ENC2017-000356
OF
T�PrintForm 2
CITY OF CAMPBELL ENCROACHMENT PERMIT Permit -No N C � i -7—000 JC7
DEPT. OF PUBLIC WORKS (for working within the'public. X-Ref. File
70 North First Street right-of-way) Application DateMC2 f 7
Campbell, CA 95008 Application Expiration Date 2T7
Ph. (408)866-2150 Issued / �('7
t' " APN.
Fx. (408) 376-0958
Permit Expiration Date"I 2 �
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 Feels non-refundable.)
A. Work Address; or Tract No.: Elden DR 120' E/Q Si3ascarn AVE. PM#f31266033
Utility Trench Location: Same as Above
B. Nature of Work: Pale& 2 Anchors Replacement
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 ofwork. The plans shall show the relation of the proposed work -to existing surface and underground improvements. When approved
by tile City Engineer, said plan becomes apart ofthis permit.
D. All workshall 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 shutdownand/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
startingwork. Notice must be given to Public Works at least 24 hours before restarting any work.
Name ofAppiicant. Pacific Gas &Electric Telephone: (408) 605-667'
Address: 308 Stockton AVE, San Jose, CA,,95126
E-Mail Address; DDHN@PGE.Com 24-H,oURCMERGENCYPHONE NUMBER: 1-800=743-5000
Is this work being done by propertyowners-at their own residence? j " . YES:(" NO
Tile Applicant/Permittee hereby agrees by affixing theirsignatureto this'permitto hold the City of Campbell,ats officers, agents; and employees free, safe
and harmless from any claim or:demand for damages resulting frorii'the work- covered by this permit.
Tile ApplicantlPermittee hereby acknowledgesthat they have read and understand both the -front andback 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 t public right,of-way,.
tr'7 Z�� 1?
Accepted: 1_31 .. '—Cz— ._ '.` " _, /
:(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 may
;specifically approved by Inspector 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 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.
_i/ 4. Per Section 4216 ofthe 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. USATICKET NO.
__S. Prior to anywork,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
$�
PLAN CHECK DEPOSIT
$
SECURITY FOR FAITHFUL PER FORMANCEILASOR & MATERIALS
$
CONSTRUCTION CASH DEPOSIT
$'
PLAN CHECK & INSPECTION FEE
$
EMERGENCY PERMIT FEE
$_.
APPROVED FOR ISSUANCE
For City Engineer
12 Months After Date of Issuance
RECEIPT 10.
Date
i'
GENERAL PERMIT CONDITIONS
I. A Construction Cash Deposit is required. Charges will be made againstthis depositif there is an emergency call -out, overtime inspection or when City
ordered barricading is required. Any such costs In excess of the deposit will be billed to the Permittee.
2. A one-year maintenance period and surety are required. Such period will begin on'dateof written acceptance by the City.
3. Refund or the cash deposit balance and refund or cancellation of the Faithful Performance'Suretywill be initiated by written acceptance ofthe work
by the City.
4. Submit project schedule 10 (ten). days prior to proposed startof work. Special provisions may be required for work within City facilities and
downtown Campbell.
5. The Permittee must request in writing a final Inspection and acceptance, of the worst upon completion. Acceptance by the City will be made in writing
to the Permittee.
6. Maintain safe pedestrian and vehicular crossings.and free access to private driveways, bus stops, fire hydrants; and watervalves.
7. A Construction Traffic Control Plan and a Construction Schedule are required for all lane closures, detours, and street closures. This plan must be
reviewed and approved prior to any lane closures.
8. A Construction Traffic Control Plan shall conform 'tothe Caltrans Manual ofTraffic Controls for Construction and Maintenance Work Zones, dated
1990, available at Caltrans. Traffic control equipmentshall include Type II flashing arrow signslfrequired.
9. 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 Permittee.
10. Sawcut'for all PCC or AC removals, All PCC removals shall be to the nearest scoremark and shall be doweled to existing improvements.
11. Prior approval of inspector is required for any work done after normal working hours, on weekendsor holidays and may require reimbursement of
Inspection costs at the current overtime rate.
12. 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.
13. Compaction testing of subgrade, base rock, and asphalt concrete by Permittee is required unless otherwise stated by the City Engineer.
14. The Contractor or Pennittee will. have a supervisory representative available for contact on the project at all times during construction. Contractor or
Pennittee shall provide a phone number at which they can be contacted outside the hours of 8:00 a.m. to 4:00 p.m.
is. No storage of materials or equipment will be allowed near the edge of pavement, the traveled way, or within the shoulderline which would create a
hazardous condition to the public.
16. 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 permit may be required, nor does it relieve the Pennittee ofany obligation to obtain any other permit required by law.
17. This permit -does not release the Pennittee from anyliabilities contained in other agreements or contracts with the City and any other public agency:
18. This permit is not transferable:. Work must`be'performed by the Permittee or his designated agent.or contractor as specified thereon.
19. Call back (call out) due to emeregencies regarding this permit shall be at the current overtime rate with a three (3j hour minimum charge per
occurrence.
20. Pursuant. to Chapter 14.02 of the Campbell Municipal Code, applicant. shall not cause to be discharged any material Into the municipal storm drain
system other than storm water. Applicant shall adhere to the BEST MANAGEMENT PRACTICES -established by the Santa Clara Valley Urban Runoff
Pollution Prevention Program.
21. If 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 modification or departure and to specify the manner in which the same is to be made for City -owned or maintained facilities,
22. Permitttee must provide advance notification to all parties that may be affected bythe permit activities. Notification shall be reviewed by the City prior
to distribution and include dates of -work and a contact.name and phone number.
Applicant shall be responsible for ensuring thatall those providing services under the applicant are aware and understand all of the above conditions.
I—ZS_17
Applicant Date:
Contractor (Print Name)Date:
1:1FORMS\Templates\Encroachment Perm its\Encroach ment Permit STATIC form2.pdf
Rev.02/14
SEE SPEC SHEET 2 FOR ADDITIONAL
TRAFFIC. CONTROL STIPULATIONS
Pedestrian and Bicycle Access
to remain open at all times.
Minimum 12ft clearance for traffic
Work shalll not exceed 12 hours
FOR TCP (QUESTIONS
CALL 209400-7075
0
41
613
taQ`1
SIGNS BEING USED
'. 48X48" W1-4
�48X48° W20-1
KEEP
—► 36X48" R4-7a
RIGHT
R4-7a
'-'i111-
fll°'®y 1 Ft30 24X24" Barricade r4
rnounted, placed on > m, � ,A, q /� ass'"
+� I both sides of the street ?0.7 y1F�RK /-1 Eii 28 1 01b
20' apart 72hrs prior
to the start of work.
TOW k%VAYI Loc 1
zowr_
`>:%TE: ADDITIONAL TRAFFIC CONTROL
'IME: PERSON TO MAINTAIN CLOSURE AND
,r-1 ASSIST BICYCLE, PEDESTRIAN AND DRIVE
PU.U'T TII SCALEWAY TRAFFIC SHOULD NEED ARISE
HOURS OF WORK SHALL BE DETERMINED BY THE CITY OF CAMPBELL
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SPEED
TAPER
SIGN SPACING
TAPER
TANGENT
25
125'
1001
t26-
30
180'
35
245'
P50'
- 35 3
70 ',
40
320'
A
80ba"::
45
540
350
9p '
50
800'
an,nmmi—, .....
STREET WIDE ENOUGH STOPPING TRAFFIC IS
NOT REQUIRED BUT TRAFFIC CONTROL PERSON
WILL. ASSIST HOMEOWNERS IN AND OUT OF THEIR
DRIVEWAYS AS NEEDED.
0
N
Elden Dr
ELEC
PM# 31266033
CITY OF CAMPBELL
Elde 0r
Eld r@SBascom Ave San Joso, CA
PG&E C4 Rise Services, Inc.
209AOO-7075 PS-1 12-6-2016
CITY RISE SERVICES, INC
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3-1�OA EPR 12kV .4n
12kV 20,3-6CU 12kV
3-2 PT1548-3J
PRI 55 16OnDG
~� SEC /16nDG PT1548-4 PRI 3/8 DG
19 LEAD CD SEC 3/8nDG
15M ANCHOR 10' :LEAD
- 5/2- 55/4 15M ANCHOR (SIDEWALK)
° LATT.37.274967
TO LONG:-121.932917
SAP ID # 100522286 C"I
LOC # 1 ABN55/2POLE
PT # 1548 JP #4
SET 1970 SOLD 1970
SET NEW55/4POLE
PG 48-19 . PT 23-5
PG #160228CU JP #1
638-B
PX
55
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FIRE AREA NON—EXEMPT EQUIPMENT STAMP
Identify the Subject Pole Fire Area
-District (per Doc. #072148 and Utility
Bulletin TD-2301B-004):
❑ FRA ❑ SRA ® LRA
❑ OWF ❑ UWF
Per the Power Line Fire Prevention Field
Guide, the equipment being installed is:
® Exempt ❑ Non —Exempt ❑ N/A
❑ If Installing Non —Exempt Equipment
in a Fire Area, verify in SAP that the
the CN-25 has been activated.
By. JOSE CASTANEDA-JVC8-12/5/2016
Signature. Name [Corp ID]. Date
N a
PG75104-6
PG75104
PT
PG ST/LT
4PG PRI
RISER QUADRANT
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111
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0332-C
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N� PT14538-4
CITY OF, CAMPBELL
PERMIT REQUIRED
PIA? VOLTAGE: 12 'kV VOLTAGE AREA:1 H EST: JOSE CASTANEDA 925 327 0990
CIO'.I0�f':AQ126413 ELEC.MAP:AQ126-N1 CONSTRUCTION SKETCBADE:
SOURCE SIDE DEVICE FUSE 6791 ELDEN DR 120' E/O S BASCOM AVE SUPV: ANDREW TROMBATORE 916 472 2296
UB & CIRCUfL EL PATIO 1118 � CAMPBELL CA 95008 REP: VICTORIA NGUYEN 408 725 2011
IDS(,N URBAN RAPTOR ZONE NO PLNR: MOHAMED ELZAIN 408' 365 2202
100DINI AREA: LIGHT ARRESTER DIST: 3 ; n' Know what's below. � NO ENVIRONMENTAL JPA : PG160228CU SCALE: NTS
COWDSION AREA: NON INSULATION DIST. B Call before you dig. ISSUES NO11F: 111665138 DATE:12/5/2016
INST. D(EMPT FIRE AREA: LRA GAS MAP: 3412-J61 GAS CONFLICT: NO I NEAR LOC: N/A PM: 31266033