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ENC2009-00008~:ITY OF CAMPBELL ENCROACHMENT PERMIT rtnit No.~G,- "~~ ~Q~ O0 DEPT. OF PUBLIC WORKS (for working within the ~ -Ref. file 70 North First St. public right-of-wa ) Campbell, CA 95008 ~ ~ (408) 866-2150 Issued _ ( ~ Application Daze ~~ ,' Fax x(408) 376-0958 Pe it expires ' 12 months Applications fires in 6 months APPLICATION -Application is hereby made for a Public Works Pertmt in accordance wi- th Campbell Municipal Code, Section 11.04. ( 6 if the permit is not issued. Application Fee is non-rcfundableJ ~~~ V C V ~k-~c~t~4l / 1 I A. Work address or tract t! C~ :~' ~ iA+t ~tYl"ir ~ ~ • .. n ~~ ~l 1 ~~~Y ~~ ,~ ~u~~i~~ ~. /~ ~ /~ s L ~ ~- ~,' ~Z1 12 Utility trench location ~!n 5~" l71 ~;'Jvr(/~/1 /? rt' / {~ r .'_C' f'nJ{i'~C . ~~ r B. Nature of work _ ~ ~ ~ yt ?I (/ h "r- ~^' I}`) GZ"t t'~ - ~ i (7 t? t.Z.i U l~ _ ,,~.. ADMINISTRATION C. Attach four (4) copies of an rngineered plans showing the location and extent of the work, and four (4) copies of the prclit~tinary ~ngmeer um~ate of work plans shall show the relation of the proposed work to eziscing surface and underground improvements. When approved by [he City Engincer, said plan bccoms a part of this permit D. All work shall conform to the Ciry of Campbell Standazd Specifications and Details for Public Works Construction; the General Permit Conditions listed on the reverse side; and the Special Provisions far this permit, listed below. Failure to abide by these conditions and provisioru may result in job shut-down andlor forfeiture of Faithful Performance Sureties and cash deposia. (Sce Grnera! 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 STARING ~/ORK. NOTICE MUST BE GIVEN TO PUBLIC WORKS AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK. Name of Applican[ ~~ ~- t.- Telephone ~~~' f / ' ,i i 1- ~ r / ``__ (print name) Tr~ Address ~ ~~~~ W~ ~ ij ~' ~ yt ~ J ~_b~ ?4i H UR EMERGENCY TELEPHONE NO. "7 ~ - ~ 1-~ ~'.5 r 4 is this work being done by the property owner at their own residence) Yes ~ No The ApplicandPermitttx hereby agrees by affixing their sigttature to this permit to hold the City of Campbell, its officers, agents and employes free, safe aztd harmless from ny claim nr A.m_ d fir d~m~g.c r nlrino from L~:e wnr4 r .rryi h rE::c .r...i > v r __ _ -_ -.. .-~..~ ...b .. ... ..:tom-. n ..~ .... r_....... The ApplicanVPeratittce hereby acknowledge thaz they have read and understand both the from and back of this permit, and they will inform their contractor(s) of the information. ~^ ,; - f ~~ (~; ,.~-~ { Accepted ~~~~'``~ ~~~~'~~~ , ~~__ 11 ~l o ~C) ~~-. (sign) Date SPECIAL PROVISIONS _l. Streit shall notbe open cut for underground ihstallaziotts. #finirnum curs n~ be allowed for wrmeaiotts onczplorazion holes. Such curt may be specifically improved by the hupcctorprior to cutting. - _?. Pavemeru may be cut for underground installations and must br restored in accordance with the Utility Trench: Restoration Standard Details, Method 'A` Backfill, unless otherwise approved by [nspetxor. ; 3. Work to be staked by a licensed Land Surveyor or Civil Engineer and two (2) copies of the cut shcecs sent to the Public Works Departmn,r before stetting work. _4. Per Section 4215 of theGoverrtment Code this permit is noevalid for;ezcavaziotu-until Underground Servitx Alert.(USA) hoc been notified and the inquiry idrntifica[ion number has been ernered hereon. USA Phone:1=800-227-2600. USA TTCKET NO. 5. SEE PUBLIC WORKS FEE SCHEDULE FOR CURRENT FEES TYPE .AMOUNT RECEIPT NC. PERMIT APPLICATION FEE ~ TII-- S S P~ S ~' PLAN CHECK DEPOSIT S SECURITY FOR FAITHFUL PERFORMANCE/LABOR & MATERIALS S CONSTRUCTION CASH DEPOSIT - S PLAN CHECK & INSPECTION FEE ~ 2~p ,~ ~- ~ JZ 2, /°~ APPROVED FOR ISSUANCE for City Engineer Date rev ~~ ~~ ,,L~ t~ i L .''~ 4M~ f. ~~ :~ 3 I~ D 'I~ ''~ O m STA TE HIGHWAY /NON - STAT E ~ H I G H WAY (CIRCLE ONE) ~: yAMIL TON A ~E FOC ~ I F C N o A ,. N N o ~ _ ~ 10' N N ~ O A '- ~` (~ ~ ~ ~ ~ O ~ '~ ~-' EXCAVATE 4'x4' ~ 5' z G CUTOFF ~ ~1 TE . ' "' ©M A I N ~ ~ . -~._ ' ,~ r. .~ ~ o ~ #5 ~ ~ ~ ' ~~--J ~ , , N N O A 85' ~ ~ ~ - ~, ~ - _ ~~ N ' N V _ - ~ ~, O ~ N O A N ~ 'SIGNAL ED INTERSECTIONS i I i i --- - EST: CPH4 C0: GYC1 ADE TRAFFIC CONTROL S°~ I : 46 PCA ~ NOT1F: 1030053 $UPV: J R R A R I K H A L I D T A OTHER: R~: S S~ HEETS ~ PwR: 655 W. HAMILTON AVE ' PM REV sCALE: NONE onTE: 11 10 08 PACIFIC GAS AND ELECTRIC COMPANY .30633116 . Figure CSJ-1. Single Lane Closure -Right Lane T ~ ~ 1 _1 NIW .00£ ^, r H a ^ • ._ 000 ..~ Note:^See Table A for Sign, Cone Spacing, and Taper Lengths. REVIEWED (_ AS NOTED) BY: DATE: / _ / 20_ 150' MIN ~~, `~ ~~ C~ `~` 1 -rt--® PERMIT #: PROJECT INSPECTOR MAY MODIFY TRAFFIC CONTROL PLANS AS FIELD CONDITIONS DICTATE Typical Application 1 Figure CSJ-22. Sidewalk Closure l t t •: ~--~ 3a3N ssoaD ~~ 03sOlO N1VM301s F-~ . _H Note: aSee Table A for Sign, Cone Spacing, and Taper Lengths. REVIEWED ( AS NOTED) BY: DATE: / / 20 PERMIT #: PROJECT INSPECTOR MAY MODIFY TRAFFIC CONTROL PLANS AS FIELD CONDITIONS DICTATE H SIDEWALK CLOSED CRO~ •~ ,~ ~• l l t t Typical Application 22 -, ~.~ n .. ~ ~ r ~NERAL PERMIT CONDITIONS 1. A CONSTRUG'1,')i0N CASH DEPOSIT is required. Charges will be trade against this deposit if there is an emergency call-out, overtime inspection or when Ciry ordered barricading is required. Any such cosu in excess of the deposit will be billed to the Petmittee. 2. A,ONE-YEAR MAINT~IAIGQE TERIOyD AND SURETY are required. Such period will begin on date of written acceptance by the Ciry. 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 Ciry. 4. The Permittee MUST REQUEST IN WRITING a final inspection and acceptance of the work upon completion. Acceptance by the Ciry will be made in writing to the Permittee. ~ ~ 5. MAINTAIN safe pedestrian and vehicular crossings and free access to private driveways, bus stops, fire hydranu and wager valves. 6. A CONSTRUCTION TRAFFIQ CONTROL PLAN and a CONSTRUCTION SCHEDULE is required for all lane closures, detours and stteet closures. This plan must be REVIEWED and APPROVED prior to any lane closures. 7. The CONSTRUCTION TRAFFIC CONTROL PLAN shall conform with the Caltrans Manual of Traffic Controls for Construction and Mainrenance Work Zones, dated 1990, available at Caltrans. 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. OVERTIME INSPECTION PREMIUM will be charged against the cash deposit for inspection required ouuide the hours of 8:00 a.m. to 4:00 p.m. at the current overtime rate, minimum one hour charge. I1. 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. Adequate signing and lighted BARRICADING is required on the job site. Failure to provide such signing and bamcading 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 Pertnittee is REQUIRED unless otherwise stated by the Ciry 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 Pemrittee 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 agreemenu or contracts with the City and any other public agency. I8. This permit is NOT TRANSFERRABLE. Work must be performed by the Petmittee 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 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 Nonpoint Source Pollution Control Program. Applicant shall be responsible fqt ensuring that 211 those providing services under the applicant are aware of and understand all of the above conditions. /~.-~~l \`~ ~~ Applicant !~ t~ ~ ~>~ Date j:\forms\pwpenn2 6/96