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CITY OF CAMPBELL ENCROACHMENT PERMIT Permit No F,,�C ac 1 QQ\CAS
DEPT.OF PUBLIC WORKS (for working within the public X-Ref.File
70 North First Street right-of-way) Application Date Al!psi 1.3, .20/
Campbell,CA 95008 ` /4--O,2,
a Application Expiration Date I U.61Ph. (408)866-2150 Issued_ _�_�� 1 APN 4.O -I4-O2,
Fx. (408)376-0958
Permit Expiration Date
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.: 1173 W.Campbell Avenue.Campbell,CA 95008
Utility Trench Location: Middle of the street.6 feet long,3 feet wide,and 8 feet deep trench.
B. Nature of Work: Emergency repair on damaged 4"Vitrified Clay Pipe sewer lateral.
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)385-3009
Address: 100 E.Sunnyoaks Avenue.Campbell,CA 95008
E-Mail Address: jpicado@westvalleysan.org 24-HOUR EMERGENCY PHONE NUMBER: (408)378-2407
Is this work being done by the property owners at their own residence? r YES rg 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: A/ado (On Atha of 1041 14"S4Mtah'an Di, rict). Arsf /3, 2a/4-
(Applicant Permittee) (sign) Date
Bill *way ( Pgci 'c Underond Coosirvc k4). Auqus f 13,2-01-
(Contractor) (Print Name) itiate
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.
6. Public Notification Requirements:
7.
SEE PUBLIC WORKS FEE SCHEDULE FOR CURRENT FEES AMOUNT RECEIPT NO.
PERMIT APPLICATION FEE $
PLAN CHECK DEPOSIT
SECURITY FOR FAITHFUL PERFORMANCE/LABOR&MATERIALS
CONSTRUCTION CASH DEPOSIT O
PLAN CHECK&INSPECTION FEE $
EMERGENCY PERMIT FEE
APPROVED FOR ISSUANCE
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 beat 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.
T 9e Pleado (On 1acha/ of wti1 V4/Icy San/s'o'on District). /119, 1- /3,,2o/4
Applicant G Date:
BO fliira ' ( &egc Undeero.nd Conslivc#o Ayv5�/3, 2o1
Contractor (Print Name) Date:
1:\FORMS\Templates\Encroachment Permits\Encroachment Permit STATIC form2.pdf
Rev.02/14
West Valley Sanitation District
2014-2015 Sanitary Sewer Repairs
WORK ORDER
WO No. 3
Issued To: Pacific Underground Inc. Issue Date: August 13, 2014
Issued By: West Valley Sanitation District
Type and Location of Repair: ❑ Main 0 Lateral ❑ Both ❑ Other
1173 Hacienda Avenue. Campbell, CA 95008
Street Address/City
(Provide scope of work and map(s) for work ordered.
If multiple locations or routine repair, attach list)
Callout Urgency: ❑ High Emergency (4 Hr. response)
WI Emergency (24 Hr. response)
❑ Urgent (96 Hr. response)
❑ Routine (14 calendar days)
WO Issued By: Alan Kern Time Issued: 3:00 p.m. August 11, 2014
WO Issued To: Bill Marrow Time/Date On-site:
Was Contractor's arrival time on-site within required response? ❑ Yes ❑ No
Basis for Reimbursement: (Show calculation for each repair location)
Replace 6 feet of the damaged 4" diameter sewer lateral of 1173 Hacienda Avenue, in City of
Campbell. Start the repair 35 feet and end 41 feet in front of the cleanout. Extend the repair if needed.
The lateral is there 8 feet deep. Use 4" Clay pipe and 4" clay to clay Flex-Seal adjustable repair
couplings with ARC stainless steel shear rings. Once the trench is open, allow District inspector to
clean the line with water. District inspector will then televise the lateral to see if the repair needs to be
extended. Place 3/4" crushed rock as pipe bedding 6 inches under and around the new pipe. Backfill
the rest of the trench with material approved by encroachment permit. Replace street asphalt. The
repairs will be compensated under items # 8 (Repair on moderate Traffic Street). Extended repairs
will be compensated under items # 8A.
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illetroScan/Santa Clara (CA)
Owner :Aragon Steven& Kimberley Parcel :406 14 021
CoOwner Bldg Id : 1
Site : 1173 W Hacienda Ave Campbell 95008 Land : $643,731
Mail : 1173 W Hacienda Ave Campbell Ca 95008 Struct : $214,665
Xfered :08/21/2007 Doc# : 19557380 Other .
Price :$805,000 Full Deed :Grant Deed Total : $858,396
LoanAmt :$555,000 Loan :Conventional %Imprvd :25
Lender :Wells Fargo Bk %Owned : 100
VestTyp : Married Persons IntTy : Adjustable Exempt :$7,000
LandUse :01 Res,Single Family Residence Type : Homeowners
Zoning : R-l-8 TaxArea : 10005
SubPlat :Hacienda Heights Twnhms 13-14 Tax :$10,573.48
Legal :HACIENDA VILLAGE MAP B 1873 MLS Area : 15
Census : Tract : 5067.02 Block :2 Phone
MapGrid : 873 B I Owner
Total Rms :7 Bldg SF : 1,712 Units Year Built : 1953
Bedrooms :2 Lot SF :9,600 Patio :No EffYearBlt : 1953
Bathrooms :2.00 Useable SF :9,600 Porch :Yes Garage Sp :2
Stories : 1 Lot Acres :.22 Elevator Garage SF :490
Dining Rm : 1 Lot Dimen :60X 160 Lease SF Bldg Cond :6.0
Family Rm : 1 Pool :Yes Office SF Bldg Class :6.0
Rec Room : Fireplace Sprinkler Bldg Shape : L-Shape
CntlHt/AC :None
OFFICE OF COUNTY ASSESSOR SANTO CLARA COUNTY. CALIFORNIA
BOOK PACE
406 14
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Information compiled from various sources. CoreLogic makes no representations
or warranties as to the accuracy or completeness of information contained in this report.