ENC2010-00070_`
CITY OF CAMPBELL
DEPT. OF PUBLIC WpRKS
70 North First St,
Catnpball, CA 95008
(40$) $66-2150
Fax (408)376-0958
ENCROACHMENT PERMIT
(for working within the public
right-of-way} /
Issued 5l ~"5 ~ ~O
Permit Expiration Date
Pt:rmit Nom C~c> ~ ~~ `~~ ~ ~
X-Ref. File
Application Date 05/14/10
Application Expiration Date 10
APN X11 ~ ~ ~ C~31
APPLICATION - Applicaiitm is hereby made for a Public Works Ptttrttit in accordance with Campbell Municipal Code, Section I I.04. {Application expires in six {Q}
months if the pertnitis not is ppiication Ftx is non-refundable.}
A. Work address ar oract# ~~ Dillon Ave ,~h/ t~/3C7.S-8'~~
utility trench Iocatian tap hole behind sidewalk in dirt 4' x 4' x 4'
B Nature of work Dig tap hole to install anode on gas service.
C. Attach four (4} copies df an engineered plan showing the location and extent of the work, and four {d} copies of the preliminary Engineer's Estimate of work. The
plans shall show the relation of the proposed work to existing surface and under~•aund improvetnenu. When approved by the City End Weer, said plan becomes a
part of this pcnnit.
B. All work shalt conform to the City of Campbell Standard Speciftcations and Details fat Public Works Conswction: the General Permit Conditions listed on the
reverse side; and the Special Provisions for this permit, listed below. Failure to abide by Chew conditions and provisions tray result in job shutdown andlor forfeiture
of Faithful Performance Sureties and cash deposits. (See General Permit Conditions 1 and 2.}
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 before restarting any work.
Name of Applicant PG&E Telephtmc 725-2153
( tint n
Addres510900 N BlaneyAve, Cupertl~lo, ~b14 24-HOUR EMERGENCY TELEPHONE NO. HOO/74 ~~0~1~'I` /~D
E-Mail Address ~~ V
is this work being done by the properry owners at their own residence? Yes ~_NO MAY ~ 0 1010
The Appiicant/Permittte hereby agrees by affixing their sipoature W this permit to hold the City of Campbell, its officers, agen~c and empioye~,~~~~~~
from any t:iaim or demand for damages resulting from the wank covered by this permit.
The ApplicanUPtrminee hereby acknowledges that they have read and understancAboth the front and hook of this permit. and they wilt inform ttteir cantracurr(s} of the
information. Applicant is advised that upon issuance of this permit, property owner, or property owner's successors, shall be responsible for any and all damages
arising out of the ecmdition of any private improvements in the p tic right-of-way.
-..,.a,~ _ '~ 05/14/10
Applicant Permittee) (sign} Date
PG&E---John Gambucci 05/14/10
Contractor (Prink Name) Date
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Street shall no[ be open cut for underground installauons. Minimum cues l~ be allowed for connections or exploration holes. Such tuts may
~e snecificaUv ag r~mved by the Inspector prior to cutttnr.
Pavement rtaay be cut far utsdcrground installations and must be restored in accordance with the Standard Details Trench Restoration Method
"A", unless otherwise approved by Inspcetor.
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.
Per Section 4215 of the Gavemtttent Cade this permit is not valid far excavations until Underground Service Alert (USA} has been notified and
the inquiry identification number has hero entered hereon. USA Phone E -800-227-2600. USA TICKET NO.
Prcr tc any work. the property owner stall cx:.cutc an Agreement for Private improvements in the f`nb1i:. fizgtt-of-.gay, which shall he
recorded.
Public Notification Requiretnenu:
SEE PUBLIC WORKS FEE SCHEDULE F R CURRENT FEES
AMOUNT RECEIPT NU.
PERMIT APPLICATION FEE ~ 33 5 ~_
PLAN CHECK DEPOSIT ~
SECURPCY FOR FAITHFUL PERFORMANCE!LABOR & MATERIALS $
CONSTRUCTION CASH DEPOSIT $ -~-
PLAN CHECK fi INSPECTION FEE S~
APPROVED FOR ISSUANCE ~ sIZS~~~
For City Engineer Date
Permit Expires 12 Months After Dare of Issuance
{, P 1
GENERAL PERMIT CO~AtI?ITIt??VS
1. A Construction Cash Deposit is required, Charges will be made against this deposit if there is an attergeney tail-out, overtime inspection or when City
orderal batacading is required. Any such costs is excess of the deposit will be billed to the Pertttittce.
2. A txtt-year tttainte'xtance period oral surety are required.. Sudt period will begin on date of wrttttn atxeptuue by the City.
3. Refund.. of the rash deposit balance and rcfsmd or c~oacllasiaa of the Faithful Performance Surety wiq be initiated by the writun atxcptance of tht work
by dte City.
4. The Perrnittee must trgttest in writing : final inspeetiao and acxeptarttx ~ t'he wont upon corrtplctioa. Acceptantx by the City will be made in wndng o0
the Ptxmittee_
5. Maintain safe pedestrian and vehicular ctossiitgs and free access tc private driveways, bus stops, fire hydrants and water vzlves.
6. A Construction 't'raffic ComrN Plan and a Consnttctioa Schedule arc required for all lane closures, detours and street closures. This plea must be
reviewed and approved prior m any lane ciasnres.
i. The Traffic Control Platt shalt conform to she Caitraps Manual of Traffic Caorroh for Coe~rncssors and Muataunce Work Zaties, dated
14510, availaliie: at Caltrans. Traffic cntetra! equipment shall i>uc Type t1 fkashta~ arrtrw signs if required..
8. Replace as directed by the City Engiteer any damaged ~ removed. improvements is accordance with Gry Standards and Spocifications at the ante
expense of the Ptxrtuttee.
4, Sawcut for atI PCC ar AC removals. All PCC removals shad be to nearest scorcmark and shad be doweled w existing improvements.
I t). Prior approval ~ inspector is required for nay work done after norttiai working hours, wt weelcwdc or holidays and may require reimhausattent of
inspccnott costs rot the current ovatirot rate.
I t Adtquam signatg and bsrripdiag is rsgntred oa dx job sit~ee Failure to pravitk such sigr-ing and barricading may mutt in the Ci s vidin st
ty' 1~ g €
and barricades amt tag the cpst (wcng ati lobar and nxstcnals) against rite r degrosit,
t Z Corttpactioo textscg of subgradc, base rock. and aspha}t ccxtc7+ete by Permitter is required tntksc otherwise stated by rise Cry Engineer.
13. The Contractor or Permittee will have a supervisory representative available for contact on the project at all times during cottstrucuon. Convscctor or
Permiaee shalt provide a phone number at which they can be contacted antside the hours of 8,0o a.m, to 4:Oil p.tn.
l4. No storage of rrmtearials or equipment will be allowed nor the edge of paverr~t, the traveled way. or within the shouWaiiae whidr would create a
hazardous condition to the public
t5. 'Phis pexsnit s~talt troll be construed at autttanzation fa extavatioa and grading on private prt>perty adjacent w the work ar any cxhes wort; for which s
separate perrmt map bK required. nor does it relieve the Permittee of any obigatioet to obtain arty other permit regxurrxl by taw.
l b. 'this permit does not release the Perrrtittee from any 1aa~6ties contained in other agreerneats or contracts with the City and any outer public agetrcy
i 7. This permit is not transfi;nble. Work must be performed by the Permttee or his designated agent ~ contractor as specified thereon.:
t $. Celt back (call out} due to tanetgettcies regarding this permit shall 6e ar the current overtime rate with a three f3} hour minitwtm charge per txcurrtncc
i 4. Prusuant to Chaptc t 4.f1= of the Campbell Municipal Code, applicant shall nor cause to be discharged any rnaurial iMO the ttamitapal storm drain system
onus dtaa SPrev~rnno~a 1iC30t stall adhere tt3 the BEST MANA(`iiEMET~iT PRACt"ICF.S estebfis>ted try the Santa Clara Valley tJrbaa Rtmof-
20. if tht public intuest rtxluires a ratacl;ftgtion of. a a depattutr from, the plans and speciftcaootts, the City shalt have the audtority to require or approve
any rnodifrcatiege or deparntre and to specify the manner in which flit same a to be made for Gty-owned or maintained facilities.
21. Permittee must provide advance norificatian to all parties that tray be affected by the permit activities. Nodficxtgcxt shall be reviewed by City prior tra
distritsution a<~ in;.tudc dates of work and a contact. nom:. and phrxtc nu3tbcr.
Applicant shall be napooisibk fix enstuirtg that all those providing. services wades the applicant are aware of and tmderstand all of the above conditions.
Applic:an:
PG&E--John Gambucci
Ctmttacwr (Print tvame}
05/14/1.0
bate
05/14/10
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PGBiE Permit Sketch for: City of Campbell
Address:297 Dillon
Nature of Work: dig tap hole over gas service to install anode behind sidewalk
Surface: Dirt Cut Excavation size: 4' x 4' x 4'
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y ~ wry ~, t ~ _ _..,,,, NOTIFICATION #: 104654947
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„~,~,~,,,ctor must have these p~aas ~~ ,
-~n ~hN iob site during construction
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