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City vof Neic wBeach
Newport
port Bea ehach cA92sso III�IIIIIIillllllllllllllll"III�IOIIIIIIIIIiIIIIIIIIII Permit No: N2018-0461
100 Permit Counter Phone (949)644-3311 Project NO
Online Inspection Request - www newportbeachca.gov /Online y I i, : )6A N ED
Services
Inspection Requests Phone (949)644-3255
Job Address: 1 PUBLIC ROW NB Thomas:Guide:
Description Replace 120 LF of gas main on Via Oporto between Via Lido and Via Malaga. Pavement restoration per City Standards.
Parcel #
Legal Desc :
Owner: CITY OF NEWPORT BEACH Contractor : NPL CONSTRUCTION CO
Phone: Phone: 623-582-1235
Address : Address : 19820 N 7TH AVE STE 120
PHOENIX, AZ 85027
Contractor State Lic: 732974
Applicant: SOUTHERN CALIFORNIA GAS COMPANY License Expire : 02 28, 2019
Phone : 714-634-7298 [
Address : 1919 S. STATE COLLEGE BLVD
ANAHEIM, CA 92806 - `' Business License : BT30013384
Business Expire : 02 28, 2019
Special Cond.: Pre -job inspection required Workers' Compensation Insurance - -
Carrier : AMERICAN ZURICH INSURANCE CO
Policy No : WC6510563
W. C. Expire: 04 01, 2019
Permit Processing Fee :
$241.00
Sewer Connection :
$0.00
Total Fee
$2,716.00
Agreement Fee:
$0.00
4TT Box Cover:
$0.00
Paid :
$2,716.00
Traffic control Plan Check .
$0.00
Total Water Meters
$0.00
Balance :
$0.00
Inspection Fee
$2,475.00
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 Z2 4
Date
General Services Approval :
Date _/_/
WORKSHEET FOR ENCROACHMENT PERMIT
CITY OF NEWPORT BEACH
PUBLIC WORKS DEPARTMENT
11PROJECT ADDRESS: 3355 Via Lido (work will be on the one-way street off Via Oporto) Xst: Via Oportoli
DETAILED DESCRIPTION OF PROPOSED WORK:
Alter 2" Steel Main on Via Oporto. (1) 3'xl 20' Trench
NOT# 2041189815 MCU# 5270661 CC# 2200-0565
APPLICANT: SoCalGas jPhone: 714-634-7298 Linh Do/permits
Email Address: LDo@semprautilities.com
Mailing Address: City/State/Zip:
1919 S. State College Blvd. Anaheim, CA 92806
OWNER: 1Phone:
Email Address:
Mailing Address:
City/State/Zip:
ALL CONTRACTOR INFORMATION IS REQUIRED -PLEASE COMPLETE
CONTRACTOR: W9L.
I
Office Phone:
Company (if different):
Jobsite Phone:
Other Phone:
Email Address:
Mailing Address:
City/State/Zip:
State License Number & Class:
q1L4 Expires:
City Business License Number:
Expires:
WORKERS COMPENSATION INSURANCE - Certificate of Insurance (Section 3800 Labor Code)
Company: Policy No: Expires:
......... . ....................... .... ........................ ........
INFORMATION
.. .................. . ... ... ............ I .............
........... . .. . ..... 4 ......... . . .. . ..... ......... ..... . I .. ... .
.�fettand . ..... ....... . ..... . ...... ... ... ... . ...
.. . ..... ........ .................... :.X.
. ... ...... . ......
.. ....... . . . . ....... .. .. .. ...... . .... .. ..............
.. ....... ...
Mail R6fdiid.T6` .................................... ...
FOR OFFICE USE ONLY
Special Conditions of Permit: Pre--3ob *,o%%pec4-;0n fn"uired
ADDITIONAL APPROVAL REQUIRED FROM THE FOLLOWING DEPARTMENTS
Utilities:
General Services,
Traffic: Fire:
Other:
Engineering Technician:
Roa':
Public Works
I mod: M�
st:
I
Date:
Permit No.
I W2011-0401
f fusers/ptAvisheredlancroacWmastersieptkorkshRetxls '*_1 -
Public Works Department 949-644-3311
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All Fees Are Non -Refundable Unless Otherwise Stated
PROJECT ADDRESS:
PERMIT
N2018- O�to1
I pool;o- ROW
NUMBER:
APPLICANT: 1 � � Caw►1P So.rN+�+i•n L' o � � o onY
Permit Processing Fee:
Inspection Fee:
Public Works Only
$241.0 1
Public Works Field Inspection
$165.00 vS
Other Department
$275.00
Utilities Field Inspection
$121.0
General Services Inspection
$165.00
Agreement Fee:
Water Quality/Artificial Turf Inspection
$108.00
Preparation of Report/Agreement
$817.00
Document Recordation Fee
$192.00
Refundable Deposit:
TBDB
Monitoring Wells
$502.00
Improvements
TBD
Street/AlleylWalk Closure:
$65.000
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
1 THE FOLLOWING ITEMS REQUIRE APPROVAL FROM THE ]ke7erue7mvision 1
t REVENUE DIVISION PRIOR TO PAYMENT OF FEES Approval:
I
[Water Meter:
Installation Charge
[
13/4" Meter
$50.25
�3,00 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
13" Meter
$3,310.00
1
14" Meter
$4,730.00
16" Meter
$7,190.00
Q -
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
IRod;
0.2,11V. —
Per cialist
Receipt No.
f /users/pbw/shared/encroach/masters/ep front and back masters/
Rev 12/18/2017
epfeesheet xis -revised 11/8/17
`m
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 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 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 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 (ie 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 boy 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, MemonaI 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 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 Stale 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, of 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 C6de)
I certify that I have a Certificate of consent to self -insure, Certificate f Worker's
Compen ation Insu n e, or a Certified Copy th reoU"-L'-L
_L Dat 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 Per 't InspectioR is required b calling
Public Works at 949-644-331
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, 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 Mork:
Department or corrections will be required (i e removals exposing connecbnns.
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 ac now edges he/she has read an nderstands t e term 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. X ! ��� I ��J� Permit fees are nonrefundable. , . Date: � I Signature: f v
City of Newport Beach
Public Works Departm
Phone: 949-644-3311
Fax: 949-644-3318
NAME: SoCalGaS
ADDRESS• 1919 S. State College Blvd. CITY. Anaheim
STATE: CA ZIP: 92806 PHONE (Day): 714-634-7298 (Night): 800-427-2200
NAME: Planner: Brent Floyd 714-432-6021 Business License No.
ADDRESS • CITY:
STATE: ZIP: PHONE (Day): (Night):
EXACT LOCATION OF ENCROACHMENT: 3355 Via Lido (work will be on the one-way street off Via Oporto)
Use street address or approximate number of feet from nearest intersection). xSc Via Oporto TG 888-H7
Reason for Encroachment: Alter 2" Steel Main on Via Oporto. (1) 3'x120' Trench
DUMPSTER 1 HAULER COMPA Y:
Date Closure to Begin: Date Closure to End: _�
CONDITIONS OF APPROVAL:
1 CITY RESERVES THE RIGHT TO REVOKE OR MODIFY CONDITIONS AT ANY TIME 1
I (Permittee) hereby certify the information provided is true and correct, and I agree t
ecomply with the terms and conditions on the front and back of this permit. Permitte
,no- t —�> guarantees do indemnify and hold the City of Newport Beach harmless against an
its f-_ v claims, Irabillty, orjudcfinents.for damages arising out of permitee's activities.
X �c L -L.- Date: 9/5/2018
Reviewed by. -- _ _ Date
- ------------
Aapro led t:-y al
Permit Fee $ Receipt No
stroet�iosi.a_.p;;rmit��sleis�=_vrci�ic�urennp�: oo-� .�.
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4
,• �•t} THE'WORK AREA HALL BE
INSIDE THE BLACK RECTANGLE
USE CONED AND SIGNS THE PIMPLE INDICATES THE
O ALERT ORNER! THAI WORK WE WILL BE DOING (lAA
THERE WILL BE NO S OPORTO IS A ONE WAY STREET
PARKING, SO TRAFFIC STREETI
j a FRCId VW LIDO TO 32ND
CAN FLOW THROUGH. W
DHE
A
� 1 \
t .018 City of Newport Beach Page 13 of 17
'fbsAM INSP15O - Daily Inspection Request Report
Requested Inspection Date : 11/13/2018
Inspection Type: ENCROACH
Inspection Area : PW
Site address : 1 PUBLIC ROW
A/P/D Information:
Activity : N2018-0461
SubType : NEW
Status : APPROVED
OWNER: CITY OF NEWPORT BEACH Phone:
APPLICANT: SOUTHERN CALIFORNIA GAS COMPANY Phone : 714-634-7298
Description : Replace 120 LF of gas main on Via Oporto between Via Lido and Via Malaga. Pavement
restoration per City Standards.
Requested Inspection(s)
Item: 10050 EXCAVATION- PW
Requested Time: 11/13/2018 12:00:OOAM Requestor: WEBUSER
562-658-9323
Entered By: WEBUSER
Comments: ANY- /
Assigned to : zzzzzzzzzzz*
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