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CITY OF CAMPBELL EI~,.rtOACHMENT PERMIT Permit "~ C Za o9' GOO ~ 8
DEPT. OF PUBLIC WORKS (for working within the public X-Ref. File
70 North First St. right-of-way) p
Campbell, CA 95008 Application Date ~ U ~ ,css
(4~i) i~6-215 Issued 6 2 5 ~ ~ Application Expiration Date~~.
Fax (408) 376-0958 C `~
Permit Expiration Date ~ 2 S ~ APN ~~ 2 ` ~ ~ ' ~2~ ~' '~`-
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APPLICATION - A lication is hereb made for a Pubhc Works Permit in accordance with Cam bell Munici al Code, Section ] 1.04. A itcation ex fires sr 6 Z
PP Y P P ( PP ~ P ~ ( )
months if the permit is not isstted. Application Feet iLLs non-refundable.) ~ ~"s
A. Work address or tract# ~~ ~ ~L~r~L ~~ ~
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Utility trench locat
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B. Nature of work Il7d ~ +(~ w1'(/~: f~X15,/BFI ~ ~Xy'~ r~ ~weUF~t~ ~~I.CJ~~ ~i~k 3,~5 x ~ ~ y 1~~~~i~
C. Attach 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 work. The
plans shall show the relation of the proposed work to existing surface and underground improvemrnts. 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 Specia{ Provisions for this permit, listed below. Failure [o abide by these conditions and provisions may result in job shutdown andlor forfeiture
of Faithful Performance Sureties and cash deposits. (See General 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 starting work. Notice
must be given to Pub ' c Works at least 2t4'hours before restarting any work. /~\
Name of Applicant ~!~ ~~C~^ ~~h~ Telephone ""'~ ~ ~ is ~ ~Z
r(~ Iw aGef1~1' ~l"t/~ CU~(~O name
~SGY 24-HOUR EMERGENCY TELEPHONE NO.
Address
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E-Mail Address r/ r ~f ~ "'rL • ~U~
is this work being done by the property owners at their own residence? Yes No
The Applicant/Permittee 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 Applicanf/Permittee hereby acknowledges that they have read and understand troth the front and back of this permit, and they will inform their contractor(s) of the
information. Applicant is advised that upon issuance of th' permit, property owner, or property owner's successors, shall be responsible for any and all damages
arising out of the condition of any private impr ments i e public right-of-way. L/
Accepted b~L ~0 l
(Applicant Permittee) (sign) Date
Contractor (Print Name) Date
1. Street shall not be open cut for underground installations. Minimum cuts ~ be allowed for connections or exploration holes. Such curs may
be specifically aovroved 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 Phone 1-800-227-2600. USA TICKET NO.
_5. Prior to any work, the property owner shall execuu: an Agreement for Private lmprovements in the Fublic Right-of-Way, which shall be
recorded.
_G. Public Notification Requirements:
SEE PUBLIC WORKS FEE SCHEDULE FOR CLIRRENT FEES AMOUNT RECEIPT NO
PERMIT APPLICATION FEE $ 32~ ~._
PLAN CHECK DEPOSIT $
SECURITY FOR FAITHFUL PERFORMANCE/LABOR & MATERIALS $
CONSTRUCTION CASH DEPOSIT $
PLAN CHECK & RVSPECTION FEE _ $~
APPROVED FOR ISSUANCE
For City En Date
Permit Expires 12 Months After Date of Issuance
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GENERAL PERMIT CONDITIONS
1. 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 final inspection and acceptance of the work upon completion. Acceptance by the City will be made in writing to
the Perminee.
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 Conswction Schedule are required for all 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 [o the Caltrans Manual of Traffic Controls for Construction and Maintenance Work Zones, dated
1990, available at Caltrans. Traffic control equipment shall include Type TI 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 neazest scoremark and shall be doweled to existing 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 overtime rate.
11. Adequate signing and barricading is reyuired on the job site. Failure to provide such signing and barricading may result in the City's providing signing
and barricades and chazging the cost (including all labor and materials] against the cash deposit.
l2. Compaction testing of subgrade, base rock, and asphalt concrete by Permittee is required unless otherwise stated by the City Engineer.
l3. 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 outride the hours of 8:00 a.m. to 4:00 p.m.
14. No storage of materials or equipment will be allowed neaz the edge of pavemrnt, the traveled way, or within the shoulderline which would create a
hazardous condition to the public.
I5. 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 Permitlee of any obligation to obtain any other permit required by law.
1 G. 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) titre to emergencies 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
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 Ciry prior to
distribution and include dates of work and a contact name and phone number,
Applicant shall be responsible for ensuring that all tho~ providing services under the applicant are aware of and understand all of the above conditions.
G~`~U~
Date
Contractor (Print Name) Date
]~forms~pwperm
Rev. 11/9/05
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L5 J PGdtE TO INSTALL 3' X 5' X 4'6" HEAVY FULL TRAFFIC
PRIMARY SPLICE BOX
PGd~E TO REMOVE 30" X 48" HEAVY FULL TRAFFIC
PRIMARY SPLICE BOX
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PROJECT CONDTf10NS STAMP
TyP.(,) or work
^ Nsw Bwtns~t
® PGdtE UaintenanCS d: Construction
Project Cor~tlons:
® NONE APPARENT n poJ~ot d~Mpn ahagw, oonEooR ADQ
or
^ CONDRIONS APPLY:
^ PERYflS ^ TAIL90ARD ^ OTHER
(Prw~a. aedllaial hfamdbn an Ins edo.)
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EL PATIO 1113
SSD SWITCH 5091
MAP H-16-17 "
OF
`~~ - - CLASS 3 AREA
AFETY B INSUL DIST
12KV AREA SC
R ~~ CITY OF CAMPBELL PERMIT SKETCH
~~'~ ° ~~D REPLACE PRIMARY ENCLOSURE ~F' 103170
~' ° ~~ 51 MICHAEL DR, CAMPBELL ~ ~~
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~E: ~ ' ~ PACIFIC GAS AND ELECTRIC COMPANY 30698644
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