ENC2010-00061cirY of cAMPBEii.
DEPT. OF PUBLiC wpRKS
70 North First St.
Campbell, CA 45008
(408) $66-~ i50
Fax {408) 376-0958
ENCROACHMENT PERMTT
(for working within the public
right-of--way}
Issued ___~ ~ ~ ~ (CJ
Permit Expiration Date S ~ ~ ( ~
rL'rntitNaL.~C a1~10'OO~In\
X-Ref. File
Application Date _ .~~0 j ~ 1 ~ ~ 1 ~
AppIicatior, Expiration Date 1 ~ -~~
APNc~1~_~~~ O,~
APPLICATION -Application is hereby trade for a Public Worirs Permit in accordance with Cam bell Munici al Code, Section i 1.Q4.
months if the permit is not issued. Application Fee is ran-refundable.) P P R (ccApplication expires in six (6)
A. Work address err erect ~ 62 Pa a St c~C
Utility trench
front of house in street Merv . _ O
E. Nature of work 3.5 x 5.5 trench and re
ace asphalt
C. Attach four 4 c (} p p ry g .,' •r~
(} epics df an engineered plan showing the location and extent of the work, and four 4 co ies ai' the relimina En sneer's ork. The
plans shall show the relation of tits prt~osed work to existing surface and under~ound improvements. When approved by the City Eng;i~eer, sold plan becomes a
part of this petittii
D. All work shall conform to the City of Campbell Standard Specifications and Details for Public Works Construction; the General Permit Conditions listed on the
reverse side; and the Special Provisions for this permit, listed below. Failure to abide by these conditions and pmviscans may result in job shutdown antl/or forfeiture
of Faithful Performance Sureties aad cash deposits. fSec General Permit Conditions 1 and 2.}
E. The Contracttx must have this permit and approved plans at the site and must notify the Public Works Department at least two days before startin; work. Notice
must be given to Public Works at least 24 hours before restarting any work.
Name of Applicant PG&E Telephone 725-2153
Address 10900 N Blaney Ave, Cuper(fW~S;14 24-HOUR EMERGENCY TELEPHONE NO. 1800/743-500
E-Mail Address. JJGJCe~PGE.COM PM 41063197
Is this work being done by the property owners at their own residence? Yes X No
The ApplicantlPtrrnittec hereby ~°~s by affixing their s a°ttature to this permit to hold the City of Campbell, its officers, agentx and employees free. safe and harmless
from any claim or demand for damages resulting from the wank covered by this permit.
The ApplicandPermittee hereby acknowledges that they have. read and. andetsrand~both the front and hack of this permit.. and they will inform their contractnr{s) of the
information. Applicant is advised that upon issuance of this pertttit, property owner, or property owner's successors, shall be responsible for any and all damages
arising out of the. ctmdition of any private improvements in ti}e public right-of-way.
%~-~ 05/13/10
(Applicant Petznittee} (sign} Date .
PG&E--John Gambucci 05/13/10
Contractor (Prink Name) Date
_I . Street shall not be open cut for underground installations
tee sneciftcaliv ag~roved by the htstxctor prior to cutting.
T2. Pavement tray be cnt for tutderpround installations and n
"A", unless otherwise approved by lnspecta.
,3. Work to be staked by a licensed Land Surveyor or Civil 1
before starBng work.
,~4 Per Section 4215 of the Gavemment Cade this permit is i
the inquiry identification number has been entered haeat
~5 Pror tc any work:. the property owner stall ~c:.utc an A;
recorded.
~G. Public Notification Requirements:
7.
SEE PLfAL.1C' WORKS FEE SCHEDCILF FOR CURRENT FEES
PERMIT APPLICATION FEE
PLAN CHECK DEPQSIT
SECURITY FOR FAITHFCIL PERFORMANCEfLABOR & MATERIALS
CONSTRUCTIOTf CASH DEPOSIT
PLAN CHECK & INSPECTION FE;r
AMOt NT RECEIPT N0,
s 33S ~t
$~
APPROVED FOR ISSUANCE
For Ctty Engineer Date
Permit Expires 1~ Months After Dare of Issuance
FJ is ~f ~-L+-1'~ ~ S ~ 1/
%'.
GEAL PERMIT CE~NDITIC?N~
f. A Cnnstructsan Cash t?tpessst is required. Cbargec witF be made agssast fists deposit if there is an emergency tact-out overtime inspectitm or when City
ordered barricading is required. Aap such cosu is excess of the deptnit will be hilted to the Pcrtnittee.
2. A oat-year maintenance period atsd surety ass required. Such period will begin oa da+rt of written aeceptassce by Ilse Csty.
3. < Refiiad of liar sssh deposit baiaasce abd refsr~ tx s~oa of ttac FaithfuC P!aituraaa+ce Suasty vrill bt isitiasrd by dae wrsttea acceptance of the wssrk
by dse City
4. TEta P'i~ssnttex anust rsquGCt ro wrstiag a front itasprxeioa and aeceptasscs of the work apes eAeegstetietit. A f ;+ ttae City wilt be saasie is wti€iag m
fist Ptrmsttee.
5. Miiatasa safe pedestrian and vehicular crossings and free access to private dtiveways, busstops, fire hydrants and water vatvCS.
6 A Ce~asuuctias Traffu Casttol Pisa and a Coasatacdtsa Sctteduk are regaissed f~ alt lane clesaures, detoars and sweet closures. This plan aawst bt
reviewed and approved priear w nay lase clnsrass.
i. Ttae Caasasaiat 1'iaf~ic Cmttoi !'tier atraft caaforus ao dae Gattratss Manual ~ Traffic Cetotrols far Coastrtsetioa std Maine work Zones. dared
t9S10. avaifaC.sic at Caltrsns. Tia~'sc control aquipment stand iarmt~e Type II arrow signs if -
8. Replace as dirt,CtGd by the City F.agitsar nay deranged a removed inaprovenxtats ro acconlatace with Gty Standards and Sptcifscationx ~ dse sort
expense of ttie Perteuttee.
9. Sawcut for aCl PCC or AG rea-ovals• Alt PCC rcasovats shall be to nearest scorcmark and shat! be doweial w existing itnpmvtsrtss~xits•
l0. Cirinr spprrsuaf rsf inspector is required for any worts dose after nomrtial working boars, as wedrmds or haiidays a~ arty require rei~t of
nsptotiori assts u flee turreot overshoe rue,
13. Adegaate siguiac std battripdiag is re~sirrd oa the 1'~ s-tt t=ame to proviek suds siding sad barrie~tGag may rssuh is flit City"s tuowidting srgamg
mx! sad g ~ east ttrsc~ng aA Iabar and yak? tl-c cash dept~u.
12. Gampactiou tesuag of subgr+de. base roeE, sad aspbath asacrete by Pcrrrssttee sx requmed unless ottxnvise stated isy ~ Ciry Engineer.
13. The Coatraetpr or Perarittee wifl tuvt a supervisory representative available for contact on the protect at a!t limes during cdistiucKioa. Cemtrsctor or
Permiuee shalt provide a phone another at which they can be contacted outside the hours of 8:9!7 a.ai. to 4:lxf p.m
14. Na storage tsf raatasais or ettaiptaea[ wiIl bt aliowsd scar the edge ~ pavesneast die travtded way. yr within the stxxskitrGrse wtsiadt would create a
haSardoos candstttaa to the pub&c.
t5. Ttss perarut stmt not be ccsastraed ax autieasizatian fa ext~vatttsa nerd grading oa private property adjacaat to the worT` err nay other wtxi; for wCiich a
separate permait Lady bt regairai, sac ~ it relieve the #'amituc of any otrt~gation to ohmic nay outer permit. required by taw
1 b. This permit does na rettase tlse P+errraituc from say liabiCities cnaGVaed sa odser a$reetaeats trr coattaots wills !tie City sad nay txtser pabtic agency.
11. This permit is sssx traresfcrable. Wark toast be performed by the Permittee or hi:t designated agent oT caanaetat as specified thercnn.
f $. Cali back (call mot) dtie t,o eraa~gtr+cies regarding dais permit shalt be at the current averttme rate with a tta'et (3}hour tttsaimum charger per occiarena-
4. Ps:rsaant ro Qtaptes 14.!7? d the Carrgabelf Muaicit+al Cadiz, appfirant shall not cause to be ~ nay iasatersat iron tree ataacipal storsa drain systsan
other dean s@orxn wirer.. Appticsot sliafl to tlac BEST MANAGEMp~tT C'RACTICES estabhshad t>y tlae SsreEa Clan Valley Urbata
. Prevsaucia P4rnga7cm.
29. if dtt pnibtic iatssest requires a snotHfecuioia ~. err s deparatxs from, the plans and specs{scttita~, dx City shalt love rtes authasiry tct squire err approve
any ration cr dtpartare nerd W specify the manner in which dte same is to tie made for City-owned or aisiatasned fmatiacs.
?1. Perrnstue must pmvide advance. aotificatiat to alt parties that trtay be affected by the permit activities. 1Votifisxidon shall be reviewed by City prior to
distnbutic:L ar,3 it ~ lull:. dates of worS; aim a t:astaei tiarasc anti phizse nwtiber.
Appiigaa st~il be trsgoosibte fa easrusng that all dsieae providing services trader the appi~artt arc aware of sad emde~aatd all tff the: abrn a rxmdiuoas.
05/13/10
05/13/10
Daze
~ A~r~t
PG&E John Garnbucci
Coziffactor (Print Name)
~. 11191tt~
Pacific Gas and Electric Company
Field Paving Measurements
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ORDER NUMBER ~
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ORDER DESCRIPTION, ? ~ j} ~
PROJEC f ~IT~ ~~ i l~~-.-~ ~ 1f r ~'~ /'~ ~ ~~
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PREPARED BY ~..
DATE PREPARED
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