ENC2014-00163SEP o 9
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CITY OFCAitRPBELt j7 NCROACHaIIENTPERMIT Perm(tNo
DEPT.OF PUBLIC WORKS UbI1C I or otflil gj%t�ln the public X-Ref File
70 North First Street rIgEt-8Wvg1ycjjtjQApplication'08te •-\ LA
Campbell, CA-9500e , I Application Expiration Date-
Ph. (4f18) 266-215.0 Issued
APN `2_%'b05r -1 1
F% `(408):316-0958 I )�
Permit Expiration Date
APPLICATION - Application 'is hereby'made fora Public Works Permit in accordance with Campbell MunicipaLCode,,Section1`104. .(Applicationexpiresin six
(6) months if the permit is n'ot Issued. Application Fee is non-refundable.)
A. Work Address or Tract No:: L240Q S BASCOM AVE CAMPBELL
Utility Trench Location: 75.' EAST OF E CAMPBELL AVE,& S BASCOM -4' FROM PROPERTY LINE
B. Nature:of Work: TAP HOLE OVER.GAS MAIN TO CUT GAS.SERVIGE
........ ...... —
C. Attach four (4) copies of an engineered plan showing the location and extent ofehe Work, and four (4) copies of the preliminaryEngineer'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'partof this permit.
D. All work shall conform to the City ol"Campbell.Standard Specifications -and Details for Public Works Construction; the General:Permit Conditions.
listed onthe reverse side; and'the 5pecla1Provisions for this permit, listed below, Failure to abide by theseconditions and provisions may result
in job shutdown and/arforfeiture of Falthful Performance Sureties. and, cash deposits.,(See General Permit Conditions l and 2 j
E.. The Contractor must havethis permit and.appro'Wo plan s.at the site and: must notify the Public Works Department at least days before
startingwo& Notice must be given to Pub[ icWorks.at least 24 hours befote restarting anywork.
Name'ofApplicant PG&E Telephone: 4Q8 725 2153
Address: 1 10900 IV Blaney AVe, Cupertino, Ca. 95014
E-MAI Address- JJGJ@PGE.COM 24-FIOUR EMERGENCY PHONE NUMBERS $00-7437$000
Is this work beingdone.b the property owners at their own residence?
.... _......
Y p. to Y YES, _r. NO'
The, Apo licant/Permittee hereby agrees by affixing their signature to this permit to hold the:City of Campbell, its officers; agents, and .employees free, safe
and harmlessfrom any claim or demand for -damages resulting from the work covered bythis permit.
The Applicant/Permittee hereby acknowledges that they have read and understand both the front .and back of this permit, and'they:wiil informtheir
contractor(s) of the information. Applicant is advised that .upon issuance of this permit, property, owner, or property owner's. uctessors,. shall be
responsible for:any and all damages arising out of the condition of any private improvements in the public right-of-way.
-Accepted:
0<9/08/14
P.G&E John. Gambucci 09/0.8/14.
(Contractor) (Print Name)' Date
SPECIAL PROVISIONS:
1. Streetshall not be open cut for underground` installations. Minmay Minimum cuts be allowed for connections or exploration holes. Such cuts may be
specific aiiyapproyedbytheInspectorpriortocuitina.
,2. Pavement may be cut for Underground installations and must be restored in accordance with the Standard Details'Trench l?estorat on Method
"A", unless otherwise approved by the Engineer.
3. Workto be staked by.a licensed Land Surveyor or. Civil`Enqineef and two (2) copies of the cut sheetssentto the Public Works.Department
before starting work:
4; Per Section 421'6 of the Government Code this permit is not valid for excavation uniV 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.
S. Prior to any work; the property owner shall executean:Agreementfor Private Improvements,! I n the PublicRight-of-Way, which shall be recorded.
61 Public Notification Requirements:
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SEE P016LIC WORKS FEE SCHEDULE FOR CURRENT FEES .AMOUNT RECEIPT
PERMIT APPLIcATIONFEE $ 3QjS
PLAN CHECK DEPOSIT $
SECURIT`f FOR FAITHFUL PERFORM ANCELLABOR & MATERIALS $,
CONSTRUCTION CASH DEPOSIT
PLAN CHECK & INSPECTION FEE
EMERGENCY PERMIT FEE
APPROVED FOR ISSUANCE `si l 1A-� � (I �' I I L4
For City Engineer Date
Permit Expires 12 Moriths After'Date of Issuance
GENERAL PERMIT CONDITIONS
d, A:Construction'Cash Deposii l' required: Charges will be made against this deposit If there Is anemergency.call-out,; overtime .inspection'or when City
ordered barricading is required. .Any such costsin excess of the deposit wilI be billed to the Pert ittee
I Atone-yearmaintenance, period and surety are required. Such period will begin on date of written.AeOotancebythe City.
3. Refund or the Cash deposit ba lance and refund or cancellationof the Faithfu I Performance Surety Will be initiated by the written' acceptance' of the work
by the City.
4. 5ubmitproject :schedule 10;(ten) daysspriorto proposed start of work. Special provisionsinay be required for work Within City.faciliiles and
downtown Campbell..
5. The Permiftee must request in writirid a final Inspection and acceptance of the work upon completion..Acceptance by the City will be made in -writing
to the Permittee.
6.1 Maintain safe pedestrian'and vehicular crossings'andfree access to private driveways, busstops,:fire hydrants, and water valves.
7. A Construction Traffic Control Planand a Construction Schedule are required for all lane closures detours, and street closures. This plan must be
reviewed and approved prior to any lane closures:
8:: A ConstructidnT.rafflc Control Plan shalt conform to the Galtrans. Manual of.Traffic Controls for Construction:and:Maintenance Work Zones, dated
1990, availableatCaltrans Traffic;control equipment shall include Type ll flashing -arrow signs if required.
9., Replace as directed by the City Engineer any damaged or removed.iirprovements in accordance,with City Standards and Specifications at the, sole
expense of the.Permktee..
10. 'Sawcutfor ali PCCor AC'mmovals. All PCC:removalsshall be to the:nearestscoremark and shall be doweled to existing improvements.
1i. Priorapprovalof. inspecior,isrequired foranyw_orkdoneafternormalworkinghours, onweekendsorholidays and;mayreg41re.ieiFnbursementof
inspection Costs -at the current overtime rate.
12.. Adequate signing and barricading is required onthe job site Failure to proJide such signing and barricading May result in the City's providing signing
and barricades and chard Ing ibe cost:(including all labor: and,rnateriais) against the cash deposit.
m Compaction testing of subgrade, base rock, and asphalt concrete by Permittee is required unless otherwise stated by the City Engineer..
14. The Contract.oror Pen-riltteeWill hav6.a 'supervlsory repireseritative available for eontactori the project atiill times during construction. Coritractoror'
Permitiee shall provide a phone number at which they can be contacted outside the hours of 8.00 a.m. to 4:00 p.m
11 No storage ofmawrials 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.
16. This p6rmIt shall. hot, be Construed 8 authorization for excavation and drading on private property adjacenttoihLa work,or any other workfor which a
17.: This permit does not release'the'Permittee:from any liabilities contained in other agreements or:contracts.wiih the Cityand anyoth.erpublic agency,,
i8. This permit is not transferable. Workmust be performed bythe Perhiittee orhis.designated agent or contiactoi as speeified thereon:.
15. Call back,(call out);due to emeregencies regarding.this,permit shall be at.the current overtime ratewith a three (3) hour minimum, charge per.
occurrence.
20. Pursuant to Chapter 14.02'ofthe.Caropbell Municipal Code; applicant shall not cause`to be discharged any material into the munidpai 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
21 If the, public interest requires a modification of, ora'departure from the'pians and speciflcatlons,the City shali:have.the authority to require.orapprove
any madiflcationor departure and to specify the mariner in which the same is to be made for Gty-ownedor maintained '• facilities.
22. 'Permitttee must p/avide advance notificationto;all,parties that may be affected bytite.permit activities: Notification shall be reviewed by tile City prior
to distribution and include dates of work and a contact name and phonenumber.
Applicantshall be responsible forensuringthat all those, providing services under the applicant are aware and understand all' of the' above conditions.
Jahn Gambucc ` � r 09/08 14
.Applicant Dater
John Gambucc 09/08/14
Contractor (PrintName) Date:
J:\FORMS\Templates\Encioachmetit Pertnits\Encroachnyent PerriiitSTATIC forni2tpdf
Rev02114
PG&E Pen -nit Sketeb for: City of Campbell
Add.res.s:.2000 5 Bascom..Ave.
Nalure,of Work: Abandon Gas Service at Main
Surface: Dirt Cut ExcAvation size:.4' x 4'x' 4'
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Additional Permit Conditions
July 21, 2015
_Permit No. ENC 2014-00163
Camden Ave
1. Submit traffic control plan for City's review and approval prior to the start of
construction. (also submit County's approved traffic control plan for Camden Ave)
2. 'a trans ounty permits�re required for all the work in County r.o.w
3. Dane 'losure hours ar�4fx-o.9 am to 3
4. Treneh_p.la 11 becessed n Camden Ave.
5. Ty e T lur , b shall e p aced over the main lines and service line.trenches.
6. Slurry seal shall not be scheduled on garbage collection day
7. Give prior notification to the residents and businesses where fire hydrant will be, installed
8. Residents & Businesses shall be given 7-days and 48-Hours advance notice
9. The hours of work shall be 8:00 AM to 4:00 PM — Monday through Friday, excluding holidays.
10. Access to side streets and private drives shall be maintained at all times.
11. The site shall be swept as needed to maintain clean roadways, a minimum of once a day.
12. All edges of trenches shall be saw cut. Any broken pavement edges shall be squared up by saw
cutting and repaved.
13. All permanent pavement markings shall be installed within seven (7) calendar days of final
finish paving.
14. All sidewalk and/or curb/gutter replacement shall be saw cut to the nearest score line.
Syed Wahidi, Public Works Inspector
�- l 4-C-V 2- W (Ci
HALETTERS-CORRESPWW- Camden Ave.doc