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ENC2009-00009_IHN-~l-~U09ilJECJ} 1S,~U F~ ul~~,,'uoa ~; i ' r{yf~f1tP~r~rfYl~" fy~ CITY OF CAMPBELL ENCROACHMENT PERMIT ~ PermitN~"'~C.+,?f~~ - ~®'~.q DEPT.OF PU8L1C WORKS (for working within the public ~~ ~~ X-Ref. File 7o North First Street ri ht-of-way) Application 17ate ~~^~ a ~,,_ Campbell, CA 95008 ~ -~ -, G' Application Expiratlon Date 1 Ph, {408) 866-2150 Issued ~ --^ ~ APN ~q '~ ~+-~ 15 Permit Expiratlon Date - 2. APPLICATION - Application is hereby made for a Public Works Permit in accordance with [ampbell Municipal Cade, $e{cion 71,04. (A~~~sl~~~ (b) months if the permit Is not Issued. Application Fee is non-refundable) 1~ \VN/ A, Wprk Addressor Tract No.: 466 SALMAR TERRACE ~ ,a..~ ~~ Utility Trench Location: SALMAR AVE, 280' EAST OF HARRISQN AV PUBLfC ./Aphlf4l~~~W-~lO~e B. Natu[e pf Wprk: RETIRE WAT1:R SERVICE (Abandoned service, not an our maps) C. Attach four (4) copies of an engineered plan showing the location and extent of the work, and four (4) copies of the preliminary Engineer's Estimate of work. The plans shall show the relation of the proposed work to existing surface and underground Improvements, When approved by the Gty Engineer, Bald plan becomes a part of this permit. D. All work shall conform to the City of Campbell Standard Speclficatlons and Octalls far Public works Construction; the General Permit Conditions ILted en the reverse side; and the Special Provisions for this permit, listed below. Failure to abide by these renditions and provisions may result In Job shutdown and/or forfeiture of.Falthful Perfprmance Sureties and cash deposits. (See General Permit [ondltions 7 and 2,) C. ThrContractormusthavethispermltandapprovedpiansattheslteandmustnotifythePublicworkspepartmentatleasttwodaysbefore starting work. Notite must be given to Public Worics at least 24 hours before resrarcing any work, Name of Applicant: 5AN JOSE WATER COMPANY 'Telephone: 40$ 279-7$3p Address: 1265 5. BA5COM AVE., 5AN 105<:, CA. 9512$ E-Mall Address: nfck_bernhardt@sjwater.com (24•WgUR EMERGENCY PHONE NUMBER: 408 279 7900 Is this work being done by the property owners at their own residence. i YES ri NO The AppllcandPcrmltteeliereby agrees by affixing ihelr dgnature to this permit to hold the City of Campbell, its officers, agents, and employees free, safe and harn7less from any claim or demand far damages resulting from the work Covered by this permit. The ApplirantlPermittee hereby acknowledges that they have read and understand both the front and back of this permit, and they wail inform their contractor(s) of the information. Applicant Is advised that upon issuance of this permit, property owner, or property owner's successors, shag be responsible for any and all damages arising out of the condition of any prlvate~prprovemencs in the public right-pf-way. Accepted: /~ ~ ~ /~~~i~~r.J~i trt~ {Applicant Permlttee) (sjefn) pate ( ntractor) (Print Name} Oate SPECIAL PRQU)$IQ(V$; 1. Street shalt not be open tut for underground installations. Minimum cutsrrjay be allowed far Connections or explpration holes. Such cuts Gpay_b~: ;neclfically ap12t•.Cy,~d•by.3~e.ln~pectvr prior to cutting. 2. Pavement may be cut for underground installations and must be restored In accordance with the Standard Details Trench Restoration Method "A",unless otherwise approved by the Engineer. _3. work rp be staked by a licensed Land Surveyor or CIvl1 Cnglneer and two (2) copies of the cut sheets sent to the Public Works Department b~f6rc starting wprk, 4. Per Section 4215 ofthe Government Code this permit is not valid for excavations until Underground Service Alert (USA) has been notified and the inquiry Identlflcatlon number has been entered hereon. USA Phone: 1-80i7-2:7-2600. USA TICKCI' NO, S. Prior to any work, the properly owner shall execute an Agreement for Private Improvements In the Public Rigltt-of•Way, which shall be recorded. _6. Public NotificationRequlrements: ___ _ 7. $~~PJ.llil.l_C~~lORKS FEE SCHEDULE FOR CURRENT FOES AMpUNT _ PCRMITAPPLICATION FEE $ ~8S PLAN CHECK DEPOSIT 5 SECURITY FOR FAITHFUL PCRFORMANCf/(ABOR & MATERIALS ; CONSTRUCTION CASH DEP051T S PLAN CWFCK& INSPECTIpN FEE $ 7 ~~n.. . APPROVED FOR 155UANC[ ~: "- RECEIPT. 2Z/~ Permit Expire512 Mpnths After Date 0(ISSU8nCe ~, ~ - --- -- ;~ ~ ~ . -- --- ~ - --- --- --- - ~,9i~~ r,s Q.~ -- --- --- A V E - -- -- --ti ~ ~ ! ~. ~ ~ ~+-'_ _ Gtr ~ tai w _ -- - ~. ~ ~ I ~ -_ -- i W ~I N CJ v ~ ~ IN j -.~ ~ s tV ~ ~ I Q a ~ ~ < ! °' ~ ~ ~' `;' ns ~ ~ ~ ~ ~ a i ~ ' ''~ H Y b I ~ , , ~ ~ j ~ ~ j v ; ~ i ; , ~ ... ~ j ~ ! "E-oos ,~ , - ;~ _ -34 E i ~ ,I i PAR-~{ D R P ~ E)__'_~- __ _ -R. ____-~ 0 00 ~ ao 301285-'! -39'S ~ ~ ~.~.~, ~ ~~ ~~~ ACA OwD , U~ NON ~ do ~ ~ ~~ 3 -'~ N ~ I C ~ ~ w~~- ~ ~ C~ ;_._ 343481 -1-6 'W ~ i~ ii o ~ rn - _ -I ~ ~~~ 7 °° d ~''- - 343482-'!-4~'W s '~ ..~ c< ~ I W ~ ~ ~ r' 3434$3-1-2~'W ~ ~~ cp i tD o w ~ !~ ao ~ ~ ~ ~ o ~ ,V t~ J ~~ ~ - ___. _" I~ ~ I ~ ~/ O i ~ ~ to ~ ~ ~ G~ 2 ~ i ~ ~ --244' E ~~_~ ~ -~7-~- --c''--~~34~ 84-1-29'E ,_.~..r ~~~ ~ ~'i ~, ~,, a ~, -475 ~ w w I ~ -t~-,a,-_ ._.~ ~ y q ~i ~ .--, o ~ w w ~ an w .. Iw Iw w i y i 3~4_5~~5-1-4 'E ~' i G ~'' ~ _~ ~, ~. ~~ ~ ~ ~ ~~ i~ I~ ~ ` 3 ~6-1 ~7 ' E o ~ ~ o - _~t ~ ~ ~ ~ ~ ~ --~_~. ~ ~ - ~ ~ -y ~~ ~j 25 ~ `mow ~ m ~ ~. N ~ I.,, ! .rte I ~ 3 3487-1-9~4'E~ -- ; ~ L Cn C!i ~ - - - I ~. ~ ~ ~ S ~ ~ ~ ^m~ ~6~ ~ - ' ~ ~ r pt ,~ ~, rTl ' ~ 1 "'-~~ VY _IAN-~l-~C109(11~E0? 1h; 50 NICK BERNHARDT SAN JOSE WATER COMPANY 1265 S. BASC4M AVENUE SAN JOSE, CA 95128 OFFICES (408) 279-7830 ~Ax: (~$) 279-7sa9 Facsimile Transmittal P. 11111;'004 ~ECEIVED- ~~ ~ ~ ~~ ~~ ~ zoos ~uBUC woRKs ADMINISTRAl1ON To: City of Campbell ~~'°'"~ Nick Berhhnrdt Date= January 21, 2009 Re: ~CiICi1Ql" AV.. {In9c! ding 4 Gover St+eet ) ® Urgent ^ Far Review ©Please Comment ®Please Reply L7 Please Recycle Note: Please issue permit for above address. An old abandoned service was discovered we want to retire this service at the main. Tt serves no one and is nat on any of our maps. Thanks _IHhl-~l-~i109~;b!ED} 1L3:50 P. LIli3!OL11 GENER/1L PERMIT' CONDITIONS ]. A Canstruc[Ipn Cash peposlt I5 required. Charges will be made against this deposit if there Is an emergency caN-out, overtime Enspedion pr when City ordered barricading is required. Any sUCh costs in exce55 of the deposit will be billed t^ the Permlttee_ Z. A one-year maimenance period and surety are required. Such period well begin on date of written acceptance by the Clty. 3. Refund or the cash deposit balance and refund ar eancellatlon of the Faithful Performance Surety will be inl2lated by the written acceptance of the work by the City. a. The Permlttee must request fn writing a final inspection and acceptance of the work upon complet)an. Acceptance by the City will be made in writing to the Pcrmittec. 5. Maintain safe pedestrian and vehicular Crossings and free at[css to private driveways, bus stops, fire hydrants, and water valves. b. A Construction Traffic Control Plan and a Construction Schedule are required for all lane closures, detours, and street closures. This plan must be reviewed and approved prior to any lane closures. 7. A Construction Traffic Control Plan shall conform to Cho tahrans Manual of Traffic Controls far Construction and Maintenance Work zones, dated 1990, available at Caluans. Traffic control equipment shall Include Type I1 flashing arrow signs If required. 8. Replace as directed by the Clty Engineer any damaged ar removed improvements In accordance with City Standards and 5peciftcatlons at the sole expense of the Permlttee. 9. 5awcut for all PCC or AC removals. All PCC removals shall be t^ the nearest scoremark and shall be doweled to existing Improvements. i 0. Prior approval of Inspector is required for any work done after normal working hours, on weekends or holidays and may require reimbursement of Inspection costs ai the current overtime rate. 11. Adequate slr~ning and barricading Is required on the)ob site. Failure to provide such signing and barricading may result In the City's providing signing and barricades and charging the cost (Including all labor and materials) against the cash depasiL 12. Compactlpn testing of subgrade, base rack, and asphalt concrete by Pcrmittec is required unless otherwise stated by the Clty Engineer. 13. The Contractor ar Permlttee will have a supervisory representative available far contact on the protect at all times during construction. Contractor or Permlttee shall provide a phone number at which they can be contacted outside the hour of 8:60 a.m. to 4:f]0 p.m. 1 1. No storage of materials or equipment will be allowed near the edge of pavement, the traveled way, or within the shoulderllne which would create a hazardous candltion ro the publle i 5. This permit shall not be construed as autharizatlon for e><cavatlon and grading on private property adjacent to the work or any ocher work for which a Separate permit maybe required, npr does It relieve the Permlttee Of any obligation to obtain any other permit required by law. t [,. This permit does not release the Permlttee from any liabilities contained In other agreements or contracts with the Clty and any other public agcnuy. 17. This permit is not transferable. work must be perfam~ed by the Permlttee or his designated agent or contractor as specified thereon. 18. Call back (coq out) due to emeregencles regarding this permit shaft be atthe current overtime rate with a three (3) hour minimum charge per occurrence. 19. Pursuant ro Chapter ta.o2 of the Campbell Municipal Code, applicant shag not cause to be discharged any material into the municipal storm drain system other than Storm water. Applicant shall adhere tb the [iE5T MANAGEMENT PRACTICES established by the Santa Clara Valley Urban Runoff Pouutlon Prevention Program. 20. If the public interest requires a modificatlvn of, ar a departure from the plans and speelfications,the Clty Shall have the authority to require or approve any modification or departure and to specify the manner in which the same is to be made far Cityowned or mainialned facuitles. 2t. Permltttee must provide advance notification to all parries that may be affected by the permit actlvltles. Natlflcatlon shall be reviewed by the Clty prior to dlstributian and Include dates of w^rkand a contact name and phone number. Applicant shall be responsible far ensuring that all [loose providing services under the appli[ant are aware and understand all of the above condltlons. Applicant Date: Contractor (Print ~~ /./ ~ ~ " ~- pate: a:Relnalwebsktelland Dev PormslEncraachmenc Permit STATIC form2.pdf Rev.(1119/OS)