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ENCROACHMENT PERMIT Permit No ' --NCtNC 20111-- 000 72
CITY OF CAMPBELL X-Ref.File
DEPT.OF PUBLIC WORKS (for working within the public
70 North First Street right-of-way) Application Date 4.- , March.2/,.20/p-
Campbell,CA 95008 Issued 3�2��( Application Expiration Date
Ph. (408)866-2150 — APN 249—44- 0/0
Fx. (408)376-0958 :j/14/Permit Expiration Date (S
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 or Tract No.: 665 Hawthorne Avenue. Campbell,California.
Utility Trench Location: Middle of the street along Poplar Avenue.
B. Nature of Work: Replace 14 feet of damaged 8"VCP mainline.Trench will be 14'long,3'wide,8'deep.
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.
Name of Applicant: Jorge Picado(West Valley Sanitation District) Telephone: (408)378-2407 ext 109
Address: 100 E.Sunnyoaks Avenue.Campbell,CA 95008.
E-Mail Address: jpicado@westvalleysan.org 24-HOUR EMERGENCY PHONE NUMBER: (408)828-1949
Is this work being done by the property owners at their own residence? r YES r 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 the condition of any private im rovements fAtzee,
in the public right-of-way.
Accepted: f rte Picado (wai Voll San' M;.i Asar/c-f i iic`Tsc 'alg1, "Ialch .2//Am-
(ApplicarPermittee) (sign) Date
Paak Uric/Qrgrrovrit/ Consa<rac-liar Bil/ Marrow -rri , March a/1 20/¢
(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.
V2. 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.
6. Public Notification Requirements: -
7.
SEE PUBLIC WORKS FEE SCHEDULE FOR CURRENT FEES AMOUNT '377
RECEIPINO.
PERMIT APPLICATION FEE $ (+L�
PLAN CHECK DEPOSIT $
SECURITY FOR FAITHFUL PERFORMANCE/LABOR&MATERIALS $
CONSTRUCTION CASH DEPOSIT $_ /�
PLAN CHECK&INSPECTION FEE $_ _ 31 7Cl.,
EMERGENCY PERMIT FEE S. _--
'3/ 211/19
"� �--
APPROVED FOR ISSUANCE _ _
For City Engineer Date
Permit Expires 12 Months After Date of Issuance
GENERAL PERMIT CONDITIONS
1. 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.
S. 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.
—rw9e Picrrdo an behalf a 41/441 Panay sanikehim l�isr(h _ 74( , Havr/)2/,�D/¢
Applicant Date:
2111 A4.rrro() r)t beha/lof ,Pacr i (Meleuroimo( Cols7F✓ctio2 `�"'d1, Hayek .21, P0/4-
Contractor (Print Name) Date:
J:\FORMS\Templates\Encroachment Permits\Encroachment Permit STATIC form2.pdf
Rev.02/14
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EGEND ' i r`Y , ;. _ 4-1O 22
ewer Structures _+ 7- 4 ` I •
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� ! Outside Drop MH > , n s rP' 4'4 f ..677 c �.i1M' +"a ;" r--$3,0,g-C: ..0", '-'
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�1',, � ,,,,, , F 0 Location No. 3: Re lace the last
�� i 14 feet of 8"VCP mainline next to the • ' '
�� 0 A• ' downstream manhole. Chip and hammer
kp �'� r; ,� • 4-10''F-08� the base to insert new pipe. Restore
`w.' ',' '5 tit :�` the bench and channel of manhole
0RTH � � f x ° !
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1414430 West Valley '� - .: gl
Sanitation District HAUVT�HORNE AVrE 6VCP , `
in
300' ,. s� �h ' v �,�` .=�'
nnotatipn , .T� k, ro., N �• s ..
Legend
(Manhole 014 04 w '
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6a8 1> 2 ) a West Valley S
`°ep`h' ' , �'o Fiscal Year 2013-20et-A :
Ule Z�CQi / , f t /,' QD ` a:X: ` Work Order No. 1(
1 IstszoN --Ihr MiI'n fmm ` ,),
kve the D/S M11] o �
i .� f , !. Local
�IDwhl—►�5p5 � — e'
''°""' '' '• 14. '� Poplar Avenue. Can
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eery , i4-�_,,, ., i'.'. "vi'`r' 1. „t .• 4 -.
POPLAR AVENUE
Work Order No. 16. `Location No. 3
PIPE SEGMENT: Between upstream manhole 409 and
downstream manhole 4-104-08-104-
PIPE LOCATION: Campbell, California.
PIPE DESCRIPTION:
• 8" Vitrified Clay Mainline
• 8 feet deep
• 32 feet long
• Moderate traffic area
PROBLEMS:
1. This line carries high flow.
2. Longitudinal crack on 12 o'clock side of the pipe starting 16 feet from
the upstream manhole. This is a continuous defect.
3. Longitudinal cracks extend to the upstream manhole.
4. Severely broken pipe located 27.1 feet from the upstream manhole.
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REQUESTED REPAIRS:
1. Perform a 14 feet long point repair. Start the repair 16 feet and end at
the downstream manhole.
Repairs to be compensated with bid item #8 and 8A of the repair
contract.
Call District inspector 30 minutes before the damaged pipe is removed,
so inspector can determine if point repair needs to be extended. Chip and
hammer the base of the downstream manhole to insert the new pipe. Restore
the base and channel of the manhole with high strength concrete.
Since this pipe carries high flow, by-pass pumping is required. Use only clay
pipe and 8" clay to clay flex-seal adjustable repair couplings with ARC
stainless steel shear rings. Place 3/4" crushed rock as pipe bedding and 6
inches around the new pipe. Backfill the rest of the trench with material
approved by encroachment permit.
Note: Footages and distances of the locations of the repairs are
approximate. Contractor is responsible for locating the exact
location of the repairs.
ivietroScan/Santa Clara (CA) ,(
Owner : Henry Scott K Parcel :279 44 010
CoOwner Bldg Id : 1
Site :665 Hawthorne Ave Campbell 95008 Land :$225,288
Mail :665 Hawthorne Ave Campbell Ca 95008 Struct : $91,729
Xfered : 07/21/1995 Doc# : 12954170 Other •
Price :$235,000 Full Deed :Grant Deed Total :$317,017
LoanAmt :$188,000 Loan :Conventional %Imprvd :29
Lender : Miscellaneous Fin %Owned : 100
VestTyp : Single Person IntTy : Adjustable Exempt •
LandUse :01 Res,Single Family Residence Type •
Zoning : R-1-6 Res Single Family Residence TaxArea : 10025
SubPlat : Los Palos 13-14 Tax :$4,389.58
Legal MLS Area : 15
Census : Tract : 5065.02 Block :2 Phone
MapGrid : 853 F5 Owner •
Total Rms : 8 Bldg SF : 1,700 Units Year Built : 1946
Bedrooms :3 Lot SF : 11,421 Patio :No EffearBlt : 1946
Bathrooms : 1.00 Useable SF : 11,421 Porch :Yes Garage Sp :2
Stories : 1 Lot Acres : .26 Elevator Garage SF :420
Dining Rm : I Lot Dimen :81 X 141 Lease SF Bldg Cond :5.0
Family Rm : I Pool :No Office SF Bldg Class :5.0
Rec Room : Fireplace :Yes Sprinkler Bldg Shape :U-Shape
CntlHt/AC : Heat Pump
0<<ICE 00 COUNTY ASSESSOR CLARA COUNTY. CALIFORNIA
ROOT( PACO
279 44
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Information compiled front various sources. CoreLogic makes no representations
or warranties as to the accuracy or completeness of information contained in this report.