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ENC2010-00089CITY OF CAMP;~~4~. ^ ~ I ` , ~ D DEPT. OF PUS v 76 Norta~t First St. Campbell. c.A g~oaB~U~ 1 1 1~~ X408) $66-? 1~0 Fae 0.087 376-095£+ PUBLIC WORKS ADMINISTRATION ENCROACHMENT PERMIT ffor worKirc within the puolic rieht-of-way} issued ~ ~ (~~ ~ ~ Permit Expiration Data ~ ~ ~ ~~ Permit No ~ N C ~ I C ~- C~ UO 3 ~' k-Ref. File .Application Date ~v ~ ~ '-i ~ I (~ Apolicatton Ex?~iration Date I Z/ l y /f O APN y~ y Z~ 0 Q y APPLICATION - Applicaficm is hereby made for a Pubtit Works Permit in accordance with Campbell Municipal Code, Secnan I I.44. {Application expires in six !G} months if the perzrut is not issued. Appheation Fee is non-refuntiabic.) A. Wark address or rractt* 571 Kenneth ~/h ~'~ ~~~ y6 Utility trench location power pole in front of address E Nature ofwark Install grounding rod at power pole C. Attach faur {4} copies of an engineered plan showing the location and extent of the Wark, and four {4) capies of the preliminary Engineer's Estimate of work. The puns shall shave the reta[ion of the prapased Wark to existing surface and under~ound improvements. When approved by the Gq• Engineer, said plar. becomes a part of this permit. D. All wank shall conform ro the City of Campbell Standard Spccifieations and Details frn Public Works Constructian: the Genesa3 Permit Conditions listed an the reverse side: and the Spacial Provisions far this permit, Listed below. Failure to abide by these canditions and provisians trtay result in fob shutdown ancU'or forfeiwrc of Faithful Performance Sureties and cash deposits ;See Genera! Permit Conditions 1 and 2.) E The Contranor must have [his permit and appravrd plans at t}ie site and must notit}' the Public Wark: Department at least even days before sgrtinc work. Nciicc must be given to Public Works at least 24 hours before restarting any work. Name of Applicant PG&E d,~_ Telephone 408/725-2153 Address 10900 N Blaney Ave, Cuper~~rio;~~~14 ~4-HOUR EN[ERGENCY TELEPHONE NO $OO/743-5000 -Mail Address JJGJ(p~PGE.COM Is this work being done by the praperry owners at their awn residence" Yes X No The AppiicantlPermiItee hereby agrees by affixing their signaIure to this permit to hold the City of Campheii, its officers, agenLS and employers free:. safe and harmless frarn any claim ar demand for damages resulting from the wark cavered 6y this permit. The Al>plicant/Permittee, hereby acknowledges that they have r:.ad and undersgnd both the front and hack of thee permit. and r.hey will infacm their c_ontracux{s;• of the int'orniation. ,Applicant is advised that upon issuance of this permit, praperty owner, or property awner's successors, shat! he responsible for any and all damages arising out of the canditian of any private improvements in the public right-or-way John Gambucci {Applicant Permittee} (sign) Date PG&E __ 06/07/10 Contractor (Vrint Name; [late SPF,CIAL PROVlSI(~NS _I. Street shall not. be vpen cut for underground installatons. Miriinium cuts may he allowed far connectians or exploranon holes. Sueh cuts may he sneeificaily aunmveri by the lnsnector anon to cutUnr. _'?. Pavemenl tray lee cut for underground installations and must be restored in accordance with the Standard Details Trench Restoration Methad "A", unless otherwise approved by lnspectar. ~?. Wark to be sgked by a licensed land Surveyor ar Civi] Engineer and two (2) copies of the cut sheets sent io the Pu6iic Works Departniem before salting work. 4 Per Section 4215 of the Govemrnent Cade [his permit is not valid for excavations until lnderground Service Aier lUSA) has ixen notified and the inyttiry identification number has been entered'nerean. USA Phone 6-804-'_'=?-2600. USA TICKET NO. Prier to nay wort,.. t.,c pr;:~puty owzicr s:.al; cx;sutc as A~recmeat fcr Private improvements in the I'iiuli~ Right-cif-~.a;r, whichhaL' hr recorded. G Public Natiticatian Requirements: SE^ PLiAi tC WORKS FEE SCHEDIIL~ FOR CLiRRENT F'.ES AMOI?NT RECcIPT NQ PERMIT APPLICATION F>~E ~-~=- PLAN CHECK DEPOSIT ~ SECURITY FOR FATT"rIFUL PERFClRiv1ANCEILABOR & ~lATERlALS S CONSTRUCTION CASH DEPOSIT S~_ Y"~ \ PLAN CHECK & INSPECTION FEE g--~~ APPROVED FOR ISSUANCE ~ I ~ / ~U For City Engineer Date Perrii[ Expires 1 r Months After Date of Lssuan:;e 'T'~ u /~ 1\~ 1 ~' GENERAL PERMIT CO'~'DITIQNS i • A Construction Cash Dcpasit is required. Changes will be made against this deposit if there is an emergency tali-out ovcrtimt; insptcvon ar when City ordered barricading is required. Any such costs in excess of the deposit will be billed to the Percninct "' A one-year ntainttnanc« ptnod and surety arc rtquirtd Such period wilt lit~n on date of wntitn aeccpranc,° by ttic City. ... Refund of rite cash dcpos7t balance aad eland or eatzcetlatian of ttie Faitluul P~fartnauc« Surety wil! be initiated by rite wntt«n ac,.; ptanz;, aG ttte weak by the City.. ~. Tht Perrtuttte must nsquest is wriuaQ a txaai iaspt_nian and a:xpra>sce tri rue work upa9ta camp"ttvcrti. A;.ccptanct by the City .viii 'vt mad« in writins ro the Pernssttte. 5. Maintain safe pedestrian and vehicular crassinp and free ac;.ess to private driveways, bus stops, fire hydrants and water valves. 6 A Ctxistruction 'traffic Ctxitral Pian and a Construction Schedule are regained for all !acre closures, detours and stre«[ closures. This plan must be rcvicwu3 and approved prior to any lane closures T4sc Canstnicpon Tra£f'ic Coatmi Dian stroll etmfoam w the Catttans Manual of Traf=itc CmttroLc far Cpnstsyptas and Maiascasaric: W,xl~ Zans~, # f 994.. a>«~ailablt at Caltrans. Traffic cxmtra! trniprr~xtt stroll inciudt Type II ftashtde anew sisms if rcuuiraf E. Rtptac« as directed by rite Cin Engine«-. any damaged os removed tmprt}wtmtnis in accardanct with City Standards and 5ptvificatitxts at the sole expense of ttie Ptxtntttee. 9. Sawcut for all PCC or AC remnvals. Alf PCC removals shalt be to nearest scarernark and shall be dcrwei«d w existing impmvements. 34. Friar approval of itispeetar is required for any wart: dons afar normal wanking hours, on wtcktnds or holidays add rrsay require reimbursement of inspcrrtion costs at the :urrtntovdumc rats. 1 i Adequate suing and bamcacliag is reamru! ao the~tob sits. ~tilurr to provid« such si~ina and barri~ine inay renal[ in th; City`s provtdin~ ssgamg and tiam~dcs and c~lsarr rig the cast t inctndina till latwr and mster:a i., a fawst t}tc ras#s depczs:t. Y i 7.. Compacuan testiag of subgradt, bast rock. and asphalt ccxieretc by Perrnittce is rtuurred unless atherwist stated by the City Engmter l3. The Contractor nr Pcrrrsittct wilt have a supervisory rcpresentauve available for cantac! an the psoj«ct at all times during ctuistnichan. Cuntractor or Permittte shall provide a phone number at which they can be contacted outside the hours of 8:U4 a.m. to 4:4f} p.m. !4. Na xttasa~e of mattnals ar wuipment will bt allowed nps [hc tdg« of pavemtat. the Iraveled way, or within the shouldtrlinr which would crtat« hazardous caadivtxi to the vublic l This permit stsall oat be canetrued as autiwrizauon far ea~vatian and ?radtng an pttivatt property adiac«nt to the work ar any rKine: work fns which « sttsasau pcrsnit rrety~ be rtzluix~, nor uaa it raiicv« the Ptrmtt tr#' any twlss~tscxt tci obrain any atecr pe2IIiit r~nirad ay law lb, This pcrnut does oat release the Permitter from any hatriiiucs ctintaintd in ochre agirtmtrits or contracts with the Ciry and aay other pss`cslic agency i'r. Tnis permit is not transftrafile Work must be perforttitd by the PetTrtitte« or his dtsigr[ated agent ar contractor as specified Ibttron 1 ~. Cal! back icall Duty due to emtrgcneies rc~rdine this ptrrnit shall be ar the current averurne rats wtth a thre« (3}hour minimum citarge per occurrence. ! 9 Pursuant to Chapter 1 d.4? of the C.ampbe!f 3+duntcipal Code. applicant shall nrx court to be discharged any atattnat lean the municipal scorn, n systerr tatntr titan srorTn water Applipmt sisal! adtttre to sate BF.St MAi*iAvE"vfE14"' PRAC't'lCE.S ~tabCashtd by tt~ Santa Clara t=a!!ty l.irltan Rmtaf:" Pnlluutxa Pstvtn[ion Pri~gram .'.4. tf the aubRic interest requires a atodificaaors af. ar a deparrnrt frtxn. the plans and spetificaborss. the City shall have doe authority to reauirc or apptvva any modification to deparam sod to specify tine manner an which ils« sarr~ is to int made far Ciry-awned ar maintained faciliucs 23. Ptrrrsitue must provide advance notificaticsn [o all patties that may be affected by the permit activities. Nasafication shat! be reviewed by Ciry prior ec~ disviuutscn and ircludc date; a` wort; and a conact aamc aria phone nuu her. Apphcana steal; be rrsptsnsibu for ttisnuing tisat till thane providin, scnviccs under th« applicant arc aware of and understand ail of the abnw :andiuotss Appli^.aitt __ PG&E--John Gambucci Contractor (Print Name} 06/07/10 ~at« 06/07/10 bat« nfacrnsi©wtnszm Rte. ! ! t9tQ w 0 bA cd N Q (0 C O O _O t ~ O w .r N N (0 ~ w,, Y ~p C_ .~.-~ N C .~ .` ~a ~ ~, m~ ~~ ~. ~, m ~ a~ ~ a~ a~ ~ a~ O U H ~ ^~ Q Lim ~./ `rw/ Y C J a C N C d 0 0 N r, M C) - ~ -~ cu , __ ~. 6~ ~~~ ~~ e ~ E ~ w _ E U . ~ w X ~ 4.. 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