ENC2010-000732010-Jun-02 10:54 AM Pacific Gas and Electric Co 559347544
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Appilratlon Date
Appllcafiion FxpiTatiort ~tI1~A ~
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APpi,lGAT(ON-Applkatlonlsherehy madeforr+PUbIIcUVorkePermiclnaagrelen~etivl[FrCampbellMvni~palcude,5ecgon7r.0a, (ApplkatinnexPlreAln"~
(ti) monthsHEhr•permltlsnotlssard. Application Feels11nr1•re£gnd~(tle,1
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C, Attachfour(h)mplesoFapen~4teer2dplxpa{lpwingthAletatianand2xtehFthevmrk,sndfour(4}coplp5ofthep[4)ImineryERglflpEr~~'x
Esttmate of wnrk. 1'h~ plpns ahall ohowthe relattoq dtth~ pro posed wor{cty eodsting.urFecc` end underground ImpTpvglri911tg. Whitt gppc~Y~
by the City Engineep said }?1811 }1ACOB144 a part of tlils p ernrlb
D. Allwork!~hplfennfomltotitrsCigrofCainphe115tar1dard5peclAcatlonsandRetai(S~OrPubifeWorksConstfuCtltltl;th>y~+an9fnlPprmitCnndltbns
Iistedanther~fs~fideFrpellhp5pe~ialPro~lsionsfnrtntsparmlG)fatedbelaw. FaAUf2tasbldgbYth~econditlortsandpmvicionsmeyresuIt
lnlobshuedownand/ofFCdlltUfdtsff~hhtuiPorformanceSuretiesandshahdopo9tts. (SeeGe+lernf Perm$CGrtrllklenel end2.)
6. 7i1e Contractor must have ~khfA p~almf k and Approved plans al the ETte anti must notify the PUbIIc VlfotKs D9pPrrn'Ikn4 E C fe95t two d~7y5 b2lt+t?
startfia wock- Notice must be GIYAri t0 AUbttC Warks at IeagtZ4 hours before TB6Cdrting any work
PJarneaFAppllcanl:
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C-Mall Addte,4R1
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~l-HtJUR EMEFt;EN4Y wHan+E WUM~PR;
{.Sthi6workbeingdonebychepiop~ttyowru:r9dtllSehownresfdenre2 r YES ~; ND
71re Applicartt/Parmlttee hereby agrees by afFi>tilt~ their Signatur0 tb this permftto hold the City of Gampbetl, Its ofircers, dQellts, bpd rlrnployeos free, safti
and horml~s from sar~y Helm nr demand for derneges resulting hrom the waek covered try this permit.
The AppflranrlPermlttaa hereby acknowledges that they have read and urlderstrrnd both dtiQ from and back of tftiS permit and ifiey Vyllt lnforlr+ tNe1r
wlrtractof{s1 of the {nfgrfnltlon. Applkant Is xdukod that upon Issuance of this permit: property owner, nr property ovmel's successors, shall be
responslhtclfc}ragynndgllderluges erlsingoutalthecandittan.oF~mprov2merttg(nthQpuhllcdgh1Fo11weK
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4>2~C5lly~kpt05'PSttP~ tfie Insr~rc[or arior to cultirt4.
z Pavemen[maybecutforundergroundlC6tdltdtiansaprarllp~tbere9tpredtnaetAfdenteWtththhStandardDetallsTrAhcllRe~tan~onMcChod
"R°, unfesc a:henvtse approved by the Engineer.
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,.Y,.5, PfiDtMAlYlrwbfE4th@properlyowrtCrShflllexecuteanAgreementforPrlvat~lmprovemegts-nthePubficRrght•nFwAyrWltilcitishallbe
rorarded.
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Sias PUBLIC WD6K5 FpF ~~~p~1,b ~Fi CURAE4Tf FEE5 Aa+ttltlNT (-~~
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APPROVED FDA 455UAHIGF. - - --
Far nglneer
PePmIiExPlros 12 MonthsAEter Date0F1>;suance
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No. 1671 P. 3
May. 26. 2010 1:36PM ° ~flc Gay and Electric Ca,
GENERAL PERMIT CONDITIONS
l ordered barricading Ibs required' Any such costs In exlcess ofthe deposit wllll bepbllled to thelPermittee envy call-0ut, overtime Inspection or when City
2. A one-year maintenance period and surety are required. Such period will begin vn date of written acceptance bythe City.
g. Refund orthe cash deposit balance and refund or cancellation ofthe Faithful Performance Surety w111 be Inltlated by the written acceptance of the work
by the City.
a, The Permlttee must request In writing a final Inspection and acceptance of the work upon completion. Acceptance by the City will be made in writing
to the Permittee.
5. Maintain safe pedestrian and vehicular crossings and free access to private driveways, bus.stops, fire hydrants, and water valves.
6. A Construction TYaff c Control Plan and a tonstructton Schedule are required for all lane closures, detours, and street closures. This plan must be
reviewed and approved prlorto any lane closures.
7. A Construction Traffic Control plan shalt conform to the caltrans Manual ofTraffic Controls for tonstructlon and Maintenance WorkZones, dated
~ g9o, available at Caltrans. Traffic canttal eq~lpment shall includeType ll Flashing arrow signs If required.
g, Replace as directed by the City tngineer any damaged or removed Improvements 1n accordance with Ciry Standards and Specifications atthe sale
expense of the Permlttee.
g. Sawcut for all PCC or A[ removals. All Ptt removals shall be to the nearest scoremark and sha11 be doweled to existing Improvements.
10, Prior approval of inspector Is required for anywork done after normal working hours, on weekends or holidays and may require reimbursement of
inspenlon costs atthe current overtime rate.
11. Adequate Signing and barricading 75 required vn the Job site. Failure to provide such signing and barricading may result In the City's providing signing
and barricades and charging the Cost(including all labor and materials) against thecash deposlC.
1 Z, Compaction testing of subgrade, base rock and asphalt concrete by Permlttee Is required unless otherwise stated bythe Ciry Englnee-.
13, The Contractor or Permlttee will have a supeNisoryrepresentative available for contact on the project at all times during construction. Contractor or
Permittee shall provide a phone number at which they can be contafted outside the hours of 8:60 a.m. to 4:00 p.m.
1q. No storage of materials or equipment will be allowed nearthe edge of pavement, the traveled way, or within the shoulderllne which would create a
hazardous condition to [he public.
ts. This permit shall nut be construed as authorization for excavation and grading on private prapertyadJacentto the work or anyotherworkfarwhleh a
separate permit may be required, ner does it relieve the Permlttee of any obligation to obtain any other permit required 6y law.
16. This permit does not release the Permlttee from any Ifab1{ltles contained In other agreements or contracts with the City and any other public agency,
77. This permit is not transferable. Work must be performed by the Permlttee or h1s designated agent or contractor as specified thereon.
18. Call back (call out) due to emeregencles regarding this permit shall be at the current overtime rate with a three (3) hour minlmurri charge per
occurrence.
19 P stem other than sto4m wateheApp~ pant shall adhere~toehe BE157 MANAGEMENT PAACTICEScestab~lshed by thel5antaoClara Va IeypurbanrRunoff
sy
Pollution Prevention Program.
20. If the public Interest requires a modlF]catlon of, or a departure from the plans and specifications, the lily shall have the authority to require or approve
any modlflcatlon ar departure and to specify the manner In whkh the same is to be made for ttry•owned or maintained fadllttes. rlor
Zt to dial but on and Inc ude dates of work and a cal tact nameaand phone numbeby the permit actlvlties. Notification shall be reviewed by the Clry p
Appllr~apehall~e respvnslblefor ensuring that all those providing services undpyti ant are aware and understand all of theabove conditions.
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bate:
Contractor (Print Name)
bate:
J:1~ORM51Templates\Encroachment PermltslEncroachment Permit STATIC form2.pdf
Rev. 3/08
May. 2b. 2010 1 :3~PM ~ ~ f I ~ Gas and El eet r I ~ Co. No. 1b71 P. 1
RECEIVED
MAY 2 6 2010
PuBUC woRlcs
X To: - ADMINISTRATION
FAx NUMBER : L ~.- Q ~'~ j C~
FROM: ~~~
FAx NUMBER: lC~ ~ ~ w ~~~~
DATE: ~ oZ.~ /
REGARDMG: ~~ Gy~~
TOTAL NUMBER OF PAGES INCLUDING GOVER: ,
PHONE NUMBBR FOR FdLLOW~UP• `l~~'~C~ ~ ~C~~ ~ ~ ~ IC~
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COMPANY NAME
STREET ADDRESS, CITY, ST ZIP CODE
PHONE ~ FAX ~ WEB ADDRE55