ENC2011-00063 ~o
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CITY OF CAMPBELL ~
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DEPT. OF PUBLIC w
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70 North First St
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Campbell, CA 9500 y
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(408} 866-2150
Fax (408) 376-0958 ~ ~J~~~
~ROACHMENT PERMIT
working within the public
Issued
Permit Expiration Date ~~( 2
PermitNc~ ;/NGZLII-~C~C~(c~~~
X-R-f. File
Application Date 06/07/11
Applicauor; Expiration Date_ 121.E / I I
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)
A. Work address ortract# 511 Campbell Ave pm30846684
Utility trench location 26' from south property line
B. Nature of work tap hole 4' x 4' over gas main to abandon gas stub
C. Attach four (4) copies df an engineered plan showing the location and extrnt 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 City Encineer, said plan becomes a
part of this petmit
D. All work shalt conform to the City of Campbell 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 beiaw. Failure to abide by Chest conditions and provisions may result in job shutdown andlor forfeiture
of Faithful Performance Sureties and cash deposits. (See General Permit Conditions I and 2.)
E. The Conracwr must. have this permit and approved plans at the site and must notify the Public Works Department at least two days before starting work. Notict;
must be given to Public Works at least 24 hours before restarting any work.
Name of Applicant PG&E---John Gambucci Telephone 725-2153
Address 10900 N Blaney eve, Cuper~'no `~~14 gq_HpUR EMERGENCY TELEPHONE N0. 1-800-743-5000
E-Mail Address JJGJ@PGE.COM
(s this work lacing done by the property owners at their own residence? Yes x No
The ApplicanUPermiitte hereby awes by affixing their sia awrc to this permit to hold the City of Campbell, its officers, a~entc and employers free, safe :rod harmless
from any claim ar demand for damages resulting from the work covered by this permit.
The Applieant/Permittec hereby acknowledges that they have read and understand both the fnmt and hack of this pt.~rrrtit and they will inform their contra::tor{s? of the
information. Applicant is advised that upon issuance of this permit, property owner, or property owner's successors, shalt be responsible for any and all damages
arising out of the condition of any private improvements in the bC ght-of-way.
Accepted John Gambucci ~ 06/07/11
(APPIi:.ant Pemtittee) (sign) Date
PG&E 06/07/11
Contractor (Prink Name) Date
_I. Street Shalt oat be open cut for underground installabons. Minimum cuts l~ be allowed for connections or exploration hales. Such cuts may
/ y be specifically approved by the insoector prior to cuaine.
Pavement may be cut for underground installations and must be restored in accordance with the Standard Details Trench Restoratior, Method
"A", unless otherwise approved by Inspector.
-_3. Work to be staked try a licensed Land Surveyor or Civil Engineer and two (2) copies of the cut sheets sent to the Public Works Department
before starting work.
~4 Per Section 4215 of the Govemmcnt Code this permit is oat valid for excavations until Underground Service Alert (USA) has been notified and
the inquiry identification number has beta rntered hcrecm. USA Phone 1-800-227-260(1. USA TICKET NO.
~5 Prcr to an}' work. L4c property owner sP.ali cx;.cutc an Agrecinent for Private Improvements m the Public night-of-VJa}', which shall be
recorded.
_6. Public Notification Requirements:
SEE PLIBLIG WORKS FdE SCH£DIJLE FOR CiJRRENT FEES AMOUNT RECEIPT NO
PERMrt" APPLICATION FdE $ 3 5a
C,
PLAN CHECK DEP051T _
SECURITY FOR FAITHFUL PERFORMANCElLABOR & MATERIALS $
CONSTRUCTION CASH DEPOSIT
PLAN CHECK fi INSPEC
0 $
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T7
N FEE n $
APPROVED FOR tSSUA
For City Engineer ` Date
Permit Expires l~ Months After Dare of Issuance
GENERAL PERMIT CONDTI'IO?~S
4. A Construction Cash Deposit is required. Charges wilt bt tirade against this deposit if there is an emergency call-out, oveRitne inspection or when Ciry
ordered barricading is required. Any such costs in txctss of the dep~it wilt be bitted to the Perniittee.
?. A one-year maintenance period and. surety are required.. Suds period Witt begin ~ data of writttxt aecepmux by the City.
3. Rtfsmd of tits rash deposit balance turd refund cx rsacr23arion of du Faithful Perforrnanct Surety will bt initiateri by tilt writsm acxptancc of the work
by the City.
d. The Permittee must request is wriaag : Fi>ul itispeceion and acceptance of tae work upcm campletioa. Acceptatux by the. City wilt be made in wtitiag m
the Ptrmiaee.
5. Maintain safe pedestrian and vehicular crossings and free access to private driveways, bus stops, fire hydrants and water valves.
6 A Construcrian Traffic Control Plan and a Coassrtzctioo Schedule arc required for all tans closures. detours and StreU closures. This plan must bt
teviewul and approved prior to any tent closures.
7. The Construction Traffic Caatrol Plan shalt raafarm to she Caluzns Manual of Traffic Controkt for Construction and ~taiutrnanct 17R+'ork ZAnrs, dated
1990. available at Caltraau Traffic cocttrtil equipment. shalt istchtde Type II i}ashing arrow signs if regtired.
3- Replace as directed by the Ciry Engineer any damaged err removed improvtmutts in accordance with City Standards and Spenifications at tl~ sole
exptast of the Pertnittee-
9. Sawcut for all PCC or AC removals. Al! PCC removals shad be to nearest scortmark and shall be doweled w existing impmvements,
30. Prior approval of inspector is rtquiretii for any wank done afar aoxntial working hours, on weekends or holidays and may require rtimhu:seniertt of
inspection costs n the arrrent overtime rate.
11. Adequate 5ignina attd bamading eS required on the job site. Faiiurt tti provicit such signing and barricading may result in the City's providing sigriioi
and barricades and ciurgiag du cost (inca~ng alt tabor aad irrutxials) against life cash deposit.
12-. CompacUOn testing cif subgtade, base rcxk. and asphalt catcrete by Permittee is requrrtd unless titherwist stated by the City Etginett.
l3. T'he Contractor or Permittee will have a supervisory represtntativt available for contact on the project at all times during cartstruction. Contractor or
Ptrmiaee shall pmvide a phone number at which they can be contacted outside the hours of 3:00 a.m, to 4:011 p.m.
!4. No swage of materials or equipmtrtt will be allowed near the edge of pavancnt, the traveled way. or within the shxwklerline whica would crtare a
hazardous coaditKm to the public.
t5. Ttus permit shall not be asnsutred as authorsratian fas• exctvation and grading on private property adjactat w flit work or say otleer aaxi: far which a
5tparatt per:rrit rna..y br required, nor dots it relieve the Ptrrriitter ofaay obligation to obtain any outer permit rrgcured bv.taw
i G. This pcrtnit dots not release the Ptrmittec from any liabilities Containtd in other agtraxtunts or Contracts with the City aril any other public agtacy
17. This permit is not transfessbte Work must be performed by the Pcrmittec or his designated agent or contractor as specified thereon..
! 3. Cali back. (call one) due w c,riergeneies regarding this permit shall beat the cuirtnt overtime raft with a three (3} hour tniamum charge per accttrrrncc.
19. Pursusnt w t~iapta t d.fl2 of dse CarrrEibdl Municipal Cods, applicant shalt not cause tti be discharged any matti•iat into the irumicipat'storm drain system
rxher than storm ware. Apphcsnt shalt adktre m ttic $EST MANAGEMEIr'f PRACTICES Cstabiishod b'Y the. Santa Clam Valley tlrfian Runoff
Polhttion Prevention Progtame
20. If der puhfic interest requires a ttrodificaooa of. or a departure from. the pleas and specifications. the City shall have the authority to rtquirt or apprtrve
any modification or deparnire and to specify the rttanner in which the sats~ is to tit trade for City-owned or maintained facilities.
21. Pcrmitttc must provide advance notification ro al! parties that may be affecud ny the permit activities. Notification sha11 bt reviewed by City prior ct~
disabutios aaG in~luci:. dazes o` work and a conta,^t name an3 phone nuaibcr.
AppLratit wall be responsible for enaruing flier all those providing savica uridet tht applicant arc aware of and understa:td alt of the above conditions..
John Gambucci ~~ ~,~~~~,'" 06/07/11
Date
PG&E 06/07/11
Contractor (Print Name} Date
hfornu~pwperm
Rev. l l Nr05
PG&E Permit Sketch for: City of Campbell
Address:511 Campbell Ave
Nature of Work: Abandon Gas Service at Main
Surface: Asphalt Cut in Street Excavation size: 4' x 4' x 4'
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