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ENC2008-00127Sip 23 08 09:02p 40EI_~57 0343 p.7 _, ~ Print Form ENCROACHMENT PERMIT Permit Na ~I~,) C ~ l7 ) ~' "' 1 U ( ~"~ CITY OF CAMPBELL DEPT. OP PUBLIC WORKS (for working within the public X-Ref. File 70 North First Street right f-way) Application Date ~ '~ Campbell, CA 95008 " 1 ~ ~ Application Expiration Date ~- L~._~ Ph- (408) 866-2150 Issued APN ~-24 - ~ ~ t S`~c?' c% iJe l I ~, Fx. (408) 376-0958 q Zy- ~ ~Z - ~ -3 - l D~ C I(F' 1 v Wit; til (~Ut, 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 issued. Application Fee is non-refundable.) ~ ~~o - --- -------- ~~~-~iFt.: A. Work Address or Tract No.: ~i s'ue' - {Yv! o i~e.l l ,ms ___ - -- ~1LC_._1~.~-1~-1~t~- Utility TrenchL«ation: i PUBLIC WCflN(S* _--------_-._-- --__._____-__AC~Ii1A11~11STNAT~ R. Nature of Work: ! ~T T~'~P ~~- 'Po l.e- C. Attach four (4) copies of an engineered plan showing the location and extent of the work, and four (4) copies ofthe preliminary Engineer's Estimate ofwork. The plans shall show the relation of the proposed work to existing surface and underground improvements. When approved by the lily Engineer, said plan becomes a part ofthis permit- d. All work shall conformto the City ofCampbell 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 CondRions 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 before starting work. Notice must be given to Public Works at least 24 hours before restarting any work. t--- ---- - ----- ~e luv-t <.LR~~ Telephone: ---- -----_ . __..._.__-__.._....._.- __. __ Name of Applicant: ; ~-C)"1'Y\C-CP~'~ ----~ - - -- - -- K~rJ~)~ ~ _ I~ Address: I d0 ~~i _ P use-~^,~_ --. Co,~t.c~orr~, C.a- q 4 ~ E-Mail Address: ~~~~ ~ ~ ~ 24-HOUR EMERGENCY PHONE NUMBER: ,~2ce,1~1 _ ~~ cu ble , COvrtctW ~ rC0/h Is this work being done by the property owners at their own residence? r YES ~AIO The ApplicanVPermittee 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 they have read and understand bout 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 an all damages arising out ofthe condition of any private improvements in the public r(ght-of-way. ~~ 3/~ Accepted: "~ f~ (Applicant Permittee) (sign) Date ~~~e~~ ~~ . ~~~ (Contractor) (Print Name) Dale SPECIAL PROVISIONS: 1. Street shall not be open cut for underground installations. Minimum cuts may be allowed for connections or explora['ron holes. Such cuts ma be -specifically approved by the Inspector prior to cuttirtg. 2. Pavement maybe cut for underground installations and must be restored in accordance with rite Standard Details Trench Restoration Method "A",unless otherwise approved by the Engineer. 3. Wark to be staked by a licensed Land Surveyor or Civil Engineer artd two (2) copies of the cut sheets sent to the Public Works Department before starting work. 4. Per Section 421 S of the Government Code this permit is not valid far excavations until Underground Service Alert (USA) has been notified and the inquiry identlflcation number has been entered hereon. USA Phone: 1-800-227-2600. USA TICKET NO. S. Prior to any work the property owner shall execute an Agreement for Private Improvements In the Public Right-of-Way, which shall be recorded. 6. Public Notification Requirements: 7. SEE PUBLIC WORKS FEE SCHEDULE FOR CURRENT FEES PERMIT APPLICATION FEE PLAN CHECK DEPOSIT SECURITY FOR FAITHFUL PERFORMANCEILABOR & MATERIALS CONSTRUCTION CASH DEPOSIT PLAN CHECK & INSPECTION FEE AMOUNT s 32cj S S 5 Z U RECEIPT N0. Q ~`>2- ~ ~ 2`r (a~ APPROVED FOR ISSUANCE For City Engineer Permit Expires 12 Months Aher Date of Issuance ~~ K 4 /1, ~ ~ I j ~~ ~/ Sep 23 08 09:03p 408.57 0343 p.8 ~~5-r Tai , _ ~o ~~~r al ~ ~ ~ s (~ ~.~sTtN~r'~~~ ~7 I ~ G~~ ~ ~~' ~je S~T Sectita~" 4 f s "3 l C, W V O l5 ~'~j / ~, S'~4ti~~ SLwE~ GIs 20 1~~ \Sl 9 p a+fi d+-~5 ~f s ~, nwm ~-- ~tl~ o~-~q~is 1~~ ~~ of S ~' N~ ~~,~o~d T~~ P°~~ bk5~- "1 S 3 ~ sr. (~ a-~-44 afs z ' f~11n/ APPRUVEC~ ~ ~~~ CON'STRUCTI~N. ~ ~ ''~`~ C;i~~ ~xa Campb~li Public ~~~~ ~ ~'~;rmifi ~®. ~~'~~~` °' ~'' ~-~ t~o~ ~~ ~+ raw. ~~~~ an the job ai-a durtrKp cwnarrutrb-r - ~-~;~ ~1~~0 C~-b U ~(S 3 Sep 23 08 09:03p ~~ r ~, ~ ~ ~a~ ~yl~ ~ 7r! d3' ~ r ~~ ~ ~ 1~ b ~~a a ~~~e ~ ~: l 1 ~1'~ ~J r ~! ©~ S ti v 408 957 0343 ~~' , ~ ~~ ,~- ~ ~~ ~ ~ d ~ ~~ ~~ .~ `n '~~, as~ ~a S ~~ ~(~ ~~ v I "~` r~ 5- p.9 ~ ~ b~ f. 4~ r~ F~ Sep 23 08 09:03p 408 957 0343 p. 10 Shoulder Work on Undivided Highways SIGN SPACING ft. TAPER LENGTH ft. t,PT10NAL CHANNELIZ ER SPACING (ft. SPEED Undivided (S) Divided (S) Shoutde (T1) Lane (T2) BUFFER LENGTH (it.) 8 Tapers Buffer! Work Aroas 0-35 200 - 70 - 1Z0 35 50 40-45 350 - 150 - 220 40 100 50.55 500 - 185 - 335 50 100 ti0-70 1000 - 235 - 550 60 100 1 Shoulder taper length based on 10 (t. (standard shoulder width) oTLset 2 lane taper length based on 12 R. (standard lane width) ofset TYPE ROADWAY SIGN MAXIMUM HEIGHT WORK 20NE LENGTH (L) URBAN 1' Portable 1 MI 7' Post . RURAL UNDIVIDED 1' Portable 3 Mi 5' Post . ~ Citannelizer Cone or Drum Protective vehicle ,+, g;y„, ® Truck Mounted Attcnuator (TMA) A6 Truck or Trailer Mounted Arrow Panel ® Wcxk Space Notes: In addition to shoulder work, this typical application is applicable to work beyond shottider where vehicles and equipment are parked on the shoulder. A protective vehicle shall be used while work is in progress. The protective vehicle should be equipped with a TMA and positioned at least 150 ft. in advance of the work space. [f encroachment onto driving surface occurs and there is nvt 10 ft. of driving surface available for the lane of traffic, that traff c lane shall be closed. Refer to appropriate lane closure typical applications. if an arrow panel is used for an operation on the shoulder, the caution mode shall be displayed. For shotrt duration or mobile operations, signs, channehzation devices and protective vehicles may be reduced or eliminated if a work vehicle with activated rotating lights or strobc lights is used. However, if limited sight distance exists in a stationary operation or workers are on foot, a protective vehicle should be used. This protective vehicle should be equipped with a TMA and truck mounted flashing arrow panel and positioned at least 150 ft, in advance of the work space or work vehicle, as applicable. if a protective vehicle is used, a vehicle mounted sign shall be mounted at a recommended height of 48 in. above the road surface. For work beyond shoulder, where vehicles and equipment are parked on the shoulder, the protective vehicle may be eliminated if a work vehicle with activated rotating lights or strobe lights is used. Additional warning signs shall be erected at each intersection with another state highway within the work zone. Upon the discretion of the supervisor, additional warning signs may be erected at other intersections within the work zone. Other appropriate signs may be used in lieu of SHOULDER WORK AHEAD sign. ~ - - i' ~_ r `° ~ 'j~' Protective Vehicle Roll•Ahead Space T1 is i SkIDl1LDER ,,worth AFIEAD' ~c~sT T~rn~. ~ a `~~.lcu~ & Sl cam( S TA-2 Sip 23 08 09:04p 408 957 0343 p.ll ~ ' . r= i i /