ENC2010-00015CITY OF CAMPBELL
DEPT. ~F PUBLIC WORKS
70 North First St.
Campbell, CA 95008
(408} 8bb-'~ lit)
Fax (40$) 37b-p958
Ptrttut No E'N G 2a~ t} «~ tS
X-Ref. File
Application Date 2-
ApgIicatian Expiration ate.. /~n
ENCROACHMENT PERMIT
(for working within the public
tight-of--way)
Issued 2y (D
Permit Expiration Date Z h
APPLICATION - Application is hereby made for a Public Works Permit in accordance with Campbell Municipal Code, Section 11.04. (Application expires in six (6}
months if the permit is not issued. Application Fee is non-refittuiab}c.)
A. Work address or tract
UtiEity trench tocatian_ sidewalk 15'
PM 30751;~~n
~vED
B Nawre of work trench for new as and electric service ~ _B ~ ~ ~~10
C. Attach four {4) copies df an cngintrred plan showing the location and extrnt of the work, and four (4) copies of the preliminary Engineer's Es WO s
plans shah show the relation of the proposed work to existing surface and underground improvements, When approved by the City Engineer, sitQ comes a
part of this permit.
D• Ali work shall conform to the City of Campbell Standard Specifications and Details for Public Works Construction; the Grneral 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 Faithfu9 Performance Sureties and cash deposits (See General Permit Conditions 1 and Z.)
E, The Contractor must have this permit and approved plans at the site and must notify the Public Works Department at least two days before starting work.. Notice
must be given to Public Works at least 24 hours bcfort restarting any work.
Name of Applicant PG&E 408/725-2153
Telephtme
Address 10900 N Blaney Ave, Cupert~no,`~v~14 24-HQUR EMERGENCY TELEPHONE NO. ~ 800-743-5000
E-Mail Address
is this work being done by the property owners at their own residence? X Yes
No
The Applicant/Permittee hereby a~~rees by affixing their signature to this permit to hold the City of Campbell, its officers, agcrtt-~ and employers free, safe and hurrnless
from any claim or demand for damages resulting from the work covered by this permit.
The App[icanVPermiaee hereby acknowledges that dtey have read and understand born the frtmt and hook of this pcrrriit. and they will inform their contracuir(s) of the
information. Applicant is advised that upon issuance of this perrtiit, property owner, or property owner's successors, shall t>c responsible for any and all datn:iges
arising out of the crmdition of aqy private ~mprovem~ents in the public right-of-way.
- 02/18/1.0
(Applicant Permitux) (sign) Date
John Gambucci 02/18/10
Contractor {Print Name)
Date
SPECIAL PROV 1S10NS
l . Street shat} aof be open cut for underground installauoas. Minimum cuts ~ be allowed for connecuons or expioranon holes. Such cuts
be snecifical}v anaroved by die Insaectornrior to rrtttin~.
T2. Pavemcrtt may be cut for underground installations and must be restored in accordance with the Standard Details Trench Restoration Method
"A" unless otherwise approved by inspector.
~3 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 staffing work.
__,~4 Per Section 4215 of the Govemtnent Code this permit is not valid for excavations until Undergroand Service Alert (llSA) has been notified and
the inquiry identification number has been entered hcrepn. USA Phone i -806-?27-2604. USA TICKET NO.
_5 Pror zG any work. flit property owner shaL° ~:.cutc an Agreement far Private improvements in the Pi;blie night-of•V~ay, which shall be
recorded.
=G. Public Notification Requirements:
'' __
SEI: PLJBLIC WORKS FEES H DCJLE FOR URRENT FEES
PERMiT APPLICATION FEE
PLAN CHECK DEPOSIT
SECURI'T'Y FOR FAITHFCJL PERFORMANCEJLABOR & MATERJALS
CONSTRUCTION CASH DEPOSIT
PLAN CHECK & INSPECTION FEE
APPROVED FOR
For City Engineer
Permit Expires 12 Months Afar Date of Issuance
~ ~ ~~ ~ Z '"I, ~/ 1 S ~ ~/
AMO JNT RECEIPT NO.
$ 3 35
$ ,y,
2 2 to
Date
GENERAL PERMIT CQNDTTI4NS
1. A t:,artsttirrctipn Cash Deposit is required, Charges will be made against this deposit if there is am emergency call-out, overtime inspection or when City
ordered barricading is required. Aay such costs im excess of the deposit will be biked to the Pertnittee.
2. A attc-ytar:uainttnance period and ssuery ate requited. Such ptsiod will begin cm date of wnttem atxtppnrce by the City.
3. Refund. of the cash deposit bataaae and refttml or aocellatiat arf ttx Faithful a Surety will be initiated by there wrtrem aaxptinee of the work
by the City.
4. The Pezaaittee mtxzt ~t io writing a Fimii intptx'tion and uxeptattcc of the wean upo° campletioat. A~ by the City will be asade its writing 6t)
the Permittee• +
5. , Maintain safe pedestrian and vehicular crossings and free access to private driveways, bus stops fire hydrants and water valves,..
6 A Coastructiae Traffrc Control Plan and a Consatiction Sciacdtrle are required for aU lame closures, derostrs attd sweet closures. This pksts must be
reviewed and appuovexl prior tie arty lane cbsntes.
7. Tax. Cmsmrctia: Traffic Cmaoi Plan shaf3 canfacm ra rite Caltrans Manual of Traffm Casagls for Coastrutxiaa and Mairmemmtx Work Zones, dared
195111, avaihble at Cattraaz. Traffic extatro[ egnipasc>3t shai# i~htde Type II flashing art~ow signs if regaired-
S. RepLsce as directed by the City F,ngitsar any damaged a rGnovtd irmproveraenta in zccctrdamce with Gty Standards and Specifications ~ the 3ok
expense of rise Pettntttee.
9. Sawcut for all PGC or AC removals, All PCC removals shad be to nearest scorcmark and shall be doweled w existing impmvemeusts.
I0. Prior apgsmval of insptxux is required for any work done afar norrttat working hours. on weekends or holidays oral may require reimtxtrsenxtet of
i~nspeetiae costs at the atrrent ttrvenimt ran.
l 1 Adequate siguittg and barripdiag is required at tlx ,job sift.. Failure w provide such signing and barricading rrray rewU in the City's providing wgnimg
anK1 txa and chargrag the cost Cwchufiag aA tabor and ealsi amt We cash deposit,
12 Compaction tes;iag of subgnde, Case rack. and asphalt concrete by Permittee is required sinless otfierwise stated Cry the City Etegrmer.
13. The Contractor or Pt:rnnitee will have a supervisory represCntabve available for contact ors the project at all times during ctxrstrucvoa. Contrsretar or
Permiaee shall pmvide a phone number at which they can tx contacted outside the hours of B:OQ a.m, to 4:1111 p.m.
l4. S1o stoa~e of rrrataiats ar equipment will be aUOv+ed reesr tin edge ~ pavement, the travt:kd way. or wittin the shoulderltx vehicle waeld create a
haz~dbus txraditxxr to tlu pnbl"ic
15. Ibis permit shall riot be as ant6orizatian far excavation and gruiing ore private property adjxmt to the wts3: ter any othsr wtxk fir wlei~ a
separate permit may be -e4uired. nor does it relieve the Permittee of any obligatiats w obraia any other permit. regaircd by law
l fi. This permit does not release the Pennittee from any Eiabil'uics mntaiuat in other agreesneats or conuaets wide the City ante any attic pabiic agency.
17. This permit is rat transferable.. Work must be perEgmncd by the Pcrm`ttttc or his designated agens or contractor aS specified deereon.
l B. Colt back (call out) due to emergencies regarding this permit shall tx err the current overtime rate with a three (3) huatr minimum charge per occetrrentx.
19. Pursuant to Chapter 14.(12 of the Campbell Musricipal Cale, applicant shall not cause w be discharged any material iruct the mlmicipal storm dram system
tettra thsa sttxza watt Applicant shall adtterc ua the BF,S° MANAGF1.itx1T PRACTICES estabtislxd 'try thz Santa Clan Valley t)rbaa Rsmofi'
Podhriion Prevention Ptregtasts•
20. if tht public mtert~ raquira a mothfintitm of, a a deparaut frtxrr. dx p~ arrd speeifeeauoms. the City shall have the audttxiry to require or aPps''m'=
any modification ar deparnric and w specify the msnnca~ in which the same is to be made fa Gryovvntd ~ maintained facilities.
21. Perntitue must pmvide advance notifit~tiom to all parties that may be affecud by the permit activities. Notificaritm shall bi: reviewed by City prior us
distribution an ; inchtdc ~ of wart: and : crniuct tuttu. and phone nusrbcr.
Applicant shall be rsspraosibie far etrsuring tbat aB t#ersee providing services order the applicant arc aware of arMt undexsnatd till of the above wnditioat.
2 -/P•iy
l~t~
Contracwr {Print Name) Dace
Rev. I l AroS
VAN DUSEN LN
w
-- -_ ~
Q
GAS TAP HOLE W
4' X 4' X 18" UNDER GAS PIPE ~
a
15' ~' EDGE OF PAVEMENT ,
TIED SIDEWALK
--
Public .. ~--
Works Permit No.~L~-ci- ~~~
GS
NOTES : com-oc-o- ~„„~ have -~ dew
on the job si-e dwng co+WrutliorR
* PG&E TO TRENCH AND BACKFILL ALL.
* PG&E TO DIG GAS TAP HOLE AS SHOWN 4' X 4' X 18" UNDER GAS PIPE
* PG&E TO TRENCH APPROX. 15' DOWN SIDEWALK TO SPLICE BOXES IN DIRT
* PG&E TO INSTALL PIPE & PULL WIRE
* SPLICE BOXES INSTALLED IN PUE BEHIND
SIDEWALK PM 30756630
MAP 3473-A8
~~ CPA 3412-32
MAOP 60 PSIG
CAMPBELL
EST: John Gombucci ~0:
ADE: John Gambucci GAS CONSTRUCTION SKETCH SD:
suPV: Shell lclss 1555 VAN DUSEN LANE
CAMPBELL NOTIF: to~saoo
REP: Charles Mankiller , OTHER:
PLNR: PERMIT COPY-- sHT: SHEETS
SCA ONE Do2't8 to ' PACIFIC GAS AND ELECTRIC COMPANY PM~30756630 REV.
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