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ENC2011-00108~ ~q~;~~~ _' P~irit~Fo~m`" CITY OF CAMPBEI,I. ENCROACHMENT PERMIT Permit No ~C L61 •I - G G~ G8 DEPT. OF PUBLIC WORKS (for working whhln the public X-Ref. File 70 North First Street rigghtl-of-wa/y,) Apppcatlon Date ~ Campbell, CA 95008 Iswed l / ~ 3 / 1 ~ Apptication Expiration Date 1 Ph. (408) 866-2750 - APN '2 7 ~ q O 45 Fx. (408) 376-0958 ~, ~ ~ ~ ~~ Permtt Expiration Date - 1 I 1 i/ I 'L APPLICATION - Applcation is hereby made for a Public Works Permit In a-cc-ordance w[th Campbell Municipal Code, Section 11.04. (Application expires in sbc (6) months ifthe permit (snot issued. Application Fee isnon-refundable.) A. Work AddressorTract No.: Utility pole in front of 174 N 2nd St., Campbell Utility Trench Location: N/A B. Nature of Work: REMOVE/REPLACE CONCRETE AROUND THE POLE AND INSTALL 2 GROUND RODS C. Attach four (4) copies of an engineered plan showing the location and extent of the work, and four (4) copies of the preliminary Engineers Estimate of work The plans shall show the relation ofthe 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 fisted on the reverse side; and the Special Provisions for this permit, listed below. Failure to abide by these conditions and provisions may resuh in job shutdown and/or forfeRure of Faithful Performance Sureties and cash deposfts. (See Generei Permit Condtions 1 and 2.) £. 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 least 24 hours before restarting any work. NameofApplicant: PG&E (Paul Rodgers) :Telephone: 40&725-2165 -_. .. ,..._ _ . _....... .... ... ._. _. _ i Address: 10900 N Blaney Ave., Cupertino ca 95014 E-Mall Address: parl@pge.com 24-HOUR EMERGENCY PHONE NUMBER: ! i-$00-743-5000 _.._ _. ... _ .. _._ 111 Is this work being done bythe property owners at their own residence? ~• r" YES ~ ~ NO The Applicant/Permittee hereby agrees by affixing their signature to this permit to hold the Qty 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 Appilcant/Permittee hereby acknowledges that they have read and understand both the kont and back of this permit, and they will inform their contractor(s) of the information. Applicant Is advised that upon issuance of th permit, property owner, or property ownePs successors, shall be responsible forany anld all damages arising out ofthe condition ny vat p ements In the publk right~f-way. Accepted: Ct..i..l ~/ _ ~~~ ~ ~ /~ ~l) (ApplicantPermlttee)~~ (sicftl)' Date (cornractor) (Print Name1~ ~_._ SPECIAL PROViS10N5: 1. Street shall not be open cut for underground lnstaliations. Minimum cuts ~y be allowed for connections or exploration holes. Such cuts maybe sceciflcally aooroved by the Inspector orbrto cuttino. ~. Pavement may be cut for underground installations and must be restored in acwrdance w(th the Standard Details Trench Restoration Method 'A",unless otherwise approved by the Engineer. 3. Work to be staked by a licensed Land Surveyor or Ov11 Engineer and two {2) mpies of the ctrl 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 NSA} has been notified and the tnqulry identification number has been entered hereon. USA Phone: 1-800-227-2600. USATICKET 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 Renulrements:_ 7. SEE PUBLIC WORKS FEE SCHEDULE FOR CURRENT FEE_c PERMIT APPLICATION FEE PLAN CHECK DEPOSIT SECURITY FOR FAITHFUL PERFORMANCE/LABOR & MATERIALS CONSTRUCTION CASH DEPOSIT PLAN CHECK & INSPECTION FEE AMOUNT RECEIPT NOS s 3Go $_ U APPROVED FOR ISSUANCE 9j~ir For City Weer pate Permit Expires 12 Months After Date of Issuance ~~; . ;,,~ . GENERAL PERMIT OND177ONS 1. A Construction Cash Deposh is required Charges will be made against this deposh if there is an emergency call-ouy overtime inspection or when Clty ordered barricading is required. Any such costs in excess of the deposit will be billed to the Perrnittee. 2. A one-year maintenance period and surety are required. Such period will begin on date of written acceptance by the City. 3. Refund orthe cash deposit balance and refund or cancellation ofthe Falth(ul Performance Surety will be initiated by the written acceptance of the work by the City. 4. The Permhtee must request in writing a final inspection and acceptance of the work upon completion. Acceptance by the Clty will be made in writing to the Permittee. S• Maintain safe pedestrian and vehicular crossings and free access to private driveways, bus stops, fire hydrants, and water valves. 6• A Construction Traffic Control Plan and a Construction Schedule arc required for ail lane closures, detours, and street closures. 7"hfs plan must be reviewed and approved priorto any lane closures. 7. A Construction Traffic Control Plan shall conform to the Caftrans Manual ofTrafflc Controls for Construction and Maintenance Work Zones, dated 1990, available at Caltrans. Traffic control equipment shall indude Type II flashing arrow signs if required. 8. Replace as directed by the Clty Engineer any damaged or removed improvements in accordance whh City.Standards and Specifications at the sole expense of the Permhtee. 9. Sawcut for all PCC or AC removals. All PCC removals shall be to the 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 atthe current overtime rote 11. Adequate signing and barricading is required on the Job site. Failure to provide such signing and barricading may result In the City's providing signing and barricades and charging the cost (including all labor and materials} against the cash deposit. 12. Compaction testing of subgrade, base rock, and asphah concrete by Permittee Is required unless otherwise stated by the Clty Engineer. 13. The Contractor or Permittee will have a supervisory representative available fqr contact on the project at ail times during construction. Contractor or Permittee shall provide a phone number at which they can be contacted outside the hours of 8:00 a.m. to 4:00 p.m. 14, No storage of materials or equipment will be allowed near the edge of pavement, the traveled way, orwhhln the shoulderllne which would aeate a hazardous condition to the public, 15. This 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 permh may be required, nor does h relieve the Permittee of any obligation to obtain any other permit required bylaw. 16. This permit does not release the Permittee from any ilabilhies contained in other agreemerrts or contracts with the City and any other public agency. 17. This pemtit is not transferable. Work must be performed by the Permittee or his designated agent or contractor as specified thereon. 18. Call back (call out} due to emeregendes regarding this perrnh shall be at the current overtime rate with a three (3) hour minimum charge per occurrence. 19. Pursuant to Chapter 14.02 ofthe Campbell Munidpal Code, applicant shall not cause to be discharged any material into the munldpal stone drain system other than storm water. Applicant shall adhere to the BEST MANAGEMENT PRACTICES established bythe Santa Clara Valley Urban Runoff Pollution Prevention Program. 20. ff the public interest requires a modification of, or a departure from the plans and specifications, the City shall have the authority to require or approve any modff(cation or departure and to spedty the manner in which the same is to be made for Cltyowned or maintained fadllties. 21. Permitttee must provide advance notification to all parties that may be affected by the permit activities. Notification shall be reviewed by the C[ry prior to disMbutlon and include dates of work and a contact name and phone number. Applicant shat( be responsible for ensuring that all those providing services under the applicant are aware and understand all of the above cnn~~w,,..~ 9/~ZI i~ Date: ~ontroctor (Print Name) - Date: J:Rekta\Webstte\Land Dev Forms\Enaoachment Permh STATIC fomt2.pdf Rev.(11/9/OS) Print Form CITY OF CAMPBELL ENCROACHMENT PERMIT Permit No ~. ~ C.2 O~ ~ - ©O I Obi DEPT. OF PUBLIC WORKS (for working within the public X-Ref. File 70 North First Street Bright-of-way) Application Date Campbell, CA 95008 Issued l I ~ 2/1 ~ Application Expiration Date ~ ~ 9 I ~ Ph. (408) 866-2150 APN x,79 `~ 9f~74~ Fx. (408) 376-0958 Permit Expiration Date 2 Z 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 isnon-refundable.) ~EC~plk~i~Tract No.: Utility pole in front of 174 N 2nd St., Campbell ~~~ olt8irych Location: N/A UE3L1 WORKS 4A~'~~ REMOVE/REPLACE CONCRETE AROUND THE POLE AND INSTALL 2 GROUND RODS 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 Ciry 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 least 24 hours before restarting any work. Name of Applicant: PG&E (Paul Rodgers) Telephone: 408-725-2165 Address: 10900 N Blaney Ave., Cupertino ca 95014 ~ , E-Mail Address: pari@pge.com 24-HOUR EMERGENCY PHONE NUMBER: 1-800-743-5000 Is this work being done by the property owners at their own residence? #,~. r YES ~ r NO The Applicant/Permittee 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 Applicant/Permittee 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 the public right-of-way. Accepted: (Applicant Permittee) (sign) Date (Contractor) (Print Name) Date SPECIAL PROVISIONS: 1. Street shall not be open cut for underground installations. Minimum cuts may be allowed for connections or exploration holes. Such cuts maybe specifically ap rop ved by the Inspector prior 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 the Engineer. 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 PERMIT APPLICATION FEE $ 3 6 O PLAN CHECK DEPOSIT $ SECURITY FOR FAITHFUL PERFORMANCE/LABOR & MATERIALS $ CONSTRUCTION CASH DEPOSIT $ PLAN CHECK & INSPECTION FEE 5 ~ APPROVEDFORISSUANCE For City Engineer Permit Expires 12 Months After Date of Issuance RECEIPT NO~ FETY M,4PF NOTE: ~ PLEA~~ ASSIGN THE FOLLOWING SAFETY PLEDGE CUSTOMER TO THE NEW TX: 174 N 2ND ST I ALWAYS PUT SAFETY FIRST. 156 N 2ND ST I LOOK FOR AND ACT TO 175 N 2ND ST RESOLVE UNSAFE SITUATIONS, I HELP AND ENCOURAGE 169 N 2ND ST ~ OTHERS TD ACT SAFELY. 161 N 2ND ST N jjjjjjjjjjj^ 149 N 2ND ST z N 235 223 213 201 189 175 N 2ND ST NEW MIDSPAN OH SERVICE INSTALLED ON PM~30870088 169 161 COORDINATE # 3157966-29072 LOADING DISTRICT sc TX SIZE - 50 KVA 10 - 31 COST - 6 L.F. - 30 149 GRANT ST. NOTES 1. GAS CREW TO REMOVE AND REPLACE CONCRETE AROUND THE BASE OF THE POLE AS NEEDED TO INSTALL TX GROUND RODS. 2. INSTALL TRANSFORMER, SECONDARY BOBS AND RESAG EXISTING SECONDARY CONDUCTOR AS REQUIRED. 3. REPLACE PRIMARY X-ARM. EST• PAUL RODGERS Z UI N M i 25 LEG *D STAi.~, DESCRIPTION 50KVA OH CONY TXT~ D ~ SECONDARY BOBS ~ C7 ,~ G O ~ LATIMER AVE o I m . n - -~ T ~ ~ .";' 234 ~~ ~ o `n ~ ~ -~ ~ 222 ,~ ~; p~ ~ O • ~ O ryp~'~ ] ~ ~ V hQ 210 - = ~ , ~ I> ~ IN I~ IN ' OPEN HERE 0 I ASA ~ I ~~~ M,I s 45'PT6452-6 I ! I Y ~ N I I Q I ~ N I I~ 200 - Q ^ 188 174 N 156 CLASS 3 AREA "B" INSUL. DIST H-16-16 EL PATIO 1 1 14 SSD FUSE 29019 PROJECT CONDITIONS STAMP TYPe~a) oT Work: ®Naw Budnsa ^ PGkE Nointsrancs k Conwtrudion Project Conditioro: ®NONE APPARENT M poet dwgn ehangw, eanrnct ADq ^ CONDITIONS APPLY: ®PERMIIS ^ TNLBOARD ^ OTHER (Provid. addkleM Mormollon en Rr Mbw) CITY OF CAMPBELL .r: ADE: PAUL RODGERS CONSTRUCTION SKETCH SUPV: SHELLEI( KISS REPLACE OH TX TO MEET VOLTAGE REQUIREMENTS REP: CATHERINE ONLY IFO 174 N 2ND ST., CAMPBELL PLNR: NA scaLE: DA : PACIFIC GAS AND ELECTRIC COMPANY NTS s so 2011 I NOTIF: 10535958 SHT: 1 OF 1 SHEET PY: REV. 30873134