96-266
ENCROACHMENT PERMIT
(for working within the
public riabt-of-way
/I /8 r;ep
Permit No.
X-Ref. tile
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CITY OF CAMPBELL
DEPT. OF PUBUC WORKS
70 North First St.
Campbell, CA 95008
(408) 866-2150
Fax (408) 37~58
Application Date / / / / 'II 'i V
Application expires in 6 mOnths
APPlJCATION - Applicltion is bereby IIIIde for. Public Worb Permit iD KCOnIaIIce wiIb Campbell M~ Code. Sa:Iioa lUN. (AppI..... apira iD 61111111b1
tr die permit is DOt issued. Applialtion Fee is ~le.)
A.WorhddrasOrlractl /&7 F;.",1 5vIlf\Yoo./<.~ Ave,(::;ToAAfTt: \.)>11)
Wily IraIch location Ir. .{;Ol'- t of I B1- ; .5 """b()ok~ /lve. 0,", .5 u MY Oo.k ~ .
.
B. Nllureofwort S~fo.rl 0. Lf-:-c,t 1/:///" /o..7er....( c:; ro~ 6 "c? /J1A:~ ~e""er)
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C. Aaacb four (4) topics of an coaiDer:red plans IbowiDa die IocaIiaa IIId ClIIId ~ die WOIt, IIId four (4) copilll of die pnIiruiMry ErrciDeer'I s.cm.c ~ 3fart. TIle
pIaaa IballIhow !be reIIlion of !be proposed wort 10 aiatiDa IWface IIId lIIIderpauad irrIpro__. Wbca appnmd by die City ErrciDeer, .... pIIII ......... JIIIt of
Ibis permit.
D. All wort sbaII conform 10 !be City of CanIpbdJ StIDdanI Specitkaica IIId DeIaiIs for Public Worb Coaatnrc:aoa; die Geoen1 Permit c-itiow IiaIed CIlI!be revene
aide; and die Special Provisions for this pamit, listed below. Failure to Ibide by dIeIe COIIditioIIIIIId proviaioalllll)' I'II1IIt iD job .-..cIowD lII/IJIor forfeiIure of Flitbful
PerfCll'lllllllCe Sureties IIId casb deposits. (See Geoen1 Permit C-ditioas 1 and 2.)
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E. THE CONTRACTOR MUST HAVE TInS PERMIT AND APPROVED PLANS AT THE SITE AND MUST NOTIFY THE PUBUC WORKS DEPARTMENT AT
LEAST TWO DAYS BEFORE STARTING WORK. NOTICE MUST BE GIVEN TO PUBUC WORKS AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK.
Name of Applicant We-sf U,//ey ~/1I-I-eJ'.+/~"\. V/5fo"6+ T~ ~ T~8-d.iOr
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Address IOC) /:;. >II""YI:J-..J<.S /f~e/ c-o..m.oj,er 9500B 24 HOUR EMERGENCY TELEPHONE NO. ::J9tf-0l5oT
t .f)LL!~ fJ~Lui.tJlI PO&x- /0'1-7 I L.(A./f,U?t.IlL.. (SIc?) ~q -~S/f,o
II tbis wort beina clone by the property owner . tbeir own rcsideoce? Yes '>< No 9 Y'.!:l:o ~ -" R..~
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Tbe ApplicantlPmnittee hereby aerees by atrWna tbeir lipIture to Ibis pamit to bokI die City of CaqlbdJ, ill officcn. ... IIId cmployea free. IIIfe IIId barmIca from
any claim or demand for cIIm8ccs rcsultin& from die wort covered by tbis permit.
TIle Applicant/Permittee bereby acknowledaes lbIt !bey baYe rad and WIlIentaad bolh lbe en. and bICt of Ibis permil, aad !bey will iaform tbeir COIIIIactOI(s) of die
iDfCll"Dlltion.
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PUBLIC WORKS DEPARTMENT RECEIPT
Effective July I, 1996
TO: City Clerk PUBLIC WORKS FILE NO. 0Y~/J&k
PROPERTY ADDRESS If? F. <: . L AI}IL.
lAter: Please collect & 7
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I Proiect Revenue I soecifv oroiectl . .....
43S.S3S.4921 S
ENCROACHMENT PERMIT
4722 Application Fee
Non-Utility Encroachment Permit (S22S)
R-I First Permit (No Feel. Sub"""uent PermitlYr ISIOOl
Utilitv Encroachment Permit
Arterial/Collector Street S32S1 ~.:l ~ "u
Residential Street/Other Areas S225)
2203 Plan Check Denosit - 2% of ENGR. EST. SSOO min \' ,
2203 Faithful Performance Security IFPSl 100"1. ofENGR.EST.l ,
2203 Labor and Materials Security 100"10 ofENGR. EST.l
2203 Monumentation Security 100"1. ofENGR.ESTl ,
2203 Cash D"'osit 4% ofENGR.EST.)(SSOO minl$lO.000 m""j ,
2203 Labor and Material Security 100% ofENGR. EST.) ,
Plan Check & Inspection Fee (Non-Utility)
4722 Engr.Est. < S2S0,OOO (12% ofENGR. EST.)
.. 2203 En.r.Est.>S2S0,OOO lne;;;;;it 8% of ENGR. EST./S30.000 min. I" ,
4722 Utilitv < SlOO.OOO 8~.1 1,10.60
Minimum Charge Per Location ($120)
ConduitslPipelines up to SOO Feet (SI.60/ft)
Above SOO Feet (SI.1 O/ft.)
ManholesIV aultsIEtc. ($IOS/ea)
Pole SetlRemoval (SIOS/ea)
Street Tree PlantinaIRemoval SIOS/tree\
.. 2203 Utility> $100.000 Actual Cost + 20% .. ,
4760 Proiect Plans & Snecilications Proiect No.
4760 Standard Soecilications & Details (SIIPu SI2fBookl
4760 Copies of Enuineerinu Mans & Plans ($.50/5O.ft.l
4722 Penalties: Failure to restore DubHe imorovements (SIOO/Calendar Davl
IMuni Code Section 11.34.0101
4722 Penalties: Failure to correct unsafe conditions ISIOO/Calendar Dav)
LAND DEVELOPMENT
4722 Lot Line Adiusunent SSOO)
4722 Parcel M;;;;-(4 Lots or Less). $1,060 + S2SlLol)
4722 Final Tract Man IS or More Lotsl SI,380 + $2SlLotl
4722 Certilicate of Comoliance SSOOI
4722 Certificate of Correction S300\
4722 Vacation of Public Streets & Easements $SSOl
4722 Assessment Segregation or Reapportionment
First Split ($SSO)
Each Additional Lot ($170)
4721 Storm Drainage Area Fee Per Acre (R-I, S2.(00)
(Multi-Res, S2.2S0)
(All Other. S2,SOO)
4920 Parkland Dedication Fee
496S POsl.alle
TRAFFIC
4728 Intersection Turn Counts (Two-Hour Countl $601
4728 Intersection Turn Counts lam. or o.m. oeaksl SI2S1
4728 Traffic Flow Mao (Dailv Traffic Volumes) S27)
4728 Campbell Traffic Model (Full Scone Assessment) S2.2SOl
4728 Campbell Traffic Model IReduced Scone Assessment) S7401
4271 Truck Permits $3S/trinl
4728 No Parkin. Si.ns SlIeach or S2S/IOOl
OTHER
TOTAL S 4-45',0 ~
NAME OF APPLICANT I/d,,~ Va If w S-IL~ ;..fa. 4-:<...., Ii ,'~rjd
0 510 - 4-4-'7 - 4"\)f...g
NAME OF PAYOR 0WclMtI, P:. .J;...LJ. IIIIL. PHONE
ADDRESS 75'2 j)f~" <r~ Ua.u L /~/"d/l..I cA ZIP 9f'>56
"Actual Cost Plus 20% Overhead 1N0n-lnterest beari:<LnoSitl
FOR
CITY CLERK
ONLY
Date! Initials
RECEIVED
NOV 2 11996
CITY CLERK'S OFFICE
'For Plan Check and Cash Deposits, send yellow copy In Finance.
h:lrecfrm4. wk3(mp )rev7/1/96
Receipt Dale /1- at. 1.QlP
RECEIVED FROM Dt,L{l.ANo-,o PI PEL.., N C, IN C2.
No.135644
(S'Hs, QQ)
o FOR RE":Jl
1 0 FOR P \,u. i1~ =tqlP-~(p (47AA) APf fEt g~5P2
~Cj1~I~y)p ~(fJ~~) LtflJ....rfY 1pJ).!ZQ TO
\ \ \J- ACCOUNT I 0 ~sh
PAYMENT 0' chec. \ UpL9
BALANCE DUE 0
DOLLARS
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NOV 15 '96 08:26AM AT&T FAX 9015PF
P.2
P~E'"
THE MACKIE GROUP
POBOX 925
FOLSOM CA
916-933-9213
95763-0925
THIS IS TO CERTIFY THAT THE PoLICIES OF INSUMNCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR T)t! POLICY PERIOD
INDICAtED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHeR DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCI: AFFORDED BY THE POUCIES DESCRllED HEREIN IS SUBJECT TO All THE TERMs,
EXCLUSIONS AND CONDITIONS OF SUCH POUCIES. UMITS SHOWN MAY HAVE BeEN REDuceo BY PAID CLAIMS.
tyPE Of INSUIWccE I I'OLICY NU"'EIl . - I POlIC" !"EcnVE I POt.IC'r
DATf'(MMJODfTT) DATE~
~PNi"f
A TIG INSURANCE ~OMPANY OF MI
---... - -
CQt,lPA.'o/Y
8 TIG PREMIER INSURANCE COMPANY
-
COMp~y
c GOLDEN EAGLE INSURANCE CO
COMp~y
0
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DURANGO PIPELINE, INC.,
POBOX 1047
LIVERMORE CA 94550
510-4 9-4516
CQ
LlW
A GENI...-L LUlIIIUTY
X COMMERCiAl GeIolEP.AL UAIIIUlY 914 4 4 cA 9 6 0 5 0 2 52
CI.AI"'S MACE ~l OCCuill
OWNER'S. CONTJlACTOR'S PROT
MOD. OCCUR~ENC
UMI'r.I
5/24/96
tJfNERAL NXJJE<lAli . 1 000,00
5/24/97 PAODUCTlI. t;QMPICI' IlIJG . 1,000 00
~&AOVNlURY . 1,000 00
~~ . 1,000 00
FflE Dl\AW1E (Any ~ ftr.1 S 50 00
MiDDP 1AnJ-__1 5 00
5/24/97 COMlIIN~o SINGLE lMT $
I
IOOIl. Y Nlultr 1$
(I'W perawll I
IlClDl. 1'1UJRY S
(IIW~
PfUlERlY OAMAOE I I
AUTO ONly. EA AC:CIDENT .
on1efl TIiMI AUTO ONlV
EAcH ACCIOEHT
AGGI.:ClATe
EACH ClC:QMlENCE
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AUTOIlOBILr UAIIIUlY
: ~y AUTO
B : AU. OWNED AU IOS
,jl SCHI:OUI ~O AUTO!;
X HIRED Auf os
X NC)N.()WNED lWTOS
91444CA960S0253
5/24/96
GMAllIl L1A111LIlY
IN( AUTO
1H~ Pl:lJPRlETORI
PNlT1\lil'lilElCECuT1Ve
OF~Mf.
Ontlll
NWC-392123-00
7/01/96
1
DeIu uaIIIurr
llAI8AalA FORM
OTliElil T1iM/ UMBAeWl FOfw
C WOAQM CQIIPEN",no.t UD
III~' LlMluTY
IIolCl.
EXcl.
7/01/97 Elf!J04AWD01T . 1 000 00
a DBEAtI.1'QUC\I LMT . 1 0 0 0 0 0
Q,~.EA!MPl.OYEE . 1 000 00
DDClaI'T1Ofl OF OPIIlATlOftS/lOCAno.tSNIMlCLISIIPB:W.1l'fMS
All operations - see endorsement attached.
. ... ~HO"",
WEST VALLEY SANITATION OIST.,
OF SANTA CLARA COUNTy
100 E. SUNNYOAKS AVENUE
CAMPBELL CA 95008
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SHouLD ANY Of' lltE -"OWl ~ l'INc:IQ 81 CANCEI.&.ID 8EFQtIlE '"I
EDII...-floll DATI! lltlll2CJlf. lItI IAlIIIICI COIIPAHY WILl. ENOUVOR TO IlA/L
JJL. DAft WRITTEN lIOlq 10 ,,"5 ClERTll'ICA1'f NClUlIft IUlIIIiD TO THE: lUT.
aUT fAlLUR. ?Q IlA/L fiIQl MOlq '"""' IIIPOSI MO WUClATI08 Oil I.IMIUf't
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NOV 15 '96 08:26RM RT&T FRX 9015PF
Named Insured:
Policy Number:
Durango Pipeline Inc.,
91444-CA96050252
THIS ENDORSEMENT CHANGES THE POLICY" PLEASE READ IT CARJ:Fl1LLY
ADDITIONAL INSURED ENDORSEMENT
i'HE REQUIREMENT TO ADO ANOTHER PERSON OR ORGANIZATION AS AN ADOrnONAL INSURED ON THIS POLICY UNDER
A WRrlTEN CONTRACT OR AGREEMENT CURRENTl Y IN EFFECT OR 6ECOMIWG EfFECTIVE DURING THE TERM OF TI{I!
POLICY AND A CERTIFICATE OF INSURANCE USTlNG 1J.iAT PER.~ON OR ORGAN1L\nON AS AN ADOmONAl..INSU~D HAS
REEN ISSUED. THEN "WHO IS-AN INSURED" (SeCTION II) IS AMENDED TO INCLUDE AS AN INSURED THAT PERSON OR
ORGANIZATION (CALLED" ADDrlDNAlINSUREO")
THE INSURANCE FOR THAT ADDITIONAL INSURED IS LIMITED AS FOLLOWS:
That person or organization is only an additional insured for its' liability willa out of "your work"
for or on behalf of this additional insured and ;
2. The limits of liabiliry for the additional insured are those specified in the wriUea contract or apeement, Or
in this policy. whichever is less. These limits are inclusive of and are Dot in Iddilion to the limits of
insurance shown in the declarations and:
3 All other policy terms, conditions and restrictions also apply including, but nor limited to the "other
insurance" .
THIS ENDORSEMENT AND ANY COVERAGES PROVIDED HEREIN APPLY ONLY TO THE POLICY TO
W~ICH IT IS AITACHED AND IS NOT EXTENDED TO ANY OTHER POLICY ISSUED TO THE INSURED.
ADDITIONAL INSURED: West Valley Sanitation District of Santa Clara County
100 E. Sunnyoaks Avenue
CampbeIJ CA 95008
It is hereby understood and agreed that the West Valley Sanitation District, City ofCID1pbcIl, Town of Los Gatos,
City of Monte Sereno, City of Saratoga and County of SantA Clara, Its' Officers and employees, in their capacity 8.$
such, are named as additional insured under this policy, but solely as respects liability llriIin& out of all operations of
the Named Insured in and (or the aforesaid agencies. It is futher agreed that all of me lfilrwentiODd will be given
(0) days written notice before any reduction of coverage Or cancellation oflhis insuraDCt is effective:. It is fUtIler
understood that the contractors' ia.surance is primary to any other valid and collectible iDsunnce available to the:
WC!lt VaJley Sanitation District.
LC-ADI (09/92)
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