HomeMy WebLinkAboutN2017-0148'Aaww.or� City
tyofNewport Beach
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CiviccDBach, CA 92660 11111111l
ti Permit Counter Phone (949)644-3311
Online Inspection Request- www.newportbeachea.gov/Online
Services
Permit No: N2017-0148
Project No :
Inspection Requests Phone (949)644-3255
Job Address : 5 CAMBRIA DR NB Thomas:Guide: 919J7
Description : Install sewer cleanout on existing sewer lateral per City Standard #406-L.
Parcel #:
4610-311-3 -
Legal Desc :
N TR 7844 LOT 94
Owner:
KOLAR JUDITH G W
Phone:
0
Address :
12 VIA AVORIA
NEWPORT COAST, CA
Applicant: WEST END ENGINEERING
Phone: 714-231-8216 [
Address : 3024 E. CHAPMAN AVENUE
ORANGE, CA 92869
Special Cond.: Pre -job inpsection required.
SCANNED
COMPLETED
Contractor : W4z318216NGINEERINGINC
Phone
Address : PMB 246
2942 E CHAPMAN AVE
ORANGE CA
Contractor State Lic: 587219
License Expire : 01 31, 2018
Business License: BT20070701
Business Expire : 06 30, 2017
Workers' Compensation Insurance - -
Carrier : STATE COMPENSATION FUND
Policy No: 9163091
W. C. Expire: 05 21, 2017
Permit Processing Fee :
$241.00
Sewer Connection :
$0.00
Agreement Fee:
$0.00
4TT Box Cover:
$64.00
Traffic control Plan Check :
$0.00
Total Water Meters :
$0.00
Inspection Fee :
$330.00
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:
Date:
Utilities Approval :
Date :
Traffic Approval :
Date:
General Services Approval :
Date:
Total Fee
$635.00
Paid :
$635.00
Balance :
$0.00
Receipt No :
_-7(o153
Other Department : —Date: _/_/
Permit Denied Date: _/_/
Issued Permit: -� 4" Date: 3 /11 / r
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 Encroachment F'enmils may be liken out by the owner of benefited property or a licensed contractor A licensed
contractor must provide ,I t ellei of Authon: ation to allow another party to pull a permit An approved copy of the -
permit and construction plan ~hall be kept it the job site at all limes Woik which has been done pnor to issLTPrde Of
a permit, is subject to rejeclionifine CiIV reserves the right to void permit if work does not commence within 30 days
after dale of issuance
2 The Permittee agrees to defend indemnify and hold the (;it,, its aulhonzed agent officers representatives and
employees harmless from anv tesponsibility liability, suit or action of any description ansing out of any accident loss
or damage to persons of property occurrinq as a result of work undertaken under this permit
3 All work shall be done in accordance with the approved plans St,indaid Specwl Provrsronn and S/,imam Dr,iwuty.s
of the City of Newport Beach and in compliance with all applicable State laws and CItV ordinances
4 Permittee guarantees all work performed under this permit to be free of hidden and latent defects Any failures shall
he corrected within two weeks after notification to the satisfaction of the Public Works Director
5 A valid State licensed contractor must perform all c onstruction within the public right-of-wav unless waived by the
Public Works Director A valid Stale Contractor License Class A can perform any work in the public right-of-way For
construction or connection to water lines a valid Slate Contractor License Class C-34 is required F or construction or
connection to sewer lines a valid Slate Contractor License Class C-42 is required
6 All trenching and/or resurfacing shall conform to City Standard 105-L for parkwaynoadway 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 perrmrts to perform excavation or trench work front 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-waV 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 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 fie water sewer, or street lighting condwtsl to verify locations Maintain a one -foot
clearance over or under exisinq t,ity-owned utilities Sewer c learl require VCP or PVC SDR35 be used with a
4TT boY over the riser
9 Properly lighted barricades must he provided and maintained ground all trenches, excavations and obstructions All
signs flags, lights and other warning and safely dev,,es 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 time,,
10 Work within or near beat h sensitive areas will not be allowed durinq 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
1 1 Any work that extends into lral of parking lanes and impedes the normal flow of train, requires the applicant to
acquire a Temporary 1)neet Closure Permit from the F'uhlic Works Department Access for fire police and
emergency vehicles must he maintained at all limes Traffi(. Control must be per Work Area Traffic Control
Handbook (VVA7CHt No nighttime traffic lane closures unless prior approval has been granted Any lane(s) closure
on a major street will only bo allowed between 9:00 a m. and 3 00 p.m (Monday thru Friday) unless approved by
the Public Works Departinent Ariv work affecting the Slate Highwav s traffic or within the State Highway right-of-way
will require a Caltians Permit All vehicles shall be lawfully parked
12 This permit does not iulhonze the closure of sidewalks streets or alleys for construction access storage of
materials or parking of r onstruction 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 hows in advance of restricted access and any inconveniences
14 Refuse or unused materials shall he 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 I nterrupled To place a duntpster or materials rn the public right-of-waV. a
Temporary Street ',IoSurP I'ernnt must he obtained from the Public Works Department
WORKER'S COMPENSATION INSURANCE (Section 3800 La or Code)
I certify that I have a Certificate of consent to self Certr cate of Worker's
Compens ion Irysurance, or a Certified Copy the
Date: � nIll Signature:
CERTIFICATE OF EXEMPTION (Section 3800 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 shall indemnify
and hold the City harmless for any liability associated with the minor
encroachments
Date: Signature.
24-hour notice for Encroachment Permit Inspection 's required by calling
Public Works at 949-644-3311.
15 Any above ground utility facdities will tequne documented approval (rani the adjacent
affected property owner(s)
16 Homeowner contractors and subconlracotrs may eat h be liahlt for viol,ilon5 of t%'ater
Quality Laws Best Management Practices will be enforced It is agatnsl the law In
discharge construction debris into the qutler and storm drain I elonv violations of Wntot
ihJallty Laws are punishable by I up In S;'S 000 andor III) to tier,- rear. .I `,( itr�
prison plus the full cost to clean up an illegal discharge or spill
17 If a refundable deposit was pat(], applicant must submit .l Soils Conrp,it lrc:t
Certificate or Evidence of a Slurried Backfill and request a final inspet.tinn join, the
Public Works Department I lorries may he held for six months after hn,il rispw bun
before a refund will be processed
18 No trees in the public right-ot-way shall he planted ientovod Inrnnied nr relu' ,ttt'd
without approval from the General Services Department
19 All work in the public right-of-way must meet the approval of I Pt:blic Vdock .
Department or corrections will be required (I e removals exposiurl romir,, 1-os
etc I Additional inspection fees may be required
20 Permit is for standard materials in the public ngnt-nf-wati only, unless pi itrutily
approved by Public. Works and an Encroachment Agraenienl has been processed
21 Permit is valid for 'description" of work noted on front only Additional vvotl,
performed may require Issuance of a separate permit and or additional tees
INo work related to this encroachment permit shall be performed until the Public Works Department has issued this permit. Applicant hereby acknowledges he/she has re d erst rids the 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 cI ^�/
Permit fees are nonrefundable. Date' ( Signature:
FEE WORKSHEET FOR ENCROACHMENT PERMIT
CITY OF NEWPORT BEACH
PUBLIC WORKS DEPARTMENT
All Fees Are Non -Refundable Unless Otherwise Stated
PROJECT ADDRESS: PERMIT
N2017-
NUMBER:
APPLICANT:
TO BE COMPLETED BY PUBLIC WORKS DEPARTMENT
Permit Processing Fee:
Public Works Only
Other Department
Agreement Fee:
Preparation of Report/Agreement
Document Recordation Fee
Monitoring Wells
Street/Alley/Walk Closure:
Traffic Control Plan Check
O Inspection Fee:
$241.00 Public Works Field Inspection
$275.00 Utilities Field Inspection
General Services Inspection
Water Quality/Artificial Turf Inspection
$00
$192 192.00 Refundable Deposit:
$502.00 Improvements
$65.00= Newspaper Rack Inspection
8-1/2" x 11" $65.00 Sewer Connection Fee
24" x 36" $143,01=1 4TT Box & Cover
Additional
_ _ _ THE FOLLOWING ITEMS REQUIRE APPROVAL FROM THE _ _ R
1 REVENUE DIVISION PRIOR TO PAYMENT OF FEES A
(Water Meter
13/4" Meter
$50,25
11" Meter
$121.50
11 1/2" Meter
$285.00
11 112" Turbine Meter
$700.00
12" Meter
$425,00
12" Turbine Meter
$845.00
13" Meter
14"
$3,310,00
Meter
$4,730,00
16" Meter
$7,190.00
Installation Charge
n
$165 00
$121 00
$165.00
$108.00
TBD
TBD
$108 00
$00 $6464 00
venue Division I
$528.00
Water Meter Boxes:
For Parkway & Sidewalk Area (Box + Cover = Cost)
1" Meter: 13,00 + 37.00 $5&00
2. Meter: 27,00 + 61.25 $88 25
For Traffic & Alley Areas (Box + Cover = Cost)
11"Meter 13 00 + 38.00 $51 00
2" Meter: 27 00 + 162 00 $189.00
Certificate of Compliance Fee (+100i of hrly over 3 his) $288.00
Development Services Fee (Plan check hourly) $155 00
Final Tract Map Checking Fee $2,488 00
Final Parcel Map Checking Fee - Moderate $2,488,00
Lot Line Adjustment Fee $1,079,00
Park Dedication Fee Zone TBD
5200-5029
5200-5015
5200-5026
5200-5027
5200-5028
405-470
Street Easement/VacationFee (+100%ofhrtyover 4hrs) $1,02200 5200-5031
Street Tree Fee ($700 Planting Fee) TBDI 030-2284
Engineering Tech:
Total Amount Due:
For Finance use only
Permit Specialist
Receipt No.
I /userslpbwlsfwradlencr rnasters/ep front and back masters/
Rev 1/5/2017
tomrzoie
WORKSHEET FOR ENCROACHMENT PERMIT
CITY OF NEWPORT BEACH
PUBLIC WORKS DEPARTMENT
COMPLETE THE BELOW INFORMATION
PROJECT ADDRESS: iAi" j k)
DETAILED DESCRIPTION OF PROPOSED WORK:
L q_^ w u- j i
APPLICANT: W ;�57 -.7—Nb
Phone: ! L( 231 221
Email Address:
Mailing Address:
City/State/Zip:
A
OWNER:
Phone:
Email Address:
Mailing Address: City/State/Zip:
ALL CONTRACTOR INFORMATION IS REQUIRED -PLEASE COMPLETE
CONTRACTOR:/lam y -21? L L_�ki7 L'
Office Phone:
Company (if different):
Jobsite Phone:
Other Phone:
Email Address:
Mailing Address:
City/State/Zip:
State Licen77se mber & Class:
` e V7NuExpires: / /
City Business License Number:
Expires:
WORKERS COMPENSATION INSURANCE - Certificate of Insurance (Section 3800 Labor Code)
Company: Policy No: Expires:
Munici al O erations: 949-644-3055
Utilities: 949-644-3011
Urban Forestry: 949-644-3083
FOR OFFICE USE ONLY
Special Conditions of Permit:
ADDITIONAL APPROVAL REQUIRED FROM THE FOLLOWING DEPARTMENTS
Utilities:
Municipal Operations
Traffic: Fire:
Other:
Engineering Technician:
Permit Specialist
Date:
Permit No.
N2017-
.se's.'oWlsnara0lericroaeNmesiersleW.wxsneel Ms
Public Works Department 949-644-3311
100 Civic Center Drive, Newport Beach, CA 92660