ENC2010-00124CITY OF CAMPBELL
DEPT. OF PL?BLIC wORhS
70 Nort;i First St.
Campbell. C.A 95008
(408) 866-2I50
Fax (408) 376-095fi
ENCROACHMENT PERIvIIT
(for working within the public
right-of-way}
Issued -_~'~~G
Permit Expiration Date ~~ ~
Permit No t tvL2L l L - C~ ! LI
X-Ref. File
.Apatication Date _O$/26/1 O
ApnIicatiar, Expiration Date 2 / ~_(~,/ I ~
APN yG.3 - /5~-- CAS 3
APPLICATION - AppIicauan is hereby made for a Public Wurks Perm*.t in accordance with Campbell Municipal Code, Section I ? .04. {Application expires ir, six !G}
months if fire permit is not issued. Application Fee is non-refundalsie.}
A_ work address or ~a~t ~ 1580 W Hacienda Ave
PM 30797285
Utility trench location tap hole across street 12' from north property line
Nature Of work cut off service to house at 1580 w Hacienda Ave
C. Attach four t4} copies of an engineered plan showing the location and extent of the work, and four (C) copies of the preliminary Engineer's Estimatr of work. The
plans shall show the relation of the proposed work to existing surface and underground improvements. When approves? by me City Engineer, said plar, becomes a
part of this pet-mit.
D. Al! work shah conform to the City of Campbell Standard 5pecificatians and Details for Public Works Construction: the General Permit Conditions listed an the
reverse side: and the Special Provisions far this permit, listed below. Failure to abide by these candidons and provisions may result in )ob shuulown anc4'or forfeiture
of Faithful Performance Sureties and cash deposits lSee Genera! Permit Conditions 1 and 2.1
E The Contracwr must have this permit and apprnved plans at the sits and must notify the Public Works D::partment at lc:tst rwo days before starting work. Notiec
must be given to Public Works at least 24 hours before restarting any work.
Name of Applicant PG&E
Telzph<ine 7252153
Tint n
Address 10900 N Blaney Ave, Cuper{Pno, ~~014 24-HOUR EMERGENCY TEi,EPHONE NG 1-$Q0=.743-5000
E-Mail Address JJGJ PGE.COM
is this work being done by the property owners aC their own residence^ XX Yes No
The Appiicant/Permittce hereby agrees by affixing their signature to this pcsrrtst to hold the City of Cartiphell, its o{ficzrs, agents and employees fret:. safe and harnsless
frarn any claim or demand for damages resulting frnm the work covered by this permit.
The App[icandPerminz^. hereby acknowledges that they have read and understand-both the Irani and hack of This pcrnri~ and they will Inform their contractorts of the
information. Applicant is advised that upon issuance of this permit, propem owner, or property nwnar's successor;, shat! he responsible ror any and all damages
aiisina out of the condition of any private improvements in the public ngitt•of-~p~a}/,
__ ~. -~'=~-~-~`~ 08/26/10
fAPPlicant Pei{ tree} (sign} n Date
PG&E John Gambucci 08/26/10 _
Contrac[or (Prink Name) Date.
_l. Street shall not be open cut for underground installations. A~Sniuium cuts may be allowed fur connec[ians or explaranon hales. Such cut_~ may
be__snecifically annmved by the inspector prior to cutun~-
~?. Pavement may be cut for underground installations and must be restored in accordance with the Standard Details Trench Restoration Method
"A", unless otherwise approved by inspector.
^3. Work to be staked bV 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 »215 of the Ciovemment Code this permit is pat valid for excavations until l.indergrnund Service .Alert (USA} has been notified and
:he inyuir;~ identification number has been entered hereon. USA Phone l •$00-227-260(1. USA T[CKET NU.
~` Prier •s. any wark. t.`,c praputy uw•tscr s:.alt execute an ,:grecnicat for Pri•aatz Improvements in the Ptiili~ ;\i~ht-of-:'Jai, which shall b
recorded..
G Public Notification Requirements:
SEE PLiBLIC WORKS 1_CE SCHEDIILE FOR CURRENT FEES AMOI?NT RECcIPT NU
PERMPI' APPLICATION FcE S 3~7D ~~_
PLAN CHECK DEPOSIT ~
SECURITY FOR FATT-rIFLiL PERFORMANCE~'LABOR ~: M.ATERIALS a
CONSTRUCTION CASH DEPOSIT $
PLAN CHECK d` INSPECTION FEE $_-~€
.APPROVED FOR ISSUANCE '~'° ~~ ~1 I G ~®
For City Engineer Date
Permit Expires I2 Months After Date of Lssuan;:e
GENERAL PERMIT CQNI)iTIO?~S
i. A C,anstructian Cash Deposit is required, Charges will be tootle against this depasi[ if there is an emergency cal(-out overtime inspection ar when City
ordered barricading is required. Any such costs in excess of the deposit will be bitted to the Permittee.
?. A one-year maintenance penoti and stttrty art requires! Such penal wilt began an date of wettest acceptance. by the City.
~_ Refund of ihs cash deposit baiancc and r~fssnd or caucc2lation of the Faithful Perfartcauct 5um~r will be iniuats~i bu the wrisstti ac~ptaace of the svrosY
by the Czty.
a. The Permittee mast request in wnuttg a final inspection and ac~ttanee of the work. ups catrtp'tetion..ri~xeptart~ try the City will be made in writing tc
the Permittee~
5. Maintain safe pedestrian and vehicular erassine and free access to private driveways, bus stops, fire hydrants and water va:ives.
6 A Cautruction Traffic Cants! Plan and a Constrttcaoa Schedule are required far all lane closures, detours and sueei closut~cs. This plan must be
reviewed and appravtti prior w any larte ciastnrs,
The Construction Traffic Control P'.ast shall c«tfarm to the Ca14-tins Mantta3 of Ttafttc CootroLs far Consuucuots arid Maiattnancc Worrk 2ancs. dat~#
199(}. a'<ailakstt at Caltrans_ Traffic castrol etluiptnertt snail inciuds Type iI frothing arrow signs if required,
8. Replace as directed by tare City Engineer any damagtad or rernaved improvements in acccxdaru^.c with City Standards and Speriftcatians at the sale
expense of the Perrntttec.
9. Sawcut far all PCC nr AC remnvals. Al! PCC removals shall be to nearest scacmark and shall be doweled w existing improvements,
lQ. Prior appmvai of ittspecttrr is required four any wart; dart after normal working hsturs, on weekends ar holidays and may require reimbursemrstt of
inspection cosu as the curreru averiime mu.
l 1 Adequate signing and bamc~ting cs required on the jat+ site. Failure to provide such siting atzd barri.-ading sttay° result in the Ctn"5 providing s>rEning
and barti~des and charging the cost tincludeng all tabor and tnatctsats; against the rash dent~it_
i ?. Compaction testing of 5ubgrade, base rock- and asphalt caicrete by Permitter :s requ:i~ed tiniest otherwise stated by the City Engineer
la. The Contractor ar Permittec will have a supervisory representative available far contact on the project at alt times during caistntctian. Ctititractor at
Permitter shalt provide a phone number at which they can be ennuicted outside the hours of 8:tlG a.m. to 4:(K) p,m.
14. Na storage of mattxiats a equipment will be allowed near the edge of pavement., the naveted way. or within the shoulderline which would create :a
hazacriious carditian to ldio aubli;
t This permit shall not be txtnstrued as autharizatiari fig ex~valian and grading an pn3•ate property adiarzxtt to the work to an} nitre' wart, fnc w#rtcii a
scpasate pesrrrit may be required, ncir does it rciieve the Permittee of nay i3biigauan u;~ awain any other tirrxnit tz~tutc~d a;: tar
lfi. This pcrrrtit does not release the Permitter from any Liabilities contained in other agrccrttents or contracts with the City and any ether public agency
I7. This permit is not transferable Work must be perfarnied by the Pcrniittee ar his designated agent ar conL:tctot as specified thereon
1 S. Cal! back (call out} due to emergencies regarding this permit shall be ar the current avesurstc tats with a three (3) hour minimum charge per occurrence.
19 Pursuant to Chapter 1 ~.t2? of rise Campkxil Muniet}sal Cade, applicant shaft not amsc to be discharged an}~ ittatexial inttr fire municittal storm drain cyst,-rs;
tither tisatt sttxrr watt Appli,ant shalt adhere to the BEST tvSANa:CiE.41Elv^' PRACTICES asablistted by the Santa Ciar~ ~'a!!cy tiraar. Burial:
Ptyllutian Prevenuai Program.
2{l tf the ptibtic interest requires a modiftcatian of, a a depatntrc Pratt, the plans and spcctfsraaans. the City shall have the authority to requac or appmv=
any mrxfifeanan ar depamtre and to specify the manner m which the same i5 to rte tnatie far City-awned or rnaintamcd facilities.
23. Ptrtrtittee must provide advance natifica[ian to all parties that may ire affected tsy the permit activities. Notification shaTi be reviewed by City pear m
di5tributiau aria iriclufi4 daw of wart: aria a Ganta,:c rioter anti ptlanc ntitibCi.
Appttcant shall t.~ rrspttnsibte fa ensuring: that ail Chase providing services undue zhe applicant arc aware of and understand all of the atKrw rondivans
PG&E John Gambucci
08/26/10
Contractor (Print Name}
Date
08/26/10
Date
Jlfarrttsipwpetm
Reo 1 t9t(1{
PG&E Permit Sketch for: City of Campbell
Address: 1580 W HACIENDA AVE
Nature of Work: Abandon Gas Service at Main
Surface: Asphalt Cut in Street Excavation size: 4' x 4' x 4'
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