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ENC2010-00087 CITY QI? GAMP.BELI, DEPT: oF>~UB~cwoxxs 7Q Nottlt EirstSt. Gaxhohell; CA 9~Od8 (~48j 866-2 i5Q Fax (408),376-098 ENCROAGHYlENT P1I2Iv1IT (far worrr~irlg within tha public right-of-way) lsstied ~~ ( G t ~C' Permit Expiration Dale. ~ (1 ~ l i Pet7uitl~a ~NC2ol(7_ OOC~3'7 X-Ref, File. Application Date ~ /O Application Expiration Data1 1.f~ ApN_tiU 3-r~ 9- d~ APPI.1CATiON - Appficatitm is hereby made fpc a Public Wotirs 1?ermit in accardanccwith,Campbeit Municipal Code, Section I ? .44- (Application expires in six {6} months if the gcr¢ttt is notissu,^.d. Application Fee is noa-rciundabie:} A. Work address,ar tmcx:n p 7'D ~ /'O L~~ ~ /4' ~ £- n ~~ ,~U 7 7~ (~~ Utility trench to~tirn. P1r ~ " (D Q: !r A Y~~~"" S~ / %A'~ ?~o%C ~ n, ~-g/~GC~./' %y A'~ND D /l~ B.tvatureofviork_- ~~[~ i<x. ~~S ~G/`/rC{ //~~pl`Q Onl 1~(VJT 5~~~~ ~jDUI~.t! _~~jG~, C::AttaCh four {4j copies d"f an ~Q iteerecl Platt s~toiyng the lOc 2tion and extent of the wor};, and four (A) copies of fne preliminary Erigoeer`s Estimaic`,of work; Tlic plans sha1.1 show thG relation:of the . pr~posea wcu'k to axisttnr surface,and.nndZr~aund impmvezncntsW--lien approved by the City Eagiuecr, said Flan becomes a partof this petmiL D. All work shalE `conform to the City of t ampbeli $tandarii Specitications and Deaaits for Public Works Construction; [he Gcnerel Pemut Candi[ions;listed op the reverse side; and the Special Provisions'-far this persni~ listed below. Failare ro abide by these.condi4ons:u;d ptpyisions tray result in job shutdowtt and'/o`r forfeiture of Faithrul Petformartce Sureties and cash deposits.. {See 1;3eneral Permit Condi[idns 1 and 2:) - E: The Contractor mtcst hava this'petittit ]trrd appravetf plans at tht site and muss notify the Pubic Works Oeplttmetit at lc:tst two days before. startirie v,ork. Notice must be a ven to Public W/o~rks a[ least-24 hours before rrs(tar'tng any: wnk- Nante pf AppTicant~ Rt~LZ N1 . '7 ~/Y~ ~i S~ JJ~c ~~T ~' ~' ep y°Y 7 2 ~~ ZZ 9 Q Tel' hanet d9BO E rint name / Address ~ /{~. ^B ~AI/ ~' ~/ ~ ~ V~ ~ ,/~.j- 9 S~b / ~ ?4-HOUR EMERGENCY TELEPHO1vE NC._ / ~Oo ~ ~p'~' s~ s ~ E Ytart Address. AG'y ~ ~ ~ ~ ~ Cp.~- Is dris wprk oeing done by the ptnpery owners at their awn residence? 'Yi's ,~~No Ttic; Applic:rnt/Pcrmittce hereby a~rebs by affixing their signature to tfiispcrmrt to hold the City of Cantnbcll, its offtc~s, agents And emplpy~S fret:, Soft: and htifttlit,¢5 from any ctai;m ere ttdmano for damaae~ resuldao from the wdrk' cowed by this j?ertn4. The ApplicAnt/PermimCe hereby acknowledges that they have r;ad and untletstand,ho[h the fretnt and back of this ptrntiE: and they viii inform [heir t:oitUactnr(s} of the infcirm:ition- ApplicanE is advised that upon [ssuance`of this permit:. property owner, or property owner's successors, shall be responsible for gay and aJl darna~es arising au[ of the condition of any private irnprovemynCS in the pu61'tc rilght-of-way. (AppLcatrt Pesmtttcc) (stgnj - Date _ ContractQ; (PrintTVathc} Date _ , SPFC~IAL PFtQV1S10NS =1: Street steal) not be oFiers cut for ttidergtound'installatioirs. Minimum cutsm__,~a + be allowed for cannectiTOnsor expiot-ation haleti- Stich cuts may be z ecificilly approved by the. tnsnrcter prior to cutuii~: - _d.. Pa:~emcnt may be cut for un~ciginuiid instailAnons and titust be restoted in accordance will tlre.Standatd Details-Trench R-croration ts4~t un css of erwrse apprpvcd by Inspector; - ,~ Work eo be staked b}+ a Iicrnsed Lmd Surveyor t+r Civil Ett~inecv and two {?,) copies of the ctitslie'ets sent to-the Public Works Csepartment tief~re starung work. _d, Pm section 42i5 of rhd Crovcrirrgent Cod's this pcrrrtif is not valid for exeai~anona.tntil Under'~ri)nnd Scrvic~ Alen (CJBA}has been nocifed`atid the inquiry idennficatioti nutriber~sas bc,^.r Gtitci-ed Etcreon-" USA Phanc 1-800-?27-?600. ' L1S,4 TICKET N0. S. Pror to 2ny work: thcpropcty Uu~ncr s:tal; cxr;,utcan A~,rccmcnt for!'t-i-/ate lmprovemenT; iu the ['alit:: ~, t-v1= rJaj; wf3ich shall be recorded: _G. Public 1?atitication Requirem°ntsr ' 7. SEE PU&LEC WORKS FED 4CFiEDiJ~.E'FbR CitRRENT F`^4 AMOUNT RECEIt'T NO. PEItNiIT APPLICATION Fain S 335 PLAN CHECK DEPOSIT ~ SECURITY FOR FAIT'rIFZJL PERFL3RMA7VGEILABOR X. MATERIALS ~ COI~ISTRLICTION CASY-I DEPOSIT .FLAN CHE~IC cL~. INSPECTION FEE ~` /~ -~-- APPROVED FOR ISSUANCE... ~--- (/j ~O./ ~ G Far Ctty En~aeer Dam Pcmvt fi~,`pires 12 .Montns'After DAre of Cssuance W W U ~~ L.L C C Q Z 1 /~-J - ' u+ ~~-~~~ S GEI~'ER:AL PER.~1'. G(3NDITIO~S 1. "n Gotistrttcbn t;asit. Airpbsttis rtt{tiitrd. GSarges will bc.made against tltix deposit if their is an ettir.~eucy caf!-out, b~ettirnt inspection ~or veneq CYty otdeced hntricad"rttA:g rbquitrd. ,tidy stxclt: cosis iit excess o~ t3tc dgxssiE will be Fulled to tiie Pcrmi ttee. A sari",-yam mair~resta iseriocl aad s~ety:art rrquiYed. Such period wit ~~u as daza of wtitsat arccprattca by dnc Gty. 3. kafuntl qt's t~sFt deposit balance aitd reined tM txncc3~titet a~'tFrM ~'aiil~tti ins ~urexy wiH lr itu by the wciIIea saz3ttaacc: tt3't~ east by the f~ty: 4. T'Frtr Permittee tmtst rrgetest iat wt3€iug a'InaI iaspenaoa and s~ep~cc a€ tits work Acc~ptanee by rite C ttgr w~i ~e axis in w3sun~ to t}ie Ittrtniliec. ~~ 5. Mattttain?.safe pedestrian and-vetiicutar crassing5 aitd~frte access to ptiv~te tFtiveways, bus,stops, fire 4ydtatits and.watex vai*ret:. &. ?1 Cohstrot~on 'Traffic C'.onttbi Platt :arid a GOtt3auctiott, 5chirdt-lir ace required for all. lane closures, detours and stress ctasttres. This ptaa crtusC be rcvtewtd and apPtitvtd ptitir to ady Sant clasuses: 7. "tit0 CaarDn c C.~ttrp! Plui:saari tt~ni'oi rt! io Ste ~ Ma~tus;; tt!`.'[S~i"C`s ~Cc~uat+Ts f~ t~faR tnd ~r-ix••~••^•.,. 'ffl; ?Acst~s, c9atc~il I'4t9Q, a+raila~ ate: 'lac trot t s-h~a8 inc~xte'Yypn~t ~ ittOptt iti~zo g. TY:~tCicn az ~reciei by tt~ t".tty ~itgitte~ any dai2iaged oa ietrttivcd iroptbvisittots is accctdsnce wiih C'tt~r Standards and SguFitcatiaat ~ tE>=,sole ezpease c€'thC Prrsnitiee:` 9, Sawi:ut for all PGe or AC teitiovals: A11 PCC:rcinodals shalt be to iacurst st:oremiii%and si~tlhe doweltiS to existing impiovcinents, I fl. Prtir..appritval of 'inspector is rtqutred fur any work dtta~ aCier tiotiii3l workag hours: no wtekettds, to holidays and may rz:gn'trc rrimbutstmcat of inspection cans at the tnacz:nt artxtlrt~ rate: ,.. - I C: qtr s~~;ga~rad s~~~hgt~ttr=d-~ #tii: jot-site: Ft<ilirra~to. pravid~ sarlt ~r,g std ~g t;%~y r~i~ll~ ~h-t~ ~t~°p~E,~tft~`~1~-- - ------ .__-- aaa luriic~es and; tea ama ihd cost ~riciuding all !>i>~ and maC#ia~t) agastfst 2ise ca~+ dE, .. 1.? ~~t3nn trctin~a~suborad~, Fru~ rock: and asphatt eoac~t+ett by, i~ is regairrd unless ath~riisc stated ~y th,: ~;tar utgtncEz t'3: The Contractor a Pertnitree will hays: a suptrvisnry. representative d,v~ilalrte f~ contact on the project. at a1F Urttes during etktstntction: Coatractcx ar Petmittee shall pmyide a phoiic tiutnber at whiCEt tkry can be contacted dntsidc dte:fiours of 8'QU a.m. tti 4:Qll p.m. 14. Na suxa~e of matetiaB a'egtupmrtst will bo aliowad near the edge of paxemeai, the travcleid vray.. or witltira i}tc shotiiderlinc which would rxeate a Irsssrsdais coat~tittp to rite ottblic. 13, Tbis permit shdH not be ctnsstia~ as aathoriniioa Cor ~re3vatipt and. ajad+ng wt priate property asf}acatt to the v~k ar aay cuhcr work t`rx whicc't a scpsrate permit ra2y. be Bert,-ors does it soFievt the p~tnittet of aay ot>gig;~ifln is obtain say. dher permit regaue:d t>yrlaw.. IG, 'Cols pctrtrit does not cclc3s: m~ PerrntttcC from aay [iabiliti~:cotttainrd io other aemegC'Ca' rrontracts cvitli the Cty and soy otFter pabiit u~rncy- l7-. This ncrmrt is rtoL transfCcable, Work must be pcrfrrrmed by-[tie Pcrmittee or hiR dtxignatcd-agent or ctptractnra5 specified thereon.- 18: Call 'atck (colt out} tluc:w'emergettcFes rt~~arding dus permit sltttU ~ nt: thccucrtat ovc~timc ritto,wih a three t3~ tinuc tztittitnura chtrge Per ocenttente, l9. ~'tiitSxiant to t~tap<ct 1a.U? o€;! - -~vl. . ` ` C.~~, a~ it~pi SFiaC{.it~csrt~e to i+c ~~t an' ta+}l~3a[u EFt~e - = stti~a.tL~ua ' tliart starzu water: [cant shill aiiCse~ teY t2m B , h1PsP~FA~EFA}?I~E#' Y'R:A fis7url by :tom 5.a~at-t!laxx Valley rh6gm Rte' FalFut~n Rrwcn#ioa PrAgam, ?A. Cf :thE ~ihiic inr~esi irgi~irts n mode Cicatii~ +~ tu' aa:~pasuiie' frortR tk~'glstts tlnd sp~cncatia~t. the"C`~.'ty U havt the ztuthariry to mite ar aptiria~c airy tnodiiication or deparaua and to speciig the tnaorter ta:wliit3t $te same is to bb tttadc frg f.~-owned os maintaiszGd Caciiities. ~3,' Ptrmittccnust pmndeadv~rioe npttftcatiott to a() games that-tray be affected by the tieiinit aeuvtEies: l~tonficanita sEmtl be rtviWwed by City prior: to t3is~ibuuw a.,3 iatcl>ruc dar~'owoit arHi'a coata~aam.:.arr3 pha-te num'nrr. " that! be re:spoexiti}e foe• easariag ~ slider: prv+~l sravires nntltr tit:. appTtcs:itatt: aware of anti noted ail; rri the a5ovs soaditititts< -.~- Ze/D L~att -~: Zo/d 7lfrsmslpwa~mi Rw. 13!9X16 APPRO~ ~D ~~R CONSTRUCTIOP PG&E Permit Sketch for: City of Campbell ~ ~ ~'' O f Cam ~ ~ j ~ public WO~~-~:~ ~'~rrnit No. c=~~c~~~~~-~~~~,c~~ Address:708 CROCKETT AVE. ~.rar~c'or must have these pCans Nature of Work: Abandon Gas Service at Main „~ ,tip ,~h s;te dur;ny construct;on Surface: Asphalt Cut in Shoulder Excavation size: 4' x 4' x 4' _-__ t ~ ._ , J ._ e33 ~y ~ Gn ~30Cr~-:}~ ~ ~i 1 ~~`.~' '~ ~ 665A ~ 1/2PL'01 0 v (JT) ~ ~. a o`~~~. :.__2.~r c y_ :~ -> ~~, r .r~~~ •.~~kk4 ~ r ~~ G F `~ G iR_ f 4 riJ ~ ' ~ ~1__ Z7 ~.~3 I i72 ~-v2~t 9e v~c~4~ I 692 I 701- 3/_ 4~ _ 6329U1 do ~r (,~., © "D Z h z ~ Io Dm m m m r r =. ~_ ~ m m r ~ a N D ~ ~ 0 0 o y r ~ ~ m ~ ~ _ c - m -- w m o G) D C7 r ~ C c s ~ r m _m - ~ ~ : ~ ~n D p ~ m ~ Z ~ N to y m m cn ~ ~ ~ ~ ~ m m ~' n N N fD { O~ ~ m D ... ,.. ~ ~ c 'G U I I I ~.lJ V ~ T O O ~~ ~c D T' ~ T mid I ="" C~~ ~ Oi.` .+ ~ ~ O ~ ~ O ~. o m -* y '~ ~ ~ fD ~o~~m ~~ ~ s O ~ ~ ~ ~ ~ '. ~ ~~ ~ ~3 ~~ o °c x. o °m m ~~ ~ ~~ O ~ O ~G ~ N ~ ~ ~ ~ ce r:a~, y a~~•~ c='~osua Q ~ vi y ~ tD - ' ~ 07 ~ N. ~ O Q ~~ ~ ~ ~ n. ~ ~ ~ ~ K ~. ~ O O n ~ -* .-r, ~ ~ -O d S N O ~ fD n C1 ~ II1 O O ~ O .n_.. ~ ~ ~ ~ ~ N n 'O'n ~ C7 cD O ~ m ~ f ~ N ~ N ~ ~ ~ ~ ~~. to d ~ a1 O ~ O C~7 ~ C'1 X N = ~' '~ C7 N N ~ ,.+ fD V7 ~ O fl" ~ ~ O ~ ~ ~ ~ N c~ ? ~ ~ a cQ ~ ~ ~ ~ C'1 ~ ~ ~. 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