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ENC2017-00224 Print'Form CITY OF CAMPBELL ENCROACHMENT PERMIT Permit No —cQIML f DEPT.OFPUBLICWORKS (forworking within the public X-Ref. File -710 — 00 70 North First Street, right-of-v� y) Application Date �IT Campbell, CA 95008 Application Expiration Date Ph.(408)866-2150 Issued 2Z APN �2�31 Fx. (408)376-0958 y Q Permit Expiration Date Z l V APPLICATION-Application is hereby made fora Public Works Permit in accor nce wi h 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 or Tract No.: ` ..._ U vv�_oNv Utility Trench Location: /v. ....lrAa0,J e............ o� acv.........�&s3 ........... B. . Nature of Work: `7P/��z— C. Attach four(4)copies ofan engineered plan showingthe location and extent ofthe work,and four(4)copies ofthe 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 CityofCampbe-11 Standard Specifications and Detailsfor PublicWorks 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. 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 atleast 24 hours before restarting anywork. Name of Applicant: l J �f /� �/ /�G`' Telephone: q�— 6 3 Address: /' (/` aka _ e '0_16c_ . . ... _. __ E-MailAddress: (for; 24-HOUR EMERGENCY PHONE NUMBER. L14 �GI_057&S� Is this work being done by the property owners at their own residence? YES 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 improvements completed in the public right-of-way. Accepted: /' �.1 10 �l4/'.��/I�/��� !All—C. [ (Applicant Permittee) (sign) Date (Contractor) (Print Name) - Date SPECIAL PROVISIONS: ❑ 1. Streetshall not be open cutfor underground i'nstallations.Minimum cuts m.ay be allowed for connections or exploration holes.Suchcuts maybe specifically approved 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 4216 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. ❑ S. 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 pp( CG RECEIPTNO. PERMIT APPLICATION-FEE $ PLAN CHECK DEPOSIT $ SECURITY FOR FAITHFUL PERFORMANCE/LABOR&MATERIALS $ CONSTRUCTION CASH DEPOSIT $ PLAN CHECK&INSPECTION FEE $ CA InZ l S(oZ EMERGENCY PERMIT FEE /( $ y APPROVED FOR ISSUANCE r' q For City Engi neer Date Permit Expires 12 Months After Date of Issuance GENERAL PERMIT CONDITIONS 1. The Permittee must provide evidence of insurance and Additional Insured Endorsements as required by the City.Insurance shall be maintained forthe duration of the permit work. 2. A Construction Cash Deposit is required.Changes will be made against this deposit if 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. 3. Refund of the construction cash deposit balance and refund or cancellation of the Faithful Performance Surety will be initiated by the written acceptance of the work by the City. 4. A one-year maintenance period and surety are required.Such period will begin on date of written acceptance by the City.Surety posted shall be equal to 25%of the original Faithful Performance Security. 5. Submit project schedule 10(ten)days prior to proposed start of work.Additional lead time may be required for work within City facilities and downtown Campbell. 6. The Permittee must request in writing a final inspection and acceptance of the work upon completion.Acceptance by the City will be made in writing to the Permittee. 7. Maintain-safe pedestrian and vehicular crossings and free access to private driveways,bus stops,fire hydrants,and water valves. 8. 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. 9. A Construction Traffic Control Plan shall conform to the 2006 California Manual on Uniform Traffic Control Devices(MUTCD). 10. 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 as expeditiously as'possible. 11. Sawcut for all PCC or AC removals.All PCC removals shall be to the nearest scoremark and new PCC shall be doweled to existing improvements. 12. Prior approval of inspector is required for any work proposed after normal working hours,on weekends or holidays and may require reimbursement of inspection costs at the current overtime rate. 13. Work on arterials and collectors may require the use of changeable message boards.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 construction cash deposit. 14. Compaction testing of subgrade,base rock,and asphalt concrete by Permittee is required unless otherwise stated by the City Engineer. 15. -The Contractor or Permittee will have a supervisory representative available for contact on the project at all 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.and on weekends. - 16. No storage of materials or equipment will be allowed_ near the edge of the pavement,the traveled way,or within the shoulderline which would create a hazardous condition to the public. 17. 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 relieye,the Permittee of any obligation to obtain any other permit required by law. 18. This permit does not release the Permittee from any liabilities contained in other agreements or contracts with the City and any other public agency. 19. This permit is not transferable.Work must be performed by the Permittee or his designated agent or contractor as specified thereon. 20. Call back(call out)due to emergencies regarding this permit shall be at the current overtime rate with a three(3)hour minimum charge per occurrence. 21. 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. 22. If the public interest requires a modification of,or a departure from the permit,plans,special provisions and/or 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. 23. Permittee must provide advance notification to all parties that may be affected by the permit activities.Notification shall be reviewed by the City priorto distribution and include dates of work and a contact name and a phone number. 24. Applicant shall remove water from utility vaults in accordance with the requirements of State Water Resources Control Board Water Quality Order WQ 2014-0174- J3WQ. Said vault water shall not be discharged into the City of Campbell's storm drain system. See http://www.waterboards.ca.gov/water issues/programs/nodes/utiiitvvaults.shtml for more information. Applicant is hereby responsible for ensuring that all those providing services under the applicant are aware of and abide by all of the above conditions. Applican �n A � �I� Date: Contractor (Print Name) Date:- J:\FORMS\Templates\Encroachment Permits\Encroachment Permit STATIC form2.pdf Rev.03/17 JoAnna Thomason,Office Specialist pF­CAM, City of Campbell �1 Department of Public Works 7AW& 0 North First Street U r Campbell,CA 95008 ° ° Phone:(408)866-2150 E-Mail:Joannat@cityofcampbell.com *CHAR- _ Transmittal To: Jeff Mello Date: October 31,2017 Company:Mello Pipelines Re: Refund check Please find enclosed a check in the amount of$875.00 for the refund of fees paid on cancelled Permit ENC2017-00224 Thank you, JoA na T-h-oYpason , Offic list cc: ENC2017-00224 I \Wonouliuli.cityhall.ci.campbell.ca.us.local\Profile_Data$\oannat\Desktop\My Forms\Templates\Transmittal Fonn.DOC(Rev.03/08) ....:.:. ........ ...... ...... i .__1.,...: ..... :. - -------_---------------------------------------------------------------------- -- - -- ------ ---------------_-------------------------------------/------------- CITY OF CAMPBELL VENDOR No. 10010145 CHECK NO. 265000/ I 4cconnt 3'urchase:Order:. .:...Invoice NuTnber..... .:...... Amount....... :......... DeScri kan.r. .i I 101,730 4722 CR101717 455.00 PREMIT FEE REFUND 101.740 4722 CR101717 420.00 PREMIT FEE REFUND I I- , I I 10010145 MELLO PIPELINES INC i I I - I — -- ----- ----- ----- ------ ------- ------ ------J--- -1 CQ O`er !CITY CAMEBELL Wzs PARco earrx x,A 11 z4 CHECK DATE CHECK Np �` Fµ " .« z 42 Q MON'.S'GOh]ERY STREET 1210 10/3 Q/17 2 6 5 0�0 70 NORTH FIRST STREET �U ,�„ 5`AS FRANCI5C0 CA 94104 ` g �. ' CAMPBELt, CALIFORNIA 95008 5 AMO UN T 7 5 0 wl �. V TER� OID AF 90 DAYS I Y PAY THE SITM OF EIGHT HUNDRED SEVENTY FIDE DOLLARS & ERO CENTS tm', ;l r�/I I� mo zxE MELLO :PIPE�INES .INC .� x � m ,ORDER .._ - I �� 2 6 0--MC- GLI�N'CY LN CAMPBELL CA 95008 f 1 �' II■ 26 5�00011' i: L 2'LOOfl 248�: 4 i�2 L8 5 54 L 5n' 4 n Sn. ' - - - .. ....... t .. ........:5 .. I................................. ` .-_-............................ .............. See Reverse Side for Easy Opening InstructiorOs CITY OF CAMPBELL 70 NORTH FIRST STREET i CAMPBELL, CALIFORNIA 95008 I i MELLO PIPELINES INC 260 MC GLINCY LN CAMPBELL CA 95008 I I JoAnna Thomason From: JoAnna Thomason Sent: Tuesday, October 17, 2017 8:42 AM To: Roger Storz; 'Alan Kam'; Syed Wahidi Cc: Jason Cumbo Subject: RE:773 Union Ave Ok, I'll go ahead and prepare a check request for the refund and cancel the permit in Tidemark. JoAnna OV•CA41, JoAnna Thomason any. 4' Office Specialist U rr City of Can11)bC1l Public Works Department 0 o 70 N. First Strect!Campbell. CA 95008 N..1-N_�.cittvo cariil)bell,corn I 408.866.2150 IlReHoLv From: Roger Storz Sent: Tuesday, October 17, 2017 8:20 AM To: 'Alan Kam'; Syed Wahidi Cc: JoAnna Thomason; Jason Cumbo Subject: RE: 773 Union Ave Thank you Alan. Syed/JoAnna, go ahead and cancel the encroachment permit for constructing a new sanitary sewer lateral at 773 Union Avenue. Thank you, Roger From: Alan Kam [mailto:AKam(a)westvalleysan.org] Sent: Tuesday, October 17, 2017 7:23 AM To: Roger Storz; Syed Wahidi Cc: JoAnna Thomason; Jason Cumbo Subject: RE: 773 Union Ave Roger, Yes, an existing lateral was identified and is in acceptable condition to be used for 773 Union Ave project. Thanks, Alan From: Roger Storz [mailto:rogers@cityofcampbell.com] Sent: Monday, October 16, 2017 7:39 AM To: Syed Wahidi; Alan Kam Cc: JoAnna Thomason Subject: Re: 773 Union Ave Hi Alan, Can you please confirm that they have an existing lateral. i Thank you, Roger Get Outlook for iOS From: Syed Wahidi <syedwncityofcampbell.com> Sent: Monday, October 16, 2017 7:32 AM Subject: FW: 773 Union Ave To: Roger Storz<rogersncit. o�fcampbell.com> Cc: JOAnria Thomason<ioannat(a�cityoofcampbell.com> Roger, Mello Pipelines is requesting to cancel this sewer permit since sewer connection is not needed as it was built some time ago and they have verified with WVSD. Shall we first confirm with WVSD? of•C.t4,(� Syed Wahidi Public Works Inspector V rC;it� of Campbell I Public Works Department 0 o 70 N. First Street j Campbell,CA 95008 w_ti.3-,w.citvofcarnplelt..cc1m.1,408.866.216ti •()RCHAIRO• ,.... .._..... .u,....,..�_...... ....,...__..,.......,..._..,....,. _ �.W..._...._.,. From:jeff mello [jeff mello [mailto:mellopipe wsbcglobal.net] Sent: Friday, October 13, 2017 11:55 AM To: Syed Wahidi Subject: 773 Union Ave Syed, We are not going to install a new Sanitary Sewer lateral in Union Ave since there is a existing lateral. Please see if I can get a refund for my Encroachment permit. Permit# ENC2017-00224 Thanks, Jeff Mello Mello Pipelines 408-761-0585 cel 408-377-6103 408-377-6153 fax 2 W6st:Valley Iz, No: 43449 j&-jb " District Sanitation _ Sewer Connection Permit SD L Issue Date: By: OFFIA HOURS&CONTACTS: FEES, BACKFLOW PROTECTION P 7:30 r J a.m.to 4-30 p.m.Monday thru Friday Connection $ q3at3- ?1 t 100 .SunnyoSKS Ave.,Campbell,CA 95008. Capacity 05 Field check required I Processing Basement -phone:(408)378-2407 11 Service Advance information Services Department Check valve required:Yes_& LOCATI ION: APIJ i BUILDING SEWER CONNECTIONS: Se er Map Book Page Tra6l Lot Total Due: $ Total numbEtr of connections to this Project Assmt rz property: Address'7-:J 7!, hV — Paid by Check No. 1.Lateral ID No. is located Jurisdiction 11 sdiction CAne-z'1'82!eA% Hillside:Yes_& feet— of—property line, _feet from main sewer and BUILDING TYPE: INSTRUCTIONS: feet deep. �0:b Single Family •Permit is invalid if work is not completed i." Condo/Town House within 12 months of issue. Connection to Main Sewer feei I Do not connect until the main sewer is accepted Multiple Dwelling Units US from DS MH f, Industrial by the District. US MH i Commercial •Obtain a building or plumbing permit from the Pipe Type Jurisdiction listed above. REMARKS; Street encroachmept permit is required from J List any additional connections on ;f •Keep Tradius around cleanout clear of reverse side of this form. OLD„PERIVIIT No. Sub No. vegetation or obstruction. Original—Applicant Pink—Accounting Yellow—City/County Bldg.Inspector Card—District File fi Total Control Panel Lam TOO:13,;aiandro(cDwe,;tvalleysqn.org 'Message Scare:I From: High(60): 91'n:PriesLen:y0nol.cam MY Spam Blocking Level:Medium Medium(75): Low(90): Block this sender Block aol.com This message 1 V47S delivered because the content,filter score did not exceed y o u;-filter level. l J r J / c� "N �lr ri Ala Jf.• .. � W_ � 1 {' u t co �av� �i4 pia ��vi SjC� cZsc 01S d9£ °S nd NOINn jss8 NPa I S I�CAMPB�ENT p l CqN IV6 41, ,.CALAIVS 145 4s2,g SAN S tV-ORS N951, 888. 770)0 p 4 Vl tgy� 83': Sso gesi�he d gY: PUBLIC WORKS DEPARTMENT UTILITY ENCROACHMENT, TRAFFIC & MISCELLANEOUS RECEIPT Effective July 1, 2017 TO: Finance PUBLIC WORKS FILE NO. ��"'C?i0-2Z PROPERTY ADDRESS '?� :�C:4') Please collect& receipt for the following monies fTEtVi 4 �rIO N"F EMI LE wr ■ .. aye,'- /-yy,}@a!y`�, gyj@.a�. AM .Y#faiST f.PR ... i. ..' u ✓..� 5` L �. A r 5.1 �� k. i {,ivYW� Y+vP. �( �h j 4722 Utility Encroachment Permit Application.Fee $455.00 R-1 Encroachment Permit N/C Emergency Permits $130.00 Plan Check&Inspection Fee Minimum Charge Per Location $420.00 � � C Conduits/Pipelines up to 500 Feet $2.95/ft Above 500 Linear Feet $1.75/ft ManholesNaults/Etc. $190:00/ea Pole Set/Removal, $190.00/ea 4760 Storage Container Permit.(valid up to 60 days only) $170.00 4760 Project Plans&Specifications Project No. 4760 Standard Specifications.&Details $1/Pg$15.50/13k 4760. Engineering Maps&Plans Aerial Plot 24"x 36" $65.00 Aerial Print 8 1/2"x 11 $32.00 Map Research.(includes max of two 24"x36"copies) $32.00 Maps and Plans 24"x 36" . $15;00 . 4722 Penalties. Failure to restore public improvements $100/Calendar Day.(Muni Code Sec.11.34.010) 4722 Penalties:�Failure to correct u safe conditions $100/Calendar Day 4722 Work Wlthcut Permits- 4 Times.Applicable Fee/Min.$500 771 TRAFF..IC 4728 Traffic Flow Map(Dail Traffic Volumes) $35:00 4728 Signal Timing Information . $73 per hour 4271 Truck Permits $,1.6.00 per trip 4728 No Parking Signs $1 each or$25/100 vr r_. sv �er'tn filg�l eL wit sue''.+I'<�r!1a Nv7ml,1an3 .,_.,,z. a tmYi,. 511.7424 Postage Other(Please Specify) TOTAL — y NAME.OF APPLICANT 1 (O NAME OF PAYOR c C L 4 PHONE ADDRESS (�- Zr'v ZIP s- jg�"d�'�y3xi^. N +air FOR RECIli'LU B1( "' 4 a„,.rA' � CITY CLERK � 1 � �- � ,��, � � 3 ���� w�� ONLY .. ._.?;_ i t 4.-.' 4." -Y l �� ;—x.Y, ,. -,_ ._v'R.a'- ."L','yp..'✓°dk—``.r'-k,�v,-`,. . r :.'.. ..��.�. 1''z.— .F` ...: ' ` �='h.,Sn.. J;IroRMS%TempatesWdministrativaTeceipt Fotm Utility Encroachment&Misc 17-IBAs CITY OF CAMPERE F;EC:tlit BY. CFSriiEl`, 01000271562 �1'i�.:;;a {iCLf..i3 PIPELINES INC TODA 'S DATE: 09,1222/17 REGISTER DATE: 09 22 1 1 TIME: 00:D0 DESCRIPTION AMOUNT y '! i� i. A ?Ui�iV �..a�YF F L v 455 aLl} CUST a 5-17 4 ENGR & aLEZtZ;I4! FILING*!! 455'00 CUS T ID: 1.000 TOTAL DUE- -%1�750.00 TENDERED. $1175000 .. - dl+�fii2fi'fYGsE a trJ a G:i.4 Vendor# (Finance.Use Only) Ct of Cam bell[ _ Check R uest To Finance Director' ' \ Check Payable To` MelloPipelmes,_fnc .. " (36Characters). Address-'Line 1:,` 260 E. Mcblijncy Lane.. (35 Characters) Line 2: - (35 Characters) ; City: Campbell.' State: CA Zip: 95008- Description:' P,ermit,Fee Refund (?s Characters] Invoice Number.: Permit#ENC2047-00224.. Invoice.Date: Total Amt Payable:.. $875 00 .: - - - (En act Amount) : _ Account'Number., .1-01.7-30.4722 Amount: $455.00 Account Number:.,. .101.740.4722 Amount: $420.00. Purpose:,. Encroachment permit canceled. Fee refund. Receipt#271562,9/22/17 ,Requested by.'. Title: Office Spec Date: 10/17/17 `JOAn .a Thorr son Approved by Title- _ Engineer Dater : Sr. RogerStorz .. Sped ial: Instructions For' . d Check Mail Ai Is:' -� -.Mail in Attached,Envelope: Interim Check: : . We By, Return To:. 'JOANNA .. "P (Name) -(Department) Other: 'H;\Check RequestsVNello pipeliries.zls(Rev.03/08) ! # a • ! # • •' ! • • ! # W • • • • y{� • • • • • • ! • • • • 77 � v" r� �C � tact cr "cx � td b � t7 d � fl d © C •�. �p � ' � C C'� � d x � � � ► � a � `'� to �s � C � a. � fl E0 p e* to Co c� p c� �' O, p ' �„ p cQ p cQ c� o c �.� P ' `C * ram ` cc ,,. C cc �-► O ,. ►-� fit, rA p� !-.• fl ra o a �s too ' a. .-* eo ,.A. a a ,� ca pa `,� Fa C'� ' �' A 0 cr c� ' . r„ a a. i„ C o $ 0 o cn tc cp vs c� `G a c' cp ' 0 2 �' � � cv t� r„ o � ` � � p � t� 'z3 C? cg � i O � � v �s t�" p p *p � � � � '' �* ce a O r* .o ��cc cc ►-i' e t : 'rscr •3 p v�i za fl a rAcr `� C ` �t a a rr--�� o i3 p- . 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