ENC2008-00157~rI'X~ OF CAMPBELL ENCROACHMENT PERMIT Permit No. ~~i~--~~~"~~~ ~ t
DEPT. OF PUBLIC WORKS (for working. within the Ref. file
70 North First St. public right-of--way)
Campbell, CA 95008
(408) 866-2150/ ~ ZE, 4 ~ ~3 Issued ~ Z ~ ~~ Application Date l Z- ~i -U ~
Fax 4(408) 376-0958 Permit expires in 12 months Application expires in 6 months
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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 the permit is not issued. A pliration Fee is non-refundable.)
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A. Work address or ttaa t ~~I ~ N i'a Wt Jr U ~ - - `I S Sin
Utility trenvt location
B. Notate of work _~ ~CgU A Yf ~ ~ V1STGt' ~ ~ PN ~dl ~
C. Attach four (4} copies of an rngineered plans showing the lacazion and extent of the work, and four (4) copies of the preliminary Engineer's Estitttare of work. The
plans shall show the relation of the proposed work to existing surface and underground improvements. when approved by the Ciry Engineer, said plan becomes a part of
this permit.
D. All worst shall conform to the Ciry of Campbell Standard Spxificaziotu and Details for Public Works Cotutrvaion; the General Permit Conditions listed on the reverse
side; and the Species[ Provisions for this permit, listed below. Failure to abide by these conditions and provisions tray result in job shutdown and/or forfeiture of Faithful
Performaace Sureties and cavh deposits. (See Grneral Permit Conditions 1 and 2.)
E. THE CONTRACTOR MUST HAVE THIS PERMIT AND APPROVED PLANS AT THE SITE AND MUST NOTIFY THE PUBLIC WORKS DEPARTMENT AT
LEAST Two DAYS BEFOQRE~S~TARTING WORK. NOTICE MUST BE GIVEN TO PUBLIC WORKS AT LEAST 24 HOURS BEFORE RESTCA~RTING ANY WORK.
Name of Applicant ~~ ~`~ Telephone 2 1~ - (~ )~
3T ~ Sty not name) r
Address V G g.•~t1, ~1 • ~ ~qvt ~p'S 24 HOUR EMERGENCY TELEPHONE N0.
15 this work being done by the property owner az their own residence? Ya ~No
The Applicant/Permittee hereby agrees by affixing their signature to this permit to hold the City of Campbell, its officers, agents and employes free, safe and harmless from
say claim or dct*.ta^.d for ~+=m2gs raulcirg from the work c.,ver~ by phis pc.^tit.
The Applicant/Pertrtivee hereby acknowledge thaz they have read and understand both the front and back of this permit, and they will inform thew contrat:tor(s) of rho
iafotmazion.
(sign)
Date
SPECIAL PROVISIONS - -
1. Street shall not be open cut for underground installations. Ivfinimum ats may be allowed for cocuteaiotu or czplorazion holes. Such cuts may be soccifitxlly
anoroved by the Insoectororiorto cuttine. - - ..
2. Pavement may be cut for underground installations and must be.testored in accocdanix with the Utility Trench: Ratoraaon Siattdard Details, Method 'A' Baclcfill,.
_.
unless otherwise approved by Insparor.
-~` Work to be staked by a iitxtued Land Surveyor or Civil Engineer and two (2) t:opis of the cut shalt sent m the Publ'te Works Departmetu before starting work.
V 4. Per Sectioa 4215 of the Govsrntnenc Code this permit is nor valid for:ext:avations until Undorground`Service:Alett, (USA) has hoes notified oral the inquiry
identification number has been emered.hereon..USA Phone:1-80(0227=2600. USA'TICKET:NO.
_: - .
.SEE PUBLIC WORKS FEE SCHEDULE FOR CURRENT FEES TYPE ' • AMOUNT RECEIPT NO:
.:PERMIT APPLICATION FEE u~
,s ~~ '~
'PLAN CHECK DEPOSIT :: ;
SECURITY FOR FAITHFUL PERFORMANCE/LABOR & MATERIALS S
CONSTRUCTION CASH DEPOSIT S
-PLAN CHECK & INSPECTION FEE ` S~'?~~
APPROVED FOR ISSUANCE '~ L'~. f l -t/
for City nginetr ate
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ENERAL PERMIT CONDITIONS
1. A CONSTRUCTION CASH DEPOSIT is required. Charges will be trade against this deposit if there is an emergency call-out, overtime inspection
or when Ciry ordered barricading is required. Any such cosu in excess of the deposit will be billed to the Permittee.
2. ALONE-YEAR MAINTENANCE PERIOD AND SURETY are required. Such period will begin on date of written acceptance by the Ciry.
3. REFUND of the cash deposit balance and 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 accept2nceof the work upon completion. Acceptance by tfre Ciry will be trade
in writing to the Permittee.
5. MAINTAIN safe pedestrian and vehicular crossings and free access to private driveways, bus stops, fire hydt~nu and water valves..
6. A CONSTRUCTION TRAFFIC CONTROL PLAN and a CONSTRUCTION SCHEDULE is required for all lane closures, detours and street closures.
This plan must be REVIEWED and APPROVED prior to any lane closures.
7. The CONSTRUCTION TRAFFIC CONTROL PLAN shall conform with the Caltrans Manual of Traffic Controls for Construction and Maintenance
Work Zones, dated 1990, available at Calttans. Traffic control equipment shall include Type II flashing arrow signs if required.
8. REPLACE IN KIND any damaged or removed existing improvements, including planting.
9. Sawcut for alI PCC or AC removals. All PCC removals shall be to nearest scoremark and shall be doweled to existing improvements.
I0. OVERTIME INSPECT);pN PREMIUM will be charged against the cash deposit for inspection required outside the hours of 8:00 a.m. to 4:00 p.m.
at the current overtime rate; minimum one hour charge.
I1. SATURDAY INSPECTIONS must be arranged in advance. Saturday inspection time is charged at the current overtime rate with a Three hour
minimum. Advance payment for the estimated time is required.
12. Adequate signing and lighted BARRICADING is required on the job site. Failure to provide such signing and barricading may result in the City's
renting such signing and barricades and charging the cost (including all labor and materials) against the cash deposit.
I3. Compaction testing of subgrade, base rock, and asphalt concrete by Permittee is REQUIRED unless otherwise stated by the Ciry Engineer.
24. The Contractor or Permittee will have a SUPERVISORY REPRESENTATIVE available for contact on the project at al] times during construction.
Contractor or Petatittee shall provide a phone number at which they can be contacted outside the hours of 8:00 a.m. to 4:00 p.m.
I5. No STORAGE of materials or equipment will be allowed near the edge of pavement, the traveled way, or within the shoulderline which would create
a hazardous condition to the public.
16. This permit shall 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 Permittee of any obligation to obtain any other permit required by law.
17. This permit does NOT RELEASE the Permittee from any ]iabilities contained in other agreements or contracts with the Ciry and any other public
agency.
I8. This permit is NOT TRANSFERRABLE. Work must be performed by the Permittee or his designated agent or contractor as specified thereon.
19. 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.
20. 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 [o the BEST MANAGEMENT PRACTICES established by the Santa Clara Valley Nonpoint Source
Pollurion Control Program.
Applicant shall be responsible for ensuring that all those providing services under the applicant are aware of and understand all of the above condirions.
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SSD: SWITCIi 889
"B"INSULATION DISTRICT
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CRONWELL
IFOR MORE INFORMATION PLEASE CONTAC
PROJECT MANAGER: TONY LEWIS O (805)548-1231
ADE :DONNA KOVACH O (408)722-5222
ESf1MATOR :DEBRA 9ATfH O (408)722-5262
II ENVIRONMENTAL ISSUES STAMP I
Type(s) of Work:
^ New Business
® PG&E MDintenonce & Construction
Project Conditions:
® NONE APPARENT (it project design changes, contact A0E)
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^ CONDITIONS APPLY:
^ PERMITS ^ TAILBOARD ^ OTHER
(Provide adtlitionol information on line below)
BY:
SIGNATURE, NAME, [CORPORATE ID], DATE
EST: DEBRA SMITH
ADE: DONNA KOVACH
SUPV: WAYNE LEDBETTER
REP: TONY LEWIS
PLNR:
SCALE: DATE:
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OVERLOADED JOINT POZE REPLACEMENT NOTIF: 103169177
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TOP & RELINQUISH:
50' CL3 JOINT POLE
SET & SOLD_1962
INSTALL NEW:
50' CL1 JOINT POLE
PG=25,783 LBS
PT GRADE: 24
SAFETY FACTOR: 4.50
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