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ENC2006-00078CITY OF CAMPBELL DEPT. OF PUBLIC WORKS 70 North First St. Campbell, CA 95008 (408) 866-2150 Fax (408) 376-0958 Permit No ~P1C. 2D0(- C~00~$ X-Ref. File Application Date a 10 D Amendment Date a D ENCROACHMENT PERMIT AMENDMENT No. ~_ ISSUED ~( ~0 ~~~ A. Work ]~ ~ ~ C G L11J C. Y L~ address B. Nature of /~ Work "L~~ ~~~/IC,~ ~~Cl~ ~~~ C. Attach three (3) copies of a drawing (or other documentation) showing the amendment, extent and dimensions of the work. The drawing shall show the relation of the proposed worked to existing improvements. Drawings or other documentation provided and attached for proposed amendment: Two ~fj • 5` x 11 h S I~ ~M $ /S~7 Ti~rt t~F ~ p r7l~tow l ~iN o IJ~ ~js,S S~l'1-ucc.~- -(~t~s ~m.1f~ A~c~ iNC-~ ~c,~ , D. When approved by the City Engineer, said drawing becomes a part of this permit. All conditions associated with the previously issued encroachment permit shall apply to the work contained in this amendment. E. 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 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 securities. The Applicant/Permittee hereby agrees by affixing their signature to this permit to hold the City of Campbell, City of Campbell Redevelopment Agency, its officers, agents and employees free, safe and harmless from any claim or demand for damages resulting from the work covered by this amendment to the previously issued encroachment permit. The ApplicantlPermittee hereby acknowledges that they have read and understand the requirements of this amendment, and that they will inform their contractor(s) of the information. 2 ACCEPTED ~I.i~~~~1/A~ /~E' . l~~il%(~liG l¢!l ( ~ ~ " oZ(1Qrd NOTES: A MPBELL STANDARD DETAILS AND CONDITIONS. THE CONTRACTOR MUST HAVE THE ORIGINAL PERMIT AND ALL AMENDMENTS ON THE PROJECT SITE AT ALL TIMES. APPROVED FOR ISSUANCE '~ for Cit En ineer Date Applic nt/Permittee) (Sign) Date ~~~~~ a~~d cis-~,,~~:~., LL WORK SHALL C NFORM WITH THE ATTACHED APPROVED PLANS AND ALL APPLICABLE CA .~ T J:\Forms\Encroachment Permit Amendments: -\ ~~ +~ ~~ \„f Illlllvvv `~~ / ~ ~~~' ~pN ~ ~ i y ~' C Ln ®~~~ ~W ~~ U~,UVU ~ ~~6f ~ ~ ~~ ~ r s r~ ~ ~ 'i ~ 1 m '~ ~ , -1" ~ 1~' M Z ~~ w Ions p~ ~p ~ 'r• d O n' c~ ,,~~++ u[) W toy ~ ~n9 c7 ~ O + ~( t*i N ~ c~ ~ s i~ppb ~ Q .ja ~ N en CS O 1`k ~ J +4~- ~ W V ~ +tJ'~Z *Z N"3 i _ .;. .,;, S --~ 1 .p ~ ..t ~' y oof • ~ . . _- 4 ' . - ..- g :~~ r .r 1 7 1. `~1 .. I r 1 ~T' E `- • ,rj, j ,,.fir l ,. , :' ~, ;j v r ~ ~ ~~ ~ ~ ~ ~~,: ~r , ~ y /` > ~ r . .. ., x.94 ~- _ ~~`~~ ~f-~ _ _~=-=-'-~"~ ., .. .. _. ... W - .~.-. o ~=--., ~i .~ ---.~ fJ7 ~ 7 ,~' ~' ~~' "' _ N t`~w Gras I.,IN ~ . TAI C Fl (~+~ ~ F I t-~- Ta ~~ (~`'N~ JaE~ •. P~~~cr Pt~~s ~ 2.5'` ~~~N~ 4~ (Lv iSS~~-12~ I~ APPROX. LOCATION OF PROPOSED Jt3M1T TREI'~CH. ~RiFY 1tNTH PG&E Pn~ IN G( PLA1dS A1V0 THE CITY li~'SPECTOR. if TRENCH EX1ENflS BEYOND THE F~€GflNSTRUCTED PORTIC~1 OF btcGLt~ICY LANE, REPA{P STREET Si1RfACE PER "UTfUTY TRENCH RESTC3RAT}ON" DETAFL CITY SIDS. _.__. ,,1 APPROX. LOCATION OF PROPOSED 2 , ~ ~- ~~tN p JO~iT TRENCH. 1~R~EY WMITH PG&E PLANS ACID THE CITY i~S#~ECTOR. Y~B~~(?~D p~v-~167 if' TRENCH EXTENt?S ~Y{~PiD THE R~EC#3NSTRUCTED PORTION OF McGllNCY LANE, REPAfR STREET SL~`tfACE PER "UTILITY TRENCH RESTLDRATIUN" DETAIL CITY STT?S. ~ rl~l ~AS LINE g . ~ T~~CN. ~c k~F-t-I.7° ~ ~-S , c~ ~ n ~ ~-- -- cn ~ I cEa ~ f- s v ~ ~W ~ ~ ~ ~ ~ >< x ~ vii cn ,a. to rir w ~ ~ ~ ©~ w rn ~ ~J ~ ~J rJ ~ ~N~~~ ~ ~J ~ ~ ~ - ~ INV ~o.zs .o. C ~. . W •' _ ~f ~L•. S . 1 - ~: - .~~' - tY -. •1 1 t '~ f,v N -, C ~ •. R ., - ~ ~. ~ i - ~ ~ ~. _.t}'-tt`-- _. _"."~--tom,-,-c•__ ___..__..----_._ .r ~) ,h.... -- '~' -- ~i~'- ~ ~ `~~,~~~ ~,~ ~ ~+~J 56°55'00 ' E _ ,. :, ~ ~'_ - __ A --- ~ ~ -_ 2 0 9 r - _- - -_ _- ___ - w-- "-~ k ~ -~'"'.-..~ ,' O ~ ~ q _ -_-j- _-- - -~'~:~ -- - --~ - - - -- ~ 4 2 ~ ~ i F" m i } L' ~ \ a 1, `.a' r~ { ~ _ ~ ~ ~.~ Nllfr+ ~...~ ...J ~~.\~ ~• i '~ \` ~~ ~ ~,, ~ ~ ~ ~ ~ ~ ~ ~ ~cx ~ ~ ~~.~U ~ w ,~~ M ~ Z ~~1 ~~~~ ~~r~'~4 ~~~ ~y ~ ese plans I"` ~ Ccr+rocsor mud hov anstrudion. size burin ~7n ~+ie ;'ob C-TOPO C-BNDY-RESOLVED, C-1MPR-TTLB, C-UTIL, C-IMPR, C-TR CITY OF CAMPBELL DEPT. OF PUBLIC WORKS 70 North First St. Campbell, CA 95008 (408)866-2150 Fax (408) 376-0958 ET OACHMENT PERMIT (fo..~orking within the public right-of-way) Issued 5 ~~ ~d,~ Permit Expiration Date ~ 5 ~~" Perm ~ ~ ~~ ~ r~C: c~C>~• - C ~007F~ X-Re.. ,le Application Date '~ " ~ 2 - d~ Applic/a~tion Expiration Date APN !~\ i 2 ' ~`J ' UO~ O ~ ~ ~ ~~z~ 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 issued. Applicatifon~Fee i/s non-refun`da'ble.) , ~ ~ ,~ A. Work address or vact # ~ ~~ K ~C~~%l U ~G~F t.{xl\1l~ Utility vench B. Nature of work ~e.~l,(~LC. V ti ~o" 7 ,~r I`~~ ~ ~i.J~~•- 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 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 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. Notice must be given to Public Works at least 24 hours before restarting any work. Name of Anolicant ~' Telephone "1"~ ~~ ~ - ~~~ --7 r _ ` ~Prc~~~ Address 1 ~O C~~U-`~,%\ ~Vt/1( ~ '~~~J ~ 24-HOUR EMERGENCY TELEPHONE NO. E-Mail Address a C''r `D Vti P ~~~ 1 ~ GC~1.•L~ 2~~1/1 P~Lj (_..E~J~l Is this work being done by the property owners at their own residence? Yes _~_No The ApplicanUPermittee 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 ApplicanUPermittee hereby acknowledges that [hey have read and understand both the front and hack of this permit, and they will inform their convactor(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 condil~on of any private improvements in the public right-of-way. Permittee) (sign) c Date ~ ~t~ ~~~~~y ~ ` \ 2-~~ Contractor ((Print Name) SPECIAL PROVISIONS _1. Street shall not be open cu[ for underground installations. Minimum cuts may be allowed for connections or exploration holes. Such cuts m~ be specifically approved by the Inspector arior 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 ]-800-227-2600. USA TICKET NO. 5. Prior to any work, the property owner shall execute an Agreement for Private Improvements in the Public Right-of-Way, which shall be recorded. _G. Public Notification Requirements: 7 SEE PUALIC 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 t'Elginee~ sires 12 Months After Date of Issuance Date WEST VALLEY SAF1iTA71QN DiSTRiCT OF SA-V'CA CLARA COllh~Y AMOUNT RECEIPT N0. ~5.~ , s~(S~®G ro 0 w b x O ~3 ~ ~ ~ z 0 0 0 0 ~ 0 0 ~~ WW N o~ ~W ~~ W ~, 0 0 ~~ m d ~~ ~ ~ ~ mo R a m 3 ° m a .~ n ^v n ~' y o ?» c o. x ~ 65 o .- cn o ~ w 0 0 0 ~, °o °o I a ~ o o '-C 0 0 0 ~. 0 0 o a, 0 ~n cn ty ~- ^, N N rs. N N `C7 ~ ~ Q. n n n m m a ~ ~ x o ~ ~ ~ Cam" w w ~ i-r z z c~ d c x ~ ~ ay c ~ 0 `C ryO. G d K ~ O p~ W O ~ o c %1 ~~ m r; ~ y ~ ~ .. ~ z ~ x O ~ O p 01 rj O ~ O I~ O p J ~ 00 ~ ~ W ~ O~ N O rn PUBLIC W.,.cKS DEPARTMENT RECEIPT ERecOve July 5, 2005 A~I' //~~,,JJ~~ ~~J /~ !x' City Ckrk PUBLIC WORKS FILE NO. (/' V (mil ~`~' - ~ ~/~a ~/'/ PROPERTY ADDRESS r J 3 Pl-~~~~ Rease collect & receipt for the fdbwirnp monies: T. IT$M AMOUNT ROACHMENT PERMIT 4722 Applfcatfon Fee Non-Utility Encroachment Pertdt (5275.00) Minor Encroachment Permit < 55.000 (561.00) Residential Street/Odrer Areu (5291.00) Ran Check Deposit 2% of Engineer's Estimate (5500 Mn) Faithfd Performance Security (FPS) (100% of ENGR.ES7'.) Labor aM Materials Security (100% of ENCR. EST.) Manumenlatian Security (100% d ENGR.ESTJ Cuh Deposit (4% of Engr. F'sq(5500 mirJS10,000 max) • Ran Check & lupection Fee (Non-Ulillly) Engr.Esl.<5250,000 (l3%of ENGR.F.SI'.) Engr. Esl. >5250,000 (Deposit S% of Engr. Est./530,000 min)•• Utilty < 5100,000 Midmum Chargc Per Lacalbn ($11{0.00) Conddts/Pipcllnes up to 500 Feet (52.25At) Above 500 Linear Feel (51.35/R) Manhoks/Vadrs/Etc. (5125.00/ea) Pok Set/Removal (5125.OO/ea) Street Tree Ranting/Removal (5135.00) Utility > 5100,000 Actual Cost + 20% •• Storage Container Permit (5125.00) Pnglect Rans 8: SpecNcalbu Protect No. Standard SpecBkatbu & UetaiLs (St/Pg SI5.50/Bk) Copies of Engineering Maps 8: Bans Aerial Rot 24"x36" (554.00) 0722 Penaltks: Fnilurc to correct unsafe conditbu (S10WCalendar Da ) 4722 Work Without Permits (4 Times Applicable Fee) LAND DEVELOPMENT CerliRcate rnf Compliance 5650.00) CertiMate of Correclbn (5400.00) Notary Fee (per slgnwture) (510.00) Vacatbn of Publk Streets & Easements 152,200.Da) Assesarcnt Segrcgatbn or Reapportionment Flr t Shct (5725.00) Each Addilbrel tut (5200.00) Storm Drainage Area Fee Per Acre (R-1 52,120.00) (Mdtl•Res 52.755.00) Ins aher sz.650.00) Due Uoon Cert. Intersectbn Tum Counts (a.m. n Tralfk Row Map (Daily Tragic CamobeB Trallic Model (FWI & Truck Permits No Parkin[ Sh TOTAL 5 / /C • N ~-~ NAME OP APPLICANT)) ~ /(`nJ ~ / ~ ~~ p %/1,~~ ~~ NAME OF PAYOR~` ~ ' ~+ ' V"'VLL~~~N-L'r~ Q~%~r'-e--/ 7.IP ~~ ••Actuxl Cost Rus 20% Overhead rest bearing de' t) / FOR - - .~ ~ ~ _.... CITY CLERK RECL iAY ONLY Dal R i •For Pin cb~ek and enrm Diu, ama yeuow copy to Fl,~are. n#T1/ ' A 1 [T Ift[- A CSI A CI J:Irm~vaapt r rm os-OV re~.frzl ros Li l i t~i t"Hi;GI+E~L, LH itEC.!aIi R'i•: :+~i!i'S I1fUGCiE!~~,~ 7ui!A's"S I!A'tE: t~5,'"1~;"U5 IiEBI~TER I{~1TE: i3t,'?iub TIDE: iI{:~i:ilt i!E•~CnIPTICtn! ~,t~t~tlilT E~4 sr; t~ 3~fyl!I!! Eltltet r *oJs;.+.~0 EfVL~~{ s~ 5llAI!I4+ EItIn!G = ~it+G.i+C T E~~I!EREt; ~ i Iu. ~u I:NNi~GE: ~. A~ ~f r .. .. ~ _.. ~ t 4~: i~1 ,