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ENC2010-00011FEB-11-2010(THU) 10;46pC~rl~/CD P. 001/003 L VG „: ~'...8 ~ 20~~ ~t:r`~~"'P.rlht?F'ofm~`~r,:.~~. PUBLIC WORKS PermltNo^F.~I r~ZD~t7 ~~~~ ~ CITY Of CAMPBELL ,A©MINI~T'IMENT PERMIT DEPT.Of PUBut WORKS (or working within the public X•Ref. File 70 North First Seraat right-of-way) AppliCdtian Date ~ ~ //y ~ e ~o Campbell, fA 95006 Issued Z ~ `~ l fj v Appli on Explratlo~~ Ph. (406) 86fr~150 APN Fx. {4081374.0958 '~ Permit Expiration Date Z ~ APPLICATION - Application is hereby made for a Public Works Permit in accordance w{th [ampbell Municipal Code, Section t 1.04. (Application expires In six (~) months if the permit Is not Issued. Application Fee Isnon-refundable.) A. Work Address or Tract No.: 104 George Coure utility Trench Location: East side of 5.1 st St, 52' South of ~. Rincon Avenue B. Nature of Work Abandon 3/4" water service [. Attach four t4) 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 [ity Engineer, said plan becomes a part of this permit D. Ail work shall conform to the City of Campbell Standard Spec(flcatlons and Details for Public Works Canstructlon; the General Permit [ondltlons listed on the reverse side; and the Special Provisions for this permit, listed below. Failure to abide by these condRions and provisions may result in Job shutdown andlor forfeiture of Faithful Performance Sureties and cash deposits. (Sec General Permit Condltians t and 2.) E. The [aneractor must have this permit and approved plans at the site and must notify the Public Works department at least two days before stoning work Norice must be g}ven to Fubllc Works at least 24 hours before restarting any work NarncofApplicant: SAN JOSE WATERCOMPAfVY Telephone. 40$279-7830 ,Z29-9~y~ Address: 12b5 5. Bascom Ave, San Jose, CA. 95128 E•Mail address: nick_bemhardt@sjwatercom ~~ z4-HPUR EMERGENCY PHGNE NUMD[R: 408 Z79 7800 Is this work beln done b the ro g y p perry owners at their own resldence7 rl yE,S ~ NO The Applicant/Permlttee 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 or demand for damages resulting from the work covered by this permtt. The Applicant/Permittee hereby acknowledges that they have read and understand both the front and back of ehis permit, and they will Inform tltelr contractor(s) of she tnfonnation. Applicant is advised that upon issuance of this permit, property owner, ar property owner's successors, shall be responsible for any and all damages arising out ofthe condition of any priv Im rovements In the p/~ubl~c right-of--way. Accepted: I/'/CiC %~E~ s r .~-.~... o~L- ~.es /r~~~p ~o (Applicant Permitted ( N Date (Cantraetorf (Print Name) Date SPC[IAL PRD,V,ISI.O.N~. 1. Street shall not be open cut far underground Installations. Minimum cuts maY be allowed for connedlons or exploration holes. Such cuts m6Y be sneclflcally aperevcd by ~e,)pg~ctor prior to cuttlna, ~ 2. Pavement may br cut for underground installations and must be restored In accordance with the Standard Oetalls Trench Restoration Method 'A", unless otherwise approved by the Engineer. _,,,~. Work to be staked by a licensed Land Surveyor or Civil Engineer and two (2) copies of the cut sheets sent to the Public works Department before starting work. 4. Per Settian 4215 of the Government Code this permit Is not valid far excavations until Underground Service Alert (USA) has been notified and the inquiry Idendfieation number has been entered hereon. USA Phone: 1-eDO-X27-2b00, USA TICKET NCF. _ _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. $CC.)?VBL1C WORKS FEE SCHEDULE FOR CLiBBCN~'.EEES AMOUNT PCAMIT APPLICATION FEE S 3 ~ -7 PLAN eHecxar•POSir s SECURfTY FOR FAITHFUL PERFORMAN[E/LABOR & MATERIALS 5 CONSTRUCTION CASH DEP051T 5 PLAN [YIECK $ INSPECTION FEE S U APPROVED FOR LSSUAN[E Permk Expires i 2 Months After Date of Issuance RECEIPT N 2111 la DetT IG~ ~-ir~~~~s ~,~ FEB-11-2010(THU) 10;46 P. 002/003 ts~NER/,~,~~jjjlrf LT COND1T14N5 1. A Construction Cash Deposit is required. Charges will be made against this deposit If there is an emergenry Cell-out, overtime lnspettion or when ply ordered barricading Is required. Any such Costs in excess of the deposit will be billed tv the Permtttee. 2. A one-year malntenanec period and surety are required. Such period will begin on date of written acceptance by the Qty. 3. Refund or the cash deposit balance and refund or canceltatlon of the Fahhful Pertarmance Surety will be Inltlaled by the written accepwnce of the work by the lily. 4. The Permittee must request in wilting a final inspeRlpn and acceptance of the work upon completion. Accepwnce by the Clty will be made in writing to the Permlttec. S. Maintain safe pedestrian and vehicular crossings and free access to private driveways, bus stops, fire hydrants, and water valves, 6. A Construction Traffic Control Plan and a Construction Schedule are required far all lane closures, detours, and street closures. This plan must be reviewed and approved prior tp any lane closures. 7, A Construction Traffic Control Plan shall conform to the Coltrane Manual of Traffc controls far Construction and Maintenance Wark Zones, datad 1990, available at Coltrane. Traffic control equipment shell include Type II flashing arrow signs if required. a- Replace as dirotted by the City Engineer any damaged or removed Improvements In accordance with tiry Standards and 5peciflcatlons at the sole expense of the Permlttee. 9, Sawcut fpr all PCC or At removals. All PCC removals shall be to the nearest scoremark and shall be doweled to exisgng Improvements, t o. Prlar approval of inspector Is requ(red forarty work done after normal working haun, on weekends or holidays and may require reimbursement of inspettivn costs at the current overtime rate. 11. Adequate signing and barricading Is required on the job site, Failure to provide such signing and banlCdding may result in the City's providing signing and barricades and charging the cost (including all labor and materials) against the Gash deposit. t z, Compaction testing of subgrade, base rock, and asphalt concrete by Permittee Is required unlu~ss otherwise stated by the City Engineer. t a. The Contractor or Perminec will have a supervisory representative available for convect on the pro}ect at all times during consauctfon. Contractor or Permtttee shall provide a phone number at whkh they can be contacted outside the hours of 8:00 a.m, t0 4:00 p.m. 1 a, No storrge of materials ar equipment will be allowed near the edge of pavement, the traveled way, ar within the shoulderline which would create a haL,rdous condition to the public. t 5. This permit shalt not be construed as authortratlon for exovatlon and grading on private property ad}scent to the work or any other work for which a separate permit may be required, nor does it rnlieve the Permlttee of any obligation to obwtn any ocher permit required bylaw. 16. This permR does not release the Permittee from any liabilities conwined in other agreements or Gonitdcts with the Gty and arty other public agency. t 7. This permit Is not transferable. Work must be performed by the Permlttee or his designated agent or contractor as specified thereon. 18. Call back (Gall out) duC to enreragendes regarding tills permit shall be at the current overtime rate wltll a three (3) hour minimum charge per occurrence. t 9. Pursuant to Chapter 14,oZ of the Campbell Munidpal [ode, 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 tiara Valley Urban Runoff Pollution Prevention program. 20. If the public Interest requires d modification of, ors departure from the plans and specifications, the City sfwll have the authority t0 requlrt or approve any modification or departure and to specify the manner In which the same Is to be made for Cityowned or maintained facilltles. 21 • Permitttee must provide advance nonpcatbn to alt panics that may ire affected by the permit actlvldes. Notification shall be reviewed by the Clty prior to dlstrlbution and include dates of work and a convect name and phone number. Appti W nt shall be responsible for ensuring that all thgse providing services under the appliwntare aware and undetstend all of the above conditlans. Contractor (Print Name} J:Rcina\Webslte~Land Qev pO1TnslEntroachment Permit STATIC fOrm2.pdf Rev. (11/91051 Ddte: Date: FE6-11-2010iTHUi 1G; 46 P. DU'lC1U avE~ ~a~ c~~sTRUGTroN. APPR Cit~~ ~~ Campbell ~2~1~ -~11 Works ;~~; rr5it No. ~''``---- Public C~„«ror „wsr have these d~ on the Ieb site durino ~os+srnK-h~