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					                      VTA CONSTRUCTION ACCESS PERMIT APPLICATION
        Plan Check Number:                                                  SION #: ____________________

        Permit Applicant:                                       Address:
        City:                                                    State:                           Zip:
        Contact Person:                                                   Title:
        Phone #:                                                           Fax #:
        E-Mail Address:
        Emergency Contact Person:                                         24/HR Emergency Phone #:
        Work being performed for:
        Company Name:                                           Address:
        City:                                                    State:                           Zip:
        Contact Person:                                                    Phone #:
        E-Mail Address:                                          Contractor’s CA. License Number
        Work being performed by:
        Company Name:                                           Address:
        City:                                                   State:                            Zip:
        Contact Person:                                                    Phone #:
        E-Mail Address:                                          Contractor’s CA License Number
        Project Location:
        Start Date:                                               Completion Date:
Estimated Number of Regular Work Days:               Estimated Number of Overtime/Weekend or Holiday Days:


        The permit evaluation process usually takes 7 – 14 working days from the date that a complete application
        is received.
                                          SUBMIT APPLICATION PACKAGE TO:
                                          Santa Clara Valley Transportation Authority (VTA)
                                          Design & Construction Division, Permits & Utility Locating Services
                                          3331 N. First Street, 2nd Floor, Bldg. B
                                          San Jose, California 95134-1906
                                          (408) 321-5856
        By signing this application form, the Permit Applicant agrees to all of the terms and conditions contained herein
        and to any provisions set forth in the Construction Access Permit.



Authorized Signature:                                                                     Date:
Print Name:                                                                Phone #:


PERMITAPPCURRENT1                                                                                        Rev. 11/20/06
VTA CONSTRUCTION ACCESS PERMIT
Page 2 of 3

       TERMS AND CONDITIONS OF VTA CONSTRUCTION ACCESS PERMIT
I. THE FOLLOWING ITEMS OR CONDITIONS ARE REQUIRED FOR ALL PERMIT APPLICATIONS:
    a. Completed and signed Application Form with the initial permit fee of $920.00. The final permit fee will be
       determined after review and approval of the application and/or plans. Payment may be made by cash or check
       payable to Valley Transportation Authority, (VTA). For further information regarding permit fees call (408)
       321-5856. Applicant agrees to reimburse VTA for all actual and direct costs expended by VTA, including costs
       to process this application and inspect the permit work."
    b. Applicant to provide below a detailed description of the work to be performed on VTA’s property. Applicant’s
       description of the work must include:

       1. Type of Project              2. Traffic Plan         3. Distance from the Nearest Tracks
       4. Contractor Schedule          5. Cost of Project      6. Impact on VTA Operations (If Known)
       7. Work Plan




   c. Ten (10) sets of Plans and Specifications for construction projects. All plans submitted to VTA must show, VTA
      property lines, tracks, stations, facilities and all known underground utilities.
   d. Do you have a cooperative or other agreement with VTA concerning this project?         YES  NO
      If so please provide a copy of the agreement with your application.
   e. Prior to final approval of the permit, Applicant must provide VTA with evidence of the following insurance
      coverage:
      Insurance Coverage:
                                                   Projects $1,000,000 &Under           Projects Over $1,000,000
       General Liability                                   $1,000,000                           $5,000,000
       Automobile Liability                                $1,000,000                           $5,000,000
       Worker’s Compensation                               $1,000,000                           $1,000,000
       Employer Liability                                  $1,000,000                           $1,000,000
       Railroad Protective Liability Ins.                  $1,000,000                           $5,000,000
           (See Item II. f below)
       VTA Shown as Additional Insured
       Best’s Rating of No Less Than B+, VIII
      All public agencies that are self insured, must provide to VTA evidence of self insurance prior to issuance of the
      permit.


Authorized Signature:                                                                    Date:
Print Name:                                                              Phone #:
VTA CONSTRUCTION ACCESS PERMIT
PERMITAPPCURRENT1                                                                                       Rev. 11/20/06
Page 3 of 3

       TERMS AND CONDITIONS OF VTA CONSTRUCTION ACCESS PERMIT
II. THE FOLLOWING ITEMS OR CONDITIONS ARE REQUIRED WHEN APPLICABLE:
    a. When workers or their equipment are working within or have the potential of working within 10’ of the Light
       Rail Tracks/System, or over/under any catenary system, the Contractor is required to obtain a Light Rail
       Restricted Access Permit, in addition to this permit. Call (408) 546-7608 for further information.
    b. All workers, on VTA’s light rail property, are required to complete VTA’s Railroad Worker Protection and
       Safety training class prior to beginning any work on the project. Call VTA’s Light Rail Technical Training
       Center at (408) 952-6800 for further information.
    c. When workers or their equipment working within or have the potential of working within 15’ of Caltrain’s tracks
       or 25’ of Union Pacific Railroad’s (UPRR) tracks, within VTA property, all workers are required to complete a
       Heavy Rail Safety Training Class. Call VTA’s Light Rail Technical Training at (408) 952-6800 for further
       information.
    d. Work within the Silicon Valley Rapid Transit (SVRT/BART) corridor requires a permit or written authorization
       from UPRR. Contact Terrel Anderson, Manager of Industry and Public Projects, Union Pacific Railroad, 10031
       Foothills Blvd., Roseville, California 95747. He can be reached at (916) 789-6334. A copy of UPRR’s permit or
       written authorization will be required prior to VTA issuing a Property Access Permit. All workers are required to
       complete RWP Safety Training. Call the SVRT Rail Access Coordinator for further information: Bill Baker at
       (408) 321-5925.
    e. Submission and approval by VTA of a Traffic Control Plan.
    f. Construction work within 50 feet of the Light Rail Tracks/System or over/under any Catenary System or within
       25 feet of any freight railroad track on VTA property requires the applicant to provide Railroad Protective
       Liability Insurance.
    g. The Contractor/Applicant is responsible for arranging and paying for all costs for railroad flagmen/ watchmen
    h. For construction work, a copy of the Prime Contractor’s State of California Contractors License must be
       submitted.
    i. Applicants wishing to install a utility or a facility on property owned by VTA must submit a copy of a document
       such as a License or Recorded Easement, that allows Applicant to enter, construct, install, maintain or operate
       uponVTA property. If no such document exists, Applicant must enter into such an Agreement with VTA prior to
       receiving a Permit. Applicant shall submit a site plan together with either a 8 1/2 “ x 11” or 11” x 17” size
       exhibit that illustrates the location of the proposed encroachment, utility installation and/or the location of any
       existing utilities plus nearest public cross street. Because License fees are based on property values and other
       factors, fee information will be provided after the application has been reviewed and approved by VTA.
    j. As stated in Government Code 4216.9. (a): “No permit to excavate …shall be valid unless the applicant has been
       provided with an initial inquiry identification number…” Applicant or its Contractor shall notify VTA’s Permit
       & Utility Services Unit of the USA Ticket Number prior to start of work.

III. POWER SHUT DOWN:
    a. VTA will make an assessment to determine if a power shutdown of the Overhead Catenary System is required.
       In your opinion, will this job require the Light Rail Overhead Catenary System (OCS) power to be shut down in
       order to safely perform this work? (Required for all work above or within 10’ of OCS)
        YES NO
       If VTA determines that a Light Rail power shutdown is required, any actual costs incurred by VTA resulting will
       be borne by Applicant or its Contractor.

IV. BUS STOP AND/OR SERVICE INTERRUPTION: Estimated Number of Regular Work Days:
    a. Will this project cause Bus Stop and/or Service Interruption?
              YES                             NO



Authorized Signature:                                                                     Date:
Print Name:                                                               Phone #:



PERMITAPPCURRENT1                                                                                        Rev. 11/20/06

				
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