ENC2011-00084CITY OF CAMPBELL ~~
DEPT. OF PUBLIC WORKS
70 North First St. J
Campbell, CA 95008 ~~j~ ~~~~
(408) 866-2150 VV
Fax (408) 376-0958 ~~j, > ,C
VV ~~~ JG~
ENCROACHMENT PERMIT
(for working within the public
right-of--way)
~! ~~
~rmit Expiration Date ~ ~ ~2
Permit No EN'C2011- 0~~4
X-Ref. File
Application Date - 8~ 1 ~ l 1
Applicatio2n Expiration Date 2-~~ 1
APN __ 3Q5.~-7 CXi2J
APPLICATION - Apphcation is hereby~~,~~'or 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. App Fee is non-refundable.)
A. Work address or tract # 3 ~~
Utility trench location L
B. Nature of work ~ O.~ ! ~i _ C -~. ~~ U ~A /~Q~ ~ / h sf~ LY! P _ /Z rt /,O_.~
C. Attach four (4) copies of an engineered 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 City Engineer, said plan becomes a
part of this permit.
D. All work shall 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 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 Conditions 1 and 2.)
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 l/e~ast 24 hourecs before restarting any work. Q (~ J g ~j ~,/ p
Name of Applicant / ~ al G Ja ~ ~ ~ y / ` / v ~ .Telephone !~ D - ~1. S Z„O .~ y
(print name)
Address O O ~ ~ p 24-HOUR EMERGENCY TELEPHONE NO.
T-
E-Mail Address
Is this work being done by the property owners at their own residence? Yes ~No
The ApplicanUPermittee 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 ApplicanUPetmittee hereby acknowledges that they have read and understand both 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 and all damages
arising out of the condition of any private improvements in a public right~of-way. ~+ /
Accented ~~~ /. L. ~ . ~/~b /G
(Applicant
Contractor (Print Name)
Date
Date
SPECIAL PROV ISIONS
_1. Street shall not be open cut for underground installations. Minimum cuts ~ be allowed for connections or exploration holes. Such cuts may
be specifically approved by the Inspectorprior to cutting.
_2. Pavement may be 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 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 Government Code this permit is not valid for excavations until Underground Service Alert (USA) has been notified and
the inquiry identification number has been entered hereon. USA Phone 1-800-227-2600. USA TICKET NO.
_5. 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
AMOUNT RECEIPT NO.
PERMIT APPLICATION FEE $ -3~°0 ~_
PLAN CHECK DEPOSIT $
SECURITY FOR FAITHFUL PERFORMANCE/LABOR & MATERIALS $
CONSTRUCTION CASH DEPOSIT $
PLAN CHECK & INSPECTION FEE $~
APPROVED FOR ISSUANCE ~~ ~~~~( I
For City Engineer Date
Permit Expires 12 Months After Date of Lssuance
cfrr~~~~zA>; ~1/xivzaa~ c~i~aar~rxoivs
I . A Construction Cash Deposit is required. Charges will be rrr:tde against this deposi[ if then: is an emergency cal6aut, overtime inspection or when C:ify
oedtred barricading is required. Any such costs in e?ccess of the deposit will he billed to the Permittce.
2.. A one vest rnaintenaucz, period and surety arc required. Such period will begin art date of written acccptant:~ by the Chy.
3. Refund of the cash deposit balnnec and refund or eaucellatien of tht Faitltfnl Per~Ftrrrnarrce Surety v:ill tan initiated by the .vrittrn arccpiaucc crf the tcorl:
by the City.
4. Tlrt Permittee must request in writing a Final inspection and acceptance of the work upon camplelion. Acceptance by the City will be made in writing to
the Permittee.
5. Maintain safe pedestrian sad vehicular crossings and fret access to private driuea~ays, bus stops, firs hydrants and water vah~es.
C,. A Construction Traffic Control Plan and a Construction Schedule are required for all lane closures, detours and street. closures. 'Chic plan must be
reviewed andapproved prior to any lane closures.
7. The Construction Trafftc Control Plan shall conform to the Caltrans Manual of Traffic Controls for Construction and Maintenance Work Zones, dated
1990, available at Caltrans. Traffic control equipment shall include Type II flashing arrow signs if required.
8. Replace as directed by the City Engineer any damaged or removed. improvements in accordance with City Standards and Specifications at the sole
expense of the Pennittee.
9. Satacut for all PCC or AC removals. All. PCC removals shall be to nearest scoremark and shall be doweled to existing improvements.
10. Prior approval of inspector is required for any work done after normal working hours, on weekends or holidays and may require reimbursement of
inspection costs al the current overtime raft.
11. Adequate signing and barricading is required on the job site. Failure to provide such si},nring and barricading may result in the City s providing signing
and barricades and. charging the cost (including all. labor and materials) against dre cash deposit.
12. Compaction testing of sutrgrade, base rock, and. asphalt concrete by I'ermitlee is required unless otherwise stated by the City t3nginecr.
13. Tire Coahaetor or Pennittee will have a supervisory representative available far contact on the project at all times during construction. Contractor or
Penmittee shall provide a phone uutnber at which they can be contacted outside the hours of 8;00 n.m, to x:00 p.rn.
14. No storage of materials or equipment wilt he allowed near the edge of pavement, the traveled way, or within the shoutderline which would create a
hazlydnus condigon to 4he public.
I5. Tl»s permit shall not be construed as authorization for excavation and grading on private property adjacent to the work or any other work for which a
separate permit may He required, nor does it relieve the Permittee of any obligation to obtain any other pemrit required by law.
1G. This permit does not release dre Pennittee from any liabilities contained in other agreements or contracts with the City and any other public agency.
17. This permit is not trtnsferahle. \Vnrk must be performed by the Pcrmittce or his designated agent or contractor as specified thereon.
i 8. Ca11 back (call otn) due to emergencies regarding Ibis permit shall heat the current overtime rate with a three (3) hour minimum charge per occurrence.
19. Pursuant to Chapter l AA2 of the Campbell tr4unicipal Code, applicantshall not cause to be discharged any material into the municipal storm drain system
other than stomr water. Applicant. shall adhere to the EEST MANAGBMENT PRACTICES established by the Santa Clara Valley Urban Runoff
Pollution Prevention Program.
20. if the public interest requires a modification of, or a departure from, the plans and specifications, the City shall have the authority to rcquira or approve
any modification or departure and to specify the manner in which the same is to be matle for City-owned. or tnaintaincd facilities.
yl. Nernrittee must provide advance notification to all parties that may be affecced by the permit activities. 1\otification shall be reviewed by City prior to
distribution and. include dates of work and a contact name and phase number.
App}leant shall ~ responsible for ensuring thntall-tl
i
~ ,~ ~~~ -~ Applicant
services under the applicant are aware. of and understand all of the above conditions.
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