HomeMy WebLinkAboutN2000-03207-99 EP FormAs
EXHIBIT "A"
CITY OF NEWPORT BEA H ENCROACHMw,
(Please type or print legible. ress hard - makes 3 copies)
Permit # E.P.2,&pe,- .37-V
[1] APPLICATION FOR: d CURB CUT ❑ SEWER CONNECTION
(CHECK ONE) 11STREET EXCAVATION ❑ WATER CONNECTION
Amount Fee Paid $ 134 I O
❑ UNDERGROUND UTILITIES ❑ OTHER:
Receipt# ZA`7 r9 C1
[2] ADDRESS OF WORK: ,' 3 Z3BHi Z -)E Dt2\'\� F
[3] APPLICANTS NAM :ADDRESS: _ ;AREACODE: r'+U
�GizS` �Vy 31 5%r :PHONE:
[4] OWN�ER'S NAME: :ADDRESS: :AREA CODE: t d5
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[S] CONTRACTOR'S NAME: :ADDRESS: :Office Phone:
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- x) I:Job Site Phone:
[6] APPLICANT HEREBY MAKES APPLICATION T0: r r.4bu (t A—N E) /3
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(SEE ATTACHED PLANS)
SPECIAL CONDITIONS OF APPROVAL REQUIRED BY CITY:
❑ Locale 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 47 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. a' O S [B] STATE LICENSE NO.
[9] WORKERS COMPENSATION INSURANCE
CERTIFICATE OF INSURANCE
(Section 3800 Labor Code)
19' I certify that I have a Certificate of consent to self -insure, or Certificate of Worker's Compensation Insurance or a Certified Copy thereof.
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Policy No.: Company: Expiration Date: I of -
Date: a I sD Applicant
_
i nature)
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
Workefs Compensation laws of California. If, a If, after signing this 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: Applicant:
(signature)
11] CONTRACTOR LICENSE EXEMPTION
❑ 1 am exempt from hiring a Cantroctor as I am the OWNER of the property and am personally performing all work within the Public fight -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
ercroachments. I will be responsible for replacing the improvements if the City removes them for maintenance of utilities or other public need: and 1, the
property owner shall indemnity and hold the City hamiless 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 ditions of is permit are printed on both sides of this form. Applicant hereby acknowledges t at he as read
es to abide by them.
A/
and un rs s said to a =IGNATURE
OWNERS OR AU1 (
14] * * * **-TREES WITHIN THE CITY'S RIGHT-OF-WAY * * * * *
NO TREES WrrfIIR.THE crrrs 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:
IXPIRATI
DATE ISSUED: - o� ON DATE OF PERMIT:
PERMIT DENIED:
White - Permit Pink - Temporary Office Copy Yellow - Applicant
TO BE COMPLETED B•Y FIELD PERSONNEL
Inspector: Contractor: F1
INSPECTIONS
DATE
TIME
COMMENTS
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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, 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 (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
151" and September W, and Christmas Vacation from December 19" to January 1s\, 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 1-8004224133 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).
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08-12-2002 Inspection Request Reporting Page 9
Requested Inspect Date:
Tuesday , August 13, 2002
Assigned To:
Inspection Type:
ENCROACH
Inspection Area:
PW
Site Address:
2323 BAYSIDE DR NB
A/P/D Information
Activity: N2000-0320 Type: ENCROACH Sub Type: NEW Status: APPROVED
Const Type: Occupancy: Use: Insp Area: PW
Applicant: FINTON ASSOCIATES Phone: 949-673-9587
Owner: WMC DEVELOPMENT Phone: 949-723-9100
Description: REMOVE AND REPLACE CURB AND GUTTER AND DRIVE APPROACH
Reauested Inspection s
Item: 10250 FINAL - PW Requested Time: 01:15 PM
Requestor: MIKE KILBRIDE Phone:
Comments: FINAL Entered By: BROOKS K
Assigned To:
Action: Time Ex _. p:
Inspector.
Comments:
Date: Time
'41-
AM PM
REPT131 Run Id: 393