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Home My WebLink AboutENC2014-00191 Prins Form CITY OF CAMPBELL . ENCROACHMENT PERMIT Permit No L—NC20IL+—O019j1 DEPT.OF PUBLIC WORKS - • (for working within the public X-Ref.File . 70 North First Street right-of-way) Application Date f 0-2- Campbell,CA 95008 Issued 1 f°I2�j I i l•j Application Expiration Date 4-22- l 5- Ph.(408)866-2150 . ' APN Fx. (408)376-0958 C . PerrtiitExpiration Date (6[2-3 I I✓ . APPLICATION-Application is hereby made fora 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_ 70.12/.14,111414-111404-die-• (2dfittpiaeii .' r i ' ` r1 ' Utility Trench Location: i • _�°e�yt/1 Sly`r{�c, -t f/V 01/4 -.._ �'� � . ._._....._._...._i B. Nature of Work: CA Wilt r! }}4 8 r 6.ellik/e_five-jdssit-elikff 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." Ali work shall'conform to the City of Campbell Standard Specifications and Details for Public Works Construction;the General Permit Cohdition 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 h�o/ur/s before restarting any work. • Name of Applicant s 'r 3b'� �� u11- ; Telephone:1....64(9!C:/.Z t�r�.-1 I2C' —•--.i �v rL r1 y� Address: • �,7Ve ‘Site-r;-40 .�FAI& , c..iNKjb-€ CA C cl&t"l.- _._ .. E-Mail Address: J Q, [j E_ ' E t •(o�L 4 24-HOUR EMERGENCY PHONE NUMBER: I Q�t 7Lt- t..,0 • .• Is this work being done by the property owners at their own residence? r YES NO • The Applicant/Permittee hereby agrees by affixing.their signature to this permit to hold the City of Campbe I,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.Appllcant/Permlitee 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 this p nit, property owner, or property owner's'successors, shall be . responsible for y and all damagCotOc1arrising out of tthe con ition o$any private rove is in the public right-of-way.Accepted: 1�C, ° . `O vi i -- - (Applicant Permtttcc) (sign) Date (Contractor) - (Print Name) Date SPECIAL PROVISIONS: 1. Street shall not be open art for underground installations. Minimum cuts •y 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-B00-227-2600. USA TICKET NO. _ _ S. Prior to any work,the property owner shall execute an Agreement for Private Improvements in the Public Right-of--Way,which shalt be recorded. • . 6. Public Notification Requirements: . 7.. SEE PUBLIC WOR S f- E SCHED AMOUNT -, 5 RECEIPT • PERMIT APPLICATION FEE PLAN CHECK DEPOSIT $SECURITY FOR FOR FAITHFUL PERFORMANCE/LABOR&MATERIALS $ - CONSTRUCTION CASH DEPOSIT - $ PLAN CHECK&INSPECTION FEE $ '3 8 5 a EMERGENCY PERMIT FEE $ V - APPROVED FOR ISSUANCE • t - ( C'/23/ / ' For City Engineer Date • GENERAL PERMIT CONDITIONS • I. .A Construction Cash Deposit is required,Charges wilt be made against this deposit if there is an emergency call-Out,overtime inspection o r 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 Caitrans.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'scorema rk 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 an 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.wt o;4:00 p.m. 15. No storage of materials or equipment wilf be allowed near the edge of pavement the traveled way,or ithin the ms h. which would create a hazardous condition to the public.. ' 10. , 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,nordoes 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. lithe 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 acontact name and phone number: Applic nt shall be responsible for ensuring that all those providing services under the applicant are aware and understand ail of the above conditions. o kilq., lD Z, -1 Applicant Date: Contractor (Print Name) • Date: • J:\FORMS\Templates\Encroachment Permits 1Encroachment Permit STATIC forrrr2.pdf • Rev.02/14 CALL811''-'' -, rik., le1��' "4�•. LEGEND P-' �- G Gas Pipe (Existing) SAFETY PL£IIG£ (4N L J 3'x3' Bell hole at depth 12" existing gas pipe /ALWAYS PUT SAFETY FIRST /Lli`Yl Hat AND ACT TB4, WTR Existing Water R£511Y£UNSAFE SITUATIUNS • C •811 811 -SWR Existing Sewer I HELP AND E77PAGE CALL TWO WORKING MRS TO ACT SAFELY DAYS BEFORE YOU DIG TICKET ND DATE' FOREMAN NOTES BY. - CUTOFF EXISTING 1"PL SERVICE AT THE MAIN a - HOUSE WILL BE DEMOLISHED - PG&E WILL PERFORM ALL WORK - EXCAVATION WILL BE IN DIRT BEHIND SIDEWALK - CAMPBELL PERMIT REQUIRED 3/4" u, ... 8' G CUTOFF 1 "PL SERVICE LC AT THE MAIN to N`` 764-1 PL-14 G � EFV CC L" 0 0 z -- N ♦ 60' � „ 3 4G G I 0, ---� 20' #764 or---- 2' iH C2C < I -- - 10' 0 _.._ A_ __------" ROLLED GUTTER ___J� ` U' DAVID DR . \ 3412-H5 ESTAE Craig Sunada CITY OF CAMPBELL PERMIT DRAWING SD DD SUPV: Man Davila CUTOFF 1 " PLASTIC SERVICE AT MAIN NOTIF: 109198582 REP: Robert Lopez OTHER: PLR: 764 ALMARIDA DRIVE, CAMPBELL SHT: 1 of 1 SHEETS , scale: DATE: PACIFIC GAS AND ELECTRIC COMPANY Pik REV. REV. 1"=30' 10-08-2014