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Encroachment - Caltrans - 2013-03-20Print Permit STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION ENCROACHMENT PERMIT TR -0120 (REV. 6/2012) In compliance with: ® Your application of March 20, 2013 ❑ Utility Notice No. ❑ Agreement No. ❑ R/W Contract No. of of of Page 1 of 1 °ermit No. 12 -13 -N -US -0138 )ist/Co/Rte/PM 12 -ORA -55 PM 2.021 We 03/29/2013 �ee Paid �eposit, EXEMPT EXEMPT 0.00 and Number (1) TO: Costa Mesa Sanitary District 625 W. 19th St. Costa Mesa, CA 92627-2716 Attn: Greg Santone 949-645-8400 PERMITTEE and subject to the following, PERMISSION IS HEREBY GRANTED to: 0.00 Number TO PERFORMING MULTIPLE LANE CLOSURE PER ATTACHED PLANS FOR SANITARY DISTRICT TO RAISE TWO MANHOLES TO GRADE, ON SR -55 AND 19TH ST.. All performed work shall be in accordance with current Caltrans Standard Specifications and Standard Plans, Section 600 (Utility Permits) of the Encroachment Permits Manual, California MUTCD latest edition, the attached Provisions and Permit Plans stamp -dated MARCH 19, 2013. Permittee shall contact State Permit Inspector Hossein Shakeri at 949-756-7648 between 7 AM and 9 AN a minimum of two working days prior to the start of work 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. i ne roiiowing arracnmenrs are also mciuuea as parr or oris permn (L necK apprncaore): ® 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 _June 1, 2013 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. COPIES TO: Maintenance H. Shakeri File:13-0138 Chamberlain, District Director SAIED HASHEMI , P.E., District Permit http://onramp/epermitibin/print_Permit.php?id=158704 3/29/2013 PAGE'1 OF 2: ATTACHED TO AND MADE PART OF PERMIT NO. 12 -13 -N -US -0138 In addition to the attached General Provisions (TR -0045), the following Special Provisions are applicable: • Notwithstanding General Provision #4, 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. 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." Orange vests and hard hats shall be worn at all times while working within State right-of-way. By acceptance of this permit, the permittee understands and agrees to reimburse the State for all costs incurred for performing corrective work in the event that the permittee or permittee's representatives fail to install, replace, repair, restore, or remove facilities to state specifications for the immediate safe operation of the highway and satisfactory completion of all permit work. State forces may perform corrective work or it may be contracted out. Understood is that the above charges are in addition to permit fees, and an invoice will be sent to permittee for said charges after satisfactory completion of all work. The issuance of the permit shall not set as precedence for other permits approved in the future. • It is the responsibility of the permittee, permittee's agents, or,contractors to comply with all provisions of this permit and instructions from the State permit inspector. Permittee shall keep the permit package or copies thereof, at the work site at all times and show it upon request to any Department representative or law enforcement officer. When the permit package is not available, then immediate suspension of permit will occur. • 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 mutcd2012.htm • Contractor shall comply with Department 2010 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.gov/hq/esc/oe/proiect_plans/HTM/stdpins-US-customary-units-neWlO.htm • Permittee shall furnish the necessary inspection to provide for public safety and to insure that all work within or affecting the State's right of way pursuant to this permit is in accordance with State Standards and requirements. The State permit inspectors will monitor the work authorized under this permit and the work is subject to the approval of the State permit inspectors. • Permittee shall remain solely responsible for compliance with all requirements of this permit. • Prior to performing any work pursuant to this permit, the permittee shall obtain all necessary permits and authorizations required of other governmental agencies and by law. The permittee shall make the necessary arrangements with the appropriate agencies to monitor and test performed work to ensure accordance with requirements of those agencies. • American National Standards Institute (ANSI) compliant Class II vests and hard hats shall be worn while working within State's. right-of-way. Workers working at night will be required to wear ANSI Class III warning garments. Class III compliance can be achieved by combining ANSI Class E pants worn with an ANSI Class II vest. • Permittee's contractor shall submit a written schedule to the State permit inspector for review and approval prior to the beginning of the work. Continued on Page 2 PAGE 2 OF 2: ATTACHED TO AND MADE PART OF PERMIT NO. 12-13- N -US -0138 • The State permit inspector must ascertain and agree to all work details and all aspects of traffic control or no work shall begin on this permit. • If a safe passage way cannot 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. • 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. • Personal vehicles of the Contractor's employees shall not be parked on paved shoulders or traveled way within the limits of this work. • If a time extension for this permit is required, request one 30 days in advance of the expiration date. Permit closure occurs after the expiration date, once this occurs reactivation will not occur. It will be the responsibility of the permittee to reapply by submitting an application and plans, if the need for a permit is still present. • Unless otherwise approved by the State Permit Inspector all work that interferes with public traffic shall be performed night time between 11:00pm to 5:00am only. • The full width of traveled way shall be open for use by public traffic on Saturdays, and designated legal holidays, after 3:00 PM on Fridays and on the day preceding designated legal holidays, and when construction operations are not actively in progress. • Except as specifically provided herein, all requirements of the Vehicle Code and other applicable laws must be complied with in all particulars. • 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. • Should any deviation from these procedures or conditions be observed, all work shall be suspended until satisfactory steps have been taken to ensure compliance. • In the event of any discrepancy between Permittee's Permit Plans and these Permit Special Provisions, these Special Provisions shall prevail. • 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 Specification Section 81 'monuments' and Standard Plan A74, Type D, or equal with prior approval of the District Surveys Engineer." "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 Engineer.' • All open excavations within State right of way shall either be back-filled by the end of the day, or otherwise secured to protect the public. Trenching, backfilling, and paving operations shall comply with current Caltrans Standard Specifications. AS -BUILT PLANS, ARE REQUIRED UPON COMPLETION OF ALL WORK. PLEASE REFER TO THE GENERAL PROVISION TR -0045, ITEM 22 FOR THE "AS -BUILT REQUIREMENTS. NO FINAL INSPECTION WILL BE PERFORMED UNTIL THE DEPARTMENT IS IN RECEIPT OF AS -BUILT PLANS. • 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. STATE OF CALIFORNIA- DEPARTMENT OF TRANSPORTATION STANDARD ENCROACHMENT PERMIT APPLICATION TR -0100 (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]) This application is not complete until all requirements have been approved. =10'a1 3 8 FOR CALTRANS USE PERMIT NO. 12 —13 — 0 UL — 0 138 DIST/CO/RTE/PM ,Z-yAA-55-Z SIMPLEX STAMP 1. COUNTY 2. ROUTE Orange 13.POSTMILE 55 2. p?— I ® 4. ADDRESS OR STREET NAME 6. CITY r 7fI13 nR R 20 AM 1 SR 55 (Newport Blvd.) Costa Mesa 6. CROSS STREET (Distance and direction from site) 7. PORTION OF RIGHT-OF-WAY DATE OF SIMPLEX STAMP 19th St. #4 & 5 S/B & #3 & 4 N/B 8. WORK TO BE PERFORMED BY 9. EST. START DATE 10. EST. COMPLETION DATE ❑ OWN FORCES ® CONTRACTOR 4/10/13 ® 5/10/13 11. MAX. DEPTH AVG. DEPTH AVG. WIDTH LENGTH SURFACE TYPE EXCAVATION I N/A 12. EST. COST IN STATE HIGHWAY RIGHT-OF-WAY FUNDING SOURCE(S) 10,000.00 ❑FEDERAL ❑STATE ❑ LOCAL ® PRIVATE 13. PRODUCT TYPE DIAMETER VOLTAGE / PSIG 14. CALTRANS PROJECT E.A. NUMBER PIPES 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. Close multiple lanes per attached plans for Costa Mesa Sanitary District to raise two manholes to grade. 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 ❑ 0 NO (If "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 m 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 ® NO (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 i] NO (If "YES", provide a description) 21. Is work being done on applicant's property? ❑ YES © 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, 1120 N Street, MS -89, Sacramento, CA 95814 ,DZj j01 STATEOF CALIFORNIA- DEPARTMENT OF TRANSPORTATION STANDARD EIdCROACHIVIENT I'ERi1iIT APPLICATION Page 2 of 4 T NO. PERMI TR -0100 (REV. 07/2007) ,2 —13— iJ O ` _ p i 3 5 22. Will this proposed project require the disturbance of soil? ❑ YES Z NO If "YES", estimate the area within State Highway right-of-way in square feet AND acres: (ft2) AND (acres) estimate the area outside of State Highway right-of-way in square feet AND acres: (ft2) AND (acres) 23. Will this proposed project require dewatering? E] YES ® NO If "YES', estimate total gallons AND gallons/month. (gallons)AND (gallons/month) SOURCE': [_]STORMWATER []NON -STORM WATER ('See Caltrans SWMP for definitions of non -storm water discharge: http://www.dot.ca.gov/hq/env/stormwater/index.htm ) 24. How will any storm water or ground water be disposed of from within or near the limits of this proposed project? ® Storm Drain System M Other(explain): Combined Sewer / Storm System [:] Storm Water Retention Basin PLEASEREAD THEFOLLOWING CLAUSES PRIORTO SIGNING THIS ENCROACHMENTPERMITAPPLICATION. The applicant, understands and herein agrees to that an encroachment permit can be denied, and/or a bond required fornon-payment ofpriororpresent encroachmentpermit fees. EncroachmentPermitfeesmaystil/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 work shall be done in accordance with Caltrans rules and regulations subject to inspection and approval. The applicant, understands and herein agrees to the generalprovisions, special provisions and conditions ofthe encroachment permit, and to indemnifyand hold harmless the State, its officers, directors, agents, employees and each of them (Indemnitees) from and againstanyand all claims, demands, causes ofaction, damages, costs, expenses, actual attorneys'fees, judgments, losses and liabilities of every kindandnature whatsoever (Claims) arising out of orin connection with the issuance and/or use of this encroachmentpermitand 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; and 2) damage to propertyofanyone. Exceptas provided bylaw, the indemnification provisions stated above shall applyregardless of the existence or degree of fault of Indemnities. The Applicant, however, shall notbe obligated to indemnifylndemnities forClaims arising from the sole negligence and willful misconduct ofState, its officers, directors, agents oremployees. DISCHARGES OF STORM WATER AND NON -STORM WATER: Work within State Highwayright-of-wayshal/be conducted in compliance with all applicable requirements of the National Pollutant Discharge Elimination System (NPDES) perrnitissued to the Departmentof Transportation (Department), to govern the discharge ofstorm waterand non -storm waterfrom its properties. Workshall also be in compliance with all otherapplicable Federal, State and Local laws 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 WaterPo/lution Protection Plan (SWPPP), ora WaterPollution Control Program (WPCP), and the approval of same by the appropriate reviewing authority prior to the start of any work. Information on the requirements mayalso be reviewed on the Department's Construction Website at: http.,#www. dot. ca. govlhq/construc/stormwater/stormwaterl.htin 25. NAME of APPLICANT or ORGANIZATION (Print orType) E-MAILADDRESS Costa Mesa Sanitary District I scano@crosdca.gov ADDRESS of APPLICANT or ORGANIZATION WHERE PERMIT IS TO BE MAILED (Include City and Zip Code) 628 W. 19th St. Costa Mesa, CA 92627-2716 PHONE NUMBER FAXNUMBER 949-645-8400 1949-650-2253 26. NAME of AUTHORIZED AGENT/ ENGINEER (Print or Type) IS LETTER OF AUTHORIZATION ATTACHED? E-MAIL ADDRESS Greg Santone 1 m YES ❑ No greg.santone@gmail.com ADDRESS of AUTHORIZED AGENT/ ENGINEER (Include City and Zip Code) 2602 S. Halladay St. Santa Ana, CA 92705 PHONE NUMBER FAXNUMBER 714-719-1242 714-352-8303 27.SIGNATU5ofAPPLICANTorAU ORIZEDAGENT 28. PRINTOR TYPE NAME 29.TITLE 30. DATE Greg Santone Agent 3/20/13 13 STATE OF CALIFORNIA -DEPARTMENTOFTRANSPORTATION STANDARD ENCROACHMENT PERMIT APPLICATION TR -0100 (REV. 07/2007) Page 3 of 4 k -Z-13- NUL-0 ORDER/REFERENCE NUMBER FEE CALCULATION -- FOR CALTRANS USE ❑ CASH ❑ CREDITCARD NAME ON CARD ❑ CHECK NUMBER NAMEONCHECK ❑ EXEMPT ❑ PROJECT EA _ _ _ _ PHONE NUMBER PHONENUMBER _ _ ❑ DEFERRED BILLING (Utility) CALCULATED BY (1) (2) REVIEW 1. HOURS @ $ 2. HOURS @ $ 1. FEE / DEPOSIT $ DATE 2. FEE / DEPOSIT $ DATE TOTAL FEE / DEPOSIT $ $ INSPECTION 1. HOURS @ $ 2. HOURS @ $ 1. FEE/ DEPOSIT $ DATE 2. FEE / DEPOSIT $ DATE TOTAL FEE / DEPOSIT $ $ FIELDWORK HOURS @ $ $ $ $ EQUIPMENT & MATERIALS DEPOSIT DATE DEPOSIT DATE DEPOSIT CASH DEPOSITIN LIEU OF BOND $ $ $ 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 PAYMENTBOND F-1 DATE AMOUNT LIABILITY INSURANCE REQUIRED? YES ❑ NO AMOUNT STATE OF CALIFORNIA -DEPARTMENT OFTRANSPORTATION STANDARD ENCROACHMENT PERMIT APPLICATION TR -0100 (REV. 07/2007) INSTRUCTIONS for completing page 4 Page 4 of 4 SIT NO. L 2 - 13 -NOL -0130 This page needs to be completed when the proposed project DOES NOT involve a City, County or other public agency. Your answers to these questions will assist departmental staff in identifying any physical, biological, social oreconomic resources that may be affected byyour proposed project Wthin the State highway right-of-way. And, to determine which type of environmental studies maybe requiredto approveyourapplication for an encroachment permit. It is the applicant's responsibility forthe production of all required environmental documentation and supporting studies, insome cases this may be costly and time-consuming. If possible, attach photographs of the location of the proposed project. Please answer these questions to the best of your ability. Provide a description of any "YES" answers (type, name, number, etc.) 1. Will any existing vegetation and/or landscaping within the highway right-of-way be disturbed? no 2. Are there waterways (e.g. river, creek, pond, natural pool or dry streambed) adjacent to or within the limits of the project or highway right-of-way? no 3. Is the proposed project located within five miles of the coast line? yes 4. Will the proposed project generate construction noise levels greater than 86 dBA (e.g. jack -hammering, pile driving)? yes S. Will the proposed project incorporate land from a public park, recreation area or wildlife refuge open to the public? no 6. Are there any recreational trails or paths within the limits of the proposed project or highway right-of-way? no 7. Will the proposed project impact any structures, buildings, rail lines, or bridges within highway right-of-way? no 8. Will the proposed project impact access to any businesses or residences? Am 9. Will the proposed project impact any existing public utilities or public services? no 10. Will the proposed project impact existing pedestrian facilities, such as sidewalks, crosswalks, or overcrossings? no 11. Will new lighting be constructed within or adjacent to highway right-of-way? no