ENC2011-00096CITY OF CAMPBELL
DEPT. OF PUBLIC WORKS
70 Notch First St.
Campbtll, CA 95008
(408) .866-2150
Fax {40$) 376-0958
ENCRaACHMENT PERMIT
(for working within the public
right-of-way) ~ /
Issuea ~Y 23 / I t
Pctmit Expiration Date ~~~~
Ptxtnit No ~EN C2.C ~ 1 - ~, 009 C~
X-Ref. File
Application Date _ ~~ ~2 Z~ - 1
Application Expiration Date_~ ~22~(
APN_ NSA
APPLICATION -Application is hereby made for a Pub&c 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. W ork address or tract ~ `/~/C/Cf~~S~i~2 F.3G 1~,p ~ ~/~GO~
Utility trench locationj~~ti%~7L-~~ ~L/.~ .3~~ ~ T~~/Q/e~/Cl~i/J4/~ /ejy~/G,f7~-/ ~f/F,
T` W O s//Nc.5~8s77~ .G3Lt/
B. Nawre of work ~~t.'C.~ /~~rrC' ~2 1 BEC Liter, t~~ ~~~~ / '~TiiGL f' 2J f~.eLS -SAY-z(~1~~~
C. Attach four {4) copies of as 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 improvemnts. When approved. lay the City Engineer, said plan becomes a
part of this permit
d. All wort; shag conform to the City of Campbell Standard 5pecificatitms and Details for Public Works Construction; the General Permit Conditions listed on the
reverse side: and the Special Provisions for this permit, listed bekaw. Failure to abide by these cwtditions and provisions may result in job shutdown and/or forfeiture
of Faithful Perfarrtance Sureties and cash deposits. (See General Permit Conditions 1 and 2.)
E. The Contracot>< must bout this :permit and approved plans at the site and must notify tine Public Works Department at lost two days before starting wori;. Notice
must be given to Public W/orks at toast 24 hours before restarting any work.
Name of Applicant ~+4 >~ Telephone ~ - SZ ~~ b7
(p ' aam,,e~
Address, 0~ .471~'G.CJ7JN ,~l/~ ~nVQ~Tl 24-HOUR EMERGENCY TELEPtinNE Nl~._
E-Mail Address G~,Oe S ~ /°~~~-~
is this work being done by the property owners at their own residence? Yes _~,No
The ApplicantlPermittee hereby agrers by affixing their signature W this permit to hold the City of Campbell, its officers, agents and employees free, safe and harmless
from any claim or demasrd far damages raulting from the work covered by this pantie.
The ApplicantlPermittee hereby acknowledges that they have read and understand both the frc»rt and hank of this permit. and they wit! inform thtir conttactnr(s) of the
information. Applicant is advised that upon issuance rs pumit, property owner, or property owner's successors, shall be responsible for any and all damages
arising out of the condition of any pri 3adi~lp~v menthe public rigitt-of-way.
_//
licant Permitter) (sign) Date '• F
~~~~ ~ /mil/
(Print Name)
_l . Street sha11 not be open cut far undergnxrnd insrallauons. Minimum cuts ,thy be allowed For connections or eatploration holes.. Such cuts mgy
be soecifipally aptnyved by the. lnsaecuar prior m cuthne.
!,~?. Pavemeai ttsay be cut far undcrgrottnd installations and must be restored in atattdance with rho. Standard Details Trench Restoration Method
"A", unless otherwise approved by Inapcttor.
~3. Work to be staked by a licensed Land Surveyor or Civil Engineer and two (2) copies of the cut sheets sent tp the Public Works Department
before starting work.
,_4. Per Section 4215 of the Governmcat Code this permit is not valid for excavations anal Underground Service Alert (USA) has bees notified and
the inquiry identification number has ban entered hertaoa. USA Phase 1-806-227-2600. USA TICKET NO.
,S. Prot ua any work. the: property owns shat; Cxttutc an Agreement for Private ltnprovemenu in the 1`nblic Right~f-Way, which shall be
retarded.
_,_G. Public Notification Requirements:
7.
SEE PU)3LIC WORKS FEE SCHEDULE FOR Ci1RRENT FEES AMOUNT R~ 1~ P'T N0.
PERiv11T APPLICATION FEE S ~~~
PLAN CHECK DEPOSIT
SECURITY FOR FAITHFUL PERFORMANCElLABOR & MATERIALS $
CONSTRUCTIOTI CASH DEPO$TT` S y
PLAN CHECK do INSPECTION FEE ll $~ (~`
APPROVED FOR.
For City
Permit Expires i2 t
AU1G 2 2 2Q19
PUBLIC WORKS
~MtlMr.~'T~!~TI~N
After Date of 15suante
08123/2011 08:29 4' 991089 PGE 308 S' ;TON SJ PAGE 02102
~EIY~RAL pERMI~' CdNDITTd11?S
1, A Codso~uetioa Cash'Dept~sit is retltarnd, Chseget will be: uWde agvtrS1 this deposit if tJtera is as etrlergYttey tail-ottl, ovtYtiine istspectitm or when City
ordoed barrltading is regtrired. Any snob ~ in excess at the deposit wilt be billyd za dsc Ferntiaet.
?. A tilu-yc:V IIiilifti3aflC~ ptriad and sllll•ly d!! fGquitEd. S4ti! period will bogie 4h date of anitua aeteptutce by c6e Cary.
3. Refattd of tits nsh tleyUSit oalaooe ttttd tC`gnd Or ~* -n'«w of the FaitSrul P~":ormaace Snerry will br iaioated iyy ibe wriYSCa astee of the vaCelt
by rite ~. ~ .
a- The Pccdrs~ mmt tegng5t in wcittn;: ~a# ittsp~titxt and s= rptmca v; [>L work ttt~e actmpidiea, Attept>ace by ale Ciry will lte rm~;. in wzt~ a
the Pcrrtuaes.
S. M,aimain sate pedestrian and vthicuiar LTpatiq~ add fry access ro private dtivewaya, bas atttps, fire hytlranls and water waives,
6. A Cnestrucdon TrafAe Conant Platt and a Coastrtuvoe Schedule ate required for al.l lane closnrss, rlt:toms and strew tltattr~, This pmn must be
tzviewad and ap}ntsved prior to any oat: ekttxsres
7. 'lire Cansaneamt 7'tafftc Gmavi Plats ~alr tx7afottn W the Caltrarss Maawl of 7:~c Controls for COnm„tzia+t and IVtainom~tse Wort 2nna, woad
1994, a.av1>eb~ at Caltrms. Yoffie ean+zoT gvipmtat shaII iechtde Tapt:la llasittag arrnxr suss if rscmr~
8- Replace as tiimcted by dr_ CirY Engineer any damaged a rC'nttvgd improvQ-rents in nt:cwtdance wilt Gry Stsndatde anti SpGrinsstienx st the sale
raptytSe 4f the pefYatrt~.
4. 5aweut for all pCC ar AC remevsls~ Atl FCC rentgva,Js ehall be to nearest scort:mark and Shall be doweled a existing imprnvemeftts,
10. PriCr apprdval of iltspt>:tor is required ftr ttpy work done afro normal wonting hours, an weelce;tds rn holidays and may tLquirp reimbursemmr. pf
ittt'pativtt cosy u die eutiWt ovettirne ride.
11. Adogtgr t;i~aingand bttttiadiftg is requited on du job silt. Filitutt io provide such sigattitg ahd batrieatyng may rrsvlt in the Cup's providing sigtdag
and barricades itnd ehatgiog the east (ineludeg a[I labor and ma[e~ala) a_~st the cash de, asn.
I ? Canpyttion teeeieg of Subgrrde. Tme rtlct, wed a.{pitgl l eork'Y'~e by Ptrrniarr is reyutred unless otherwise ,.fated by the City isngme~-
19. The Conttnetor of Pesmitxe wi11 hart! a supervisory represeatruiYt'• avaiLihlC: for t:aetacl on tilt: project at all times tltrnng ctrn-RmtCtidn, Conlrretar ar
Pamittee shall pmvldt a phone number at which they can be conueted autsidc tha ha~trs of 8bt3 a.m. en 4:Oq p.m
!a, No storage o{ ttaeerials tx equipatpa will be allowed nor the edge tlf paveneent, the beaeled way. ar within the shooldcfiee which would ere3[e a
hararddas coaditioo to the pabiic
15. This ptttr>it shat} not be maeaued as anttroriratim 1w er~vatirrt aril ~admg on pettyte peopGry adprectt to ttx work ex anv r+dtf wal. ftr whirl,
awawte permit tmy bt: res2ttirat ear dom it re)iow ate Perttittr< of anx obh&atit,n to Obtain any orbs pererut xgnired by taw
15- This permit d4eS naa ro{rase tilt Prtmitt~ from :ey liabi line. ertnrained to Miter a~tfctCe qr t:rnttsects with the Gty and arrv tailor public aiteuey.
T7. This permit it rtd tn[tAfetabte. Work r+wta lx performed ty the Perrnitnec qr his dcsignatrsf agent. n< cmttrretor ae .peeified thereon.
18. Call back (ctrl oat) due eo emerlpertt:;es regarding this permit shall he at the caaent ovenime rarr vrsrh a three i;31 hPttr minimum ch;irge pa ocivtrehce
r 9 Pint ~ t~taQts l a-~-+ of the Campbell iNneicspal Cork. applic'at stesll ntr, eattct i4 oe disch~ any material irn0 ate tttmtitxpal s+drtn dtairt systt~
ft1bC than stoRb r.xta. App6eser Stsall a~ssre to tJK BEST !~tAtiAG?~v1F~,. FlL4C1Ca~i, s~.blished !nr d~ Su[ta Cmra Valley l.lrhmn RtmaE
PaUudon Prcvctapo Pttr~mt,
20. If ate p<ibfic :actCCSt requires a nnodficaoon of, ar a ttcpaan,rc from. the plans and spee[freaPrna. the CEty shat) havC the autltpriry tO rmukrt er approve
any modiflc~on br deoarmre and ttS Specify tl'~ ttnneer in which dtc sartc is to be rrnde is Ciry•thrmEd ar maintained facilitrrs.
21 • FtrRfittGe must provide advance netiftcatinn to aA panic: dtP[ may be affected ity the pertnir actkvicits. Nttdfi<ation shoII be rrh+iawed by Ckty prior m
disaibtlsoG ~: rtcluda d~ o-i wtlr'~ ~ s taxttact name and Thane nt~ ;t$t't,
Applieam zhaP. fx tespoesrble foe rs >~t a0 dime ~.*idinp x.-tutees undue the applieaatt mre ak~re of and undeeata~d all tf tlG about -0oditions
~~ ~~/~ t/
{Print Name) bate "'
1trOrrt[slpwparn
1L~. 11 A.105
CITY OF CAMPBELL ENCROACHMENT PERMIT Penttit No ~-f~' ~:2-C- I- I - ~ i C~~i~) ;
DEPT. OF PUBLIC WORKS (for working within the public X-R~f. File
70 North First St. right-of-way)
Campb~Il, CA 950U8 A fit:ation Date ~r7~~f ~' ~
{408) 866-2150 Issued _ CJI~ 2~/ l I d AppIicatior, Expiration Date_ ~
.Fax (408) 376-x958 ,~! `- ~-~ ~ / t
Permit Expiration Date ~~ APN _ 1~' ~ A
APPLICATION -Application is hereby made for a Public Works Permit in accordance with. Campbell Municipal Code, Section 11.44. (Application expires in rix {G}
months if Ctre permit is not issued. Applic~at/ion Fee is non-refundable.)
A. Work address or tract ~ ~~/UCe7 Erj~~/~ /3L ~/,d ~ ~~O~GQ~ ye~~
r
Utility wench location ~n~es/FS"~i2 BLl/.7~ 3G_f` fit///~ /~ie~/Ct~wJ~/F Qi ~i~ / .[ ilG
/~ • wlv !/iNC•5'd~s7'E/t2 .c3
B. Nature of work EYr.1 /d ~' _tZ l ~3E'L L/.,b, ~~
C. Attach four {4) copies df an end peered plan showing the location and extent of the work, and four {4) copies of the preliminary Engineec 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 Ea~,ineer, said plan becomes a
part of this permit.
D. All work shalt conform to the City of Campbell Standard 5pceifications and Details for Public Works Construction: the General Permit Conditions listed pn the
revers side; and the Speciat Provisions far this permit, listed below. Failure to abide by these conditions and provisions trtay resuh in job shutdown andlor forfeiture
of Faithful Performance Sureties and cash deposits. fSee General Permit Conditions 1 and 2.}
E. The Corarat:wr must have this permit and approved plans a[ the situ and must notify the Wbtic Works Department at least [wo days before starting work. Notice
must be given to Public Works at least 24 hours before restarting any work. /
Name of Applicant Telephone ~ - 5Z ~~~ ~b,
(pritl~nam~e~
Address 3oB Sr7T>'G~~1111// ~~ ~ ~/~1DSfl 24-HOUR EMERGENCY TELEPHONE NO.
E-Mai I Address t'~t~ .~ ~ /~'f.,7~. L~OI~
Is this work being dime by the property owners at their own residence? Yes _~No
The ApplicanUPermittee hereby a~~rees by affsxing their signature to this permit to hold the City of Campbeti, its oftieers, agents and employees free, safe and harmless
from any claim err demand for damages resulting from the work covered by this permit.
The Applicanl/Persnittee hereby acknowledges that they have read and understand-both the frtmt and hack of this permit and they will inform their ccmtracKnr{sj of the
information. Applicant is advised thrt upon issuatrce o is permit, property owner, or property owner's successors. shall be responsible for any and ap darn;tges
arising out of the condigon of any pti r v men i the public right-of-way
Aeeepted __ _ _ __~ e1 -~i
Permittee) (sign)
Date
mil,
(Print Name}
Date
-I . Sweet shall not be open cut for underground installations. Minimum cuts ~ be allowed for connections trc explorsnon holes. Such cuts may
he snecifrcally approved by the Instrector prior to cuuinR.
2. Pavement tray be cut for underground installations and must lr rcst~ed in accordance with the Standard Details Trench Restoration Method
"A", unless otherwise approved by inspcetnr.
^i. Work to be staked by a licensed Land Survtyor or Civil Engineer and two (2) copies of the ctit sheets sent to the Pubiie Works Department
before starting work.
,4 Per Section 4215 of the Government Cade this permit is not valid for excavations until Underground Service Alen (USA) has bezn notified and
the inquiry ideatiftcation number has been entered hereon. USA Phone 1-804-^_27-2600. U5A TICKET N0.
_ Prier tr, any work. tltu property owner s.~all exc,:ntc an Agrecmcct for Private improvements m the Public Right-of-.~`ay, which shall be
ra;ordcti.
~G. Puhlic Notification Requiremen[s:
7.
SEE PLIBI IC WORKS 1rCE SCHEDULE FOR CLJRRENT Fir~S AMOLIN'T RECEIPT NU.
PERMIT APPLICATION FEE S ~~~ ~_
PLAN CHECI: DEPOSIT ~
SECURITY FOR FATi'HFUL PERFORMANCEILABOR & MATERIALS
CONSTRUCTION CASH DEPOSIT $
PLAN CHECK & INSPECTION FEE g~
APPROVED FOR ISSUANCE ~~~ P1 %Z 3
For City Engineer Date
Permit Expires 12 Monrits Afar Date of Lssuance
I~lJBL.IC WURKS
~rt+-,r t t+.,. ~,~'n~-rr gaol
Figure CSC-13. Right Lane -Beyond Intersection Closure
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MIN TMRN~~G~r~r
L
Note:^See Table A
for Sign, Cone Spacing,
and Taper Lengths.
REVIEWED
(_ AS NOTED) BY:
DATE; _ / _ / 20
PERMIT #:
PROJECT INSPECTOR MAY
MODIFY TRAFFIC CONTROL
PLANS AS FIELD
CONDITIONS DICTATE
!S
i
S
i
S
i
Typical Application 13
Note: aSee '
for Sign, Coi
and Taper L~
REVIEWED
DATE:
PERMIT #: _
PROJECT INSF
TRAFFIC CON'
FIELD CONDI"
Figure CS7-22. Sidewalk Closure
Typical Application 22
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