HomeMy WebLinkAboutENC2014-00054 ^'' Q 541 Print Form
i• D o 201
Permit No C N Q. ZO\L -Loos-Lk
CITY OF CAMPBELL �{� I. ENCROACHMENT PERMIT
DEPT.OF PUBLIC WORKS M ;g�a ing within the public X-Ref.File
70 North First Street p1 \kS P`dm�t\ right-of-way)rs Application Date 3/)of I 11
Campbell,CA 95008 ?e,\C Issued 3 9�� �{ Application Expiration Date
Ph. (408)866-2150 APN . . Q 3 soil
Fx. (408)376-0958 3/1 2/'y
Permit Expiration Date 1
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 Addressor Tract No.: 33 ) E. /AM I 4---re= Ail - (24i-/(027)
Utility Trench Location:
B. Nature of Work: "3,044— /2." c2 Jt v 727 S e-r-
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 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 and/or forfeiture of Faithful Performance Sureties and cash deposits. (See General Permit Conditions 1 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. C70,-,-0
Name of Applicant: C. Telephone: set,— /g
Address: &.5I) At-1fl stk.V . �i+� Clop e/e( ?cis S
LIZ
E-Mail Address: kQv,� ,`4L,`,�� ACC 24-HOUR EMERGENCY PHONE NUMBER: t(
Is this work being done by the property owners at their own residence? ell— r YES NO
The Applicant/Permittee hereby agrees by affixing their signature to this permit to hold the City of Campbell,its cers,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 the condition of any private improvements in the public right-of-way.
Accepted: -09/;9.
(Applicant Permittee) ./ :r Date
C..%-, )(1=2/Ali do h
(Contractor) (Print Name) Date
SPECIAL PROVISIONS:
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 in the Public Right-of-Way,which shall be recorded.
V 7. NE CLOSu(LE d (-{AM 1 Lie 'V4 1.10 WED tin q AM — 3 PM•
SEE PUBLIC WORKS FEE SCHED CUR FEES AMOUNT RECEIPT NO.
PERMIT APPLICATION FEE $ 3 77 G.
PLAN CHECK DEPOSIT $
SECURITY FOR FAITHFUL PERFORMANCE/LABOR&MATERIALS $
CONSTRUCTION CASH DEPOSIT $
PLAN CHECK&INSPECTION FEE $ 317 0
EMERGENCY PERMIT FEE - $
APPROVED FOR ISSUANCE y 3/1)/} 11
For City Engineer Date
Permit Expires 12 Months After Date of Issuance
GENERAL PERMIT CONDITIONS
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. A one-year maintenance period and surety are required. Such period will begin on date of written acceptance by the City.
3. Refund or the 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. Submit project schedule 10(ten)days prior to proposed start of work.Special provisions may be required for work within City facilities and
downtown Campbell.
5. 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.
6. Maintain safe pedestrian and vehicular crossings and free access to private driveways,bus stops,fire hydrants,and water valves.
7. 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 prior to any lane closures.
8. A Construction Traffic Control Plan shall conform to the Caltrans Manual of Traffic Controls for Construction and Maintenance Work Zones,dated
1990,available at Caltrans. Traffic control equipment shall include Type II flashing arrow signs if required.
9. 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.
10. Sawcut for all PCC or AC removals. All PCC removals shall be to the nearest scoremark and shall be doweled to existing improvements.
11. Prior approval of inspector is required for any work done after normal working hours,on weekends or holidays and may require reimbursement of
inspection costs at the current overtime rate.
12. 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 cash deposit.
13. Compaction testing of subgrade,base rock,and asphalt concrete by Permittee is required unless otherwise stated by the City Engineer.
14. 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.
15. 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.
16. 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.
17. This permit does not release the Permittee from any liabilities contained in other agreements or contracts with the City and any other public agency.
18. This permit is not transferable. Work must be performed by the Permittee or his designated agent or contractor as specified thereon.
19. Call back(call out)due to emeregencies regarding this permit shall be at the current overtime rate with a three(3)hour minimum charge per
occurrence.
20. 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.
21. If the public interest requires a modification of,or a departure from the plans and 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 for City-owned or maintained facilities.
22. 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 dates 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.
Applicant Date: 3/
/e/e/
Contractor (Print Name) Date:
J:\FORMS\Templates\Encroachment Permits\Encroachment Permit STATIC form2.pdf
Rev.02/14
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CALIFORNIA DIVISION
BAY AREA PLANNING & ARCHITECTURE - PERMIT DEPT
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CDCAMPBELL. , CALIFORNIA
3 O PROJECT ID: 204627
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DRAWING INDEX
ii Z -O Z SHT NO. DESCRIPTION
& 0 O Z5" (1)
1 TITLE PAGE
CD 2 LEGEND & GENERAL NOTES
�..R 3 LAYOUT PLAN
4 TRAFFIC CONTROL
C 5 DETAIL
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6 STORM WATER PROTECTION PLAN
(� ♦�/ 7 TRAFFIC CONTROL SIGNS AND NOTES
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ZTHIS IS AN COMCAST DOCUMENT, PROPRIETARY & CONFIDENTIAL 330E HAMILTON AVE
o IMPORTANT NOTICE REV DESCRIPTION DATE TITLE BLOCK
`� Comcastr'') Section 4216/4217 of the Government rto issued
requires fo a DESIGN: —
Dig Alert Identification Number be Issued before a DRAWN BY: JUR 0 ISSUE FOR PERMIT 03/10/2014
` "Permit to Excavate" will be valid For your Dig Alert I.D. PROJ#: CAM 330 E HAMILTON AVE-BORE-METRO E
CALL TOLL FREE APPROVED:
CONSTRUCTION TYPE: BORE AND PLACE CONDUIT
CALIFORNIA DIVISION 48 HOURS BEFORE YOU DIG APPROVED:
BAY AREA PLANNING & ARCHITECTURE - PERMIT DEPT UNDERGROUND SERVICE ALERT SYSTEM: SANTA CLARA
3055 COMCAST PLACE.LIVERMORE,CALIFORNIA 94551 1-800-227-2600 APPROVED:
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CALIFORNIA DMSION V 48 HOURS BEFORE YOU DIG APPROVED: CONSTRUCTION TYPE: BORE AND PLACE CONDUIT
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CALL TOLL FREE APPROVED:
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CONSTRUCTION TYPE: BORE AND PLACE CONDUIT
CALIFORNIA DIVISION 48 HOURS BEFORE YOU DIG APPROVED:
BAY AREA PLANNING & ARCHITECTURE - PERMIT DEPT UNDERGROUND SERVICE ALERT SYSTEM: SANTA CLARA
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STORM WATER
PROTECTION PLAN
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SEDIMENT CONTROL BMP.PLACE BAGS PLACEMENT AT TYPE PLACEMENT AT TYPE NOTES
TIGHT AGAINST FACE OF CURB. B AND E DROP INLETS A, C, D, & F DROP INLETS I•s"ru"aE o o °w,„Qa,V,;,N
AND PARKING LOTS ACRES)
BACK OF CURB EXISTING OPEN 5 CH zF N ML TERPSS...SHALL BE MANUFACTURED
OPYLEE.NY
EXISTING DROP FROM ST R...SHA POLYPROPYLENE.0
BACK HOOD '�1I 111) 117. MIrQ1UX DETAIl.A Darr GRATE ParEsreR OR ETHnENE FAawc LMTHA
FACE OF CURB SEE NOTE 2 I DAM En
DETAIL A MOToa FOOT. EW�vA OPENING svE
CURB
UM ROW MTE OFtl
Cr •
GALLONSMINUTE/SO FT.
'L 3 THE FILTER BAG MAY BE SUSPENDED FROM
Y ' OR HELD W PLACE BY THE FASTING INLET
-� 1 1�� GRATE(OR OTHER APPROVED ME TH00).
MINIMUM ,�.1_ PROVIDING NO MODIFICATION OR DAINAGE
A.. .1.1)) FLOW 5 CX LznNL '`BACK OF .r. B.
I. FRAME,SHALL TEIIE mLET�wwTE sTulGi"ANoie
r/ a5° MINIMUM GRATE CONTACT CAUSED TO REST MORE THAN MAI 151
B B l(/ /) AT BACK AAfTIDSID�ET CONTACT, MIME THE INLET FRP.WEE DETAIL A)
S �, -�i J� (FLOOD ALL SIDE 4'eorrou oP THE RwxeT aox�T PROVO.THE
OUTLET PIPE IS UNOaSTLIIILTED
., i' LIP OF GUTTER wvmaM
--4
HAG DEPTH 5 HE antLOWS s.THE BAG OR s FRMHALL NOT BE eE SHAL TO L
I,�I-,�-�. :1..j"
l J CATCH
CEP)SHOW AT N FOR FLOOD RELEASE
DRAINAGE INLET
CUTLET PIPE 6 INLET FLTERBAOS SMALL OF INSPECTED
'eel- OUTLET PIPE WEEKLY SE AFTER ANDEACH MONTHLY RAINFALL CURING
t i .M WITH FILTER BAG HE WET SEASONANDYONL MONTHLY WRING HE
"'G� DETAIL A DRY SEASON,
000FosRE�ccu0000n0 SHALL000
nEncrim''�'''F EXISTING DROP LSXIMUM CM 5') BAGS SNnLLONBE PEPAIRE0OR REPI,AOEO A5E THIRD THE DEPTH OF THE 0
�rf NOTES: INLET GRAT SOON AS DAMAGE OCCURS
`..� I.)SEDIMENT TRAPPED UPSTREAM OF
lif s kV SEDIMENT CONTROLBMPSHALLBE INLET SEDIMENT
ji REMOVED WEEKLY AND PRIORTOA PLAN VIEW CONTROL
a, () RAINFALL EVENT. STORM DRAIN INLET
a pi) () 2.)PLACE BMP'S TIGHTLY TOGETHER AT FILTER B FILTER BAG
el- y.� JOINTS TO PREVENT OR MINIMIZE FRAME EXISTING DRIP
SEEPAGE AT JOINTS. (OPTIONAL) INLET FRAME
•
O O
�' e THIS IS AN COMCAST DOCUMENT, PROPRIETARY & CONFIDENTIAL 330 E HAMILTON AVE
, ��! - rgIMPORTANT NOTICE REV DESCRIPTION DATE
(/'� //'��� Cl DESIGN: STORM WATER PROTECTION PLAN
o V V1 v Section 4216/4217 of the Government Code requires a
C4Itit
i' Dig Alert Identification Number to be issued before a DRAWN BY: JUR 0 ISSUE FOR PERMIT 03/10/2014
"Permit to Excavate" will be valid For PRO) CAM-330 E HAMILTON AVE—BORE—METRO E
C) err/ I your Dig Alert I.D. PROVED: #
��'It •(�I CALL TOLL FREE
CALIFORNIA DIVISION v 4-8 HOURS BEFORE YOU DIG APPROVED: CONSTRUCTION TYPE: BORE AND PLACE CONDUIT
C1'.9 BAY AREA PLANNING & ARCHITECTURE — PERMIT DEPT UNDERGROUND SERVICE ALERT SYSTEM: SANTA CLARA
I (1/a 3055 COMCAST PLACE.LIVERMORE,CALIFORNIA 94551 1—BOO-227-26OO APPROVED:
jv� NODE: GNAG SHEET: 6 OF 7
Vi
a •
LEGEND
6H - 3
• Traffic Cone or Delineator DISTANCE BETWEEN SIGNS **
T Sign ROAD TYPE
Direction of Travel A B C
( Not a pavement marking )
URBAN (LOW SPEED)* 25MPH OR LESS 100 FEET 100 FEET 100 FEET
IqI Flashing Arrow Sign (Where Required)
Refer to Page 7 of Caltrans manual URBAN (Low SPEED)* MORE THAN 25 MPH TO 40 MPH 250 FEET 250 FEET 250 FEET
Type A, Type I , or Type II . URBAN (HIGH SPEED)* MORE THAN 40 MPH 350 FEET 350 FEET 350 FEET
Y High Level Warning Device (Flagtree) RURAL 500 FEET 500 FEET 500 FEET
EXPRESSWAY/FREEWAY 1,000 FEET 1,500 FEET 2,640 FEET
Barricade (For Excavation Only)
Refer to Page 12 of Caltrans manual
to select for Details on (**) THE COLUMN HEADINGS A, B, AND C ARE THE DIMENSIONS SHOWN IN FIGURES 6H-1 THROUGH 6H-46. THE A
Type I , Type If , or Type III . DIMENSION IS THE DISTANCE FROM THE TRANSITION OR POINT OF RESTRICTION TO THE FIRST SIGN. THE B
DIMENSION IS THE DISTANCE BETWEEN THE FIRST AND SECOND SIGNS. THE C DIMENSION IS THE DISTANCE BETWEEN
Flogger THE SECOND AND THIRD SIGNS. (THE "FIRST SIGN" IS THE SIGN IN A THREE-SIGN SERIES THAT IS CLOSEST TO
IMI
THE TTC ZONE. THE "THIRD SIGN" IS THE SIGN THAT IS FURTHEST UPSTREAM FROM THE TTC ZONE.)
NOTES:
—0 1. Contractor is responsible for clean up
C D 2. No Parking/Tow Away signs will be posted 48 hours in advance to clear 6 H — 4
cr -D work zone.
. 3. Use flag trees on all C-18/C-23 signs.
-• SPEED LIMIT(S) TAPER SPEED LIMIT(S) TAPER
D END
C) XI ROAD WORK LENGTH (L) LENGTH (L)
O G20-2 METERS FEET
60 km/h OR LESS L=WS' 40 MPH OR LESS L=WS'
IGHT THE 155 60
g n 0 ' ROAD RLANE ROADSHARE / L=WS 45 MPH OR MORE9 crj 7:I-- WORK L=WS
ROAD LANE 70 km/h OR MORE z
AHEAD CLOSED w16-1 CLOSED 1.6
~� W20-1 •H�DW20-5R W4-2 C30 (CA)
�sqq pi C' WHERE: L= TAPER LENGTH IN METERS (FEET)
BIKE LANE W=WIDTH OF OFFEST IN METERS (FEET)
Is CLOSED S=POSTED SPEED LIMIT, OR OFF-PEAK 85TH PERCENTILE SPEED PRIOR TO WORK
ri; AHEAD W9-3
izSTARTING, OR THE ANTICIPATED OPERATING SPEED IN KM/H (MPH)
0 ?
P c- CD
CD ' THIS IS AN COMCAST DOCUMENT, PROPRIETARY do CONFIDENTIAL
IMPORTANT NOTICE 330 E HAMILTON AVE
REV DESCRIPTION DATE
c c omcast CO] Government DESIGN: TRAFFIC CONTROL NOTES AND SIGNS
/ Section # 4216/4217 of the Code requires a 0 ISSUE FOR PERMIT 03/10TE
/2014
Dig Alert Identification Number to be Issued before a DRAWN BY: JUR
"Permit to Excavate" will be valid For your Dig Alert I.D. PROJ#: CAM-330 E HAMILTON AVE-BORE-METRO E
CALL TOLL FREE APPROVED: CONSTRUCTION TYPE: BORE AND PLACE CONDUIT
0 CALIFORNIA DIVISION HOURS BEFORE YOU DIG APPROVED:
BAY AREA PLANNING & ARCHITECTURE - PERMIT DEPT UNDERGROUND SERVICE ALERT SYSTEM: SANTA CLARA
P.
( 3055 COMCAST PLACE.LIVERMORE,CALIFORNIA 94551 1-800-227-2600 APPROVED:
NODE: GNAG SHEET: 7 OF 7
vl) z
•