ENC2009-00117f`"~` c. r ~ ,.
_ ~
QTY pF CAMPBELL ENCRQACHMENT PERMIT Permft No~_ L ~ L ~~ ~ ~~U_~
DEPT. OF PUt3LIC WORKS (for working within the public X-Ref. File
70 North First Street right-of-way) Application Date _ I ~ o _ _
Campbell, CA 95008 - A iication Ex Craton Date
Ph. (408) 866-2150 Issued ~ ~ 7 ~ pp p
_ __..._ .............__ APN _ _._ '¢~~- '" C7 ~ - Off.
Fx. (408) 376-0958
Permit Expiration Date ~~.._~ S ~ ~
APPLICATION -Application is hereby made for a Public Works permit in accordance with Campbell Municipal Code, Section 11.04. {Application expire x
{6j rnunths ifi the permit is not issued. Application Fee isnon-refundable 1
_~____. ~~. ................__-~- W~
r,. ~,varkAddress arhract No.: 248f50 Virginia Avenue. Campbell, California 95008 ~~,/
_ _ ~
utility Trench Location: Point repair to start under the street sidewalk and to extend into the paved stree
is. Nature of work: Open trench to replace 7 feet of broken 4" leaver lateral. Trench will be T x 2' x t,' dee~
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 shoav tl7e relation of the proposed work to existing surface and underground improvements. 4^Jhen approved
by the City Engineer, said plan becomes a part of this permit.
U. Ali vrork shall conform to the City of Campbell Standard Specifications and Oetaiis for Public Vdorks Construction; the General Permit Conditions
listed on the reverse side; and the Special Previsions for this permit, listed below, Failure to abide by these conditions and provisions may result
in job shutdown andlor forfeiture of faithful Performance Sureties and cash deposits. {See General Permit Conditions t and 2.)
The Contractor must have this permit and approved plans at the site and must notify the Public Works Department at least two days befarc
starting work. Notice must be given to Public 1Norks at least 24 hours before restarting any work.
- _
Name of Applicant: 4best Valley Sanitation-District - Jorge Picado Telephone: (408) 378-2407
Address: 100 East 5unnyoaks Avenue. Campbell, California 95008
E-h-1ai1 Address: IjpicadoCr?westvalleysan.org 24-HOUR EMERGENCY PHONE NUMBER: ({408) 378-2407
is this vrork being done by the property owners at their oven 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 dajm or demand fc+r damages resulting from the vaork covered by this permit.
fhe ApplicanL`Permittee hereby acknowledges that they have read. and understand bath the front and back of this penni4 and they will infann 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 priva~mprouer~ents in the public right-of-avay.
Accet:teci:.~a~_I_J~C~ 1 ~~ijT Vti~t~r]r s:7IHIf~ t~'7~p r.rt:~'/. _.._._-_____ Il ~'~ ~.°a
(Applicant Permi tee) {sign] Date
(Contractor] (print Name} Date
SF~IAL PItOV1510N5
t, Street shall not be open tut for underground installations. Minimum cuts be allowed for connections or exploration holes, Such cuts 1d~Y~J'„
spec~S.aJ1y aPproye..~i l)j! t.FjP In~pecto~ri4r to cuttinn.
2. Pavement. may be cut for underground installations and must be restored in accordance witty the Standard Details Trench Restoration tvtet}tod
"A",unless otherwise approved by the Enyineer.
3. 1Nork to be staked by a licensed Land Surveyor or Civil Engineer and kavo {2) copies of the cut sheets sent to the Public Works Deparurient
before starting work.
_.__..____,4. Per Section 4215 of the Government Code this permit is not valid far 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 N0. _ _
S. Prior to any wark, the property ovener shall execute an Agreement for Private Improvements in the Public Right-of-Way, 4vhich shall br>~ W
recorded.
_. _ ___6. Public Notrfication Requirements:~_.__.__
;~E[ PUBLIC WORKS FEE SCHEDULE FOR CURRENT FEES AMOUNT _
PERts'iITAPPLiCATiONFEE $__--~ ~?C,~~.~ .............__
PLAN CHECK DEPOSIT ~
SECURITY FOR FAITHFUL PERFORMANCEILABOR & MATERIALS $...__ N._.____.~_ W._
CONSTRt1CTlON CASH DEPOSIT S
PLAN CHECK&INSPECTIONFEE $-~-~~~r~; ____
APPROVED FOR ISSUANCE
_ __
RECEIPT NO/- ~
---------S~X,.---..._._______
For City Enyineer
Permit Expires 12 Months After Date of tssuance
Z
o ~F
N ~~
~~"^ ~ fA
c::~ U
J Z
iuy~ 2~
y
V~ ~, L-a /I ~ ~~ Z ~ •~~ l~
GENERAL PERMIT tOND1T14NS
1. A Construction Cash Deposit is required. Charges vai11 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.
?. A one-year maintenance period and surety are required. Such period will begin on date of vrritten acceptance by the City.
3. Refund or 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.
.. The Permittee must request in writing a final inspection and acceptance of the work upon completion. Acceptance by the City vdill be made in vrritiny
to the Permittee.
5. Maintain safe pedestrian and vehicular crossings and free access to private driveways, bus steps, fire hydrants, and water valves.
6. A Canstruction Traffic Contra) Pian and a Construction Schedule are required for aH lane closures, detours, and street closures. This plan must be
reviewed and approved prior to any lane closures.
7. A Construction Traffic Contras Pian shall conform to the Caitrans Manual of Traffic Controls far Construction and t~;aintenance W'Vork Zones, dates
13)0, available at Caltrans. Traffic control equipment shalt 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 at the sale
exttense of the Permittee.
9. Sawcut for all PCC or AC removals. All PGC removals shall be to the nearest scoremark and shall be doweled to existing improvements.
10, Prior approval of inspector is required for any work done after Hermes working haurs, on weekends or holidays and may require reimbursement of
inspection costs at the current overtime rate.
t t. Adequate signing and barricading is required on the job site. Failure to pravide such signing and barricading may result in the City's providing signing
and barricades and charging the cost {including ail labor and materials) against the cash deposit.
t ~. Compaction testing of subgrade, base rock, and asphalt concrete by Permittee is required unless otherwise stated by the City [ngineer.
13. The Contraaar or Permittee will have a supervisory representative available for contact on the project at a!I 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.nt.
.4. No storage of materials or equipment tivill be allowed near the edge of pavement, the traveled way, or within the shouideriine 4vhich would create a
hazardous candition to the public.
t 5. This permit shall not be construed as authorization for excavation and grading on private praperty adjacent to the work or any other work far which a
separate permit may be required, nor does it relieve the Permittee of any obligation to obtain any other permit required bylaw.
t G. This permit does not reVease the Permittee from any liabilities contained in other agreements or contracts with the City and any other public agency.
U. This permit is net transferable. Work must be performed by the Permittee or his designated agent or contractor as specified thereon.
1 S. Call back (call out) due to emeregencies regarding this permit shall be at the current overtime rate with a three {3) hour minimum charre per
occurrence.
t 9. Pursuant to Chapter 14.02 of the Campbell tvtunicipai Code, applicant shall not cause to be discharged any material into the municipal storm dran-:
system other than storm water. Applicant shalt adheee to the 6EST MANAGEh1ENT PRACTICES established by the. Santa Clara Vaiiey Urban Runoff
Pollution Prevention Program.
20. If the publit interest requires a modification of, or a departure from the plans and specifications, the City shalt have the autharity to require or approve
any modification or departure and to specify the manner in which the same is to be made for Cityowned or maintained facilities.
~ t. Pennitttee must provide advance notification to all parties that may be affected by the permit activities. Notification shall be reviewed by the City prior
to distribution and include dates of work and a contact name and phone number.
Applicant shall be responsible for ensuring that ail those providing services under the applicant are aware and understand all of the above conditipns.
_ ...~o~~ r! , • ~~c~~} ftle~s}~ Valf $crrx~it u~ia~1 .~-5 ~lt~ .. _ __ /! 'F ~,20[l ~ .
Applicant hate:
Contractor (Print Name) Date:
i~,fURtii,\Tempiates\Encroacitment Permits\Encroachntent Permit STATIC form2.pdf
Rev. 3103
_'~.
{
~~
.
Ws
i .x
E;.. ~>,
x; ~ F
3
~~' c
r°
V'}
'
~fit~
~ ^
~ ~
~~
11
i •r
i E
t
; i
1 .
~ ~
~
l
j
{ i, ~
~ S:
~
1~
>~
^
~` 'j
`~
~j .
pp I
f
I
J >r
I
AP~Rfl~/~~ ~' ~~~~~~~
~; ~3~ ~ }~ ~~P~~
Public WorfL- ~~rmit ~~~ ~~~
(( C :: r. ~ x: aP ~tlttSl /-QyD /~lElp p(p
~ ext tMe ~~b she dur}'ny ,cow
~
'
.ry
'+
i
~, ti
~_ _ .....
M1 ~o
~
...
t. ~ n z<
. ,
.. ~aAi3krt ~ ~ ,".~"}" r
e,
~~ 4y '~`~ a, ~.'~,.. J d .
j :3
$ ~: 7~ ~ t• '~~~ p ~ •
,,, ~;r ~~, k ~ " .
,~-
~$u ti.. *4 /f ~ r Y" tiff ' i C' i
' „
r
+fi
rf
.({~~; ~ ~ r k ~ _+ j'~ is ~
N7y
~, 1~ k 1~~ ~
~~~~~~~
.
S~M~
• 111 ... ~k~ ~'
~
~ ,..........
....
~'~ A d~ ~ , F l~
j ~.a}, .~ ,+Li
"ti ~:..
~
. ~d .. '
,. ~ ~
.
t
j eit
~,5. r1~,~ ~ ; ~
"~ '. r:n ~
u
I' ,~};',
t ~
+l
p -~~ s
i
~,
I ~ ~. ~
i =
v~
~ ~ ~
~p s
e~`; 2 ~ 1~
i ~ s 'YyK;..
~
!
' r
' r ,~ ~ i
~ ~, ~, ~ .'~!"'' x'33.. .6"~~~v"`" ~ ~
R t?. 4 9~ ~~4 ~ 3~ ~,; pc ~
,,,:~ -.~
79~_ ~/J~ ~ , 3
y . ,R q d o • :~ N~ S
.T. ~ e.i `~ r ~ ~ ~ ~ ~ ~ rrt 1~ ~
~. ~
___
p - i~ ~i ` •f jpCk•t '
,_M;..a„,_,.~. 60.0 ,BOO O ?T /K ~ •~- -~\ ~ and 's
j .. :i. ;
~~l ~ N± ~ 1
~; 7 8 ~
„tP ~ ~~ ~y tV,S ~ ~ .~ L I
d' _ ~ ~
9 t 6~ rq*» t !
"c,,~ f ~
;{~ 5' y'\ ~ cpQ ~ ~
t
~ 1 ~'
'~ ~ t
~.~~ ''~1` * _.- 273.2 _ ~ ~~df
i~.~ ~a z~4 ~ ~~'
y9.za M ~ ~ ~ ! lfQ
~ $2 o+q t !, o ~ ~ t'O
~~ M Crzq s +~ ~ ~ - -- - -"_, fib/ , - } ~ /
o. •.st rsf ar • J t
v ~ ~ ~ ,:fin ~ ! - . .
N ~~ $3 ,y ~ +~ ~ r{
r... ~
. ~ ~ 3C i .7 ~ ( J~wEr~ ~V~~f r/ i~ -
• rv
~.. ~ ~~, «. l00~ ,Fyt /
J '
~ "
t.
.. ~2 (S~~ ~ ..~~ '~• ti
D 6 p _ ~ \J ~~ G~
~ 8~ 2s)pQ ry~~',`=
~!~ t sib y (/`A {~r11 ~f .
~ ~ , ~ ~ ~,
tS ~ r~ O V t~'Cs #`J • •y ~~
l`` ~..: .,,, ~ r r
~ ., r~.
..~.. .~
.~ ,
~.~ .~.~
~~, ` ~ ~ ~'` ~xrecl t d b
' Q ~ ~ Baok Pagc 5co1e
...
..
/~i'/~ ~ /
x ~! ~~~ 13 ;"=10Cis ~"
Q