ENC2009-00047CITY OF CAMPBELL
DEPT. OF PUBLIC WORKS
70 North First St.
Campbell, CA 95008
(408) 866-2150
Fax X408) 376-0958
~ROACHMENT PERMIT
(for working within the public
right-of-way)
Issued 3/30 /D
Permit Expiration Date 30 !(7
Pet Jo ~rv~. 2b0~- l7~-[' /
X-Ref. File /
Application Date ~~~~ lb
Applicat'io`rn Exp//iration Date ~ 1 O
APN "'C" fl~0-~ 3 "
APPLICATION -Application is hereby made for a Public Works Permit in accordance with Campbell Municipal Code, Section 11.04. (Application expires in six (6)
months if the permit is not issued. ApQpli~cjat~ifon Fee is non-refundable.)
A. Work address or tract # (~ O C~ TD R ~ ~~ ~LA~'
Utility trench location___ 'T rsT'~'~ _ /-
B. Nature of work C~~~~g „ war l !~ ~ >~ Cli87~Y_ ln.Q~`'•
in R-O.c~.
Attach four (4) copies of an engineered plan showing 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 2J
E. The Contractor must have this permit and approved plans at the site and must notify the Public Works Department at leas[ two days before starting work. Notice
must be given to Public Works~(a[ leas[ 24 hours b/efore restarting any work. //''``~~
Name of Applicant ~\ ~ L ~ ! ~..2 ~~~ ~6N•f~~ Telephone
l ~~ ~ ~A ~ V not name) a _~`
Address , ~• `T• -1 `~ 4-HOUR EMERGENCY TELEPHONE NO.
E-Mail Address
Is this work being done by the property owners at their own residence? Yes /~ No
The ApplicanUPermittee 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 ApplicanUPermittee 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, ~ 11 be responsible for any and all damages
arising out of the condition of any private imp~~r/ovements in the public rignh~t-of-way r~
Accepted ..~ r~Z~ ~' - 0 t"•'~~ -5~ p~
(Applicant Permittee) (sign) Date
pJ~-LG' ~1JSTQI~C'?i[~t~ 3/'3~/b
Contractor
Date
SPECIAL PROVISIONS
_1. Street shall not be open cut for underground installations. Minimum cuts ~ be allowed for connections or exploration holes. Such cuts may
be specifically approved by the Inspector prior to cutting.
_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 Inspector.
_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 Phoue 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 N0.
PERMIT APPLICATION FEE $ 2fQb•~
PLAN CHECK DEPOSIT $
SECURITY FOR FAITHFUL PERFORMANCE/LABOR & MATERIALS $
CONSTRUCTION CASH DEPOSIT $
PLAN CHECK & INSPECTION FEE /~j,~ $
APPROVED FOR ISSUANCE ~~~ "v"im--~' 3t1 ~
For City Engineer Da e
Permit Expires 12 Months After Date of Issuance
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GENERAL PERMIT CONDITIONS
I. 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 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 City.
4. The Permittee must request in writing a fnal inspection and accep~ance 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 al] lane closures, detours and street closures. This plan must be
reviewed and approved prior to any lane closures.
7. The 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 nearest scoremark and shall be doweled to existing improvements.
]0. 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.
7 6. 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 emergencies regarding this permit shall beat 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. Permittee must provide advance notification to all parties that may be affected by the permit activities. Notification shall be reviewed by 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 of and understand all of [he above conditions.
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CITY of CAMPBELL
Public Works Department
July 9, 2009
Peter Ha
1504 W. San Tomas Aquino Road
Campbell, CA 95008
SUBJECT: PERMIT NO. ENC2009-00057
LOCATION: 1504 W. San Tomas Aquino Road, Campbell, CA
FINAL INSPECTION AND ACCEPTANCE
Dear Mr. Ha:
The City of Campbell has made a final inspection of subject Public Works improvements and
finds the work to be acceptable and in conformance with City standards. Accordingly, the City
Engineer accepts the improvements.
The one year maintenance period stated in the permit begins as of the date of this acceptance
letter. The permittee is responsible for the repair and/or replacement of any defective work or
failures that occur within one year. The City will inspect the improvements within one year
and notify you, in writing, whether or not any repairs are required.
Your cash deposit of $2,000.00, plus any interest due, is now being processed and will be sent
to you under separate cover.
If you have any questions, please call me at (408) 866-2165
Sincerely,
Syed Wahidi
Public Works Inspector
' i~MQ
cc: Suspense - 11 months
Permit #ENC2009-00057
Inspector File
h:Aword\permits\2009_57 final ins_accpt ltr (jd)
70 [~lorrh First Srreer Campbell, California 95008-1423 rFi 408.866.2150 rnx 408.376.0958 rn~ 408.866.2790
Ref undnble Deposit Check Request
To: Finance Director
Check Payable To:
Address -Line 1:
Line 2:
City:
Description:
Account Number:
Account Number:
Account Number:
(Finance Dept ady)
Total Payable:
Purpose:
Peter Ha
1504 W. San Tomas Aquino Road
Campbell State: CA
Refund Deposit
101.2203
101.540.7448
Interest Earned
Zip: 95008
Amount: $2,000.00
Amount:
Amount:
(Finance Dep[only)
(Exact Amount)
Refund Faithful Performance Security Deposit on 1504 W. San Tomas Aquino Road
Voucher #: Permit #: ENC2009-00057
Receipt #: 216557 Date: 04/30/09
___~~~..
Requested by:_ .~---~-~-~^'-- Title: PW Inspector Date: 7/10/2009
Sye ~ahidi -"~ ";
Approved by: ~~~ ,~~' ~~ ~;,~%-~,_..~ Acting City Engineer Date: 7/10/2009
MicYSelle Quinney by Lisa Petersen
Finance Dept Only:
Verified by: Title: Accounting Clerk II Date:
Approved by: Title: Accountant Date:
Special Instructions For Handling Check
Mail As IS: Mail in Attached Envelope: Interim Check:
Needed By:
Return To: Joanne D'Ambrosia Public Works/City Hall
(Name) (Department)
Other:
vn: rormsiexceucnKreq - Kevised u5iuu
PUBLIC WORKS DEPARTMENT UTILITY ENCROACHMENT & MISCELLANEOUS RECEIPT
Effective July 1, 2008
TO: City Clerk '1
PUBLIC WORKS FILE NO. N C . ~ O - b~ ~7
PROPERTY ADDRESS $ ~'O~C~ L~e~
Please collect & revel t for the followin monies:
ACCT. 1TEM AMOUNT
ENCROACHMENT PERMIT
4722 Utility Encroachment Permit Application Fee
Utilit Arterial/Collector Street
$585.00
Residential Street/Other Areas $325.00
4722 Plan Check & Inspection Fee
Utilit < $100,000
Minimum Charge Per Location ($260.00) 2(,0. b a
Conduits/Pipelines up to 500 Feet ($2.35/ft)
Above 500 Linear Feet ($1.40/ft)
ManholesNaults/Etc. ($130.OOlea)
Pole Set/Removal ($130.00/ea)
Street Tree Plantin /Removal $150.00
** 2203 Utilit > $100,000 * Actual Cost + 20%'*
4760 Stora a Container Permit $130.00
4760 Pro ect Plans & S ecifications Pro~ect No.
4760 Standard S ecifications & Details $1/P $15.50/Bk
4760 Co ies of En ineerin Ma s & Plans
Aerial Piot 24" x 36" $55.00
Aerial Print 8 1/2" x 11" $25.00
Aerial Search Fee $25.00
Ma sand Plans 24" x 36" $12.50
4722 Penalties: Failure to restore ublic im rovements $100/Calendar Da Muni Code Sec. 11.34.010)
4722 Penalties: Failure to correct unsafe conditions $100/Calendar Da
4722 Work Without Permits 4 Times A livable Fee
MISCELLAN EOUS
511.7424 Posta e
Other Please S ecif
*Engineer's Estimate shall be as approved by the City Engineer.
NAME OF APPLICANT L~P~ I--~'
TOTAL
$ x(00 ' 6 D
~~-~ 1,/„e 0"tZ~'2 ( Sr•
NAME OF PAYOR
PHONE y~f% l7O
ADDRESS ~ O Z ~r, V~ ~ S, '~ ZIP a S~ ~ U
"Actual Cost Plus 20% Overhead Non-Interest bearing deposit/
FOR RECEIVED BY
CITY CLERK
ONLY Date ~ % t# ~~
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