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ENC2011-00025~~~ ~~'~ - CITY OF CAMPBE~ '` ~~ ~Q ACHMENT PERMIT DEPT. OF PUBLIC S ~ ~~~~C~bikin; within the public 70 North First St. ~~~~ \G~Q~ t-of--way) Campbell, CA 95008 ~L ~5 /.7 / (408) 866-2150 QJ~~C~ Issued ~/ Fax (408) 376-0958 !~ -~ /7 I L Permit Expiration Date, ~M 30~-~ q q ~ i c~ PezmitNo r~ti~~~Z~~ ~ - ~©Q,2i5 JC-Ref. File Application Date ._;~, - Applicatiar Expiration Date APN ~~~ ' 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 is~sQue(d~.(~JApp~~lic/anon ~Fiee.Ais.,,n/otn-refundable.) A. Work addressor tract # V ~ 1 w" . L.1't f ~ t 1~., ~rn~ Utility vench location 1 ,i B. Namre of work ~ ~ ~ ~~L L ~'~ ~~ C. Attach four (4) copies df an cnr nctxed 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 Ciry Epp Weer, said plan becomes a part of this permit D. All work shall costftmn to the City of Campbell Standard Specifications and Details. for Public Works Construction: the General Permit Conditions listed on the reverse side: and rho Special Provisions for this pertnit, listed below. Failure to abide by these condiuons and provisions may result in job shutdown und/or forfeiture of Faithful Perfomrance Sureties and cash deposiu. fSee Genera! Permit Conditions 1 and 2.} E. The Contcacwr must have this permit and approved plans at the site and must notify the Public Works Depatmen[ at least two days hefore starting work. Notice must be given to Public Works at least 24 hours before restatvng any work. ~ ~ ~A ~j t, }~~-~ Name of Applicant 1' ~ ~~ ~,~~ C'TT~'11`~'~~ Telcphtmc 7 Z°J ' y~~~ _ `"'`-' taro ~~~, ' `-` , n , ro ,^ (print name) Address j~``''~J Vt'(~,p ,JI (,~~f 24-HOUR EMERGENCY TELEPHONE NO.~ E-Mail Address ~~C-4 ~ 1 ~~ a ~d-~ Is this work being done by the propetty owners at their own residence? Yes ~No The ApplicandPermittee hereby acrces by affixing their s'sgaature to this permit to hold the City of Campbell, its officers, agcntc and employees free. safe and humrless from any claim or demand far damages resulting from the work covered by this petmiG The ApplicandPermittee hereby acknowledges that they have rcrd and undersiand•hoth the front and track of this pcrmit_ and they will inform their enntractnr(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 a[I darrctaes arising out of the condition 5/nyJ{~riva~improvemen~t~sin~th~e pu/blic right-of-way.. 1 1-~' ` i Accepted ~~~~tf[!1~'t.31 ~~G" " -' ~ ` 1 ~ l _' l 1 Permiuee} (sign) Contractor (Print Name) Date _1. Street shall not. be open cut for undergrtxrnd installations. Minimum cuts may be allowed for connectsons or exp#orabon hates. Such cuts may be snecificaliv approved by the lnsnector prior m cum. _2. Pavement may be cot for underground installations and must be restored in accordance with the Standard Details Trench Restoration Method "A" unless otherwise approval by Inspector. _~. Work to lx staked by a licensed Land Surveyor or Civil Engineer and two (3) copies of the cot. sheets sent to the Puhlic Works Department before starziag work. ,4 Per Section 4215 of the Govemmrnt Cod; this permit is not valid for excavations until Underground Service Alert (USA) has been nonfted and the inquiry identification aumbcr has been entered hereon. USA Piione i -800-327-2G00, USA TICKET NO. _5 Pror w any wozk. the property owner sfaL' cxc:.urc an Arrecmcat for Private Improvements in the Publir. RightK,f-Way, whioh;hall be recorded. ,G. Public Notification Requirements: 7. SEE PUBLIC WORKS FEE SCHEDtJLE FOR CURRENT FEES AMC}t!NT RECEIPT NU. PERMIT APPLICATION FEE $ r7 C` ~ PLAN CHECK D£POSiT $ 58CUR1TY FOR FAITHFUL PERFORMANCER.ABOR & MATERIALS $ CONSTRUCTION CASH DEPOSIT $ PLAN CHECK & INSPECTION FEE $ APPROVID FOR ISSUANCE~7 ~ ~ ~ For City Engineer Date Permit Expires 12 Months Afar Date of Issuance PG&E Dependency Management Desk 8 River Park Place East Fresno CA 93720 March 2, 2011 Re: Encroachment application To: City of Campbell 70 N 1St St Campbell, Ca 95008 Attached permit application is for the following location: 804 W CAMPBELL AVE Approved permit should be mailed to: PG&E -Fresno RMC Dependency Management Desk 8 River Park Place East Fresno CA 93720 1~ ~ cFi A ~~ ~, ~~ '90 ae~lo ~ ,~~ q~ 1 ~T"y~Rp S N Additionally, please reference our job order #30799716 on approved permit. If you have any questions, feel free to contact ,Robert Chavez, Electric Estimator @ (925) 459-8041 or by email: R3CGCa~pae.com. Thank you, Cheryle Bradley Dependency Management Desk Phone (559) 347-5241 FAX (559) 347-5333 ~=M~=~_ o~z =~ ~~~ ~ e G C r n O C!J ~D r ~~~~ ~d -~ ~~ o~~ t~y'~ ~~~~ .~ a ~ '~ C] O ~Z ~ _ ~ a ~z x z~ y ~ ~ n ~ n a n n d~~ m a a u: c~_ - - ~ a~ g~4~ ma- 4~ & ~ ~ m ~ $ ~ ~ $ " " ~ ~ ~ ~ 5 ~ ~ ~ ~ ~ _ "$ ~ ~i o ~ : ~ e - is ~ . e i <~~4 ~~ sop 4p ~ ~ ~ ~ ~ ~ 4 ~ ~ ~ A ~ F 9 E ~ ~ ~ m ~ ~ ~ ~ ,.444 5y q ss py a ~ e ~ ~sL ~p~ ~ r ~~ ~~ ~ ~ 8 A Y _ X N ~ ~ ~ 4 V 4 4 ~~A ~d ~ ~ ~ Q ~ ~ i SI " ~ ~ ~ ~ 7 4~ ~~ ~~ ~ a~~a ~ ~ ~ & ~ ~'V m ~ ~ V V ~~ ~ ~ e 4 ~Q~ ~~~~ ~~"~~ ~c~~Q ~~ ~ 4 a ~ ~~~ ~ 9 F 2 €,~ 4 ;, q ~ k y ,`-~ R a~ 7Ng~ ~ ~ ~ ~ ~~~~ ~PPROi~ED FAR CC~~ 9STRUCTlOl~ Cit~r ©fi C~ < = ~ aPublic ~~~ ~g~ ~§~~ m~ ~~ ~°~ ~~~ ms~~ ~s ~~ ~'~~ mP~ ~~~^ ~~ ~€ ~~~ ~=a ~~~~ ~~ ~ e~~ a~ a ~_ ~€ ~~~ ~~~ ~~'s~ ~ es ~ g`~' e~ ~ ~~ '~ ~a~ ~ v~ ~qa~ ~Q ~~~ ~ ~~ s~ Ba ~~~ K '£g ~~ ~~ ~~ ~~ w~ ~~ .~~ .~ 4mg ~ ~~ ~„ ~~ ~ ~~ ~ m~ Q ~~ ~~~~ ;~ Br o-~~~ gk ~~ Fp~~~ :F dmpbel! 1~VOrk~ Permit I~a...~ ~,~~~ Contractor must have t hese plans ~ on the job she during construction. ~ ~ O ~ d ~ ~~ fTl ~ -~ ~ ~ "" Z c ~ ~ ~ ~ ~ ~ ~~ AA ~ n n om-' o ~ >= a e m ~ ~ ~ bd D H ~ z m ,. ca ,-- m f'l r Z '-' D r ~ ry ~ r ~ d D ~ -~ ~ ~ Z -~ -~- Wro~ Q ~ ~~ ~~ ~ ~ ~~ ~ ~~ 'R '`~"~ ~,~ 'g s __+encsre~m..xw F _ Fwvnrex as ~~ Z ( ) ~ C ~' ~ f'l C H "" Z mm~ 1-1 3 inn ~33 ~ Oaip.S =~c . r i C r -c _„ n o~ C r Z ~~~~~~ b on ~ n t~ .~ ~ ~~ ~ 00 td y CJ tr" t~ ~ U] y ~z ° z~ z C] x I O~ I ~~ 0 V ~ A ;~ I I N ApPROV~~ ,~~~ c~n~sY~ucTio~o G~~1~ -~~ cam~obell y O n' R ~ Z O m~N=OZ ~ ~ ublic W©r' ~ g y T°J~N' ° .a ~-~._.~.r.. _ ~ g ~ A Car.rrnctur must P~me these plans w o+~a°n ~ ~yN ~ nn ;he joh site du+ing constwdion. ~g myn< I ~~z N D Y o I s z n ~ s ~ I ~ n Arm iT~ N N ~ A Z m I I I D ~A I i No = x ~ z ~ ~ I ~ a y~c jm°z imo n~m Z > Z F j r m~~ A ~ o o< .A r 3 i '; P ~~ ~ ~~ ~ wi ~~ -- - ,_ -i a~ ~ ~ I i -~ ~ _~~~ i II^^ ±N~ ~ ~ ~~~-IS 9 5~ ~i z ~° `~ 0 ~ _ I, ~~~~ ~ ~ ~~~~~~ ~_ ~~ ~~ ~~~3= ~ i ym ZD~mA 11--~~~'/ A N n N !~ ~y-.o° I y m x'r ~ ~~ i ~ `_ i ~I. 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