ENC2011-00055CITY OF CAMPBELL
bEPT. OF PUBLIC WORKS
70 North First St.
Campbell, CA 95008
(408) 866-2150
Fax (408)376-0958
ENCROACHMENT PERMIT
(for working within the public
right-of-way)
Issued 6~3 / ~
Permit Expiration Date ~ 12
Ptrntit lvo tN~ z~ I ~ = ac~cs~
X-Ref. File _
Application Date 5/ 2011
Applicatior, Expiration Date l i/~ I/ I l
APN `~ ~ ~ 31f" C) 3 Cc
APPLICATION -Application is hereby made for a Public Works Permit in accordance with Campbell Municipal Codc, Section I l .04. {Application expires in six (6)
months if the permit is not issued. Application Fee is non-refundable.)
A. Work address or traet# 1250 HOFFMAN LN. PM 30842715 LOC 2
Utility trench location NO TRENCHING
E.Natnreofwork REPLACE OVERHEAD TRANSFORMER ON EXISTING POWER POLE
C. Attach four (4} copies of an end veered 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 under~nund improvements. When approved by the City Eng~eer, said plan becomes a
part of this permit.
D. All wor4 shalt conform to the City of Campbell Standard Specifications and Details for Public Works Construction: the General Permit Conditions listed an the
reverse side: and the Special Provisions for this permit, listed below. Failure to abide by these conditlcros and provisions may resuh in job shutdown anrLor forfeiture
of Faithful Performance Sureties and cash deposiu (See General Permit Conditions I and 2.)
E. The Contracwr must have this permit and appmved pleas 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 ofAppiicant ROBIN WIBETO -(PG&E) Tdephime (408)725-2155
10900 N. BLANEY AVE., CI~~EtF~~INO S19 `~
Address 24-HOUR EMERGENCY TELEPHONE N0.~8O0)743-5000
E-Mail Address RDW8@PGE.COM
is this work being done by the property owners at their own residence? Yes X No
The ApplicanUPermittee hereby a~~rees by affrxing their sia afore to this permit to hold the City of Campbell, its officers, agents and employees fret., safe and harmless
fmm any claim or demand for damages resulting from the work covered by this permit.
The Applicant/Perminee hereby acknowledges that they have read and understand both the fmnt and hack of this permit, and they will inform their ccmtrattnr(s; of the
infonnatitm. Applicant is advised that upon issuance of this permit, property owner, or property owner's successors, shall be responsible for any and alt damages
arising out of the cemdition of any private improvements in the pu n of-way/- , Q
Ac~ptea ROBIN WIBETO f ~,~~' 4/•,~`•"~ 5/12/2011 ..
(Applicant Petatittee) (sign} pate
Contractor (Print Name) l?ate
SPECI AL PROV ISlONS
_l. Street shall not be open cut for underground installauons. Minimum cuts may he allowed far connections ar exploration holes. Such cuts may
be snecificaJl~proved by the insaector prior to Cutting. -
_2. Pavement maybe 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 5urvtyor or Civil Engineer and two (3) 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 ~mhd for excavations unril Undcr~ pond Service Alert (USA) has been norified and
the inquiry identification number has been entered hereon. USA Phone { •800-227-2600. USA TICKET NO.
~5 Pror to aay work. the property owttcr sta!1 cx,:cutc an Agreement for Private ]mprovemenv m the f'u:.ii: Right-of-.Vey, which shall be
recorded.
_G. Public Notification Requirements:
7
SEE PCIBLIC WORKS FEE SCHEDULE FqR CLIRRENT 1 ~'E.5 AMOt7NT RECEIPT N0,
PERMIT APPLICATION F'dE $ 35O
PLAN CHECK DEPOSIT $
SECURCTY FOR FATT'HFUL PERFORMANCEJLABOR & MATERIALS $
CONSTRUCTION CASH DEPOSIT $
PLAN CHECK &. INSPECTION FEE $ ~ U
APPROVED FOR [SSUANCE ~r3~/ I
For City Engineer Date
Permit Exuires IZ Months After Date of ksuanee
'tVt71LL~1~1nIIWOb
Syl~`IOM 01~8f1d
t~OZ l ~ AdW
~~l~EItAL PERMIT CONDITIONS
t. A Construction Cash Deposit is required. Charges will ba made against tilts deposit if there is an emergency cail•out, overtime inspection or when City
ordered barricading is required. Any such costs in excess of the deposit will be billed to ffie Permittee.
2. A one-year maintenance period and~surety era required. Suclt penal will begin on date of written acccptanw by the City,
3. Refund of the cash deposit balanco and refund or cancellation of the itiaithfu) Performance Steely wilt bo initiated by the written axeptanca of the work
by the Clty..
4, The 1'ennittee must request in writing a final inspection and acceptance of the work upoa cotnplction. Acceptance by the City wilt Ixs made in writing to
the Permittee.
5. Malnroin safe pedestrian and vehicular crossings and free access to private driveways, bus stops, fire hydrants and water valves.
G A Construction 'CYa~c Control Plau and a Construction Schedule era required for all lane closures, detours and street closures. This plan must be
reviewed and approved prior to any lane closures.
7, Tha Coasttuctiott Traftc Control Plan shall conform to the Cnitrans tvfanual of Traffic Controls for Constmction and Maintenance Work Zones, dated
1990, available at Ca[ttans. Traffic rnatrol equipment shall include Type Il flashing arrow signs if required.
8. Replace as directed by the City Engineer arty damaged or removed itnprovetnettts in accordance with City Standards aad Spectfications at the solo
expatse of the Permittee.
9. Sawcut for all PCC or AC removals. All PCC removals shall be to ttcarest scoremark and shall be doweled to existing improvements.
LU. Prior approval of inspector is required for arty work done niter normal working hours, on weekends or holidays and may require reimbursement of
inspection costs at the current overtime rite.
11. Adequate signing and barricading is required on the Job site. Failure to provide such signing attd buricading may result in the City's providing signing
and barticadcs and charging the cost (including all labor and materials) against the cash deposit
12. Compaction testing of subgmdc, Vase rock, and asphalt conctrte by Permittee is requited unless otherwise stated by the City engineer.
13. The Conuaetor or Permittee will have a supervisory representative available for contact on the project at all times during constcuetion. Contractor or
Permittee shalt provide a phone number at which they eau ba contacted outside ttla hours of 8:110 a.m. to 4;00 p.m.
___ _
--
14. iVo storage of materials or equipment will rte allowed near lire edge of pavement, the traveled way, or wilhia the shouldcrline which would crwte a
hazardous condition to the public.
I5. This penult shalt not be construed as authotizatiott for excavation and grading on private properly adjacent to the work or arty other work for which a
separate permit tray be regitirtd, nor does it relieve the Permittee of any obligation to obtain anyother permit required by law.
16. 'dris permit does not release lira Permittee from any liabilities containctl in other agreements or contracts with the City and any other public agency.
17. 'flits penult is not transferable. Work must ba performed by the Permittee or his deslgtrated agent or contractor as specified thereon.
18. Cult bsck (call out) due to emergencies regarding this permit shall be at the current overtime rate with n three (3) hour minimum charge per occurrence.
19. Pursuant to Chapter 14.02 of the Campbell Municipal Code, applicant shall not cause to be discharged any material into the municipal storm dtaitt system
other than storm water. Applcant shalt adhere to the REST MANAGBMEIVT PRACTICPS established by the Santa Clara Valley Urban Rwtolf
Pollution Prcventiort Program,
20. if the public interest requires a modification of, or a departure from, ilia plans and specifications, the City shall have the authority to require or npptovc
any tnodiftcation or dgrarNre and to specify the manner in which the same is to be made for City-owned or mainhalned facilities.
21. Permittee must provide advance notification to alt parties that tray be affected by the permit activities. Notificotion shall be reviewed by City prior to
distribution and include dates of work and a corrtact name and phone number.
Applicant shall be possible for ensuring diet all those providing services under the applicant arc aware of and understand all of the abovo conditions.
.. ~J ~ /~~
ri
n ~ Applicant ~ ~~ ~ ~ Data
Contractor (Print Name) Date
]lforms~pwperm ,
Rev. 11/9105
~ lLZ~80~ .~d
t ~0 t ~1HS
~b3H10
66~9fZ50t ~'~IlON
~OS
:0~
.lNb'dWO~ ~12i1~3~3 aN`d Sd~ ~I~I~'dd
A1Nf10~ VbVI~ V1NVS ` 1138dWV~
Nl NVW~lOH OSZI`l~ VWOI l3U SSL~
S,Xl HO U30VOla3A0 3~dld3b
H~Z~IS ZIyII~~d
N'
Z
O
U
0
xx
~~
J J
Q Q
zZ
op
z~
W Z
' W
Z ~
OZ
U U
2 =
O O
8g
aQ
>>
Y Y
N ~ O
ZN~A
O W J
H ~ J
U ~ ~
N
~~z
00
W
`~,•
s`R, A~v ~V ~ 1~G
~~~ ~ , o''
_.~
Q i ~,o~~ ~''~~ ~ ~
Q '~ s.
~ ~~ ,
GP ~ ti
z~ ~ ~~
~ '`~tiF.
s ~h os s°. ~°o
S 8 !~ ~
~- W ~~` F
Z V ~~
.. ~ J~~ o
a
~~
o~
~a
Z ~ M,
I U
as
Q_
~L
' V ~ ~ ~ p O ~ OpO o
N r °m M cro
r r N 1~ N nM
IA ~ M C7
i N °1
~ ~ ~~~
~ ~ .~
- - --~ -
_ n~z- arr/z ~z~ __ ~ ~
r
421 ~N144321 Ol IW ~' -~
'N1 N`dW~~OH N m
t toZ~t
~31Va
U_
~
O ~
Q NN
O ~ ~
Z~
y ~ of
O~Z N O ~
O MQ N Q
i~ q0' SJ89,~
~ a N~
r
~ 4
0
R p• ~9~i
A ~ ~ ~~~~
LOM
~g9
~ 3~ Y