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ENC2009-00068"Print Form ENCROACHMF.N'T PERMTT Permit No ~ ~- rLO~ - ~ ~ ~ ~CJ CITY OF CAIaiPBELI pF,PT, Df PUBLIC WORKS (far working within ttx public X-Ref. File 7o haorttt first Str¢+at r/ig'ht-oaf,-w/ay) Applcation Data ~. Z Campbell, CA 95Q08 Issued {o~~/ ~'j ~ Ap(>licetirsti Expiratiorr©att r.. Ph. (ate}s6a-trio „ /^ /' APN 28$-02-029 Fx. {qp8) 3?4-0958 Permit Expiration t7att lO!/ y/ G APPLICATION - Applicatron is hereby made far a Public Works Pewmit in accordance with CampbtH Municipal Cade, Section 31..04. (Application expires in six (6} months If the permit Ps not issued. Application Fee is non-refundab(t.} A. 4YorkAddressarTractNo,: 9$0 E Hamilton Ave {AMERICA'S TIRE) 1 uYilityrrenatLacatian: S side E Hamilton Ave 5' outside of P(L (si0ewalk easement), 205' w Of S (Bascom Ad e. Nature of Work: Replace Pola Mounted Tr forx~r, install riser on existing otiliiy pole, pu11i rice firms pals to panel in custoaer installed conduit, tie in new and rowed electric service. {NO Excavation By P6iiE? DeveloperlContrac#or 7renchiryt On)9ff Site d installing Conduit. C. Attach four (4} copies of an engineered plan showing the location and extent of tht wank, and four {4) copies cd the preliminary Engineer's Estimate of xrork. The plans short show the retatian of the proposed work to existing surface and underground improvtments. Whtn approved by the City Engineer, said plan becomes a part of this permit. Q. All work shall conform to the City of Camptxtl Standard Specrfications and Details for Public Works Construction; the General Permit Conditions Listed on the reverse side; and the Special Provisions for this permit, listed below. Failure to abide by these condititms and provisions may result in job shutdown and(or forfeiture of Faithful Performantt Sureties and cash deposits. (see General Permit Candirians 1 and 2.) E» The Contractor must have this permit and approved plans at the site and nwst notify the Public Works Department at least two days btfore starting work. Notice must. tx given to Public. Works at least 24 hours txfart restarting arty work. NameafApplkant: PGBE (SCOTT YEATER) Telephone; 40$-722-5225 Address: 900 I.IGNTPOST WAY STE. 150 E-Mai1 Addresx SRY2@PGE,GOM ~~1+~ 24F~t.lR EMERGENCY PHOMEMUMBER:0.743-5000 lsthisworkbeingdonebytheprapertyowntrsattheirownresidencc? TRENCHING (~ YE5 ~"~' NO The Appticant/Pemtittee hereby agrees by affixing their signature to this permit to bald the City of Campbell, its officers, agents, and emptoytes fret, safe and harmless Fram any ctairn ar demand far damages resorting from the work covered by this permit. The Applkant/Permittee hereby acknowledges that they have read and tmderstand both the front. and bark of this permit, and ~+ty wilt inform their contractor{s) of the tnformatian. Applicant is advised that upon issuance of this permit, property ~'+'^t7~ ~' Property owners saxcessors, shaft be responsible for any and alt damages arcing out of the tanditis~# any private improvements in the public right-af-way. e ACGepttCk PG&E SCOTT YEATER {sign) 09 Matt NIA rr.,nr.arr,xl [Prim Name) DMe SPECIAL PROVISIt _t. Street shall not be open cut for wuierground installations. aAinimum cuts t~ be allowed for conntttions ar expkxation hales. Such cuts ~ ' acv auo{,g eYtxi try the Ins r orior to wttina. „~„„2. Pavement may be cut for underground installatbns and must bt restored in accordance with the Standard Details Trench Restoration Method "A", unlessath+trw`atopproved by tha Engineer. _____3. Work to be staked t7y a licensed Land Surveyor or Civil Engineer and two (2) topics of the cvi sheets sent to the Publk Works Department btfwt starting work. ±t. Per Section 4215 d the Government Code this permit is not vagd far excavations until Underground Service Alert (LISA) has been notified and thairiquiry identification number has been entered hereon. USA Phont: 1-8tX1-22~-2600. USA TtCtCEf NC3. 5. Prior to any work, the property owner shall execute an Agreement fog Private (mprtrvemertts in the Pub1k Right-of--Way, which shaft be recorded. 4. Publk Notifrcatian Requiremerrts' 7. [KK Pl IRI_IC WORKS FEE SCHEDULEfOR CURRENT FEES PERMI7APPLICATION FEE PLAN CHECK DEPOSIT SECURITY FOR FAITHFUL PERFORMANCElLABOR & MATERIALS CONSTRUCTION CASH DEPOSIT PLAN CFI(:{tc & INSPECTION FEE APPROVEDfOR~SSUANCE AIv10UNT 5 ~ S RECEIPT NO. l; ~ S LX c S C / 2/0 ~i Pemtit Expires 12 Months After Date of Issuance n ~ ~ v ~.~ ~'~ ~ ~ i. A Construction Cash Deposit is required Charges wil# be [trade againstihis deposit if there is an tmergtncyrall-out, oti«ertirnt inspection orwhen City ordered baaicading is required. Arty such costs in excess ottfte deposit will be baled to the Permittee. 2. A ont~year mainttnzdnce period and surety are required. Such period wifi begin orr dart of wrftten acceptance by the Clay. 3. Refund ar the cash deposit baronet and refund or cancellation of the Faithful Performance Surety will be initiated by the written acceptance of the work by the City, 4. The Pertnlnet must request let writing a final inspection and acceptance of the wank upon corrtpktian. Acceptance by the City will be made in wrhinq to the Permitter. S. Maintain sett pedestrian and vthrcular crossings and fret access to privet[ driveways, bra stops, fire hydrarns, artd water valets, 6, A Constructiat Traffic Control Flan and a ConstrucTiort Sch+eduie are required for all lane tlosurts, detours. and street dowres. 'this plan must be reviewtd and approved prior to any lent closures. 7. A Construction Traffic Control Plan shall conform to the Cahrans Manual of Traffic Controls for toratruction and kiaintenarkr Work Ztxtes, dated i994T, arepabk at tahraru. Traffic control equ~rtient shalt include Typell flashing arrow signs if required. 8. Repbteas directed by the City Engineer arty damaged a removed improvements let accordance with City Standards and Spedficatbns at the sole expense of the Permitter. 9. Sawcut for ail PCC a AC removals. Alf PCC removals shall be to the nearest scoremark and shag be doweled to etcistinq improvements. 10. Prior approval of inspector is required ftx a ny work done after rwrmal worltinq hours, on weekends or holidays and may require reimbursement of inspection torts at the current overtirtte rate. 11. .Adequate signing and barricading is requirrd on the job she. Faaure to provide such signing and barricading may resuh in the Guys providing signing and barricades and charging the cost lktduding al! labor and materinisi against the cash deposit. 12. Compaction testing of subgrade, bast rock,. and asphah cacxxete by Permitter is required unless otherwise stated by the City Engineer. 13. The Contracts ar Permitttt wRi have a supervisory representathre avaliahie for contact txt the projett at all tittroei during construct3at. Contractor or Pemtittee shad provide a phone rwmber at which they tan be contacted outside the hours of 8:00 am. to 4:00 p.m. i4. No sitxagr of materlais or equipment wi6 be allowed near the edgr of pavement, the travettd way, tx within the shotdderllne which would orate a hazardous candhiors to the pubic. 15. This permit shalt not be construed as authorization for excavation and grading on private property adjacent to the vrork or arty other work far which a separatr permit rrtay bt required, nor does it relieve tht Permitter of arty obligation to obtain any other permit required bylaw, t i5. This prrmh does not ukase the Permitter from any tiabilitks cottLained in outer agretrnrr+u or contracts wMt [fie City and any other public agrncy- 17. This permR is not transferable. Work must be performed by the Permitter or his designated agent ar contractor as sptcifiM thereon. 1$. CaU bark {tall out? dut to emeregettcies regardiriq this permit shall beat the current overtime rata with a three {3) hour mb+imum charge par occurrence, 19. Pursuant to Chapter 14.02 of the Campbep Munkipai Coder applicant shall trot taus[ to be discharged any material into the munidpal storm drain system other than storm water, Applicant shah adhere to the BEST MANAGEMENT PftACTiCES restablistred by the Santa Ceara Yalky Urban Runoff Poliutforr prevention Program. 20, If the public interest cequircs a modification of, or a departure from the plans and sprcificatiora, tlteCity shad! have the authority to requi2 or approve any modification ordeparture and to specifytYte manner in which the same is to be made for Qty-owned w rrsaintained facgities, 21, Pennimee must provide advance rtotitication to ail parties that may be affected bSr thr perms acdWties. Notifkatiort shall be rreiewrd by dte Chy prior to distributiart and include dates of work and a Contact name and phone numbtr- Applicant shall be respatsibte for ensuring that aA thost providing services under the appricantare aware and understand aR of the above conditions. PG&E SCOTT YEATEH .,~y~,.t!"~'`"' ~.fl. 5129/08 Appiitant NIA Contractor (Print Namel Date: Date: J3FURM51TempiaaestEncroachmtr~t Ptrmhs\EncroarF+mant Permit STATiC fwm2.pdf Rrv. 3148 ~~ 4 ~ ~ ~ N O ~ V ~ ~ ~ ~T ~ -~ ~ F- -~ O ~ ~ ~~ ~_ ~~ ~_ ~ ~ w` Q' ~ ~ `-' ~ ~ Q cJ a ~ a~~~~~~ a. 5~ ~ ~ '¢~ +r ` (~ L:. t ~~ b ;._ a d ~ ...~ ~ '"'.! ~ ~ ~ i ~ ,U Q. .a ~ ~ mo __ _~ ~_ ° ~ LlJ d - ~ ~ ~ s c i ~ > ~ o w >. L ~ ~ m m i E ~~ ~ w ~ ~ m ~ = m E 'w c .a m i m ~ ~L '' ~ 3 > a = m `a ~ L ~"~ R 'a 3 ego ~0 3 > o ° _ ~ ~ 's m ~ t ~~ Q 1- LL w r N ~"1 S ~cc.~ c o ~ T ~^ 2 25' 35a'~ 350" c~ a~ z N .~ ~ r N Ol ~ N G) ~ Q y N? z - t .~~ o a m ~ ~ •- C C Q ~ ~ r > j E ~ d atJ W ' U c _ m U J N Q J N `p G N a V o N ~. . c O Q t ~ U J m ~ J m J m l11 o W y ~ ~ z a , o ~~} U Z H f/~ ` o (~~7 0 O 0 : I Z a ~ z C7 d ~ °a ~ ~ I I{{ S ~ . ~ ~1 ~ c 4 T N N ~ a N (n 1 ~ a ~ W 3S.~P~ P6&E Fresno ~ Dependency Permit Desk 8 River Park Place East, 1st Floor Fresno, CA 93720 June 1st, 2009 City of Campbell Public Works Department 70 North 1St Street Campbell, CA 95008 Re: ENCROACHMENT PERMIT Attached is a permit application for the following location. RECEIVE JUN 0 ~ 2009 PUBLIC WORKS ADMINISTRATION 980 E. Hamilton Ave, Campbell (5 side of E Hamilton Ave - 5' outside of P/L (sidewalk easement) 205' W of 5. Bascom Ave) (Americn's Tire) Please mail the permits and invoice to: P6&E Fresno Dependency Permit Desk 8 River Park Place East, 1st Floor Fresno, CA 93720 Additionally please reference PM # 30675219 on the invoice. If you have any engineering or design questions, please contact Scott Yeater (408) 722-5225. Thank you, Michelle Rocha Dependency Permit Desk FAX (559)347-5333