ENC2009-00033"fat, 4. 2i:~~:a9 S,>jRM ~'acific Ga; and Electric C~~, No, 3488 F'. 1
... ~ C ~~ enG~J ~" ~rwt l~ M
CZ'l~'Y t}N' t:AnzF'liELi. ENCROACT-TM)J1~T PERMIT Permit N~JV~ C 2 0~-''7 ~ ~ ~~
IIEPT. OF PUELIC WORKS (for wurlJng witlun rile public ~ }~-T~ef. File _
Ill North First St- right•of-way) ,3 ~ p~]
Campbell, CA 950(18 C~ AppliCaiion Date -!
(408) BG6-2150 lssucd ~ ( Application Expiration Date
Fax (408) 376-0958 ~ ~ .. ~~
Pernut Expiration Date ~ ~ u APN
APPLTC.ATIt7N - Applcation is hereby made for a Public Works Peri]tit ;n accordance. with Campbell Mm}icipaf Code, See[ion 11.04. (Application expires.in aiz (6)
months if the permit is oat issued. Application Fee/is nan-refundable,) `' 1 -
A. Work address or tract #~ ~ ~~ /. Ln7 a ~ ~ V ~ x j~ ~ ~~il{'Y~ ~~, 4~
Utility trench location ~ ~ ~ ~ ~ ~ { >n ~-n~, ~ ~{~t'Y~~ ~~ 1Q~/ ~~ Q 7
i;. Naturcofwork ,.~.~~,.-r.~(',pY1(~(,L~('~1 ~ P ~ f t_O [ J~~ ~W~ W'U~d Cl ~~
C. Much 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 wortc.~
plans shall show [he rela[ion of the proposed work to existing surface end underground improvements. 'When approved by rho City Engineer, said plan beco
part of this permit.
D. All work shall conform to [he City of C'ampbGt Standard Specifications ar~d Details far Public Works Cons¢uotiun; the General Permit Conditions listed th
reverse side; and the Special Provisions for this pemut, listed below. Failure to abide by these conditions and provisions may result in job shutdown and/or fort r
of Fsithflrl Performance Sureties and cash deposits. (See General Permit Candiuons 1 and 2.) '
E. 9"he Contractor must have this peinvt and approved plans at the site and must notify the Public Works Department at ]cast two day, bcforc slatting a+ork. Ndlr~
must be given to Fublic 1'i'orks at to/a~st ?tt hours heforo restarting any worY., ,
Name of Applicant ~ ~ ~ C _ ___ . Telephone - _.. ____
n (print name) ! ~ ~r
Address 1'i ,~ 1d z4.li0UR E1vIERGEN~C}Y TELEPHONE NO. ` ~ 2 ' Z Z T
E„MailAddress ~~t'rIZ ~ PG~~Cvr~ 1~IcaS~ I~GiX C'/J'Y~'+P1~~[~~~~'Mt-~ '~
Is this work tieing done by the property ovmers at their ovm residcnccY Yes )Vo r~~- 7 ~. ~ " ~ ~ ~ Z..
'The ApplicantlPermittce hcrchyagrees by affixing Ihe1r signature to this permit to hold the Cily of Campbell, its oFfrccrs, agents and employees free, safe and harmlrss
from any claim or demand for damages resulting from the work covered by this permit.
The ApplicandPermittee hereby acknowledges that they have read and understand both the front and back of this permit, and they will inform their contractor(sj of the
inforrnaGon, Applicant advised lost upon issuance of this permit, property o~mer, or property owner's successors, shalt be responsible for any and all damages
arising out of the can of any private improvements in the public right~of-way.
(Applicant Pcrmitlsc} (sign}
Contractor (Print Name)
~(~~
Data
Aatc
_I . Street shall not be open cu t for underground installations. Minirriurn cuts N~ be allowed for connections or e,tptnration holes. Such cuts may
pc spcci teal y sp ra.P !wed by the Inspector prior to cutting.
_Z. Pavcn-tcnt may be eu[ fur underground installations anfl must be restored in accordance wick the Standard Ddails Trench Restoration Method
"A", unless otherwise approved by Inspector.
_3. Work to be leaked by a licensed Land Surveyor ar Civil Engineer and two (2) copies of the cut sheers son[ to the Public Works Department
bcforc starting work.
_4, Per Section x}21 S of the Goveniment Code this permit is not valid for excavations until Underground Scrvicc Alert (USA) has been notified and
the inquiry identification number has been cntcrt;d hereon. USA Phooe 1-800-227-?600. T,1SA TICICL'T Np.
~,,,5. Prior to any work, the propcnyowner shall execute an Agreement for Private Improvements in the Publiu Right-oP-Way, which shall he
recorded.
_6. Fublic Notification Requirements: ~ _ __-
_7.
SEE PLISLIC WORKS SC:HBI7ULE FOR CURRENT 1 13I34 AMOUNT )ZP~~+~ NO,
PFIRNTTTAPPLICATIGNFEE ~ $ 3Zcj a
FLAN CFTECK DEPOSIT g u~.
SECURITY T'OR FATTH]~UI. PfiRFURMANCEJI.ABOR & MAT$RIAI.S ~ „
CGNSTRI.It'T1pN CAST-T DEPOSIT
PLAN CHECK & INSPECTION FEF.. $ (~ p - y~-
APPRO\rED FUR ISSUANCE ~~__ _ ~~ ~ cJ~
Pnr C_lty Engineer Date
Pernut Expires 12 Months After part of Tssuancc
f c
~1 r
C Z~' . ~ ~J
Z
g ~F
cv O Q
~ ~~
cs U ~
~ ..l z
m
~ d ~
Q
Mar. 4. 20~i~ ~ : ~4R~I ~a,~ i f i c (a and El r ct t i ~ Co. No. X488 r• 2
GENERAL PEP.MxT CCINbITT(lNS
1 • A Construction Cash Deposit is required- Charges will be made against this deposit if there is art emergency cal]-trot, overtime inspection or when City
ordered barricading is required. Auy such costs in excess of the deposit will be billed to the Perrttittee.
2. A one-year maintenance period and~surciy are required. Such period will begin on dstc of wriuen acceptance by the City.
3. Refund of !hc cash deposit baIancc and refund or cancellaHun of tlrc paithfLl Performance Surety will be initiated by the written acceptance of the work
by the Ciry.
4. The permitli a must rc~uest In wtiGng a frnat inspectiou and acceptance oP the wort: upon uumpletion. Acceptance by the City will be made in writing to
[hc Perrnittcc.
5. ~ Matntuin soft. pedestrian and vehieutar crossings and free access to private driveways, bus stops, fire hydrarus and water valves.
o. A Conslruc[ian Traffic Control PIan and s Construction Schedule are required for all lane closures, detours and street closures. This plan must be
rcvicwed and approved prior w eny lane closures.
y. The Construction Traffic Control PIan shall conform to the Csltrans Manual of'T~affic Controls for Construction and Maintenance Work Zones, dated
1990; available at Cattrans. 7}affic control equipment shall include Type ]Y tlashn4 arrow sip s if required.
8- Replace as directed by the City gngineer any damaged qr removed improvements in accordance with City Standards and Speeifrcations at the sale
expense of the Pcrrrnltee.
9. 5awcut for all PCC or AC removals. Al] PCC removals shat] be tv nearest scoremurk and shall be doweled to cxistiag 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 ovgtime talc.
11- Adequate signing and barricading is required on the job sitc• Failure to provide such signing and bamcadtng may result in the City's providing signing
and barricades and chargittp the cost (Ineludmo all labor and materials) against the cash deposit.
12. Compaction testing of subgrade, base rock, and asphalt concrete by Permi[[ee is rcyuired unless otherwise stated 6y the Ciry engineer.
is. The Contractor p; Pcralincc will have a supervisory representative available for contact on the project at alt times during construction- Contractor pr
Pcnnluec shall pmvidc a phone number at which Ihcy can be contacted outside the hours oP $:DD a.m. to 4:00 p.m.
14. No storage of materials or equipment will be allowed near the edge oP pavement, the traveled wuy, or wiihin the sboutderline which would create a
ha-rardous condition to the public.
15. This perm][ shall aot be construed as authorization for excavation and grading on private property adjacent to rho work or any other work for which a
separate porntit may be required, nor dpcs it relieve the permittec of any obligation k. obtain any other permit required by Iaw.
1 fl- This permit does not rolease the Permittcc from any liabilities contained in other agreements or contracts whh the Ciry sod any other public agency.
l7. 'This permit is not CransPerabte• Work must 6c performed by the Permittee or his desiansted agent ar contractor as spccjfied (hereon.
18- Call beck (call out) due to emergenciea rggarding this permit shall beat [he current overtime rate wish a three (3) hour minimum charge per occurrenco.
t 9. pursuant to Chapter t a.Q2 of the Camphctl Municipal Coda apphcant shall not cause to be discharged any material into tltc municipal storm drain system
other than storm water. Applicant shall adhere m the BLST MANAGBM~NT PI:ACTICES established by the Sams Clara Vatlcy Urban Runoff
Pollution Prevention Program,
2U. ]f the public interest requires a modification pP, dr a departure from, the plans and specifications, the City shall have the authority to require or approve
any modification or dcpariure and to specify the manner in which the same is to be made, for Cityowned or maintained facilities.
Zl, Perntittee must provide advance nop8cadon to all parties that may be affected by the permit activities. Notification shall bts rcvicwed by City prior to
'disuibution and include dates of work and a contact name and phone. number.
Applicant shat] be responsible fur ensuring that all those providing services under the applicant are aware of and understand all of the above conditions.
~~
(~ 6
Data.
Contractor (print Nsmc}
Date
Jlformslpwpetin
Rev. 11191175.