HomeMy WebLinkAboutN2018-0111t�w~'100
City VO cNe pport Beach
CA 92660 IIIIIII IIIIIII IIIIIII III�IIIII II IIII II III
N 2 0 1 8 0 1 1 1
Permit Counter Phone (949)644-3311
3 y� Online Inspection Request - www newportbeachca.gov / Online
Services
Job Address :
3 CAPE ANDOVER NB
Description :
SIDEWALK REPLACEMENT WITHIN EASEMENT
Parcel # :
1178-034-8 -
Legal Desc :
N TR 15012 LOT 9
Owner:
HOEVEN DREW
Phone:
Address :
2201 DUPONT DR #700
IRVINE, CA 92612
Applicant: RICK DORN
Phone: 7145857322
Address :
Special Cond.: PRE CON MEETING REQUIRED
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 :
Permit No: N2018-0111
Project No : 1816-2017
Inspection Requests Phone (949)644-3255
VI/, i--I-,
Thomas:Guide: 88966
Contractor : RICK DORN CONST
Phone: 714-585-7322
Address : P O BOX 10047
WESTMINSTER CA 92685
Contractor State Lic: 357535
License Expire: 05 31, 2019
Business License : BT30049443
Business Expire: 01 31, 2019
Workers' Compensation Insurance - -
Carrier : WC EXEMPT
Policy No: (NO EMPLOYEES)
W. C. Expire:
Total Fee $406.00
Paid : $406.00
Balance : $0.00
Receipt No:
Other Department :
Date:
Permit Denied
Date
Issued Permit :
Date:
/
/
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COMPLETE THE BELOW INFORMATION
PROJECT ADDRESS: ?� e-
DETAILED DESCRIPTION OF PROPOSED WORK:
AV
APPLICANT: -�
Phone: / —
Email Address: ' v
Mailing Address:
City/State/Zip:
OWNER: —�nJ
Phone:
Email Address:
Mailing Address:
City/State/Zip:
' ., cc rItA=OR NWORMTM IS c
CONTRACTOR: G:C
Office Phone:
Company (if different):
Jobsite Phone:
Other Phone:
Email Address:
Mailing Address:
City/State/Zip:
State License Number & Class:
/ Expires: rr 8
City Business License Number:
Expires:
WORKERS COMPENSATION INSURANCE - Certificate of Insurance (Section 3800 Labor Code)
Company: Policy No: Expires:
Municipal Oerations: 949-644-3055
Utilities: 949-644-3011
Urban Forestry: 949-644-3083
FOR OFFICE USE ONt.Y
Special Conditions of Permit: iALooCI
ADDITIONAL APPROVAL REQtlIRED FROM THE FOLLOWING DEPARTMENTS
Utilities:
Municipal Operations
Traffic: Fire:
Other:
Engineering Technician:
Permit Specialist
Date:
2j
Permit No.
N2018- 01 i
f /users/pbw/shared/encroach/masters/epworksheet xts
Public Works Department 949-644-3311
100 Civic Center Drive, Newport Beach, CA 92660
Permit Processing Fee:
Public Works Only
Other Department
Agreement Fee:
Preparation of Report/Agreement
Document Recordation Fee
Monitoring Wells
Inspection Fee:
$241.00
Public Works Field Inspection
$165.00
$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:
TBD
$502.00
Improvements
TBD
Street/Alley/Walk Closure:
$65.00
Newspaper 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
Additional
_ _
THE LO FOLWING iTEMS REQUIRE APPROVAL FROM THE Revenue Division
]Approval:
l REVENUE DIVISION
-
PRIOR TO PAYMENT OF FEES
Qty.
. 21 . 1
(Water Meter:
Installation Charge
$528.00 1
13/4" Meter
$50.25
1
11" Meter
$121.50
Water Meter Boxes:
1
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
1
14" Meter
$4,730.00
1
t6" Meter
$7,190.00
J
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 My over 4 hrs)
$1,022.00
5200-5031
Street Tree Fee ($700 Planting Fee)
TBD
030-2284
Engineerin Tech:
Permit Specialist
Amount Due:
Receipt No.
Rev 12/18/20171 F - 1� 13 '� I
For Finance Use Only
/users/pbw/shared/encroach/masters/ep front and back masters/
xls-revised 11/8/17
Ali- zor�
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
Lficroachment Permits may be taken out by the owner of benefited property or a licensed contractor A licensed
c ontractor 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 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 date of issuance
I he Pemuttee 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
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
Pernuttee guarantees all work performed under this permit to be free of hidden and latent defects Any failures shall
be conected within two weeks after notification to the satisfaction of the Public Works Director
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 State Contractor License Class C-42 is required
All trenchiny 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 front the California Division of
Industrial Safely 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 systern, sloping of the ground, or other equivalent
rneans Trenches less than 5 feet in depth shall be guarded when hazardous ground movement may be expected
The Public Works Department Inspectors must inspect all work in the Public tight -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
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 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
411 box over the riser
Properly lighted barricades trust 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 I ransportation It needed, barricades can be obtained from the City at a charge of $10 00
per barricade per day with a minimum charge of S35 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
Work within or near beach sensitive areas will not be allowed during, City holidays, spring break Memorial Day
weekend, sumnier between June 15 and September lb, and during the holiday season from December 19 to
January 1, unless approved by the Public Works Department
Any work that extends into traffic, or parking lanes arid impedes the normal flow of traffic requires the applicant to
acquire a leniporary Street Closure Permit from the Public Works Department Access for fire, police and
emergency vehicles must be maintained at all limes 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 Pernut All vehicles shall be lawfully parked
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
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
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
fQr the collection schedule so service is not interrupted To place a dumpster or materials in the public right-of-way, a
-I ernpowry Street Closure Pernut 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-insur , ertifi ate 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 witll_Weprovisions of Section
3700 or this permit shall be deemed revoked.
Date: �`� _ l 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 Perm
it-ktspection is required by calling
Public Works at 949-644-3311. �j
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 dram 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 Works
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 shall be performed until the Public Works Department has issued this permit. Applicant hereby acknowledges he/she has read and erstands 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. ., L
Permit fees are nonrefundable. Date ,J�'% // C?
Signature:
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` 3/5/2018 City of Newport Beach Page 1 of 13
4:30:20PM INSP150 - Daily Inspection Request Report
Requested Inspection Date:
03/06/2018
Inspection Type:
ENCROACH
Inspection Area :
PW
Site Address :
3 CAPE ANDOVER
Activity :
N2018-0111
SubType :
Status :
APPROVED
OWNER:
HOEVEN DREW
Phone:
APPLICANT:
RICK DORN
Phone: 7145857322
Description :
SIDEWALK REPLACEMENT WITHIN
EASEMENT
{ S nN
Item:
10010 BACKFILL / COMPACTION- PW
Requested Time:
3/6/2018 12:00:OOAM
Requestor: NBIVR
6572897329
Entered By: NBIVR
Comments: PM
Assigned to:
Inspector: 1&I)Alik Date
Comments:
0c,
F:\Users\PBW\Shared\ENCROACH\MASTERS\FORMS\Inspectorsheet.doc
Time: ZZO AM PM
REPT131 Run Id: 4018
3/12/2018
6:34:15AM
City of Newport Beach Page 2 of 9
INSP150 - Daily Inspection Request Report
Requested Inspection Date : 03/12/2018
Inspection Type: ENCROACH
Inspection Area : PW
Site Address : 3 CAPE ANDOVER
"ID hdorma&m:
Activity :
N2018-0111
SubType :
Status :
APPROVED
OWNER:
HOEVEN DREW Phone:
APPLICANT:
RICK DORN Phone : 7145857322
Description :
SIDEWALK REPLACEMENT WITHIN EASEMENT
Requested ks)
Item:
10010 BACKFILL / COMPACTION- PW
Requested Time:
3/12/2018 12:00:OOAM Requestor: NBIVR
6572897329
Entered By:
NBIVR
Comments:
PM
Assigned to:
C� 3 / -2
J t�'
3 far- Ail dove, r,
ro '. Ad
Inspector: i ?!I!. �
Comments:
Date: Time: AM PM
NJF
%T�
F \USers\PBW\Shared\ENCROACH WASTE RS\FORMS\InspectorSheet doc