ENC2010-00074CITY OF CAMPBELL o Y L ENCROACHMENT PERMIT ...trait Na Eti'G,2OI C~ ~' C}C`)C~ 7'~
DEPT. OF PUBLIC WS o 0 Q (for working within the public. X-Ref. File
70 Nowt First St. ~ ti ~ right-of-way)
Campbell. CA 95008 W ~ N f .~ /~ Application Date 5/ 10
c'.i U - ~o O Apglicaciat; Expiration Date ' ~
(4118} 86b-2I50 ,~T J Z Issued
Fax (408 376-095$ ~ ~ ~~ ~ ~ APN 2-~b~ l 7 ~~~~
[W ~ a p Permit Expiration Date
APPLICATION - Applic3~f is hereby trade for a Public Works Permit in accordance with Campbell Mantcipal Codt, Section 1 l.{l4. (Application expires in six (6}
months if rite permit is not issued. Application Fee is non-refundable. }
PM 30775664
A-Work address or tract# 1314 EI Sol o Ave
Utility trench location ' er as main
B Nature of work to hole 4' x 4' x 4' to abandon as service to house
C. Attach four f4} copies of an engineered plan showing the location and extent of the work, and four {4) copies of the preliminary Engineer's Estimatr of work. The
plans shall show the relation of the proposed work to existing surface and undergt'ound improvements- When approved by the City Engineer, said plat. becomes a
part of this petznit.
D. All work shall conform to the City of Campbell Standard Specifications and Details for Puitlic Works Construction: the Genera3 Perntit Conditions hslcd on the
reverse side: and the Special Provisions for this permit, listed belpw. Failarc to abide by these conditions and provisions may resuh in job shutdown •rndlor forfeiture
of Faithful Performance Sureties and cash deposits lSee General Petmtt Conditions 1 and 2.)
E, The Contracwr must have [his permit and approved plans at the siu and must notify the Public Works 1epartment at least two days before starting work. Notice
must be given to Public Works at least 24 hours before restarting any work.
Nance of Applicant PG&E Telephane 408/725-2153
Tint n
Address 10900 N Blaney Ave, Cuper~ino,~b14 ?4-HOUR EMERGENCY TELEPHONE NU. 1 gOOR43-5O0
E-Mail Address JJGJ(C7PGE COM -
Yes X No
is this wark being done by the property owners at their own residence"
Tbc Appiicant/Permittce hereby agrees by affixing their signature to this permit to (told the City of Campbell, its officers, agents and employers free. safe and harntless
fram any claim ar demand for damages resulting from the work eavered by this permit.
The Applieanr/Pectninee hereby acknowledges that they have read and understandhoth the fron[ and hack of th+s pcrntit, and they wilt inform their contracux(sj of the
information. Applicant is advised that upon issuance of this permit, property' owner, or property owner's successors. shalt ire responsible for any and all damages
arising out of the condition of any private improvements in th ubtie nght-of-wa
/? ~ ~~ 2.,,, ' 05/21 /10
Accepted
(Apphcant Permittee) (sign)
llate
PG&E--John Gambucci 05/21 /10
Contracwr (Print Name} i)ate
SPECIAL PROV ISIUNti
l . Street shall not be open cur for underground installations. Minimum cuts ~ be allowed for connections or exploranon holes. , ut:h cuts may
be snecifrcaliv avnmved by the lnsnector prior to cuttrn~-
2. Pavement tray be cut frn underground mstallanons and must be restored in accordance with the Standard Details Trench Restoration Method
"A", unless otherwise approved by Inspector.
T3. 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.
4 Per Section 4215 of the Government Code this permit is na€ valid for excavations until Underground Service Alert (USA) has been notified and
~^;_ USA TICKET NO.
.a the inquiry identification number has bean entered hereon. USA Phone f -800-__ 2600. r z ,
5 Pror tc any' wark. the prnpeirty ow'tttr s=.al': exv<:utc an Agreement far Prtvatc Improvements in the public Rt~bt-c~~ • ...,y , which shat' be
recorded.
L Public Notification Requirements:
AMOUNT RECEIPT NU.
SEE PLJBI 1C WORKS )~E SCHEDUL- FOR CURRENT ),rFS 335
PERMIT APPLIC.ATiUN FEE
PLAN CHECK DEPUSIT ~
SECURITY FOR FAITHFUL PERFORMANCE+'~ABOR ~: MATERIALS ~
CONSTRUCTION CASH DEPOSIT $--~
PLAN CHECK 8: iNSpECT10N FEE
APPRO~`ED FOR ISSUANCE ~~ I ~
For City Engineer
Permit Expires 1~ Months After Dare o*.' Lssuance
r L` ~-. ~ r ~ ~V /lj ~~
~•
GEI~GERAL PERMIT CCJI.NDITIQNS
t. A Construction Cash Dtposit is required, Charges will be made against this deposit if there is an emergency tail-out. overtime inspecvat or when City
txderrd barricading is required. Any such cosu in carcass of the deposit will be billed to the Permiteee.
'~- A cane-year trtaintenattre period and surety are required. Stich period. will bogia as dart of wnmat &cceptanre by tha Ciry_
3. Refund oftythe rash depas#t bay and reload or carsrcllatiAn of the Faithful Perforsrance Surety will be initiated by rho writttrt arrxataaro of the work
by the Ci
a- The Ptzmitice must requests wriuag a final iaspccnrm and acreptaace ref the work upon compicucut. ,4cceptatirw by ~~ City wilt be ttsadc in v+ritiatt ua
the Permitted `
S. Maintain safe pedestrian and vehicular crossings and free access to private driveways, bus stops, fire hydrants and water valves„
6 A C~struction ?raffir Ccxtrrol Plan and a Cotasirtrrtion Schedule are required far ail lotto closures, detours and sucxt closures. This plan mus bo
reviewed and approved prior to any tone cbsures.
't. The Cottstracticaa Traffic Control Plan shalt txxtform ua the Catirarts Manval of Trafttr ContmJs f~ Consuurutxs attd Maintenance 1k'ork ?..Aces, dated
1990, availablo at Cattnas_ Traffic ctxtrrol equiptssmt shalt ittcietde Type II firachrng arrow signs if trrluir'xi.
5. Replace as direcred by the City Ertgineer any damaged or rtnnoved improvoments in areordance with City Standards ,and Spe: ifiratians u the sale
expense of the Permtctet.
9. Sawcut for alt PCC or AC removals. Ail PCC removals shall be to nearest scoremark and slsail be dawcied w existing mpmvemcnrs.
10. Pnnr appmvai of tttspertor is required for any wort; dtaoe aftex nottnal working hours, an weekends ore ho}idays and tnay require roimburument of
inspection costs at tht wrreru overtime rate.
13 Adequate si~tiag tied barricading is rtzlaired on the gob site. Faiurc to provide such sigstiag anti barricading may result is rho City's ptov~ding stgtung
and laarric3dcs and rhargiag the roar tincwdina alt tabAr and trtaterrals,a against the rash deposer.
T Z. Compaction testing of sub~ade, bast tack. and asphalt concrete by Pcrmitteo is required unless otherwise stated by the City Engines.
13. The Contractor or Permittee will have a snpervrsoty rcprescntaUvt available for cantacl ort the project a/ alt umes during canstructian. Cuttuactar of
Permittee shall provide a phone number at which Choy can be cartutcted outside the hours of 8;U0 a.m. to 4:Oti p,m.
14. No storage of rttateriait or egntpment will be allowed near the aclQe of pavement, the travek.tl way. or within the shouklexline ,which would crcato ,~
hazardous roaditxm to the public.
I-'. This perrrtit slaal! not be txattsuued as sutlxxtzatiAa fax excavation and wading on private }' adjactnt to tlrc work, or ,any atltc work fAr wttrrlt z
~u parrrtit racy be required, oar does it rciiew. the Permittoe of aav obligautan tt~ tabtain tiny ocher permit rcquiroct a, lax,
16. This permit does not release the Permitter from any habih[ies ctxitained in other agretraettis or cantraru with the City and aay Atha public agoccy
i 7. This permit is not transferahie Work must be performed by rho Pcrrrtitree ar his designated agent or conv:tctor as specified theraon
i 8. Cali back (call out} duo ira emetgtneics regarding this pettrtit shall be at the current aventtne rata with a three. (3) hour trunimum charge per occurrencd
1 `~ Pursuanr ro Chi{xex i C.O~ raf die Campbell Municipal Code, applicant shall not ause to hie discharged
txher than storm waur. Appiirans shall adhere to she: BFS'." MAi~iAGEMEI^.T PRACTICES ~yybia ~~ t~ c,~~ ~ n systetn
Polhuitm Pnevettnon Program.. y tlriaan RrmAf
20. If the public interest rcgrrirts a modifir~tian of. or a depamrrc front. the plans and specifrpaons. the City shall have the authority to requm Ar approve
any rrrodificatitm ar departure and tcs specify the manner in which she same is to be made far City-Awned ar ntaintaaned faciliues_
23. Petmittee must provide advance notiftcaaan to alt patties that may be affected tsy the permit activities. Natfira[itm shat! be roviewed ray City prim tt,
disvibuticn ar,:, in;.ludc ;arc; of wort: and a ~nta.~t Haan.: aAd phone nu.-sir.
Applicant shall be resporssibk far ensuring that tiff throe providing servtccs wrote the applicant tiro aware of and understand alt of the above condivoos
Appheant _ 05/21 /10
PG&E--John Gambucci ~"
contractor 05/21 /10
(Print l~iame) ~
7lfarmstpwperm
Rc~~ 11 /91Q
APPI~C~~1 ~ ~~~~~ ~~C?~~~ ~ ~UCTIQ~
PG&E Permit Sketch for: City of Campbellt> U ~JJ ~ I C ~f~f ~ d ~r ~ ~-' ~ ~' x'11 ! ~ ~~~ ;~. Et~L2L11Cr
~niio~+u~ .za~st have these plans
Address:l314 El Solyo ;„~, s;,. ~~,;no ~o~~,,,,,,;,,,,
Nature of Work: Abandon Gas Service at Main
Surface: Concrete Cut Behind Sidewalk Excavation size: 4' x 4' x 4'
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