HomeMy WebLinkAboutENC2013-00002 CITY OF CAMPBELL ENCROACHMENT PERMIT nit No E ce. \3 0 00 �--
DEPT.OF PUBLIC WORKS (for working within the public X-Ref.File
70 North First St • right-of-way) I
Campbell,%� �►Fr.l�, E.- .� I Application Date l -2g `1,- \ I\3
(408)866-213 13 Issued '1 I Application Expiration Date
Fax(408)376-0911\14 Q 2 2® l I
H Permit Expiration Date / 3)l It APN T 7`j Z'7 o(c'Lk
APPLICATION 1' erg tlatlfi
T p�,�� made for a Public Works Permit in accordance with Campbell Municipal Cade,Section 11114. (Application expires in
six(6)montistlt'the ermit is note issued. Application Fee l 1iss non-refundable.)
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A.Work address orl�traLn 1O-! E. 4 a rn I f'f�'7 1 V& F 6)3 �o f S LL41-e-•
- Utility trench location 4' 5 1-Y)at- to I o 0+I) -4-X 4/ 141-) C(rnori /7L.Gf (�OCuJe.s-6-.7.9B.Nature of work nick_I vi re-10C-t-I r CP-4-a-5)
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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 learnt 24 hours before restarting any work. r
Name of Applicari th. Joy �.e..2�c eCo Telephone)76S '.D 7q 78-6 7
(pri t nom )1 �+� I p
Address/ID le) ,-7-711.1 1�7 dl- h'7 C O9' t c��I�14-HOl1R•EMERGENCY TELEPHONE NO.
E-Mail Address
Is this work being done by the property owners at their own residence? Yes 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 thisperrnit, 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. • •
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•Accepted ( 3P/Y1 Jose_ !/l.l ao Ki. -r r) cJ l)1 i i .v •
i 2 2 -12
(Applicant Permittce (sign) - Date
• -Olk-- (.:& /r-.3 '—/,)---.)
Contractor (Print Name) Data
' SPECIAL PROVISIONS \✓ '
_l. Street shall not be open cut for underground installations. Minimum cuts xony be allowed for connections or exploration holes. Such cuts may
be specifically approved by the Inspector prior to cutting.
_2. Pavement maybe cut for underground installations and must be restored in accordance with the Utility Restoration Standard Details Method
"A"Backfill,unless otherwise approved by Inspector.
_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 4215 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. .
SEE PUBLIC WORKS FEE SCHEDULE FOR CURRENT FEES AMOUNT RECEIPT NO.
PERMIT APPLICATION FEE $ 370 _0.
PLAN CHECK DEPOSIT.. $
SECURITY FOR FAITHFUL PERFORMANCE/LABOR&MATERIALS $
CONSTRUCTION CASH DEPOSIT
PLAN CHECK&INSPECTION FEE s 70 .
AYYRUV EU 1•Uk ISSUANCE f/1,J 3
For City Engineer Date
Permit Expires 12 Months After Date of Issuance '
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Revised 12.27.04 ..
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 of-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. The Penni ttee 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. .
5. Maintain safe pedestrian and vehicular crossings and free access to private driveways,bus stops,fire hydrants and water valves.
6. A Construction Traffic Control Plan and a Construction Schedule are required for all lane closures,detours and street closures. This plan must be
reviewed nod approved prior to any lane closures.
7. The 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 11 flashing arrow signs if required.
S. 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 Permitter. •
9. Sawcut for all PCC or AC removals. All PCC removals shall be to•nearest scoremark and shall be doweled to existing improvements.
10. 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.
11. Adequate signing and barricading is required on the jab site. Failure to provide such signing and barricading may result in the City's pruc'id?cg
signing and barricades and charging the cost(including all labor and materials)against the cash deposit.
12. Compaction Testing of subgrade,base rock,and asphalt concrete by Pennittee is required unless otherwise stated by the City Engineer.
13. The Contractor or Perinittee will have•n supervisory representative available for contact on the project at all times during construction.
Contractor or Pennittee shall provide a phone number at which they can he contacted outside the hours of 8:00 a.m.to 4:00 p.m.
14. 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.
15. 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.
16. This permit does not release the Permittee from any liabilities contained in other agreements or contracts with the City and any other public
agency.
17. This permit is not transferable. Work must be performed by the Permittee or his designated agent or contractor as specified thereon,
18. Call back(call out)due to.emergencies regarding this permit shall be at the current overtime rate with a three(3)hour minimum charge per
occurrence.
19. 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.
20. 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.
-Applicant shall be responsible for ensuring that all those providing services under the applicant are aware of and understand all of the above conditions.
CSit)1 KJOS'e LaaeA
4)1A-1-'&ii JO II tbk
Applicant Date .
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Contractor (Fri Name) •Date
J:\forms\pwperm _
Revised 12.27.00. . •