95-269
CTY OF CAMPBELL
DFPI'. OF PUBUC WORKS
10 Nortb F"mt St.
CampbeD, CA 9SO(B
(a) 866-2150
ENCR.OAawBNT PERMIT
(for wortiD& witbiD tbe
public rilbt-d-way)
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Permit up- iD 12 IDOl. /?;led
!emUt No.
X-Rd. file
95-269
AppIic:atioD Date 11 / 2 7 / 9 5
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APPUCAnON - AppIic:atioD iI bereby IUdc for a Public Worb Permit iD aa:ordaDce with r.-.mpbdI MUDic:iJ-I Code, Secdoa lUM. (.Appll_tioe apireI
iD 6 moatbl if tbe permit iI DOt iIIuecl).
A. Wort Iddrca or trIl:t #
Utility tJeadllocatioD
240 First Street, 150' N/O Sunnyside
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B. Nahue 01 wort
Main Repair, 4x4 cut in asphalt
C. Attach four (4) copies 01 aD eqiDeend dmwiDi IIIowiDi tbe Iocatioa, atcDt ad dimeaIioaI 01 tbe wort. The dnnriac IbaIlIbow tbe JelatioD 01 the
~ wort to CIiItiDa IUrfac:e aad UDdCIpouDd imJM~ Wbca approved by tbe Cty &pacer, laid drawiD& bccomcIa put 01 tbiI permit.
D. AD wo!t IbaI1 COlIform to tbe Cty'1 GcaenI ~. Stadud COIIItIuctioIl PrcwiIiaaI aad Stadud CoIIItructioG Details for Public WOJb
CoaItructioa; tbe GeDcral Permit CcaditioGlliIted OIl tbe revene aide; ad tbe Special PrcwiIiaaI for tbiI permit, lilted below. Pai1ure to abide by
these COIlditioaI aad pnMIioaI may rault ill job lbut-dowD aad/or forfeiture 01 Faitbful PafOl'lDaDCe Sureties aad c:aab depoIitI. (See GeDcraI
Permit Oloditioall aad 2.) S~ 1..11 '-20 vJ ic.,k ~ 79-7[ffl, n
E. A DClIlIefuDdabIe applicatioD fee mUll --"'"'1 tbiI tlppIicltioa.. 1 q 7 y
NamcorAppIiI:aDt San Jose Water Company T~ 279-~
1221 So. Bascom Ave, San Jose, CA 95128
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II tbiI wo!t bciq doDe by tbe property oncr at their on raidcDcc?
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Complete aDd atucb Workers' Compe_tioD aDd CoDtDctor bfoImatioa forma.
The AppIicaat/Permittec bereby apecI by afIiziq their lipature to tbiI pcrmit to bold the Oty 01 Campbe1I, ita olficeJ'I, ..... ad ~ free, ute
aad barm1cII from any claim or demand for dIma&a raultiq from tbe wo!t ClMred by tbiI permit.
The AppIicaDt/Permiuee hereby ackDowIedp:I that they bro'e Jeacl aad UDdcIItaDd botb tbe froat aad bact or tbiI permit, and they will iDform tbeir
CIOIltrll:tor(S) 01 tbe iDformatiOD.
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Jane (emergency verbal)
(Applicut (Pamittec) print/lip
11/27/95
Date
NOTES: ALL WORK SHAll.. CONFORM WI1H nIB A1TAOIBD, APPROVED PlANS AND ALL APPUCABLE CAMPBEU. SI'ANDARD
DRAWINGS AND CONDmoNS.
nIB CONTRACI'OR MUSI' HAVE 11DS PERMIT AND APPROVED PLANS AT nIB SITE AND MUSI' NO'I1FY nIB PUBUC WORKS
DEPARTMENT AT LEASI'lWO DAYS BEFORE SI'AR11NG WORIC.
NO'I1CE MUSI' BE GIVEN TO PUBUC WORKS AT LEASI' 24 HOURS BEFORE RFSrAR11NG ANY WORIC.
PfLIO(C TO ~AoLFlLL,jNG aCll1l,f.Tlfi tV )
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SPEaALPROVlSIONS No//-':''I IAlJfrCTo~
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_1. Street IbaD DOt be opeD cut for UDdeJpouDd iIIItIDItioM NiDimum cuts may be allowed for ~ or cxploratioa boIcI. Such cutl must
be mecificaIJv atlDI'OV'ed bv the IDmector mior to cuttiD2.
PlMment may be cut for UDdeIpouDd iDltaUatioDl and mlllt be ft:Itored ill IIalOIdaDce with tbe Utility TIeDCb RatoratiOll Standard DnIwiDg.
Won: to be Itatecl by a IiccDled LaDcl SuIYeyor 01' 0viI EqiDeer aad two (2) copies 01 tbe cut IbeetllCll! to tbe Public Worb Department
before ItartiDg wort.
C';'G~ ~ -t-MuST ~ ~ ~1/(';/::~ eo~ f/1T~U;{) A1Iff&/ij~ V"u:r.J/,de tlr
4" X' ' ItUl MA/../IJ/ f :ili1 . ~j II.(.,. M ~ ~MN6.
SI'ANDARD
AMOUNI'
RFl""PJVI' NO.
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PERMITAPPUCAnONPEE SZ10.00 S~;-.o.. Q.
PLAN OIECIC. DEPOSrr ssoo.oo S
SURBI'Y FOR PMI'HPUL PERFORMANCE (1~ OP ENG. PSI'.) $
CASH DEPOSrr (4'% OF SURElY, S500 MIN) $
PLAN OIECIC. .t INSPECllON PEE (FIRSI' SQ.S3O,OOO 149&; S I J. 0 . .. II ~
Next $3O,~S80,OOO 109&; AmouDtat ~r than $8Q ~S200 mia) ) I
APPROVEDFORISSUANCE ~ ----4::- /~/~?f!5'
for Ci BqiDccr
h:PW PERMn'fRev.4,194 (lee OCher 1icIc)
USA phone (800) 642-2444 TICKET NO.
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O"CHAY,O"
CITY OF CAMPBELL
Public Works Department
FAX MEMO
DATE: March 28, 1996
TO: San Jose Water Co. -- Sandra Luczkowiak
FAX #: (408) 292-5812
FROM: Randy Westfall/Public Works Inspector
SUBJECT: Utility Cut Deficiency Report
PERMIT # D~J?ICIENCY.
...----------------..-------.
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95-269
240 First St., 150' n/o Sunnyside: The short section of
c&g was never replaced. Remove the c&g and chase the
void area, backfill and recompact, then replace the C&g.
Be sure to dowel into the existing concrete on either
end.
none yet The area the water valv 1n the center of
the street at the 1 10n of Phelps Ave. and Valley
Forge W 1n ing. I 't tell if the valve is
leaking or not, but there is wate the depression.
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Deficiency must be corrected within 10 days.. Work must be
performed under a current encroachment permit. Notify Public Works
prior to any work being done and for inspections, by 8:30 a.m. on
the day before work is to be done.
Telephone (408) 866-2165 Fax (408) 376-0958
70 North First Street. Campbell, California 95008.1423 . TEL 408.866.2150 . FAX 408.379.2572 . TOD 408.866.2790
NEW PW FAX #
Ann 1'11__ 1"0,.1"0.__
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CITY OF CAMPBELL
Public Works Department
FAX MEMO
DATE:
December I, 1995
TO:
San Jose Water Co.
Ken Ashford
FAX #: (408) 292-5812
FROM: Randy Westfall/Public Works Inspector
SUBJECT: Utility Cut Deficiency Report
PERMIT # DEFICIENCY
95-269 Work is located at 240 First St., 150' north of
Sunnyside. I called Jane as soon as I got the emergency
permit application to say that the material was still
saturated outside of the 4'x4' hole that was excavated
for this permit. I requested that she have you call me
to discuss the work prior to anything else being done,
and also reminded her that we were requiring slurry
backfill in that hole, as per normal specifications. I
now see that the hole has been backfilled with AB after
sitting open for a couple of days. This hole must be
backfilled with slurry as required prior to final
resurfacing. Addi tionally, the area adj acent to the
leaking service has sunk enough to have affected the curb
and gutter. The short section of C&G must be removed and
replaced, and the area behind it backfilled to the
correct grade.
Deficiency must be corrected within 10 days. Work must be
performed under a current encroachment permit. Notify Public Works
prior to any work being done and for inspections, by 8:30 a.m. on
the day before work is to be done.
Telephone (408) 866-2165 Fax (408) 376-0958
70 North First Street. Campbell, California 95008.1423 . TEL 408.866.2150 . FAX 408.379.2572 . mD 408.866.2790
CI'l'Y OF CAMPBELL
FIELD ENGINEER'S DAILY REPORT
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CITY OF CAMPBELL
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PROJECT NO. 9r: J-h
REPORT NO: J
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INSPECTOR: R. ~51fALL
FIELD ENGINEER'S DAILY REPORT
CONTRACTOR: 5"") 0f c
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