ENC2009-00035CITY OF CAMPBELL ENCROACHMENT PERMIT Permit Na ~1~~ oO~~~v~
D$PT. OF PU$LTC WORKS {for working within the public X-Ref. File
70 North First St. right-of-way)
Campbell, CA 950Q8 7 ~j (~ Application Daze.
{408} $60-2150 Issued 7 / " ~ Applicazion Expiration Date ~~
Fax (40&) 376-095$ 3 /~
Permit Expiration Date ~ O APN _ ~~ ~ ' ^' V 1
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APPLICATION - Application is hereby made far a FubGc Works Fer-rtit in accordance with Catnpbeli Municipal Code, Section 11.04_ (Application expires in six (b}
mtmths if the permit is not issued. Application Fee is non-rcfttnd2bie,1
A. Work address or tract k ~ ~~ ~~ ~~ -'T v ~ - ~~ 3a~ Cgs ~ 6 ~]
Utility trench location O Gll~ ~ 5"I"iZCaZ~Z- 5 (.~2tJlGC- C K.OS,S Yv~O ~~ ~ ~I~(t ~(.7~ ~YL.I.VLt~ Ct'C-QSS ~'~
B. Nature of work ~ E~ t> Tt~ Lt7GV £f!L D W ~ SC312U LUs ~ (,oW ~rL OAL ~ ~K.CWI/~~t-tit Ct~1'~ C.(S'
C. Attach four f4) copies df an engineered plan showing the toeation 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 dte 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 Fertnit Conditions listed on the
reverse side: and the Special Provisions fnr this permit., listed below. Failure to abide by these conditions and provisitxts may result In job shutdown and/or forfeiture
of Faithful Performance Sureties and cash depasiu. (See Genera! Permit Conditions 1 and 2.}
E. The Contracau must have this permit and apprnvad plans at the site and must ratify the Public Worn; Department at least two days before stattino work. Notiec
must be given to Public Works at least 24 hours befafra( rrstartin~ any work.
Name of Applicant I~~ ~ ~~ ~`~~p.~-~-T'~~C.. (~~~~ ~t$ clephtms Y~8 L ZZ - SZD~
~'(f:U !_.l Ef tf'r~0~>-' I.l~ ~'~-/ WLnnt~YL(1 eN+~l. ~~ ~I I - ~00 - ~] ~E 3 ' ,~D O O
Address 24-HQUR EMERGENCY TELEPHONE NO.
G ~ IL I tG? ~U ~ Co wr ~ S'o ~ 7
E-Mail Address ~
Is this wark bcinr done by she property owners at thnr awn residence? Yes ~No
The; ApplicandPerrnittee hereby acr~rees by afftxing their s'sanature to this permit to hold the City of Campbell, iu officers, agents and employers free. safe and harmless
from any claim or demand for der gcs resulting from the work covered by this permit.
The ApplicandPermin ° acknawl ges that they have read an understand both the front and hack of this pc-rmit, and they will inform their ctmtra.~-tar(s; of the
information. Applicant vised that pop i uanee of this property owner, or propetty owner's successors, Shall be responsible or any and all damages
arising out of the etmditi a priv/imp vemtnts in [he p [i: nght-of-way.
Accepted C/ ~ ~~~ Z~! `~~
n~ Permittce} (sign) Date
~j %
Contractpr (Print Name} Date
SPECIAL PROV ISIONS
1. Street shall not be apert cut for underground instatlations. Minimum cuts 1~ be allowed for connections or exptoranon hates. Such cuts may
be snecifrcaliv agprtrved by the Inspector prior ro cuum~-
2. Favemtrtt may be cut for underground installations and must be restored in accordance with the Standard Details Trench Restoration Method
"A", unless otherwise approved by inspector.
3. Work to be staked b_v a licensed Land Surveyor or Civii Engineer and two (2) copies of [he cut sheets sent to the Public Wanks Department
before starting work.
_4 Per Section 4215 of the Government Code this permit is not valid for excavations until Underground Service Atert (llSA} has been nattfted and
the inquiry identiftcation number has been entered hereon. USA Phone I-$~-22;-2600. USA TICKET NO.
5 P cr ro any wort. the prap~ty owttcr s`.•.aL' cx:.rutc an Agreement for Private Improvements in the ; ublic RiKht-of-~dai~, which snail be
recorded.
.~6. Puhlic Natitication Requiremenu:
SEE PUBLIC WORKS FEE SCHEDEJLE FdR CiIRRENT FEES AMOUNT RECEIPT N
PERMIT APPLICATION F'dE S ~8~ ~~
PLAN CHECK DEPOSIT $
SECURITY FOR FAITHFUL PERFORMANCEJLABiDR & MATERIALS $
CONSTRUCTION CASH DEPOSIT $
PLAN CHECK dt 1N5PECTTfSN FE£ $ ~~
~ 3 ~
c
APPROVED FOR ISSUANCE ~ o
l
For City Engineer Date
Pemtit Expires l2 Months After Date of Issuance
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GENERAL PERMI'T' CQNDITTnNS
1. A Constructiap Cash Deposit is required. Ctrarges will be made against this dtpasit if daerc is as emergency coil-out. overtime inspection or when Ci[y
ordered baxritadin; is required. Any such cosss in excess of the deposit will be billed to the Ptrmittes.
?. A one-year mainttaatra period and surety ar-_ required. Such period will beg<a tm date of written accepnnee by the City.
3. Rchmd of the nsfa deposit balance acrd refmd or as[cellatien of She Faithtful Puformnnce Surety will be initiated by ffie writtar arxptanct ~ the work
by the Cit}r•
4. 'T'he Pta-minse anus[ trclpest in wntiaa a fiaai ittspectitta ami actxptanrz of the work upon c[rmplttim. Accxptaacr by the City will be mad[ in writing tct
rite Petmiaee
5. Maintain safe pedestrian and vehicular crossings acrd free access to private driveways, bps stops, fire hydranss and wooer valves,
6. A Canstntetiatt Traffic Conuol Ptah and a Construction Schedule arc scgtaired far all lane closures, daours and street. closures. This plan mess be
ttviewed and. approved price to any lane closures.
T. Ttte Cottscpsziart Traffic Caatrtil Plan shag arouftxm to the Cxtaans Mantxai of Traffic Cwrs~ far Construtxiora and Maipaxaanet Work 7aoes, dated
2440. availahk u Calams. TrafCtc control espdpmestt shall inept Type II itashiag attnw signs if rra;uirecf.
&_ Replay as dineettd by the City Engineer any damaged ar removed improvetxusttts in accadanrx widr Gty Standards and Spcciftcatians at the sore.
acpense of tlae Pettnaaee.
9. 5awcut for a[I PCC ar AC removals, All PCC rerrtovals shall lrc to nearest scartmark and shall be dawekd to existing improvements.
10. Friar approval of inspxtor is required fns apy woa'k docac after nartna! working houis, oa+ wetkmds ar luahdays atd may require rtimhutsement of
inspection tm~ at the tatereru avertitne tste.
11 Adequate sigttinl<and barrit~diug is required on the job silt. filuxe ttt ptewidt such suing and barricading may result in the City's providing signing
and bamcadrs acrd arargina dac cans[ #ioctuding art tabor crud trratxrials) against the qsh dtposit
t ~ Compscaion testing of snbg:ade, trace rock. and asphalt cnaacrtxe by Ptrmiatee is ceganred uttt~s otherwise s[atrd lay thr city Enginetr-
13. The Contractor ar Pernaitree will have n supervisory reprrseutauvt available for contact on the project ai all uttaes during coosaucuop. Cantructor of
Pertnittee shall provide a phone nursrber at which they can be contacted ousstdc the hours of 8:00 a.m, to 4:Ot! p.trt
14. No storage ~ t[tauriak tr egaigmast will tx allowed pear thr edge of pavemrnt, the tr:tvekd way. ar within aitc slwcrktexlinc which waakl create a
hazardous condition to the public.
i5. This permit SitaU trot br construed as audtarizauoa far ezcavauoa crud gFading on pnratt prttptrty adpceat w the work a any Atha work for whiff a
scpatatr paint may be re4uirtd. oar doesra rt:licw_ the Permitter of any abiigaticxr to obtain any other permit regwred by taw.
{ Ci. Thss ptxmit does nax release tttt Permittc from any liabi}itiex contained in other agreemcats ar contacts with the City and any other pnbfic agency.
17. This permit is not transferable. Wrnk must he performed by the. Pamittte ar his dcsigna[ed agent ar contxactar ns specified thereon.
1 g. Call back teal! out) due to emagencirs regarding this ptxmit shall beat ffie current overtime rate with a ttrret (3} huts' minimum charge pa oCCUrrtracc
t 4. Pursuant so Chairter ! 4.tt2 of the Catrgabelt hfurucipal Code,. applicant shall nex rouse to 6t discltat~gCd any material itflo the rrnmicipal s[mm drain s~vstem
otter titan starrn water. Applicant shall adtxre w tt~ 8Ea" MANAG1+tvlENT PRaCT`iCES estatatished by the. Santa Clan Vatky i}rlaaa Rrmcaf'
Pollutbnra Prevention t'rvgram.
20. if the public intmxt requirtt a rtrodification af, ar a depararrt froru, the plans and specincaaorrs. the City shall have [lac authority w require ar apprrne
any rrradification or re and to specify the m-a[mer in which tiu same is to be made for City-awned tx rnainwtaed fa71"stirs.
2?. Pcmaittee must provide advance gatifscatitm to aTl parties that may be affected by the pemait activities. Notification shall be reviewul by City prior m
distrib;ttian and srccludc j:dt~ of war!: and a coptaat cram:. and phoac ntamtcr.
Apptignt shall be
tlaaz a[I those providing
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,~- L
uaadu the applicant art aware of and understand alt of the atxxve :.aaditians.
~a! ~ ~ Da~6 D
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Contractar (Print Name? Dam
Jtfozttul}swperm
R,w. l 1191{[5