ENC2010-00115RIIU-04-20101~1ED) 10;23 Cah~eCom
(FR~1'"7425830 P. 002/005
Print Fo'm
C1TY OF CAMPBELL ENCROAt:riMt?t~tT PERMIY Permit Np ~~ ~) r•J ~ C~ ~
pF.PT. QF PtJBt,IG WOAltS (for working within tl~e public X-Rtrf. Fll
7o North Firxc savrtt right~af~way) Application Dare o
C,aropbal4 Ca95aos Issued ~ ~ S ~ o Application Expiration 17ate
Ph. (408) 866"2150 -~ ~ee ApN
Fx. (446) 37d-o9S8 Parmlt Fxplmcton gala v S
APPLICATIQN - Application Is hereby made fors publlS Works Pdrmkt In accordance with Campbell Municipal Coda, SgCtlan 11,04. (AppllCptlan axp{rtrs In six
(b) months if the permit (s not Issued. Applieatlon Fee Is non-rgfundablaJ
A. work Addressorl'ractNo: l~ GG.~ti ~ ~:.~>~i~3~~~ g~,/,a~
Utllity'TranCh LtKation: ~1 ~~~ U~~G'~ ~ I..V t~
S. Nature of Work '~~r~~~ ~~~ , q ~ G r ¢~ ~~L~ ~1 ~_ ~t~. ~~~
[, Attach four (4) copies of an enginegrgd plan showing th4 loracion and dxtdnt of the wprk, and four (41 eoples o to prgi+l-m~knq`~ry7Englnaar's
Estimate aCwork The plans sha11 showthc rcladan of the proposed work to existing surfactrand underground improvements. When approved
by the Clty Engineer, said plan baearnes a pert of thM, permit
!?. Ati work shall conform to the City of Cnmpbdtl 5wndard Spadfleat(onx and Details far Public Works Construction: the Gandral Pannit Conditions
liatad on the ravarsd side;and thaSpdslal Pravistpns farthia permit, Ilsttrd below, Fo{lure to abide by chest: candltlansand provisions may result
In job shutdown andlor fodglture of Faithful Parformancd 5uttitldsand Cash deposits. (Sac General Permit Conditions 1 and 2J
E. 'file Contractor must have this permit bad approved pionsatthe sltQand must notify the Publlt Worlgl I~apartmantat least two days before
alerting work. Natica muse ba givdn to Public works at least 24 hours before restarting any work
Name of Applicant: ~L~~+ ~~.tr~ 7aldphana; ''~(~ 7 ~''~ ~ ~ ~C'~' ~.Z7
Addrata; , ~ G 4''tJdr!@~t,~ f Y=,4„~`F- t~ ~ r t^„/~ ~ ~ 3
G Mall Address; 34~HOUR EM>:RGENCY PFIQNC NLIM9E~;
IsthlswarkbdingdandbythtrprapanyawnarsattheirawnrtrsklanCa? ~- YES ~'~' NO
'The AppllcanVParmittae haroby agrees by raHi>,Ing their signature to this permit to hold tltia City of Campbdll, Its afflCarx, agents, and employees free, safe
and harmltrax Pram any CIa1m ar demand far damagds rasulttng from the work ttwered by this permit.
Tha AppilcanUPgrmlttgd hgraby acknowl4dggs that that' havd road and unddrrutnd bath the franc bad bock of this permlL and thdy wlil Irtfbrrtt choir
contractor(sl of thq Information. Applicant is advlsgd that upon issuance of this permit, prapany owner, ar property owner's succasson, shaA ba
responsible for onyand all damogps adsing out of the tondltksn ofany private lmpravamanSi li't the pw~c right-pf-way. _ _
ACkapted:
(Appi{eantPt:rmittaa) rrl~nt
Detn
~~
ICOntraCtan
rvama~
uaca
5P_ECIAL.P_ROVI51GN5:
1. 5traatshali notbappan Gutfar underground inswltat{ans. Minimum Cutx j~b4 allowed fart:onnetNons ar exploration hdids, Such Cupt~py~
~R~evrd by the Insa e n lOf tD cutiln4.
Z Pavement may bgCUt forunderground Installations and must btr restored In accordancawith tha5randard ptrtaNsTrcneh Restoration Method
"A", unless otherwiseeppraved by the Engineer.
~~3. Work to be staked by o licensed Land 5urveyorar Civil Englneerand two (2J copies of the cutshadts sent w the Publle Works Deportment
before Storting work
4, Per5cetlan 421 S afthc Gavemmenttode this permit 15 natvalld forexcevatlans until Underground 5arvica Alert (USAI has been notlRed and
the inqulrytdontl(ft:edon number has been antert:d hereon. U5A phone: 1900.227.2600. USATICKET NQ.
,,,..,,,rs. Prlorto any work, the property awnarshall axtrCttit: on Agreement far Private Improvements In the Pub11G Rlghbef-Wpy, which shall btr
rrCprdad.
4. PubtleNadflCOtlan Raqulremenr;
7.
t P lpt_IrWQBI'';FE: 5¢{ DL. FQRriUBRE TFE 5 AMOUNT3Sv RECEIPT NO. /\~
PERMiT APPLICATION FEE S
PLAN CHECK DEP05TT 'r
S1:tUR1'tY FOR FAr1'HFUL PERFORMANCEILA90R & MATERIAL5 5
CONSTRUCTION CA51i DEPOSfT S
PLAN CWEt;K & INSPECftQN FF.E 5'"'"'~~S,~
' $I 5 ~ iG
APPROVED FOR 155UANCE
FcrClty Engineer to
PermlC 6tplres t 2 Months After fate of issuance
jL ~ ~ ('tiy1 ~ 1~ ~ ,~ ~
aUr,-~~a-201ui~JEO) 1r~;24 Cah'eCom (Fa~)~"''425$730 P.rJU31G05
GENERAf~.PERMiT CONDITICthlS
I, a Constlvctlon Caah Dapoait Is roquirgd, Charpo4 w{il ba mods aga{nst this daposlt IC throe is an amerr~ency toll-out ovartlma Inapnctlon ar whoa City
orclarvd 6nrrlrading Ix raqu{red, any such goxtx In e^Casw of the depasJt will be blllad to the Permittcw.
~, a ana•yaar maintenance period and surely ate required. Such prrlod will begin on datq of wtletgn nccaptbncn by the City.
3. Refund or the cash dapmtt bnlancaand refund nrcancolindan aftho Faithful parfonnance5uroty will be Inltlated by the written aeceptonre of thework
by the Clty,
4, Thy Pannlttaa mutt roquatt In wrtting a Mal Inspeetlan and acceptance eF the work upon camplgtian, A~capWnca by tho C<ty will bn mach In writing
tv the Parmittee.
5. s~talntainsnfapgdgstrlanandvqhiculnrcrossinQsandfroaaccasstaprlvatedrlveways,busstaps,(Irahydrann,nndwatarvalvgi,
6, AConztruetlonTraf(icConirolplanandaCanstructlon5chadulenrproqulrgd(ornlllnngtlasural.damunt,and><traetCivsuras.7hlsplanmuseba
rgviewgd and nppravgd prlartnnny IangClosures.
7, A Constna:tlanTraKlcControlplan shal(conform tv the CaltransManual ofTraffic tontrolsfar Cnnstructlanand Malntonanca WorkXanas, dated
1990,avall~ble at Caltrans. Traf11C control equlpmont shoal Include7ypn I! Flashing arrow signs IF roqu(rod,
B. ftoplacq nsdlrgC[gd by thq C1ty Enginogrnnydmm~ggd orrgmovod Improvements In accardancewith CltyStandarcls and Speclflcatinns utthn gain
oxpensa of tho Pennittae. '
9. 5awcut for alt PCCvrAC removals. All PCC rrmovata shall be to the nanrestscnrgmarkand shall bn dnwolad to ex{sting Improvements.
t lt, hrlorapproval of Inspactnris raquirod far any workdnnentternwmal worWng hours, an weekends or hotldaysnnd may rnqulrq redmbursemantnf
Inspeetlan Costa pt the currant avartlma rata.
I t. Adequatgslgningand barricading Is raqulred on thq Job sits, Failurq to pravldq ouch aipnlnQand barricading may rrsuft In thaClty's providlnp signing
and barrlcndesand charging the cast (Including nil labor and matedplal pgalnstiha cpsh deposit.
12. Campadlvn tasting of subgrade, bass rock, and asphaltconcrate by Permlttre Is raqulrad unlessothorwisq acntad bythn City i:nQlneer.
13. Thq Contractor orpermitiee will hove a supervisory reproaantaducavnllnbla forconwct on tho pmjeetat all times during construction. Contraetoror
~Pgmtittaa shall provlda n phana nu mbar at whkh that' r,nn ba conutctad outslda the hourx of 9:QQ a.m, tv 4;pp p,m.
ta, Nostaragavfmatarlalsarequlpmantwlllbeallowedneartlterdgaofpavamenr,thetravaltxlway,arwlthinthgshnuldgriinawhlchwvuldcroatea
hnxardtwsconditlon to the pubUc
tS, This,pannltahallnotbaConstruadaxauthvrl:ationCvraxeavatNanandgradinganprivatepropertyndjacenttnthewarkaranyothgrwatkfarwh{eha
separate permit may be raqu{rod, nor Baas It rofieve the Parmittaa of any obligation to obtain ony nthnr parmlt taqultnd bylaw,
7G, 'thix.pgtmitdagxnnetalgasqthnPqtmlttqqframarsyllab111tlasr~ntainadlnothnraQntqmantsarCantmeeswlihtheGtyandanyathorpuhllGagqnty.
1 T. This permit is nattransfarabla. work must ba parfarmed by the Permlttea or his dnslgnotad aggntor eaneraemras spacliiad eharaan,
t & Cnll back Irpll oud dug to amarogonclas rggardinq this pertnk shall be at tho currant avartima rate with a throe (31 hour minimum charge par
accurrancn.
t~, Pursuaneto t;hapter 14.07 of the Campbq{I Munldpal Cada,appllcantahall Hat 5nuaota ba dlachargad any malarial Into the municipal storm drain
syatom otharthan alarm wntar. appNCant shall ndhgrotathq IfES'1' MANAGEMbNTPRAC7iCf:5estabgshed bytha Santa Clara Valley urban RunnfF
Pollution Pravantlan program.
Zo, If thq publlq tntgrost requirgsa modlRcatfan of,nr o dgparturo from thq plnnx and apaclffcptlons,tha City shall havatho authority tv requlreorapprove
any modlflrAtlon ar daparturo and ttr spotlit' tho mphnor In whkh thq samq is to be mpda for Clty~vwned or molntalnad facllltles.
fit, Parmitttaq must provide advance notlRwtian to all part{gs that may bq nffgctgd by the parmiractlultlas, Nbtlticatfan shall ba rovlawed by the City prior
to distrihurlon and Includn datoa of wnrkand a contact Hama and phony number.
Applicant shall be rospons{ble for ansuring that all those providing servicm under the applicant pta aware and undorsprnd all of the above condkions.
appllwne ~ / /
Contractor (Prinrtuamgl
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RILE-04-2010(IJED) 10;20 La~'zLom
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CableCom
(FRS` ,7~258t30 P. 0011005
c~~~,~.com, Inc.
825 Cl~adbourne Road
~airficld, Ca. 94534
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;~~ ~ 20~~
Telephone {707} 759-4070 fax (70'~ 759-5741
T r a n s m i t t
date: ~ ~ ~ 1 ~ (~
To: ^,S W r~~~ ~.4-~~ a~ t
~'ronn: J ~ I.r c~ a ,~.~ ~~. y~
a 1
Number Qf Pages: .~ (including cover)
Cammcnts: -
Coafideatilsli~~ Notice
~'lsi~ ~acai~xc Davos shoot, and any dooumtneo which max aceampuny iC, contain
intaxsnat~.on ~xaai CableCom Sssc. which is intCndcd xos uac only by also indiv~.~lual, ca
wham iC ~.s adrlsacued, ratsd Which stay canta~,n ~.n~axn~at:~an ChaC is y~sivi~,c~lcd,
conxJ.donC~,a~, and/az otherwise exam~+e xxam diacloauxe undas ap~+l~.calal.a law. ~t e12o
re~adcx o~ Chin Alc~a~ay~c i~ not the intended roa~,pient az aha emp~.ayQe as :t~anC
reeponaibie faz dolivering this n~rsanagc to tho ir~ter~dod socipier~t, cny xcviow,
di:~c~.aaura, ~tiaaouwi,ss+a~tian, di~tzil~uC~,an, aap~-ir~q or athas ua~ee o~ tls~.xi tnaaaagc ax ~,ts
~ukr~canccc is aCxlatly prohibited. S~ you h~tvg receivo~l tlsis~ commurric+~ticn in cxxox,
p~,caoe naCi~y ua immediarely by Ce~.cphano to ~assarsge dos the retuz7s o~ th~.a
communicari.on Co u;~ et our expona~. x'h~u1k you.