ENC2011-00052CITY OP CAMPBELL
DEPT. OF PUBLIC WORKS
70 North First St.
Campbell, CA 95008
(408}866-2150
Fax (408} 376-f1958
APPLICATION -Application is hereby made far 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 anon-refundable.}
A. work address pr tract*_ IN FRONT OF 555 EMORY AVE. PM 30842712 (LOC 2)
ENCROACHMENT PERMIT
(for wor'tcing within the public
right-of-way)
Issued `7~(v,~l ~
Permit Expiration Dau ~/7("~l~Z
Pcrntit No r N `•2G 1 1 - aD~5
X-Ref. File
Application Date ;. j ~2 ~' ~~~ ( ~
Applicaaor, Expiration Date
APN N /A
UtiFity trench location
B.Natnrepfwprk REPLACING ELECTRIC TRANSFORMER ON EXISTING POWER POLE - NO DIGGING
C. Attach four (4} copies df an engineered plan showing the IocaLion and ezten[ of the work, and four {4) copies of the preliminary Engineer's Estimate of work. The
plans shall show the relation of the prtlposed work tp existing surface and under~ound improvements. When approved by nc~ City Engineer, said plan becomes a
part of this petirsit.
D. All wprk shalt conform to the City of Campbell Standard Specifications and Details far Public Works Construction: the General Permit Conditions listed on the
reverse side: and tiro Special Provisions fpr this permit, listed below. Failure to abide by these conditions and previsions may result in job shutdown undlor forfeiture
of Faithful Performance Sureties and cash deposits lSec General Permit Conditions 1 and s.)
E. The Contracwr must have this permit and approved plans a[ the site and must notify the Public Works Department at least twp days before starting work. Notice
must be given [o Public Works at least 24 hours before restarting any work.
ROBIN WIBETO (PG&E) Telephone (408)725-2155
Name of Applicant
nt named 800 743-5000
Address 10900 N. BLANEY AVE.,CUPERTINO (~,a. Qi O -~ 24-HOUR EMERGENCY TELEPHONE NO_~_ ~.~EIVED
E-Mail Address RDW8@PGE.COM
Gs this wprk being done by the property nwners at their own residence? Yes X No ~~~ ~ ~ 2011
The Appllcant/Permitux hraeby a~ us by aff[xing their signature to this permit to hold the City of Campbell, its officers, agznts and employers fj~~~i it 1K.S,
from any claim or demand far damages resulting from the work covered by this permit A~1'MIN1$Tf~dAll'~N
The ApplicanVPermictec hereby acknowledges that then have read and understand both the fmnt and hack of this pcmtit and they will inform their contractor(s) of the
infprmation. Applicant is advised that upon issuance of this permit, property owner, or property ownei s successors, shall be responsible for any and alt damages
arising out of the condition of any pt~ i vements }n lhe,publi rtght- way.
- /1~(,/) 5/7/2011
• ----•~a
(Applicant Permitter) (sign)
Date
Contractor (Print Name)
tiara
_l . Strut shall not be open cut for underground installations. Minimum. cuts >~ he allowed for connections or explpranon holes. uch cuts may
be specifically avnroved by the Inspector prior tp Cuttme-
_2. Pavement may be cut for underground installations and must be restored in accordance with. the Standard Details Trench Restoration Method
"A" antes otherwise approved by Inspector.
~3. Work to be staked by a licensed land Surveyor or Civil Engineer and twp (2) copies of the cut sheets sent to the Public Works Department
before starting work.
4 Per Section 4215 of the Gpvemment Code this permit is not valid for excavations until Underground Service Alert (USA) has been notified and
the inquiry identification number has been eatercd hereon. USA Phpne i -800-227-2600. USA TICKET NO.
_5 Pros to any work. the propety putter s.atl cz.:cuu an Agreement for Private improvements in the Pnhii: Righi-pf-'.'v'ay, which shall be
recprded. '
_.__G. Public Notification Ret}uirements:
_7.
SEF PLIALIC WORKS FEE SCHEDULE FOR CURRENT ~-ES AMOUNT RECEIPT NO.
PERMIT APPLICATION FEE $ ~ ~ ~
PLAN CHECK DEPOSIT S
SECURITY FOR FAITHFUL PERFORMANCER,ABOR & MATERIALS ~
CONSTRUCTION CASH DEPOSIT ' S~ -~-
PLAN CHECK d: INSPECTION FEE $
11
APPROVED FOR ISSUANCE
For City Engineer Date
Permit Expires 12 Months After Date of Lssuance
tJ~~. Lit ~1t~ (`t
taEN~RA~L PT~RM~'!` G4ND~TIC?N~
t. A Coaswi.•dbu Cash Deposit is raqujred. Chac¢q sviil 6amada agpitut thic dtposit if (itcse ii an emugrc_acy call-out. 6verdthe ittspeedon •or w$qt Cry
ai¢aad 6umca,tiag Is required. Aby such coats fa excess of thpdt:ppsic wilt trp hilkd Co rite >kitttittee. •
2. A oae-yeanrtaintwatt~periodand'ettrety arorequfrerf. 5iidt period will begra.on data of vniaen accepwtca by tha.Cliy.
3. Tts(urtd of ttrecaah dcpcsit biraac sad rtfaa6 ex tancel(iticn of drt 1•rtidrfo7 Ferfoitttinu S~t'tty wUl fe initiated b}r die writria atta eitloe+aurfr
vY RteGty.
4. Tha 1'amittet muse tegaest iti tvtitirtg x fmai ihspectioa attd accepuaee of the work upi>a ocmgtlttion. Jteceptxtsce by toe City wait be tnsdh ie wtitiag W
fire Permiaec.
~. M aintaia Safe ped~spian aotf vthicular ktbssiags atld•(~ ours ta. privart dtivaways, bus stops; !'fro hydrants and w{tec raive#.
lr. A CotrstraCdon Tra(t~c Contiul Plan aaQ a Coasuixdori SCticditfE are tegnired for alf tare c~bsures; tietouts and sttroct eiosuru. 'this plan must ltc .
rtvidtved ars4 apptpved priorro any iattealosum.
7. The tr6nsaursioa Traffic {;attmi Plan shall eoafoms to tbaCaitnns Manual of•Tntfic CotmdS #or Ctis+sRUCrion and hl~iateaaatx ih'ork2dn~, died
i99d.•ataitabEtatChtttans '}"rat~ioconunla{nip~mtshaBiaalirdeTypcBftasitiagum+vsigrtsifregaited.
3. Rep4'rca as directed by the Citp Fagiatrx any damaged or trmovod improvettrcnts in acwrdance v~ith Crty Standards asd 5pecincauons s the mk
expenseaf the Permiace.
9. SswWt kx hll i'f.'~ or AC removals, Atl i'CC remowls shall be to nearest scorcmark and shalt bes doweled to existing imprit3trnsnts. '
10. Prior approval a( insprctnr is required for any wnA• done situ normal working hours. ao N+takeads•tu• hol;days sad may. rrx(uire retmblrrsrntwt of
inspavoo r~.cu u the cutteru ovtnirae nte.
i t: Adegrertic signistggnd 6writadiag is required on the job spc. F»•shrre to provide such signing and t>arr(cadiag may result .a tftc Cily's pmvidiag signiax
sad barricadts and titargag the rust (including aif tabor sad rtctttriatsi against the t;ash'tlepKrit
i f. Cnrnpactlon msciag of subgrade, base rock. sad asplrait cartcrett: by Permince is requirtd unless athawtsc stated by the City Eaginrxr.
• 13. 'Tire Coutractoc tr Perroittec wl{! have a supervisory represuttative availabix for ca7tatt'on ltte project u all timed'durin~ tansttuMioa. Coausator ar
•YCimlttrx shalt pmvide a phone numlxr at wiiich they can be odntacted ouutde Rio hours of 8:04 aan. to 4:00 p.m
la. Nn'staragt of mntedaB or equipatrnt viii bn allowed trstr the cd8a d pavrmrnt, the tnvefed way,:or wiWin she shouldtriihe •which would create a
harsnfous eondlinrrt to thepubtic - •
i$. This permit Shall n« be taRStistod is:aatt+orintion for excavation sad Sc¢dtng on priiyte pxtperty adpctat to the vbtk or aAY ~'~ wtxt: fu which a
separate peirrnt rcag tit requieid, nor dos it refiovc thu PerrrriUte of oar abfigatian to obinia mty ntF.a pcrrnit rerjv)rett by.,lave.
lb. Tats permit dolts not t'elease this 7ermiuu from any liabilities tontalaed is other agrcuneau ar comiaets with tha City acct ony txhtYpyhlte agency.
i7. Tltir permit i! net uansfenhle. Work roust be performed by the Pcrmictee a his dcsigrtued agttnt or wuuaaor as apeeilied thereon.
19. CnH bacl; (ea(! Lull duo to turrergraraiet regarding this permit shalt bd at the caaent ovutime rata with a aura (3) bhur miraioum charge pu,occvnenEa.
19, Pursaxntm.C.'hapterld,0lb(jhcCarrgtFell3liunicipsECo3c.apy3iwntststliarx.csosctobcdischat8aianymateriafliitoiittuuiriieipitscecm.tG~iosy~teat •
aihc. tftart attxtn water. Applicant s'ha1E edl::.te to drb BE.SS' MANAGEMENT ~R31t':.'fICHS •estatilisln~ by flit-Santa irliss Valtdy l7rbm T._uno(E
Pullntiart prtiveotioh t'rvgtarrt. .. .
2ti. if tite.priblie sstterrst requ'rr4s {r modrfrc'atioa A(, or a dapxnuie from. rite plans attd Spe~ificgatm, the City shall hays dY. du¢tbrity to rer}uiri: tx apprart•
any tnoditiixition`or deparnnzand td specify file trwnrirx in wh'sch the saarait tit be•aradt; for Citywiviied a irtaitiuitied'iaeititiat.
2I, Perntitfed rtuist pidvide-ad0•ance niidflSatTai fo ail parties ltiat may lx affeaied by the'pdrinit ltnivitits: Tiotilicrtibn ~tidlF bt retrjtwt8 hjr City giior to
distrl6udon sad ktctudestncu of wor'a and a contact oarrtc grid phaie nuatber,
wppliGintshail•itaresptwsfbkftxeasutidgthua~UatttuprQ~~idingservittxi>std~tbeapplla+ni,arcdwarccPa>idUnd~atsrdalloLtfiL5bo3'trn4ditlottt •
Appi t ~ ~ '.
• Contractor (Print Name)
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