ENC2000-00101· CITY. OF CAMPBELL
DEPT. OF PUBLIC WORKS
70 North First St.
Campbell, CA 95008
(408) 866-2150
Fax (408) 376--0958
ENCROACHMENT PERMIT
(for working within the
public right-of-way)
Permit expires in
X-Ref. file
Application Date ((> ~ ~,~ '- OO
Application expires in 6 months
>y made for a Public Works Purnfit in acamrdance with Campbell Municipal Code, Sec. fion 11.04. (Ap~ic~x~n~jj~jllll~~lJ~ · -...~~'"'~' ~J~
APPLICATION- Application is here
if the permit is nol issued. Applicatk n Fee is non-refundable.)
C. Amach fora' (4) copie~ of an engin~red/plans showing the location and extem of the work, and four (4) copies of the pn:lim/nary Engineer', Estim of work. The
plans ,hall *how the rela.uon of the proposed work m existing surfac.~ and underground improvements. When approved by the City Engineer, said plan becom~ a part of
this permit. /
D. All work shall mnform to the City!of Campbell Standard Specific. afiova and Demits for Public Worka Construction; the General Permit Condkiom Ii*re, el on the reverse
side; and the Special Pmvision~ for th~ permit, listed below. Failure to abide by these conditions and provisions may result in job shut-down and/or forfeiture of Faithful
Peffo~ Sureties and c..a.sh deposit. (See General Permit Conditions I and 2.)
!
E. THE CONTRACTOR MUST HAyE THIS PEK.MIT 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.
Pacific Gas & Electric Company Telephone 408 725-ZZ~
Nan~ o£ Applicam
(palm name)
^adv=~10900 N. Blaneyi Cupertino 95014
I~ ~ work being done by the proper~ owner al their own residence? Yes No
The ApplicanU'Permkmc hereby agrees ~y affixing their signature to this permit to hold the City of Campbell, its officers,, agents and employees flee, safe and harmlu~ from
any claim or demand for damages resulting from the work covered by this permit.
Thc Appli~a~a~/Perminee hereby ackno+ledges thai they have read and understand bo~h the front and back of this permit, and they will inform their contraclor(s) of thc
i~o,,=i~. ~ ~ -- i -
SPECRA L PROVISIONS
1. Sa'ce~ shall not be open ~ ut for underground installations, Minimum cuts may be allowed for cormecfiom or exploration holes. Such;cw, z may be sl:~cificallv
approved by the Inspectc mot m cutting. :..:: ..... · :. :: ...: :'~:: ::.::i::'::':. .. . · · . .:...
¥/~'2. Pave. mere may be cut fm under,ground im~lafiom mad must be restor~ in acr~rdance with the Ufilit7 Trench Restoration Standard De~ils. Method 'A' Backfill.
unless ofl~er'uise approve d by Inspector. '. ' '.. ' .: . :'":..: . . ' . . · ' '
3. Wixk. tO be ~mked by a llcr..med La.nd Surveyor or Civil Engineer and t~to (2) r. opim of the cut. shee~ scm m the Public Wor~ 12~artme~ before sta~.ing wcrrk.
4. : Per Section 4215 of the (~ovemmera Code thiz permk is not valid for excavat~ns until Underground Service Alert (USA) has been noOfied and ff~e inquiry:
idemifz~.ion number has beea enmr~xl hereon.. USA Phon~ 1-800-227~2600. '. ::' USA. TICKET NO, ' ' '
5. '"' '3'-' .Y"..'5'. : ' . ' ' ;,'.' ....'-' :.:: '.i..:.:iJ':' i:> .:.:::'.: :' :~: :.:'"': 2'. i'.' ..::: :.:.:;:.'. 7':'.' :-..<':'' .'.. ' · ...... ·
SEE trB:rc Woms cun _
P~ APP~CA~ON ~E
~N ~CK DE~S~ ."
SEC~ FOR
CONS~U~ON CASH DE~S~
for C~ Eng~ .
':-: .' .. :.:. :' :: ..:...:: : ..: ..: .:::: :::..; '. :..:..: :.: ....
'AMOUNT:..:::: ...... -. RECEIPT NO.
l:tlorn'~ \pwpcrm2d rev.6i 96
ENERAL 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 Permirtee.
2. A ONE-YEAR MAINTENANCE PERIOD AND SURETY are required. Such period will begin on date of wriuen acceptance by the City.
3. REFUND of the cash deposit balance and refund or cancellation of the Faithful Performance Surety will Ix initiated by the wrinen acceptance of the
work by, the,City ~i ~
4. The Perm/nee MUST REQUEST LN WRYFING a final inspection and acceptance of the work upon completion. Acceptance by the City will be made
in w~i~ng ~ the Perminee.
5. MAINTAIN sale l;~destrian and vehicular crossings and free access to private driveways, bus stops, fu'e hydrants and water valves.
6..A CONSTRUCTION TRAFFIC CONTROL PLAN and a CONSTRUCTION SCHEDULE is required for all lane closures, detours and street closures.
This plan must be REVIE!~rED and APPROVED prior to any lane closures.
7. The CONSTRUCTION TRAFFIC CONTROL PLAN shall con. form with the Caltra. ns Manual of Traffic Controls for Construction and Maintenance
Work Zones, dated 1990, available at Call:rani. Traffic control equipment shall include Type II flashing arrow signs if required.
8. REPLACE IN KIND any damaged or removed existing improvements, including planting.
9. Sawcut for all PCC or AC removals. All PCC removals shall be to nearest scoremark and shall be doweled to existing improvements.
I0. OVERTI2vIE INSPECTION PREMIUM will be charged against the cash deposit for inspection required outside the hours of 8:00 a.m. to 4:00 p.m.
at the current overtime rate, minimum one hour charge.
I 1. SATURDAY INSPECTIONS must be arranged in advance. Saturday inspection time is charged at the current overtime rate with a three hour
minimum. Advance payment for the estimated time is required.
12. Ad~'fiate signing and lighted BARRICADING is required on the job site. Failure to provide such signing and barricading may result in the City's
renting such 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 Perm/nee is REQUIRED unless ~therwise stated by the City Engineer.
14. The Contractor or Permirtee will have a SUPERVISORY REPRESENTATIVE available for contact on the project at all times during construction.
Contractor or Permit'tee 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 pavementTthe traveled way. or within the shoulderline which would create
a ha:,,rdous 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 Perminee of any obligation to obtain any other permit required by law.
17. This permit does NOT RELEASE the Perminee from any liabilities contained in other agreements or contracts with the City and any other public,
agency.
18. TI:tis permit is NOT TRANSFERRABLE. Work must be performed by the Perm/nee or his designated agent or contractor as specified thereon.
19. 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
ocl:urrence.
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 Nonpoint Soume
Pollution Control Program.
Applicani shall be responsible,for ensuring that ali those providing services under the applicant are aware of and understand all of the above conditions.
Applic.a~n
t ~' ~ · ' Date
j:\forms\pw'perra2 6/96
PG&E Per,nit Sketch for: City of Campbell
Address: 1129 Audrey Ave.
Abandon Gas Service at Main
Nature of Work:
Surface: ASphalt Cut in Street
Excavation size: 4' x 4' x 4'
1102-1/2PU 97 ~