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ENC2008-00161_ _ , -ENC2D('~8- COI ~~ ~ ' CITY GF CAMPBELL ENCROACHMENT PERMIT t Per7lit l a bEPT. OF PUBLIC WORI:S (tor working within the public X-Ref. File. ~ 70 North First St. ngh[-Uf-way) Campbell, C.A 9500S 2 I ~~ IG~I Application Date 12 /2008 ~ ~~ (408) 8bb-2150 Issued Application Expiration Date Fax (d08) 376-0958 2 I I ~ (U i i D P E p APN ~~ O Q + - ~Zy rat ate emut xp on ,~ APPLICATION - Applicaticm is hereby made far a Public Works Permit in accordance with Campbell Municipal Codc, Section 17.04. (Application expires in six1 months if the permit is noc issu•;.d. Application Fee is pan-refundabie.j *~.~ work address or tract* 655 Creekside Wy., Campbell A PM# 30616934 "~ . utility trend, iacaciatt Intersection of Hwy 17 off-ramp and Creekside Wy s. Natnre of wark PG&E to trench and install gas service ' ' " as engineered plan showing the iacatioo and extent of the work, and faun {4) C. Attach four f4) copies dr t:apies of the preliminary Engittear s Estimate of work. ThC'~ plans shall shave the relation of the pmpased wark to existing surface and underground improvements. When approved by the City Engineer, said plat. becomes a part of this permit. D. All work shall conform to the City of Campbe[I Standard Spceiftcations and Details for Public Warks Construction: the Genera! Permit Conditions listed an the reverse side: and the Special Provisions far this permit, tilted below. Failnrc to abide by these conditions and provisions may nsutt in job shutdown andlor forfeiture of Faithful Pcrfnrrztance Sureties and cash deposits (See Genera! Permit Conditions l and 2.) E. The Contrat>tur must have this permit and apnrnved plans at the site and must notify the Public Works Department at le;tst two days before startle; warn. Notict: must. be n van to Public Works a[ least 24 hours before restarting any work. Narne of Applicant PG&E Telephone (408) 722 - 521 1 (print name) Address 900 Lightpost Wy., Morgan Hill 24-HOUR EML-RGENCY TELEPHC)NE NU E-Mail Address is this wort: being done by the property owners at their own residence" Yes ~ Na Tnc Applic:tndPe-rmittce hcrchy agrers by affixing their signature to this perntit to ha]tt the City of Carrtpbe!!, tts offices, agence artd employees free; safe and harmless from any claim or demand for damages resulting from the wark covered by this pertr5it. 'T'he Applicant/Permitter. hcrchy acknowledges that they have read and understand both the fmnt and hack of This pcrrtrit. and they will reform [heir conuacux{s; of the. infortnauan. Applicant is advised that upon issuance of this permit, praprrry trwmer, or property owner's successors, shall be responsible for any and all damages arising out of the condition of ary privau: improvements in the public right-ot-way 12/11 /2008 7 f ~~ l/ ^-'~ ~, S ~ ~(,~pplicant Petmittee) (sign) Uatc Contractor (Print Name) Date. I . Street shall nut. he open cur for undergrtmnd installations. Minimum cuts may; he allowed far connections or exploration itolc:;, Such cuts may !rc specifically anProved by the lnsoectnr prior to cn [ltn~. ___'. Pavement may he cot. for underground installations and must be restated in accordance with the Standard Details Trench Restantian Methtxi "A", unless otherwise approved by Inspector. _3. wark eo be staked by a licensed Land Surveyor or Civi] Engineer and two (3) copies of the cut sheets sent to the Public Warks Deparunem before starting work. _,,,_.4 Per Section 4215 of the Ciovemmertt Code this permit is pat valid for excavations until Underground Servee:.Aiett (USA) itas been notified and the inquiry identification number has'ne.~n entered hereast. USA Phone i-800-237-600. USA TICKET NO. _ Prior tc any wort:. the prope,~ty ow7tcr sl;al' caccutc an Agretatlea; for Pt'ivatc improvements to the I'uilic RiAht•af-way, w[;i;:h shall be recorded. ____6 Public \'otificatior, Tieyuiremen[s SEE PLi13LIC WORKS FEE SCHEDULE FOR CiIRRF..NT FEES AMOUNT RECEIPT N0. PERMIT APPL]CAT10N FEE ~ SYS PLAN CHECK DEPOSIT SECURITY FOR FAITHFL7L PERFORM.ANCE+~vADOR & MATERIALS g CONS"TRUCTTON CASH DEPOSIT 5 PLAN CHECKS 1TJSPECTION FEE g.~t~=q ~L-~ AI'PRO~rED FOR lSSU.ANCF_ ~ ~ '«1G For City Engineer Date1 Permit Exntres 12 Months After Data. of Issuance Z ~ YO o ~x: ~ Y.~, U N C_.3 J ? "1.I m ~ e_._~ a 0 CONSTRUCTION NOTES: ~ PGdcE TO TRENCH AND BACKFlII.OFF-S(1E f PGdcE TO INSTALL GAS SERVICE IES~lQ: _i I I I I ~ I I I ~I ~ V ~I -~ a ; ~ ~ { ~I r ~~ ~-~ ~ ~ a .~ 3 ~ '~ ~-0 ~._ ."~... ~ o il..l ~ ~ u o ~" 4 ~_ w-si.---- n., ~ ~Q a 5' (,7 N I I i - - - - - - - PROPOSED GAS SERVICE ' -------- ~ -~-------- EXISTWG GAS FACIItf Y I _..~..__ ~~ . EXISTpJG sroRU DRAIN i f -----SW EXISTING SEWER FACIL((IY --~---~- V+1 EXISTING WATER FAC~liY I ~ M 30616934 3412-H6 f~ILX-NONE I sHUTDOwN AREA WSJ AREA a-15 ~ so tic ~ I CAwIPBEII _ .•~ u a -~ 17 OEf ~P ~ _~. - __-- .~.-- w wAU ~ ~ ~ ~ I _`"y~' BOX ~ I u7 G 2' pL 5' 655 N c~ c~ °' " ° T~ w ~ PERMIT DRAWING N0~' >!oz~945~ su~v: cn~tle Diaz 655 CREEKSIDE WY ~` °sra~° ~ CAMPBELL sNT: s NT:lrs ~NTC ~ SCALE: N.T.S. DA 2 13 2009 , PACIFIC GAS AND ELECTRIC COMPANY •30616934 1 STATt: UT CALIEfl12;~1A • 1jEPART~1lrN'r OI'TRANSPORTATION ENCROACHMENT PERMIT 7"R-0.120 Irt cotnpliance with {Cfaeck aJe): llist/Co/Rte/PM 04-SCL-17 12.2 Yow• application of December 24 2008 Pee Paid ^ Utility Notice No. ^ Agreement No. of of ^ 1~W COntCRCt No. Of TO: ~ Pacific Gas and. Electric Company 111 Almaden Boulevard, Room 814 San Jose, CA 95115 Attn: Alfred. Poon Phone: (408) 282-7544 Deposit Performance Dond Amount (I) (Paynrent Bond Amount (2) fiormd Company (1j ~ Bond NumUer PERMITTEE and subject to the following, PERMISSION TS HEREBY GRANTED to: Trench and install about 145'af 2" plastic gas service on State Highway 0~1-SCL-17, Post Mile 12.2, at the northbound Route 17 off-ta'mp into the Creekside way in the City of Campbell. A minimum of one week prior to the stat~t of work under this permit, notice shall be given. and advance approval of construction detail, operation, public safety and traffic control shall be obtained from State Representative, Jim Wong, 500 Queens Lane, San Jose 95 l 12, (408) 452 713 1, weekdays, beriveen 7:30 AM and 4:00 PM . All permitted work requires the permittee to apply for and obtain a work authorization number prior to the start of work. See the attached "Encroachment Permit Project 1'Vork Scheduling Procedures" and the attached "Permit Project Work Scheduling Request corm". Additional time beyond the minintutn seven day advanced notice required in the above paragraph. may be required for obtaining approval . The following attachments are also included as part of this permit (Check appliea6le): In addition to fee, the permittee will be billed actual costs Corr ® Yes ^ No General Provisions ^ Yes ®No Utility Maintcnauce Provisions ^ Yes ®No lieview Yes ^ No Storm ~'Vater Special Provisions " ®Yes ^ No Inspection ^ Yes ®No A Cal-OSI IA permit roquired prior to beginning work: ~ Yes ---------Field Work ~t (If ary Cnlhamis effort expended) ^ Yes ®No The int'onnation in the environmental documentation has been reviewed and considered prior to approval of this permit. This permit is void unless thcwark is completed before March 3I, X009 ~' ~~ -' t `I'bis permit is to be strictly constnmed and no other work other than specifically mentioned is hereby autlmorizcd. No project work shall be comnmcnced until all other necessary permits and environmental clearances have been obtained. APPRQVFD: KR CC: Bob Salazar (2), J.Wong Dist. "Traffic ManagetlP. Chan BT ~;,Ll-.SAB„ IPT District Director ~- TMC/ J. Richardson, Traffic System/1'. Chan " t3Y: City of Campbell ~ ~u____ MICHAEL D. CO DIE, District Permit Engineer ~~ ,~ .. Pa3e 1 F,} NA~F,; kacific Gas And I:IcetciaCompany fL'RMIT#:0408-bUL2196 DATE: January 12, 2009 When approved, traffic control performed under this permit shall be in accordance with the appropriate State Standard Plans T-IO through T-14. Where rewired by the plan, the use of a flashing -arrow-board is MANUA'I'O1ZY. See attached Standard Plan 1'-11. For shoulder closure ,.see Standard .Plan Sheet T-I O. Parking may be restricted, as needed.. Traffic c~ratrol and .lane closure on northbound Route 17 off-ramp is authorized from 9:00 AM to 3:00 PM, Morrday through Friday, holidays excepted. Provide two lanes of through traffic on off-ramp and left and right trans egress onto the Creekside way, also provide one through traffic lane in each direction of the Creekside way during the traffic corit4ral hours. Lane closures is not authorized at any other times. The .site of the work shall be enclosed by suitable ban•icacies, sighs and lights, as approved by State's representative, to warn and protect traffic effectively. Excavations made within the limits of the highway shall be backfilled before leaving the work f'or the night unless otherwise authorized by State's representative. After backfilling the trench, temporary surfacing shall be placed if reg~ured by State's representative, Open trenching is authorized one lane at a time with necessary traffic control as required by State's representative to keep traffic moving in both directions during working hours with as little inconvenience thereto as possible; and if at the end of the working,. day backfilling operations have not been properly completed, steel bridging shall be required in accordance to the attached "Reguirement for Temporary Steel Plate Bridging With a Norr-Skid Surface" to make the entire highway facility available to the traveling public. Trench backfill shall confor•rn to Section 19-3.06 of the State's. Standard Speeificat.'tons and the curretlt edition of the Standard Plans. Tests for relative compaction of structure backfill material used in baclfilling trenches may be made in accordance with Test Method. No. California 231 (Nuclear gauge). Any base, surfacing or pavement shall be replaced in kind, or as otherwise required by State's representative. Trench. restoration shall conform to the attached detail plan. Pavement to be removed shalt be saw cut to a minimum depth of 100 mm (4") to provide a neat and straight pavement break along both sides of trench. Asphalt concrete (AC) pavement shall be saw cut to the full depth. Sidewalk shat) be broken and removed to the closest scoremark and shall be reconstructed with portland cement concrete placed to a depth of 90 mtn (3.5"). A monolithic pour of sidewalk and club and gutter shall not be permitted. Any damage to the existing State facilities shall. be repaired at permittee's expense. Certain details of work. authorized hereby are shown on permttee's plan submitted with request for permit. Minimum cover over proposed facility shall be 36" Page 2 of3 NAME: Pacific Gas and Electric Company PERMf'CN: 0108-GUL2 ] 9b DATI; January 1Z, Z009 All 1'ermittee's personnel shall wear appropriate personal protective equipment, including hard hats and bright-colored vests, shirts or jackets with. retro-reflective iiiaterial while on State highway right-of--way. All utility work shall: be performed in accordance with the appropriate .provisions contained in the Department of Transportation )/ncroachrnent Permit Utility Provisions dated .lanua~y, 2007. Permittee shall be billed for any additia~al inspection cost at the current Caltraiis rate of $82.00 per hour. Immediately following completion of the work permitted herein, the Permittee shall fill out and mail the notice of completion attached to this permit. Page 3 of 3 $TATS OF CAL•TFO)2N1A, DEPARx"biLNT OF TRAbiSPORTA'CION FNCROAi'fltifENTDERMIT GENERAL PR4VISIUI\S TR•4D45 (ItEV.45r2D07) 1. AUTHORITY: The f„lcpartmcnt's authority to issue encroachment perntits is provided. under, lliv- I, Chpc 3, An. 1, Sect. 6GU to 734 of the Sveets told Highways Code. 2. REVgCATIC?N: F.nCroaahtt+cnt pcttnits arc revocable on five days 13. notice unless otherwise stated on the penult and except as provided by Iaw for public corporations, franchise holders, and utilities. These General Provisinns and the F,ncroachmt»t Pcrntit L7tillry Provisions are subject to modification or abmgatiou at any time. PCrmiuces' joint use agreetnentc, frenchisc rghu, rC,actved rights or any otTter agreomentc fur operating purports in State highway tight oC way arc exceptions to ibis revocation. 3. DENIAL FOR NONPAYbi6N'I' b)r CrI;ES: Failure to pay permit fees when due can result in rejection of future apPlicadnns anti denial ofpcmtits. 14. A. ASSIGNi19F.NT: Hu party other :hen the pcmrincc or pcrmittee's sutheriv<d agcrtt is allowed to work under this gerrnit. 5. ACCLP'rANCE OF PRUY1S1ONS: Permittee understands and wets to accrpt thacc Cicnarai Provisions and all attaChtrtents to this permit, fur any work to be performed uodcr this perthit. 6. t3$GINNiNG OF ~YURK: When traffic is not impacted (sea Number 35}, the pcrmittca shall notify the DepardnenPs representative, two {2) days hefore the intent to start pcnnittcd work. Pennittee shall notify the Departrrrent's Representative if dtc work is to be i11tC(rupud for a period oC five {5} days or nwrc, unlccs othcnvisc agrCCd upon. AD work sltitU be performed cm weekdays during resular work hours, excluding holidays, unless otltecwise specified in this perittit. 15. 7. STANllAt2DS QF I~UNSTRUCTION: All work performed within highway right of way' shall confarnt to rccogttizcd construction standards and currant fkpartrrtcttt Standard Specifications, Department Standard Plans High and Low Kick Faclltry Specifications, and Utility Spacial. Provisions. where reference is mide to "Contractor and irtrginccr;' these era antcndcd to be iced as "Permitter and Departtnant representotive." K. PLAN CHANGES: Changes to plans, speciGCations, and permit provisions arc not allowed without prior approval from the State representative. 9. INyYELTtON AND APPROVAL: AD work is subject w monitorin}; and inspection. Upon completion of work, pettniute shall request a Gnat inspection for acaptancc and approval by the Department. The local agency pexmitiee shalt not givo final Construction approval to its contracror until final acceptance end approval by the Deparunent is obtained. li). PERMIT AT WORKS1TEt Petrnittee shalt keep the permit package or a copy thereof, at the work sift and straw it upon request to any Dcparttncnt representative or law enforcement officer. if the permit package is not kept and made availabic at the work site, the work shall be suspended. 11. CONFLICTING 3rNC:ROACHiNENTS: PcrmittCO shelf yield start of work to ongoing, prior authorized, work adjacent to or within dre limits of the project site. When exisdn& encroachments conflict with new work, the permittee shall bear alt cost for rearnatgemants, {a.g., ratocati0n, attcnction, renwval, etc.). ' 12. PERhit1'$ FROM OTHER AGTsNCiI;S: Tills permit is invalidated if the pottniuee has not obtained all permits nacescary and required by law, from tht Dublin U41iti~ Commission of the State of California (PUG), California UccupaGonnt Safety and Hcatth Adrnintstrati4n (Cat-OSHA), or any other public agency having jurisdiction. PEDESTRIAN AND BICYCLIST SAF<:TY: A safe minimum passageway of d' shall be maidtaineel through the work Brea at existing pedestrian or bicycle facilitlCS. At n0 time shall pcdcKtrians be diverted unto a portion of the strCCt usCd for vehicular traffic. At locations where safe altcrnatc passageways cannot be provided, appropriate signs and barricades shalt be htstatlcd at the limits of construction and in advunce of rho limits of Consvucdou at the nearest crosswalk or interection to detour pedestrians ro facilities across the 9trcct. Anention is directed to Section 7-1.49 Public Safety of the tkpattmcntStaudard Specifications. Yt1[31,I1,: TRAFFIC CONTROL: AS required by 1nw, the pennittee shall provide traffic control protection warning signs, lights, safety devices, etc., and take all other measures neccsrary fnr traveling public's ea.fcty lwhilC providing d'affic control. the nerxfs and control of all road users (motoriaLs, bioyetists and pcdCSaians, including persons with disabilities in necordance with the Americans with Disabitfdgs Act of 1990 (ADA)j shalt be an essential part of rho work aetlYity. Day and night time lane closures shall comply with the Catifnrnia Manual on Unifirnn Traffic Control Devices (Part b, Temporary Traffic Conwl), Standard Plans, and Standard Specifications Tor traffic control sysxme. Y7reae General Provisions are not intended w impose upon. the petmittee, by third parties, any duty of standard of tare, greater than or different from, as required by law. MQVYhitJhl INTERFERENCE WITS TRAFFIC: PcmuttCC 5hllli Platt and conduct work su as w create the icastpOSSible inconvenience to the traveling public; traffic chull »nt br tmroasonably delayed. On rnnventfonal highways, permiRee shalt Plata properly attired flagger(s) to stop or warn the traveling public; in comptiancc with the Californim Manual on Uniform Traffic Control Devices {Chapter 6E, $laggcrCantrol). ib. STORAGE. OF EQUIYriiENT ANIs MATERIAt,S: Thv storage of cquipttunt or matcrialc is no allowed witl»n State highway right-uf- way, unleus2eClflgtl within the Special Provisions of this aptxific eneroachn>ent permit. If GnCroachmant Permit Special Provisions allow for the storage of equipment or materials within the State tight of way, the equipment and rtrateria{ storage shall comply with Standard Specifications, Standard Plans, Special Provisions, attd the Highway Design Manual. 'fhe clear recovery zone widths must be followed and era rho minimum desirable for the type of thciiity indicated bolow; iree~mys attd expressways - 30', conventional highways (no curbs)' ZO', convardonat highways (with Curbs) - 1,5'. If a fixed object Wnnol be eliminated, moved outside the Clear recovery zonq nr rnoditicd t0 be reads yielding, ii should be shielded by a guardrail or a Crash Cushion. 17, CAItt: 4F DRAINAGE: Pt:rmittCe shat) provide alternate drainage for any work interBering with an existing drainage facility in wmplianco with the Standard SpecitcaGons, Standard Plana and/or as ditecteti by the Departrnent'a rcprCSCntativC. 18. RESTORATION AND REPAIRS IN RICH'C Oi* WAYt Pennittee is responsible for restoration and repair of Smte highway right of way resulting Ytom permitted work (State Streets and Highways Codc, Sections G70 et. seq.). t9. tLtGIiT OP tiYAY CLEAiV UP: Upon completive of wont, pcrminee shall remove and dispose of ail scraps, brush, timber, materials, etc, off the right of twat'. The aesthetics of the highway shah be as it vac befnro work started, 20. COST OF WORK: Unless stated In the permit, or a separate written agreement, the pctmittee shall bear all costs incutsed for work within the State right of way pod waives all claims for inderrmificatian or contnbutton Crom the State. Z1. AC!'UAt, COST l3ILLfNCr When speci[ied in She permit, the Department wilt bill the pertnittca actual costs at the currently set hourly rite forencroachtttent permits. Z2 AS•1}UILT PLAN!i: when required, pcrmittcc shell submit one (1) set of folded as-huiit plans within thirty (30) days alter completion 25. and approval of work in compliance with requirements tiered as tot Tows: 1. Upon romplction of the work provided herein, the pcrmittee shall send one vellum or paper -et of As-built plans, to the State representative. Mylar or paper sepia plans are not acceptahlC. 2. All changes in the work wilt be shown an the plans, us issued with rho permit, including changes approved by Encroachmrnt Permit Rider. 3. The plans aro tq be stamped or othrnvisc noted AS•DUILT by the petrr:ittce`s rdpresentative who was responsible fur overseeing the work. Any original plan that was approved with a Stale stamp, or Galtraus representativd signature, shat] be u+cd for ptnducingYhe Aa-13utlt plans. 4. If As-Suitt plates htcludt signing or striping, the dates of signing or rtripitrg removal, relocation, or installation shalt be shown on the plane whet required as a condition of the permit When the construction plane show signing and striping for staged construction on separate sheets, the shear for each surge shall show the retrarval, relocation or installation dates of the appropriate staged striping and signing. 5. As-Built plans shall cnntsin the Permit Number, County, Route, sod Post Mile on each shed. b. Disclaimer statement of any kind that diffEr Crum tree obligarions and protecGans provided by Sections 6733 through 6135.6 of the California Business and Professions Cade, shall not be included on the As•Built plans. Such statements consUwte non-compliance w1t1t Encroachment Petrnit requiremrnts, and may re+sutt fn the Depratrncnt of Tmncponatinn retaining Performance Bends or deposits until proper plans uro submincd. Failure to comply rmy also restdt in dental of future pennita, or a provigiori requirin6 n public agency >n supply additional. bonding. 23. PER117ITS Ft)ti RECORD PURPOSES O>tLYf Wlten work in the rigttt of way is within an arse under a Joint Uae Agrxmcrrt (NA) or a Consent to Gammon Use AyTCCmcot (CCUA), a fee exempt pcrntit is issued to the pemtittx for rho purpose of providing a notice and retold of work. The Permittee's prior tights Shall be prascrvcd without rho intention of creating new or ditfcrdrtt rishts or obtibnrtions. "Notices and Ret:orJ Purpnscs Only" shall be stamped across rite taco of rho permit. 24. BONDING: The prarrritrca shalt file bond(a}, in advance, in the amount set by tlto Department. Failum to maintain bond(s) in full force and etY'ect will result in the Depaztment stopping of al! vrork and revoking permit(s), Bonds are not rcqufred of pttblie aorponttions or privately owned utilities, unless pcrrrrittcd failed to comply with tlrc provision and conditions under a prior pumit. 7fte surety company is responsible for any Talent defects as provided fit Calit'ornia Code of Civil Procedures, Seaton 337.1.5. Local agency pormittcc shall comply with rtiquiroments established as followc: in recognition that project construction work done on State property will not be directly funded and paid by Slate, for the putpdse of protcxting stop notice claimanm and the ittterests of Skate relative to successful prnjret completion, the local agency pcrmittee agrees W require the cortstruetion contractor iirmish Iwt}t a payment and parfnm,ance bond to the local agency's Warne with both bonds complying with the requ;rentuttg set forth in Section 7-1.02 of Stak's currant Standard Speciticutions before performing any projtxt con~trucrion work. The local agency permitted shall defend, indmnrrkfy, and hold harmless the State, its officers and employees fmrn all pmjcct construeGun rotated claims by contractors and alt stop notice or mechanic's lien claimants. The local agency also agrees to remedy, in a timely manner and to State's satisfaction, any latent defects occurring as a result of the project construction work. PtfTUItE Rit)VINC OF INSTALLATtViVS: Petmittae understands and agrees to relncatc a permitted installation upon notice by the D+:parmicnt. Unless under prior property right Or agrument, the permithe shall comply with said notice at his sole expense. 26. ,tRCHAEOLpGICAI.lHISTORICAI.: {f any archaeological or historical resources arc revealed in the work vicinity, the permitted sh.'dt imrnedia:cry stop work, notify the Deperirttcrtt's rcpresentative, retain a qualified archaeologist who :hall cvahtate the site, and make rcconunendaGuns w the Department represenurtive regarding the continuance of work. 27. PREVAILING ~WACF„y': Work perfornusd by or under apermit may mgoire permittce`s contractors and subcontractors to pay appropriate prevailing Wages as sat by the Department of industrial Rclatinns. ]nquirice or requests for inccrlxctations relative to onforcetment of prevailing wage requirements are directed to Stotn of C,atifomia Dcpartntent of lndustriat Rctations, 525 Galdcn Grata Avenue, San rtancisco, Cattfontia 94102. 2tt. RESPONSIBILITY FOR I?Al-9AG1r: The State of t:,nlifumis and alt officers and employees thereof, including but not limited to the Director of Transpnciation and the Deputy Dvcctor, shall not hr answerable or accountable in any manner fur injury to or death of any person, includfng but eat limited to the perntittee, persons employed by ~+ permittee, persons at:Hng in behalf of the perrntttcc, or for damxgc to property from any cause. The prrmiuce shall ba responsible for any liability imposed by law arts for injuries to or death of any person, btcludbtg but not timikd to the pcrmitacc, parsons employed by rho permittee, persons acting in behalf of rho parmittee, or far damage to prapcRy arising out of work, or other activity permitted mtd done by the permittea under a permit, or arising out of rho. failure vn the pcmtittee's part W perform his obligations under any pcmtit in respect to maintenance or any ether obligations, or resulting from defects or obstructions, or from any reuse whatsoever during the progress of the wntlt, or other activity or at any subsequent time, work or other activity is being performed under the obl;gadons provided by and tencemplated by the permit. The permitter shalt indemnify and snvc harmless the State of California, all vfffaars, employees, and State's cortaactoro, lheru,t includfng but not limited to der Director of Tranapdrtadon and the Deputy Dlrcctor, Clem al! claims, auto or actions of every Hama, kind and description brought for or on •rccnunt of injuries to or death of any person, including but not rimitad to tlrt permi¢ea, parsons employed by the pemdttee, persons acting in behalf of tlta permittee and the pubiia, or damage to pmtxrty resulting from the perfortnanec of work or odser activity under the permit' ar arising out of rho Collura on the pcrmtttee's part to perform his obligations under any permit in respect to maintenance or any ether obligations, or resulting from defects or obstructions, or item any cause whatsoever during the progress of the work, or other activity or at any subsequent time, work or other activity is behtg performed under the obligations provided by and contemplated by the permit, except as od,cnvisc provided bystatuta. The duty of the perntiuce to indemnity and save hacmiess includes ffie dudes to defend as set forth in Section 2976 of the Civil Code. The pcrmiute waives any and ail rights t0 any type of expressed ar implidd indtarmity against thn 5xttc, its officers, employees, and State contractors. It is the intent of the parties that rho pcrtniuca wit) indemnify and ho-d hamilcss the State, lt3 offleets, employees, and State's contractors, from any and all claims, suits or actions as set forth above regardless of the existence or degree of fault or negligence, whether active or passive, primary or secondary, an the part of the State, the pcrmittcc, persons employed by the permi-tea, or xcpng an bchaif of the permitted. For the puryoss of this section, "State's contractors" shall inctudo contractors and their subconu;tetors under contract [o the State of Califomia perfgnning work within the limits of this permit. 29. NO PRECEDENT ESTABLISHED: Yhis pemtit is issued with the undcrsWtrting that it does not establish a precedent 30, FEDERAL CIVIL ttICH't5 RFQIIIREM$NTS FOR PUBLIC ACCOMMOAATIQN: A. The pcrmittcc> for hitmtlt his personal representative, successun in intexest, and assigns as yart of die considerauat hereof, does hereby cgvcnsnt and agree that: t. Nu porsan on t)rc grounds of race, color, or national origin shall be excluded fivm participation in, bq denied the bcriefits of; or ba otherwise suhjdgted to discrimination in rho use of said facilities. 2. Thal in t:OMet:tion with the arnstruetivn Of #ny imprpvcmClltS on said lands and the funiishinga of services thereon, no dixcainrination shall be practiced in the selection and retention of first-liar subwntractors in the selectign ofsccond-liar subcontraetofl. 3. That such d'ucrintinatiun shall nut be praetfccd against the public in their access W and tree of the facilities and services provided for public sacomrtrodatinns (such as eating, sleeping, veer, recreation}, and operolio» on, over, or under the apace of the right of way. 4. That the permitted shall use the premise in compliancq with art other requirements imposed pursuant to Title 13, Coda of Fedcml Regulations, Commerce and Foreign Trade, Subtitle A. t7flice of the Secretary of Comn>crce, Patt 8 (15 C.P.R. Part 8j and as said Reb~rtlauons may be amended. S. That in the event of breagh of any of rho above nondiscrimination covenants, the Stara shalt have the right to terminate the pdrtni: and to reenter and repossess said land and lire land and the faailifiec thermn, and hold the same as if seid permit had never barn made Ot issued. 37. MAINTENANCE OF IIIt;317WAYSt The pamittae agrees, by acccptancc of a permit, to properly maintain any sncroachntent. Thir axsurancc requires the pcrmituc m provide inspection and repair any damage, ai pcrmtttee's expense, tv State faailidcs resulting from rho Cnl:rnaGhmerlt. 32. SPECIAL EVENTS: in accorrlerree with subdivision (a) of Strexts and Higftways Coda Section 682.5, the Aepartment of Transporinuon shall not be rcaponsiblc for rho conduct or operation of the ptrmiued activity, and the applicant agrees to dctbnd, indemnify, And hold harmless the State and the city or county against any and all cisims arising out of any activity for which the permit is issued. Pcnnittce unddrsgnds and agrees that it tell! comply with the obiigetions of Titles U and tIt of rho Amyricans with Disabnigcs Act • of 1490 in the conduct of the event, and ibrihar agrees to indemnify and save harmless the Slats of Califomia, all offlcets and employees thereof, including but not limited to daa Director of Transportation, from any claimm ru liability srlsing vet of or by virtue visakl Act. 33. PRIVATE US£ OF ItIGH7` Olr WAY: highway right of way shall not bs used for private purposes without compensation to the Stute. The. gifting of public property use and thcrcforo public fmrds is prohibited under the Califomia ConstiNtion. Article 16. 34. FiR1,D WORK REIMBURSEMENT: Permitted shall rcimburvc Stara for field work pcrfomxct on permiuee's behalf to correct or remedy ha2arda or damaged facilities, or clear doUris not auaaded to by the pcrmittcc. 35. NOTIFICATIl7tV QIF 1)F.PARTMF.NT AND T'&1C: i he permitted shall notify the I)tpartrrwnt's raprescntaUvc and the Transportation Management Center (TMC) at least ~ days bcfori: initiating a lane closure or condueGng an activity that may cause a tragic hnpact. A confirmation notification should occur ~ d#ys bcfare closure or other potcntiai traffiic impacts. [n emergency situations when the corrcetivc work or the emergency itself mny affect trek, 1'MC and the l7epartrncnt's represenlativc shall be notified as soon us pascibie. 36. SUSPENSION OF 'fRAfp'1C CUNTROL OPERATION: The pgrrniKCq, upon notification by the Department's represcntativa, shalt irranediatety ausprard an lane closure operations and any upcrution that impedes the flow of traffic. All costs associated with this swpcnsian shall be borne by the parmiucd. 37. UNDERGI{OUND SEi2VICli ALGI~T (USAj NOTIFICATION; Any excavation requires compliance with the provisions oC Govcntment Gode Section 4216 et. seq., including, but not limited to nodcc to a regional notification center. such as Cinderground Scrvigc Alert {USA). The pcrmiucc shall provide notification at least 48 hours before performing any excavation work within the right of vxry. LNCROACIiMENT PrR1YIIT WORK.SCHEDULl41Y+G PROCEDURES 1. INSTRU~IONS: Fill in blanks or check appropriate boxes. Attach maps or diagrams, if available. Enter beginning day through ending day of work week {M-T-W-TEI-F-SA-SU). ManthlDay: Enter month (f-12) and day (1-3 t) of requested week. Start & Finish Time: Use 2d hour clack format. Read page Z of your Permit Special Provisions for hours & days. allowed. Separate lane closure #'s are required for each direction and facility. Use separate line for each. Lanes are numbered in direction. of travel from left to right, excluding turn pockets; left being #1 or "fast lane". Check boxes under RESTRICTED LANES to indicate lanes or part4 afhighway to be closed. "VL"(VArions Lanes) may be checked with cote in Comments Section stating number of lanes to remain open at alt times. 2. ABBREVIATIONS: Auz=auxiliary, CI~Center Divide; CaII=Collector; Cann=Connector; Contra Ftow~lose t direction of traffic and divert to lane{s} in opposite direction or a turn lane. Day of Week=(M-T-W-TH-F-SA-SU}; Dic=Direction (N~North, SS=South,Wli~West, or E~East); F/[.=fog Iine; Lns=Lanes; L=Left; Med= Median; tJff/It~Jff--Ramp; On/R=On-Ramp; Park Strip=Parking area parallel to lane; Pckf~-Pocket; Roll=Rolling (for closure such as sweeping}; R=Right; Shldr-Shoulder; SR=State Route; V/L=Various Lanes; V/Lao=Various Locations. 3. Requests for .scheduling shall be submitted on this form via FAX to 514-285-3960, or, via E-Mail. to ?': r ~xtr _i ~rrn !%rn~i~~4;.r ~~ ~G~~ ,_~t~ $~~.~; or, through the designated State Representative {page 1 of permit). 4. Alt permitted work (with. or without tratfie control} is subject to advance scheduling on this form, seven (7}days in advance of the work week requested. Submittals and approvals shall continue on a weekly basis. 5. If work begins weekly on Sunday, the work. week shall be Sunday through Saturday. If work week begins on Monday, the work week shall be Monday through Sunday. 5. Incomplete, illegible, or inaccurate requests may be returned for correction. Assistance for completing the guest tray be obtained from the designated State Representative. 7. Every attempt will be trade to return timely requests with closure ID or work authorization numbers, to the Pertnittee by close of business on Thursday, prior to the scheduled work week. When deemed necessary to ensure public convenience, Coltrane may deny and/or reschedule the request. 8. All requests must include a contingency plan `for restoring public traffic (i.e. reopening of a closed. lane, ramp and/or shau}der} in the event of {i) CHP or the loco! authority requires opening due bo an unforeseeable incident. in the nearby vicinity, or {2) permitted experiences an equipment breakdown, shortage of or lack of production materials ar any other failure which would otherwise delay restoring public convenience within the time limits specified in the peanut. The contingency plan shall include availability of any proposed standby equipment and stockpiled Materials that can be utilized for the immediate opening of closures when ordered by the State representative. Acceptance of the contingency plan by the Engineer shall not relieve the Contractor from We requirement of opening the restricted travel way to accommodate public traffic as specified in the lane closure hour's section of the permit provisions. 9. Coltrane will review and process the request by entering all information into the State-wide Lane-Closure System (LCS). This process generates a work authorization ntunber*. This number will be entered on the request form and. returned to Permittee as approval to proceed AND will be used to "R,aal-Time $talus" on a daily basis. I'ermittee shall. communicate with Coltrane 24-hour District Communication Center (DCC) via telephone at 510-285-6359 twice daily when working, or once daily if cancelled. a. When work begins (first cone down), Permittee shall contact Coltrane DCC and relay: "(Closure ID #*L its 10-97". b. When work ends (last cane removed}, Permittee shall contact Caltrans DCC and relay: "(Closure ID #*) is 10-98". c. tf the work is cancelled an any scheduled day, Permittee shall contact Csltrans DCC and relay; "jClasure m #*) ~ 10.22". A "10.22" (cancellation) can be phoned at anytime before the scheduled "14-97" time, but no later than I hour prior to scheduled "10-98" time. Yau may be asked to fax confirmation of "10-22" to We DCC FAX at S14-Z85-G358. d. During the work, any unexpected occurrences including delayed openings, accidents, etc., shall be communicated to Caltrans DCC @ 510-286-6359, immediazety. Avoid possible miscammunicationwhcn calling status. Use the PItIONETIC ALPHABET to state your Closure ID: A = Adam, B = Boy, C = Charles, D = David, E = Edward, F =Frank, G'= George, H = Fleury, if = Ida, J = Jahn, K =King, L =Lincoln, M =Mary, N = Nora, O =Ocean, P = Paul, Q =Queen, R = Robert, S = Sam, T = Tam, U =Union, V =Victor, w =William, X = X-ray, Y = Yellow, Z =Zebra. Facample: F82CA="Pau182 Charles Adam" 10. The intent of these procedures is to help ensure public convenience by identifying planned closures an the State Highway system, resolving potential conflicts, and disseminating. sit available "R.EAL-TIME" information, via the traffic media to all motorists, including but not limited to the public, CIIP, local police and sheriffs' office, and emergency fire and rescue personnel. * "closure ID number" it the same as " i~wrh' authorizatlox number" Page 2 aft Revised 7-2t-OS Encroachment .Permit Work Scitedulin Re uest Form ~^~' Submit request to schedule tra#lic control weekly, ?days in advance, using this t'ortn. Submit to Permit duty Station by F ~.X, a'10-286-3960, or E-mail: Yennit_Duty Engir:eer•~rr~dot ca.gov. #temii:der; - Notify inspector listed on page 1 or 2 of your Permit. Check Permit Special Provisions for. authorized work trouts. Any deviation. from the Permit must be requested uz writing. LrISTRtICTTt)t`IS AT+lY3 ApH~ViATTUNS: See Procedures on reverse of this form (page 2). l . Permit No.• 2.Expiratron Date: 3. Request Date: _ 4. Caltrans Inspector: __~ ~. Rzquested Work Week; to 6. Route: 7. County: _~ _ 8. City or township: _!:.---- 9. ^PostMiles or ^Kilopost: From: Ta: i0. Existing Lanes (iu ;,ach Dir): Dir Lns~, i Dir Lns 1 t . Describe Location (use landmark if necessary}: From: Ta: _.... 12 Nameaf Conventional Highway or Surface St; l 3. L tluou~l Fill in or `x' if applicable: (a) ^ Divided Hwv or ^ Undivided Hwv (b) ^ Fuil-Closure ^ t dir or ^ both dir (c}^One-way Traffte Control: ©nly on "Undivided" Hwy (~ilterr+nte use of same kale for both directioru--holm trjc 3-10 min w,flaggers) (d)[]Connector Ram~•. (State Higlnvay #) to {State Highway #) Closed ^ or Latte # (e}^Off/ramn: (Free+vay to City St) Ramp Name: Offlramp Closed ^ or Laitc#: (f) On/ram : (City St to Freeway} Ramp Name: Onlramp Closed ^ or Lane#: (g)^I,~ivert Trfc or Contra Flow: Reconftgure lanes/divert trfc to Lane# ~in the -Direction; Lane(s) open ea direction. (h)^IntermittentTtaffic Control (i) ^Various Locations (j} QLoa -Tg elm !24_± hours continuous) ETO k Ycar: Time Dir * * * * * * Restri cted Lanes * * * * * '` Brks C;iosure iur~ From To DAY ~~ 24-HRCI.UCK Nt3 SB Fan Cto srirna v T~ CartratlS Aux CD PCK7 5 to ~ldt do ill » ll DATE DATE SU-M-T-w- TH-F-gA Start (10-97) Finish {t0-98) EB wB g~ Aetour L R 1 2 3 4 5 6 L y co w or of Fork t i Ro Colt lviod L it Strip Min -ing e'~-++ ~+ 14. Description of workkomments: 15. Detour (Required jot fill cloavre}: l6. Contingency Plan: 17.On--site during work (circle tjopplicable) CHP / PD 1 Other: 18. Name: Permitiee: Contractor (if different than pemuttee): Address: On-Site blame: ~~-~; Personnel CURtact Office: 0~~. Name(s) Cett: Cell; Phone Na. ~~' ~ ~~~ t9. upp• A f mrw. rv» QTATfTC rwrC'IR}Tt!'*f•fl1NC PT FA~P' M TCF"Yt7 iR Fi~Tn P S+nNMFi. AWARE .~ RFSPnN$ 1 Petmittee shall STATUS scheduled work DAILY via Caltrans 24-Hotu Commutrication Center at SiQ-286-6359. Status using Closure l) No(s) at the start of work, (10-9'T}, and again when work is finished for ttte day, {IO-98~. To cancel (li#-22), phone 510-286-6359 ot- fa~c fio 510-286-6358 before the scheduled 1Q-97 time, but no later titan 1 hour prior to the scheduled 10-9$ tune. Any delay in picking up your closure must be reported immediately to 510-286-G359 or Permit Inspector. See item 9 on reverselpage 2. 40ffica of Petmits/0ffioe of Traffic Management Page t of 2 Revised 07-2 t-05 2006 STANDARD PLAN 7 i ~.. ~,w,. ~ ~ ~ ~~ ~ ~ ~ ~ ~~.~.,. gk g E, ~ ~ p z N N O 19i ~ _~ ~~ ~ o, g ~ ~ 6 ~ NaZ r ~ tl~~i 3 Y~ 6 3~ 3~ ~ z n '' J~ gg~ ~~~~ ~ ~~ °g OW tJ ^ ~ t ~ R^~ f ~ • .a. ~ ~ ~ iii N~ V ~ Z S I I ~ ~ au~.a I ~ w J 4 I I ~ .- I I . ,~g I I• .~ w I I' a • U N• • J •~ ~ S~ b a 1 $I• ~ P~ b a~ ~~ vc~ w ~• g3 ~ ~g ~}~~ fiao ~ • ~g .- Sub °~ d ! 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