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ENC2011-00004Print Form 1 d CITY OF CAMPBELL R-1 ENCROACHMENT PERMIT Permit No. ~xCz©~ 1-vim ~{- DEPT.OFPUBLIC WORKS (Non-engineered work within the public right-of-way) X-Ref File 70 North First Street (S 10,000.00 maximum value of work) Application Date I - (:r • Zo i Campbell, CA 95008 Application Expiration Ph. (408) 866-2150 ISSUED: ~ ~ ~ ~ ` Z ~ ~, Date ~ ' ~J "~lJ1~ Fx. (408) 376-0958 Permit Expiration Date: I ' ~ - ?-u I Z APN 27__9_-_z ~' APPLICATION -Application is hereby made for a Public Works Permit in accordance with Campbell Municipal Code, Section 11.04. (Application expires in 6 months if the permit is not issued.) A. Work Address: `~iLJ ~ .~~ .~,/~ S+_ B. Nature of Work: I ~~5.~ I ~~~,Lp.} ~~~ ,~ i 5 c~~l~~n Gra~c~ M~r ~ I ~ C. Attach three (3) copies of a drawing showing the location, extent and dimensi ns of the work. The drawing sh II show the relation of the proposed work to existing improvements. When approved by the City Engineer, said drawing become a part of this permit. D. All work shall conform to the City of Campbell Standard Specifications and Details for Public Works 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 securities. NAME OF APPLICANT: /~ n ~ ~ ~~.~ ~ ~ S t, ~„` Telephone: +~ O f ~ '~(~1 _ 7 r; Address: ~ ~ N ~, E-Mail Address: ~ CJ~C';~ (v'rnrnlt.Yl,i (~~{~~(~r~ S~~ /'~'IGtC:- ~ L G'/YI The Applicant hereby confirms that this work is being done by the property owner/applicant at their own residence. The Applicant hereby agrees by affixing their signature to this permit to hold the City of Campbell, City of Campbell Redevelopment Agency, 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 hereby acknowledges that they have read and understand both the front and back of this permit, and that they will inform their contractor(s) of the information. ACCEPTED: Y ~A (Applicant/Pe it1 (Sign) NOTES: All work shall conform with the attached approved plans and all applicable Campbell Standard Details and Conditions and applicable insurance requirements. The Contractor must have this permit and approved plans and must arrange to meet with the Public Works Inspector at the site at least two days before starting work. Notice must be given to Public Works at least 24 hours before restarting any work. Per Section 4215 of the Government Code this permit is not valid for excavations until Underground Service Alert (USA) has been notified and the inquiry identification number (Ticket No.) has been entered hereon. USA Phone: 1-800-227-2600. Ticket No.: 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 the design, installation or condition of private improvements in the public right-of-way. SPECIAL PROVISIONS 1. Prior to any work, the property owner shall execute an Agreement for Private Improvements in the Public Right-of-Way, which shall be recorded. 2. 3. STANDARD AMOUNT RECEIPT NO. SECURITY FOR FAITHFUL PERFORMANCE (100% Of_E_n_gr's Est.) $ 5Q0 ~" 2~2~1 R-1 PERMIT FEE C=; $ / APPROVED FOR ISSUANCE: !~~~ / •' 2U ~- ZQ ~ ~ ' for City Engineer Date Permit Expires 6 Months after Date of Issuance. ~ ~_ ~ ~ ,;; - ~ ~ ~~ GENERAL PERMIT CONDITIONS 1. Payment of a security to insure faithful performance and completion of the work is required. This security is refundable upon completion of the work and written acceptance by the City. 2. A one-year maintenance period for all work is required. Such period will begin on date of acceptance by the City. It is the applicant's responsibility to remove and replace unacceptable improvements within the one-year maintenance period. 3. Refund or cancellation of the Faithful Performance Surety will be initiated by the written acceptance of the work by the City. 4. 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. 5. Maintain safe pedestrian and vehicular crossings and free access to private driveways, fire hydrants and water valves. 6. 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. 7. 5awcut for all PCC and AC removals. All PCC removals shall be to nearest scoremark and shall be doweled to existing improvements. 8. Adequate signing and barricading is required on the job site. Failure to provide such signing and barricading as specified by the City Engineer may result in the City's providing such signing and barricades and charging the cost to the Permittee. 9. The Contractor or Permittee will have a supervisory respresentativesvailable for contact on the project at all times during construction. 10. This permit shall be kept at the site of work and must be shown to any authorized representatives of the City of Campbell or any law enforcement officer upon demand. 11. No storage of materials or equipment will be allowed near the edge of pavement, within the traveled way, or within the shoulderline, which would create a hazardous condition to the public. 12. 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 relieve the Permittee of any obligation to obtain any other permit required by taw. .\ 13. This permit does not release the Permittee from any liabilities contained in other agreements or contracts with the City and any other public agency. 14. This permit is not transferable. Work must be performed by the Permittee or his designated agent or contractor as specified thereon. 15. Prior approval of inspector is required for any work done after normal working hours, on weekends or holidays and may require reimbursement of inspection costs at the current overtime rate. 16. 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. 17. If the public interest requires a modification of, or a departure from, the plans and 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 for City-owned or maintained facilities. 18. 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. Applicant shall be responsible for ensuring that all those providing services under the applicant are aware of and understand all of the above conditions. ~ h ~;,~ Applicant ~~G~~r Dat~ J:\FORMS\Templates\Encroachment Permits\R-1 Encroachment Permit STATIC form2.pdf Rev. 3/10 ~~T O TnnCt=1(` OC/^CIDT PUBLIC WUKKJ UCt'HK 1 IVICIV 1 a_ralvv ucv ~w~ ~.~~~. ~ .. ~ •~~.• Effective July 1, 2010 TO: City Clerk PUBLIC WORKS FILE NO PROPERTY ADDRESS Please collect & recei t for the followin monies: ACCT. LAND DEVE ITEM --JLOPMEN7 ncroac ment ermit A ication ee Non-Utilit Encroachment Permit $350.00 •~- • •---•~ d -"~ Zd (I'-d~L~L~T i ~~ ~ ~YC~~ ~ I ;AMOUNT j Minor Encroachment Permit <sio.ooo 5200.00 ' Initial R-1 Permit N/C I Subsequent R-1 Permits within Two Year Period 5200.OG 2203! Plan Check De osit 2% of En ineer's Estimate $500.00 min - 11 Utility and R-1 Permits no deposit required _ 4722! Gradin &Draina e Plan Review Sin le Famil Lot 5250.OG Site < 10.000 s.f. $750.00 Site ? 10,000 s.f < Acre $1.000.00 ~ > 1 Acre Site _ $1, 500.00 Non-Utilit Ptan Check & Inspection Fee "2203 i 4722' En r. Est. up to $250,000 En r. Est. ?$250,000 14°io of En ineer's Estimate - ~,. Actual cost +20% Admin Overhead I Min 535.000 De osit _ _- __ ___ __- ' 2203~ 22031 Emergency Cash Deposit Faithful Performance Secunt FPS ; 4% of Enqr Est ` ($500 min/$10 000 Max)' 100% of ENGR. EST. C-C~ ' 2203! Labor and Materials Securit ~ 100% of ENGR. EST. _ ' 4721 !; Storm Draina e Area Fee Per Acre R-1 $2.120.00 (Multi-Res $2 385 00) AII Other $2.650.00 -- - 47221 Parcel Ma (4 Lots or Less $3.600.00 + $80llot 4722 Final Tract Ma 5 or More Lots $4.400.00 + $10811ot I 2203' Monumentation Secunt 100% of ENGR. EST. ___ 4920 Parkland Dedication Fee '75%/25°~o Due Upon Cert. of Occu anc _ 4722'.. Lot Line Ad ustment 51.400.00 ' __ i ~ 47221 Vacation of Public Streets & Easements $2,250.00 i 47221 Certificate of Com liance 51.700.00 ' __ ___ 47221 Certificate of Correction $500 00 j ~ 47221 A eal Filin Fee 5200.00 I 4722` Notary Fee (per signature) $10 00 _ 4722 i Assessment Segregation or Reapportionment First S lit $800.00 I _ -, Each Additional Lot 5250.OG I 511.74241 TRAFFIC 47281 Postage - Traffic Flow Ma (Daily Traffic Volumes $34.00 I 4728 Si nalTimin Information $72.OOIHr ~ 4271 Truck Permits $16.OOrper trip ' 47281 No Parking Signs MISCELLANEOUS $1ieach or $25/100 ~ i ~i Other (Please S eci 'Engineer's Estimate shall be as approved by the City Engineer and shal "Actual Cost Plus 20°~o Overhead (Non-interest bearing deposit) NAME OF APPLICANT ~]~ ~ 15P~ NAME OF PAYOR L l include ali items of work. TOTAL $ ~~ i PHONE 3 O - I ADDRESS ~ /~ ~ ~rd ZIP ~~~ Q FOP. CITY CLERK ONLY (RECEIVED BY ~~-'L~~ ~ i"~~ ~~Date ~ l~ Recei t # ~ -~~~ ~~ ~ "For Plan Check and Cash Deposits, sendyel~ow copy to Finance. f ~' I y'~ I i I / ,yea ~cri~~~ua ~ 1 ~ 232D41 ; ~ ~ _ ,. .._ _~ }' % _, „ 1 ^ { 4~ `~ ~ ; ' ~~ i..~,_ ~..' . a4 0 -~ n .o ` ~ ~ d -a ~ ~.,, o d ~ o ~ °' ~ ~ W °~ r O o d~ ~.. ~ a G M `1 ,~ "S 1~ ~'{~ a ~ O w ~ ~ lV ~ o z~ ~, ~ C1 .,,, ~" y o o ,~ 0 o o ~ ~ i~ ~ N f~ O ~ ~ ~ < 7 a C G ~ ro m n ti d ~ .* .~ m w .-. a o p N ~ O 'p ..j •~ O K P'+ v 5 o c o ~ o ° ~ O O O O p O 0 w '~ o~ ..r N ~ O N O !~~( ~ _~ ,~'_1 ~ C 2c II - l~~L'L~ `~ ~'ERMIT # j, a ` ~~-~ ~,1.~ ~' ~') ~ E 1V'rIT APPLICATION" CITY OF CAMPBELL -BUILDING DIVISION DATE. /~/~'L~ J % C/~~~ l ~ ~ZG` SUITE BUILDING ADDRESS: ~~i/ ~~ ~~ ' '~ PERMIT TYPE• BUILDING ~j ELECTRICAL ~ PLUMBING ~ MECHANICAI.~ DEMOLITION SIGN GRADING OTHER REM (N) COMM. DEMO SIGNS DESCRIPTION OF WORD: (N) SFD RES. ADD ry r - ~ ~. ~ OWNER'S NAME: l~~Ni: t~~% UPS ~~~ ADDRESS: ~ ~` ~ ~ ~ ~ ~~~ ~ ~~ CITY: ~ ~~r~~~L L APPLICANT'S NAME: ADDRESS: CTfY: CONTRACTOR'S NAME: CONTACT PERSON: ADDRESS: CITY: l~//1/ c:f-'~'' C~ ~- S ~~rr~~~ G VALUATION ~~~~, ?~7~- 70;> ZIP: ~~~-Z~~''1~ PHONE #: 7 ~~'~ ~ 7~~ ~ ~` `~ ZII': ~~ 5~~~~~i '~ ~~>>~/ S U/w~l ~ C'% ~`1 ~" S J ~'.% ~ T` L~'U7~`/~ LICENSE # ~ ~° - Z ~~ Z ~ 7 i J' S'l}/~'~1,~'-~ C~ /~? t PHONE #: °7`U ,~ :~- 7,- ~i~/~~Oi~" ~ ~~ ~~ S~ ~ _, .l~l~' `JAS ,~ ZIP: ARCHITECT/ENG NAME: ~; ' ~~ ~~ - PHONE#: CONTACT PERSON: _ ' ADDRESS: /l ZIP: CITY: STORED ON SITE: YES NO ~. HAZARDOUS MATERIALS: USED ON SITE: YES NO (For use or storage of hazardous materials, provide a HazMat Information Statement to the Fire Dept. Hazardous Materials Specialist for revieR~ and comment. FIRE SPRiNKLERED: YES NO ~P~'! # ~v~ao~^-p7vc> F A ~~(-~~.I7ay orn~0^~~ iy -~.i~I~j~~ ~ 2^~~~~~ oD]~Dr~p C:U~-C ~ ~ ~.. O~~;OV~ ~ ~-~~~ z moo- x ~. ~rn~~ ~ L. ~~~= rn s rn ~ ~~z ,< ;>. i ins ~idewQ.1-L QWM ~x;s-~~ ~C~ree !~. 3` d S-~rQe-~ 0 ~ n ~o. ~iv~v~ ~~5~' f' cur b ins-}-~11 ~1e~ ~s dal l orb C~~ ~y,r~ ~~ ~~ ~~~ ~be~-4~-~~s i Z a.+nd 13 AP~~ovEQ ~oR oorvsT RUCTION. City of Campbell Public Works Permit No. ~' -o~~y co~t,,,~t„ ,p,~ ~ t~..~, on ti» lob site during ~ 1'-6" MIN. (2) DEEP WATERING TUBES AT ® I EDGE OF ROOTBALL A (2) 4-PLY, 1"x 2'0" MIN. ~ RUBBER TIES INSTALLED WITH a TWIST & NAILED TO STAKES w ~- 2"MIN. (TYP.) \ PINE STAKE (2 TYP.) TREE `~ 2" GALV. ROOFING NAIL (1 EACH END) 1 "x4" RWD. l FERTILIZER 1 GAL. 2 TABLETS OR 5 GAL. 3 TABLETS 15 GAL. 6 TABLETS 24" BOX 10 TABLETS t ~~~ ~~ OAST IC) ~~mp I! 2) RUBBER TIES PLACED 6" MAX. ,.,,,, ,,;;an have the~o plates BELOW MAIN FORK OR BRANCH ,,+ snc: during consirurtirAr (2) 2" DIA. LODGE POLE PINE STAKES TREATED WITH CHEMONITE OR w~ APPROVED EQUAL. INSTALL STAKES ~~ ~ OUTSIDE ROOTBALL (USE (2) 3" DIA. x ~ W LODGE POLE PINE STAKES FOR 24 o ~ ~ BOX OR LARGER) w ,~ ~ oa i -g i"x4" ROUGH REDWOOD WITH (2) O dF MIN 2" GALV. NAILS EACH CONNECTION - - (LOCATE ON PREVAILING WIND SIDE) az z H pWq~ ~ ~ ,-. PLACE ROOT CROWN 1/2"-3/4" z~ o ~ ~ ABOVE FINISHED GRADE .~ ~ ~ z `J ~ x 2" OF FINE SCREENED ~'~ w x ao REDWOOD OR FIR BARK MULCH ~`" = FINISHED GRADE 9 - .-. z .: ~~ FERTILIZER TABLETS z ~ I ~ ~~ (AGRIFORM) a O U ' I i~ x ROOT BALL SCARIFY SIDES OF ROOT BALL AND SIDES AND BOTTOM OF 6" MIN. PLANTING HOLE AMENDED PLANTING 4" DIA. X 3'0" LONG PERFORATED FILL MIX -STYRENE PIPS WITH PLASTIC SLOT 2 X CONTAINER GRATE SET 1 ABOVE GRADE. FILL EACH SIDEITOF 3~REE~RAIN ROCK (TYP. (3' MIN.) REVISED STREET TREE PLANTING & STAKING DETAIL DATE: JANUARY 2008 DRAIPN BY cxECxED BY _ CITY OF CAMPBELL DETAIL 12 APPROVED NOTES; (unless otherwise specified in the plans or special provisions) 1. All trees shall be a minimum of 15-gallon size and of the variety indicated on the plans or specified by the City Engineer. 2. Each tree shall be approved by the Engineer prior to planting. Contractor may request Engineer to pre-approve tree at local nursery. 3. The exact location of each tree shall be approved by the Engineer prior to planting. 4. Vertically cut the root ball at three or four places to loosen roots and discourage circling. Vertically scarify sides and bottom of planting hole. 5. When planting, hold tree so that previous planting level is even with sidewalk level and gradually place top soil about the root ball. 6. Top soil fill shall be an approved garden mix loam that is mixed at a 1:1 ratio with the native soil removed from the planting hole. 7. When hole is three-quarters full, fill with water to compact the soil and eliminate air pockets. 8. Fill planting hole with loose soil to ground level. 9. Construct a watering basin around each tree as shown. 10. Planting operations must be followed by a deep, thorough watering of each tree. 11. Substitutions in tree varieties are permitted only upon writter authori- zation from the City Engineer. 12. All street trees installed in commercial and industrial shall be installed with an irrigation system (fed from on-site). APPROV~U i~CR C®NSTRUCTION. Cit~r ~f Campb~li =~~~blic WOr!~~ i+'~rr~it No~'~~~ -~,,~... Controctor must hava tifese plans nn the ioh silo during construdiorw REVISED STREET TREE PLANTING NOTES DATE: JANUARY 2008 DRA~PN BY', CHECKED BY APPROVED CITY OF CAMPBELL DETAIL 13