ENC2010-00098Jun, 2$. 2CIlU 9:51P"" No, 2b47 P. 1
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CITY OK CAMPBELL WpRKS ENCROACHMENTPERMI7 PermitNo~_~C,2C:10 • (,(°;(~,~~
DEPT. OF PUBLIC WORt(~+UB(-(C .~A'{/ON (for working within the public X-Ref. File
70 North First Street ~,pMIN#~ right-of--way) c
Campbell, CA 95008 / Appllcatlon Date bra / '2 . ~ `I~
Ph. (408} 866-21gp Issued 6 ~ (a Appllcatlon Expiration Date 12/ ~ j
Fk, (406)376-0458 / APN ~~/,~
Permit Expiration Date 6 ?i`7' I
APPLICATION -Application Is hereby made for a Public Works Permit in accordance with Campbell Municipal Code, Section 11.09. (Application expires In six
(61 months If the permit Is not issued. Application Fee isnon-refundable.)
A• work address or Tract No.; 140 S Milton Ave, C/s Rlnt:on
Utillty7rench Location; !n front of address
B• Nature pFWork; Tag 7 20594 -repair asphalt damaged dur)ng emergency leak repair,
C. Attach Faur (4) copies of an engineered plan showing the location and extent of the work, and four {4) copies of the preliminary Engineer's
Estimate of work. The plans shall show the relation of the proposed work to existing surface and underground improvements, When approved
by the City Engineer, Bald plan becomes a part of this permit.
D. All work shall conform to the CI[y of Campbell Standard Specifications and Details for Public Works Construction; the General Permit Conditions
Ilsted on the reverse side; and the Spgc;al provisions far this permit, Ilsted below. Failure [o abide by these conditions and provisions may result
injob shutdown andlor forfeiture of Faithful Performance Sureties and cash deposits. (see General Permit Conditions 1 and ~.)
E• The Contractor must have this permit and approved plans at the site and must notify the Public Works Department a[ least two days before
starting work, Notice must be given to Public Works at least 2A hours before restarting anywork.
Name of Applicant: Pa[ifl[ Gas & Electric Co
Telephone: 408- 7Z 5-z03 3
Address: Attn• Gas T&D / 10900 N Blaney Avenue, Cupertino, CA 95014 '
E-Mail Address: f6be~pge.COm 24~HOUREMERGENCYPHONENUMBER:
is this work being done by the prppe~y owners at their own resldence7 800-743-5000
~`" YES r NO
The Applieant/permittee hereby agrees by affixing their signature to this permit to held the City of Campbell, Its officers, agents, and employees free, safe
and harmless from anyclalm ar demand for damages resulting from thework covered by this permit.
The Applicant/Permlttee hereby acknowledges that they have read and understand both the
contractor(s) of the Information, Applicant is advised tha~..uP issuance of this permit
responsible for any and alLdamaaPS,~dd~n ,,.,* ,.r u,,.......,:er _ _ ~ s~~
Accepted'
of this permit, and they will inform their
or property owner's successors, shall be
~. ,,,....o,,,~, Date -
SPECIAL PROVIStON5~
t. Street shall not be open cut for underground Installations. Minimum cuts may be allowed for connections or exploration holes. Such cuts niav he
soeciflcally annroved by thn i na rot rarior to cuttl^a
_~. Pavement may be cut For undergroundlnstallatlonsand must be restored in accordance with the Standard Details Trench Restoration Method
"A", unless otherwise approved by the Engineer.
,_,,3. Work to be staked by a licensed Land Surveyor or Clvll Engineer and two {~) copies of the cut sheets sent ro the Public Works Department
before starting work,
_4. Per Section 4215 of the Government Code this permit is not valid for excavations until Underground Service Alert {USA) has been notified and
the inquiry identification number has been entered hereon. USA Phone: 1-840-Z27-2600. USA TICKET NO
_5. Prior to any work, the property owner shall execute an Agreement for Pr{vate Improvements !n the Public Right-of-Way, which shall be
recorded.
_8. Public Notlflcatlon Reoulremenre~
_7.
SEE PUBLIC WDRKS FLE S H D 1 FOR t1RRENT FEES AMOUNT 3 S
PERMIT APPLICATION FEE RECEIPT N
PLAN CHECK pEP051T 5 -- ~~!
SECURITY FOR FAITHFUL PERFORMANCt:/LABOR & MATERIALS $
CONSTRUCTION CASH DEP051T S
PLAN CHECK& INSPECTION FEE ~ l~
APPROVED FOR 155UANCE ~ /'/Z I (~ ~
For Clry Engineer b Datel
Permit Exphes 12 Months After Date oflssuance
gull, 28, 2411 9,51E"" No, 2b47 P, Z
p~F~MIT CONDITIONS
t. A Construction Cash Pepaslt Is required. Charges will be made against this deposit IF there is an emergency calf-ouG overtime inspection or when City
ordered barricading is required. Any such costs fn excess of the deposit will be billed tp the Permlttee.
2• A one-year maintenance period and suretyare required. Such period will begin on dale of writteh acceptance by the City,
3. Refund or the cash deposit balance and refund or cancellation of [he Faithful Performance Surety wll! be initiated by the written acceptance of [he wprk
by the City_
4~ The Permlttee must request In writing a final inspection and acceptance of the work upon completion. Acceptance by the Ci[y will be made fn wrl[Ing
to the Permlttee.
5. Maintain safe pedestrian and vehicular crossings and free access to private driveways, bus stops, fire hydrants, and water valves.
s. a Construction Traffic Control Plan and a Construction Schedule are required Far all lane closures, detours, and street closures. This plan must be
reviewed and approved prior to any lane closures.
~• A Construction Traffic Control Plan shall conform to the Caltrans Manual of Traffic Cantrtals For Construction and Maintenance WorkZones, dated
1990; available at Caltrans. Traffic control equipment shall include Type II Bashing arrow signs If required.
$- Replace as directed by the Clty Engineer any damaged or removed improvements in accordance with Clry Standards and Specifications at the sole
expense of the Permlttee.
~• Sawcut for all PCC or AC removals. All PCC removals shall be to the nearest scoremarkand shall be doweled to existing improvements.
i0. Prior approval of;nspector Is required Far any work done after normal working hours, an weekends or holidays and may require reimbursement of
Inspection costs at the current overtime rate.
11. Adequate slgning and barrlcading Is required on thejob site. Failure to provide such slgning and barrlcading may result in the City's providing slgning
and barricades and charging the cost (including all labor and materials) against the cash depos![.
1 z- Compaction testing of subgrade, base rock, and asphalt concrete by Permlttee is required unless otherwise stated by the Clry Engineer.
13. The ContractororPermlaeewill have a supervisoryrepresentatlveavallableFor contactonthe project at all times duhng construction- Contractor or
Rermlttee shall provide a phone number at which they can be contacted outside the hours of 8:00 a.m. to 4:00 p.m.
14. No storage of materials or equipment welt be allowed near the edge of pavement, the traveled way, or within the shoufderllne which would create a
hazardous condition to the public.
15. This permit sha11 not be construed as au[hori2ation for excavation and grading on private property adjacent to the work or any other work forwhicft a
separate permit may be required, nor does It relieve the Permlttee of any obligation to obtain any other permit required by law.
16- Thls permit does not release the Permlttee from any Ilablhtles contained In other agreements or contracts with the Ciryandany otherpubllc agency,
~ 7. This permit Is not transferable, Work mustbe performed by the Permlttee or his designated agentorcontractor as speclfledthereon.
1 B. Call back (call out) due to emeregencies regarding this permit shall be at the current overtime rate with a three {3) hour minimum charge per
occurrence.
19. Pursuant to Chapter 14.02 of the Campbell Municipal Code, applicant shall not cause to be discharged any material Into the municipal storm drain
system other than storm water. Applicant shall adhere to the BEST MANAGEMENT PRACTICES established by the Santa Clara Valley Urban Runoff
Pollution Prevention Program.
20. If the public Interest requires a modlflcatlon of, or a departure from the plans and speclRcations, the Clry shall have the authority [o require or approve
any modification or departure and to specify the manner In which the same is to be made far City-owned or maintained facllitles,
21. Permltttee must provide advance notification to all parties that maybe affected by the permit activities. Notification shall be reviewed by theCltyprlor
to distribution and Include dates of work and a contact name and phone number.
Applicant shall be responsible for ensuring th4t,all thong-providing services under the applicant are aware and understand all of the above condltlons.
Applicant ~ ~~ ., /~
Date: r
Contractor (Priht Name)
~~.
Date;
J~IFORMS~TemplaCeSlEn~raachment PerITIIt5lEncradChmenl PermItSTATIC form~.pdF
Rev, 3/06
July. 2fi. 2014 9;52AM 410, 2b47 F,
Pacific Oas and EI6Ctric Company ~ / G~! tom' ~ ~~
Field Paving Measurements
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ORDER NUMBER _ ~
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