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ENC2009-0004804101 i' ©09 15:56 CITY OF CAMP9ELL DEPT". OF PUBLIC WORKS 70 Nprth First Street Campbell, CA 35008 Ph. {gpgJ866-1t50 Fx. (448) 376-0958 1-408-3~^-1821 WVSD ENCROACHMEN7PERMIT (for working within the public~~ right-of way) Issued 'Z C l Permit Expiration Date Z ~ ( ~ PAGE 02!03 u s,,,; n.,. ,,;,..,:.},~ ,. . PermitNp~~ .. n ~tf X-Ref. File Application Date Application Expiration Date tu/ ny APN APPLICATION - gpp(ication is hereby made for a Public Works permit in accordance with Campbell Mi,nicipal Code, Section 11.04, (Ap is rOR'eR'riri~ E D (li) months if the permit is not issued. Application Fee is non-refundable.) A. Work Address or7ract No.: ~ooa 7154 Holmes Avenue J ... ........ _ ...P11SL6C WORKS L'ility Trench Location; Trench starts 2' behind the sidewalk and extends 20' towards the center o t e street. '4TION .. 6• Nature of Work: ! ..... _-...__ Replace the old, damaged 4 VCP sewer lateral with a new~PVt sewer lateral. C. Attach four (4} copies of an engineered plan showing the location and extent of the work, and faw (4} copies ofthe preliminary Engrneer's , stlmate of work. The plans shall show the relation of the proposed work to existing surface and underground improvements. Whrn approved by the Ci~l'y Engineer, said plan becomes a part of this permit. D- All work shall conform to the City of Campbell Standard 5pecifcations and Details for Public Works Construttion;theGonera! permit Conditions listed on the reverse side; and the Special Provisions for this Permit, listed below, Failure to abide bythese conditions and provisions may result in jab shutdown andlar forfeiture of Faithful Performance Sureties and cash deposits. (See General Permit Conditions 1 and 2,} E• TheCantractormusthavethlspermitanda starting work. Notice must be given to publpc Works at leastt24 hours before a tart ng any work orks Department at least two days before Name ofApplicant: West Valley Sanltatlon district-Jorge Picada ... .......... ....... 'Telephone: (408) 378-2407 ~ Address ..,,,.. ......,.,. 100 East Sunnyoaks Avenue. Cambpell, California. 95008 6608. ~ - _. E-Mail Address: ", .....,. )plcad0@westvalieysan-org 2q-HOUR EMERGENCYPHpNE NUMBER: .... . Is this work bein done ~ (408} 378-407 g by the property owners at their own residence? ., .. ... .' YES ~' The Applicant/Permittee hereby agrees by affixing their signature to this permit to hold the City of Campbell, it officers, agents, and employees free, sale and harmless from any claim or demand for damages resulting from the work covered by this permit. The Applicant/Perm;ttee 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 ermit, •~ 7' ~~r p property owner, or property owner's successors, shall be responsible for any and all damages arising out of the condition of any private improvements inthe publlcright-of-way. Accepted: +t}SSis~wr~~ G'~y~ j~rY.f: ~1 ~4rpd ppliCantPerm$te¢) {sign) / + "r~~ MB/lo Pik/,;,~ .~Ji~r Date e ~~/Ia. (Contrattar) (Print Name) ~/I ~ f ~ ,~CIAL PROVIS~}~s• Date ,1- Street shall not be open cut for underground installations. Minimum cuts may be allowed for connections or explaratlon holes. Such cuts maybe a r v h l r ri uttin , Z. Pavement may be cut for underground installations and must be restored in accordance with the S~Candard Details Trench Restoration Method "A", unless otherwise approved by the Engineer, ,_3. Work to be staked by a Ikensed Land Surveyor or Civil Engineerand two (2}copies of the out sheets sent to the Public works Department before snorting 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: i-800-2Z7-26tl0. USA TICKET Np. w`5. Prior to any work, the property owner shall execute an Agreement for Private Improvements in the public Right-of--Way, whir:h shall be recorded, _6. Public Notii'ication Requirements• _,~7, I W FEE LE F R NT F PERMlTAPPUCATION FEE AMRUNT ~ 2 ~- RECEIPT NO, Q PLAN CHECK DEPpSn' S SECURITY FpR FAITHFUL pERfORMANCE/LABOR & MATERIALS $ CoNSTRU[i'ION CASH DfPOSrT S- pLAN CHECK & INSPEC71pN FEE S 5_ c APPROVED FOR ISSUANCE _-F Ity Engineer ~ Z C Permit Expires 12 Months After Date of Issuance Date ~~L~ a~ - 1'h i ~ 04i'0112009 15:56 1-40$-3~^-1$21 WVSD PAGE 03103 GEN AL PERMIT CONpITlONS 1 • A Construction [ash Deposit is re r9 g . quired. Cha es will be made a alnst this deposit if there i5 an emergency Call-Out, overtime inspection orwhen City ordered barricading IS required, Any such GpstS in ex~eSS~Of the depOSitwill be billed to the Permlttee. 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 Pertormance Surety will be initiated by the written acceptance of the work by the City. 4• The permlttee must request In Writing a final inspection and acceptance of the work upon tompletlon. Acceptance by the Citywiil be made in writing to the Permittee- 5• Maintain safri pedestrian and vehicular crpssings 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 ail lane cl4sUres, detours, and Street closures. This plan must be reviewed and approved prior to any lane closures. ~- A Construction Traffic Contrpl plan shall 7990, available of Caitrans. Traffic control equipment shall nclude T ual of7raffic Controls for Construction and Maintenance Work zones, dated ype II flashing arrow signs if required, $• Replace as dirgCted by the City Englneerany dams fled or removed improvement; in accordance with Clty Standards and Specifications dtthe Sole expense of the Permlttee. 9• Sawcut for aq PCC or qC removals. All PCC removals shall be to the nearest scorCmark and shalt be doweled tp existing Improvements. 7 0. Priorapproval of inspector is required for any work done after normal working hours, on weekends or holidays and may require reimbursement of inspection cpstS at the Current overtime rate- 7 7~ Adequate Signinq and barrl [acting is required on the job site, Failure to provide such signing and barricading may result in the Clty'S providing signing and bdrritades and Charging the cost (Including all labor and materials) againsttheC35h deposit. t Z• Compaction testing of subgrade, base rack, and asphahconcrete by Permlttee Is required unless otherwise stated b the CI 13• The Contractor or Permi Y ty Engineer, Perm ittee shill) provide a phonjel number atwhiCh hey an be contacted olutsld Contact on the project at all times during construttian. Contractor or e the hours of 8:00 a.m, to 4:U0 p.m, 14, NO Storage of materials ore ui mcnt will hazardous condition w the public. q p be allowed nearthe edge of pavement, the traveled way, or within the shoulderline which would create a 15, This permit shall not be construed as authorization for separate permit ma excavation and grading on private propercy adjacentto thework pr any other workfor which a Y be required, nor does it relieve the Permlttee of any obligation to obtain any ether permit required bylaw. ~ B. This permit does not release the PermltteE from any liabilities Contain ed in other agreements or contraCG; with the Cify and any other public agency, i 7. This perm it is not transferable. Work must be performed by the Permlttee or his designated agent or contractor as specified thereon. 78- Call back tcall Out) due to emeregenCies regarding this permit sha71 be at the curt occurrence. ant overdme rate with a three (3) hour minimum charge per 10. Pursuant to Chapter 14.02 of the tam system otherthan storm water. Applicantllshall adheretothe 6E15TMgNA6EMENT PRACTt ES established h aterlal incothe municipal storm drain Pollution Prevention Program. Y the Santa Clara Valley Urban Runpf f 20- If the public interest requires a modification of, or a departure from the plans and spccificatfons, the Ci any modification ordeparture and to speCif7r the manner in which the same is to be made for Ci[ •ownedsoamafn a the authority to require or apprpve 2i, Y twined faClliti¢s. Permimee muyt p,oyide advance notification to alt parcies that may b8 affected by she permit activities. Natlflcation shall be reviewed by the City prior to distribudon and include dates of work and a Contact name and phone number. Applicantshall be respanslble for ensuring thatdll those providing services underthe appllCanC areaware and understand all of the above conditions- GG~a>~ Ya11e ~$ay ~i~a~ 's~-i~. Ass~'s,~a„f ~~ ~'c~~o . rf.~o'~+ p Applicant ~ %~ ~+~m/. Date: M~!/a CPC/:rte ~~.,,J ContractoY (PYint Name) ~ /Jj ~ ~ ~~, Date: J:\FORMStTemplateslEnCroxhment Permits\EnCroachment Permit STg71C farm2,pdf Rev, 3r08 I-1~!~'E;''~Et~~9 14:5; 1-~1~5-X64-13?1 4~1VSLi PAuE H4!1=14 APPf~(JVEC~ r'~'`~~ CONSTRUCTION. F~tahlic Wor~:~~ ... xs~~ ~~;.~°.~..e'z-O.~~- ; 0 u~~ ,r Pint-.~ !Aesn ~icgs See Page !.~ ~ r ~~ ` F~ Ctt L~ ~ 26 ~~ "~O n '~ o ~ ~~~ C ~.,1 ~S / 6~ ° S ~7 °'k ~. ~ ,Q` v3 ~`, Asa ~~ ~,~ -~ ~~~ -9 ~, ~~~ H r ~ ~ .. a $~~ O O ~ ~ ~ , ~ , fj~ Q1 ~ ~ 6~ ~~ I,pa. ~ 5t A 4~ ,tl` ~ o~~ ~ >.t ~48J f1 C' 7 ~ ~U W ~ b ~ ~ /~ fb ~ 9r .p ~~BY- ~ ~ ~+3 ~ N /00. Cl0 W ~ ~ry ~ ~~ "39 CJ7 b ,~ -~ e~ bF ~ '~ cry' ~' ~ ~ N ~ W ~ Q/ 66.5 Ap /3 S O CN 9 ,+} , ~ y0.00 W 6,.5'.Ot,S C~ ~ ~ N 666 d 6 m ~~~~ D GFI ~ ~ N S, O tw .. w ° ~ F N ~ V m N y w p o 'n C Z ~ ~ ` ~ ~ ~ ~ ~ ,4 ~+ti ~ 4 O ~1 Opp H ~ 10 0.80 ~~ a c _ ' Pa •SO. o ro ~ ~'' 6S-, D ~ + -0' ,~ ~ + ~ Q w O ~ 65 ~ 6,rf d ~ m ,. s a + o ~ ,~ 9 e 11. 14° Q U CC 8s OAKS aD 4 '°= g5 0 ~~ i+E'2L ~ /i5,33 ~.CjQ 86.07 64.75 ~ 'P d~° $ ~ ~ W U p~ p yy .. ~~ ~ ~ ~ k //3.33 ~ 64.75 ~~~ G 86.0 1E9.50``~~{ ~ + ~•~..1 ~~~'~ H Ei6,c~4 ~~' ~ • ~ Q w b~ ~ _a ~ O ~ o a CCV__ h'1 `v P 'V 0 to 04l01~'2009 15:56 1-408-3F~-1821 WVSD PAGE 01!03 'E'SA V~~~E.'i~f. Sani~atEOn f~rst~rct ~A~~IMILE TR,AhfSNIITTAL RECEIVED APR 0 1 2009 TIME: ~=.~ pr,~. TO: ~' of Cam ,bt// FAX NO.: ATTEN'TTdN: serf GG~1~icJi' FROM: L4~¢ j~f/~~.. , SUBJECT: ~r Af l/S~¢ ~orn~r~ ~ TOTAL PAGES TRANSMITTER? MESSAGE: _3 (including this cover sheet} ~- sy~t ~~-' cur rssUe lkf c~-i en~roach~~ mi¢ ~r la~J1t,G~,~ o~ ftr~ ~~a 'a~cver ~~t.~-a.G cf 11 ~~ ~{~Imr~ ~c~r/E . ~hc~,r av rig ~ctar~c~ . c_Jv 100 EAST SLIN~''OAKS AVENUE, CAMPBELL, Cry, 9500$ T'ELEPRQNE (448) 378-2407 FAX (408} 364-1821 PUBLIC WORKS ADMINISTRATION ~~oa~ -~a~ - a9~8 . ~~c7'd. $-126