ENC2009-00076CITY QF CAMPBELL ENCROACNMEH'T PERMIT
DEPT. 4F PUBLIC WORKS (for working within the public X-Ref. File
70 North First Street right-of-way) Appl(r,~tion Date ~
CampbeN,CA95008
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(408) 8G4-2159
Issued 7/7/~ ~ /~
ApplicationExpirotlonDate
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Fx. {408) 376-0958
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Permit Expiration Date _ ~^
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APPLICATION -Application is hereby made fur a Public Works Permit in accordance with Campbell Municipal Code, Section 11.04. (!~1 ~ nxX
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(b) months if the permit is not issued. Applicatlan Fee Is non-refundable.)
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A. Work Address ar Tract Noz t~j~ ~,~,ti.~1 ~~ ~ ~,~
PUBLIC WOR~K(~5~
UtiliryTrenchlocatian: ~,~~[ SIL7~ ~,~ ,.~~y~{a7 ,,c-j' r ~S(~i $~~J'f~-( U~ ~`!"~
Q. Nature of Work: 'R-EYV)UV~ ~ '~~-'~ F V4L~~S r:~ `sl D6 6.~1 k L- r~ ~' U "T tia-C -~-~,J--~
C. Attach four (4) copies of an engineered plan showing the location and extent of the work, and Four (a~ pies 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 Clty Engineer, sold plan becomes a part ofthis permit.
D. A[I work sitali conform to the City of Campbell 5tandarc! Specifications and Details for Public works Construction; file General Permit Conditions
[(sled on the reverse side; and the Spedal 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 5uretles and cash deposits" (see General Permit Conditions 7 and 2.)
l:" The Contractor must have this permit and approved plans at the site and must notify the Public Works Department at least two days before
starting work Notice must be given to Public Works at feast 24 hours before restarting any work. ~' ,~ ~r,
Name of Applicant: C,CfV~'1 C r~ ~~ ... ~ l 1 ~~ /~ A-~ ,ry ~~~,~ Telephone: I ~(z ~~ • `t`~.`f- - (~ ~ ~.- ^7
Address: ~~~~ ~~~/~'~ ~Y~-- I ~l~~f t~-'{t''~1C.~L(-~'` ~'...~~c`J'7~ I
E-Mail Address: ~ 24-HOUR EMERGENCY PHONE NUMBER: ! G~(~~ : ~ ~~~ - ~ ~~
Is this work being dofllfne by the property owners at their own residence? ~ YES ~"" ryp
The Applicant/Pennittee hereby agrees by afflxing their signature to this permit to hold the City of Campbell, its officers, agenu, and employees free, safe
and harmlessfrom any claim ordemand fordamages resulting from thework covered bythls permit
The Applicant/Permittt:e 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 info adon. Applicant is advised that upon issuance of this permit, property owner, or property owner's successors, shall be
responsible for any nd ail ages arLsi tit of be~a diq n of any private Improvements in the public right-of-way. .y / /~
Accepted: _. ~ _ d ~ 1 ! l /
(App iCantPermi~e~~ A (slt~n} -- D 1 1~ r -._
~~ ~~ ~S ~ v I M t ~(_ Cr~.J. ~r~a~
-~" (Corrtractar) (PlintName) - Date
SPECIAL PROVISIO,J~S•. ~-~"
_1. Street shall not be open cut for underground installations. Minimum cuts p1~}(be allowed for connections or exploration holes. Such cuts may he
speclflcally aooraved by the Inspector prior to cutting.
_„Z. Pavement may be cut for underground installations and must be restored in accordance with the Standard Details "french Restoration Method
"A",unless otherwise approved by the Engineer.
`3. Work to be staked by a licensed Land Surveyor or Civil Engineer and two (Z) copies of the cut sheets sent to the Public Works Department
before starting wgrk,
_4. Per Section 42] 5 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 Phone: t •8tltl-ZV-Z600. USA TICKET N0.
-S- Prior to any work, the property owner shall execute an Agreement for Frlvate improvements inthe PubllcRight-o1~Way, which shall be
recorded,
~. Public Notlflcatlon Requin:ments• ~ ~~
SEE Pt WORKS FEE SCHEDULE FOR CURRENT F££S AMOUNT RECEIPT
PERMIT APPUCATK7N FEE $ 5 8 ~
PLAN CHECK DEPOSIT $_.".._ _
SECURITY FOR FAfrHFUL PERFORMANCEMBOR & MATERIALS $T . _
CONSTRUCTIdN CASH DEPOSff $ _
PLAN CHECK & INSPECTION FEE $ ~~
APPROVED FOR ISSUANCE __ C- _ _ _ ~~7/~~'~ _
City Engineer ~ Date
Permit Expires tz Manths After Date of Issuance
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Prifi>r Form
Permit Nq~~. ~ .. ~ ~~
G1=NERAL PERMIT ~pl!Ipl IpNS
I . A Construction Cash Deposit is required. Charges will be made against this deposit If there is an emergency tall•ouL overtime inspection qr when City
ordered bartiwding is required, Any such cysts In excess of the deposit will be hilted to the Permittee-
z. A one-year maintenance period and surety are required. Such period will begin on date of written acceptance by the City,
3. Refund or the cash deposit balance and refund or cancellation of the Faithful P¢rFormante Surety will be initiated by the written acceptance of the work
by the City-
4. The Permittee must request in writing a final inspection acrd acceptance 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 five access to private driveways, bus SCOps, Flro hydrants, and water valves-
6. A Construction Traffic Control Plan and a Construction Schedule are required for ail lane closures, detours, and street closures. This plan must be
reviewed and approved prior to any lane closures.
7. AConsrntdlonTrafflcControlPlanshallconfomstotheCaltransManualof7raFfittontrolsforCanstruaianandMaintenanceworkZones,dated
1990, avaiiabieatCaltrans. Traffic control equipment shall includeType II flashing arrow signs IF required.
8. Replace as directed by rite City lrngineer any damaged or removed impravemerts in accordance wirh City Standards and Speclfkatio,ts at the sole
expense of the Permittee.
9. Sawcut for ail PCC or AC removals. All PCC removals shat l be to the nearest scoremark and shall be doweled m existing improvements.
10. Prlar 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. Adegtsste signing and baricading is required an the job site- Failure to Provide such signing and barritading may result in the City's providing Signing
and barrkades and charging the cost (Including all labor and materials) against the cash deposit
12. Compaction testing of subgrade, bass rock, and asphalt concrete by Permittee is required unless otherwise stated by the C1ty Engineer.
73. ThetontractororpermitteewillhaveasupenrisaryrepresentativeavaitableforcornaavntheprojectatalitlmesduringconsCructton.Contraaoror
Permittee shall provide a phone number at which they can be Contacted outside the hours of 13:00 a.m. to 4:00 p.m.
14, No storage of materials or equipment will be allowed nearthe edge of pavement, the traveled way, or within the sheulderline which would create a
hazardous condition to the public.
15, Thls permiC shall not be construed as authoYZation For excavation and grading on private property adjacent to the work or any other work for which a
separaue permit maybe required, nor does it relieve the Permittee of any obligation to obtain any other permit required by law-
s 6. This permit does not release the Permittee from any Itabilltles contained In other agreements or contracts wirh the C;ty and any other publ Ic agency.
7 7- This permit is not transferable. Work must be perfomled by the Permittee or his designated agent or contractor as specified thereon,
t s. Callback [call our} due tv emeregencies regarding this permit shall be at 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 otherthan storm water. Applicant shall adhere to the BEST MANAGEMENT PRACTICES established by the Santa Clara Vai[ey IJr6an Runoff
Pol{uticn Prevention program,
20- If the public internst requires a modlflcatlon of, or a departure from the plans and specifications, the City shall have the authority to reyulre or approve
any modlFlcation or departure and to specify the manner in which the same Is to be made for Clty-owned or maintained fatilities-
21. PermittCCC must provide advance notification m al I parties that may be affected by the permit 8etivities. Notifitatian shall be reviewed by the City prior
to distribution and include dates of work and a contest name and phone number-
Applicant shalt he responsible for ensuring that all those providing services under the applicant are aware and understand all of the above conditions.
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Contractor (Print Name} Gate:
J:ReInalWebsttelLand Dev FormslEncroachmentPcrmit STATIC form2-pdf
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Comcast
3055 Triad Dr
Livermore, Ca 946tii
Fax
To.
From: Jillian harve
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Fsx: 408-076-0958 Pages: 2
Phone; Da#e: 06/~i~108
Re: cc:
^ Urgent ^ Fcr R®view ^ Please Comment ^ Plees® Reply ^ please Recycle
f~ncroachment permit
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