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ENC2006-00024CITY OF CAMPBELL DEPT. OF PUBLIC WORKS 70 North First St. Campbell, CA 95008 (408) 866-2150 Fax (408) 376-0958 E"`^ROACHMENT PERMIT (~ orking within the public right-of-way) -7 /' Issued ~ ~2 / ~~,(-~ J z i~~ Permit Expiration Date 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 issue"d~. Application Fee is non-refundable,,.)//JJ A. Work address or tract # t7C ~ 3 ~e-ST f!"~. crCq,~/ ~;~/.~~ Utility trench location B. Nature of work ~ ~ Z"~,e.-~J ~t~/~, ~?~iLa L 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 improvements. When approved by [he City Engineer, said plan becomes a part of this permit. D. All work shall conform to the Ci[y 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 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. must be given to Public WorkJsfat least 24 hours before restarting an/y work. Name of Applicant ~~ ^^ 1 10 ~C~~ /j~,S (1~/~ Telephone 3 ~ ~ ~ 6 ~~ 3 Address~~4,/ a,vlL ~~f ,{t/r.~ ~~(~ t name) ! j ~/~~, + 24-HOUR EMERGENCY TELEPHONE NO. z~~'-76 ~ ~a .~~ E-Mail Address / ~ uG..l (O aj ~~ ~ sj~~ ~~~~~ ~ n~ T Is this work being done by the property owners at their own residence? Yes K' No Notice ~ 0 U The ApplicanUPermittee hereby agrees by affixing their signature [o 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, shall be responsible for any and all damages arising out of the condition of any private improvements in the public right-of-way. 6 ~ 2-2~ -ate (Applicant Permittee) (sign) Date LLB t?' ~ .k~s ~ -z~ -v~, Contractor (Print Name) Date SPECIAL PROV IS10NS ] . Street shall not be open cut for underground installations. Minimum cuts may be allowed for connections or exploration holes. Such cuts may - / be specifically anaroved by the Inspector prior to cutting. "r' 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 execute an Agreement for Private Improvements in the Fublic Right-of-v/ay, which shall be recorded. _G. Public Notification Requirements: 7 SEE PUBLIC WORKS FEE SCHEDULE FOR CURRENT FEES PERMIT APPLICATION FEE PLAN CHECK DEPOSIT SECURITY FOR FAITHFUL PERFORMANCE/LABOR & MATERIALS CONSTRUCTION CASH DEPOSIT PLAN CHECK & INSPECTION FEE /'\ APPROVED FOR Permit For City $ri~tneer sires 12 Months After Date of Issuance Date .T' e ~ r,. `N~ ~~ ~ LL: Perr. o ~ ~N~ 2 OGC -Q7 ~Z~ f- X-Rel. File Application Date Z,~Z ~ ~ Application Expiration Date ¢( 97 G APN ..~ O~ ". 31 - ®O3 AMOUNT RECEIPT NO. g 2~ I ~8~73~ $~_ 2lZ7/~6 Q Q 14-- Li.. 0 C [" vi G 0 ~~ z Q ~~ W y ;,ENERAL 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 [he deposit will be billed to [he 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 Permittee. 5. Maintain safe pedestrian and vehiculaz 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 a[ 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. 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 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 m' 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 creau 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. 16. 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 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 petnrlt 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 the above conditions. Applicant _ Hsu ` ,~ Contractor Date / Name) ~ Date J\forms\pwperm Rev. 11 /9/05 WEST VALLEY SANITATION DISTRICT SANTA CLARA COUNTY 100 E. Sunnyoaks Ave., Campbell, CA 95008 (408) 378-2407 LOCATION: ~ ° ' - A.P.N _ { ~ ' O7S Sewer Location: Bk._Pg. Tract ' ~!~ Lot f' Proj. Assort. Address: ~`` ,i Jurisdiction ' ~1'- ,• BUILDING TYPE: Single Family ~••''FCondominium/Town Houses Multiple Dwelling Number of Units Commercial Industrial Othe~Information: F -'~~ :'~~~~~'`' ~e y r . T •' ~ - Change in Status: ~ ~ ' '~ ' ~~ ~` -' SEWER CONNEGT~ON PERMIT NUMBEFF' - Issue Date ' '~l 3~~~' FEES: Acreage Frontage Service Advance Processing Other: ~ Capacity ~.?, F -. BUILDING SEWER CONNECTION: Feet of Property line feet from Main Sewer and feet deep. Connection to Main Sewer Feet upstream from M.H. Using - BACKFLOW PROTECTION: _ Field Check Required TOTAL , x~ ` Call District for foundation survey Disposition; _ _ ~ . ~`'~!{ GO Zone ~ RL SJ ~ Device Required; Yes No ~%~!. / Type: INSTRUCTIONS: Street encroachment permit required from ~' ` ,' ~'` + ` o Permit invalid if not connected within 12 months of issue. Do not connect until main sewer is accepted by District. o Obtain a building or plumbing permit from the jurisdiction listed above. -~ ,~. -. ' -. ~; WHITE -PERMIT /PINK -DISTRICT /YELLOW -JURISDICTION BUILDING INSPECTOR'S COPY /CARD -DISTRICT COPY SEWER CONNECTION WEST VALLEY SANITATION DISTRICT PERMIT NUMBER- ~},~ ~ ~' SANTA CLARA COUNTY 100 E. Sunnyoaks Ave., Campbell, CA 95008 (408) 378-2407 LOCATION: ! A.P.N. _. ~ _ ~- 0710 Sewer Location: Bk. ``'~ Pg. Tract ~ ', Lot - - Proj. Assort. Address: ~{' ^` ' Jurisdiction ` `= - BUILDING TYPE: Single Family w%'` Condominium/Town Houses Multiple Dwelling Number of Units Commercial Industrial Other Information: ~ - w Change in Status: Issue Date BY `' FEES: Acreage Frontage Service Advance Processing Other: Capacity $ .~ ' ~' BUILDING SEWER CONNECTION: Feet of Property fine feet from Main Sewer and feet deep. Connection to Main Sewer Feet upstream from M.H. Using ` BACKFLOW PROTECTION: Field Check Required TOTAL Call District for foundation survey Disposition; ~ ~' GO Zone RL SJ ~~ Device Required; Yes No ~~ Type INSTRUCTIONS: o Street encroachment permit required from o Permit invalid if not connected within 12 months of issue. o Do not connect until main sewer is accepted by District. o Obtain a building or plumbing permit from the jurisdiction listed above. f; i. WHITE -PERMIT /PINK -DISTRICT /YELLOW -JURISDICTION BUILDING INSPECTOR'S COPY /CARD -DISTRICT COPY WEST VALLEY SANITATION DISTRICT SANTA CLARA COUNTY 100 E. Sunnyoaks Ave., Campbell, CA 95008 (408) 378-2407 LOCATION: ~ - A.P.N. ~ 077 Sewer Location: Bk. - -' Pg. Tract '~ Lot Proj. Assmt. Address: Jurisdiction f`~ '! BUILDING TYPE: . Single Family ~~ Condominium/Town Houses Multiple Dwelling Number of Units Commercial Industrial _ Other Information: Change in Status: FEES: Acreage Frontage Service Advance Processing Other: Capacity SEWERCONNECTaON ~ PERMIT NUMBER . ~~ ;~# Issue Date By -~ BUILDING SEWER CONNECTION: Feet of Property line feet from Main Sewer and feet deep. Connection to Main Sewer Feet upstream from M.H. Using BACKFLOW PROTECTION: Field Check Required TOTAL ~' ~.t~ Call District for foundation survey Disposition; GO Zone RL SJ Device Required; Yes No Type: INSTRUCTIONS: o Street encroachment permit required from o Permit invalid if not connected within 12 months of issue. o Do not connect until main sewer is accepted by District. o Obtain a building or plumbing permit from the jurisdiction listed above. WHITE -PERMIT /PINK -DISTRICT /YELLOW -JURISDICTION BUILDING INSPECTOR'S COPY /CARD -DISTRICT COPY n ~, M w. -. -a :.,- ~ -~ SEWERCONNE~~:ION ~~~~ WEST VALLEY SANITATION DISTRICT PERMIT NUMBER ~ C} SANTA CLARA COUNTY 100 E. Sunnyoaks Ave., Campbell, CA 95008 (408) 378-2407 LOCATION: A.P.N. -- _ - D7g Sewer Location: Bk. Pg. Tract Lot Proj. Assmt. Address: ' Jurisdiction -~' BUILDING TYPE: ,Single Family `! CondominiumlTown Houses Multiple Dwelling Number of Units Commercial Industrial Other Information: ` Change in Status: Issue Date By - FEES: Acreage Frontage Service Advance Processing Other: Capacity $ _ - ;' ' BUILDING SEWER CONNECTION: Feet of Property line feet from Main Sewer and feet deep. Connection to Main Sewer Feet upstream from M.H. Using ' BACKFLOW PROTECTION: Field Check Required TOTAL ' ~ "~ Call District for foundation survey Disposition; , GO Zone RL SJ~~ Device Required; Yes No Type INSTRUCTIONS: o Street encroachment permit required from o Permit invalid if not connected within 12 months of issue. o Do not connect until main sewer is accepted by District. o Obtain a building or plumbing permit from the jurisdiction listed above. WHITE -PERMIT /PINK -DISTRICT /YELLOW -JURISDICTION BUILDING INSPECTOR'S COPY /CARD -DISTRICT COPY WEST VALLEY SANITATION DISTRICT SANTA CLARA COUNTY 100 E. Sunnyoaks Ave., Campbell, CA 95008 X408) 378-2407 LOCATION: A.P.N. . 1 .. ~--_©7 Sewer Location: Bk. -:%~ Pg. `°' Tract ' ''~ f~`r Lot Proj. Assmt. Address: '~ ~~' `~ , ~';`;° Jurisdiction ~ .~.' _ ° ~~ `.' ~'. BUILDING TYPE: _~. Single Family +~`~~ Condominium/Town Houses Multiple Dwelling Number of Units Commercial Industrial Other Information::," '' %''" ''~ Change in Status: y '"{ r . Issue Date 'l B ~~ FEES: Acreage Frontage Service Advance Processing Other: Capacity PERMTC UMB~~ ~~~~ { ". BUILDING SEWER CONNECTION: Feet of Property line feet from Main Sewer and feet deep. Connection to Main Sewer Feet upstream from M.H. Using ;,g ...,- BACKFLOW PROTECTION: Field Check Required TOTAL -~~~~ ~ Call District for foundation survey Disposition; ~ ~ ? GO Zone RL SJ Device Required; Yes ~Noj =~""fr ~,r Type: INSTRUCTIONS: Street encroachment permit required from o Permit invalid if not connected within 12 months of issue. o Do not connect until main sewer is accepted by District. o Obtain a building or plumbing permit from the jurisdiction listed above. WHITE -PERMIT /PINK -DISTRICT /YELLOW -JURISDICTION BUILDING INSPECTOR'S COPY /CARD -DISTRICT COPY i 0 w z~ ~~ ;; ~~ ss ~' ~~ ~~ ~~ m 0o r; d~ m_~ g g ~, . a d [ ~ ~', t~7 0 ~ w ~ ~. Cn ~ o' 'rf r' cu ,.d ~ ~ ~ ^d y fC IFI ~. ~ y 8 ~ ~ ~ ~ ,~ ~ o ~, ~ ~. ~' ' o A+ ~ a 0 0 o N ~- ~ ~ ~ ~ ~ ~ w w O O c '~' ~ ~' N N C C ~ ~ d d by ~ ~ ~'! N N N N p~ p~ d m O S ~ U O~ H 0 ~_ d A ~ ~ ~ pO !--' ~ O S ~ w N N . ~ C7 O N p Q OO ~ O "' "' PUBLIC h .CS DEPARTMENT RECEIPT FYfatWcJWy 5, 2005 ~~ I Y` (//~ ^/ /v~ ~ ... ~~ ~~ TO: City Clerk PUBLIC WORKS FILE NO. . c•'^ 1 " Z ' ~ ~ ~ -~ PROPERTY ADDRESS I > C.G Rcave mlMet & receipt fur tM fdlnwinF mrntes: (ACCT. .:ITEM - - AMOl1NT ENCROACHMENT PERMIT 4722 Appllcatbn Fec ~ L Non-UOllty Encroachment Permit fS275.W) Minor Facroaehment Permit <S5.000 (56I.W) Rd First Permit (No Fee) Subsequent (5135.W) UUllty Encroachment Permit ArterlaVCdlector Street (f530.W) ResidemWl Streef/OtMr Artas (S2YI.W) 2203 Nan Check De t 2%of Ettxineer's Estimate (SSW tNn) 2203 FalthfW Rriormancc Security (FPS) (IW%of ENGR.EST.) 2203 labor aM Materials Security (1 W % of ENGR. EST.) 22U3 Monumetnatbn Security IIW%of EN(:R.FST.) 2203 Cash De t (4% of Fapr. E.t)(SSW mttv510,OW max) Ran Check & hnpedbn Fee (NomUtillty) 4722 FaRr.Ect.<5250,OW (13%of ENOR.EST.) 22U3 r. Est. >5250,000 (Deposit S% of FaRr. NilJS30,000 min)•• d722 Utility<S1W,000 MlWmmn Charxc Per lacatbn (S1011.W) . CandWWRpelittes up to 5110 Feel (52.25At) Above SW IJnear Fat (SI.35/ft) MaoholcsNaWtrJEtc. (5125.W/ea) Pde Set/Removal (5125.011/ea) Street Tree RamityJRemoval (5135.W) 2203 Ul0ity>SIW,OW Actual Cost+211%•• 4760 StoraRc Container Permit (5125.W) 4760 I'rojat Batts 8 Spalfmatbtts Project No. 4760 Standard SpalOcatiotn & Ik1aiL~ (SI/F'a SISSII/Rk) d760 Copltr of FaRlnreri Maps 8 Ram Aeral Rot 2d"x36" (£Si.W) Aerial Print S l2" x II" (S22.W) Ma ~ and Ran' 24"x36" (58.25) 4722 14naltkx: FWlurc ut resture ublic irrgtmvemcntc (SIOWCaIeMar Day) (Mad fade xa.11.M.altfl 4722 PerWtks: Failure to com~ct unsafe corWitkatc (S1aV(:aktttlar Uny) 4722 Work Without Ikrmllc (4 Times A plicablc Fee) LANG DEVELOI'M ENT d722 Lut Lfnc A4Jusiment (SgINI.W) 4722 Parcel Ma (41.otx ar Lora) (£3AW.W +f75AOt) d722 Final Tmct Map IS or More 1~) (54.200.00+SIWAot) d722 Certificate of Comolfattce 56511.W1 Vacation of PWaie Streets & Fisemrnts (S2,2tatW) A.u: sment SeRrepttion or Reapportionment First Spilt (S725.W) Each Addltbtal Lot (S2W.W) Sturm UralruRe Arca Fee 1'er Acre (R-1 f2,1211.W) fMWti-Res S2.'SUS.W) (nn cxMr sz.65o.W) ParklaM Ixxlieatbn Frc (75%/25% Uue anon Cen. or Occuwncv) Intersation Tum Counts (7'wo-l Inlersectian Tum Cants la.m c 'f raflk Flow Map (Daily Tra0ic Catrgshell'Patfic Model (FWI & Campbell Trallic Moael (Reduc Sioul Timine Idormalion TO"fAl. OFAPPLICANT ~ "~ ~ ~~ Y'~'?GG.",~ s,L ~ ~~~ ` OF PAYOR ~~ ~ ~ ~ ~I~PE L , Il/C-~, //y~ 1'IIONF C( ~ 0 ~ ~ 7 ~ ~ V / ~ ss ~~J m~ ~ ~~>/~,~ 4~ ZIP ~ Sao ~ FOR CIT)' CLERK )tEC:CIV i~D - - ONLY :~- ,. ;~ ,., ,.. rote Hee Pt« ~ ~ ~. •FortRanC.heck~aal(aelt.Depaalts, aced ye0nw oopY.to Flaurt. ~ ' ... - '-Datd IWthlls j:\lorms4eceipt farm OS-06 rev.(JL I /OS ;^ ~_ Iw 'I I I i <~~ II~,f,~~ I r~~k%. ~ .b1 197. ~0 ' ~ it , ;~ 1 ! ii ! ,~ ' F~L? X36. <I"~~ i i i ' I 1 I I 1 :pry J-~.i~'CZ..n..G_'~ '~'. , !I t ! it f I I I ! , i li / ~^ I I i ! I ! ;I I , ~~; ! I II i _ ~1 li I II i ~~ I ,I j i! i , i I~ I ~~,: ~ I I, ' (4) WATER N JOINT TRENCH ~%" 12 RCP ( ) cr I Ifi97.0;i ! ,, SERVICE PIPE ~i~ ' ! ~i ~ I. ©S=0.01 ; I _ ~_ ;, T i0 i_~ ~ .~ 7 ~ 1 I GUT; I~G ;~~'- ~~, X ~ "!~? '.:> ., I ~ -i i t C'' i I( I I~ - ! I~~ W W W W -1- u% j II I - - - - I,~ I ! ! I j ~I I ~ 1 _ ~ ~~ ~ 3 O j i~l i i \ - JT JT - JT - JT o - T - JT 3 "`~ O ' II I ~" j I ,_, _ -_._ ._ ._ __ J , ~~'? ~ ; ~ Ili ~ ~ {- ~_ ~~ ~~ „r \~ ` y / - I ~\~, , ,. ' _ I __ r 7:, ~ ~ - ~_.~ < <,~ ur _ ~ ~ \ ,~ ~ a: '- i ! I- ~ ~ `-~- GAS METER :%~ ~9:%.s~l O e,l,\~„ t; il~ i ~i i \ ~ ~' ~~+, ~~;~'~ C\I~ETER 1~ '~ELEC-METE ~~, III ~~ r U ., Z ~~ _- _ ~ ~ .. ~ _. n' * ` \\ aL ~ INE ~ ~ /, ~ ~ I ~ - i '.=~, BACK FLOW PRE ENTOR BY OTHERS ,3~, i <,~;;;~; I ~~ ~ C'7 i ~ ~ (5) WATER ~ ~ 7 ! I~ i j o~ ~ \\I CE PIPE ~ ~~I~,% .,~ I I __ _ -- I 6.13v If L1c'r,E~ ~ I i/" ~ 3 (~,fj~ , it ~'~~ ~~ ~~ ~~ , ';~ ~ ~~- I ~ ~ I ~ I„ ~\ 1 1 l I ~, i I , u i I I I \~' t ~-- ,i/ i . _.. ' i I.'~, ~ r ~ ~. _ _-.. ,~. ' ~'( I j I ~ I ~ - - ;~. 1 - -- _ i . ~_ , ~ ~, _ ~ .- ~ - _IN 3 PIPE i s '' ; ,=' I r- -~ : = _ -- ---- - --- - _ ~ - -- .__. __. _- ; ~ , ,~ f I I a f '' '~~` 4 ~ ~~ ( ) ~, __ I ~, ;~ ' INV 197.00 i I ,~ '' '~ ~` \ I ` "J ' r. ~ ~, ~~ I ! ' ~ i i III ~ / ~ i ~v ~ ( f ~' ~ ~- ~~- ~ ' ''~.~ T`•~-_ _ _ - ..- II ! I I i~ .~~._.-.._ w~ ~ ~ _ i Cif r l7 r ~:~ ~V -. '.} c~ ~ f~U ,~..~/ . __ _ i .-. _- __..._--i7- I'\ _ _.._. I ~ ' I~ I, ~ ' ~ ; . ~ I-; ~ ~~~ N 9 L 8T I i ,O O' I ~~I ! 3) 3" METAL PIPE ~~.INV 197.58 (@ PIF I If~V--1-9~~., , ; L~ BC II j @ S=0.01 r~ <;.:(~: ' i I ~~~; .~.~ , \,~ R,t~q !~)7.i~z i 1 j f ' , i G~ . v f c^ n~ ~ i J ~ -, C' ~ ~~ ~ ! \ \-~ "~ ~--,