96-152
3-28 . I 996 8: 55Atvl
FROtvl ;^tvlPBELL PUBLIC WKS 408 3760958
P.2
CITY OF CAMPBELL
bEYr. OF PUBUc WORKS
'0 North Fir$t St.
Cmnpbdl, CA 95008
(408) 866-2150
Fax (408) 376-09S8
ENCROACHMENT PERMIT
(for working ~thin tile
....Ik .-oIJ> " ".
Wued 419 C1i~(~~
Permit apim in 12 n1OS,'''''---
Permit No.
X-Ref. Fi1~
c:;~~/ ~~
Application Date ~. ZR .9(.,
Application ~itts in 6 mos.
APPUCAnON - Application is hereby IJIlIde fur a Public Worb Permit In ICCOtdanc:e with Campbe1J Municipal Code, Secaon 11.04. (Application
upires in 6 months if the pennit is not issued Application Pee is DOn-retwxlabJe).
A. Work ad4ress or tract , J. ~ POIJ.ll,2.f'. 'il..O F. V6/Z.1-< AI 2 N.E PoL'i.AiZJ) l2.i) ~ ~ ~J ;2~
Utility trench locatiOn = I f
5t' . I r
B. Nature of work I '""'Tel B,'ilE:l1ArlJti1 PdliAf2.u j2i::J. t OPF-iV (:IA{~CJr:(F.mBJn:WD~~p{~. 2~~5AW ~U%fil...UW.O rZ}).
,
C. Atw:h four (4) copies of engineered plans showing tbe location and ~ of the work. and four (4) cgpie$ of the prelimimuy Engineer's
Estimate of work, The plans shall show tile relation of tbe proposed Work 10 existing ufal:e and UDdcrgtound improvements. Wben approved by
the City Engineer. said plans become a pan of this permit.
D. All work maIl confonn to the City of Campbell S&andard Specificati0n5 and Deuils for PubliC Worb Ccnstnx:cion; the General Pcnnit Conditions
listed on the reverse side; and the Special ProvisiO!l$ for this pcnnit, listed below. Failure to abide by these~jriom and provisions may re.sult in
job shut-down and/or forfeiture of ~aithful Performance SuretiC$ and cash depo5its. (See General Permit Cooditions 1 and 2.)
E. THE CONTRACtOR MUST HA VB nus PEQM]t AND APPROVED PLANS AT THE SITE AND MUST NOTIFY DIE PUBUC WORKS
DEPARTMENT AT LEAST TWO DAYS BEFORE ST.-\RT1NP .WORK. NOnCE MUST ~E GIVEN TO PUBUC WORKS AT LEAST 24 HOURS
BEFORE R.ESrARTlNG ANY WORK. Yy. DALeo C(JN~rtt. 'fOP-7?Q -7'997 f'q...c 77R __ ~"91
Nome 0' ApplioamJP'nn.... ..5ow7Ji&;Y.cAhk ~71fJE,!dJ)#3 271.<- T~ 'l27-:i27.!f..,rxr 2J t-
Address 34lf(,,) (.!,lJi2J1FTT DiL SAN/A elAflA /A 9.5tJ5Lj
Is this work being done by the property owner at U1eir OWn residence? Yes No
The Applicam/Permittee hereby asrees by affixing their signature to thi$ permit to hold the City of Campbell. iu officers, agents and employees free,
safe and harmJess from any claim Or demand for damages resulting from the worle covered by this permit.
The Applicant/Perminee hereby aclcnowledges that they have read and understand both the front and back of this permit, and they will infonn their
contractor(s) o( the . formation:
3-28-1996 8:58AM
FROtvl r'~PBELL PUBLIC WKS 408 3760958
P.3
GEN~RAL PER~OT CONDITIONS
J. A CONSl1menON CASH DEPOSIT is 1'Cq\Iired. Charges will be made .,ainst this deposit if ~ is an cmerpncy c:all-out, overtime inspection
or wben City ordered banicadins is required. Atry such alStS in ~ or Cbc deposit will .be billed to the Permittee.
2. A ONE-YEAR MAINTENANCE PERIOD AND SBCUlUTY are required. ~ period will begill OIl dire or WriUcD ~ by the City.
3. REFUND of the cash deposit balance and ~fund or cancellation of the Faithful Performanc:e Sceu.rity will be initialed by &be written accepcance
of me work by the City.
4. The Permittee MUST REQUEST m WRITINo . finaJ ~ aDd ICCepfanC:e of 1he work upon compldion. ~ by tile City will be
made in writing 10 the Permittee.
S. MAINTAIN safe pedestrian and vtbicular CfO$$ings aDd free ~ 10 privllc c1riYeways. bus stops. m bydraDts aDd ~ valves.
6, A CONSTRlJCllON TRAFFIC CONTROL PLAN and a CONSTRucnON SCHEDULE iJ ~ for aIllanc clClSW'e$. deWurs and street
closwes. 'Ibis plan must be kEVIEWED and APPROVED PRIOR to any _ closures.
7. The CONSTRUCTION TRAFFIC CONTROL}JLAN shall c:onfonn with the Calaw MaouaJ of TraffIC CoatroIs for Coustnx:tion aud Maincenanee
Work Zon~s, dated 1990, available at Caltrans, Traffic control equipment shall include Type n tIasbiDi urow lip.
8. REPLACE IN laND any damaged or removed existing impTOvelDeJ1l$, i.nc1wfin1 planting.
9. Sawcut for all PeC or AC removals. All PeC removals shall be 10 Dearest $QOt'CtlW'k and shall be doweled to e~$ting improvematts.
10. OVERTIME lNSPSCTION PREMIUM will be charged against the cash deposit for inspcc:tion required outSide tile boun of 8:00 ..m. 10 4:00 p.m.
al the cUlTCm ovenirne rate, minimum one bOUr charge.
11. SATURDAY INSPECTIONS must be lIJftI1ged in ad\lance. Saturday inspection time i$ dwged at 1hc CUlTeIlI ovet1ime rate with. &hree boor
minimum. Advan~ payment for the estimated time is required.
12. Adequate signing and Iigbted BARRICADING is required on the job site. Pailure to provide such signing and barricading will resuIl in the City's
renting such signing and barricades and charging the cost (including all labor and materials) against the a$h deposit.
13. Compaction testing of subgrade, base rock, and asphalt concrete by Pennittee IS REQUIRED unless odIerwise staled by &he City EniiMer.
14. The ConuaCtor or Permittee will ha\le a SUPERVISORY REPREsENTATIVE available for coruct on the project at all times during constr\Iaion.
Co~r or Permittee !>hall provide a phone number at which they can be conw:&ed OUUide the bours of 8:00 un. to 4:00 p.m.
IS. No STORAGE of materials or equipment will be allowed ~ the edge of pavement, tile traveled way, or within !be shoulderIine 'I.'tl.icb would
create a huardous condition to the public.
16. This permit shall not be CCn5trued as a.uthorization for excavation and gt3dins on private property ADJACENT to the work or any Olher work
for which a sepanlle permit may be required. nor does it relieve the Permittee of any obliJaIion to obtain any ocher pmM reqWred by law.
17. This permit does NOT RELEASE the Permittee from any llabilities contained in ocher qreementS Or c:ootracu with the City and any ocher public
agency.
18. This permit is NOT TRANSFERRABLE. Work must be performed by the PenniUce or his designaled agent or CODO'aCtor as spccifKld thereon.
19. CALL BACK (callout) due to emergencies regarcling this permit. shall be at &he cum:nt overtime ~ with a three (3) bow minimum chatge per
occurrence.
20. Pursuant to Chapter 14.02 of the Campbell MwticipaI Code, applicant shall not cause to be discbarged any material imo the municipal storm drain
sySltln other than storm water. Applicant shall adhere to the 8m MANAGEMENT PRAcnCES established by &be Santa Clara VaIley Nonpoinr
~ Pollution Control Program
. Ie for ensuring that all those providing services under the applicant are a
of and undentalld all of me above conditions.
AppJi
.3 y. 76
Dare
j :pVr'permitlRev. 3/96
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PUBLIC WORKS DEPARTMENT RECEIPT
Effective July 1. 1995
TO: City Clerk PUBLIC WORKS FILE NO. q~- / 5..2-
PROPERTY ADDRESS ~f ()<{) ~ 14 ik. .
Please. collect &. receipt for the following monies:
"ACC1';<:::::::::<-:>:> J1f).( " ." AMOIIIIT
435.535.49211 Proiect Revenue (soecifv Droiect) $
ENCROACHMENT PERMIT ,
4722 ApplicatiDn Fee ~
NDn-Utilitv Encroachment Permit ($2251
R-l First Permit (No Fee). Subseouent Permit/Yr ($100)
Utilitv Encroachment Permit
Arterial/Collector Street ($325) ~~ ., . u 0
Residential Street/Other Areas ($2251
220 Plan Check Dellosit ($500) .
220 Faithful Performance Surety (FPSI (100% of ENGR.EST.1 .
220 Monumentation Surety (100% of ENGR.EST.) .
220 Cash Deoosit (4% of FPS)($5oo min.) .
220 Labor and Material Surety (100% of ENGR. EST.I ~
4722 Plan Check &. Inspection Fee (Non. Utility)
Engr.Est. < $250.000 (12% of ENGR. EST.)
.. 220 Enllr.Est. > $250000 (Denosit 15% of ENGR. EST.)" .
472 Utilitv < $100.000 :lID .<>\)
Conduits/Pipelines up to 500 Feet ($1.60fft.) (MIN. $105)
Above 500 Feet ($1.10/ft.)
ManholesNaults/Etc. ($105/ea)
Pole Set/Removal ($105/ea)
Minimum Charge Per Location ($120)
Street Tree Plantinn/Removal ($105/tree)
.. 220 Utilitv > $100.000 (Dellosit 15% of ENGR, EST.)" .
476 Proiect Plans &. SDecifications Proiect No.
476 Standard Sllecifications &. Details ($l/Po $l2/Book)
476 Co Dies of Enoineerina MaDs &. Plans ($.50/sa.ft.)
472 Penalties: Failure to restore oublic imllrovements ($1 oo/Calendar Dav)
(Muni Code Section 11.34.010)
472 penalties: Failure to correct unsafe conditions ($1oo/Calendar Dav)
LAND DEVELOPMENT
4722 Lot Line Adiustment ($500)
472 Parcel MaD (4 Lots or Less) ($1 060 + $25/Lot)
472 Final Tract Mao (5 or More Lots) ($1 380 + $25/Lot)
472 Certificate of ComDliance ($400)
472 Certificate of Correction ($300)
472 Vacation of Public Streets &. Easements ($5501
472 Assessment Segregation or Reapportionment
First Split ($550) !
Each Additional Lot ($170)
472 Storm Drainage Area Fee Per Acre (R-l. $2.0001
(Multi-Res. $2,2501
(All Other, $2.500)
492C Parkland Dedication Fee (75%/25% Due Ullon Cert. of Occunancv)
496 Postaoe
TRAFFIC
472 Intersection Turn Counts (Two-Hour Count) ($60)
472 Intersection Turn Counts (a.m. or ll,m. neaks) ($125)
472 Traffic Flow MaD (Dailv Traffic Volumes) ($27)
472 Camllbell Traffic Model (Full Scone Assessment) ($2250)
472 CamDbell Traffic Model (Reduced ScoDe Assessn'($740)
427 Truck Permits ($35/triD)
472 No Parkine SJans ($lIeach or $ 25/100)
OTHER
TOTAL $ I::) Y5. c:) ()
NAME OF APPLICANT SO"'~ &\yL"14Wc y{J
NAME OF PAYOR 6llSun.aA-)c..blc~lct.J Licst
PHONE ?2?gZ."t5
.
ADDRESS 3450 ~tr o'l. .6.o.J\.... CII4~ t t.A ZIP ~C;~"*
"Actual Cost Plus 20% Overhead (Non-Interest bearino dellosit)
fOIl
em ClDlK
ONLY
I:-w ~~S'l
1
RECEIVED
APR 0 9 1996
CITY CLERK'S OFFICE
"For Plan Check and Cash Deposits, send yellow copy to Finance.
Date/Initials
h:\recfrm3.wk3(mp)rev.l/9/96
CITY OF CAMPBELL
CONTRACTOR:
DALV>
PROJECT NO. 7b --) 0-
REPORT NO: I
DATE: q-Cj-'1?
WEATHER: h,//
INSPECTOR: K. .vs:.51fALL
FIELD ENGINEER I S DAILY REPORT
~UT~ M-y C'~.
Po lIo.r.e <!- Y, (~ ~ $lH'fG vI~ ~ JltvJJ-
ITEM
DESCRIPTION
cc:
PAGE: I
OF I
04-01-1996 03:56PM
FROM BARLOCKER-LINK INS. SERU.
TO
3760958
P.02
Barlocker-Llnk Ins. Services
P. O. Box 576
Morgan Bill, CA 95037
(408) 779-3211
..,..,
Daleo, Inc.
168&0 Joleen Way, Bldg. B
Morgan Bill, CA 95037
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THIS IS TO CEJmFY THAT THE POLICIES Of INSUMNCE USTED BElOW HAVE BEfN ISSUED TO THE INSUAED NAMED ABOVE FOR 1HE POUCY PERIOD I
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TEAM OR CONOITJON Of ANY CONTRACT OR OTHER DOCUMeNT Wlllot RESPeCT TO WHICH THIS .
CERTIFICATe MAY BE lSS\JED OR MAY PERr~. THE INSURANCE AFFORDeD BY THE POLICIES OESCRIIEO HEReIN IS SUBJECT TO AU. THE TEAMS,
EXClUSIONS AND CoNDmONS OF StJCH POUClES. UMrrs SHOWN MAY HAVE ~ REOucED BY PAlO ClAIMS.
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lUXes 11114151
WllIlIlBI'S CU_ __
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~II_ 01' ClNJIA1IONIILCICAtIl*II~t.If.S~ m.s
Re: All C~lifornia Operations
See attached
f~-"'7f~~~~~;:~ .; .. .
City of C~pbell, its
officials, -.ployees, &
70 Korth First St~..~
Campbell CA 95008
. '!liE ISSUING COMPANY WILL I!NOEAVOR TO i
NOllce YO lllE CERnFlCATE HOLDER NAMED tq THe
MAll SUCH NO!lCE SHALL IMPOSe NO OIUGAllOlll mt
KIND UPON TH PANY. l'rs AGE'N1S OR AEPAeSENTATMS.
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04-01-1996 03:57PM FROM BARLOCKER-LINK INS. SERVo TO
3760958 P.03
POLICY NUMBER 8 020 373 GLP
COMMERCIAL GENERAL LIABILITY
lHIS ENDORSEMENT CHANGES 1HE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS
This eDdorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILllY COVERAGE PART
SCHEDULE
Name of Person or Organization: Per Certificate
Any Person, organi%ation. partnership or Joint-venture listed on a Certificate of Insurance on file with
us. for which you have agreed in a written contract to provide liability insurance,
(If no entry appears above, information required to complete this endorsement will be shown in the
Declarations as applicable to this endorsement.)
WHO IS AN INSURED (Section 11) is amended to include as an insured the person or orwmi72[ion
shown in the Schedule, but only with respect to liability arising out of "your work" performed for that
insured by you or on your behalf.
If the additional insured is an architect. engineer or surveyor. we won't cover "bodily injury" or
"property damage". "personal injury" that results from the performanc;e or failure to perfonn any
"proft.'SSionai services" fur you or on your behalf. "Professioual services" include but are not limited to
the following:
I. The preparing. approving. or Wlure to approve maps, drawings, opinions, reports, surveys,
change orders, designs or specifiations; and
2. Supervisory, engineering, surveying or inspection services
The following is added to SECTION IV - COMMERCIAL GENERAL LIABILfIY CONDmONS
subsection 4. Other Insurance:
Insurance provided by this endorsement is excess over other valid and collectable insurance available to:
the additional insured, whether primary, excess, cootingeut or any other basis.
However, we win consider ~ insurance provided by this eudoJsement to be primary inswance ami any
other insurance provided to the additional insured shall be in excess and not contribute with the
insurance provided by this policy, only if your contlad with the additional insured required this i
insurance to be primary. I
I
I
Other terms:
All other tenus of your policy remain unchanged.
CP.ool (ED. (9194)
Includes \;opyrighted material ofIn.'M'll(K:C Office. Inc., with its pemu:lSion
Copyright. IDsurlutu Services Office. Inc.. 1992
GERLING AMERICA INSURANCE COMPANY
I
TOTRL P.03