ENC2009-00075Jun. 22. 2009 ~; SIAM Pa~ ~ f I ~: Gas and El e,.i r'i ~ Co. j~ ` No, 4736 PM/1~
CITY OF CAMP$SL,L 1JNCltOACHMBNT 1'~MIT Pcrtnit No ~+yC2 C~ ~ ~' wV~~
DEPT. OF PURL!('. 'V1rQItKS {for world»g within fhc public ~-12ef. )?ile
70 North Firs[ St. right-of-way) O~
Campbell, CA 95008 ~ 2 Application Da[t r
(Q06) 6b6.215p Issued I /~G~ Application )?,rtpiration ate 1
Fax {408) 376.0958 p (, ~Z~ ~ ~ o ApN "'T b ~ ~ ' ~ (~ ~ ~ //"
Pernut Ex iration Date ")' _ y ~ -•~
~..~1 N Z
APPLICATION -Application is hereby made for a Public Works Permit in accordance with Campbell Municipal Code, Section 11.Ob. (Application expires.l~i (6) p~ Y Q
months if the perrrrlt is not is{sued~'Application Fcc yis non-refunrllablcJ j~, f C ~ F
A. Work adarcgs or tract # I ~ 0 ~ ~,~ P. S'YYV r 6Vl `I' R~l`~ X ~",~'' ,~~"~ C~P.~'~ ~ ~ J ' ~~, T ~_ J,~ ~ cei
c FraY,~ a~ A~ W ~, v cn
Utility trench location _]~ i(~'Q ~C' IM ~4,~^e ~S • J Z
F, Nature of work .~4ttX'1G4i O ~ _
14 ~ tl ('~d,M ~, Pr,S ~Pa1l.r lrVl 1 i+~Y~b~. qt S]-yY''C.1~' ~3' = a ~
C. Attach four (4) topics of an engineered plan showing the location and extent of the work, and four (A) copies of the preliminary Engineer's.Esrimate of >~ The ~
plans shall show the relation of the proposed work tp existing surface and uaderground improvements. When approved by the City )3nginar, said plan becomes a
part of this permit.
D. All work shall conform rp [he Ciry of Campbell Standarfl Specifications and Details for Public Works Construction; the General Permit Conditions listed on the
reverse side; and the Special Provisions for this perntit, listed below. Failure to abide by these conditions and provisions nary result in job shutdovm and/or forfeiture
of Faiththl Performance Sureties and cash deposits. (Sec General Permit Conditions t and 2.)
)3. The Convector must have this permit and approved plans at the sire and must notify the Public Works Departmene at least two days heforo starting work, Notiec
must be given ra Public Works at least 24 hours before res~~ra__it--ingii any work. ,
Name of Applicant ~sCl~r' 1 C. ('7~S ~ ~ ~.C~~ (•'t G Telephone ~ ~~ ~~ Z-~~ Z~' y 1
([~~ l (print name)
Address ~ ~ ~ ~ N .' 1)1~YtiR,~1r 24-faOUlt PIvI13RCRNCY T13L)?PHONB NO.
E-Mail Address ~.~~~- Q ~ , e,A h^
is this work being done by the property owners at their own residence`s 'yes Np
Tire Applicant/Permittee hereby agrees by affixing their signature to this permit to hold the Cl'ty of Campbell, its officers, agents and employees fro, safe and harmless
from any claim or demand for damages resulliag from the work covered by this permit.
The ApplicandPcrmiuec hereby acknowledges that they have read and understand both the front and back of this permit, and they w111 inform their contractor(s) of the
information. Applicant is advised that upon issuance of this ermit, property owner, or property owner's successors.';hall be responsible for any and all damages
arising out of the condition of any private improvements in tlr blie right-of-way- ,,jj,,..,, -
Accepted ~- +( t,,'~ OMI.ti bI Z- LI ufi
plicant Permiuee) {si } Datc
Contractor (Print Name)
Date
_I, Street shall not be open cut for undergrouufl installations. Minimum cuts be allowed far connections or exploration holes. Sueh cuts maX
/ be specifically approved bv,lli& alLsptctor p~oC SS cuttin6.
V 2, Pavement may be cut for unduground installations and must be restored in accordance with the Standard Dctaiis Trench Restoration Method
"A", unless otherwise approved by Inspector.
_3. Work to be staked by a lioensed Land Surveyor or Civil 6nginccr and Iwo (2) topics of the cut sheets sent to the Public Works Department
before starting work,
_4. Aar Section 4215 of the Government Code this permit is not valid for excavations until Underpxound Scrvicc Alert (USA) bas been notified and
the ingurry identification number has been entered hereon USA Phone [-8DD-227-2606, USA TICKET N0.
_5. Prior to any work, the property owner•shah execute an Agreement for Private Improvements in the Public Right-of-Way, which abet{ he
recorded.
_G. Public Notification Requirements; _ -
-~-
SE13 PrjBL1C'4y012ICS FBI? SCHEDLILE FOR CURRENT FEES Ij~T gfM~FfIPT NO.
PERMIT APPLICATION PBl3 $~,„„ ~~_
PLAN CINECTC 17)aPOSIT $
SECURI'1"Y POR PAITHFUL FERFORMANCB/LABOR i@. MATHRlALS $
CONSTRUCTION CASH DEP051T ~~~
PLAN CHECK 8t. INSPBCTl4N iwPE
APP1t0V13171'OR iSSUANi~E ~ 6/2~~~
For City >3ngincer Date
Permit $xpires 12 Months After Data of Issuance
1
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Jun, 22. 2009 9.50aM Pa- f'i c Gas and Electric Co, No, 4736 P, 2
GENERAI.1'~n1VIIT CONDITIONS
L A Consuuction Cash Deposit i required. Charges will be made against this deposit if Yhere is an emergency call-out, overtimh inspection or when City
ordered barricading is required. Any such costs in excess of the deposit will be billed to the Permittec-
2- A one-year maintenance period and surety are required. Such period will begin on date of written acceptance by the City.
3. Refund of the cash deposit balance and refund or cancellation of the 1?aithful Performance Surety will be initiated by the written acceptance of the work
by the City.
4. The Pcrmittee must request in wrilinP a final inspection and acceptance of the work upon completion. Acceptance by the City will be made in writing to
the POrtnittee.
5, Maintain sere pedestrian and vehicular crossings and free access to private driveways, bus stops, fire hydrants and water valves,
G. A Construction Traffic Control Plan and a Construcrion Schedule are required for all lane closures, detours and street closures. This plan must be
reviewed and approved prior ro any lane closures.
7, The Construction Traffic Control Plan shall conform to the Calrrans Manua! of Traffic Controls for Construeoon and Maintenance Work 7.oncs, dated
I990, available at Caltrans. 'Raffic conlroi equipment shall include Type ti flashing arrow signs if required.
B. Replace as direcud by the City Bnginccr any damaged or removed improvements in accordance with City Standards and Specifications al [he sole
expense of the Pcrmittee.
9. Sawcut for all PCC or AC removals, All PCC removals shall be to nearest scorcmark 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. ,
1 L Adequate signing and barricading is required on the job site, Failure to provide such signing end barricading may resuh in the City's providing signing
and barricades and charging the cost (including all labor and materiels) against the cash deposir.
t2. Compaction testing of subgrade, bast rock, and asphalt concrete by Perminee is required unless otherwise stated by the City Engineer.
13. The Contractor or Pcrmittee wilt have a supervisory representative available for contact on the project st all pmts during constmetipn. Contractor ar
Pernrittee shell provide a phone number at which they can be contacted outside the hours oP 8:00 a,m, to 4:00 p.m.
Ib. No storage of macerials or. equipment will be allowed near the edge of pavement, the traveled way, or within the shoulderfinc which would create a
hazardous condifron to the public.
15. This permit shalt 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 may be required, nor does it relieve the Pcrmittee of any obligation to obrain any other permit required by law.
] 6. This permit does not release the Pcrmittee from any liabilities contained in other agreements or contracts with the City and any other public agency,
17. Ibis permit is not transferable. Work must be performed by the Pemtit[ee or his acsignatcd agent or eonrractor as specified [hereon.
18, Call bACk (call out} due to emcrgcncies 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, applicanr shall not cause to be dtschargcd any material into the municipal storm drain system
other than storm. water. Applicant shall adhere to [he BEST MANAGBMBNT PRACTICES established by the 5anm Clara Valley Urban Runoff
Pullueicn Prevention Program.
20, if the public interest requires a modification of, or a departure from, the plans and apeeit cations, the City shalt have the authority to require ar approve
xny modification or departure and to specify the manner in wlrich the same is to be made for City-owned or maintained facilities-
21. Perntitteo must provide advance notification to all parties that may be affected by the permit activities. Notification shall be reviewed by City prior tc
'distribution and include dates of work and a contact name and phone number.
Applicant shall be respanaible for ensuring shat al] those providing services undo the applicant are aware of and understand alt of the above conditions.
l..U Gl, ~ S-P ~Cd f~~t ~ ~ f ~„ ~ o e~
Applicant Date
Contractor (Print Name)
Date
Jlforrnslpwperm
Rev. 11!9105.