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Encroachment - State of California - 2012-12-194 STATE-tyF CALIFORNIA - DEPARTMENT OF TRANSPORTATION ENCROACHMENT PERMIT TR -0120 (REV. 612012) In compliance with: ® Your application of ❑ Utility Notice No. ❑ Agreement No. ❑ RNV Contract No. December 19, 2012 of of of TO: Costa Mesa Sanitary District 234 E. 17th Street, Suite 205, Costa Mesa, CA 92627 Attn: Robin B. Hamers (949) 631-1731 and subject to the following, PERMISSION IS HEREBY GRANTED to: Permit No. 12-12—N—UM-0686 12 -ORA -VAR PM VAR 02/14/2013 Fee Paid EXEMPT Deposit EXEMPT Performance Bond Amount (1) 0.00 Payment Bond Amount (2) 0.00 Bond Company Bond Number (1) Bond Number (2) , PERMITTEE Perform routine maintenance and make repairs and maintenance work on exisiting sanitary sewer lines and manholes located within the State Right of Way along conventional State highways in Costa Mesa and Newport Beach (FREEWAYS EXCLUDED). Service connections are not authorized. All performed work shall be in accordance with current Caltrans Standard Specifications and Standard Plans, Section 600 (Utilities Permits) of the Encroachment Permits Manual, and the attached Provisions. Permittee shall contact the State Permit Inspector shown on the attached ROUTE ASSIGNMENT LIST a minimum of five 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. THIS PERMIT IS NOT A PROPERTY RIGHT AND DOES NOT TRANSFER WITH THE PROPERTY TO A NEW OWNER. The following attachments are also included as part of this permit (Check applicable): ® Yes ❑ No General Provisions In addition to fee, the permittee will ® Yes ❑ No Utility Maintenance Provisions be billed actual costs for: ® Yes ❑ No Storm Water Special Provisions ® Yes ❑ No Review ® Yes ❑ No Special Provisions ®Yes ❑ No Inspection ❑ Yes ®No A Cal -OSHA permit, if required: Permit No. ®Yes ❑ No Field Work ❑ Yes ®No As -Built Plans Submittal Route Slip for Locally Advertised Projects ❑ Yes ®No Storm Water Pollution Prevention Plan / Water Pollution Control Plan (if any Caltrans effort expended) ❑ Yes ®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, 2015_ This permit is to be strictly construed and no other work 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. PERMIT ENGINEER: Amir Seyed-Moghaddam COPIES TO: File: 12-0686 H. Shakeri, Permits S. Romouzi, Permits Maintenance FM 91 1436 (D12 Permit App.) Chamberlain, District Director BY: SAIED HASHEMI , P.E., District Permit Engineer PAGE 1 OF 2: ATTACHED TO AND MADE PART OF PERMIT NO. 12 -12 -N -UM -0686 In addition tothe attached General. Provisions (TR -0045), the following Special Provisions are applicable: • Notwithstanding General Provision #4, if 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. k • 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 of that travel 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 performed 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.gov/hq/traffops/signtech/mutcdsupp/ca mutcd20l2 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 og v/hq/ese/oe/project-plans/HTM/stdpins-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 permittee shal l 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 JOHN JALALI at 949-724-2266 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 -12 -N -UM -0686 • 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 -OSHA approved Shoring Plan and Calculations for excavation deeper than 5 Feet. • In the event of any discrepancy between Permittee'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. • Permittee'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 permit, 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. PERMIT INSPECTOR'S ASSIGNED ROUTE AND POST MILE FOR CONVENTIONAL HIGHWAYS ROUTE POST MILE PERMIT INSPECTOR OFFICE TELEPHONE FROM TO. 1 0.000 33.719 HOSSEIN SHAKERI 949/756-7648 39 0.000 5.880 HOSSEIN SHAKERI 949/756-7648 5.885 23.200 SHAWN ROMOUZI 949/724-2080 72 111.420 11.918 SHAWN ROMOUZI 949/724-2080 74 0.000 16.599 HOSSEIN SHAKERI 949/756-7648 90 0.000 12.828 SHAWN ROMOUZI 949/724-2080 133 (Laguna Cyn Rd) 0.000 4.096 HOSSEIN SHAKERI 949/756-7648 142 0.753 6.350 SHAWN ROMOUZI 949/724-2080 14 -Feb -13 jJ ArEOF CAti TURN IA' DEPARTMENTOFTRANSPOPTATION STANDARD ENCROACHMENT PERMIT APPLICATION TR4100 (REV. 07/2007) Permission is requested to encroach on the State Highway right-of-way as follows: (Complete all BOXES [write N/A if not applicable]) Th isapplication is not complete until all requirements have been approved. 1. COUNTY O range ?.ROUTE 3.POSTMILE Various Various Page 1 of 4 PERMIT NO. _ J� / r /,� -O O V U DIST/CO/RTE/PM. SIMPLEX STAMP 4. ADDRESS OR STREETNAME 5. CITY Verious Costa Mesa, Newport Beach 6. GROSS STREET (Distance and direction from site) 7. PORTION OF RIGHT-OF-WAY DATE OF SIMPLEX STAMP 8. WORK TO BE PERFORMED BY 9. EST. START DATE 10. EST. COMPLETION DATE m OWN FORCES ❑ CONTRACTOR 11. MAX. DEPTH AVG. DEPTH AVG. WIDTH LENGTH SURFACE TYPE EXCAVATION 12. EST. COSTINSTATEHIGHWAY RIGHT-OF-WAY FUNDING SOURCE(S) ❑ FEDERAL ❑ STATE [—]LOCAL ❑ PRIVATE 13. PIPES PRODUCT TYPE DIAMETER VOLTAGE / PSIG 14. CALTRANS PROJECT E.A. NUMBER 15. ❑ Double Permit Parent Permit Number Applicant's Reference Number / Utility Work Order Number 16. Have your plans been reviewed by another Caltrans branch? ® NO ❑ YES (If "YES") Who? 17. Completely describe work to be done within STATE highway right-of-way : Attach 6 complete sets of FOLDED plans (folded 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 previous two year permit. 18. Is a city, county, or other agency involved in the approval of this project? ❑ YES (IF "YES", check type of project and attach environmental documentation and conditions of approval. ) ❑ COMMERCIAL DEVELOPMENT ❑ BUILDING ❑ GRADING ❑ OTHER ❑ CATEGORICALLY EXEMPT ❑ NEGATIVE DECLARATION ❑ ENVIRONMENTAL IMPACT REPORT ❑ OTHEI m NO (!f "NO", please check the category below which best describes the project, and complete page 4 of this application.) ❑ DRIVEWAY OR ROAD APPROACH, RECONSTRUCTION, MAINTENANCE, OR RESURFACING ❑ FENCE ❑ PUBLIC UTILITY MODIFICATIONS, EXTENSIONS, HOOKUPS ❑ MAILBOX ❑ FLAGS, SIGNS, BANNERS, DECORATIONS, PARADES AND CELEBRATIONS EJ 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 ONO (If "YES", provide a description) 20. Is this project on an existing highway or street where the activity involves removal of a scenic resource including a significant tree or stand of trees, a rock outcropping or a historic building? ❑ YES Z NO (If "YES', provide a description) 21. Is work being done on applicant's property? ❑ YES 0 NO (If "YES", attach site and grading plans.) ADA NOTICE: For individuals with sensory disabilities, this document is available in alternate formats. For information call (916) 654-6410 or TDD (916) 654-3880 or write to Records and Forms Management, 1 120 N Street, MS -89, Sacramento. CA 95814 �( C 55 STP—TEOF CALIFORNIA -DEPARTMENT OF.TRANSPORTATION ST-ANDARD ENCROACHMENT PERMIT APPLICATION TR -01(D (REV. 07/2007) 22. V'Villhis proposed project require the disturbance of soil? [ YES 2] NO If YES', estimate the area within State Highway right-of-way in square feet AND acres: estimate the area outside of State Highway right-of-way in square feet AND acres: 23. VWIIhis proposed project require dewatering? YES © NO If YES', estimate total gallon's AND gallons/month. (gallons)AND SOURCE`: ❑STORMWATER F] NON -STORM WATER Page 2 of.4 :KMI I NU. 212- il/UA? -- a6g6 (ft') AND, (ft') AND ('See Caltrans SWMP for definitions of non -storm water discharge: http://www.dot.ca.gov/hq/env/stormwater/index.htm ) 24. Howwill any storm water or ground water be disposed of from within or near the limits of this proposed project? Stam Drain System Q Combined Sewer / Storm System Storm Water Retention Basin Otfer(explain): N/A (gallons/month) PLEASE READTHEFOLLOWING CLAUSES PRIORTO SIGNINGTHIS ENCROACHMENT PEPWITAPPLICATiON. (acres) (acres) The applicant, understands and herein agrees to that an encroachment permit can be denied, and/or a bond regrtiiedfornon-paymentofpriororpresentencroachmentpermitfees. Encroachment Permit fees maystill be due when an application is withdrawn or denied, and that a denial may be appealed, in accordance with the California Streets and Highways Code, Section 671.5. All workshall be done in accordance with Caltrans rules anof regulations subject to inspection and approval. The applicant, understands andherein agrees to the generalprovisions, specialprovisions andconditions of the encroachmentpermit, and to indemnify and hold harmless the State, its officers, directors, agents, employees and each of them (Indemnitees) from and againstanyandall claims, demands, causes ofaction, damages, costs, exp erases, actual attorneys' fees, judgments, losses and liabilities of every kind and na ture whatsoever (Claims) arising out of orin connection with the issuance and/oruse of this encroachment permit and the placementand subsequent operation and maintenance of said encroachment for: 1) bodily injury and/or death to persons including but not limited to the Applicant, the State and its officers, directors, agents and employees, the Indemnities, and the public; and2) damage to propertyofanyone. Exceptas providedbylaw, the indemnification provislons statedabove shall apply regardless of the existence or degree offault of Indemnities. TheApplicant, however, shall not be obligated to indemnify Indemnities for Claims arising from the sole negligence and willful misconduct of State, its officers, directors, agents oremployees. DISCHARGES OFSTORM WATER AND NON -STORM WATER: Work within State Highway right-of-wayshall be conducted in compliance with all applicable requirements of the National Pollutant Discharge Elimination System (NPDES) permitissued to the Department of Transportation (Department), to govern the discharge ofstorm waterandnon-storm waterfrom its properties. Workshallalso be in compliance with all otherapplicable Federal, State andLocallaws and regulations; and with the Department's EncroachmentPermits Manual and encroachment permit. Compliance with the Departments NPDES permit requires amongst other things, the preparation and submission ofa Storm WaterPollution Protection Plan (SWPPP), ora Water Pollution Control Program (WPCP), and the approval of same by the appropriate reviewing authority prior to the stmt of any work. Information on the requirements may also be reviewed on the Department's Construction Website at: hgp.,I www dot ca gov/hq/construclstormwater/stormwaterl.htm 25. NAME of APPLICANT or ORGANIZATION (Print orType) I E -MAIL ADDRESS Costa Mesa Sanitary District ADDRESS of APPLICANT or ORGANIZATION WHERE PERMIT IS TO BE MAILED (Include City and Zip Code) 234 E. 17th Street, Suite 205, Costa Mesa, CA 92627 PHONE NUMBER FAX NUMBER (949) 631-1731 (949) 548-6516 26. NAME of AUTHORIZED AGENT/ ENGINEER (Print or Type) IS LETTER OF AUTHORIZATION ATTACHED? E-MAIL ADDRESS Robin B. Hamers m YES ❑ NO rbhinc@pacbell.net ADDRESS of AUTHORIZED AGENT / ENGINEER (Include City and Zip Code) 234 E. 17th Street, Suite 205, Costa Mesa, CA 92627 PHONE NUMBER FAXNUMBER (949) 631-17 1 (949) 548-6516 27. SIGNATUREofA I^ A I 'THORIZEDAGENT 28. PRINT OR TYPE NAME 297ITLE 30. Robin B. Hamers 0istrictEn9ineer "STATE OF CALIFORNIA -DEPARTMENT OFTRANSPORTATLON -- - — - _--.-' - raga of v - ' STANDARD ENCROACHMENT PERMIT APPLICATION a RralrN TR -0100 (REV. 0712007) ttcervycs rvumncFc.: FEE: CALCULATION FOR_CALTRANS USE ❑ CASH ❑ CREDITCARD NAME ON CARD PHONENUMBER ❑_CHECK NUMBER NAMEONCHECK PHONENUMBER DCEMPT ❑ PROJECT EA , _ _ _ _ _ ❑ DEFERRED BILLING (Utility) CALCULATED BY (1) (2) REVIEW 1. FEE / DEPOSIT DATE 2. FEE / DEPOSIT DATE TOTAL FEE / DEPOSIT 1. HOURS @ $. * $ $ a 2. HOURS @ $ $ $, INSPECTION 1. FEE / DEPOSIT DATE 2. FEE / DEPOSIT DATE TOTAL FEE / DEPOSIT 1. HOURS @ $ $ $ 2. HOURS @ $ $ $ FIELDWORK HOURS @ $ * $ $ $ DEPOSIT DATE DEPOSIT DATE DEPOSIT EQUIPMENT &MATERIALS CASH DEPOSIT IN LIEU OF BOND $ r $ $ TOTAL COLLECTED $ $ CASHIER`S INITIALS $ * The current hourly rate is set annually by Headquarters Accounting. District Office staff do not have authority to modify this rate. PERFORMANCEBOND DATE AMOUNT DATE PAYMENTSOND $AMOUNT LIABILITY INSURANCE REQUIRED? ❑ YES ❑ NO AMOUNT STATE OF CALIFORNIA, DEPARTMENT OF TRANSPORTATION ENCROACHMENT PERMIT GENERAL PROVISIONS TR -0045 (REV. 05/2007) 1. AUTHORITY: The Department's authority to issue encroachment permits is provided under, Div. 1, Chpt. 3, Art. 1, Sect. 660 to 734 of the Streets and Highways Code. 2. REVOCATION: Encroachment permits are revocable on five days 13. 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 or abrogation at any time. Permittees' joint use agreements, franchise rights, reserved rights or any other agreements for operating purposes in State highway right of way are exceptions to this revocation. 3. DENIAL FOR NONPAYMENT OF FEES: Failure to pay permit fees when due can result in rejection of future applications and denial of permits. 14. 4. ASSIGNMENT: No party other than the permittee or permittee's authorized agent is allowed to work under this permit. 5. ACCEPTANCE OF PROVISIONS: Permittee understands and agrees to accept these General Provisions and all attachments 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 permittee shall notify the Department's representative, two (2) days before the intent to start permitted work. Permittee 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 way shall conform to recognized construction standards and current Department Standard Specifications, Department Standard Plans High and Low Risk Facility Specifications, and Utility Special Provisions: Where reference is made to "Contractor and Engineer," these are amended to be read as "Permittee and Department representative." 8, PLAN CHANGES: Changes to plans, specifications, and permit provisions are not allowed without prior approval from the State representative. 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 Department. The local agency permittee shall not give final construction approval to its contractor until final acceptance. and approval by the Department is obtained. law, from the Public Utilities Commission of the State of California (PUC), California Occupational Safety and Health Administration (Cal -OSHA), or any other public agency having jurisdiction. PEDESTRIAN AND BICYCLIST SAFETY: A safe minimum passageway of 4' shall be maintained through the work area at existing pedestrian or bicycle facilities. At no time shall pedestrians be diverted onto a portion of the street used for vehicular traffic. At locations where safe alternate 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 crosswalk or intersection to detour pedestrians to facilities across the street. Attention is directed to Section 7-1.09 Public Safety of the Department Standard Specifications. PUBLIC TRAFFIC CONTROL: As required by law, the permittee shall provide traffic control protection warning signs, lights, safety devices, etc., and take all other measures necessary for traveling public's safety. While providing traffic control, the needs and control of all road users [motorists, bicyclists and pedestrians, including persons with disabilities in accordance with the Americans with Disabilities Act of 1990 (ADA)] shall be an essential part of the work activity. Day and night time lane closures shall comply with the California Manual on Uniform Traffic Control Devices (Part 6, Temporary Traffic Control), Standard Plans, and Standard Specifications for traffic control systems. These General Provisions are not intended to impose upon the permittee, by third parties, any duty or standard of care, greater than or different from, as required by law. 15. MINIMUM INTERFERENCE WITH TRAFFIC: Permittee shall plan and conduct work so as to create the least possible inconvenience to the traveling public; traffic shall not be unreasonably delayed. On conventional highways, permittee shall place properly attired flagger(s) to stop or warn the traveling public in compliance with the California Manual on Uniform Traffic Control Devices (Chapter 6E, Flagger Control). 16. 10. PERMIT AT WORKSITE: Permittee shall keep the permit package or a copy thereof, 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 17 be suspended. 11. CONFLICTING ENCROACHMENTS: Permittee shall yield start of work to ongoing, prior authorized, work adjacent to or within the limits of the project site. When existing encroachments conflict with new work, the permittee shall bear all cost for rearrangements, (e.g., relocation, alteration, removal, etc.). 12. PERMITS FROM OTHER AGENCIES: This permit is invalidated if the permittee has not obtained all permits necessary and required by STORAGE OF EQUIPMENT AND MATERIALS: The storage of equipment or materials is not allowed within State highway right-of- way, unless specified within the Special Provisions of this specific encroachment permit. If Encroachment Permit Special Provisions allow for the storage of equipment or materials within the State right of way, the equipment and material storage shall comply with Standard Specifications, Standard Plans, Special Provisions, and the Highway Design Manual. The clear recovery zone widths must be followed and are the minimum desirable for the type of facility indicated below: freeways and expressways - 30', conventional highways (no curbs) - 20', conventional highways (with curbs) — 1.5'. If a fixed object cannot be eliminated, moved outside the clear recovery zone, or modified to be made yielding, it should be shielded by a guardrail or a crash cushion. CARE OF DRAINAGE: Permittee shall provide alternate drainage for any work interfering with an existing drainage facility in compliance with the Standard Specifications, Standard Plans and/or as directed by the Department's representative. 18. RESTORATION AND REPAIRS IN RIGHT OF WAY: Permittee is responsible for restoration and repair of State highway right of way resulting from permitted work (State Streets and Highways Code, Sections 670 et. seq.). 19. RIGHT OF WAY CLEAN UP: Upon completion of work, permittee shall remove and dispose of all scraps, brush, timber, materials, etc. off the right of way. The aesthetics of.the highway shall be as it was before work started. 20. COST OF WORK: Unless stated in the permit, or a separate written agreement, the permittee shall bear all costs incurred for work within the State right of way and waives all claims for indemnification or contribution from the State. 21. ACTUAL COST BILLING: When specified_ in the permit, the Department will bill the permittee actual costs at the currently set hourly rate for encroachment permits. 22 AS -BUILT PLANS: When required, permittee shall submit one (1) set of folded as -built plans within thirty (30) days after completion 25. and approval of work in compliance with requirements listed as follows: 23 24. 1. Upon completion of the work provided herein, the permittee shall send one vellum or paper set of As -Built plans, to the State representative. Mylar or paper sepia plans are not acceptable. 2. All changes in the work will be shown on the plans, as issued with the permit, including changes approved by Encroachment Permit Rider. 3. The plans are to be stamped or otherwise noted AS -BUILT by the permittee's representative who was responsible for overseeing the work. Any original plan that was approved with a State stamp, or Caltrans representative signature, shall be used for producing the As -Built plans. 4. If As -Built plans include signing or striping, the dates 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 construction on separate sheets, the sheet for each stage shall show the removal, relocation or installation dates of the appropriate staged striping and signing. 5. As -Built plans shall contain the Permit Number, County, Route, and Post Mile on each sheet. 6. Disclaimer statement of any kind that differ from the obligations and protections provided by Sections 6735 through 6735.6 of the California Business and Professions Code, shall not be included on the As -Built plans. Such statements constitute non-compliance . with Encroachment Permit requirements, and may result in the Department of Transportation retaining Performance Bonds or deposits until proper plans are submitted. Failure to comply may also result in denial of future permits, or a provision requiring a public agency to supply additional bonding. PERMITS FOR RECORD PURPOSES ONLY: When work in the right of way is within an area under a Joint Use Agreement (JUA) or a Consent to Common Use Agreement (CCUA), a fee exempt permit is issued to the permittee for the purpose of providing a notice and record of work. The Permittee's prior rights shall be preserved without the intention of creating new or different rights or obligations. "Notice and Record Purposes Only" shall be stamped across the face of the permit. BONDING: The permittee shall file bond(s), in advance, in the amount set by the Department. Failure to maintain bond(s) in full force and effect will result in the Department stopping of all work and revoking permit(s). Bonds are not required of public corporations or privately owned utilities, unless permittee failed to comply with the provision and conditions under a prior permit. The surety company is responsible for any latent defects as provided in California Code of Civil Procedures, Section 337.15. Local agency permittee shall comply with requirements established as follows: In recognition that 26. 27 K.1 project construction work done on State property will not be directly funded and paid by State, for the purpose of protecting stop notice claimants and the interests of State relative to successful project completion, the local agency permittee agrees to require the construction contractor furnish both a payment and performance bond in the local agency's name with both bonds complying with the requirements set forth in Section 3-1.02 of State's current Standard Specifications before performing any project construction work. The local agency permittee shall defend, indemnify, and hold harmless the State, its officers and employees from all project construction related claims by contractors and all stop notice or mechanic'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. FUTURE MOVING OF INSTALLATIONS: Permittee understands and agrees to relocate a permitted installation upon notice by the Department. Unless under prior property right or agreement, the permittee shall comply with said notice at his sole expense. ARCHAEOLOGICAL/HISTORICAL: If any archaeological or historical resources are revealed in the work vicinity, the permittee shall immediately stop work, notify the Department's representative, retain a qualified archaeologist who shall evaluate the site; and make recommendations to the Department representative regarding the continuance of work. . PREVAILING WAGES: Work performed by or under a permit may require permittee's contractors and subcontractors to pay appropriate prevailing wages as 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 Golden Gate Avenue, San Francisco, California 94102. RESPONSIBILITY FOR DAMAGE: The State of California and all officers and employees thereof, including but not limited to the Director of Transportation and the Deputy Director, shall not be answerable or accountable in any manner for injury to or death of any person, including but not limited to the permittee, persons employed by the permittee, persons acting in behalf of the permittee, or for damage to property from any cause. The permittee shall be responsible for any liability imposed by law and for injuries to or death of any person, including but not limited to the permittee, persons employed by the permittee, persons acting in behalf of the permittee, or for damage to property arising out of work, or other activity permitted and done by the permittee under a permit, or arising out of the failure on the permittee's part to perform his obligations under any permit 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 contemplated by the permit. The .permittee shall indemnify and save harmless the State of California, all officers, employees, and State's contractors, thereof, including but not limited to the Director of Transportation and the Deputy Director, from all claims, suits or actions of every name, kind and description brought for or on account of injuries to or death of any person, including but not limited to the permittee, persons employed by the permittee, persons acting in behalf of the permittee and the public, or damage to property resulting from the performance of work or other activity under the permit, or arising out of the failure on the permittee's part to perform his obligations under any permit 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 contemplated by the permit, except as otherwise provided by statute. The duty of thepermittee to indemnify and save harmless includes the duties to defend as set forth in Section 2778 of the Civil Code. The permittee waives any and all rights to any type of expressed or implied indemnity against the State, its officers, employees, and State contractors. It is the intent of the parties that the permittee will indemnify and hold harmless the State, its officers, employees, and State's contractors, from any and all claims, suits or actions as set forth above regardless of the existence or degree of fault or negligence, whether active or passive, primary or secondary, on the part of the State, the permittee, persons employed by the permittee, or acting on behalf of the permittee. For the purpose of this section, "State's contractors" shall include contractors and their subcontractors under contract to the State of California performing work within the limits of this permit. 29. • NO PRECEDENT ESTABLISHED: This permit is issued with the understanding that it does not establish a precedent. 30. FEDERAL CIVIL RIGHTS 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 covenant and agree that: 1. No person on the grounds of race, color, or national origin shall be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination in the use of said facilities. 2. That in connection with the construction of any improvements on said lands and the furnishings of services thereon, no discrimination shall be practiced in the selection and retention of first-tier subcontractors in the selection of second-tier subcontractors. 3. That such discrimination shall not be practiced against the public in their access to and use of the facilities and services provided for public accommodations (such as eating, sleeping, rest, recreation), and operation on, over, or under the space of the right of way. 4. That the permittee shall use the premises in compliance with all other requirements imposed pursuant to Title 15, Code of Federal Regulations, Commerce and Foreign Trade, 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 the event 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 thereon, and hold the same as if said permit had never been made or issued. 31. MAINTENANCE OF HIGHWAYS: The permittee agrees, by acceptance of a permit, to properly maintain any encroachment. This assurance requires the permittee to provide inspection and repair any damage, at permittee's expense, to State facilities resulting from the encroachment. 32. SPECIAL EVENTS: In accordance with subdivision (a) of Streets and Highways Code Section 682.5, the Department of Transportation shall not be responsible for the conduct or operation of the permitted activity, and the applicant agrees to defend, indemnify, and hold harmless the State and the city or county against any and all claims arising out of any activity for which the permit is issued. The permittee understands and agrees to comply with the obligations of Titles II and III of the Americans with Disabilities Act of 1990 in the conduct of the event, and further agrees to indemnify and save harmless the State of California, all officers and employees thereof, including but not limited to the Director of Transportation, from any claims or liability arising out of or 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 State. The gifting of public property use and therefore public funds is prohibited under the California Constitution, Article 16. 34. FIELD WORK REIMBURSEMENT: Permittee shall reimburse State for field work performed on permittee's behalf to correct or remedy hazards or damaged facilities, or clear debris not attended to by the permittee. 35. NOTIFICATION OF DEPARTMENT AND TMC: The permittee shall notify the Department's representative and the Transportation Management Center (TMC) at least 7 days before initiating a lane . closure or conducting an activity that may cause a traffic impact. A confirmation notification should occur 3 days before closure or other potential traffic impacts. In emergency situations when the corrective work or the emergency itself may affect traffic, TMC and the Department's representative shall be notified as soon as possible. 36. SUSPENSION OF TRAFFIC CONTROL OPERATION: The permittee, upon notification by the Department's representative, shall immediately suspend all lane closure operations and any operation that impedes the flow of traffic. All costs associated with .this suspension shall be borne by the permittee. 37. UNDERGROUND SERVICE ALERT (USA) NOTIFICATION: Any excavation requires compliance with the provisions of - Government. Code Section 4216 et. seq., including, but not limited to notice to a regional notification center, such as Underground Service Alert (USA). The permittee shall provide notification at least 48 hours before performing any excavation work within the right of way. STATE OF CALIFORNIA - DEPARTMENT OF TRANSPORTATION ENCROACHMENT PERMIT UTILITY MAINTENANCE PROVISIONS TR -0161 (Rev. 05/2006) Any public utility or public corporation who lawfully maintains a utility 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 govern. UMI. 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 must be shown to any Departmental representative or any law enforcement officer on demand. WORK SHALL BE SUSPENDED IF PERMIT IS NOT AT WORK SITE AS REQUIRED. UM3. NOTICE REQUIRED: The permittee 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. UM4. STANDARD OF WORK: All work shall conform to recognized standards of utility construction and the Department's current Standard Specifications. UM5. 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 interruption of essential service. In such cases, the Department's representative shall be notified immediately. UM6. 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„). UM7. 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 "UM8-4" regarding service connections for aerial wires. UM8. ROUTINE INSPECTION AND MAINTENANCE: I. Routine Maintenance and Inspection: 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 permittee may open existing manholes to repair underground cables. Where the manhole lies within the improved surface of the highway, the permittee will provide adequate protection 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 areas or closer than 10' to the edge of the pavement without a special permit; and B. Not uncover more than 50' of line at any one time. 4. Pole Lines: Permittee is authorized to: A. Stub, or reset existing pole, provided no change in location of pole or anchor is made. Stubs and anchors must not 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 maintenance provision. C. Replace broken pins and/or insulators, 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. F. Replace aerial wires and crossarms on existing poles except where wires cross the highway. Unless otherwise specifically required by the Department, 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 section (F) does not appty to scenic highways. 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 "OH 2" of the Overhead Utility Provisions. H. Clear grass from around base of poles 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 encroachment 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 02/2008) 1. GENERAL: The Permittee shall comply with the following Special Provisions and the direction of the State Representative: 2. NPDES REQUIREMENTS: The Permittee shall be responsible for full compliance with the Caltrans Storm Water Program and the Caltrans NPDES Permit requirements. For additional information, visit the State Water Resources Control Boards Stormwater Website at http://www.swrcb.ca.gov/stormwtr/index.html 3. RESPONSIBILITY FOR DEBRIS REMOVAL: The Permittee shall be responsible for preventing all dirt, trash, debris, and other construction waste from entering storm drains, local creeks, or any other bodies. of water. 4. SPOILS AND RESIDUE: The Permittee shall vacuum or sweep any saw -cut spoils, debris, residue, etc. No spoils, debris, residue, etc. shall be washed into a drainage system. 5. SWEEPING: Roadways and other paved areas shall be swept daily. Roadways or work areas shall not be washed down with water. 6. VEHICLES AND EQUIPMENT: Permittee shall prevent all vehicles, equipment, etc. from leakage or mud tracking onto roadways. 7. MAINTENANCE AND FUELING OF VEHICLES AND EQUIPMENT: Maintenance and fueling of equipment shall not result in any pollution at the job site. The Permittee shall immediately clean up spills, and properly dispose of contaminated soil and materials. 8. CLEANING VEHICLES AND EQUIPMENT: The Permittee shall clean all equipment within a bermed area or over a drip pan large enough to prevent run-off. No 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 site. 9. DIESEL FUELS: The use of diesel fuel as a form -oil or solvent is not allowed. 10. WEATHER CONDITIONS. AT WORKSITE: Any activity that would generate fine particles or dust that could be transported off site by stormwater shall be performed during dry weather. 11. HOT MIX ASPHALT: Runoff from washing hot mix asphalt shall not enter into any drainage conveyances. 12. PROTECTION OF DRAINAGE FACILITIES: The Permittee shall protect/cover gutters, ditches, drainage courses, and inlets with gravel bags, fiber rolls, etc., to the satisfaction of the State representative during grading, paving, saw -cutting, etc. No such protection measures shall cause an obstruction to the traveling public. 13. PAINT: Rinsing of painting equipment and materials is not permitted in state right-of-way. Oil based paint sludge and unusable thinner shall be disposed of at an approved hazardous waste site. Page 1 of 1 14. CONSTRUCTION MATERIALS: All construction materials, including concrete, grout, cement containing premixes, and mortar, shall be stored under cover and separated away from drainage areas. Stored materials shall not reach a storm drain. 15. CONCRETE EQUIPMENT: Concrete equipment shall be washed in a designated washing area that prevents effluent from discharging to drainage conveyances. 16. EXISTING VEGETATION: Established existing vegetation is the best form of erosion control. Disturbance to existing vegetation shall be minimized whenever possible. Damaged or removed vegetation shall be replaced as directed by the State Representative. 17. SOIL DISTURBANCE: Soil disturbing activities shall be avoided during the rainy season. If construction activities during wet weather are allowed in your permit, all necessary erosion control -and soil stabilization measures shall be implemented. 18. SLOPE STABILIZATION AND SEDIMENT CONTROL: In cases. where slopes are disturbed during construction, soil shall be secured with soil stabilization and sediment control measures. Fiber rolls or silt fences may be required downslope until permanent soil stabilization is established. 19. STOCKPILES: Sand, dirt, and similar materials shall be stored at least 50 feet from drainage features and shall be covered and protected with a temporary perimeter sediment barrier. 20. DISCOVERY OF CONTAMINATION: The State Representative shall be notified in case 'any unusual discoloration, odor, or texture of ground water, is found in excavated material or if abandoned, underground tanks, pipes, or buried debris are encountered. 21. DEWATERING: All dewatering operations shall comply with the latest Caltrans guidelines. Any effluent discharged into any storm water system requires approval from the Regional Water .Quality Control Board. The Permittee shall provide the State Representative with a copy of the Waste. Discharge Permit and a copy of a valid WDID number issued by the Regional Board.