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HomeMy WebLinkAboutENC2014-00227 RECEIVED z I ( Print Form DEC 03 2014 Permit No•�) ad V -QQaa--1 CITY OF CAMPBELL ENCROACHME T PERMIT (for working within the public X-Ref.File____... - D� F461 11StfdtlOl l right-of-way) Application Date_........__1_-'I 3(14 70 North First Street j Campbell,CA 95008 r12l 3( Lt Application Expiration Date t.o k-L•s Ph. (408)866-2150 Issued.._. OOOO__OOOO 0000....___ APN LkO 3 v- .0 v3, Fx. (408)376-0958 2/ Permit Expiration Date III 3/,15 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.: 1 2)C5C)—' We. 5-kr 111Q1 t a C it,d(c7Hk-f-h\ike , . Utility Trench Location: 4 213 C---D 1 l _ 0000 B. Nature of Work: C15 to t± -k\trlt .6 a 1._.lt 3+t IPII ( C __.. C. Attach four(4)copies of an engineered plan showin the location a extent of thejrork,and four(4)copies oi the prel(mjjary 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 roust 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. t Name of Applicant S Telephone. /ft,s "'' Address: S L..... 7.5— _� ,�✓'_..L._ 1 E-Mail Address: 7 %i e c-'f c .m 24-HOUR EMERGENCY PHONE NUMBER: 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 Campb II,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 arisin 9ut of tnconditi n of y private improvements in the public right-of-way. Accepted:...... ,__. m 0000. _.� (Applicant Permittee) (sign) -. ��„0000__ .. . zazi±( " 1 — tw")i -._..,.._. y;t 0000................. (Contractor) (Print Name) (r/ �• (,ate ate SPECIAL PROVISIQN5: 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 aoorgved by the Inspector p.f.Cor._tg 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. 000.. 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:__^_ _-___.............._... 0000...—._,.- . 0000—7' — —0000.. _......._........._ SEE PUBLIC.WQ.RKS FEE SCHEDULE FOR CURRENT FEES AMOUNT RECEIPT NO. PERMIT APPLICATION FEE $_ -38r,.t-0000_ PLAN CHECK DEPOSIT 5.__.........__-_ _.........._.._ _._0000 SECURITY FOR FAITHFUL PERFORMANCE/LABOR&MATERIALS 5_ — CONSTRUCTION CASH DEPOSIT $ . 3 -- — PLAN CHECK&INSPECTION FEE $ EMERGENCY PERMIT FEE S_, —..............._. APPROVED FOR ISSUANCE 1 2/..,310 ' For City Engineer Date Permit Expires 12 Months After Date of Issuance A .UNERAL.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 Permlttee. 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 indude 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: Contractor (Print Name) Date: J:\FORMS\Templates\Encroachment Permits\Encroachment Permit STATIC form2.pd( Rev.02/14 Paving Tag . -181145 12/03/2014 11:16 City: CAMPBELL Contract ID: 570 Contractor: Coastal Paving (P) Originating Office: Reg 4 -DeAnza Contract#: 4400008934 Contact Info: Scotian, Linda (408)725-2033 Phone #: Tag Description: 1300 WESTMONT AVE Notes: FOREMAN: LLAMAS Project Title: Dt Approved for Payment: Days To Complete: 15 Submitted by: Dt To Contractor: Phone: Dt Work Finished: Permit#'s Dt Submitted: Dt Field Checked: PENDING Exp: Cnirctor ChangesD Location Item# Item Description #Units Order# A Change: Authorized By: 1 Address: Westmont 3025 16-Asphalt-6" SF:7 x 17= 42135296 Cross: 119.0000 Details:ASPHALT PAVING 6" 2 Address: Westmont 3140 73-Striping-8"Guide Lines LF:30 42135296 Cross: 3M"Scotch Lane"- Details:STRIPING 8" Summary by Item Total Unit Extended Item# item Description Units Price Price 3025 16-Asphalt-6" 119.0000 3140 73-Striping-8"Guide Lines 3M"Scotch Lane" 30.0000 Printed: Wednesday, December 03, 2014 11:16 AM Page 1 Region: Region 4- CENTRAL COAST i ' i +6 Pacific Gas and Permit Number. _, . Electric Company, Field Paving Form Permit Expiration Date: ._ Date: /Cp/-r7 _ w_ _. Street Address: /_16'0 U✓-rs-t—H.c,4. - q -' Foreman Name: Jct f L .w.2.5 Cross Street: C.r . e—Az a c.„ PM Number: "14735-t5'6. City/County: -.6 se / 0,,e ^_ Concrete W x L Depth Roadway inches Si=Jeweli __._inches Color:Y i N I Aggregate:Y f N J Decorative/Stamped:Y/N Sidewalk ,inches Color:Y/N I Aggregate:Y/N I Decorative/Stamped:Y I N Driveway inches Color:M I N I Aggregate:Y/N 1 Decorative/Stamped:Y/N Driveway _inches Color Y/N ; Aggregate:YIN ( DecorativelStamped:Y/N Curb Ramp Domes:Y/N Curb if Gutter.Y/N &f5 Z t t ,- Valley Gutter If ! i pew/Pc 'Ali Dowels ea Size:#4 I #5 Asphalt W x L Depth Adjust/Replace Asphalt 7 (o,_inches Manhole Frame ea Mill&Fill inches Sidewalk Gas Valve Box ea Asphalt/Concrete Combo �� over ' Secondary Electrical Box ea 13'x 24"(17°x 37124'x 36" — Grind ■� inches Valve Frame ea 15" 123" Asphalt Fabric Valve Cover ea 30"x 30"132"x 32 l 48"x 48" _ Asphalt Berm/Curb If Saw Cut Depth Other W x L Asphalt If inches Place Paver I Stone I Brick _[_ In Concrete:Y i N Concrete It inches Traffic Marker Dots ea Reflective:Y/N Seal W x L Plug 1 ''h Gas Prospect Hole 5/ ea Concrete I As alt Slurry/Fog I Sand Striping Width Notes Paint ao If inches Thermoplastic If inches Traffic Legend ea Double Center Lane if 3M'Scotch Lane' If 4"18`l 12.."Crosswalk 3 ;L ; y Q 'a 1,4,4131. ei✓-Q..., 3 . i- _toot 4t.ii 'LA Vt e 1 l t ©Cil 1 1 .»vaivw.mn:.. .....:... ,., ..w..r>.iumae.w_,,..— u.rmmm......"...w.in...... .......... .....:, / ,/ f P'aci'fic Gas and Date: PM No.: Electric Company LAN ID: PO No.: City/County: Tag No.: Field Paving Form Key:sir==Striping: Mill and Fill:cowc=Concrete;Ac=Asphalt;ricfcOAsc=Asphalt/Concrete,CR=Curb Ramp Location Size of Cut (LF) -_ (LF) House Paving Saw Curb/ No. Street Name Cross Street Type W L Depth Cut Gutter Notes •