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CITY OF CAMPBELL ENCROACHMENT PERMIT Permit No E'NI t C.)C- i�L
DEPT.OF PUBLIC WORKS _ (for working within the public X-Ref.File
70 North First Street - right-of-way) Application Date 7/I Cv (I`t
Campbell,CA 95008 7/) /1 I t. Application Expiration Date t I t V 115
Ph. (408)866-2150 Issued__ APN 3 G 7 4 2 c I
Fx. (408)376-0958 1 ' ti 1�1
4i Permit Expiration Date 7�I I'IS •
APPLICATION at Ion is hereby rilaildraM Public Works Permit In accordance with Campbell Municipal Code,Section 11.04. (Application expires in six
(6) months if the permit is,notfictkiOWication Fee is non-refundable.)
A. wc\irkAddress or Tract No.: 320 SAINT PAUL DR.
Utility Trench Location: NOT APPLICABLE
B. Nature of Work: DOWN GUY AND ANCHOR REPLACEMENT ON EXISTING POLE
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: SAXON CUMMINS Telephone: 559-347-5271
Address: 8 RIVER PARK PLACE EAST FRESNO,CA
E Mail Address: S5CR@PGE.COM 24-HOUR EMERGENCY PHONE NUMBER: 559-347-53OO
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 improvements in the public right-of-way.
Accepted: iN S tagy ✓Jxuv CU+a\Mt N rt'2 Pt.. -1/110/ (� _
(Applicant Permittee) (sign) Date
---- ------
(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 cuttin .
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.
6, Public Notification Requirements:
7.
SEE PUBLIC WORKS FEE SCHEDULE FOR CURRENT FEES AMOUNT RECEIPT Na..
PERMIT APPLICATION FEE $ 3 •, 5
PLAN CHECK DEPOSIT $
SECURITY FOR FAITHFUL PERFORMANCE/LABOR&MATERIALS $
CONSTRUCTION CASH DEPOSIT
PLAN CHECK&INSPECTION FEE $ 5
EMERGENCY PERMIT FEE S
APPROVED FOR ISSUANCE rV 7/( /I L
--
For For City Engineer Date
Permit Expires 12 Months After Date of Issuance
4%
SPRINGFIELD DR .
i
REPLACE ANCHOR ir
NEW DG 3/8" x EC Notification: 107165314
PG&E GPS: LAT:37.291336' Lon 121.969650'
ANCH. 7.5M D Long
:-121.969650'
23' K1
r T
115' I 115'
(,,P 2-4AR 3-397A 12KV
40' 45' CL-4 35'
PT17105-44 PT17105-45 PT17105-46
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I- i� � SSD: SWITCH 20087
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p 35'
70 PT17105-45• N
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a W. LATIMER AVE
rte, , Underground Service Alertic
50 ,_ DC
ce
—�, 315728129134 , Call: TOLL FREE
50' 12KV 81 1
TWO WORKING DAYS BEFORE YOU DIG c9
PROJECT CONDITIONS STAMP VICINITY MAP 12KV
Type(s) of Work:
❑New Business PLAT: H1513
X❑PG&E Maintenance & Construction SPRINGFIELD DR. SSD: SWITCH 20087
Project Conditions: CKT: EL PATIO 1116
Q NONE APPARENT (if project design changes, contact ADE) JOB SITE VOLT DIST.: CLASS 1
or cn H* _320_ INSL DIST: B
❑CONDITIONS APPLY:
D LOADING AREA: LIGHT
❑PERMITS ❑TAILBOARD ❑OTHER c
( below) r CORR AREA: N/A
Provide additional information on line m
W LATIMER AVE ARRESTOR DIST: 3
RAPTOR FRAMING: YES
By: Saxon Cummins 6/2/2014 FIRE AREA: LRA
SIGNATURE, NAME, [CORPORATE ID], DATE
EST: SAXON CURS 559-347-5271 DOWN GUY REPLACEMENT JP# -
ADE: ROBERTO ROD RODRIGUEZ 559-347-52833 REV: -
SUPV:KEN HENDRICKS 559-970-0283 320 ST. PAUL DR. SHT: 1 OF 1 SHEETS
REP: JESSE JENNER 831-784-3446 CAMPBELL, CA NOTIF: 107165314
PLNR: - - PM
SCALE: NTS DATE: 6/2/2014 PACIFIC GAS AND ELECTRIC COMPANY , ' 31054277