ENC2010-00153
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CITY OF CAMPBELL ENCROACHMENT PERMIT 1r^~~,,
Permit No ~v~ 20 (G " ~U ~~3
DEPT. OF PUBLlC WORKS ffor working within the public X-Ref. File
70 North First Street right-of-way) Application Date __. O ~ ~..,,__
Campbell, CA 95008 Issued ~ ~ l U
~~ Application Expiation D to ,S ~ (1_~._.
Ph. {408- 86fi-2150 _............_....
_v_ APN ,2 ~~ ~ 3g °' 4 `~
Fx. (408) 376.0958 ~
~
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(
Permit Expiration pate
APPLICATION -Application is hereby made for a Public Works Permit in accordance with Campbell Municipal Code, Section 11.04. (Application expires in six
(6) months if the permit is not issued. Application Fee is non-refundable)
A, work Address arrract No.: 155 East Campbell Avenue. Campbell, California 95008
Utility Trench Location: ~80' North of street intersection of Campbell Av, and 3rd St. Trench will be on 3rd stre~
B. Nature of l'Vork: (Replace damaged 4" Cast Iron Lateral with a new 6"diameter sewer lateral
C. Attach four (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, said plan becomes a part of this permit.
D. All work shaA conforrn 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 this permit, listed below. Failure to abide by these conditions and provisions may result
in job shutdown andlor for#eiture of Faithful Performance Sureties and cash deposits. (See General Permit Conditions t and 2.)
E. The Contractor must have this permit and approved plans at the site and must notify the Public Works Department at least two days before
starting work. Notice must be given to Public Works at least 24 hours before restarting any work.
_..~.~.....~.. _._ __-._._ _-.-ti_._...__~..~,.__w_..._
Name of Applicant: Jorge Picado (West VaNey Sanitation District) Telephone: (408) 378-2407
Address: 100 East Sunnyoaks Avenue. Campbell, California 95008
E-h'lail Address: (jpicado@westvalleysan.org 24-HOUR EMERGENCY PHONE NUMBER: {408) 828-1949
Is this work being dome by the property owners at their own residence? (" YES (}t NO
The AppiicantlPermittee hereby agrees by affixing their signature to this permit to hold the City of Campbell, its officers, agents, and ernpioyees free, safe
and harmless from any claim or dernand for damages resulting from the work covered by this permit.
The AppilcantfPermittee hereby acknowledges that they have read and understand both the front and back of this permit, and they will inform their
contractor(s) of the information. Applicant is advised that upon issuance of this permit, property owner, or property owner's successors, shall be
responsible for any and ail damages arising out of the con/dition of any private improvements in the public right-of-way.
Accepted: ~ ~ ~,a+~'~r~'' ___ (~er~,t t/~f/e~ .`ri~a~~ ~'!sh•!rf ..~ - ~or,~Aw,. ~r~vcrnb~Y J ..20,4•
(Applicant Permittee) (sign} Date
_ _1_'z7'GtTfL ~ylA~,'~ tJYX7l CdrlSfY'G~'C~JR/"i j% ~'i~ ~4r/2Ytt~L'Y'i .~?JL7.
- _._._ _.~ _.~ ......-_~d r ___ t _
(Contractor) ~ (Print Nam Date
SPECIAL P~VISIONS_
_____t . Street shall not be open cut for underground installations. Minimum cuts may be albwed for connections or exploration holes. Such cuts maybe
specifically approved by the Inspector prior to cutting.
~2. Pavement maybe cut for underground installations and 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 Civil Engineer and two (2) copies of the cut sheets sent to 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: 1-800-227-2600. USA TICKET NO.
__.......$. Prior to any work, the property owner shall execute an Agreement for Private improvements in the Public Right•of-way, which shall be recorded.
_,.,._,....6. Publi<NotificationRequirements:.
7.
SEE PUBLIC WORKS FEE SCHEDULE FOR CURRENT FEES. AMOUNT RECEIPT NO.
PERMITAPPLICATION FEE $~~.Q.._.___.... _.....--.-~.----..__.-.._._........._.___
PLAN CHECK DEPOSIT $
SECURITI' FOR FAITHFUL PERFORMANCElLABOR & MATERIALS $
CONSTRUCTION CASH DEPOSIT $~
PLAN CHECK & INSPECTION FEE $_ . _... .7_-! (~ .._..._ ___ ___ 4~+( _ _ _
EMERGENCY PERMIT' FEE $
APPROVED FOR ISSUANCE --- I I U f~ I U
For City Engineer Date
Permit Expires t 2 Months After rate of Issuance
GENERAL PERMIT CONDITIONS
i. A Construction Cash Deposit is required. Charges will be made against this deposit if there is an emergency call-out, overtime inspection or when City
ordered barricading is required. Any such costs in excess of the deposit will be billed to the Permittee.
2. Anne-year maintenance period and surety are required. Such period will begin on date of v/ritten acceptance by the City.
3. Refund or the cash deposit balance and refund or cancellation o€ the Faithful Performance Surety wiU be initialed by the written acceptance of the work
by the City.
4. The Permittee must request in writing a final inspection and acceptance of the work upon completion. Acceptance by the City will be made in writing
to the Permittee.
S. Maintain safe pedestrian and vehicular crossings and free access to private driveways, bus stops, fire hydrants, and water valves.
b. A Construction Traffic Control Plan and a Construction Schedule are required for all lane closures, detours, and street closures. This plan nwst be
reviewed and approved prior to any lane closures.
7. A Construction Traffic Control Plan shat! conform to the CaRrans Manual of Traffic Controls for Construction and Maintenance 4AJork Zones, dated
1490, available at Caltrans. Traffic control equipment shall include Type II flashing arrow signs if required.
S. Replace as directed by the City Engineer any damaged or removed improvements in accordance with City Standards and Specifkations at the sole
expense of the Permittee.
9. Sawcut for all PCC or AC removals. All PCC removals shall be to the nearest scoremark and shall be doweled Lo existing improvements.
t0. Prior approval of inspector is required for any work done after normal workiny hours, on weekends or holidays and may require reimbursement of
inspection costs at the current overtime rate.
t t. Adequate signing and barricading is required nn the job site. Failure to provide such signing and barricading may result in the City's providing siyniny
and barricades and charging the cost {including all labor and materials) against the cash deposit.
t 2. Compaction testing of subgrade, base rock, and asphalt concrete by Permittee is required unless otherwise stated by the City Engineer.
13. The Contractor or Permittee wilt have a supervisory representative available for contact on the project at ail times during construction. Contrattor or
Permittee shall provide a phone number at which they can be contacted outside the hours of 8:00 a.rn. to 4:00 p.m.
14. No storage of materials or equipment will be allowed near the edge of pavement the traveled way, or within the shoulderline which would create a
hazardous condition to the public.
1 S. This permit shall not be construed as authorization for excavation and grading on private property adjacent to the work or any other work for which a
separate permit may be required nor does it relieve the Permittee of any obligation to obtain any other permit required by law.
I b. This permit does not. release the Permittee frarn any liabilities contained in other agreements or contracts with the City and any other public agency.
17. This permit is not transferable. Work must be performed by the Permittee or his designated agent or Contractor as specified thereon.
18. Call hack (call out) due to emereyencies regarding this permit shall be at the current overtime rate with a three {3) hour minimum charge per
occurrence.
t4. Pursuant to Chapter 14,02 of the Campbell Municipal Code, applicant shall not cause to be discharged any material into the murticipai 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.
30. If the public interest requires a modification of, nr a departure irnm the plans and specifications, the City shall have the authority in require or approve
any modification or departure and to specify the manner in which the same is to be made for Cityovrned or maintained facilities.
2 i. Permitttee must provide advance notification to all parties that may be affected by the permit activities. Notification shall be reviewed by the City prior
to distribution and include daEes of work and a contact name and phone number.
Applicant shall be responsible for ensuring that all those providing services under the applicant are aware and understand all of the above conditions.
7`'.~iGAA~c'~-. ~GtJ~'s~ 1/A11~ ,Sctni~~jo~r ..~>'s~ir'iG~ __...__ h1'o.~a`~ ~ ~yyCr~~a6~rt1~C~1C5,
Applicarir-1 ~ Date:
____ ~acr'{'c tJndergroyad Cpnslryrfjan 1~~tat~ , ~Joi~'m.~w/ !, ,2010 .
Contractor (Print Name) Date:
J:\FORMS\Templates\Encroachment PermitslEncroachment Permit STATIC form2.pdf
Rev. 09/ t 0
'~1~est a1e~.
. ~~~ Sanitation dis~r~ct
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FACSIMILE TRANSMITTAL
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ATTE~iTIC1~'~3: .~'~ed L{~i~hrd/'
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STsBJECT: ~rtcrrrt.~cl7merl~ f er~rr~t ~ -~riY 1~~" ~ , n,~~l( ,~'i/~'.
TOTAL PAGES TRAti'SVIITTED
{includii~srr this ecwer sheet)
i~[ESSAGE:
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b fornrutian corupited,jronr varJaus sources. (:'ore! ogic makes rra representations
a• Svarrcurues rrs to dte crecurac;t~ ar completeness ~jn frrnratian captained in tlrir report.