HomeMy WebLinkAboutN2000-0060LE(43)1696S
a>soraeaxxs
R/C — 45C 9UFOLT START DATE: 3/15/00
EXHIIBIT "A"
CITY OF NEWPORT BEACH ENCROACHMENT PERMIT
FOR OFFICE USE ONLY
(Please type or print. Press hard - make 3 copies)
Permit#E.P.KZ-ovo- polo
(1) APPLICATION FOR: ❑ CURBCUT ❑ SEWER CONNECTION
(CHECK ONE) ❑ STREET EXCAVATION ❑ WATER CONNECTION
Amount Fee Paid$_W� E
OD ESJ la pt ® UNDERGROUND UTILITIES ❑ OTHER:
Receipt#
(2) ADDRESS OF WORK: PORT MANLEIGH PL. PORT LOCKSLEIGH PL. NG
(3) APPLICANTS NAME ;ADDRESS: 3939 E. CORONADO,
'PHONE:
PACIFIC BELL — K. LAP1iyil1 Ust FLR. , ANAHEIM, CA. 92807
714-666-5698
(4) OWNER'SNAME ;ADDRESS:
;PHONE:
(5) CONTRACTOR'S NAME TLS :ADDRESS:
:Office Phone:
:Job Site Phone:
(6) APPLICANT HEREBY MAKES APPLICATION TO:
EXCAVATE IN A.C. PVMT. 1.727 SQ. FT.; C & G 18 L.F.; C.S.W. 34 L.F.;
DIRT 53 SQ. FT. •X -GUT 8 L.F. TO PLACE CABLE S—k -Z — To F r Ta—
(SEE ATTACHED PLANS)
SPECIAL CONDITIONS OF APPROVAL REQUIRED BY CITY:
VU
Locate and pothole existing City owned utilities (is: water, sewer, or street lighting conduits) to verify locations prior to start of any work. Maintain a
one (1) foot clearanc ror ndgr exi Ing C' y owned utilifies. To arrange for inspection of all connections to City Utilities or if a conflict should occur
please contact the Utilities Department, 48 hours prior to start of any work at (714) 644-3011. In addition, 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 1-804422-4133
(7) CONTRACTOR'S CITY BUSINESS LICENSE NO. (8) STATE LICENSE NO.
(9) WORKERS COMPENSATION INSURANCE
CERTIFICATE OF INSURANCE
(Section 3800 Labor Code)
❑ I 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.: Company: Expiration Date:
❑ Certified Copy hereby furnished
Date: Applicant:
(signature)
(10) CERTIFICATE OF EXEMPTION
(Section 3800 Labor Code)
❑ I 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 Worker's Compensation Laws of California.
If, after signing this certiff cafe 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: Applicant:
(signature)
(11) CONTRACTOR LICENSE EXEMPTION
❑ 1 am exempt from hiring a Contractoras I am the OWNER of the property and am personally performing all work within the Public right-of-way.
Date: Applicant:
(signature)
(12) HOLD HARMLESS STATEMENT
❑ 1 understand that I am locating minor encroachments within the City right-of-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; and I, the
property owner shall indemnify and hold the City harmless for any liability associated with the minor encroachments.
Date: Owner Signature:
(13) «««<24 HOUR ADVANCE NOTICE IS REQUIRED FOR ALL INSPECTIONS »»»>
CALL (714) 644-3311
The terms and conditions of this permit are printed on both sides of this form. Applicant hereby acknowledges that he has read
and understands said terms and conditions and that he agrees to abide by them.
�� Wl // � K. LAPFAM, ENGINEER 2/11/00
�
OWNERS OR ALAP40RIAS AGENTS SIGNATURE (DATE)
SPACE BELOW THIS LINE FOR OFFICE USE
DEPARTMENT APPROVAL REQUIRED DATE SIGNATURE -TITLE
uT \T\CS a tD ma 1144
IL-A,Lc qo
PERMIT ISSUED BY:
DATE ISSUED: EXPIRATION DATE OF PERMIT:
PERMIT DENIED:
White - Permit Pink -Temporary Office Copy Yellow - Applicant
` TO BE COMPLETED BY FIELD PERSONNEL
Inspector: Contractor
INSPECTIONS
DATE TIME COMMENTS
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. A approved copy of the permit & 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, indemnify 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 (714) 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 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 (714) 644-3011 at least 72 hours in advance of work for utility inspections. In addition, all trench restoration must
be inspected by Public Works Department at (714) 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 15th and Sept. 15th, and Christmas Vacation from Dec. 19th to January 1st, 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 & Fire Dept. prior to closing the streets.
Applicant must maintain access to fire, police, 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/unused materials shall be removed within 24 hours after completion of the work. If materials are not removed, the City
may remove the materials and bill the applicant. Coordinate alley closures with City's refuse pick-up days so service is not
interrupted, call 714-644-3066 for trash collection schedule.
14. Any unused driveway approaches shall be removed, and the cA and gutter and sidewalk replaced at the applicants expense.
15. Any above ground facilities will require Public Works Department approval and documented approval from the adjacent property
owner(s).
F:\Groups\Pubworl,,s\EncroachlTema