HomeMy WebLinkAboutN2000-0228SMreG\Bwoacn\rnasres\EP+7-99 EP Fornxls
EXHIBIT "A" 0
CITY OF NEWPORT BEACH ENCROACHMENT PERMIT
(Please type or print legible. Press hard - makes 3 copies)
Permit # E.P. ti -Lo 00 - 2-72 2
[1] APPLICATION FOR: ❑ CURB CUT ❑ SEWER CONNECTION
(CHECK ONE) ❑ STREET E VATION ❑ WATER CONNECTION
Amount Fee Paid
❑ UNDER IES VOTHER:St!—qlF
Receipt#
[2] ADDRESS OF WORK: 1 O D izn� s
[3] APPLICANTS NAME :ADDRES (A 921W5 149
:;AREACODE:
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7rl F V94r v&10ITPHONE: r%
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[4] OWNE(�'S\NAME : p ADDRESS: :AREA CODE:
Cl 0'I" iv/ e"h� �liC�� ;PHONE:
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[5] C NTRACTP�QF�yS NAME: -y- :ADDRESS: c_,. �5 �DU�- ;Office Phone: Io 45.7-�b0�
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Vlvyn. t Ltc �a� I rQ3 L ; :Job Site Phone: 7"
[6] APPLI ANT HERYEN MAKES APPLICATION TO:
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PlAdE
(SEE ATTACHED PLANS)
SPECIAL CONDITIONS OF APPROVAL REQUIRED BY CITY:
Con (L�t-I'L T.3.
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 cle nce 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 � R L,4I s ±,9 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. CST" 'L o o 5 'L So 4 [8] STATE LICENSE NO. 765 713
[9] WORKERS COMPENSATION INSURANCE
CERTIFICATE OF INSURANCE
(Section 3800 Labor Code)
M/1 certify that I have a Certificate of consent to self -insure, or Certificate of Worker's Compensation Insurance or aCertified Copy thereof.
Policy No.: 133X794 -D0
Company: 66k �z. 6,') Expiration Date:
V1d'
Date: Applicant�—
(signature)
[30] 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
Worker's Compensation laws of California. If, aIf, after signing this this certificate I become subject to the Worker's Compensation provisions of
the State Labor Code, I must amply 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 as I am the OWNER of the property and am personally performing all work within the Public right-of-way.
Data Applicant
(signature)
12] HOLD HARMLESS STATEMENT
❑ 1 understand that am locating minor encroachments within the City rightof-wayleassment. 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(949)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 understa said t!T[a�n�d auditions and that he agrees to abide by them.
A� r
OWNERS 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
tZRFi-� c0.00
Ir
PERMIT ISSUED BY:
DATE ISSUED: /, - / 3 - Z o 0 o E PIRATION DATE OF PERMIT:
PERMIT DENIED:
White - Permit Pink - Temporary Office Copy Yellow - Applicant
MEMORANDUM
MEMO TO: Gil Wong
FROM: Bob Stein
DATE: 6/9/00
SUBJECT: Village Odor Assessment by Environmental Support Technologies (EST)
Contact No.: 3333
Janet Divan (Traffic Section) came in and outlined her concerns and requirements:
1. She suggested that EST take three parking spaces on Bay Avenue for its trucks and
equipment.
2. She is satisfied with cones at the sampling sites as long as they are being monitored
continuously. (Gil Wong may have other requirements for these potential trip hazards.)
3. Sampling sites need to be in the parking lane or sidewalk: no sites with the traffic lanes.
4. EST can fire up its generator at 7 am, M -F.
5. EST needs to coordinate with Mike Sinacori for utilities.
Kjr k Tkoyvt S OYl —
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FAUsers\PB`MShared\Balboa Village\CorresponscWemo 060900 odor assessmeni.doc .
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NOTICE TO BALBOA VILLAGE MERCHANTS AND RESIDENTS
FACTSHEET
In an effort to improve the environmental quality of the area, the City of Newport Beach
has arranged for an Odor Assessment and Feasibility Study of Odor Control Alternatives.
Environmental Support Technologies, Inc. will be conducting the Odor Assessment
and Feasibility Study.
The study area for the Odor Assessment will be the area bounded by Main and Palm
Streets on the east and west, and Edgewater and Balboa Boulevard on the north and
south.
The Odor Assessment will take place on about five days during the workweeks of June
12 and June 19; 2000 between the hours of 7:00 a.m. and 7:00 p.m.
Three days of the Odor Assessment will involve ambient air monitoring. The fourth day
of the assessment will involve subsurface gas monitoring and the fifth day will involve
subsurface soil/sediment sampling.
The ambient air monitoring will require access to some commercial buildings in the area.
Please cooperate with the assessment contractors and allow access to your building
should they request access.
The subsurface gas monitoring and subsurface soil/sediment sampling will involve the
use of truck -mounted hydraulic-drive/pneumatic hammering equipment. This equipment
is loud. Upon request, the assessment contractor will provide earplugs to merchants
located in the vicinity of the assessment area. Hammering activities at each location will
last approximately 30 minutes.
Should you have additional questions concerning this work, please contact Mr. Bob Stein
at the City of Newport Beach. Telephone: (949) XXX-XXXX.
Thank you in advance for your patience and cooperation during this effort.