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CITY OF CAMPS ��2�S �` ENCROACHMENT PERMIT Permit No.: BLD20019 00660 4
DEPT.OF PUBLI� ORKS (for working within the X-Ref. File
70 North First Street pu is righ-of-way) Application Date 6/17/19
Campbell,CA 95008 n os
Ph.(408)866-2150 ®�I��� Issued VTR l Application Expiration Date
Fx. (408)376-0958 `� APN 412-07-001
Permit Expiration Date l
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APPLICATION-Application isherebymadefora Public Works Permit inaccord cewit Campbell Municipal Code,Section 11.04.(Application expires in six
(6) months if the permit is not issued. Application Fee is non-refundable.)
A. WorkAddress: 300 ORCHARD CITY DRIVE (CITY PARKING LOT)
Nature of work/Utility CLOSE CITY PARKING LOT TO ACCOMODATE CRANE ACCESS TO
B. Trench Location:
ADJACENT BUILDING ROOFS
❑✓ No Fee Permit for work related to City Project Project Name: CITY PARKING LOT
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 shall conform tothe 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
injob shutdown and/or forfeiture of Faithful Performance Sureties and cash deposits.
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.
Name of Applicant: Performance Air Service, Inc. Telephone: 408 920-6170
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Address: 350 Mathew St. Santa Clara CA 95050
E-Mail Address: tbrown q@performanceair8ervice.COm 24-HOUR EMERGENCY PHONE NUMBER: 408 314-3837
Is this work being done by the property owners at their own residence? El Yes Xf No
The Applicant/Permittee hereby agrees by affixing their signature to this permit to hold the City of Campbell,its officers,agents,and employees free,safe
and harmless from any claim or demand for damages resulting from the work covered by this permit.
The Applicant/Permittee 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 all
damages arising out of improvements completed in the public right-of-way.
Oighally signed byTom Brown
Tom Brown
BN rn=Tom Browryo Pert° nce rvire ln4
Accepted: Tom Brovrn m"'""`ownppe"°m """e""`.`°m,`=° 6-17-19
(Appliyaatt Rdaunittee) (sign) Date
Tom Brown°Nm-T°mBmw oPert°ma"cea,r5e"feel"4
ou=ProJett Mareger,
ma0=tbrownvDp <om,r-US ertortnanrealrzervice.
Tom Brown 6-17-19
SPECIAL PROVISIONS: (Contractor) (Print Name) Date
1. Street shall not be open cut for underground installations.Minimum cuts may be allowed for connections or exploration holes. Such cuts may be
specifically approved by the Inspector prior to cutting.
2. 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 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 4216 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.
—5. Prior to any work,the property owner shall execute an Agreement for Private Improvements'i the Public R'+lit-uf-++rays,wyhich shall be recorded.
—6.Public Notification Requirements:
7. kN2411`k;- S6 \40S _ L- 4 —7 7 14 6� to ft)J
SEE PUBLIC WORKS FEE SCHEDULE FOR CURRENT FEES I_l �AMOUNT RECEIPT NO.
PERMIT APPLICATION FEE S
PLAN CHECK DEPOSIT
SECURITY FOR FAITHFUL PERFORMANCEILABOR&MATERIALS $
CONSTRUCTION CASH DEPOSIT $
PLAN CHECK&INSPECTION FEE $
2%TECHNOLOGY FEE
TRAFFIC CONTROL REVIEW $
APPROVED FOR ISSUANCE
For City Engineer
Permit Expires 12 Months After Date of Issuance
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GENERAL PERMIT CONDITIONS
1. The Permittee must provide evidence of insurance and Additional Insured Endorsements as required by the City.Insurance shall be maintained for the duration of the
permit work.
2. A Construction Cash Deposit is required.Changes will be made againstthis 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.
3. Refund of the construction cash deposit balance and refund or cancellation of the Faithful Performance Surety will be initiated by the written acceptance of the work
by the City.
4. A one-year maintenance period and surety are required.Such period will begin on date of written acceptance by the City.Surety posted shall be equal to 25%of the
original Faithful Performance Security.
5. Submit project schedule 10(ten)days prior to proposed start of work.Additional lead time may be required for work within City facilities and downtown Campbell.
6. 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.
7. Maintain safe pedestrian and vehicular crossings and free access to private driveways,bus stops,fire hydrants,and water valves.
8. A Construction Traffic Control Plan and a Construction Schedule are required for all lane closures,detours,and street closures.This plan must be reviewed and
approved priorto any lane closures.
9. A Construction Traffic Control Plan shall conform-'to the most recent version of the California Manual on Uniform Traffic Control Devices(MUTCD).
10. Replace,as directed by the City Engineer,any damaged or removed improvements in accordance with City Standards and Specifications at the sole expense of the
Permittee as expeditiously as possible.
11. Sawcut for all PCC or AC removals.All PCC removals shall be to the nearest scoremark and new PCC shall be doweled to existing improvements.
12. Prior approval of inspector is required for any work proposed after normal working hours,on weekends or holidays and'may require reimbursement of inspection
costs at the current overtime rate.
13. Work on arterials and collectors may require the use of changeable message boards.Adequate signing and barricading is required on the job site.Failure to provide
such signing and barricading may result in the City's providing signing and barricades and charging the cost(including all labor and materials)against the construction
cash deposit.
14. Compaction testing of subgrade,base rock,and asphalt concrete by Permittee is required unless otherwise stated by the City Engineer.
15. The Contractor or Permittee will have a supervisory representative available for contact on the project at all times during construction.Contractor or Permittee shall
provide a phone number at which they can be contacted outside the hours of 8:00 a.m.to 4:00 p.m.and on weekends.
16. No storage of materials or equipment will be allowed near the edge of the pavement,the traveled way,or within the shoulderline which would create a hazardous
condition to the public.
17. This permit shall not be construed as authorization for excavation and grading on private property adjacent to the work or any otherwork 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.
18. This permit does not release the Permittee from any liabilities contained in other agreements or contracts with the City and any other public agency.
19. This permit is not transferable.Work must be performed by the Permittee or his designated agent or contractor as specified thereon.
20. Call back(call out)due to emergencies regarding this permit shall be at the current overtime rate with a three(3)hour minimum charge per occurrence.
21. Pursuant to Chapter 14.02 of the Campbell Municipal Code,applicant shall not cause to be discharged any material into the municipal 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.
22. If the public interest requires a modification of,or a departure from the permit,plans,special provisions and/or specifications,the City shall have the authority to
require or approve any modification or departure and to specify the manner in which the same is to be made.
23. Permittee 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 dates of work and a contact name and a phone number.
24. Applicant shall remove water from utility vaults in accordance with the requirements of State Water Resources Control Board Water Quality Order WQ 2014-0174-
DWQ. Said vault water shall not be discharged into the City of Campbell's storm drain system.
See http://www.waterboards.ca.goy/water issues/programs/nodes/utilitvvaults.shtml for more information.
Applicant is hereby responsible for ensuring that all those providing services under the applicant are aware of and abide by all of the above conditions.
Tom Brown Digitally signed Brm,-Brown
Dat.20Tom Brown,9:Performance Air Service Inc,,—Project Manager,email=thrown@performanceairservice com,c=US
"�Date:2019.06.1713:6920-07'00'
Applicant Date:
Performance Air Service Tom-Brown 6717-19
Contractor (Print Name) Date:
J:\FORMS\Templates\Encroachment Permits\Encroachment Permit 3 2919