ENC2006-00150CITY OF CAMPBELL
DEPT. OF PUBLIC WORKS
70 North First St.
Campbell, CA 95008
(408)866-2150
Fax (408) 376-0958
R-1 NO FEE ENCROACHMENT PERMIT
(Non-engineered work within the public right-of-way)
($5,000 ma(x~imum value of work)
ISSUED (~ 2~ 1 U
Permit Expiration Date 20 U~
Permit No ~=-N ~ 2 OC3 (~ -UCH (~j
X-Ref. File
Application Date 'Zs G
Application Expiration Date f ~ ~~
APN ~~~~ ~-~~ - (~ ~~~
APPLICATION -Application is hereby made for a Public Works Permit in accordance with Campbell Municipal Code, Section 11.04.
(Application expires in 6 months if tCh~e~permit is not issued.)
A. Work address t/ ~ ~ ~"1 C ~ I ~E (~
B. Nature of Work ~hs~~ ~l~t.~iy\.S P~/ '~Y{e ~ 1~bl~,LP t'~C;S~np
C. Attach three (3) copies of a drawing showing the location, extent and dimensions of the work. The drawing shall show the relation of the
proposed work to existing improvements. When approved by the City Engineer, said drawing 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 andlor forfeiture of Faithful Performance securities.
NAME OF APPLICANT ~, /. 'il. ,/ ~ 011 CJ~ TELEPHONE ~ ~/ ' /~/ K J
/ ~~~~ ~}~ (print name)
ADDRESS--'/ ~'/
~ ~ /~
E-MAIL ADDRESS C~~~" /~~ '~ ~~ ~~ ~M. /~ / . ~i~,-.;^
The Applicant hereby confirms that this work is being done by the property owner/applicant at their own residence.
The Applicant hereby agrees by affixing their signature to this permit to hold the City of Campbell, City of Campbell Redevelopment Agency,
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 hereby acknowledges
contractor(s) of the ipfpxtltation~.-
ACCEPTED
they have read and understand both the front and back of this permit, and that they will inform their
~~ ~ ~ °~~
(ApplicandPermittee) (Sign) Date
NOTES: All work shall conform /with the attached approved plans and all applicable Campbell Standard Details and Conditions and
applicable insurance requirements.,
The Contractor must have this permit and approved plans and must arrange to meet with the Public Works Inspector at the site at least two
days before starting work. Notice must be given to Public Works at least 24 hours before restarting any work.
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 (Ticket No.) has been entered hereon. USA PHONE: ]-800-227-2600. TICKET NO.:
Applicant is advised that upon issuance of this permit, property owner, or property owner's successors, shall be responsible for any and all
damages arising out of the design, installation or condition of private improvements in the public right-of-way.
SPECIAL PROVISIONS
1. Prior to any work, the property owner shall execute an Agreement for Private Improvements in the Public Right-of-Way, which shall be recorded.
~ --
3.
STANDARD AMOUNT RECEIPT NO.
SECURITY FOR FAITHFUL PERFORMANCE (100% OF ENG. EST.) $ ~ -
APPROVED FOR ISSUANCE `~~ -~-
fo ' y Engineer Date
Permit Expires 6 Months After Date of Issuance.
]:\forms\rlpermit
Revised 1.20.04 ~ , ~ ~~~tVJZ ~Ik
~r 7 ~
Page 1 of 1
Joanne D' Ambrosia
From: Joanne D' Ambrosia
Sent: Wednesday, September 20, 2006 4:03 PM
To: Jackie C. Young Lind
Subject: 81 Alice Ave. Historical Home
Just wanted to check with you regarding a small encroachment permit that Syed issued today to the homeowner of the above
address for a replacement tree that he has already planted in the parking strip (City right-of-way). In entering the permit on
PERMIT PLAN, I saw there was a "tag" on it for a historical residence. Are there any historical restrictions for trees in the public
right-of-way? Apparently, the neighbor accidentally knocked down the existing tree with his car. Syed has received approval for
the tree type from our Maintenance Division as is our usual procedure.
Joanne D'Ambrosia
PW Department
x2701
9/20/2006
GENERAL PERMIT CONDITIONS
1. Payment of a security to insure faithful performance and completion of the work is required. This security is refundable upon
completion of the work and written acceptance by the City.
2. A one-year maintenance period for all work is required. Such period will begin on date of acceptance by the City. It is the
applicant's responsibility to remove and replace unacceptable improvements within the one-year maintenance period.
3. 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, fire hydrants and water valves.
6. 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.
7. Sawcut for all PCC or AC removals. All PCC removals shall be to nearest scoremark and shall be doweled to existing
improvements.
8. Adequate signing and barricading is required on the job site. Failure to provide such signing and barricading as specified by the
City Engineer may result in the City's providing such signing and barricades and charging the cost to the permittee.
9. The Contractor or Permittee will have a supervisory representative available for contact on the project at all times during
construction.
10. This permit shall be kept at the site of work and must be shown to any authorized representative of the City of Campbell or any
law enforcement officer upon demand.
11. No storage of materials or equipment will be allowed near the edge of pavement, within the traveled way, or within the
shoulderiine, which would create a hazardous condition to the public.
12 othterpworktfor whicoh aeseparate permaum ytbetrequuedXnor does to elievelthe Permittee of anytobligat on to obtainoany other
permit required by law.
13. This permit does not release the Permittee from any liabilities contained in other agreements or contracts with the City and any
other public agency.
14. This permit is not transferable. Work must be performed by the Permittee or his designated agent or contractor as specified
thereon.
15. 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.
16. Call Back (call out) due to emergencies regarding this permit shall be at the current overtime rate with a three (3) hour minimum
charge per occurrence.
18. 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.
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.
Applicant shall be responsible
above concji~ons. '
that all those providing services under the applicant are aware of and understand all of the
Applicant
/~ ~~
(r .
Date
J:\forms\rlpermit
Revised 1.20.04