ENC2006-00025;TTY OF CAMPBEL-~.
DEPT. OF PUBLIC WORKS
70 North First St.
Campbell, CA 95008
(408) 866-2150
Fax (408) 376-0958
Permit No, ~-`~ ~ l ~' ~ L' ~' .2 5
X-Ref. file
Application Date ? ~ r ~ ~!/ v
Application ezpires in 6 months
APPLICATION -Application is hereby made for a Public Works Permit in accordance with Campbell Municipal Code, Section 11.04. (Application ezpires in 6 months
if the permit is not issued. Application Fee is npon'-refundable) / /~ ,(~
A. Work address or tract rY rN t u c ~ F S /' C~ ~ ~ ~V ~C (~ F~ s- ~ r J` i * `1 ~
Utility trench location / r ~
B. Nature of work ~ rn `~ 7" R r/~ [~~,~ S t~ ~l Q '~ ~ l q ~ t ~Ar 7 ~ ~ U
b~ /act.. ``,CJo S1foPP.~,t S'~ ~~
C. Attach four (4) copies of an engincered plans showing the locazion and extent of the work, and four (4) espies of the preliminary Engint~s Estimate'tSf 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 Conswxion; 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 shut-down and/or forfeiture of Faithful
Performance Sureties and cash deposits. (See Grneral 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
LEAST TWO DAYS BEFORnnE STARTIN~,GI WORK. NOTICE MUST BE GIVEN TO PUBLIC WORKS AT LEAST 24 HOURS BEFORE RESdTARTING ANY WORK.
Name of Applicant R(h'Vl N00.C~~ Telephone 'T y ~ - ~ 7 j ~ g ? ~ ~ v/
Addms ~ ~ U (~c7 ` t~c, r d'~r/~ ~~) s~ ~N ~~~ ~~ 24 HOUR EMERGENCY TELEPHONE N0. 4 ~'~~' ' ~ ~ ~ - ~l ~~ `~ J
Is this work being done by the property owner at their own residence? Yes -~' No
The ApplicanUPermittce hereby agrees by affixing their signature to this permit to hold the City of Campbell, its officers, agents and employees frce, safe attd harmless from
any claim or demand for damages resulting from the work covered by this permit.
ENCROACHMENT PERMIT
(for working within the
public right-of--way)
Issued ~~~ ~',~~~~
Permit ezpires in 12 months
The ApplicantlPermittce 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. _1
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(Applicant/Permittce) (sign)
"Zg "~ ~
Date
SPECIAL PROVISIONS
1. Swett shall not be open at for underground installations. Minimum cuts m~a be allowed for connexions or exploration holes. Such cuts may be stxcifically
I approved by the Inspector prior to wttin¢.
~ 2. Pavement. may. be cut for underground installations and must be restored in accordancet with [he Utility Trench Restoration Standard Details, Method 'A' Badcfiil,
unless otherwise approved by Inspector.
_3. Work to be staked by a licensed Land Surveyor or Civil Engincer and two (2) copies of the cut sheets sera to the Public Works Department before starting work.
4. Per Section 421:5 of the Government Code this permit is not valid-for excavations until Underground Service A{ett (USA):has ban notified and the inquiry
identification number has been emered hereon:_USA Phond 1-800.227-2ir00. USA TICKET. NO. _
_5.
SEE PUBLIC WORKS FEE SCHEDULE FOR' CURRENT FEES
. PERMIT APPLICATION FEE
PLAN CHECK DEPOSIT
SECURI'T'Y FOR FAITHFUL PERFORMANCElLABOR & MATERIALS
CONSTRUCTION CASH DEPOSIT
PLAN CHECK & INSPECTION FEE
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APPROVED FOR
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RECEIPT NO.
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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 trade
in writing to the Perntittee.
5. MAINTAIN safe pedestrian and vehicular crossings and free access to private driveways, bus stops, fire hydrants and water valves.
6. A CONSTRUCTION TRAFFI'C CONTROL PLAN and a CONSTRUCTION SCHEDULE is 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 with 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 IN KIND any damaged or removed existing improvemenu, including planting.
9. Sawcut for all PCC or AC removals. All PCC removals shall be to nearest scoremark and shall be doweled to existing improvements.
I0. OVERTIME INSPECTION PREMIUM will be charged against the cash deposit for inspection required outside the hours of 8:00 a.m. to 4:00 p.m.
at the current ovemme rate, minimum one hour charge.
I1. SATURDAY INSPECTIONS must be arranged in advance. Saturday inspection time is charged at the current overtime rate with a three hour
minimum. Advance payment for the estimated time is required.
12. Adequate signing and lighted BARRICADING is required on the job site. Failure to provide such signing and barricading may result in the City's
renting such signing and barricades and charging the cost (including all labor and materials) against the cash deposit.
23. Compaction testing of subgrade, base rock, and asphalt concrete by Permittee is REQUIRED unless otherwise stated by the City Engineer.
I4. 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.
I5. 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.
16. This permit shall not be construed as authorization for excavarion 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.
17. This permit does NOT RELEASE the Permittee from any liabilities contained in other agreements or contracts with the City and any other public
agency.
I8. This permit is NOT TRANSFERRABLE. Work must be performed by the Permittee or his designated agent or contractor as specified thereon.
19. 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.
20. Pursuant m 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 Nonpoint Source
Pollution Control Program.
Applicant shall be responsible for ensuring that all those providing services under the applicant are aware of and understand all of the above conditions.
(~ ~ r `` 1
Applicant
Date
j:\formslpwperm2 6/96