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CITY OF NEWPORT BEACH ENCROACHMENT PERMIT
(Please type or print legible. Press hard - makes 3 copies)
Permit # E.P. V4 2 ciao-- 0 oN
[1] APPLICATION FOR: ❑ CURB CUT ❑ SEWER CONNECTION
(CHECK ONE) ❑ STREET EXCAVATION ❑ WATER CONNECTION
Amount Fee Paid $ W A"y G+-0
❑ UNDERGROUND UTILITIES 0' OTHER: -S`TI� 501q'1fL'-
Receipt If
[2] ADDRESS OF WORK: New poi r - n -a s A u(F-t-
[3] APPLICANTS NAME ;AD:AREA CODE: 7 y
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col \ 0 � c)(1 0('E _ :_ 1.15 U�� I - Sj" ArJ-P (PHONE: _5_(,7- %O 4L
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[4] OWNER'S NAME: :ADDRESS: ;AREA CODE:
:PHONE:
[5] CONTRACTOR'S NAME: ;ADDRESS: :Office Phone:
:Job Site Phone:
[6] APPLICANT HEREBY MAKES APPLIC TION TO: co t,FS FF S'
SAS Mf&dcG- -Piz - 5(♦a 'J')t IJ10 HI'L-S — I-OC4?
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(SEE ATTACHED PLANS)
SPECIAL CQNDITIONS OF APPRO
AL REQUIRED BY CITY:
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❑ Locate and pothole existing City owned utilities (ie: water, sewer, or street lighting conduits) to verify locations prior to start of any work. Maintain a
one (1) foot clearance over or under existing City owned utilities. To arrange for inspection of all connections to City Utilities or if a conflict should occur
please contact of the Utilities Department, 48 hours prior to start of any work at (949) 644-3011. In add
when a sewer cleanout is required, V.C.P. or P.V.C. SDR35 shall be used with a 4TT box over the cleanout riser.
** ALL UNDERGROUND WORK SHALL BE PERFORMED BY A LICENSED CONTRACTOR**
CONTACT "UNDERGROUND SERVICE ALERT" AT LEAST 48 HOURS IN ADVANCE
OF ANY EXCAVATION AT 1-800-422-4133
[7] CONTRACTOR'S CITY BUSINESS LICENSE NO. O CA C- re [8] STATE LICENSE NO. ro W F c ...E
[9] WORKERS COMPENSATION INSURANCE
CERTIFICATE OF INSURANCE
(Section 3800 Labor Code)
❑ 1 certify that I have a Certificate of consent to self -insure, or Certificate of Worker's Compensation Insurance or a Certified Copy thereof.
Policy No.: -0 t`J �-- C (-- F Company: Expiration Date:
Data, Applicant
(signature)
10] CERTIFICATE OF EXEMPTION
(Section 3800 Labor Code)
❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the
Workers Compensation laws of Caldomia. If, a If, after signing this this certificate I become subject to the Worker's Compensation provisions of
the State Labor Code, I must compy, with the provisions of Section 3700, or this permit shall be deemed revoked.
Date: Applicant:
(signature)
[11] CONTRACTOR LICENSE EXEMPTION
❑ 1 am exempt from hiring a Contractor a5 I am the OWNER of the property and am personally performing all work within the Public right-of-way.
Dale: Applicant
(signature)
12] HOLD HARMLESS STATEMENT
❑ 1 understand that I am locating mimr encroachments within the City rightof-way/easement. It is my responsibility as the property owner 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; aM 1, the
property owner shall indemnify and hold the City harmless for any liability associated with the minor encroachments.
Data: Owner Signature:
131 «««< 24 HOUR ADVANCE NOTICE IS REQUIRED FOR ALL INSPECTIONS »»»>
CALL (949) 644-3311
The term and conditions of permit are printed on both sides of this form. Applicant hereby acknowledges that he has read
and undo oris id to and Mons and that he agrees to abide by Mem.
W
,6Vill OR AUTHORIZED AGENTS SIGNATURE (DATE)
14] * * * * * TREES WITHIN THE CITY'S RIGHT-OF-WAY * * * * *
NO TREES WITHIN THE CRY'S RIGHT-OF-WAY SHALL BE PLANTED, REMOVED OR RELOCATED WITHOUT PRIOR APPROVAL FROM
THE GENERAL SERVICES DEPARTMENT
SPACE BELOW THIS LINE FOR OFFICE USE
DEPARTMENT APPROVAL REQUIRED
DATE SIGNATURE - TITLE
-
PERMIT ISSUED BY:
DATE ISSUED: ! — / / - z o m o EXPI TION DATE OF PERMIT: 7 — l I - ZOm a
PERMIT DENIED:
'hits - Permit Pink - Temporary Office Copy Yellow - Applicant
J1
TO BE COMPLETED BY FIELD PERSONNEL
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Inspector: Contractor:
INSPECTIONS
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TERMS AND CONDITIONS
1. Encroachment permits shall be taken out in the name of the owner of the benefited property and signed by the owner or authorized
agent. ,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.
2. The Permittee agrees to defend, indemnity and hold the City, its authorized agent, officers, representatives and employees harmless
from any responsibility, liability, suite or action of any description arising out of any accident, loss or damage to persons of property
occurring as a proximate result of any work undertaken under this permit.
3. All work shall be done in accordance with the approved plans, and the Standard Special Provisions and Standard Drawing 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 will be corrected
within two weeks after notification to the satisfaction of the Director of Public Works.
5. All construction within public rights-of-way must be performed by licensed contractors, unless waived by the Public Works
Department.
6. 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. Trench excavation and backfill shall conform to Section 306-1 of the
City's Standard Special Provisions. Walls and faces of all excavations over 5 feet in depth shall be effectively 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. All work must be inspected by the Public Works Department. Forms and subgrades must be inspected and approved before concrete
is ordered. Sewer, pipelines and subgrade construction must be inspected and approved before backfilling. Public Works inspectors
are available during working hours upon 24 hours advanced notice. Call (949) 644-3311 to arrange for an inspection. Separate
Utilities Department inspections may be required. It shall be the Permittee's responsibility to restore improvements (i.e. street
pavement, sidewalk, when applicable sprinklers, etc. within 72 hours after utility work has been completed and backfilled. In addition,
all sidewalk replacement shall be done in full panels.
8. All utilities connections must be inspected by the Utilities Department prior to backfill. The applicant shall notify the Utilities
Department at (949) 6443011 at least 72 hours in advance of work for utility inspections. In addition, all trench restoration must be
inspected by the Public Works Department at (949) 644-3311. No utility installation(s) shall be allowed over or within 5' of City's
utilities, unless approved by the Engineer.
9. Barricades must be provided and maintained around all trenches, excavations and obstructions. Barricades must be properly lighted.
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 Public
Works. If the applicant does not have barricades, 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 shall be maintained at all times.
10. All work within or near beach sensitive areas will not be allow during Easter vacation, Memorial Day weekend, summer between June
1e and September 15th, and Christmas Vacation from December 19� to January 151, unless approved by the Engineer.
11. Prior to undertaking any work which will extend into the traffic lanes and impede the normal flow of traffic, the applicant must first
secure the written approval from the License Supervisor, who will notify the Police and Fire Departments prior to closing the streets.
Applicant must maintain access to fire, police and emergency vehicles. Traffic Control as a minimum must be per Work Area Traffic
Control Handbook (WATCH). No nighttime closures, unless approved by the Engineer. Any lane(s) closure in a major street will only
be allowed between 9:00 a.m. and 3:00 p.m., unless approved by the Engineer. 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. The applicant must notify the gas, electric, telephone and cablevision companies before starting any underground construction. Call
underground service alert at 1-800-422-4133 at least 48 hours before digging. Notify all affected residents 24 hours in advance of
restricted access and any construction inconveniences.
13. Refuse or unused materials shall be removed within 24 hours after completion of the work. If materials are not removed, the City m
remove the materials and bill the applicant. Coordinate alley closures with City's refuse pick-up days so service is not interrupted
(949) 644-3066 for the trash collection schedule.
14. The driveway approach shall be removed, and the curb and gutter replaced at the applicant's expense.
15. 4ny above ground facilities will require Public Works Department approval and documented approval from the ad'
owner(s).
f\uscn\pbw\shaml4Mroachv,es,vs4rnrs99.doc
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CITY OF NEWPORT BEACH
PUBLIC WORKS DEPARTMENT
3300 NEWPORT BLVD.
P.O. BOY 1768, NEWPORT BEACH, CA 92658-8915
(949) 644-3311
December 29. 1999
Mr. Ken E. Smith, Materials Engineer
County of Orange
Construction Division
1152 E. Fruit Street
Santa Ana, CA 92701
SUBJECT: Street Rehabilitation Reports
Dear Mr. Smith:
Bob Stein spoke to Jerry Sterling on Tuesday to request preparation of street
rehabilitation reports for several streets within the City. We need these reports for the
Arterial Highway Rehabilitation Program applications that we are currently in the
process of preparing for submittal in February. Jerry indicated that you might have
openings in your schedule in mid-January. This timing would work for us if we could get
final reports by the end January.
The streets of interest are:
1. Newport Boulevard (21St Street to 26th Street)
TI: 6.5
Proposed section: 2" rubberized AC on 3/8" SAMI on Y4" leveling course
2. Campus Drive — East bound lanes only (MacArthur Boulevard to Jamboree
Road)
TI: 5.5
Proposed section: 1-1/2" AC overlay
3. Ford Road (Jamboree Road to MacArthur Boulevard)
TI: 5.5
Proposed section: 2" AC overlay
4. San Miguel Drive (Port Sutton Drive to Eastgate Drive)
TI: 5.5
Proposed section: 1-1/2" AC overlay
The TI's are preliminary and will be reviewed next week.
For all these projects, we will be cold milling adjacent to the curb & gutter and median
curbs. In some sections we may be grinding from curb to curb.
Bob Stein will be able to provide as -built drawings for these projects and any reports in
our files on these streets. The City will issue a no fee permit for this work. We will of
course need to know when you will be performing the work, lanes that we be affected,
etc.
Please call either Bob Stein or me for the scheduling and costs for this work at (949)
644-3311. Thank you for your time and consideration.
Sincerely,
Bill Patapoff, P.E.
City Engineer
By:
Robert Stein, P.E.
Senior Civil Engineer