HomeMy WebLinkAboutN2017-0241City of Newport Beach
100 Civic Center Drive, Newport Beach, CA 92660 IIII N 2 0 1 7 0 2 4 1
Permit Counter Phone (949)644-3311
�t Online Inspection Request - www.newportbeachca.gov / Online
Services
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Job Address : 207 FERNLEAF AVE NB
Description : NEW CURB AND SIDEWALK PER CITY STD 182-L.
Thomas:Guide:
Permit No: N2017=0241•,
Project No: 1755-201at`
Inspection Requests Phone (949)644-3255
Parcel #
Legal Desc :
t
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Owner: ROTH,BEN/BETSY
Contractor: WEST COAST CONCRETE
CONTRACTORS INC
Phone:
Phone: 714-536-1365
Address : 333 W CITY BLVD #100
Address : 707 13TH STREET
ORANGE CA 92868
HUNTINGTON BEACH CA
Contractor State Lie: 628439
Applicant: WEST COAST CONCRETE CONTRACTORS INC
License Expire: 09 30, 2017
Phone: 714-536-1365 [
Address : 707 13TH STREET
HUNTINGTON BEACH CA
Business License : BT00017857
Business Expire: 09 30, 2017
Special Cond.: PRE -CONSTRUCTION MEETING
REQUIRED
Workers' Compensation Insurance - -
Carrier : MID CENTURY
Policy No: A0946-11-90
W. C. Expire: 01 01, 2018
Permit Processing Fee :
$241.00
Sewer Connection :
$0.00
Total Fee
$571.00
Agreement Fee:
$0.00
4TT Box Cover:
$0.00
Paid :
$571.00
Traffic control Plan Check :
$0.00
Total Water Meters :
$0.00
Balance :
$0.00
Inspection Fee :
$330.00
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
General Services Approval :
Date: _/_/
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COMPLETE THE BELOW INFORMATION
PROJECT ADDRESS:
DETAILED DESCRIPTION F PROP SED WORK:
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PPLICANT:
Phone:
Email Address: I
Mailing Address: 2
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City Sta ip:
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OWNER:
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Email Address:
Mailing Address:
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ALLOONTRACTOR NPORMIr►AECKOREDALEASE03UPLETE
CONTRACTORG %i
Office Phone:
34
Company (if different):
IL
obsite Phone:
Other Phone:
Email Address:
Mailing Address: _
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Ci to ip:
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S ate License Num er 8 Class:
Ex ices•f-13o
City Busin s License Number:
Expires:
WORKERS COMPE SATION INSURANCE - Certificate of Insurance (Section 3800 Labor Code)
,Company: Policy No: Expires:
Municipal Orations: 949-644-3055
Utilities: 949-644-3011
Urban Forestry: 949-644-3083
�:
,
Special Conditions of Permit:
Utilities: Traffic:
Municipal Operations Other:
0 Fire:
0
Engineering Technician:
Permi ialist
Date:
5 1 I'DI I
Permit No.
I N2017- o
Public Works Department 9494"-3311
100 Civic Center Drive, Newport Beach, CA 92660
A A-J
NUMBER: N2017- (DG�"J
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Permit Processing Fee:
Inspection Fee:
Public Works Only
$241.00
Public Works Field Inspection
$165.0
Other Department
$275.00
Utilities Field Inspection
$121.00
General Services Inspection
$165.00
Agreement Fee:
Water Quality/Artificial Turf Inspection
$108.00
Preparation of Report/Agreement
$817.00
Document Recordation Fee
$192.001
Refundable Deposit:
TBDe
Monitoring Wells
$502.001
Improvements
TBD
Street/Alley/Walk Closure: $65.000 Newspaper Rack Inspection $108.00 Q
Traffic Control Plan Check
8-1/2" x 11" $65.00 Sewer Connection Fee $250.00
24" x 36" $143.00__J 4TT Box & Cover $64.00
Additional _ _ _ _ _
THE FOLLOWING ITEMS REQUIRE APPROVAL FROM THE ,Revenue Division I
1
Qty-�
�• 1
,
1Water Meter:
Installation Charge $528.00 1
13/4" Meter
$50.25
Water Meter Boxes: 1
11" Meter
$121.50
For Parkway & Sidewalk Area (Box + Cover =Cost 1
11 1/2" Meter
$285.00
1" Meter: 13.00 + 37.00 $50.00 1
11 1/2" Turbine Meter
$700.00
2. Meter. 27.00 + 61.25 $88.25 1
12" Meter
$425.00
12" Turbine Meter
$845.00
For Traffic & Alley Areas (Box + Cover = Cost) 1
13" Meter
$3,310.00
1" Meter. 13.00 + 38.00 $51.00 1
14" Meter
$4,730.00
2" Meter: 27.00 + 162.00 $189.00e
16" Meter
$7,190.00
Certificate of Compliance Fee (+100% 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 EasementlVacation Fee (+100% of My over 4 hrs) $1,022.00
5200-5031
Street Tree Fee ($700 Planting Fee) TBD
... .._................�..�..�..�..�..�..�.
030-2284
Engineering Tech:
Total Amount Due:
$4
For Finance Use Only
Permit *- ialist
Re eipt No.
f:/users/pbwlshweWencroedVmasters/ep front and back masters)
Rev. 1/5/2017
epreesheet.As-revised 10121n016
ALL UNDERGROUND WORK SHALL BE PERFORMED BY A LICENSED CONTRACTOR
Contact "Underground Service Alert" At Least 48-Hours in Advance of Any Excavation at 800-422-4133
TERMS AND CONDITIONS OF ENCROACHMENT PERMIT
1 f-ncroachnxint Permils may be Laken oul by the owner of henefiled properly or a licensed contractor A licensed
contractor rums( provide a I ellor of Authorization in allow another party to pull a permil An approved copy of the
permit and constnrction plan shall be. kept at the lob site al all limes Work, which has been done prior to issuance of
a permit. is subject to iolectioNfine. Cily reserves the right to void permil if work does not commence within 30 days
after date of issuance
2 The Permitlee agrees to defend in demndv and hold the City its authorized agent officers. representatives and
employees harmless from anv 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. Slanclarcl Spn<:w/ Provisions and Sfanefarc/ Dmwm(ts
of the City of Newport Beach and in compliance with all applicable State laws and City ordinances
4 Permiltee 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 Stale 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 Stale 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 State 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. Forms 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 he 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 Locale and pothole
existing City -owned utilities fie 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
4 T T box over the riser
9 Property lighted barricades exist be. provided and maintained around all trenches excavations and obstructions All
signs. (tags, lights and other warning and safely 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 n minimum charge of S35 00 It is the responsibility of the applicant to place barricades to
protect the general public Access to lire hydrants nmst 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
I I Any work that extends into tmlfiC or parking lanes and impedes the normal flow of traffic requires the applicant to
acquire a I emporary Street Closure Permit from the Public Works Department Access for fire police and
emergency vehicles must be maintained at all limes 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 Deparinie,nt Any work affecting the State Highways traffic or within the Slate Highway right-of-way
will require a Caltrans Permit. All vehicles shall be lawfully parked.
12 This permit does nol authon2e 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 T o 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 3800 Labor C--)de) -
I certify that I have a Certificate of consent to self -insure rtificate of -Worker's
Compensation Insurance, cy a Certified Cop
Date: ® ter/ Signature:
CERTIFICATE OF EXEMPTION (Section 380 Labor Code)
I certify that in the performance of the work under 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, I 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 hall indemnify
and hold the City harmless for any liabilit with the minor
encro �76, ! /7 /
Da Signatur
24-hour notice for Encroac rment Permit Inspection is required by calling
Public Works at 949-644-3311.
15 Any above ground utility facilities will require documented approval horn the adlacenl
affected property owner(s)
16 Homeowner. contractors, and subcontrrcovs may each be liable for violnlioris of %Vak,i
Quality laws Best Management Practices will be enforced It is against the law In
discharge construction debris into the gutter and storm drain felony violation,. of \Na!er
Quality Laws are punishable by fines up to S25.000 and/or up to Ihree years. ci Sf W,
prison plus the full cost to clean up an illegal discharge or split
17 If a refundable deposit was paid. applicant must submit it Soils Corti paclto- I
Certificate or Evidence of a Slurried Backfill and request a final trrSpectinn (roll! thc-
Public Works Department. Monies may be held for six months after final uisl
before a refund will be processed.
18 No trees in the public right-of-way shall be planted. rernoved tninnied or rrancatr.ci
without approval from the General Services Department.
19. All work in the public right-of-way must meet the approval of the Pr:bfic l';ork
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 andior additional fees
INo work related to this encroachment permit shall be performed until the Public Works Department has issued this permit. Applicant hereb acknowledges he/she has r un nds a terms and
conditions of this permit and he/she agrees to abide by them. Permit is void if work is not commenced within 30 days afterWitiance.
Permit fees are nonrefundable. Dat / ,Signature: ��
5/15/2017 City of Newport Beach Page 1 of 13
433041PM INSP150 - Daily Inspection Request Report
Requested Inspection Date: 05/16/2017
Inspection Type: ENCROACH
Inspection Area: PW
Site Address : 207 FERNLEAF AVE
AMM Information:
Activity : N2017-0241
SubType : NEW
Status : APPROVED
OWNER: ROTH,BEN/BETSY Phone :
APPLICANT: WEST COAST CONCRETE CONTRACTORS INC Phone : 714-536-1365
Description : NEW CURB AND SIDEWALK PER CITY STD 182-L.
f ( Op — r-6 gM i., CppV %guested Inspection(s)
Requested Time: 5/16/2017 12:00:OOAM Requestor: NBIVR
(7144698181
Entered By: NBIVR
Comments: AM
Assigned to:
Inspector: Date: S L" i Time: AM CM)
Comments: g4 s .
-11*11I7
ry wcr E!L .� 4-z�- tWti« *19F- gt ���-�
1_ �xied
RefHe
F:\Users\PBW\Shared\ENCROACH\MASTERS\FORMS\InspectorSheet.doc
REPT131 Run Id:.-4618
Velasco, Julio A.
From:
Pekar, Kevin
Sent:
Monday, July 03, 2017 8:29 AM
To:
Velasco, Julio A.
Cc:
Sereno, Dan; Bennett, Brenda
Subject:
RE: 207 Fernleaf. Ave. Palm check
_i aga :l:j rT0'` .., j fi:'Tl '.b 2 r-2mo,,ed :.1 lO:d a' CdC1`y' T'Tx.
From: Sereno, Dan
Sent: Friday, June 30, 2017 8:16 AM
To: Bennett, Brenda <BBennett@newportbeachca.gov>
Cc: Pekar, Kevin <KPekar@newportbeachca.gov>
Subject: RE: 207 Fernleaf. Ave. Palm check
From: Bennett, Brenda
Sent: Friday, June 30, 2017 8:12 AM
To: Sereno, Dan <dsereno@newportbeachca.gov>
Cc: Pekar, Kevin <KPekar@newportbeachca.gov>
Subject: RE: 207 Fernleaf. Ave. Palm check
From: Sereno, Dan
Sent: Friday, June 30, 2017 7:16 AM
To: Bennett, Brenda <BBennett@newportbeachca.gov>
Cc: Pekar, Kevin <KPekar@newportbeachca.gov>
Subject: FW: 207 Fernleaf. Ave. Palm check
'Or 'n!; O"Ie -ia`✓e peen 'nis HOLVFd Oa!nl Severa; ',:rn s a'lCj OOKS area:
From: Pekar, Kevin
Sent: Thursday, June 29, 2017 3:53 PM
To: Sereno, Dan <dsereno@newportbeachca.gov>
Cc: Bennett, Brenda <BBennett@newportbeachca.gov>
Subject: 207 Fernleaf. Ave. Palm check
FYI
Sent from m\ Whone
Begin tor% arded message:
From: Cisco Unite Connection Messaging S} stem <unitN connection a ne\\portbcachca.goN>
Date: June 29. 2017 at 7:16:48 AM HST
To: <kpckarunc\cportbcachca.go\>
Subject: Message from CUNNINGHAM, DAN (917142066224)
7/3/2017 City of Newport Beach
6:34:22AM INSP150 - Daily Inspection Request Report
Activity :
SubType :
Status :
OWNER:
APPLICANT:
Description :
Item:
Requested Time:
Requested Inspection Date:
07/03/2017
Inspection Type:
ENCROACH
Inspection Area:
PW
Site Address :
#Jm `OOfi1UOfC
207 FERNLEAF AVE
N2017-0241
NEW
APPROVED
ROTH,BEN/BETSY
WEST COAST CONCRETE CONTRACTORS INC
NEW CURB AND SIDEWALK PER CITY STD 182-L.
7/3/2017 12:00:OOAM Requestor:
Entered By: NBIVR
Comments: AM
Assigned to:
Inspector:
Comments:
Logged
Refie
D 3L, i
Date: •7 •.-� / /2
F:\Users\PBW\Shared\ENCROACH\MASTERS\FORMS\InspectorSheet.doc
Page 2 of 6
Phone:
Phone: 714-536-1365
(� g3 = 3oA-
NBIVR
7142066224
Time: 9'.' 36 AM PM
7/17/2017 City of Newport Beach Page 2 of 9
6:34:54AM INSP150 - Daily Inspection Request Report
Requested Inspection Date: 07/17/2017
Inspection Type: ENCROACH
Inspection Area: PW
Site Address : 207 FERNLEAF AVE
ArM Inliorm@d o c
Activity: N2017-0241
SubType : NEW
Status : APPROVED
OWNER: ROTH,BEN/BETSY Phone :
APPLICANT: WEST COAST CONCRETE CONTRACTORS INC Phone : 714-536-1365
Description: NEW CURB AND SIDEWALK PER CITY STD 182-L.
Ragtiss!Mal F o rom(0)
Item: 1 lfl h/Pr --
Requested Time: 7/17/2017 12:00:OOAM Requestor: NBIVR
7142066224
Entered By: NBIVR
Comments: AM
Assigned to:
Inspector: \ 1 / Date: Time: kb AM PM
Comments: '�'a - Ut�-L.
COMPLETED
F:\Users\PBW\Shared\ENCROACH\MASTERS\FORMS\InspectorSheet.doc