ENC2009-00029 Print Form
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CITY OF CAMPBELL ENCROACHMENT PERMIT Permit No
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DEPT. OF PUBLIC WORKS (for working within the public
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70 North First Street right-of-way) Application Date
Campbell, CA 95008 .~~2 ~f /C "1 ~ Application Expiration Date
Ph. (408)866-2150 Issued APN
Fx. (408) 376-0958
Permit Expiration Date ~ ~7,~f j 1 tr' RECEIVE D
APPLICATION -Application is hereby made for a Public Works Permit in accordance with Campbe ll Municipal Code, Section 11.04. (Application expires in six
(6) months if the permit is not issued. Application Fee is non-refundable.) ,.~ .~ R, ~ ..
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A. Work Address or Tract No.: y,j D S~.~Mcy r. tie
PUBLIC WORKS
ADM I N (STRATI ON
Utility Trench Location: S S~d2 S4//-+e~r ~~~ y~g G o~c' /'a~r~S~,~ ,Cfv~ /~~ oc~~s',d. P~L
B. Nature of Work: I Gpyser PG~E' GQS Serc/ice / ma'r' f~d~ivs /c)ialn
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 City Engineer, said plan becomes a part of this permit.
D. All work shall conform to the City of Campbell Standard Specifications and Details for Public Works Construction; the General Permit Conditions
listed on the reverse side; and the Special Provisions for this permit, listed below. Failure to abide by these conditions and provisions may result
in job shutdown and/or forfeiture of Faithful Performance Sureties and cash deposits. (See General Permit Conditions 1 and 2.)
E. The Contractor must have this permit and approved plans at the site and must notify the Public Works Department at least two days before
starting work. Notice must be given to Public Works at least 24 hours before restarting any work.
Name of Applicant I O G
Address: ~ ~QpO `19n~j~®dS/C ~S/o.~ ~I<
E-Mail Address: S/1 Y 2 1, ~ 6 L C o ~^
Telephone: i ~f-'(J~-~7~ Z, -S Z ~ S~
/Sd /l~d~g•.„ //-,/l ~.~J 9So3~
Z4-HOUR EMERGENCY PHONE NUMBER: I ~Uo-7y~- ,5 Uc/d
Is this work being done by the property owners at their own residence? ~ YES (- NO
The Applicant/Permittee hereby agrees by affixing their signature to this permit to hold the City of Campbell, its officers, agents, and employees free, safe
and harmless from any claim or demand for damages resulting from the work covered by this permit.
The Applicant/Permittee hereby acknowledges that they have read and understand both the front and back of this permit, and they will inform their
contractor(s) of the information. Applicant is advised that upon issuance of this permit, property owner, or property owner's successors, shall be
responsible for any ~ all damages arising out of the condition of any private improvements in the public righ~ f-way.
Accepted:
(Applicant Permittee) (sign)
(Contractor) (Print Name)
Date
Date
SPECIAL PROVISIONS:
1. Street shall not be open cut for underground installations. Minimum cuts may be allowed for connections or exploration holes. Such cuts may be
specifica~ approved by the Inspector 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 to be staked by a licensed Land Surveyor or Civil Engineer and two (2) copies of the cut sheets sent to the Public Works Department
before starting work.
4. Per Section 4215 of the Government Code this permit is not valid for excavations until Underground Service Alert (USA) has been notified and
the inquiry identification number has been entered hereon. USA Phone: 1-800-227-2600. USA TICKET NO.
5. Prior to any work, the property owner shall execute an Agreement for Private Improvements in the Public Right-of-Way, which shall be
recorded.
6. Public Notification Requirements:
SEE PUBLIC WORKS FEE SCHEDULE FOR CURRENT FEES
PERMIT APPLICATION FEE
PLAN CHECK DEPOSIT
SECURITY FOR FAITHFUL PERFORMANCE/LABOR & MATERIALS
CONSTRUCTION CASH DEPOSIT
PLAN CHECK & INSPECTION FEE
AMOUNT
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S J
RECEIPT NO
APPROVED FOR ISSUANCE ~~ ~~~~~ ~r' ~~
~ For City Engineer Date
~~ f Permit Expires 12 Months After Date of Issuance
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GENERAL PERMIT CONDITIONS
1. A Construction Cash Deposit is required. Charges will be made againstthis deposit if there is an emergency call-out, overtime inspection or when City
ordered barricading is required. Any such costs in excess of the deposit will be billed to the Permittee.
2. A one-year maintenance period and surety are required. Such period will begin on date of written acceptance by the City.
3. Refund or the cash deposit balance and refund or cancellation of the Faithful Performance Surety will be initiated by the written acceptance of the work
by the City.
4. The Permittee must request in writing a final inspection and acceptance of the work upon completion. Acceptance by the City will be made in writing
to the Permittee.
5. Maintain safe pedestrian and vehicular crossings and free access to private driveways, bus stops, fire hydrants, and water valves.
6. 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 the Caltrans Manual of Traffic Controls for Construction and Maintenance Work Zones, dated
1990, available at Caltrans. Traffic control equipment shall include Type II flashing arrow signs if required.
g, Replace as directed by the City Engineer any damaged or removed improvements in accordance with City Standards and Specifications at the sole
expense of the Permittee.
9. Sawcut for all PCC or AC removals. All PCC removals shall be to the nearest scoremark and shall be doweled to existing improvements.
10. 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 at the current overtime rate.
11. Adequate signing and barricading is required on the job 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 deposit.
12. Compaction testing of subgrade, base rock, and asphalt concrete by Permittee is required unless otherwise stated by the City Engineer.
13. The Contractor or Permittee will have a supervisory representative available for contact on the project at all times during construction. Contractor or
Permittee shall provide a phone number at which they can be contacted outside the hours of 8:00 a.m. to 4:00 p.m.
14. No storage of materials or equipment will be allowed near the edge of pavement, the traveled way, or within the shoulderline which would create a
hazardous condition to the public.
15. This permit shall not be construed as authorization for excavation and grading on private property adjacent to the work or any other work for which a
separate permit maybe required, nor does it relieve the Permittee of any obligation to obtain any other permit required bylaw.
16. This permit does not release the Permittee from any liabilities contained in other agreements or contracts with the City and any other public agency.
17. This permit is not transferable. Work must be performed by the Permittee or his designated agent or contractor as specified thereon.
18. Call back (call out) due to emeregencies regarding this permit shall be at the current overtime rate with a three (3) hour minimum charge per
occurrence.
19. Pursuant to Chapter 14.02 of the Campbell Municipal Code, applicant shall not cause to be discharged any material into the municipal storm drain
system other than storm water. Applicant shall adhere to the BEST MANAGEMENT PRACTICES established by the Santa Clara Valley Urban Runoff
Pollution Prevention Program.
2p, If the public interest requires a modification of, or a departure from the plans and specifications, the City 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 for City-owned or maintained facilities.
21. Permitttee must provide advance notification to all parties that may be affected by the permit activities. Notification shall be reviewed by the City prior
to distribution and include dates of work and a contact name and phone number.
Applicant shall be responsible for ensuring that all those providing services under the applicant are aware and understand all of the above conditions.
Z
Applicant
Date:
Contractor (Print Name)
Date:
J:\FORMS\Templates\Encroachment Permits\Encroachment Permit STATIC form2.pdf
Rev. 3/08
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BUSINESS DAYS PRIOR TO EXCAVATION f' s . look for an 8
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GAS MAP# 3412-15 ncoura
CPA#3412-27
SCOPE OF JOB: ELE MAP# H1616 ,~
I - PG&E TO EXCAVATE 4'X6' BELLHOLE SCALE 1:60 ~
- PG&E TO REMOVE & REPLACE ASPHALT TRAFFIC CONTROL PER CA MUTCD ~,«"~
- PG&E TO LOWER EXISTING 1-1/4" STL GA5 SERVICE 1' BELOW TA-10 LANE CLOSURE ON TWO- LANE R0~ USING FLAGGERS
NEW 18" STORM DRAIN
- PG&E TO REPLACE 4' OF 1-1/4" STL HP GAS SERVICE WITH LIKE MATERIAL
- PROPOSED 18" STORM DRAIN DEPTH ®3'2"
- SERVICE RELOCATE TO ACCOMADATE STORM DRAIN FOR SONOTA TOWNHOMES ~ .~ ~ s""
- CITY OF CAMPBELL PERMIT REQUIRED ~ ~`~
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LEGEND:
Existing High Pressure Gas Facilities
Existing Water
Proposed Storm Drain
Existing Sewer
- - Property Line
Transformer
4' X 6' Bellhole by PG&E
EST: ~~SCOTT YEATER ~ C0:
ADE: MARIO I~ELENDEZ PERMIT DRAWING NOTIF: 103654045
SUPV: CHARLIE DIAZ 430 SALMAR AVE OTHER:
?REP: SERINA PONCE CAMPBELL CA SHT: 1 OF 1
PLNR• PM;
;SCALE: DATE: , PACIFIC GAS AND ELECTRIC COMPANY 41035209
REV.
California MUTCD
(FI~WA's MUTCD 2003 Revision 1, as amended for use in California)
Table 6C-~. Suggested Advance Warning Sign Spacing
Page 6C-13
Distance Between Signs**
Road Type A g C
Urban (low speed)" 30 (100) 30 (100) 30 {100)
Urban (high speed)' 100 (350) 100 (350) 100 (350)
Rural 150 {500) 150 (500) 150 {500)
Expressway /Freeway 300 (1,000) 450 (1,500) 800 (2,640)
' Speed category to be determined by highway agency
*' Distances are shown in meters (feet). The column headings A, B, and C are the dimensions
shown in Figures 6H-1 through 6H-46. The A dimension is the distance from the transition or
point of restriction to the first sign. The B dimension is the distance between the first and second
signs. The C dimension is the distance between the second and third signs. (The third sign is the
first one in a three-sign series encountered by a driver approaching a TTC zone.)
Table 6C 2. Stopping Sight Distance as a Function of Speed
Speed*
(kmlh) Distance
(m)
30 35
40 50
50 65
60 85
70 105
$0 130
90 160
100 185
110 220
120 250
Speed*
{mph) Distance
(ft)
20 115
25 155
30 200
35 250
40 305
45 360
50 425
55 495
60 570
65 645
70 730
75 820
Posted speed, oft-peak 85th-percentile speed prior to work starting,
or the anticipated operating speed
Chapter 6C -Temporary Traffic Control Elements September 26, 2006
Part 6 -Temporary Traffic Control
California MUTCD
(FHWA's MUTCD 2003 Revision 1, as amended for use in California)
Page 6C-14
Table 6C-3. Taper Length Criteria for Temporary Traffic Control Zones
Type of Taper Taper Length (L)*
Merging Taper at least L
Shifting Taper at least 0.5E
Shoulder Taper at least 0.33E
One-Lane, Two-Way Traffic Taper 30 m (100 ft) maximum
Downstream Taper 30 m (100 ft) per lane
Table 6C-4. Formulas for Determining Taper Lengths
Speed Limit (S) Taper Length (L)
Meters
60 km/h or less Wg2
L - 155
70 km/h or more L = WS
1.6
Taper Length (L)
Speed Limit (S) Feet
40 mph or less L = WSJ
60
45 mph or more L = ws
Where: L =taper length in meters (feet)
W =width of o#fset in meters (feet)
S =posted speed limit, or off-peak 85th-percentile speed prior to work starting, or the
anticipated operating speed in km/h (mph}
('Phis space left inte~~tionaUy blank)
Chapter 6C -Temporary Traffic Control Elements September 26, 2006
Part 6 -Temporary Traffic Control
California 1VIUTCD
(FHWA's MUTCD 2003 Revision 1, as amended for use in California)
Table 6F-102(CA). Maximum Spacing of Channelizing Devices
Maximum Channelizer Spacing
Speed
(km/h)
Taper*
m
Tangent
m
Conflict**
m
30 6 12 3
40 8 16 4
50 10 20 5
60 12 24 6
70 14 28 7
80 16 32 8
90 18 36 9
100 20 40 10
110 22 44 11
Page 6F-64
Maximum Channelizer Spacing
Speed
(mph) Taper*
ft Tangent
ft Conflict**
ft
20 20 40 10
25 25 50 12
30 30 60 15
35 35 70 17
40 40 80 20
45 45 90 22
50 50 100 25
55 55 110 27
60 60 120 30
65 65 130 32
70 70 140 35
* Maximum channelizer spacing for all speeds on one-laneltwo-way tapers is 6.1 m (20 ft).
Maximum channelizer spacing for all speeds on downstream tapers is 6.1 m (20 ft).
All other tapers are as shown,
** Use on intermediate and short-term projects for taper and tangent sections where there are no
pavement markings or where there is a conflict between existing pavement markings and
channelizers
Chapter 6F - Temporary Traffic Control Zone Devices September 26, 2006
Part 6 -Temporary Traffic Control
California MUTCD
(FHWA's NfUTCD 2003 Revision 1, as amended for use in California)
Figure 6H-10 (CA). Lane Closure on Two-lane Road Using Flaggers (TA-10)
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1~
Note: 1. See Tables 6H-2 and 6H~
for the meaning of the
symbols and/or letter
codes used in this figure.
2. See Tables 6E-1 and
6E-1 Q1(CA) for buffer spa
to determine location of
flagger stations.
(leuol}do)
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Typical Application 10
Page 6H-30
Chapter 6H -Typical Applications September 26, 2006
Part 6 -Temporary Traffic Control
PG&E, Dependency Permit Desk
900 Lightpost Way, Ste 150
~ Morgan Hill, CA 95037
February 18, 2009
City of Campbell
Public Works Department
70 North 1St Street
Campbell, CA 95008
Re: ENCROACHMENT PERMIT
Attached is a permit application for the following location.
430 Salmar Ave., Campbell
Please mail the permits and invoice to:
PG&E
Dependency Permit Desk
900 Lightpost Way, Ste. 150
Morgan Hill, CA 95037
Additionally please reference PM #41035209 on the invoice. If you have any
engineering or design questions, please contact Scott Yeater at (408) 722-5225.
Thank you,
_ ____ _
Kathy Donohue
Dependency Permit Desk
FAX (408) 722-5373