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ENC2008-00130Sip 23 08 08:56p CITY OF CAMPBELL ENCROACHMENTPERMIT DEPT.OF PUBLIC WORKS (for working within the public TO North First Street right-of way Campbell, CA 95008 Ph. (408) 866-2150 Issued Fx. (408) 376-0958 C' ~ i Permit Expiration Date /-~ APPLICATION -Application is hereby made for a Public Works Permit in accordance (6) months if the permit is not issued. Application Fee is non refundable.) 408 957 0343 p.2 1 Print i'orm r-~ Permit No ~-V C ~'~~' ~ ~- ©~ ~ -~ G ~`' X-Ref. File Application Date ~- ~ ~- Appliwtion E~xPiration Date ~-~ APN `'~ z'7 - -~3 - ~ ~ ___... Campbell Municipal Code, Section 11.04. (Application expires in six -------- A. Work Address or TractNo.: ~-UvSS -fig-r+~t S'`~ 1 ~ iV ISIt}vv s=j- ~~~~~~ __ ..~_____... _--- --- ---,qq-------- UtilityTrench Location: ~ ~ •~ ~ P ~ ~t 2 Q Q B. Nature of Work: ~~-P'T T~1Mp9'l4~-~ 7t'Le- ADMINISTRATION 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. Ail 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 [he 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. - _. I--------------------__--_. --------- ~. Name of Applicant: CFSYVt~cth~{~ C~~t~_ ~~~ Telephone: i~~ 7 ~b~ L-~-p j Address: 'ZCjOr? __._-~CLr`L'7 L~ -LL l.aYt<~v-c~ ~ C~ (~¢s~-U~__.__ E-Mail Address: ,,J2Lt.ir1, ~ ~~ CCLI9~ • ~a~/r~L[t.~^' CAy/s 24-HOUR EMERGENCY PHONE NUMBER: Is this work being done by the property owners at their own residence? - YES i /NO The ApplicanUPermittee 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 ordemand for damages resulting from the work covered by this permit. The ApplicanUPermittee 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 and all damages arising out of the condition of any private improvements in the public right-of-way. Accepted: ~ ca ~ o~j (Applicant Permittee) {sign) Date (tontractor) (Print Name? 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 ma specifically approved by the Inspector prior to cuttino. 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 (~) copies of the cut sheets sent to the Public Works Department before starting work. 4. Per Section 421 S of the Government Code this permit is not va{id for excavations until Underground Service Alert (USA) has been notified and the inquiry identification number has been entered hereon. USA Phone: 1 X00-227-2600. 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: 7 S~,E __.E PUBLK WORKS FEE SCHEDULE FOR 4URRENT FEES AMOUNT 32 PERMIT APPLICATION FEE S PLAN CHECK DEPOSIT S SECURITY FOR FAITHFUL PERFORMANCE/LABOR & MATERIALS 5 CONSTRUCTION CASH DEPOSIT S PLAN CHECK& INSPECTION FEE 5 0 APPROVED FOR ISSUANCE RECEIPT NO. -_. ~i2~~~~ Permit Expires 12 Months After Date of Issuance (C y.` I ~/1 ~ /~ ~~ Sep 23 08 08:57p 408 957 0343 p.3 ~r T~~n ~ Palms ~ ~~ ~ ~IS~' ~_ C ~_ Q z. h iuw~ b-l-S 7 ° / S -~ ~ ~' `'~ ~~'~{-{- GPI- rte-' ~- ~~ S 1~j ' l~' L,~~ ~-1-~ 61 S ~ ~ ~- Cxtisr 1~ak D~~nls,3, a ~ ~~+~F- ~t~o ~S ~ ~~ ~ 5~a APPRC~V!~~ ~=~ ~ CONSTRUCTIt~N. ~E~~~ .-~~ ~ ~.r~pbe~~ =~ u blic 1f~/ar~;v ~'~;r mc~ ~ ~Vo.~r~~.L C`y-- ~' 13 ~~ lomroc-or mus- bore rhea. plnr av the Job ~Ne daring ooeslruerier~ ~~ Sep 23 08 08:57p ~,~ i~ f ~~ ~~~P ~~~ 6~7 ~ ~,~J e C ~~ 408 957 0343 p.4 ~0~/"~~ ~ I~y~,~ (~IC~A,S i Sep 23 08 08:57p 408 957 0343 p.5 t 9! Shoulder Work on Undivided Highways SIGN SPACING ft.) TAPER LENGTH ft. OPTIONAL CNANNELIZ ER SPACING ft. SPEED Undivided IS) Divided (s) Shoulde (T1) Lane (T?) SUFFER LENGTH (ft.) B Tapers Bufferl Work Areae 0-35 200 - 70 - 120 35 50 40-45 350 - 150 - 2Z0 40 100 50-55 500 - 185 - 335 50 100 80-70 1000 - 235 - 550 50 100 r Shoulder taper length based on 10 ft. (standard shoulder width) offset Z Lane taper length based on 12 ft. (standard lane width) ofset TYPE ROADWAY SIGN MAXIMUM HEIGHT WORK ZONE LENGTH {L) URBAN 1' Portable ' 1 Mi 7 Post RURAL UNDIVIDED ~ ~ Portable ' 3 Mi. Post 5 Notes: In addition to shoulder work, this typical application is applicable to work beyond shoulder where vehicles and equipment are parked on the shoulder. A protective vehicle shall be used while work is in progress. The protective vehicle should be equipped with a TMA and positioned at least 150 ft. in advance of the work space. if encroachment onto driving surface occurs and there is not 10 ft. of driving surface available for the lane of traffic, that traffic lane shall be closed. Refer to appropriate lane closure typical applications. If an arrow panel is used for an operation on the shoulder, the caution mode shall be displayed. For shots duration or mobile operations, signs, chatmclization devices and protective vehicles may be reduced or eliminated if a work vehicle with activated rotating lights or strobe lights is used. However, if limited sight distance exists in a stationary operation or workers are ors foot, a protective vehicle should be used. This protective vehicle should be equipped with a TMA and truck mounted flashing arrow panel and positioned at least 150 ft. in advance of the work space or work vehicle, as applicable. If a protective vehicle is used, a vehic)e mounted sign shall be mounted at a recommended height of 48 in. above the road surface. For work beyond shoulder, where vehicles and equipment are parked on the shoulder, the protective vehicle may be eliminated if a work vehicle with activated rotating lights or strobe lights is used. Additional warning signs shall be erected at each intersection with another state highway within the work zone. Upon the discretion of the supervisor, additional warning signs pray be erected at other intersections within the work zone. Other appropriate signs may be used in lieu of SHOULDER WORK AHEAD sign. ~ Chartnelizer Cone or Drum Protective Vehicle i Sign ® Truck Mounted Attenuator (TMA) fi Truck or Trailer Mounted Attow Panel ® Work Space I ~',l r G ~~:_,~~ ~' `i •~,i ., t , ~, , l s, .E Protective Vehicle Roll-Ahead Space T1 S sHtyul.rri 1MtJttlt' nH~o TA-2 Sep 23 08 08:58p 408 957 0343 p.6