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ENC2010-00007T~ JAN-2~-~g1.0(i~IEA) 11 41 ~?Fom (FAH)7~0~7t1,5 130 P. A02lOl l ~ , Ie~ Prln>: Folm~ CITY of CwtaPBElt ENCROACHMENY PERMlT Permit Na ~ `I~L.~wl ~- c~~rO~] DEPT. CF Pt,tBLte WOR1r5 (forwortdttp within the puWle >i-Ref. File 7a earth FltseStraat right•ctFwayl APPlicadon Data Campbell, CA 95ooa Issued .. Z ` (~'~_ Application E~cplratia etc Ph. (4ue} t366.~150 APN ~ Px. (400} 3y1i-0958 Pannlt Explradon Data f I APPLICATION • Appikadon is hereby made for a Publlt: Works Parenlt In aecordanca with Campboil Munltlpal Code. 5atdan t 1,0A. (Applitadon expirgs (b} months if the permit Is nor bsued. AppllCaUon Foe isnon-rafundablal A. WorkAddrcssarTraCtNos f^jA1 O I,' ~~'^A J n Utlllty'I7anth Laeatksn; ~~II B. Nature of Work; ~~DO ~ '~ C Attach four t4} Copies of an engineered plan showing the locadan and extant o the work, and four lay Copies of the prollminay Hng(naer's Extlmate of work, The plansshaU show dta roknlon aF the prapased work to exlsdng sutiata and underground improvements. When approved tsy the City Englnaar. frald plan becomes a part of this parmh: N ~~ N Q~ ao ?~~ c•.~ U - ~ ?F D, AIt workshall Conform to the City of Campbell 5randard SpatiflCadons and petaUs far Public works Canstrutdan; the General Permit Condltlaltx Ilsrcdron the reverse silo: and the Spacial Provisiats far this permit; listed below. Failure to abide by thaw tandldons and provl9lons may result In job shutsiawnand/or forfahure of Fpitltful perfomtattee 5uradas and cash daposlC, (Sea Grnaral Pannlt Candidons 1 and 2,1 ~. The Contractor must have this partnit and approved plertsatthesita and must nodfythe Pub11e Warlo papertmantat least two days before starting work Notka must 6e gkrart as PubNc Watks at lapstx4 bouts before res4rtlhg any work. NamaafAppllCanC 2 ~+~~"' ,~~•~ akphona: ~~' ~"7 ~ ~ )/ address: ~~~' "~ - ~ ~ ~' `7 `/ ~/ `.-' ~/ /.k~ Mall Address: ~~~, ~~,~, ~ ~~~1~!'t//C. ~24~>~ a ~NtbRG~NCY PHQNE NUMBF,}t; 5~*~~ 1s this work being dnne by thepropeny owners atihelr own rasidmcai' r y~r ~0 f The AppliCant/Pertnlttee hereby agrees by atilxing chair signature m this permit to hold the dry of Campbeb, Its aEfietYS, agents, and employee, fnae, safe and harmless front any Claim or demand fordameges rasuldhg from thawork Covered by this permit The Appticant/Pemtittao hereby atknowkdgas that they have tied and understand both the front and back of dsbt permit. and they will Intotvrt their Contrartar(al of the Infarmatkxt, Applkent Is advhad that upon bsuanCe of this permit property owner. ar property owttar's asn shalt ba rasponsiblC far any and I dpamagesari~sing/AUt of the Condldon afany private Irrt manta in the u Ile rl ht•ofwtty, Accepted: ~6r~!±~~ ~ ~ - ~~.L.ir'tpa~l ~P ~~ , ~ ~/ ' fA n Partnittaa} (sign}_~/ Da a ~"'^' lContttrtrarl lprint Data ~~181.1?Rbylttn .,`1. Street shalt not be open tut for underground Instalktdons. Minimum ans~ be atlatNad far t;onnaCtlons era:p(oratlon halos. Surat cuts ~ybg ~2, Pavement may be cut for undargrourtd insadlations and must ba restored In atcardanca with the Standard Det:,lls Trench Rapcoretton Method A ;unless otherwise approval! bythe Engineer. ,.~3. work to be staked by a peensed Land Surveyor or dell Englneerand two W Koplas at the cutshaets acne w the Publk; works Departmrnt before sttrrdng work .~ . Par Sacdan 421 S of eha Government Code this pannit is notvalld far axravatlons until Underground 5errritq Alert (USA) has bean ttatlfiad and the inquiry Identipwdon number has been entarod hereon. USA phone 1d300•~7•x600. USATICItET N4 ~5.. Prior to anywork the prapertyowrtarshell extecuta nn Agraarnant forPrlvate Improvements In the PubflcR(ghntrf way. which shall ba reCOrdod. 7, PERMRAPPldCATICN FF.E PLAN CHFCIt DEP05ff 5EClJRfTr FOR FAf('h1KULP~RFQRMANCF,/l~1f30p & NUITF.AWLS CQNSf(it1C710N CASW UEP051T PLAN CHECtC& INSPECTION f~ ApPRGVED FOR ISSUANCE C5vo ~ x ~ 2•~tolY,1 ~. ~ ~ l nMOiJN7 0'~ S S S S` O RECEIPT NC. Formic Expitas 12 Moroni ARer date of Issuanta + ~ ~F x $1.45~~ ~ ~ 7070 IRK-27-2010(4JE0) 17;41 CabraCom (FRX)7074258730 P.002I011 Prlnt'Fotsn ' ' aTY aF CAMP88LL ENCROACFONENT PEfifdtT Permit Np ~ `~~ ~O DEPT, of PUBLIK W ORKS (for woridrrg within ttte public X•Raf, FIIA 7o north Flrse Straat rlght•of•way} Appllcatian Date Campbell. G 95008 APPlicatlon F~cplmtlo I~aG Ph. (4ot3)86d.~150 lasuad __ 2((, I~_ _7 Fu. (408} 37d-0958 APIY .. Permit 13rpiradan Data (I W APPLICATIpN • Appilcadan !s herabtr made for o Publle Works Pennh to pCKOrdanco with Campbell Munkipgl Code.5eetion t f,OA. (Appllcpdan expires fbl months if the permit la nat Issued. Application Fee isnon-rafundabled A. WorkAddrcssarTra¢tNa, I ~ tU /t I, ~ - ~a~/ ~ / 1 Ut81ty7ranch Lacatlant ~~~ at. Nature of world ~/DO ~ 4 Attach tour lR1 saples of an angineared plan showing the locadan and extent a the walk, and four la} copies of the preliminary 6nglnaer's lcxtimete of work. The plansshaU show the rolatlon of the proposed work to arladng surface and undergnwnd lmpnwemants. When appravetl by the City Englnaar, staid plan batames a parr of ihls parmlt O d ~F !'V Q~ 00 ?~ a mz ~ ~~ D, Ali workstudll Canfomt m the City of Campbell Standard Spaclfitadons artd getalls far Public Warkr Construtdon; the General Permit Candidnnx listed nn the reversq slda;and the5peclat provisfotts far this panniL listed below. Pollute to abidtl by these cdndldonsond provisions may result In job shutdown end/ar fatfohurc of Fpldtful Perfomtartce 5uradeaand cash daposlts, (Sea Gmaral Permit Gandidans 1 pad Z} ~, The C,ontrsctor must have this pannit and appreved plena at thastte and must nadfy the Publle WorlO Deparanent at least two days befara startinif work Notke must ba givers to Public works et feast 24 hours bafare ras4tting any work. Kama of Applicant; .~.~ ~f-~ ,~~~ elephonat ~~ ("'~ ~~~ 1 Addtess: ~ 9/ i;Hlall Address: ,~~1.r1_1! ~~~- ~ ~~~1~Y1/~C~ ~~ a I:NtEfiGF.NCY PHQNE NUM9F,f~ Is thlx want being dnna by the peaperty ownant ai their own rosldencaP ~- Y~ SAO 'Etta Applieant/Patmlaea haraby agrees by affixing tltalr signature m this permit to hold Rho Qry of Campbell, Its officers, aganry, and employees fnye. safe and harmless Pram any Cfalm or demand for damages rrouldng from thawork covered by this parml4 'fha gppllcant/Permittaa hereby acknowledges that they Nava reed and understand troth the front and back of d+Hl perrrrit, and they will Inform their tontractorfal cf the Infnrmatton, Appikant Is adviaad that upon bsuanca of this permit, property owner, or property ownar'a sa shalt ba roaponsible far any end I damage arising out of the condlUon ofany private tar meats in the pu Ile dpht~afuray, 1 /1 Accepted: / ~ / ~~ fA nj Parmittael Sslgn} Do a ~""~ (Contractor) (Print p~ ~~$L Pk~1VtSIpkK! ~_1. Street shalt not be upon cut tarundarground Installadorts. Minimum cutslpg~ be allowed far connaetions oreYplaratlon !tales. Such cuts ID~7y1Lrr ~2. Ptwament may ba cut Car underground Insatlladons and must be ntatarcd In accordance wilt the Standard Uadkis'fnmdt Rgstoretlon Method •A ~ unless othanNisa approved bytha I:nginaea 3. Work to he stiikad by a titensed 1,and 5urvgyar or Gv41 Sngineerand two 12} s;oplas a! the cut sheets sent to the Publle Warlc Dapprtmartt befarn aarrting work ^~ . Par 5acdon 42t S of thaGovamment Code this pennR b notvalld for axravatlons until Underground 5ervlca Alert (USA) has bean rtatlfied and the Inquiry Identlflcadon number has bean antarad hereon. U5A phone 1•e0t7•~27-2600, uSA'CICICI;T N4 ^S.. Prior to anywork the properly ownershelt axecuta an Agreamant for Private Improvements In the PubttcRfghtwt~Way~ which sha11 be recorded. 6. PubOCNadflcadanfiaqukeman AMOUNT Q,Q p Np, PEkMRAPPI.ItA'i'ION FF.~ PLAN [HkGt fiEPOSR S SECUItfI'Y WR FAfI'hIFUL PERFlttRMANGF.llAB01i & MATF.RIAiS S CONSTEtUt:t'i0N CASW f2EPa51T S~ PLAN CHECKBr INSPECTION ~ $ O APPROVED FOR ISSUANCE o FarClty FxrQlnaar ro Permit F~rpiraa i 2 Nlattha After dart of Issuance ~~~rr ~ >< ~ 2.~0~~ l +(~ ~ x $ arcs/~) ~ X70 IRN-27-20J0(lJEO) 17;41 Cab)eCom (FAH)707d258730 P. 003/011 ~ ~ F.~ coaoma s I. p Constlucdon Cash Deposit fs required. Chargexwlll ba mndeopainst ehfx deposit If thine k an etrlerpartry cWi-out, ouordma Inspaaien arwhcn City lxdererd barrlCadlttg b raqulrod, any xyth cash in e>,cass of cha daposic will ba billed to the Permittee. ~, a one-year maintenance period and xuretynrerequired. Such period will begin nn date of wrlttgn aCCeptonce by the Chy. ~~ Rol~ndordtacoxhdepersitbalaneaandrefundareancolktdonofthaKalthfulPerfamtancer5uretywlllbelhlWtadbythewrlttesnncCapG~rxeorthework by ~ Clh. 4. 'Yhe pennltteer muxt requeu In wddnp a Ono) inxpeCtlon and acceptance al theworkupan Compladan, Accepwnce by the dry will bo made In wrldnp to the Permlttoa. 5. Nlalntaln Pale pedestelon and vehlculnrcrosslrtgsnrxi rreenccesx t4 prluate driveways, tux xtops, Ore hydrant, and water volrey. b, A Canstrocdan'YntIfIC Comro1 pion and n CnnxmtCtlOn 5cltodule are required foray lane ciosursax, detour. and uroec dasures. Thlx plan must ba roviewe~d and approved ptloria arty lanes dosures. ~• a Conxtntedon 7roOlc Control Plan shall Conform w the Culrrnnx AAunuol or'Crallle Contrnlx farConstnktlan and ilAalntenertce workYanas,dated 1970, awailableac Calttans. TrnfRc t:antrol Oqulpment shall Indtlde7ype 11 slashing anew signs irtequlred. g. Replace ax directed by the City ~Ineer nny damaged ar removed imp-owements in acrardattce with CltyStandaedx and SpeelOCgdons at rho xale ~ponsa ar the Pemttaae. 9. SawCUt forall pCC arAC remnvnlx, AU PCC removals shall i>e to the naareu scorerrlwk and shalt bedawelad to e>dsting tmpravemenp, t 0. Prlnrapproval of insper~r Is roqulred rorony work done agar normpl working bouts, on weekends or holidays and may require relmbunumant ar Insp~tion costs at the current ovvrtinle rate. 11. Adequate slgninpand burtiKgdinp Is requlresd an the Jnb alto, Falluro to provide suds sipnatgnnd barrlcadlnp may result in the Clty'x pmwkling slpnlhp and lsarrlcadex and chanplttp the Cost (Includirtp all laborand maradals) against rho ct>Rft depaxlG 1 ~. CompoCtlon tostiny of xubgrade, bpxe raCkand oxphalt concrete by Penttlttea Is requlrtrd unless odtgtwisa sorted by the City Ertglneer, i 7. 1'Ite Contractor orparmittae wlfi have a supervisory repntxantatlve available Yor contact on tits pmJae:t at aN dines during canuruafnn. Contracmror Permlt:ea xl-oll Provide a phone numbarat whkh thapcan be contacted outside the boon nre;oq a,m, to R,'00 p.m. 14. Pka storage of mnterlalx or equlpmotrc will be nUuwed near the edpeof povomen4 the trtrvelad way,or within trtaxhoulderline whkh would create a ha~trdous eondidon to the pubpc, IS, ThispetntltrlhaUnot6ecanstruednsnUdtarizat{anfaree~-vadonandflradinponpAeatQpropariyadJnranttothawarkaranya;herworkfarwhkha separate permit may be required, nor deal It relieve the Parmlttoa oCany obllpadan to obtain any ocher permit required by law. I d, 't'his penult door not redemo the Pannlttga ham any Ilabilidas contained In othvrapraements orearttraets with the Cttyarxl any other publkagerlcy, 17. ThixpetmltfXrateronxferable, wo*~tk+'rormedbyrhapermiueaarhlsdaflgrtatedapaneore~nutteearaxxpeUlledthoraon. 18. Coil bock Irp1! out) due to emerepencles r'epardlrtg this pormltshaU ba at the currentawertima rota with a throe f3l hour minimum drarpa per occurnrnce. 19. purxuant to Chapter i 4,02 ortho Campbell MunlClpal Code.apptkane xhall not Cause to ba dlschnrped any material Into the munlclpe) storm drain xystem adtertlton storm water, Applleant xltoll adheres to the BEti7lw-NAGI.MEMt' pRACTICGS extabpshed bytha Santa Clpra Valley Urban Runotf Pollution prawentlon Program. 20. IEthe publk Entoroxt requlrpxa madlfkation nf,cra depotturtr Imm the plant and sppCifitations.tho City shop Rove the authority to nrqulrearapprow any modlOCpdan ordepnrturo artd to spvalfy the mannorin which the same is to be made rorCityatnmed or tnalntalned Facipdtts. 21 • pormlmee muxc prwldeadvanca nodOcatfon to ail parties tiros may be nrfacted by then permitacdvldex. IVodFlcodan shall ba reviewed by the Clty print to dlsedbudon and Induda dates olwarkand o tontacc Hama and photo number, pppllcahtshatl be rexpdhsibk for aratltlnp that ail throe provldtnp xarv{Ces under the appllcantaroawnrgand underxtand all attire above cnndldorn, Appikan ~.r-~-r`~ I~atrr , ~~ ~~ Contractor (print Narno) Cats Jdielnolwabsltell.and f~e+r Fonttxl~ncrooehment PannlcSTp'i'IC rorm~pdf Raw, n ~~ros~ JRN-27-2010(WE~) 1Z. d0 Cab'eCom (FRX)7074258730 P. 001/Oll C~ CahleCom CAIiLECOM, Inc. $25 Chadbourne Road Fairfield, Ca. 94534 'Telephone (707) 759-4070 Fax (707) 759-5741 ~' r a n s m i~ t t :Date: ~ ~'~/! O . ra. sy~ ~ ~,m: ~ ~ Number Of Pages: cover) a 1 CoafirXasstia.Xi,~ Notiea hie ~acaimile cavar sheet. and any ocumeata wh~,ah may accompany it, conrxin ln~ormatian xrom cab~,cCam 2na. which ie intandad for uao only by the individual re wham it iu addxaaeed, and which may contain infaxmatian th~-t is y~rivila~teel, canfidcnaial andlar athexwioc e~rainpt dram dieclenura under applicably la-w. ~x tha xeader of e'h3,~ meacacct ie not tha iatendad zecipiaat er the cmplayae ar agent xeapan~ihle tar delivgsirtg ehia me~aage re the intandad rocipic.~t, say revicw~ ciiacloaure, diaseminatian. di~tzibutiar~, copying or oehyr ueaa of chip maaa3ga ar its aubceancea i~ ~triacly prohibited. ~J: you have received thie aoa~mvniv;~tion in errez. pleaay nati~y ua immy2t~,e-tely by ea~,yphar-a as azran~te fez the zaturr- of thin cammunicatien to ue at our ex,~et~~xe. x'hank you. 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