HomeMy WebLinkAboutN2017-0108.,
City of Newport Beach II���I�I����I�I���I���I��I���III���I�I�
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Permit No: N 20-� 0 $
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100 Civic Center Drive, Newport Beach, CA 92660 N 2 0 1 7 0 1 0
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Permit Counter Phone (949)644-3311
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Project No : SCANNED
sri
Online Inspection Request- www.newportbeachca.gov/Online
Services
-
Inspection Requests Phone (949)644-3255
Job Address :
1 PUBLIC ROW NB
Thomas:Guide:
Description:
Install 19 LF of conduit, 1 above ground pedestal, and ground bed in parkway on Dover Drive north of Sussex Lane and pothole in sidewalk to locate
existing conduit on Mariners Drive east of Dover Drive. Sidewalk restoration per City Standards. (AOOJV6R)
Parcel # :
Legal Desc :
Owner:
Phone:
CITY OF NEWPORT BEACH p r •Vr�"-
i 14iai �,§x�
Contractor :
Phone :
VCI CONSTRUCTION
909-949-1350
Address :
Lt
Address :
1921 W 11TH STREET
UPLAND CA
Applicant: AT&T CALIFORNIA
Phone: 714-618-9132 [
Address: 3939 E. CORONADO ST, 2ND FLOOR
ANAHEIM, CA 92807
Special Cond.: Pre -job inspection required
Traffic control per WATCH
Contractor State Lic: 765716
License Expire: 07 31, 2017
Business License:
BT30036054
Business Expire :
06 30, 2017
Workers' Compensation
Insurance - -
Carrier:
LIBERTY INSURANCE
Policy No:
WC7631004260044
W. C. Expire:
07 31, 2017
Permit Processing Fee:
$241.00
Sewer Connection:
$0.00
Total Fee :
$1,066.00
Agreement Fee:
$0.00
4TT Box Cover:
$0.00
Paid:
$1,066.00
Traffic control Plan Check :
$0.00
Total Water Meters :
$0.00
Balance:
$0.00
Inspection Fee :
$825.00
Water Meter Connection :
$0.00
Receipt No:
Refundable Deposit:
$0.00
Total Water Meter Box:
$0.00
Street Tree Fee :
$0.00
Adjustment :
$0.00
Processed By:
Date: _/_/_
Other Department :
Date
Utilities Approval :
Date : _/_/_
Permit Denied
Date
Traffic Approval :
Date : _/ /
Issued Permit :
Date : 4L.� a of 7
General Services Approval:
Date : _/_/
LE(19)AOOJV6R "GIGAPOWER"
WORKSHEET FOR ENCROACHMENT PERMIT
CITY OF NEWPORT,BEACH
PUBLIC WORKS, DEPARTMENT
..fCOMPLETETHE: BELOW INFORMATION:. . .... .
11PROJECT ADDRESS: 1701 DOVER DR, (SEE DWG) -Y,AUG
DETAILED DESCRIPTION OF PROPOSED WORK:
EXCAVATE IN CONCRETE 8 SQ.FT., DIRT 24 SQ.FT., TO PLACE 19 FT CONDUIT, PFP CABINET
ONE 3-ELECTRODE GROUND BED, AND ASSIST PIT
'
APPLICANT: AT&T CALIFORNIA, DOUG GALVERY, ENGR. hone: (714) 618-9132
Email Address: vk3921@aft.com Valentina Gipson, AT&T Liaison
Mailing Address: ---
3939 E. CORONADO ST, 2ND FLOOR
Fc"—Y—ip:
ANAHEIM CA 92807
OWNER:
lPhone:
Email Address:
Mailing Address: City/State/Zip:
ALL CONTRACTOR INFORMATION IS REQUIRED -PLEASE COMPLETE
CONTRACTOR: vc--:L-
[Office Phone: (?cq &t-ia 2C-6-T
Company (if different):
lJobsite Phone: i G v q(a
1Other Phone;
Email Address:
Mailing Address:
City/State/Zip:
State License Number & Class:
) (, Expires:
City Business License Number:
Expires:
WORKERS COMPENSATION INSURANCE - Certificate of Insurance (Section 3800 Labor Code)
Company: Policy No: Expires:
.......... ..... .................
.. .. .. ......
Refund pa able To :=;.. ................ ....... ........ .
Ma* .. il:Rdfuftd:Td�. ... ........ . ... ..... ...
.......... . ...... .... ......
-111.11. Refund . I-- — - —, .... ..... --- ........... ...
FOR OFFICE USE ONLY
Special Conditions of Permit: 4�wc,,-.O�,,
\N 6-t 0�4
ADDITIONAL APPROVAL REQUIRED FROM THE FOLLOWING DEPARTMENTS
Utilities:
General Services: F-
Traffic: Fire:
Other:
Engineering Technician:
'PVAI'
Public Works Specialist:
I p- 06W
Date:
Permit No.
Public Works Department 949-644-3311
��srrx City of Newport Beach ����I����� II
Permit No: N201-01 ®$
100 Civic Center Drive, Newport Beach, CA 92660
Permit Counter Phone (949)644-3311 Project No
Online Inspection Request- www.newportbeachca.gov/Online
e'^ a Services
Inspection Requests Phone (949)644-3255
Job Address : 1 PUBLIC ROW NB Thomas:Guide:
Description : Install 19 LF of conduit, 1 above ground pedestal, and ground bed in parkway on Dover Drive north of Sussex Lane and pothole in sidewalk to locate
existing conduit on Mariners Drive east of Dover Drive. Sidewalk restoration per City Standards. (AOOJV6R)
Parcel # :
Legal Desc
Owner: CITY OF NEWPORT BEACH
Phone:
Address
Applicant: AT&T CALIFORNIA
Phone: 714-618-9132 [
Address : 3939 E. CORONADO ST, 2ND FLOOR
ANAHEIM, CA 92807
Special Cond.: Pre -job inspection required
Traffic control per WATCH
Permit Processing Fee:
$241.00
Sewer Connection:
$0.00
Agreement Fee:
$0.00
4TT Box Cover:
$0.00
Traffic control Plan Check :
$0.00
Total Water Meters :
$0.00
Inspection Fee :
$825.00
Water Meter Connection:
$0.00
Refundable Deposit:
$0.00
Total Water Meter Box:
$0.00
Street Tree Fee :
$0.00
Adjustment:
$0.00
Processed By:
Utilities Approval
Traffic Approval:
General Services Approval:
Date:
Date
Date
Date
Contractor
Phone:
Address:
Contractor State Lie:
License Expire :
Business License:
Business Expire:
Workers' Compensation Insurance - -
Carrier:
Policy No:
W. C. Expire:
Total Fee : $1,066.00
Paid : $1,066.00
Balance : $0.00
Receipt No:
Other Department : Date :
Permit Denied : Date : _/ /
Issued Permit : Date : _/ /
FEE WbRKSFi7 Eat �NGROAHMENT PERMIT t �' `
I�IEWPOtT BE/W g
1YgRK3�EIA�2TM6NT a �< r
All Pees: Are IVoi+l<� Refundable: Unless:Othisrti *6 St6tei7E
PROJECT ADDRESS: PERMIT N2016-
Mt'f?`osC. VIc N", NUMBER:
APPLICANT:
,v a,,.+s, a. .,.u•..Px. Y� v s .1 ..
Permit Processing Fee:
Q
Inspection Fee:
Q
Public Works Only
$241.00 p
Public Works Field Inspection
$165.00
Other Department
$275.00
Utilities Field Inspection
$121.00
General Services Inspection
$165.00
Agreement Fee:
Water Quality/ArtificialTurf inspection
$108.00
Preparation of Report/Agreement
$817.00
Document Recordation Fee
$192.00
Refundable Deposit:
TBD
Monitoring Wells
$502.00
Improvements
TBD
Street/Alley/Walk Closure:
$65.00=
Newspaper Rack Inspection
$108.00 0
Traffic Control Plan Check
8-1/2" x 11"
$65.00=
Sewer Connection Fee
$250.00=
24" x 36"
$143.00
4TT Box & Cover
$64.00
Additional
47-T LtOVWNCi FTEMS REQUIRE APPR
VAL SRO THE Revenue Qivtstan ............
r..^r'
. ...'t2EVENt1EDfVIBION.Pa2101 TOPAYINeMT'OFPeES','„ .. .�AnaruwaL':...
...'. .I
... ....
[Water Meter:.
InsiaHi ion. Charge,
F3/4":Metz~c::�:::�:•::•::•::•:-::•:•$50.25
:�:�:::�:�Wate��Meter.6dx'ss::..:.:'.:;
::....::.:.:...:�:�;
:�:�; ::I
[1 `' Meter
$d21 50
for..... y B Sldewa. Area
(Box +Cover - Co
E1 !/2 Meter :
$285 00
1 ".Meter.,. 13.00 + 37 00
$50 t)0
�1 1%2 Turbine Meter
: $700 00
•'
� .� Meter `27 00 + 61,23
$88 25•
'
�'�
E2" MAt�r
'$42.........
: I
12" Turbtn8 Mete[
$845 Q0
•;
: FdrTraffio:.3AJI�y Rrges ($ox
+:C•oVOr Cost)
13a-Meter.
$6r31p.Ab
:'....:.1:
Meter.. i3.06.+.38:OA...'.'.'.'.'.
$5:1.:OU.'.'.'.'•
44":Meter
r6'..'Met. .•..•. .•.•. .•. ..
..'.'$7;490A0
.: .. .:.'.`.
,•..•:•:•..•.•.•.'.'. .: :: ::
:. ..•.•..•:•:•:.•.•:•.•.• '�
Certificate of Compliance Fee (+t 00% of hrly over 3 hrs)
$288.00
5200-5029
Development Services Fee (Plan check hourly)
$155.00
5200-5015
Final Tract Map Checking Fee
$2,488.00
5200-5026
Final Parcel Map Checking Fee - Moderate
$2,488.00
5200-5027
Lot Line Adjustment Fee
$1,079.00
5200-5028
Park Dedication Fee Zone _
TBD
405-470_
Street EasemenWacation Fee (+100% of hrly over 4 Ina)
$1,022.00
5200-5031
Street Tree Fee ($700 Planting Fee)
TBD
030-2284
Engineering Tech:
Total Amount Due:
For Finance use only
Permit Specialist
Receipt No.
Yl
... s lJ':v -'
I
fluserWpbw/shareNencroach!masters/ep front and back masters/
Rev. 10/21/2016
epfeesneet.ws-revisetl 10/21rz016
TERMS AND CONDITIONS OF ENCROACHMENT PERMIT
1. Encroachment Permits may be taken out by the owner of benefited property or a licensed contractor. A licensed
contractor must provide a "Letter of Authorization' to allow another party to pull a permit. 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. City reserves the right to void permit if work does not commence within 30 days
after date of issuance.
2. The Permitted agrees to defend, indemnify and hold the City, its authorized agent, officers, representatives and
employees harmless from any responsibility, liability, suit or action of any description arising out of any accident, loss
or damage to persons or property occurring as a result of work undertaken under this permit.
3. All work shall be done in accordance with the approved plans, Standard Special Provisions and Standard Drawings
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 shall
be corrected within two weeks after notification to the satisfaction of the Public Works Director.
5. A valid State licensed contractor must perform all construction within the public right-of-way, unless waived by the
Public Works Director. A valid State Contractor License Class A can perform any work in the public right-of-way. For
construction or connection to water lines a valid State Contractor License Class C-34 is required. For construction or
connection to sewer lines a valid State Contractor License Class C-42 is required.
6. All trenching and/or resurfacing shall conform to City Standard 105-L for parkway/roadway and City Standard 140-L,
in the alley, where a minimum half -alley width resurfacing shall be provided, unless otherwise directed by the Public
Works Dept. 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 Slate law. Walls and faces of all
excavations over 5 feet in depth shall be 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. The Public Works Department Inspectors must inspect all work in the Public right-of-way. Farms and subgrade must
be inspected and approved before concrete is ordered/poured. Sewer, pipelines, and subgrade construction must be
inspected and approved before backfilling, or applicant may be required to excavate site. Separate Utilities
Department or General Services Department inspections may be required depending on scope of work performed.
8. All trench restoration must be inspected by the Public Works Department. No utility installation(s) shall be allowed
over or within 5 feet of any City utilities, unless approved by the Public Works Department. Locate and pothole
existing City -owned utilities lie: water, sewer, or street lighting conduits) to verify locations. Maintain a one -foot
clearance over or under existing City -owned utilities. Sewer cleanouts require VCP or PVC SDR35 be used with a
4TT box over the riser.
9. Properly lighted barricades must be provided and maintained around all trenches, excavations and obstructions. 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 Transportation. If needed,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 must be maintained at all times.
10. Work within or near beach sensitive areas will not be allowed during, City holidays, spring break, Memorial Day
weekend, summer between June 15 and September 15, and during the holiday season from December 19 to
January 1, unless approved by the Public Works Department.
11. Any work that extends into traffic or parking lanes and impedes the normal flow of traffic requires the applicant to
acquire a Temporary Street Closure Permit from the Public Works Department. Access for fire, police and
emergency vehicles must be maintained at all times. Traffic Control must be per Work Area Traffic Control
Handbook (WATCH). No nighttime traffic lane closures, unless prior approval has been granted. Any lane(s) closure
on a major street will only be allowed between 9:00 a.m. and 3:00 p.m. (Monday thru Friday), unless approved by
the Public Works Department. 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. This permit does not authorize the closure of sidewalks, streets, or alleys for construction access, storage of
materials, or parking of construction vehicles unless detailed on an attached Temporary Street Closure.
13. Applicant must notify USA at 1.800-227-2600 2 days before starting any underground construction. Applicant
must notify all affected residents 24 hours in advance of restricted access and any inconveniences.
14. Refuse or unused materials shall be removed within 24 hours after completion of the work. If not removed, the City
may remove and bill the applicant. Coordinate alley closures with City's refuse pick-up days by calling 949-644-3066
for the collection schedule so service is not interrupted. To place a dumpster or materials in the public right-of-way, a
Temporary Street Closure Permit must be obtained from the Public Works Department.
WORKER'S COMPENSATION INSURANCE (Section 3 0 Lobar
I certify that I have a Certificate of consent to self -insure, ertificate
7ompensation Insurance, or a Ce fied Copy thereof.
,gate: �—liZ'[ -7 `Tignature:
CERTIFICATE OF EXEMPTION (Section000 Labor Code)
I certify that in the performance of the work undo -this permit, I shall not employ
any person so as to become subject to California Worker's Compensation Laws. If,
after signing 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: Signature:
CONTRACTOR LICENSE EXEMPTION
As the Owner of the benefiting property, 1 certify I am personally performing all
work in the Public Right -of -Way.
Date: Signature:
HOLD HARMLESS STATEMENT
I understand that I am locating minor encroachments within the City Right-of-
Way/Easement. As property owner it is my responsibility 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. I shall indemnify
and hold the City harmless for any liability associated with the minor
encroachments.
Date: Signature:
hour notice for Encroachment Permit Inspection is required by calling
,Public Works at949-644-3311. V C/
15. Any above ground utility facilities will require documented approval from the adjacent
affected property owner(s).
16. Homeowner, contractors, and subcontracotrs may each be liable for violations of Water
Quality Laws. Best Management Practices will be enforced. It is against the law to
discharge construction debris into the gutter and storm drain. Felony violations of Water
Quality Laws are punishable by fines up to $25,000 and/or up to three years in State
prison plus the full cost to clean up an illegal discharge or spill.
17. If a refundable deposit was paid, applicant must submit a Soils Compaction
Certificate or Evidence of a Slurried Backfill and request a final inspection from the
Public Works Department. Monies may be held for six months after final inspection
before a refund will be processed.
18. No trees in the public right-of-way shall be planted, removed, trimmed, or relocated
without approval from the General Services Department.
19. All work in the public right-of-way must meet the approval of the Public Works
Department or corrections will be required (i.e. removals, exposing connections,
etc.). Additional inspection fees may be required.
20. Permit is for standard materials in the public right-of-way only, unless previously
approved by Public Works and an Encroachment Agreement has been processed.
21. Permit is valid for "description' of work noted on front only. Additional work
performed may require issuance of a separate permit and/or additional fees.
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4/1212017 City of Newport Beach Pagel of 7
4:30:36PM INSP150 - Daily Inspection Request Report
Requested Inspection Date: 04/13/2017
Inspection Type: ENCROACH
Inspection Area: PW
Site Address : 1 PUBLIC ROW
Activity : N2017-0108
SubType : NEW
Status : APPROVED
OWNER: CITY OF NEWPORT BEACH Phone:
APPLICANT: AT&T CALIFORNIA Phone : 714-618-9132
Description : Install 19 LF of conduit, 1 above ground pedestal, and ground bed in parkway on Dover
Drive north of Sussex Lane and pothole in sidewalk to locate existing conduit on Mariners
Drive east of Dover Drive. Sidewalk restoration per City Standards. (AOOJV6R)
Item: 10200 PRE JOB - PW i ; y
Requested Time: 4/13/2017 12:00:OOAM Requestor: NBIVR�.o
7609106252 � C i J��i`D
Entered By: NBIVR V
Comments: AM
Ntl�
Assigned to.: U
Inspector: J `� Date: ! / 43 Time: JO`fU AM
PM
Comments: 147 ' A-oor P V&,4- S,,_", ,
LO/l//17 T I AV
I.-I6W T-1; of�
F:\Users\PBw\Shared\ENCROACH\MASTERS\FORMS\InsoectorSheet doc
REPT131. Run Id. 4018
4/14/2,017 City of Newport Beach Page 4 of 16
6:34:27AM INSP150 - Daily Inspection Request Report
Requested Inspection Date :
04/14/2017
Inspection Type:
ENCROACH
Inspection Area:
PW
Site Address :
1 PUBLIC ROW
AMID Information:'
Activity : N2017-0108
SubType: NEW
Status: APPROVED
OWNER: CITY OF NEWPORT BEACH Phone :
APPLICANT: AT&T CALIFORNIA Phone : 714-618-9132
Description : Install 19 LF of conduit, 1 above ground pedestal, and ground bed in parkway on Dover
Drive north of Sussex Lane and pothole in sidewalk to locate existing conduit on Mariners
Drive east of Dover Drive. Sidewalk restoration per City Standards. (AOOJV6R)
Requested Inspections)
Item: 10110 CONCRETE PUBLIC WORKS
Requested Time: 4/14/2017 12:00:OOAM Requestor:
Entered By: NBIVR
Comments: AM
Assigned to:
Inspector: L/ Date: / 7
NBIVR V01
VLV//'e
�,(oqc)
Time: 8- s`--V ")PM
Comments: C0441 :12- ;L6%✓ 37.E G� �?soC- �� C �Uf7GUG7
7-i fw-;e- az*T z d
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F:\Users\PBW \Shared\ENCROACH\MASTERS\FORMS\I n soectorSheet. d oc
5/3/2017 City of Newport Beach Page 5 of 25
6:34:35AM INSP150 - Daily Inspection Request Report
SubType:
NEW
Status :
APPROVED
OWNER:
CITY OF NEWPORT BEACH Phone:
APPLICANT:
AT&T CALIFORNIA Phone : 714-618-9132
Description :
Install 19 LF of conduit, 1 above ground pedestal, and ground bed in parkway on Dover
Drive north of Sussex Lane and pothole in sidewalk to locate existing conduit on Mariners
Drive east of Dover Drive Sidewalk restoration per City Standards. (AOOJV6R)
'771
item:
10205 GENERAL SERVICE
Requested Time:
5/3/2017 12:00:OOAM Requestor: NBIVR
Entered By:
NBIVR -
Comments:
AM
Inspec&pigned to �57/ Datey S(g/ f % Time: /A PM
Cvy,•iryy�q-�� 0�2
Comments: CE f0a x- GI B . PA-D P r:14 ,�r4 -`S �c 1.5
F:\Users\PBVAShared\ENCROACH\MASTERS\FORMS\InspectorSheet-doc
REPT131 Run Id: 4018
5/4/2017 City of Newport Beach Page 3 of 12
4:30:30PM INSP150 - Daily Inspection Request Report
Requested Inspection Date: 05/05/2017
Inspection Type: ENCROACH
Inspection Area: PW
Site Address : 1 PUBLIC ROW
Activity : N2017-0108
SubType : NEW
Status: APPROVED
OWNER: CITY OF NEWPORT BEACH Phone:
APPLICANT: AT&T CALIFORNIA Phone : 714-618-9132
Description : Install 19 LF of conduit, 1 above ground pedestal, and ground bed in parkway on Dover
Drive north of Sussex Lane and pothole in sidewalk to locate existing conduit on Mariners
Drive east of Dover Drive. Sidewalk restoration per City Standards. (AOOJV6R)
Item-- A256=-=RINAL"tiliti .
Requested Time: 5/5/2017 12:00:OOAM Requestor: NBIVR
Entered By: NBIVR
Comments: AM
Assigned to: /
Inspector: Jy Date: �� Time: 9 j 3 dADPM
Comments: �t/ S "
rL /-4%7 Ste/%T/O/l/
131r?-
W'4L -
CONAN FTF=D
F:\Users\PBW\Shared\ENCROACH\MASTERS\FORMS\InspectorSheet.doc
REPT131. Run Id: 4018