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ENC2010-00145CITY OF CAMPBELL ENCROACHMENT PERMIT Permit No -EnIC~7, ~~"' W 17 5 DEPT. OF PUBLIC WORKS (for working within the public X-Ref. File 70 North First St. right-of-way) Q/I n ' Campbell, C.A 950[18 / Apalication Date ~ !5 (408) 866-2I50 Issued ~G~~1 ~ ~ AppIicatior, Expiration Date ~ Fax (d08) 376-0958 /~, Permit Expiration Date ~v ~~ APN 1 ~ "~ ~'" d2$ n Z ~O APPLICATION - Application is hereby made for a Pubiie Works Permit in accordance with Campbell Municipal Code, Section l i.(34. {Application~es i~t {~F months if the permit is not issued. Application Fce is non-refundable.} eV 0~ A. Work address or tract# 1306 Juanita Way ~ ~~~ ~ (~~~ U ~ 3 ~ o0 om Utility trench location 8' from ro ert line n/o 1306 Juanita Way (~ ~ m~ $ Nature of work Dig tap hole over gas main to abandon gas service to 1306 Juanita Way © ~~ C. Attach four {4) copies of an engineered plan showing the [ovation 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, said plan becomes a part of this permit. D. All work shalt conform to the City of Campbell Standard Specifications and Details for Public Works Construction: the General Permit Conditions listed on the reverse side: and the Special Provisions for taus permit, listed below. Failure to abide by these conditions and pmvisions trtay result in job shutdown antL'or farfeiurre of Faithful Performance Sureties and cash deposits tSec General Permn Conditions t and Z.) E. The Contractor must have this permit and approved plans at the site and must notit"}' the Public Works Department at least rwo days bef"ore starting work. Notice musE be given to Publse Works at least 24 hours before restarting any work. Name of Applicant PG&E PM30809013 Telephone 408-725-2153 ( Tint name) Address. ,1 Q9~,1O N BI9fIe~/ AyP,., ~ll .1'~InO 5014 24-HUUR EMERGENCY TELEPHONE NCr. '800-743-5000 E-Mail Address JJGJ~a PGE.COM Is this work being done by the property owners at their own residence" X Yes Ne The Appiicant/Permiltcx hereby agrees by afftxing their signature to this permit to hold the City of Campbell, its officers, agents and employes free. safe and harmless from any claim ar demand for damages resulting from the work envered by ibis permit. The ApphcandPermine:. hereby acknowledges that they have read and understand both the front and hack of this pcrnti~ and they will Inform their contractor{sj of the information. Applicant is advised [hat upon issuance of this patXnit, property owner, or propt'rty awntr's successors. shall be responsible for any and all damages arising out of the condition of any private improvements in the p liv right-of-way. ~~ (Applicant Permittee) (sign) Date PG&E--John Gambucci 10/13/10 _ Contractor (Print Name} I")ate _I . Street shall not be open cut for underground installations. Minimum eats ~ he allowed For connections or expioranon holes. Such cuts may he specifically approved by the Inspector prior to cutttn~- ~'_. Pavement may be cut far underground installations and must be restored in accordance with the Standard Details Trench Restoration Methpd "A", unless otherwise approved by Inspector. T3. Work to be staked by a licensed Lind Surveyor or Civil i~ngineer and two (2) copies of Ehe cut. sheets sent to the Public Works Deparunent before starting work.. 4 Per Section 42.15 of the Government Code this pcrrttit is oat valid for excavattons unrii Underground Service Alert (USA) has been notified and the intluiry identiftcation number has hero entered hereon. USA Phone 1800-'_27-2b00. USA TICKET NO. ~S Prcr tc any wort;. tltc proputy owner s:.all cz; cute an ,=.grecmcat for Private Improvements in the I'::blic Right-:,f-Vva; , whioh ;hall be recorded. -___b. Pubty Notification Requirements: SEE PLI$LEC WORKS FEE SCHEDt1LE FOR CURRENT 1~~.E.S AMOUNT RECEIPT NU PERMIT APPLICATIUN FcE $ 350 PLAN CHECK DEPOSIT ~ SECURITY FOR FAITHFt.iL PERFORMANCE~~ABOR d:. M.4TERlALS S CONSTRUCTION CASH DEPOSIT S PLAN CHECK ~ 1NSPECT7ON FEE $~(~ APPROVED FOR ISSUANCE ~~ 2°' I ~ For City Engineer Datt: Permit Expires 12 Months After Date of Issuance GENERAL PERMIT CONDITIt1M1S i 1. A Canstruitioa Cash,Deposit is'rpquircd. Charges wiiI be made against this deposit if there is as emergency call-out. avettimt nspmcuon ar when City ordered barricading is required. Any such costs in excess of the deposit wiJ] be billed to the Pertnitcee, ~. '. A~ate-year maintenanct period and surety are rtgturi~x1 Such period will beta as date of written atceptanee by the Gty. 3. Refund of the cash deposit baiaxt~ and reftmd ar c~eltadoa of slit Faithftai P~iarrrance 5urmry will ix initiated by the writurt acccptancm of slit wart bw the City. 4. The Permittee must request in wnun8 a Etna} iaspauon anti a~eptanec of the wart: upon crteripietiom- Atx`mptance by rite City will bt made is wrtitin2 to the Permittee_ S. Maintain safe pedestrian and vehicular crassino and frrx access to private driveways, bas stops, fire hydrants and water valves.. b A Caastruction Traffic Cannot Plan and a Construction Schedule are required for all }one c#asurts, detours and street closures. This plan must be rericwed and apprt>ved prior to any loam closures The Consuxtoticm Traffic Cattxol P'!an sisaJJ caiftxm to tt~ Cattzaats Ivtaniial of Traffic CoauoLs far Coossnicxiai and iviaiateriantx Wars; Zaaes, dated i994, available at Cattrarss. Traffic corirrol equiprtxat shall include 7ypc iI fiashtng arrow signs if requimd h_ Rtptace as directed by the City Engineer any damaged ar temaved itttpravcmtnts in accardance wins City Standards and Specifications az the sots expense of the Perrmtiee- 9. Sawcut far all PC:C ar AC removals. All PCC rcrnovals shall be to nearest scaremark and shall be dnwclmd sa existing impmvetnenrs, J0. Prior approval of inspector is required far nay work done after normal working hours, on weekends or holidays and may requirm reimbuscmuit of itispecuoxs txuis at the current ovtatime rite. }'+ Adrquatt signing and barricading is required on Elie sift. Failure Ea provide such stgting and barricading may sisals in the pity`s pmviditig signing acid barricades and atargmg slit east tinttiidiag a#I sabers and matertala) against slit casts deposit. 1 Z. Campacuon tesuag of subgndm, bast rock. and asphalt concrete by Permittee is required unless gtherwisr stated by the C:ty Engineer. 13. The Caati~aciar or Permittee will have a supervisory represtntauve available fps contact on the project at alt umms during catstrucaan. Ctxttractor at Permitrsx shalt pmvide a phone number at which khey can be taauicted outside ttte hours of S;UG a.m. to 4:Qi} p.m. l4. Na storage cif materials ar equipmait will be allowed star thin edge of pavemrnt, slit travt}ecl way. or within slit shauberline which would create a hazardars conditicxt to the puhJit: t This perrttit shall not be cazstrucd as autiecmaauan far ex^vauon alas grading cus private prapem; adiacmnt to ttu wort: ar any otli~ rvtirl: r"a w3tich a separate perrrtit may tx requii~tt. nor does it rctreve slit Prrrrittttm of nay abiigaaan to aistarn any atttcr permit required aw taw # b. This permit does not release slit Permitter from any liabilities contained in oilier agrceriicnts or canttacts wish the City and any other public agesicy 17. This permit is not transferable. Work must bt pcrfarmcd by thr Fermittec or his designated agent ar contractor as specified thereon. l ~. C'.aJl knack (tail out} due to ertiergeneies regarding this permit shall be at the current avetume rate with a three (3) hour minimum charge per accurrtnce } 9. l'ursirant to Chapter 1d.Q? of slim Carrgikxit Municipal Code, applicant siiail oat cause to be discharged. anti material into the tnunigpal storm drain system, other than s[txm water. Applicant snail adhere to tilt BEST MANAGEMEJ+iI` PRACI7CES ~takifshtd bey ttie Santa Clara Valley tJriim ittma~ Potiuti+nn Prevaxtion Progsaat, 2Q. Jf dim public. mterat regalia a itiadifignoa af, ar a departure from. the plans and specifipborts, the City shai# have slit authanry to require ar approve any modification ear departure. and to specify the mariner in which she same is m be made fns City-awned ar maintained fatcilitims. 23. Ptrmitue must pmvide advarsec notificaticm to alt parties that tray be affected by the permit activities, Notification shat} be reviewed by City prior cis disaihuticr, ar,u €t:cludc t'atc> of work and a con~,^t nairt:, and Rhone nw;~bct. Applicant shall be responaibit far ensuring that all those providing services imdr isle applicant are aware of and understand aJI of the above cxmdiuoas r / Applic'a(n~t ~~T'i--'cam J O~ h IKJ!'t aril C G S Cantraetor (Print Name) /U•/3,l ~ tlatm /o•i3, ~U hate Rfarmsipwperm Rev. l 1J9/U4 PG&E Permit Sketch for: City of Campbell Address:1306 Juanita way Nature of Work: Abandon Gas Service at Main Surface: Asphalt Cut in Shoulder Excavation size: 4' x 4' x 4' r, V~ / i I 1 '~ 'art) ' 79 ~340112P1. r "r 2Q`~ 9~33?k N'350 ,j E~ Ul -P .~ -- "r ~-~~~> ~ ~~ ~ - / ~° ~ ~Be ~- ` Z I „Z9~ c,,, ~ a I~ ~~ Iw ~ 1{{~' ~ao~ _ o `~ _'_ tiy~il'/t P~ ~ ~ ~ Q1 -ry aeiBa~-~ I ~2 SKr I l~4A vt 9l ^' ~ ~ -y B~6~LA~ fit` ~\` ,~_~r' x'"48 p/4) ('~ e, is~bi 1/3PL F csV ~Q'~ ~ w (3/4) Z+• m~y~ ~~ ~ O ,. ~~ - - jjjj ~ ~~~`-~ ~/ ~'n~ ~ ' m 1400-~,05d m. 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