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Encroachment Permit - DOT - 2015-02-19Print Permit STATE OF CALIFORNIA DEPARTMENT OF TRANSPORTATION ENCROACHMENT PERMIT In compliance with'. 71 Your application of Fabnnaiy 19, 2015 ❑ Utility Notice of No ❑ Agreement of No. ❑ RAN Contract of No, TO. Costa Mesa Sanitary District 628 W. 19th. Street Costa Mesa, CA 92627 -2716 Attn: Scott Carroll 949 - 645 -8400 and subject to the following, PERMISSION IS HEREBY GRANTED to Page 1 of I !em,9 No • Yes 12- 15 -N -UM -0099 iaVOOlmol In addition to fee, the pennittee will 12 -ORA -VAR PM VAR ate Utility Maintenance Provisions be billed actual costs for: 02/19/2015 ea Paid Storm Water Special Provisions Deposit EXEMPT EXEMPT PERMITTEE Perform routine maintenance and make repairs 6 maint. work on exisiting sanitary sewer lines S manholes located within the State R/W along conventional State HWYs. in Costa Mesa 6 NP Beach (FREEWAYS EXCLUDED).Service connections are not authorized. All performed work shall be in accordance with current Caltrans Std. Spec. 6 Std. Plans, Sec 600 (Util. Permits) of the Encroachment Permits Manual, and the attached Provisions. Permittes shall contact the State Permit Inspector shown on the attached RTE. ASSIGNMENT LIST a min. of 5 working days prior to the start of work (on non - emergency situations) and a pre -job meeting will be scheduled at the earliest mutually agreeable time. Failure to comply with this requirement will result in suspension of this permit. Permittee shall notify Caltrans Storm Water Reviewer SHAWN ROMOUZI (949 -724 -2080) to determine whether or not a WPCP is needed prior to perform excavation work within the State R /W. Ire rmlcwmg aaacnments are also Included as part m mis permit (check appllcamep. • Yes ❑ No General Provisions In addition to fee, the pennittee will • Yes O No Utility Maintenance Provisions be billed actual costs for: ® Yes O No Storm Water Special Provisions ® Yes ❑ No Review ® Yes Chi Special Provisions ® Yes ❑ No Inspection ❑ Yes ® No A Cal -OSHA permit, f required. Permit No. ®Yes ❑ No Field Work ❑ Yes ®No As -Built Plans Submittal Route Slip for Locally Advertised Projects ❑ Yes M No Storm Water Pollution Prevention Plan / Water Pollution Control Plan fifany Caltrans effort expended) ❑ Yes 10 No The information in the environmental documentation has been reviewed and considered prior to approval of this permit. This permit is void unless the work is completed before February 15 2016 This permit late be strictly construed and no otherwork other than specifically mentioned is hereby authorized, No project work shall be commenced until all the other necessary permits and the environmental clearances have been obtained. 11ttp: / /oflramp /epermit/ bin /print _permit.pllp ?id = 178699 &disc—y 2/19/2015 PAGE 1 OF 2: ATTACHED TO AND MADE PART OF PERMIT NO. 12- 15 -N -UM -0099 In addition to the attached General Provisions (TR- 0045), the following Special Provisions are applicable: • Notwithstanding General Provision #4, il'a contractor is hired, your contractor is required to apply for and obtain an encroachment permit called Double Permit (DP) prior to starting work. A deposit of $492.00 is required at the time of application. • Permittee shall contact the LOCAL LAW ENFORCEMENT JURISDICTION at least 48 hours prior to implementing traffic control measures. All closures shall conform to State standards and shall follow Chapter 8 of the Safety Manual. • Orange vests and hard hats shall be worn at all times while working within State right -of -way. • Personal vehicles of the Contractor's employees shall not be parked on paved shoulders or traveled way within the limits of this work. • Except for installing, maintaining and removing traffic control devices, any work encroaching within 3 feet of the edge of a travel lane for areas with a posted speed limit below 45mph, or 6 feet of the edge of a travel lane, for areas with a speed limit posted at 45mph or higher, shall require closing ofthattravel lane. Any work encroaching within 6 feet of the edge of the shoulder, shall require closing of that shoulder. Permittee shall notify the Department's Representative, and obtain approval of, all traffic control, lane closures or detours, at least seven (7) WORKING DAYS prior to setting up of any traffic control. • Unless otherwise approved by the State Permit Inspector no work that interferes with public traffic shall be Pei formed on weekdays between 6:00 AM and 9:00 AM, and between 3:00 PM and 6:30 PM. • Except as specifically provided herein, all requirements of the Vehicle Code and other applicable laws must be complied with in all particulars. - • All work performed pursuant to this permit shall be performed in accordance with the current Department of Transportation's Standard Specifications, Standard Plans, Encroachment Permit Manual, and shall comply with all provisions of this permit and the instructions of the State permit inspector. Any violation of this permit shall constitute grounds for revocation of the permit. All traffic control, signing and striping shall comply with 2012 California MUTCD. It is available at: http: / /www. dot. ca.g ov/ hq /traffoDs /signtech /mutedsuDo /ca muted2012 htm • Contractor shall comply with the current Department Standard Specifications and Standard Plans, Revised Standard Plans and the project special provisions. The latest Revised Standard Plans are available at http: / /www.dot.ca. eov /hu /esc /oe /project plans/HTM /stdolns -US- customary -units -new10 htm • No lane may be closed or obstructed at any time unless specifically allowed per the encroachment permit, shown in approved traffic control plans, and /or as directed by the Department's Representative. • The Permittee's work shall be subordinated to any operations which the Department may conduct and shall not delay, nor interfere with the Department's Forces or Department's Contractors. • When traffic cones or delineators are used to delineate a temporary edge of traffic lane, the line of cones or delineators shall be considered to be the edge of the traffic lane. The permitte , shall not reduce the width of the existing lane to less than 10 feet without written approval From the Department's Representative. • The requirement for a Water Pollution Control Program (WPCP) will be determined on a case by case basis. Permittee shall notify Caltrans Storm Water Reviewer Shawn Romouzi at 949 - 724 -2080 to determine whether or not a WPCP is needed prior to performing excavation work within the State R /W. For minor excavation, Please refer to the attached Storm Water Pollution Prevention Special Provisions. Continued on Page 2 PAGE 2 OF 2: ATTACHED TO AND MADE PART OF PERMIT NO. 12- 15 -N -UM -0099 • Should any deviation from these procedures or conditions be observed, all work shall be suspended until satisfactory steps have been taken to ensure compliance. • Permittee shall submit CAL -OS14A approved Shoring Plan and Calculations for excavation deeper than 5 Feet. • In the event of any discrepancy between Pennittee's Permit Plans and these Permit Special Provisions, these Special Provisions shall prevail • Refueling of vehicle or equipment within the right of way is strictly prohibited. • When the work area encroaches upon a sidewalk, walkway, or crosswalk area, special consideration must be given to pedestrian safety. Protective barricades, fencing, handrails and bridges, together with warning and guidance devices and signs must be utilized so that the passageway for pedestrians, especially blind and other physically handicapped, is safe and well defined and shown on the approved permit plan. • If a safe passage way can not be provided, appropriate signs and barricades shall be installed at the limits and in advance of construction at the nearest Crosswalk or Intersection to detour pedestrians to facilities across the street. • No materials or waste shall be stockpiled within State Right of Way. • Pei mittee's attention is directed to Standard specification, Section 7 -1.11 Preservation of Property, and Business and Professions Code, Section 8771. Permittee shall physically inspect the work site and locate survey monuments before work commencement. Monuments that might be disturbed shall be referenced or reset in accordance with Business and Professions Code. If feasible, monuments should not be set within the traveled way. All monuments that must be set or perpetuated in paved surfaces, shall be constructed in accordance with Caltrans Standard Specifications Section 81 `Monuments', and Standard Plan A74, Type D, or equal with prior approval of the District Surveys Representative. Copies of Corner Records filed or Record of Surveys recorded in compliance with the Business and Professions Code shall be forwarded to the District Surveys Representative. • A copy of this Penn it, complete with all attachments, shall be kept by permittee /contractor working under this permit and must be shown to the Department Permit Inspector, Department's Representatives, or Law Enforcement Officer, on demand. • Immediately following completion of the work permitted herein, Permittee shall fill out and fax the attached Work Completion Notice to 949 - 724 -2265 to initiate final permit processing. STATEOF CALIFORNIA• DEPARTMENT OFTRANSPORTATION Page l of 4 STANDARD ENCROACHMENT PERMIT APPLICATION FOR CALTRANS USE TR -0100 (REV. 0712007) FERIAI NONUM- 00 DIST /CORRTETM Permission is requested to encroach on the State Highway right -of -way as follows: (Complete all BOXES [write N/A if not applicable] Please print $trials sided l This application is not complete Until all requirements have been approved. 12 1 OAA • I V A IZ M A 2 SNIMPLEX STAM�Pn ❑ LANDSCAPING RG(K ✓•� 61MaNA( OR 1.000NTY a. ROUTE 3.POSTMILE Orange Various Various CADDRESSORSTREETNAME S. LITY Varous Costa Mesa, Newport Beach *• 6. CROSS STREET (Dialeacesaddlrec6'onleaver s) T.PORTION.MCNI'll Y DATE(nJTnkMTA AID 1G 46 0. WORK TO BE PERFORMED BY 0 OWN FORCES ❑CONTRACTOR A EST.earew. 10 EST. COMFtETION DATE 11. EXCAVATION MAX.DEPTH AVG. DEPTH AVG. WIDTH LENGTH SURFACE TYPE 12. EST.COSTINSTATE HIGHWAY RIGHTDF -WAY FUNDING SOURCE(S) _ QFEDERAL STATE ❑ LOCAL E] PRIVATE 13. PIPES PRODUCT TYPE DIAMETER VOLTAGEIPSIG 14.CALTRANS'PROJECT CODE 15. 0 Double Permit Parent Permit Number Applicant's Reference Number I Utility Work Order Number 10. Have your plans been reviewed by another Caltrans branch? Ia NO ❑ YES (If "YES ") Who? 17. Completely describe work to be done within STATE highway righbof -way Attach 6 complete sets of plans (folded to 8.5" x 11"), and any applicable specifications, calculations, maps, etc. All dimensions shall be in U.S. Customary (English) Units. Requested is a two -year maintenance permit to perform repair and maintenance work on sanitary sewer lines and manholes located within State right -of -way. See attached copy of pervious two year permit. 18. Is a city, county, or other agency Involved in the approval of this project? 0 YES (11 "YES", check type orprolecf and attach environmare l doccenche don end conditions of approval. ) 0 COMMERCIAL DEVELOPMENT 11 BUILDING 0 GRADING 0 OTHER Cl CATEGORICALLY EXEMPT ONEGATIVEDECLARATION Cl ENVIRONMENTAL IMPACT REPORT DOTHIR 0 NO (if "NO', please check the category below which best describes the project, and complete page 4 of this appllcallon.) ❑ DRIVEWAY OR ROAD APPROACH, RECONSTRUCTION, MAINTENANCE, OR RESURFACING 0 FENCE ® PUBLIC UTILITY MODIFICATIONS, EXTENSIONS, HOOKUPS ❑ MAILBOX ❑ FLAGS, SIGNS, BANNERS, DECORATIONS, PARADES AND CELEBRATIONS ❑ EROSION CONTROL ❑ OTHER. ❑ LANDSCAPING 19. Will this project cause a substantial change In the significance of a historical resource (45 years or older), or cultural resource? [:] YES 0 NO (If "YES ', provide a description) 20. Is this paled on an existed; highway or street where the activity Involves removal of a scenic resource Including a significant Val or $land of trees, a rack outcropping or a historic building? Q YES ® NO (IVYES', provide a description) 21. Is work being done on applicant's property? ❑ YES © NO (if 'YES', attach site and leading plans) ADA NOTICE: For iMiviMSls with vensory disabilities, His document u available in eIte. Acerad. For iagerc tioq call (916) 654-0010, TTY ?l [,or write to Records and Fares Mmagemem, 112ON Sheeq MS-89, Sacemucia, CA 95814. STATE OF CALIFORNIA• DEPARTMENT OF TRANSPORTATION Page 2 of STANDARD ENCROACHMENT PERMIT APPLICATION RI:RMIT NO. TR -0100 (REV. 07 /200]) I lZ IS — NUM- DO 4q 22. Will this proposed project require the disturbance of soil? []YES ONO If "YES", estimate the area YI'Qtla State Highway right-of -way In square fact AND acres' (fir) AND (acres: estmats the area outside of State Higibway ight-of -way in square feet AND acres: _ (ft') AND (acres) 23. Will this proposed project require dewatedng? E] YES R] NO If "YES', estimate total gallons AND gallonslmont. (gallons)AND (gallods/mont) SOURCE': QSTORMWATER ANON- STORMWATER ('See Caltrans SWMP fa defnifons of ten -storm webar discharge: into /A . dat.ca .gov/M1q /env/stormwater /inde .htm ) 24. How will 'any storm water or ground water be disposed of from within or near the !Imps of Nis proposed project? Storm orela System [J Combined sewer / Storm System p storm Water Retention Basin Otegexplain} N/A PLEASEREADTHE FOLLOWINGCLAUSES PRIORTO SIGNENGTHISENCROACHNIENTPERMITAPPL !CATION. The applicant, understands and herein agrees thatan encroachmentpermitcan be denied, and fora bondrequinedfornon- payment of prior orpresent encroachmentpermit fees. Encroachment Permit fees may still be due when an application is withdrawn grateful and that a denial may he appealed, in accordance with the California Streets and Highways Code, Section 671.5. Allworkshallbe doneinaccor dance with Caltrans rulesandregu/ abonssubject to inspection andapprovef. The applicant, understands and herein agrees to the general provisions, special provisions and conditions of the encroachmentpermit, and to Indemnify and hold harmless the State, Its officers, directors, agents, employees and each of them (Indemnitees) from andagalnst anyand all claims, demands, causes direction, damages, costs, expenses, actual attomays'foes, judgments, lossesand/ labilibesofeverykindandnatumwhatsoever (Clalms)arlsingoutoforin connection with the issuance and /oruse of this encroachmentpermit and theplacement andsubsequent operation andma /ntenance ofsaid encroachment for: f) borillyinjuryand]ordeath topemons includingbutnotlimited to the App/ /cant, the State and Its officers, directors, agents andemployees, thelndemnities, andthepublic; anal damage topropertyofanyone. Except as provided bylaw, the indemniffcation provisions statedabove shall applyregardless of the existence ordegre s offault of/ndemnifles. The Applicant, however, shag notbe obligated to indemnify /ndemnlfies for Claims arising from the sole negligence and willful misconduct of State, its officers, directors, agents or employees. An encroachment permit is not a property right and does not transfer with the property to a new owner DISCHARGES OF STORM WA D : Work within State HlghwayrighNofwayshal /be conducted in compliance with all applicable requirements of the National Pollutant Discharge Elimination System (NPDES) permit issuedto the DepartmentofTransportation (Department), to govern the discharge ofstormwaterandnon -storm waterfrom itspropertles. Workshallalso be In compliance withallotherappllcab/eFederal, StateandLocallawsandregulations ,and with the Department's Encroachment Permits Manual and encroachment permit. Compliance with the Departments NPDES permit requires amongstotherthings, the preparation andsubmission ofa Storm WaterPel/utlon Protection Plan (SWPPP), ora WaterPolludon Control Program (WPCP), and the approval ofsame by the appropriate reiriewingauthorfly prior to the start of any work. Information on the requirements may also be reviewed on the Departments Construction Website at: htto: //Www dot ca govlhalconstruclsto..ter PHONE NUMBER 949 - 645 -8400 Q YES ❑ NO FAXNUMBER 949 - 650 -2253 General Manager STATE OF CALIFORNIA- DEPARTMENTOFTRANSPORTATION Pege 3 of 4 STANDARD ENCROACHMENT PERMIT APPLICATION PERMIT NO. rR -o mo (REV. o2ngoT). I2 IS — AIULf —nn99 FEE CALCULATION -- FOR CALTRANS USE ❑ CASH ❑. CREDffCARO ❑ CHECK INUMBER ❑ EXEMPr NAMEONCARD NAMEONCHECK ❑ PROJECTCODE PHONENUMBER PHONENUMBER ® DEFERREDBILLING(Ulility) CALCULATED BY (1) (2) REVIEW I. HOURS @ $ 2._ HOURS @ $ 1. FEE/ DEPOSIT $ DATE /V 2. s FEE /DEPOSIT DATE TOTAL FEE /DEPOSIT $ $ INSPECTION 1. HOURS @ $ 2.HOURS @ 1. FEE I DEPOSIT $ ATE 2. $ FEE/ DEPOSIT DATE TOTAL FEE I DEPOSIT $ $ FIELDWORK HOURS @ $ $ $ $ EQUIPMENTS MATERIALS DEPOSIT DATE DEPOSIT DATE DEPOSIT CASHDEPOSITIN LIEU OF BOND $ $ $ TOTAL COLLECTED CASHIER'SINITIALS $ $ $ ' The Standard Hourly Rate h set annually by HQ Enc.wahment PoMifs. Dish t Office sleff do not have aulhonty to modify this .te. PERFORMANCEBOND ❑ DATE $AMOUNT PAYMENTeOND ❑ DATE AMOUNT LIABILRYINSURANCE REQUIRED? ❑ YES ❑ NO $ OUNT 0 w z v/ N a h' 0 F- U W CL U) Z �N LL W a w m o o m O m O w Z I LL LL LL W (Qp f0 m I� O V N r O V N� r IQO (O r O V N r [QO tD m r O O N r O J w H m m m m m m rn m rn m m m m m K O � N N N� N O z z w o z x z x z w o z a x Z w o z x W F m M o M m rn (D m N O M LL O LL w U J_ M M S FATE OF CA LI FORNIA, DEPAR'1'M ENT OF TRANSPORTATION ENCROA01MENT PERMIT GENERAL PROVISIONS 1'R -0045 (REV. (1 0107) 1. AUTHORITY: 'I Le Detraiment's autumns to issue encroachmenl permits is pmvided under, Div. I, Clip(, 3, An I, Sect 660 to 734 of I Streets and I lighways Code, 2. REVOCATION: Encroachment permits are revocable on five days notice unless otherwise stated on the permit and except as provided by law for public corporations, franchise holders, and utilities. These General Provisions and the Encroachment Permit Utility Provisions are subject to modification nr abrogation at any lime. Psurnmes' joint use agreements, franchise rights, reserved rights or any other agreements for operating purposes in Slate highway right of way arc exceptions to this recreation. 3. DENIAL FOR NONPAYMENT OF FEES: Failure to pay permit fees when due can result in rejcc(ton offuturc applications and denial of permits. 4. ASSIGNMENT: No party other than Ilse permitee or permiltee's authorized agent is allowed to work under this permil. 5. ACCEPTANCE OF PROVISIONS: Primitive understands and agrees to accept these General Provisions and all structural to this permit, for any work to be performed under this permit 6. BEGINNING OF WORK: When traffic is not impacted (see Number 35), the response shall notify the Department's representative, two (2) days before the intent to start permitted work. Permitter shall notify the Department's Representative if the work Is to be Interrupted for a period of five (5) days or more, unless otherwise agreed upon. All work shall be performed on weekdays during regular work hours, excluding holidays, unless otherwise specified in this permit. 7. STANDARDS OF CONSTRUCTION: All work performed within highway right of was shall conform to recognized consumption Mordants and current Uepanmenl Standard Specifications, Department Standard Plans high and Low Risk Facility Specifications, and Utility Special Provisions. Where reference is made to "Contractor and Engineer" these am amended to be read as 'Peroulme and Department representative" A. PLAN CHANGES: Changes to plans, specifications, and permil pim,vuana am not snowed without prior approval Tmm the State mpresembtim. 9. INSPECTION AND APPROVAL: All work is subject to monitoring and inspection. Upon completion of work, permittee shall request a final inspection for acceptance and approval by the Depanmern. The local agoney permitter shall not we final construction approval to its contractor until final acceptance end approval by the Department is obtained. 10. PERMIT AT WORKSII'E: scrounge shall keep the permit package or a caw Ihemoq at the work site and show it upon request to any Department representative or law enforcement officer If the permit package is not kept and made available at the work site, the work shall he suspended. It. CON'FLICT'ING ENCROACHMENTS: Pemmince shall yield start of work to ongoing, prior authorized, work adjacent to or within the limits of the pmjccl site. When existing encroachments conflict with new work, the perminec shall bear all cost for rearrangements, mg, relocation, aluminim, removal, ete.l. 12. PERM] I S FROM OTHER AGENCIES: I' his pcnnilislnvalmated if the permitee has net obtained all permits necessary and required by law, firm the Public Utilities Commission of the Stale of California (PUC), Cullfmio Occupational Safety and Health Administration (Cal - OSHA), or any other public agoney havingjnrisdictirn. 13. PEDESTRIAN AND BICYCLIST SAVE UV: A safe wouningra passageway of4' shall be maintained through the work area at existing pedestrian or bicycle facilities. At no time shall pedestrians he diverted onto a portion of the street used Far vehicular bu ic. At locations where safe altercate passageways cannot be provided, appropriate signs and barricades shall be installed at the limits of construction and in advance of the limits of construction at the nearest msswalk or intersection to detour pedestrians to facilities across the slreeL Attention is directed to Section 7 -1,09 Public Safty of the Department Standard Specifications. 14. PUBLIC TRAFFIC CONTROL: As required by law, the permitee shall preside treD'ic cannot protection warding signs. lights, safety des etc, and lake all other measures miresxary for traveling publics safety. While providing traffic control, the needs and control of all mad users [momris(s, hanyviPts end pAR,himts, including persons w,(It disabilities it mwrdrim a with (he Americans with Disah,lities Ac( of 1990 (ADA)] shall bean essential pan of the work activity_ Day and night time Irate closures shall comply with the California Manual on Uniform Traffic Control Devices (Part 6, 'rempmary 'traffic Corti Standard Plans, and Standard Specifications for traffic central systems. These General Pmvisinns are not Intended to impose upon the permitter, by third parties, any duty or standard of care, greater than or different from, as required by law. 15. MINIMUM INTERFERENCE WITH 'TRAFFIC: Permitter shall plan and conduct work so as to create the least Possible inconvenience to the traveling public, traffic shall not he unreasonably deloyed. On conventimah highways, ppanouee shall place property snared Mottoes) 1. stop or wem the traveling public in compliance wish the California Manual on Uniform Traffic Control DeAws (Clasper 6E, Flogger Control. 16. STORAGE OF EQUIPMENT AND MATERIALS: The storage of equipment or materials is not allowed within State highway right -cf- way, unless soeeifed within the Special Provisions of this specific wricaranclarent permit. If Encroachment Permit Special Provisions allow for the storage of equipmrnt or materials within the State right of way, the equipment and material storage shall comply with Standard Specifications, Stallard Plans, Special Provisions, and the Highway Design Manual. The clear recovery one widdis must be followed and are the minfintion, desirable for the type of facility indicated helow: freeways and expressways - 30'. conventional higlmays(no curbs) -20', conventional highways (with curbs) — 1, 5'. If used object cannot be climinaled, moved owild. the dear recovery zone, or modified to be made yielding, it should be shielded by a guardrail or crash cushion. 17. CARE OF DRAINAGE: Pomde. shall provide altcrnme drainage for any work interfering with an existing dminege facility in compliance with the Standard Specifications, Standard Plans and/or as directed by the Depormreat s rcppewalowc. la, RESTORATION AND REPAIRS IN RIGHT OF WAV: Panniltee is mspon able for restomtom and repair of State highway right of way resulting Pram permitted work (Slate Streets and IHallways Code, Sections 670 el. seq_)_ 19. RIGIII OF WAY CLEAN UP: Upon completion of work, permitlee shall remove and dispose of all scraps, brash, [imber, .,own.],, etc. off ate right of way, The aesthetics of tire highway shall be as it was before work started. 20. COST OF WORK: Unless slated in the permit, or a separate written agreement, the permitlee shall bear all costs incurred for work withits the Stale right of way and waives all claims for indemnification or contribution from the Stme. 21. ACq'UAL COST BILLING: When specified in the pennil the Depanment will bill the pemrittec actual costs at the currently at hourly rate for encroachment permits. - 22 A S-BUILT PLANS: When angdoed, permitter shall submit one (I) set or folded asTmR plans within thirty (30) days alter completion and appmval of work in compliance with requirements listed as follows: I. Upon completion of the work provided herein, the pemrince shall send one vellum or paper set ol'As -Built plans, to the State rcpresenletive. Mylar or paper sepia plans are not acceptable. 2. All changes in the work will be shown run the plans, as issued with tam permit, including changes approved by Encroachment Permit Rider, 3. The plans are to be stamped or otherwise noted AS -BUILT by the pemriaee's representative who 4 responsible for overseeing the work. Any original plan Ihmwa, approved with a Slate stamp, or Collars representative signature, shall be used for producing the As -Built plans. 4 I As -Built plans include signing or striping, the areas of signing or striping removal, relocation, or installation shall be shown on the plans when required as a condition of the permit. When the construction plans show signing and striping for staged emotmction on separate sheets, the shalt far each slogo 16.11 show the removal, relocation or installation dates of the appropriate staged striping and signing. 5. As -BmH plans shall ..tarn the Permit Number, County, Route, and Post Mile on each deal. 6. Disclaimer statement of any kind that differ from the obligations and pmtectiorm provided by Sections 6735 through 6735.6 of tire Callfmla Business and Profession, Code, stall nut be included on the As -Built plans Such statements constitute non - compliance with Lacroachnrent Permit requirements, and may result in the Department of Torafrormum. retaining PerlIumnemea Brands or deposits until proper plans arc submille t, Failure to comply may .1. result in denial of mine permits, or a provision requiring a public agency to supply additional bonding. 23. PERMITS FOR RECORD PURPOSES ONLY: When work in the right of way Is within an area orders Joint Use Agreement (JUA) ma Consent to Common Use Agrcen ent (CCUA), a fee exempt permit is issued to the pemtiace for the purpose of providing a Iran. and curd of work. The Permittee's prior rights shall be preserved without the intention cremating new or different rights or obligations. "Notice and Record Purposes Only" shall be stamped across the face of the permiL 24. BONDING: The pemrince shall file bond(d, in advance, in the amount set by the Department. failure to maintain bonds) in PoII firrac and etTect will result in the Department stopping ofall work and revoking pumit(s)- Bonds are not required of public corporations or privately owned utilities, unless permute¢ failed to comply with the provision and conditions trader a prior permit, The surety company is responsible for any latent detects as provided in California Code of Civil Pawedures. 9.rien 339.15. Local agency pennittee shall comply with requanna nts established as f (lows: In recognition that project construction work done on State property will not be directly funded and paid by Slate, I'or the purpose of protecting stop notice claimants and the interests of Sate relative to stce ssNl project completion, the local agency permance agrees to require the construction contractor hunish both a payment and performance bond in the local agency's nor, with both bands complying with the requirements set forth in Section 3 -1.02 of State's comenl Standard S ucifiewmas before performing any project eenstr act ian work.'I'he local agency permitlee shall defend, Indemnify, and hold harmless the Stole, its officers and employees form all protect con sm..too reined claims by embacton and all slop notice or nnechers, s lien claimants. The local agency also agrees to remedy, in a timely manner and to State's satisfaction, any latent defects occurring as a result of the project construction work. 25. FIITLIRE MOVING OF INSTALLATIONS: remains understands and Vocas to relocate a permitted dandelion upon police by the Depanment Unless under prior property right or agreement, the permiaee shall comply with said notice at his sole expense. 26, ARCHAEOLOGICALMISTORICAL: If any archaeological or historical resnurcom are revealed in the work ne nill, the permitlee shall immediately stop work, notify the [serum of, representative, retain a qualified arehaaoged who shall evaluate the site, and make recommendations to the Depanment representative regarding the continuance ofwod- 27, PREVAILING WAGES: Work performed by or under a permit may require penniaee's contractors and subcontractors to Nov, appropriate prevailing wages or .set by the Department of Industrial Relations. Inquiries or requests for interpretations relative to enforcement of prevailing wage requirements are directed to State of California Department of Industrial Relations, 525 Gulden Gate Avenue, San Fmnclsce, Califomia 94102. 28. RESPONSIBILITY FOR DAMAGE: The Stale of California and all rlY.rs and employees thereof, including but not limited to the Director of Transportation and the Dopnty Director, shall not be answerable or accountable in any manner for injury to or death crony person including but not limited to the permiaee, persons employed by the pare inee, persons acting in behalf of the permiaee, or for damage to property from any crew The pemarre shall be responsible for any liability imposed aby law and for injuries to or death of any person, including but not linked to the permince, persons employed by the perminec, persons acting in behalf of (lie permiaee, or for damage to property arising our of work, or other activity permitted and done by the pennitme order permit, or arising out of the firilum on the perminec's pant to perform his obligations under any permit in respect to maintenance or any other obligations, or mantling Rom defects or obstructions, or from any cause whatsoever during the progress of the work, or other activity or at any subsequent time, work ur other activity is being performed under the obligations provided by and contemplated by the permit. The remaining, shall indemnify and save harmless the State of California, all doers, employees, and State's esntmdors, thereof, including bur not ]it nlled to the Director of Trairs,munion and the Deputy Directop Dou.11 clat ms. snits or actions of every name, kind and description brought In, or no aeeoum ofimmics to or death crony person, including but not limited to the permiaee, persons employed by the permiaee, persons acting in behalfofthc permiaee and the public, or damage to property resulting from the perl'nnnance ortwork or other activity under the pennil, or arising out of the frilure on the penniaee's part to enfinms his obligations under any poruil in respect to maintenance or any other obligations, or resulting from defects or obstructions, or from any cause whatsoever during the progress of the work, or other activity or at any subsequent time, work or other activity is being performed under the obligations provided by and comeuppance] by the penal, except as ollum,ou provided by smr.le The duty of the permitted to indenuti I and save harmless includes the duties to de lend asset forth in Seen on 2778 of the Civil Code. The permitter waives any and all rights to any type of expressed or implied indemnity .,.fast tire State, its effects. employees, and Stale conbactre It Is the intent of the gaffes that [Ile pennlllee will indemnify and hold harmless the State, its officer,, employees, end Snte's smand tors. from any and all claims, suits or act ions as act forth above regardless of the eAstemor or degree of fault or negligence, whether active or passive, primary or secondary, on the part of the Stele, the permittee, persons employed by the permitted, or acting oa behalfofthe permitted. For the purpose of this section, 'State's contmctorti' shall include onbaahas and their satbetintmotem under contract to the State of California performing work within the limits ofthis permit. 29. NO PRECEDENT ESTABLISHED: This permit is issued with the understanding that it does net establish a precedent. 30. FEDERAL CIVIL'RICHTS REQUIREMENTS FOR PUBLIC ACCOMMODATION: A. The permittee, for himself, his personal representative, successors in interest, and assigns as part of the consideration hereof, does hereby n.rount and agree that. L No person on the grounds a] race, color, or national origin shall be cautioned! boom participation in. be denied the benefits of, or Imo otherwise subjected to dtserno cloth in the nsc ofsaid lhoilihea. 2 That in connection win, the eoustranoon of any improvements an said lands and the Soundings of services thereon, no discrimination shall be practiced in the selection and mention of first -tier subcontractors in the selection ofsecond -liar subcontractors. 3. That such discrimination shall not be practiced against the finally in their weass to and use of the facilities and services provided for public accommodations (such as eating, sleeping, rest, recreation), and operation on, over, or under (he space of the right of way. 4. That the perrounce shall use the premises in complianm with all other requirements imposed pursuant to 'I ifle 15. Code of Federal Regulations, Commerce and Foreign 'Prude, Subtitle A. Office of the Secretary of Commerce, part 8 (15 C, F. R. Part 8) and as said Regulations may be amended. 5. That in Ile even( of breach of any of the above nondiscrimination covenants, the State shall have the right to terminate the permit and to re -enter and repossess said land and the land and the facilities lhereoa, and hold the saute as 11 tumid permit had never been made or Issued. 31. MAINTENANCE OF HIGHWAYS The peimatice agrees, by cccptance of permit, to properly maintain any encroachment, This assurance requires the permince to provide inspection and repair any damage, at permittce's expense, to State facilities resulting train the encmachmem. 32. SPECIAL EVENTS: In accordance with subdivision (a) of Store s and Ilighways Code Section 682 5, the Department of Transportation shall not he responsible far the conductor violation or the permitted activity, and the applicant agrees to defend, indemnify, and hold harndess the State and the city or county against any and all claims mush, at of any activity for which the permit is issued. 'f he permitted understands and agrees to comply with (he obligations of Titles II and III of me Americans with Disabilities Act of 1990 in the conduct of the event. and further agrees to naturally and save harmless the Slate of California, all officers and employees thereof, including but not limited to Ilse Director of Transportation, from any claims or liability arising out ofor by virtue of said Act. 33. PRIVATE USE OF RIGHT OF WAY: Highway right of way shall not be used for private purposes without compensation to the Stele. The gifting of public property use and therefore public funds is prohibited under the Calif..,. Constitution, Artie le 16 34. FIELD WORK REIMBURSEMENT: Perm ittce .shall reimburse Slate for field work performed on permittee's behalf to correct or mcdy hazards or damaged facilities, or clear debris not attended to by the pemmittee. 35. NO'1'IFICAI'ION OF DEPARTMENT AND 'f MC: The permittee shall notify the Deparonear's represamative and the Iwasportatton Management Center (f MC) at leas( 7 days before initialing a lane closure or conducting an activity that may, cause a tmffie impact A confirmation notification should occur 3 days before closure or other potential tmffie impacts In emergency situations when the corrective work or the emergency itself may alTecl Imllic, TMC and the Department's representative shall be notified as soon as possible. 36. SUSPENSION OF TRAFFIC CONTROL OPERATION: 'fhe permittue, upon notification by the Department's representative, shall mediatety suspend all lane c osnre operations and any operation that impedes the flow of ballic. All costs associated with this suspension shall be home by the permitter. 37. UNDERGROUND SERVICE ALERT ('SA) NOTIFICATION: Any excavation requires compliance with the provisions of Government Code Section 4216 el seq., including, but not limited to notice to a regional notification cartaq such as Underground Service Ater( (USA) The permihde shall provide notification at least 48 hours before rotational, any excavation work within the right of way. STATE OF CALIFORNIA - DEPARTMENT OF TRANSPORTATION ENCROACHMENT PERMIT UTILITY MAINTENANCE PROVISIONS TR -0161 (Rev.0512006) Any public utility or public corporation who lawfully maintains a oddity encroachment, or their agent, may perform routine or emergency maintenance on such facility in accordance with the following provisions (unless updated at some future time, thence the future provisions shall gm em. UMl. EXCLUSIONS: These provisions do not authorize tree trimming, work on freeways, expressways, or other activities not specifically provided for in this permit. UM2. POSSESSION OF PERMIT REQUIRED: The permit or a copy thereof shall be kept at the site of the work and mast be shown to any Departmental representative or any law enforcement officer ma demand. WORK SHALL BE SUSPENDED IF PERMIT IS NOT AT WORK SITE AS REQUIRED. UM3. NOTICE REQUIRED: The peniittee shall notify the Department's representative and the Transportation Management Center (TMC) 7 days before initiating a lane closure. A confirmation notification should occur 3 days before closure. In emergency, situations that may impact traffic, TMC and the Department's representative shall be notified as soon as possible. UIOSl�Y LL`u \:IZQO[tY ):TYI All work shall conform to recognized standards of utility canstruction and the Department's current Standard Specifications. DAIS. EMERGENCY REPAIRS: The permittee may make emergency repairs, alter traffic flow, and excavate through improved surfaces only when breaks in the conduit, cable or pipeline over or under the pavement present a definite public hazard or serious marreption of essential service. In such cases, the Department's representative shell be notified immediately. VM6. OPEN EXCAVATIONS: No excavation shall be left open after daylight hours unless specifically authorized and adequate protection for traffic is provided in accordance with the General provisions "Protection of Traffic." Backfill and pavement replacement shall be performed in accordance with the applicable General Provisions (i.e., "Restoration and Repairs in Rights of Way "). UMZ SERVICE CONNECTION: These provisions do not authorize installation of conduit, cable, gas, or water service connections within State rights of way, regardless of the location of the main, existing conduit, or cable. All new underground or pipe abandon services must be covered by individual permits. See Section "UM84" regarding service connections for aerial wires. UM8. ROUTINE INSPECTION AND MAINTENANCE: 1. Routine Maintenance and hurection' Roadbed work shall be conducted between 9:00 a.m. and 3:00 p. m:, or as otherwise authorized, in writing, by the Department's representative. 2. Manholes: The p,unittee may open existing manholes to repair underground cables. Where the manhole lies within the improved surface of the highway, the notminee will provide adequate prownfion for traffic in accordance with the General Provisions "Public Traffic Control ". 3. Excavations: Routine inspection and repair of pipeline and cables shall: A. Not be made in improved surfaces, landscaped mesa or closer than 10' to the edge of the pavement without a special penal; a it B. Not uncover more than 50' of line . at any one time 4. Pole Lines: Pconames is authorised to: A. Stub, or reset existing pole, provided no change in location of pole or anchor is made. Stubs and anchors at act be placed between existing pole and traveled way. B. Replace poles, guy poles, and crossarms in same location limited to two (2) consecutive poles. No additional poles or - guys poles are authorized . under this routine mainteuance provision. C. Replace broken pins and/or insulation, repair broken wires, pull slack wires, and replace or pull broken or slack guys. D. Repair and complete transfer work on existing aerial cables. E. Install new and replace existing transformers on existing poles. Replace aerial wires and crass= an existing poles except where wims cross the highway. Unless otherwise specifically required by the Deperanent, protected cable, tree wire or plastic tree wire guard used for communication lines may be used through trees where necessary, provided the appearance of the tree or the tree itself will not be damaged. This semino (F) does not apply to scenic higiovays. G. Installations and clearances shall be equal to those required by either the California Public Utilities Commission Orders or the California Occupational Safety and Health (CAL -OSHA) Safety Orders, whichever is greater. Also see "OX 2"of the Overhead Utility Provisions. H. Clear grass from around base ofpoles and excavate around poles for inspection, including tamping and straightening. The use of herbicides or other chemicals is not authorized by this permit A separate coamachmeat permit must be applied for and issued for that purpose. STATE OF CALIFORNIA - DEPARTMENT OF TRANSPORTATION STORM WATER SPECIAL PROVISIONS for MINIMAL or NO IMPACT TR -0400 (Rev 0901012) 1. GENERAL: The purpose of these Special Pravisions is to provide the Penainee with specifications tar water pollution control in minimize, prevent, or control the discharge of material into the air, surface waters, groundwater, and storm sewers owned by the Statc or local agencies. These Provisions are not intended to take the place of the Caltrans Water Pollution Co."] Program (WPCP) for projects where soil dissolution. from work activities less than one acre, or work activities of one acre or more subject to the preparation of the Calnans Skmr Water Pollution Prevention Plan (SWPPP) that would require a waves dischargu identification number or coverage under the California Construction General Permit (Order No. 2009 - 0009 -DWQ, NPDES No CAS000002). The Permute shall comply with the following Special Previsions and the direction ofthe State Representative. 2. NPDES REQUIREMENTS: The Perrino shall be responsible for full compliance with the Cohmas Storm Water Program and the Caltmns National Pollutant Discharge Elimination System (NPDES) Permit requirements. It is the Permine's responsibility to install, inspect, and repair or maintain facilities and devices used for water pollution control practices before performing daily work activities. Installation and maintenance responsibilities on the job site include: 1) sail stabilbation materials in work areas that are inactive or prior to storm events, 2) water pollution control devices to Central Sediment and erosion, 3) implementation of spill and leak Prevention procedures for chemical and hazardous substances stored on the job site. 4) material storage, 5) stockpile management, 6) waste management, 7) non- stormwater management, 8) water conservation, and 9) illicit connection, illegal discharge detection and reporting. The Permittee shall report to the state representative when discharges enter into receiving waters, adjacent property, drainage systems or when discharges could be a cause or a threat for water pollution. The Perminee shall also control illicit discharges or illegal dumping prior to start of daily work schedule. Copies of written notices or orders from the Regional Water Quality Control Board or other regulatory agency shall be provided to the State representative within 48 hours of reported activity.. For additional information on ammr water compliance, visit the State Water Resources Control Boards storm water Website at p// •h 4 , rrv/wller us, >/r 3. RESPONSIBILITY FOR DEBRIS REMOVAL: The Permittce shall be responsible for preventing sediment, trash, debris, and other construction waste from entering the street, the stone drains, local creeks, or any other bodies of water. 4. SPOILS AND RESIDUE: The Perelman shall vacuum any saw -cut concrete waste material, debris, residue, etc. No spoils, debris, residue, etc. shall be washed into a drainage system. S. SWEEPING: Sweep paved roads at construction entrance and exit locations and surounding paved areas daily within the job site during: 1) clearing and grubbing, 2) earthwork, 3) trenching, 4) soil disturbance, 5) pavement grinding and/or cutting, and 6) after observing tracking of material onto or off the State property. Keep dust to a minimum during sweeping activities. Use vacuum whenever dust generation is excessive or sediment pickup is ineffective. Roadways or work areas shall not be washed down with water. Street sweeping operations most conform In Section 13 Water Pollution Control ofthe State of California standard specifications for construction (most current version) Intp. //. do r it, . NUV/ hy/ scloe /specitlonnons /S51'ar2010 -SSPv 6. VEHICLES AND EQUIPMENT: Pertnitte shall prevent all vehicles, equipment, etc. from leakage or mud tracking onto Page 1 & 2 roadways. If leaks cannot be repaired immediately, remove the vehicle or equipment from the job sit. 7. MAINTENANCE AND FUELING OF'VEHICLES AND EQUIPMENT: Maintenance end fueling ofequipment shall or result In any Pollution at thcjob ante. The Pertnittee shell Immediately clean up spillsdealm and Properly dispose of contaminated soil and materials. 8. CLEANING VEHICLES AND EQUIPMENT: Limit vohiele and equipment cleaning or washing at the job site except what is necessary in comrol vehicle trucking or hazardous waste. The Permittee shall clean all equipment within a berthed area or over a drip pan large enough to prevent runoff. N o soaps, solvents, degreasers, etc shall be used in State right of way. Any water from this operation shall be collected and disposed of at an appropriate sire. Containment berms or dikes shall be used for fueling, washing, maintaining and washing vehicles or equipment in outside areas. Containment must be performed at least 100 feet from concentrated Bows of storm water, drainage courses, and storm drain inlets if within a flood plain, otherwise at least 50 feet if outside the Boodplain. Keep adequate quantities of absorbent spill - cleanup material and spill kits in the fueling or maintenance roan and on fueling trucks. 9. DIESEL FUELS: The use of diesel fuel from petroleum or other fossil fuel as a form -uil or solvent is not allowed. 10. WEATHER CONDITIONS AT WORKSITE: Any activity that would generate fine particles m dust that could be transported offsite by stormwater shall be performed during dry weather. It. HOT MIX ASPHALT: Runoff from washing hot mix asphalt shall not enter into any drainage conveyances. 12. PROTECTION OF DRAINAGE FACILITIES: The Perminee shall pmtect/clever gutters, ditches, drainage courses, and inlets with gravel bags, fiber rolls, State approved fabric filters, etc., to the satisfaction of the State representative dining grading, paving, saw-cutting, etc. and materials must conform to Section 13.6.02 Materials for Water Pollution Control of the State of California standard specifications for construction (most current version). No such protection measures shall cause an obstruction to the traveling public. The Permince shall implement spill and leak prevention procedures for chemicals and hazardous substances stored on the job site in accordance in section 13- 4.01 Spill Prevention and Control, Water Pollution Control, of the State of Califomia standard Specifications for consuundon (2010 version). 13. PAINT: Rinsing of painting equipment and materials is not Permitted in state right-of-way. When thoroughly dry, dispose of the following as solid waste: dry latex paint, paint cans, used brushes, rags, gloves, absorbent materials, and drop cloths. Oil based paint sludge and unusable thinner shall be disposed of at an approved hazardous writ site. 14. CONSTRUCTION MATERIALS: Stockpile of all construction materials, including, but not limited to; plesure mated wood, asphalt concrete, cold mix asphalt concrete, concrete, grout, cement containing premixes, and mortar, shall conform to section 134.03C Material Management (Storage & Stockpiles), Water Pollution Control, of the Steve of California standard specifications for construction (2010 version). 15. CONCRETE EQUIPMENT: Concrete equipment shall be washed in a designated washing area in a way that does not contaminate soil, receiving waters, or storm drain systems. STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION STORM WATER SPECIAL PROVISIONS for MINIMAL or NO IMPACT TR -0400 (Rev 09/2012) 16. EXISTING VEGETATION: Established existing vegetation is the best farm of erosion control. Minimize disturbance to existing vegetation. Damaged or removed vegetation shall he replaced as directed by the State Representative. 17. SOIL DISTURBANCE: Soil disturbing activities shall be voided during the wet weather season. I f construction activities during wet weaker are allowed in your permit, all necessary erosion control and soil stabilization measures shall be implemented in advance of soil disturbing activity. 18. SLOPE STABILIZATION AND SEDIMENT CONTROL: Consider a certified expert in Erosion and Sediment control in cases where slopes are disturbed daring construction. The Permitke is directed to comply with Section 13.5 Temporary Soil Stabilization and Section 21 Erosion Control of the State of California (2010 version) standard specifications for concoction during application of temporary soil stabilization measures to the soil surface. Fiber rolls or silt fences may be required down slope until permanent soil stabilzation is established. Remove the accumulated sediment whenever the sediment accumulates to 113 of the linear sediment barrier height. 19. STOCKPILES: Stockpiles containing aggregate and/or soil shall be stored at least 100 fat from concentrated flows of storm water, drainage courses, and smmh drain inlets if within a Flood plain, otherwise at least 50 feet if outside the ffoodplain, and shall be covered and protested with at emporary perimeter sediment barrier. Cold mix stockpiles shall be stored on an impermeable surface and covered with Soil plastic to prevent contact with water. 20. DISCOVERY OF CONTAMINATION: The State Representative shall be notified in case any unusual discoloration, odor, or texture ofground water, is found in excavated material or if abandoned, underground tanks, pipes, or buried debris are encountered. 21. SANITARY AND SEPTIC WASTE: Do not may or discharge wastewater from a sanitary or septic system within the highway. Properly connected sewer facilities are free Gam leaks. With State Representative approval place portable sonitary facility at least 50 feet away from storm drains, receiving waters, and Flow, lines. Portion. most comply with local health agency provisions when using an on -site disposal system. 22. LIQUID WASTE: Preventjnh site liquid waste from entering storm drain systems and receiving waters. Drilling slurries, grease or oil -free waste water or rinse water, dredging, wash water or rinse water running off a surface or other nonstorm water liquids not covered under separate waste water permits shall be held in structurally sound, leak -proof containers, such as Portable bins or portable ranks. Store containers at least 50 feet away From moving vehicles and equipment. Liquid waste may require testing to detemtine hazardous material content prior to disposal 23. WATER CONTROL AND CONSERVATION: Manage water use in a way that will prevent erosion and the discharge of pollutants into storm drain systems and receiving waters. Direct runoff water, including water from water line repair from the job site to areas where it can infiltrate into the ground. Direct water from off -site sources around the job site or from comet with jobare water. 24. PILE DRIVING: Keep spill kits and cleanup materials at pile driving locations. Park pile driving equipment over drip pans, Pepe 2 of 2 absorbent pads, or plastic sheeting with absorbent material, and away from storm water run -on when not in use. 25. DEWATERING: Dewatedng consists of discharging accumulated stone water, groundwater, or surface water from excavations or temporary courainment facilities. All dewatering operations shall comply with the latest Caffmas guidelines. Contact State representative far appNI of dewatering discharge by infiltration or evaporation. otherwise, any effluent discharged into a permitted stone water system requires approval lium the Regional Water Quality Control Board. Prior to the start of dewatering, the Permince shall provide the Stare Representative with a dewatering and diseharge work plan that complies with section 134.01B Submittals, Water Pollution Control, of the State of California standard specifications for construction (2010 version). A copy of the Waste Discharge Permit and a copy of a valid WDID number issued by the Regional Board shall be provided to the State representative. i DISTRICT 12 LANE/SHOULDER CLOSURE REQUEST FORM THIS FORM MUST BE SUBMITTED 3 WORKING DAYS PRIOR TO THE PLANNED RESTRICTION. COMPLETE FORM AND SUBMIT BY FAX TO 949- 7242265 TO THE ATTENSION OF THE PERMIT INSPECTOR. BRING A COPY OF THE COMPLETED FORM WITH YOU TO THE PREJOB MEETING. Today's Date: Time: Contractor: Requestor. Field Contact Office Phone #: Cell Cell Phone #: Office EA # /Permit If Emergency Phone Number FAX LOCATION & DATE OF CLOSURE: FORTHE WEEK OF: Reporting Week begins on Saturday Direction: NB SS EB WB Days(s): ❑ Saturday ❑ Sunday ❑ Monday ❑ Tuesday ❑ Wednesday ❑ Thursday ❑ Friday Types of Closure, Closure Characteristics (check all of the following that apply): El One-Way ❑ Complete Closure ❑24— Hour /7 Day— closure ❑ Detour info available ❑ No detour available ❑ Ramp Closures ❑ COZEEP /MAZEEP ❑ Shoulder ❑ Closure conforms to the FHWA's Manual of Uniform Traffic Control Devices (MUTCD) 2012 EDITION & MUTCD CALIFORNIA SUPPLEMENT, copies of which are available online at http: / /mutcd.fhwa.dot.gov and http:ltr . dot. ca. gov/ hgttmffops/ signtech tmutcdsupp /u_muted2012.htm, respectively Estimated Delay: Minutes Reason for Restriction: "REAL- TIME" STATUS INSTRUCTIONS - PLEASE MAKE YOUR FIELD PERSONNEL AWARE & RESPONSIBLE! Permittee shall STATUS scheduled work DAILY via District's 24-Hour Communication Center (DCC) at 9499363600. Status Using Closure ID No(s) when work begins (first cone down, 1097), and again when work is finished for the day (last cone removed, 1098). If the work is cancelled on any scheduled day, Permittee shall call Calbans DCC at 9499363600 and relay; "(Closure ID #) Is 10 -22" (cancelled). The cancellation call shall be made before the scheduled 10 -97 time, but no later than i hour odor to the scheduled 10.98 time. Any delay in picking up your closure must be reported immediately to DCC at 949- 9363600 and Permit Inspector. State of California - Department of'Cransportation WORT{ COMPLETION NOTICE 12 -MP -0037 (Rev. 8/03) Permit No. Inspector Permittee All work authorized by the above- numbered permit was completed on: Date Signed CUSTOMER SERVICE QUESTIONNAIRE PERFORMANCE EXCELLENT VERY GOODI GOOD I POOR INSIDE THE OFFICE Staff courteous and helpful Staff quick and efficient Explanations and instructions clear TELEPHONE ANSWERING Timely response Give right informa5on/answer INSPECTION Inspector courteous and helpful Pre - construction meeting set and held in a timely manner Inspect r at the job site frequently Inspector able to answer questions and deal with problems OVERALL PERFORMANCE What would you say is our overall p erformance Fill out the form immediately after the completion of the work and fax it to 949/724 -2265