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Permit No
CITY OF CAMPBELL ENCROACHMENT PERMIT
DEPT.OF PUBLIC WORKS 14 2013 (for working within the public X-Ref.File
70 North First Street JAN right-of-way) Application Date \ \y—\Th
Campbell,CA 95008 Application Expiration Date '1 -ly-
Ph. (408)866-2150 ;ufllC\NorcSkin1irll 5(u+edn 1 (5 13 APN
Fx. (408)376-0958 Permit Expiration Date I I(5'I Li-
APPLICATION-Application is hereby made fof-1,Public Works Permit in accordance with Campbell Municipal Code,Section 11.04. (Application expires in six
(6) months if the permit is n . c�):forCFSe is non-refundable)
A. Work Address or Tract o.:4 Z. 2013 ROSEMARY AVE W/O WINCHESTER BLVD
JAIL
Utility Trench Location: S Adm�I11Sti c.)Uii
B. Nature of Work: INSTALL NOVA RECLOSER 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: PG&E-RAMON CHAVEZ II Telephone: 559-347-5236
Address: 8 RIVER PARK PLACE EAST,FRESNO,CA 93720
E-Mail Address: RSCT@PGE.COM 24-HOUR EMERGENCY PHONE NUMBER: 18007435000
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 ges ari.' g out of the condition of any private improvements in the public right-of-way.
Accepted: 1� f' AtIviv 6,440g 11-
a /3
(Ap is t Permittee) (sign) Dat
(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 cuttinq.
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 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. Public Notification Requirements:
7.
SEE PUBLIC WORKS FEE SCHEDULE FOR CURRENT FEES AMOUNT RECEIPT NO.
PERMIT APPLICATION FEE $ 37o
PLAN CHECK DEPOSIT $
SECURITY FOR FAITHFUL PERFORMANCE/LABOR&MATERIALS S
CONSTRUCTION CASH DEPOSIT $
PLAN CHECK&INSPECTION FEE $ 17o
APPROVED FOR ISSUANCE I �5 113
For City Engineer ate
Permit Expires 12 Months After Date of Issuance
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 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. 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.
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 and approved prior to any lane closures.
7. 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.
8. 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.
9. Sawcut for all PCC or AC removals. All PCC removals shall be to the 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 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.
12. Compaction testing of subgrade,base rock,and asphalt concrete by Permittee is required unless otherwise stated by the City Engineer.
13. 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.
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 emeregencies 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.
21. Permimee 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.
/e/.,
Applicant Date:
Contractor (Print Name) Date:
J:\FORMS\Templates\Encroachment Permits\Encroachment Permit STATIC form2.pdf
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� h TO VERIFY THAT THIS IS THE MOST RECENT DRAWING, PLEASE CONTACT; F+�
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L��y �g u PG&E ESTIMATOR:RAMON CHAVEZ II Q
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SCALE: NO SCALE 't°!2.a8•75 /f /2,k'ir/-4 j _„ ,, •// -i PHONE:559-347-5023 CELL: 559-970-0283
LOADING: LIGHT WILLIAMS RD VICINITY SKETCH cn
I N S U L. D I S T: B Ec 4590 iaic THOMAS GUIDE: PAGE Z
NONCORROSION AREA "55'w c 0
PROJECT CONDITIONS STAMP 78v x 12 j
Type(a) of Work: ,.,
❑New Business
®PG&E Maintenance&Construction sw z Z/ 2 ,„�„� H-15-15 1I.1
Project Conditions: 3/, 7113OC 3j EL PATIO 1 109 • g
(]NONE APPARENT(s project design changes,contact NO .)22+ "' ROSEMARY AVE
❑CONDn1ONS APPLY: t\ EST: RAM0N CHAVEZ II
0 PERMITS ❑TALBOARD ❑OTHER JJ a PHONE: 347-5236
(lron,de additional Intormutian on II,.below)HAMILTON AVE PAGER: W
.N. THESE DRAWINGS ARE BASED ON F-1
at RSCT DEVELOPER PLANS DATED M+-1
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EST: RSCT CO:
ADE: LJPE EL PATIO 1109 FLISR
SUPV: KEH4 ROSEMARY 8c WINCHESTER BLVD N0TIF: 105593745
REP: C4CU OTHER:
PLNR: IRB4 SAN JOSE SHT: 3 OF 3 SHEETS
SCALE:NTS DAoi/2012 I PACIFIC GAS AND ELECTRIC COMPANY PM:30891239 REV.
All lane closures shall meet or exceed MUTCD specifications as well as conform to hours of work set forth by the
* City. All areas of work when encroaching upon sidewalk access OR pedestrian safety shall have a MUTCD
N W20-1
/ Z NOT TO SCALE standard sidewalk closure detour detail in place to ensure pedestrian and public safety.Pedestrian access or
detour will be maintained at all times in the event sidewalks must be closed,all paths of travel shall be similar to
48X96 TOWABLE ARROWBOARD = one that is closed.Pedestrian traffic shall at all times have a minimum 4 feet wide area of travel.All open
excavation areas shall be backfilled or trench plated prior to public usage.All closures set forth in this TCP are the
CD
W E �� •� • W20-5RTr minimum allowed on project,field conditions may change requiring further traffic safety devices or traffic control
persons to ensure safety of traveling public,pedestrians as well as work forces. All changes to ensure safety will
! i ! ' be made immediately to ensure a safe environment for all parties.All traffic control devices,vehicles and
fn R30 24X24"BARRICADE personnel must be suited for the purpose intended as well as meet or exceed all MUTCD specifications as well as
S W4-2RT` MOUNTED,PLACED ON City specifications.ED Safety Inc shall be onsite from start to finish of work to ensure all traffic devices and
co BOTH SIDES OF STREET closures meet or exceed MUTCD specifications&above requirements are met.All devices shall be removed
r-_, 20'APART 72HR PRIOR when no longer required.
IMPALA DR. TOW-AWAY I TO START OF WORK All flaggers shall be certified and all intersections shall be flagged when required as shown on plans.If work is
J done at night or encroaches on the hours of darkness all road work ahead signs shall have flashing a beacon,
— :n
ZONE light towers will be used for flaggers and work areas and all other MUTCD requirements shall be met or exceeded
as well.NOT TO SCALE-SPACING OF SIGNS,TAPER AND TANGENTS WILL BE SPACED AS PER TABLE
N
HAS SET FORTH AS GOVERNED BY TRAVEL SPEEDS.
O
Pavement delineation not exactly as appears in field but traffic plan will
28" 101b-',.:1 LANE still work as shown.All cones shall be 28"10 lb and shall not be placed
osE. further than 40'apart.All hours of work shall be dictated by the Cities
^a�
specified lane closure charts or as directed by the city inspector.Vehicle
WORK A R E , vv1 4LT W20 path of travel shall never be less than l2'in width.Closures and
excavation not to exceed what forces expect to excavate per the daily
ROSEMARY LN shift.Roadway shall not be opened until safe for public use.All open
trenches must be plated or backfilled prior to public usage.All areas of
ROSEMARY LN � ' excavation must have a valid USA dig tag with corresponding dig ticket
1 PLACED AT EACH W20-1 number,proof must be carried with the excavating forces at all times.All
\ traffic devices shall meet or exceed MUTCD.All signs shall be high
ROAD WORK" intensity night time reflective, 48"x48"roll up signs.All signs shall have a
�� SIGNS BEING USED minimum of 2,18"day time flags attached to sign stands during day time
^ hours and if applicable flashing 12",12v beacons for night time work.
X - )5 ROAD „ Sign stands shall be MUTCD compliant as well allowing for 18°to 7'
IGH L H°A� 8X48 W20-1 height for signs as well as spring equipped for windy conditions.
0 36X48" MPH MAX CONE SPACINGS
0 48x48 W4-2 RT Speed Min Taper TAPER TANGENT
z'20-1 I -- 25 125 25 50
SPEC AL RIG LA E 48X48" W20-5RT 30 180 30 60
AHEAD
WORK SHALL NOT EXCEED 12HRS CLEFT 35 245 35 71
80
CONE SPACING NOT TO EXCEED 20' 36X48" cos"E. 48X48" C30 45 40 40 90
ALL BUFFER ZONES SHALL BE A MIN OF 125'
MIN 12'CLEARANCE FOR TRAFFIC 48X48" W1-4 Owner ALL SIGN SPACINGS SHALL BEAMIN OF 125'
PEDESTRIAN AND BICYCLE ACCESS TO REMAIN OPEN AT ALL TIMES City Of San Jose
Pealed N.". Project Number
s°Erim_ Rosemary @ Winchester San Jose,California
FOR TCP QUESTIONS CALL. SHARE
RTHE OAD PG&E
ROBERT @ 209-200-3351 PG ED SAF SAFETY NC
1 ADDITIONAL TRAFFIC CONTROL PERSON TO MAINTAIN CLOSURE Pear Sheet Number We
ASSIST BICYCLE,PEDESTRIAN AND DRIVE WAY 209-333-0807 PS-1 6/13/2012
PM 30891239 MIN SIGN SPACING 125' TRAFFIC SHOULD NEED ARISE Premed By
ED SAFETY SERVICES,INC
HOURS OF WORK SHALL BE DETERMINED BY THE CITY OF SAN JOSE