ENC2010-000722010-Jun-02 10:53 AM Pacific Gas and Electric Co 5593475344
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Hbl02/2011~ 04:20 4083161 PUBLIC WQRKS PAGE 02102
Nlay, 1b. '1010 11:~rPM ~Pa~ific Gas aid ~leotr~ ~.~~,~~ No. 16b7 P.~~LL2 .
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70 Norttr First Strret rlghtoFa+~yl ~ Appile&t10A DRte '
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APPI.ICATIbN-Appllcapen 16 herebymada for a PubElc Works PermR In ac+;ardanre with C'atrSpta21(Mun1e(pAI ~odM,Sedlert t 7.04. (AppllCat(ran ekpires in she
(fi) monthx If the permlt fs oat Issued. AppE-catlrn Fee is tson•refGndable3
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AstlmxtetlfworlcTheplensshallShowthareietfonoftheproposedwarktae>ilattr~gsurfaooendundargroundlmpravemonts.tNiTenappro ccs y~~
bytha city englnnar, sold plan becomes a part of this permlt, ~ ~ ~..~ U US
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listedanthereverseslde;andihRSRR>~IProvidonsforthlspermlt,GstedbeleW. Falluretaat~ldebythesemnrfitl4u15tlndpravlstonsmay ~ yip
In Job shutdown andloribrfrlture of FaRtlatl PetfoEmante 5urettes and cash depa5lts. (See general Permit t"endlttons 7 ant Z~J ~ d
i:. 7Fie CaFrtractormusthave this petF11IC aRd approved plans at the site and rnubt gotlfytlte PubAc Wor9a Department at leacttvfa days before
staTttnpwork, NQtlcemU!>:brlgteenmPuhlleWorksatleaAt24houtSbelarerestartinganywotk
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h this work being done bytheproperty ~vn>irS9t tlt2irown r¢ttd61teP2 r' ~+E5 r'" ND IL. ._ .... _ ..,. ,., , ,.
The AppGwntlPermlttce hcrebyagrees by affixitiq thefiir ai9naturo to this permit to hold Shp City of Campt~ll, ob ofAcers, egen4s, and ~Rtptnyaan Free, safe
and harm IQyt f torn IIFIpF CIOIAt Of d4n+nnd fbr damages resuli)ng Erato the urotkcosrered bythls permit
The AppllEan~'erml~la hnTRpy aekrtowlodges char they have read nn>i understand bath the Front end back oP this permit and IhQY win in(orrn #helr
stmt-acter(~ pf the infvrrttatian, Applicant b advfse4'that upon issuance of th-s perrntt, property own®r, or (rq' owner's suco~ssors, shall be
reaponslblc fararry ar n e9 arising out oFthecnsldltlOn ai:a~rovements In the publicrlg~ht^tr~wwzty.
W`"~ Accepted: ~ -~_ `~~r--' ~ ~ ~~
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"A" cmtrsc atharwl~e oppmvcd bythe EngitteEr~
3. Worktobestakedbyalleert.edkand5urveyorarCtvi{BF-13lneerandtWOtA3gapiesoFthecutxheetssenttothePUbTsCWCrtrrsgapnrtmerre
before starting work.
~4. PcrS~tltltlq~lSQfChe4rnrernmentCode[hlspErrtBtlSnatvalidfOTexceuatlunsutrfi117ndergraundSeNiCBAtesti{I!S/1~Itn>;fxannoti;tledand
thelrlqulryldentlttratlonnUmbprltagi7Arm6Meredhercon. USA Phone; t•BOb-X72806 i15ATIGK5CN0~.
_5. PttortaannwotOc,thepropartyowner5fiaflPXeCttt2anAgreement(OrPdv~telrnprrrVRtn!!ft!{I1~hePYbljtRT9fllwkWry,whtdishsObe
tatarded.
6. Publf=NotfflexflonRequlrerrlent5;_
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~~pl,L~WLORKC fEE SCFfFDU1.E Ft}R CL11tRENi FEES
PERMlf APPLI[ATION FEE
PL~StV CFIECK QEp05ft
S€CURiTy FOR FAfiNFUL P~RFnRtdANCElI.A801i & MATE}ilAI.5
Ct)NSTiUJCTt4N CASH OEPOSFT
PLANrHECR & INSPECTtQN FEE
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May, 26. 21)10 12:27PM P~~'~flc Gas and Electric Go. No, 1667 P.
GENERAL PERMIT CDN~ITIDNS
1. A Construction Cash Deposit Is requlred. Charges will be made against this deposit ifthere is an emergency call-ouL overtime Inspedlon or when Clty
ordered barricading fs requlred. Any such costs In excess ofthe deposit will be billed to the Permittee.
2. A one•year maintenance period and surety are required. Such period will begin on date of written acceptance by the Clry.
3. Refund or the cash deposit balance and refund ar cancellation of the Faithful Performance Surety will be Inltlated by the written acceptance of the work
by the City.
4. The Permittee must request in writing a Rnal Inspection and acceptance of the work upon completion. Acceptance bythe Clty will be made In writing
ro the Permittee.
5. Maintain safe pedestrian and vehicular crossings and free access to private driveways, bus stops, fire hydrants, and watervalves.
6. A Construction lYafflc Control Plan and a Coltstrudlon Schedule are requlred for ail lane closures, detours, and street closures- This plan must be
reviewed and approved prior to any lane Gosures.
7. AConStruttionTraFficControlPlanshallconformtotheCaltransManualofTrafficCvntrolsfvrConsttudianandMaintenanceWork2ohes~dated
1990, available at Caltrans. Traffic control equipment shall include Type II flashing arrow signs if required.
8. Repiaceas directed by the City Engineer any damaged or removed Improvements fn accordance with Cfry S[andards and Speclflcatlons at the sole
expense of the Permittee.
g. Sawcut for all PCC orAC removals. All PCC removals shall be to the nearest scoremark and shall be doweled to existing Improvements.
10. Prior approver of Inspector Is requlred forany work done after normal working hours, on weekends yr holidays and may require refmbursemehr of
Inspection costs arthe current overtime rate.
11.
12.
13.
14.
15.
16.
17.
1 B.
19.
z6.
21.
Adequate signing and barricading is required on the Job site. Failure to provide suth signing and barricading may result in the City's providing signing
and berrl[ades and Chargingthe cost (including all labor and materials) against the [ash deposit.
Compaction testing of subgrade, base rock, and asphalt concrete by Permittee is requlred unless otherwise stated bythe City Engineer.
The Contractor or Permitteewill have a supervisoryrepresehtative available for contact on the project a[ aliilmes during construetlon. Contractor 4r
Permittee shall provide a phone number at which they can be contacted outside the hours of 8:60 a.m. to 4:D0 p.m.
No storage of materials or equipment will be allowed near the edge of pavement, the traveled way, or within the shoulderline which would create a
hazardous condition to the public.
This permit shall nor be construed as authorization For excavation and grading on private property adJacent to the work or any otherwork forwhfch a
separate permit may be required, nor does It relieve the Permittee of any obllgatlon to obtain any other permit requlred by few.
This permit does not release the Permittee from arty liablllties contained In other agreements or contracts with the City and any other public agency.
This permit Is not transferable. Work must be performed bythe Permittee ar his designated agent or contractor as speclfled thereon.
Call back (call out) due to emeregencies regarding this permit shall be at the current overtime rate with a three (3) hour minlmuril Charge pet
occurrence.
Pursuantto Chapter 14.D2 of the Campbert Municipal Code, applicant shall not causeto be discharged any material into the municipal storm drain
system otherthan storm waxer. Applicant shall adhere to the BESTMANAGEMENTPRAC7IGES established bythe Santa Glare Valley Urban Runoff
Pollution Prevention Program,
Ifthe public interest requires a modlflcatfon of,ore departure from the plans and speclflcatlons,the Cityshal] have the autharityte require or approve
any modification ar departure and to specifythe manner in which the same is to be made for Ciry-owned or maintained facilities.
Permlmee must provide advance notiPcation to all parries that maybe affected by the permit adlvltles. Notification shalt be reviewed bythe City prior
to distribution and include dates of work and a contact name and phone number.
Applicant shall be responsible For ensuring that all those providing services under the applicant are aware and understand all ofthe above condl#lons.
Contractor (Print Name)
Date:
Date:
J:IFOAMS~Templates~Encroachment PermitslEncroachment Permit STATIC Fotrn2.pdf
Rev. 3/08
Nlay,2b. 2010 12:27FM P~~Ific Gas and Electric Cu,
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TOTAL NUMBER OF PAGES INCLUDING COVER;
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MAY 2 6 2010
PUBLIC WORKS
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