91-155
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Application Date ' / I C'
Application expire. in 6 .~. I
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APPLICATION _ Application i. hereby ..de for a J,>ubllc Works Perait 1n accordance with caapbell . .!~~". I
Municipal Code, Section 11.04. (APplication expire. 1n 6 ~nth. it perait not pulled) '~<4 :
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GILMAN t\V~\~
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CITY OF C'-J4PBELL
DEPT. OF PUBLIC WORKS
'0 North Fir5t St.
campbell. CA 95008
(408) 866-2150
~NCROACHMENT PEnKIT
(tor vorkin9 1n the
public riqht-ot-~a~ I
I..ued___ . ,.It! :I. JJ:1.L-
perait eicPir. 1'n 12 .oa.
parait tlo.
'7/ .1 / i..- .c...
-~
X-Ref. fUa
A.
Work address or tract .
ON SAM C-A.VA LN..
5 ~ IDG: 5 AM C-AV A LN
\N.~r)l(LLP\T\Dl\\
16 ElW~l\l O\I...LDN AVt:.
B.
Utility trench location
Nature of work: "^ A IN
C.
Attach flve (5) copie. of a drawil\9 .hovil\9 the location, extent and diaenaiona of tha work
The drawift9 .hall .how the relation of the propo.ed work to eXlatil\9 .urface and uncSerqrounc1
laprove_nu. When approved by the city EnlJin..r, ..iel clrav1l\9 becoMiI . part of thla parait.
The General Conditiona for all perait. .re li.ted on the reveree aide. SpeCial PrOYi.iona for
this peralt are U.ted below. FaJ,lure to abiele by the.e conclitiona and provlaiona ..y ruult
in job .hut-dovn and/or forfeiture of Faithful Pertoraance IlOnda and caab d~ite. (See
General Conditione 1 and 2).
D.
E. An application fee xu.t aCCOJlP&llY thla application. ft1a 1a non-retuncSable.
.a_ of Applicant J; A~ ~ 05 E W ~ T~~ c..D. 'hlephone:
Address 12..2.\ .f,O. fb A:5LOM P<V'C. ~AM ...lOSE, CALIF ~l;.Iz..~
2-79 -IE> 41d
Is this work being done by the property owner at their own re.idence?
)(no
~e.
Coaplete and attach Workers' Co.pensation .n4 contractor Inforaation foraa.
The Applicant/peraittee hereby agrees by .ffixinq their .ignature to thi. perait to hold the City
ot .
ea.pbell. its officera, avente .nd _ployee. tree, _te and barale.s troll .ny cl.1a or eleaand for
daaaqes resulting froa the work covered by thi. perait.
The Applicant/Pera cltnOVledve. that they have read and uncSeretend both the tront and
back of thia pe ey will intor- their contractor(.) of the inforaatlon.
ACCEPTED ~ _ ~fl3 /ert
pplicant (peraittee) prin,./a1gn ~te / /
12:, t:N ~ AN /'{Rt?:"S lENGINEE1<JtJ6 SUflER.VI~O~
tlOTES: ALL WORI< SHALL COtlFORK "1'l'H 'l'HE AT1'ACHED, APPROVED PLA!lS AND ALL APPLICABLE CAKPBELL
STANDARD DRAWINGS AND CONDITIONS.
THE CONTRACTOR truST HAVE'l'HIS pERMIT AND APPROVED PLANS AND truST MEET WITH THE p.1 i~cI,d N · D
THE SITE AT LEAST TWO DAYS BEFORE STARTING WORK.
NOTICE truST BE GIVEN TO PUBLIC WORXS AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK.
MAY 1 J 1991
Public WorkslEnClineerinR
SPECIAL PROVISIONS
_1.
Street ahall not be open cut tor underqround inatallationa. Mini.ua cute ..y be allowed
for connections or exploration boles. Such cute ~ust be soecificallY aDDroved bv the
Insoector.
paveaent a.y be cut for underground installations and .u.t be re.tored in accordance with
the Utility Trench Reatoration Standard Drawing.
work to be staked by a licen.ed Land surveyor or Civil Enqinaer and two (2) copie. ot the
cut .heets sent to the Public Work Oeptartaent before .tartinq work.
The hourli of work .re li.ited to outside the hour. of '7-9 .... and 3-6 p...
affecting a traffic lane. ~
v-;-:
_2.
v-').
tor any work
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V's.
OF
~~'-I~L
CR-ll
STANDARD
RECEIPT NO.
AMOU1f'l'
$ \CJ~.ClO
$
$
$
$ \O~.C;C; q>
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PERMIT APPLICATION FEE
($50.00)
$100.00
9
PLAN CHECK DEPOSIT
$500.00
(lOOt OF ENG. EST.)
(4\ OF BOND, $500 KIN)
BONO FOR FAITHFUL PERFORKAtlCE
CASH DEPOSIT
($200.00)
PLAN CHECK , INSPECTION
F~$.lOO KIN)
for City ng' ee
oate
APPROVED FOR ISSUANCE
f: PWPERMIT
Revised 7/90
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PUBLIC WORKS DEPARTMENT
CITY OF CAMPBELL
AUGUST 12, 1991
CONDITIONS OF APPROVAL FOR ENCROACHMENT PERMIT NO 91-155
ISSUED TO SAN JOSE WATER COMPANY
FOR INSTALLATION OF WATER MAIN AND SERVICES
ON SAM CAVA LANE FROM
DILLON AVENUE TO GILMAN AVENUE
A. Relocate water meters to behind back of future back of
sidewalk (28.00' from center line), if possible.
B. Install new water services to W-98'E and W-112'E (in new
pavement area) by jack and bore operation.
C. Restore pavement area in accordance with trench restoration
detail inClUding asphalt driveway at 472 Sam Cava Lane.
D. Provide adequate compaction east of 472 Sam Cava Lane, grade
surface to drain, backfill and compact pea gravelled parking
area.
E. Provide adequate and safe access to driveways.
F. Provide minimum 12' wide vehicular traffic lane on Dillon,
Sam Cava and Gilman. Provide one traffic flag person at
each approach to construction area for traffic control.
G. Hours of operation shall be the same as for residential
areas.
H. Notify Fire Department prior to water main turn-offs.
I. Install new fire hydrant at NW corner of Sam Cava Lane and
Dillon Avenue. Contact Fire Department.
J. Restore all striping, pavement marking and markers.
F:91-155
/,PPROVED FOr~ CONSTRUCTION.
City of Campbell
Public Works Permit No. 9/-/56-
Contractor must have these plans
on the job site during construction.
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MEMORANDUM
CITY OF CAMPBELL
To:
From:
Subject:
Chuck Gomez
June 12, 1991
Date:
Acting Fire Marshal Gregg Berryma~
WATER MAIN CHANGE ON SAM CAVA LANE
RECEIVED
JUN 1:~ 1991
Public W orbl Engine.rinD
I have reviewed the plans and the only comment is that the hydrant at Sam
Cava and Dillon should be changed to a standard hydrant during this work
plan. Also, flow tests should be conducted and reported to the Fire
Department after the main is replaced.
Please keep me informed as to when the work is to be done.
Thanks.
GB/jc