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Home My WebLink AboutN2000-0169e11dIGI�E11"Olrll\Mason\EP- 7-99 EP Form.ds FY14TRTT "A" CITY OF NEWPORT BEACH ENCROACHMENT PERMIT (Please type or print legible. Press hard - makes 3 copies) A PetrnJf -Z000-169 [i] APPLICATION FOR: ❑ CURB CUT ❑ SEWER CONNECTION (CHECK ONE) ❑ STREET EXCAVATION ❑ WATER CO mount F&Feld$'p 'S O ' ❑ UNDERGROUND UTILITIES ❑ OTHER: Receipt# [2] ADDRESS OF WORK: O S N`T A tAk PO4 IF - [3] APPLICANT '/§$§'NAME / ADDRESS: + ` ;AREA CODE: rC i( C� �(%� (/ L E<9 �l Lf�"C ;PHONE: %/�X- 3G" %- e� [4] OWNERS NAME: :ADDRESS: ;AREA CODE q 5 ;PHONE-. � [5] P//ONTRACTOR'S NAME: X/ / ;ADDRESS: ff ;Office Phone: 2 � ,T C c - c v j/! Cz 1 Job Site Phone: [6] APPLICANT HEREBY MAKES APPLICATION T0: (';',i< y' i ") -i- G /a L / 'r l /� <c /: C R'7-- S Z ti P,C o tLc,/vA a N 1. NJ P `. !L. C1-7 E tt C=t . C O t-3 D k�T . 0 t -DS NA, -Z T-ALtd Z b (SEE ATTACHED PLANS) SPECIAL CONDITIONS OF APPROVAL REQUIRED BY CITY: K •G' C S yy 772- Q= Q= (� �C� �/ `L� IJ D 'Li c0NZ x-5 IAcr JocArJ A o cr s rJ F - o %N ❑ 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. [8] STATE LICENSE NO. [9] WORKERS COMPENSATION INSURANCE CERTIFICATE OF INSURANCE (Section 3800 Labor Code) ❑ 1 certify that I have a Ce t' consent to self -insure, or Certific�nt Wa kers Compensation Insurance or a Certified Copy thereof. Policy No.: Company: --- Expiration Date: Date: - Applicant: (signature) [10] CERTIFICATE OF EXEMPTION (Section 3800 Labor Code) rNy that in the performance of the work for which this permit is issued, 'aII not mploy any person in any manner so as to become subject to the Workers Compensation laws of California, If, a If,. afte�ign` is i s ompensa on cions of ,, the State Labor Code, I must comply with the prpv: S " � 70 s permit shall be ed. Date: 1 •ZV 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. Date: Applicant (signature) 12] HOLD HARMLESS STATEMENT ❑ 1 understand that I am bcating 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 1, the properly owner shall indemnify and hold the City harmless for any liability, associated with the minor encroachments. Date: Owner Signature: [33] «««< 24 HOUR ADVANCE NOTICE IS REQUIRED FOR ALL INSPECTIONS 7777777 CALL(949)644-3311 The to d i rmit are inted on both sides of this form. Applicant hereby acknowledges that he has read ns ls t , nditio at he agrees to abide by them. ani6W'NERiOR'AUTHORIZED AGENTS SIGNATURE (DATE) 14] * * * * * TREES WITHIN THE CITY'S RIGHT-OF-WAY * * * * * NO TREES WITHIN THE CITY'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 E (L 1= ( ( -oo ---- - - PERMIT ISSUED BY: DATE ISSUED: �r'-l/- Zo 0o EXPIRATION DATE OF PERMIT: PERMIT DENIED: White - Permit Pink - Temporary Office Copy Yellow - Applicant A TO BE COMPLETED BY PIEL'D PERSONNEL Inspector: Contractor: INSPECTIONS DATV TIME COMMENTS b/ S q; srn5ad kg- t/ o /T. i2� dk/N 70 TERMS AND CONDITIONS 1. Encroachment permits shafl 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, 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 ail 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 wilt 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. Wails 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) 644-3011 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 151h and September 15th, and Christmas Vacation from December 191h 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 1-800422-4133 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 may remove the materials and bill the applicant. Coordinate alley closures with City's refuse pick-up days so service is not interrupted, call (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. Any above ground facilities will require Public Works Department approval and documented approval from the adjacent property owner(s). r..s pbw�Wknm W1 tasV[IIn"dm May 11, 2000 TO: Gilbert Wong (Associate Civil Engineer) FROM: General Services Director SUBJECT: Encroachment Permit #N2000-169 Staff recommends the following special provisions as conditions for approval of the above referenced permit: 1. The contractor shall not remove any City trees in the right-of-way. 2. The contractor will pay for cost of trimming one Eucalyptus robusta tree located in right-of-way adjacent to City alley. Trimming will be coordinated by the City Urban Forester and the City tree trimming contractor. Contractor will pay for this work prior to any trimming. This work is necessary to preserve the tree prior to any construction or excavation work. 3. The City will require that the contractor hire a Certified Arborist to provide a comprehensive tree report on the methods to properly excavate foundations for residence while protecting the Eucalyptus tree. The Arborist will also be on site during any excavation within a distance of 20 feet from the Eucalyptus tree. 4. The contractor is to contact John Conway, Urban Forester, at 644-3083 to arrange for any pre -construction meetings on site. These meetings need to be made with 48 hours prior notice. David E. Niederhaus DEN/MGL/lc Attachment I:\Users\GSVW Lindeman\2000\may00\HP2000 169.doc Locey, Mar From: Berger, Gary Sent: Tuesday, July 24, 2001 7:13 AM To: Locey, Mary Subject: RE: Missing Encroachment Permits I have 5190 Campus, it is not complete. ---Original Message -- From: Locey, Mary Sent: Monday, July 23, 2001 11:45 AM To: Berger, Gary; Masters, Rob; Puglisi, Mark Cc: Gunther, Robert; Oyler, Shauna; Rooks, Shari Subject: Missing Encroachment Permits The following encroachment permits have been out of the file for inspections for quite awhile. The applicant has called wondering about the refundable deposit, since they should be finalled. Please check your desks for them. Thanks. N2001-127 address 1540 N. Crown Drive pulled on May 11th for inspection. N2001-169 address 5190 Campus and Jamboree pulled on June 19th for inspection. Mary :-) 1 qVt FR ,' ARIZONA PIPELINE CORONA (MON) 7. 23' Oi 7:02/ST. 7:OlINO. 4862646725 P i IrA LMUZON"A- EUNE CO. To: C i% e 7-A IV`e w / o° �a14 4141^ 5�4 e_1 From: c s f a/ova.� Number Of Pages Including Cover. Sheet: -2- Special Instructions: 5A ers .4 e� C n P 7,j -1-A e. 514".- 1955 Sampson Avenue, Corona, California 92879-6006 (909) 270-3100 FAX (909) 270-3101