor : GREGG DRILLING & TESTING INC
Phone : 562-427-6899
Address : 2726 WALNUT AVENUE
SIGNAL HILL CA
Contractor State Lic: 485165
License Expire : 01 31, 2020
Business License :
BT00010120
Business Expire :
07 31, 2018
Workers' Compensation Insurance - -
Carrier :
ZURICH AMERICAN INSURANCE COMP
Policy No :
WCO235381
W. C. Expire:
08 01, 2018
Permit Processing Fee :
$241.00
Sewer Connection :
$0.00
Total Fee
$571.00
Agreement Fee :
$0.00
4TT Box Cover:
$0.00
Paid :
$571.00
Traffic control Plan Check :
$0.00
Total Water Meters :
$0.00
Balance :
$0.00
Inspection Fee :
$330.00
Water Meter Connection .
$0.00
Receipt No
Refundable Deposit:
$0.00
Total Water Meter Box:
$0.00
Street Tree Fee :
$0.00
Adjustment :
$0.00
Processed By :
Date : _/_/
Other Department :
Date:
Utilities Approval :
Date : _/_/
Permit Denied
Date
Traffic Approval :
Date : _/_/
Issued Permit :
Date
General Services Approval .
Date
WORKSHEET FOR ENCROACHMENT PERMIT
CITY OF NEWPORT BEACH
PUBLIC WORKS DEPARTMENT
COMPLETE THE BELOW INFORMATION
PROJECT ADDRESS: 2 1 2 Stol Gj,ct,& ncrr 'T coJ_c Ajt, in.(- VC'L%B'�-`
DETAILED DESCRIPTION OF PROPOSED WORK:
APPLICANT: cr, ., rs't� cc->C phone GZ 7 q
Email Address: G ac c e CSC « , CO(A^
Mailing Address: �7c�
City/State/ Zi(*A
OWNER: i"\ir4rc7 l: (�rw{tr J0 r
Phone:
Email Address:
Mailing Address:
City/State/Z'p:
ALL CONTRACTOR INFORMATION IS REQUIRED -PLEASE COMPLETE
CONTRACTOR: &Cf-
Office Phone: S4z L127- (y8Ctc�
Company (if different):
Jobsite Phone:
Other Phone:
Email Address: J�,.�`��,t(LJ Sc ci(li ,coL---
Mailing Address: 27 y�,1,`Jt-
City/S ate/Zip: �s
�.ii 5o
State License Number & Class:
Expires: t- I - 2cn
City Business License Number: 6- 0In` 1-0
Expires: -3t - i 1o'
WORKERS COMPENSATION INSURANCE - Certificate of Insurance (Section 3800 Labor Qpde)
Company: ��C:rj .,c l05 �.�cc,htL CO. Policy No: �jQOOZIo$2 Expires: 6-1-1$
Municipal Oerations: 949-644-3055
Utilities: 949-644-3011
Urban Forestry: 949-644-3083
FOR OFFICE USE ONLY
Special Conditions of Permit: -fie - job inspcc cr, re_,,,.ew .
ADDITIONAL APPROVAL REQUIRED FROM THE FOLLOWING DEPARTMENTS
Utilities:
Municipal Operations
Traffic: Fire:
Other:
Engineering Technician:
" ��
Permit Specia '
Date:
4 -
Permit No.
IN2018-
t /users Ipb. /shared!encroach/masterslepworksheet As
Public Works Department 949-644-3311
100 Civic Center Drive, Newport Beach, CA 92660
FEE WORKSHEET FOR ENCROACHMENT PERMIT
CITY OF NEWPORT BEACH
PUBLIC WORKS DEPARTMENT
All Fees Are Non -Refundable Unless Otherwise Stated
PROJECT ADDRESS:
PERMIT
N2018- s-l4
� Pvbkc ROW
NUMBER:
APPLICANT:
�,lo,-JS Sc� Clor'i�
Permit Processing Fee:
Public Works Only
Other Department
Agreement Fee:
Preparation of Report/Agreement
Document Recordation Fee
Monitoring Wells
Q Inspection Fee:
$241 00 Public Works Field Inspection
$275.00 Utilities Field Inspection
General Services Inspection
Water Quality/Artificial Turf Inspection
$817.00
$192 00 Refundable Deposit:
$502 00 Improvements
Qty.
$165 00 Z
$121 00
$165.00
$108.00
TBD
TBD
Street/Alley/Walk Closure: $65.00Newspaper Rack Inspection $108.00 0
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
F�
Additional
1 THE FOLLOWING ITEMS REQUIRE APPROVAL FROM THE Rvenue D eivision 1
1 REVENUE DIVISION PRIOR TO PAYMENT OF FEES ]Approval:
1
Qty.
_ Q• _ 1
(Water Meter:
Installation Charge $528.00 1
13/4" Meter
$50.25
1
11" Meter
$121.50
Water Meter Boxes:
11 1/2" Meter
$285.00
1" DFW Meter Box $96 66 1
11 1/2" Turbine Meter
$700.00
2" DFW Meter Box $203.24 1
12" Meter
$425.00
1
12" Turbine Meter
$845.00
1
1
13" Meter
$3,310.00
14" Meter
$4,730.00
!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
$1,079100
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
Enaineerina Tech: ITotal Amount Due: I For Finance Use Only
'ermySpecialist Receipt No.
Rev 12/18/2017
/users/pbw/shared/encroach/masters/ep front and back masters/
As -revised 11l8/17
I ALL UNDERGROUND WORK SHALL BE PERFORMED BY A LICENSED CONTRACTOR I
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 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 Tire 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 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
I I 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 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
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 Permii9nspection 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 owner(s)
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, or relocated
without approval from the General Services Department
19 All work in the public right-of-way must meet the approval of the Public Vlork,,
Department or corrections will be required (i e removals, exposing connecbo,is,
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 shall be performed until the Public Works Department has issued this permit. Applicant hereby acknowledges he/she has read understand e 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. Dat�__--___'&Jignaturej __
4 EGG
GREGG DRILLING & TESTING, INC.
SPECIALIZING IN ENVIRONMENTAL AND GEOTECHNICAL DRILLING
3/05/2018
City of Santa Ana
Building Department
Re: Letter of Authorization
To whom it may concern,
This letter is giving authorization to Aaron Garrett (with Clark Seif Clark, Inc.), to sign and obtain
an encroachment permit on Gregg Drilling & Testing's behalf.
If you have any questions, please feel free to contact me at 562) 427-6899.
Thank You,
/ John Gregg
President/Owner
CORPORATE OFFICE: 2726 WALNUT AVENUE • SIGNAL HILL, CA 90755-1832 • (562) 427-6899 • FAX (562) 427-3314
ADDITIONAL LOCATIONS: HOUSTON • PALO ALTO • SAN FRANCISCO
E-Mail address infw1vgreggdriIling corn • Web Site address www greggdrilling corn
ESTIMATED DURATION: 2 hours ROAD WORK AHEAD -- Warning Signs
w— approximately 350' m advance
Work Hours During Monday to Friday gam to 3pm w LEFT LANE CLOSED AHEAD ores appropriate `
2
--- ` wino ROAD WORK AHEAD
MERGE
FLASHING
ARROW /
SIGN
(Type I or 11)
v ` ` LANE
` CLOSED
r TO s
r /
10
U � x
4 G
O r
� Qs
f /
1 /
f
I /
r/
10/ xAf
OJ2ik/OQ?/ �J� W.
ROAD WORK AHEAD
LEGEND
Traffic Cone
pad with flags, Temporary Traffic
nd standard. Control Sign
Portable Flashing Beacon
onsite
trol. all Soil Boring Location
O Existing Signalized Intersection
al Street
ph Direction of Travel
NOTES
Work is for Metropolitan Water District
All signs will be equip
(MWD). MWD line located in center of
industry color, size, a
Work Area.
Work consists of one soil boring
drilled with hand equipment.
A technicican will be
Boring = 4" diameter to 10' depth max
to maintain traffic con
Traffic Control per WATCH Manual,
Speed Limit on Brist
latest edition
at Work Area = 40 m
r
ARROW
SIGN
LANE
(optional)
CLOSED
caolcnl
25' max cone spacing
WORK AREA
`
a END ROAD WORK
\
�
45U mriI
(18 rtII
`
MIN
END ROADWORK
\ ` \
Dayshott.ow,�ed
o 2
` \
Roaewey (S 00 kir"t
40 RIM)
Traffic Control Map 1.3
Bristol Street 4 MO Site 022
1 inch = 50 feel 2121 Bristol Street, Santa Ana
COUNTY PROPERTY PERMIT
Page I of _'
2018- 00092 ENCROACHMENT PERMIT
B,ihis, MusLpha J 17 06 P%1
INSPECTION PHONE COUNTY OF ORANGE
OC Public Works/ OC Planning/ County Property Permits
714-245-4550
nspection office shall be notified at least
EWO (2) WORK DAYS PRIOR to
:omtnencing permitted use. FAILURE or P.O
EO OBTAIN INSPECTION SHALL
iOID THIS PERMIT
'ERMITTEE
lark Seif Clark
' 1732 Devonshire Street
>uite B
'hates orth, CA 91311
i62-676-7927
3; 92018
Permit No: 2018-00092
Effective Date: 3/9/2018
Main Office: 300 North Flower Street, 12:00 AM
Santa Ana, California 92703-5001 Appf faVowM§Ple
Box 4048, Santa Ana, California 92702-4048 %� 1 �2018
responsibility for obtaining 12-00 AM
(714) 667-8888 a rider (extension) prior to
Fax: (714) 667-8885 this date
FACILITY
Type Facility Name '.Number
AP BRISTOL STREET NONE
ontact Person Aaron Garrett
Telephone No. 562-676-7927
nsured Clark Seif Clark Inc _ Policy PACEP305417 Expires 7/1/2018
'ER.NIITTED USE: User of County property is hereby authorized as follows, subject to provisions attached hereto
Fo set up traffic control devices on Bristol Street near 2121 Bristol Street, in Santa Ana Heights, for soil boring within the City of Newport
3each, within a portion of Orange County's Bristol Street road right-of-way, per attached plans and provisions.
Permittee is responsible for obtaining any required permissions from other jurisdictions.
Permit not valid until pre -inspection has been completed and approved.
Any street surface disturbed, excavated, or damaged shall be replaced in kind. Any asphalt concrete pavement replacement within the
ounty road right-of-way should be per OCPW Standard Plans 133-3 & 133-3-OC.
Traffic control within the boundaries of the City of Newport Beach will need to be reviewed and approved by the City of Newport Beach.
Safe ingress and egress to and from driveways shall be maintained at all times.
Temporary traffic control shall be implemented after 9 am and removed by 3 pm.
Any pedestrians and/or bicyclists shall be directed safely around the work area by means of detour or as directed and assisted safely by the
:ontractor.
It is mutually understood and agreed that this use is permitted, subject to a limited length of time, may be revoked by the County Inspector
it any time for reasons in the best interest of the District or the general public.
This permit is non-exclusive and OC reserves the right to issue permits to others for similar or different purposes upon, or including, the
trea of this permit.
-EQA Code 1 SWPPP: No
LOCATION OF WORK:
3ristol Street near 2121 Bristol Street, in Santa Ana Heights
)imensioniType: TCP Thomas Brother: 859,E7 Area: Santa Ana Heights
PERMITTEE'S ACCEPTANCE:
SIGNATURE ON FILE
COUNTY APPROVAL:
Ohvera. Jerry
3 5 2018
PERMIT \\D -%PPRO\, ED PLANS SHALL BE MAINTAINED O\ JOB SITE PERyI1TTEE SHALL COMPLY WITH REGLLAT[ONS PRINTED ON' REVERSE
SIDE OF PERMIT -\ND NTT ACHNIENTS ALL t,NDERGROU\D WORK REQI [RES PRIOR 1\DERGROt.ND SER'v ICE ALERT' COMPLIANCE. THIS
PERMIT IS \ON-I'RA\SFERABLE
Note: Surety will not be refunded until Final Inspection is performed and submitted to County Property Permits.
4/17118 City of Newport Beach Page 11 of 12
.4 TS):09PM INSPI60 - Daily Inspection Request Report
Requested Inspection Date:
04/18/2018
Inspection Type :
ENCROACH
Inspection Area :
PW
Site Address :
1 PUBLIC ROW
,* k, .i. J�y'tt-"J'i , 7"•4M1�r} I
.uy .�y '.'{;. ;rd.51MY1111
Oil 1100
`.t3i'�,�, r7_. ,.njm�-,•�r+�`{�.,•: pt,
Activity :
N2018-0179
SubType :
NEW
Status :
APPROVED
OWNER: CITY OF NEWPORT BEACH Phone :
APPLICANT: CLARK SEIF CLARK, INC Phone : 562-676-7927
Description : One 4-inch soil boring for soil sampling for Metropolitan Water District on Bristol Street
southeasteriv of Irvine Avenue. Pavement restoration per City Standards.
Requested Time: 4/18/2018 12:00:OOAM
Entered By: WEBUSER
Comments: PM -
Assigned to: 77777777777*
Inspector:
T3s
Requestor: WEBUSER
562-676-7927
Date: y- i Ik- Ig Time: I: CrO AM PM
Comments: '^ r l w, y..A RA .0 Gam'-% I 1 F-Co- C LPCt PL SOS CLkEk. +Nc .
w, L L CA (,L I �> Fce- I - 5P -c C--) y - Zo t $ , So, L SA-ANP(Z I-, Ll- "A K-e Z Aa.S
F:\Users\PBW\Shared\ENCROACH\MASTERS\FORMS\InspectorSheet.doc
REPT131 Run Id: 4018
Inspector: / Date: Time: AM PM
Comments:dr�
F \Users\PBMShared\ENCROACH\MASTERS\FORMS\InsoectorSheet doc