ENC2011-00028CITY OF CAMPBELL
DEPT. OF PUBLIC WORKS
70 North First St.
Campbell, CA 95008
(408) 866-2150
Fax (408) 376-0958
~.ROACHMENT PERMIT
(for working within the public
right-of-way)
Issued
Permit Expiration Date
Pt ~~N~ Zo i - ~ ~Z~
X-Ref. File
Application Date ?7" ~ (0 '~ t~
Application Expiration Date
APN ~ C' b- i ~- ~ r, Z
APPLICATION -Application is hereby made for a Public Works Permit in accordance with Campbell Municipal Code. Section 11.04. (Application expires in six (6)
months if the pernu[ is not issued. Application Fee is non-refulndabl/e~.)~ } //
A. Work address or tract # ~ ~ I ~ f~l ~ - "! >') J y
Utility trench
B. Nature of work
~ r ce I ~
il~ jC ~'f~t
C. Attach four (4) copies of an engineered plan showing the location and extent of the work, and four (4) copies of the preliminary Engineer's Estimate of work. The
plans shall show the relation of the proposed work to existing surface and underground improvements. When approved by the City Engineer, said plan becomes 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 Perfor~n@e Sureties and cash deposits. (See General Permit Conditions I and 2.)
E. The Contr4etor must have this permit and approved plans at the site and must notify the Public Works Department at least two days before starting_work. Notice
must be yen to Public Works at least 24 hours before restarting any rk.
C (~ ~ `^ ~ y~ ~~ ~~
Name of Applicant w~~ l ~ ` ~ ~ e I- 1 ~ f~ Telephone ~ ~ ~' ~ J ~^/}
j~ mt name) ~ ~,
Addre§s ~~ ~V ~~ ~ ~~~ ~ ~ ~ 24-HOUR EMERGENCY TELEPHONE NO.
E-Mail Address ~ 1 SPA.` I~~~` ~ J/ /~ ~~ ~ "! V - ~ ti ~ _ ~ :-} ~: P .... ~
~~ ,P ~ A ~. ~'' ~i
....__ ...,. t _i ...
Is this work being done by the property owners at their bwn residence? Yes No
The ApplicanUPermittee hereby agrees by affixing their signature to this permit to hold the City of Campbell, 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/Permittee hereby acknowledges that they have read and understand both the front and back of this permit, and they will inform their contractor(s) of the
information. 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 condiuo ~~jjJy pnvrate i provemenhS in the public right-of-way.
Accepted ~~~~~1L1 ~ ~ ~ ~ ~~~
(Applicant Permittee) (sign)
Contractor (Print Name)
Date
Date
SPECIAL PROVISIONS
1. Street shall not be open cut for underground installations. Minimum cuts may be allowed for connections or exploration holes. Such cuts may
be specifically approved by the Inspector prior to cutting.
_2. Pavement may be cut for underground installations and must be restored in accordance with the Standard Details Trench Restoration Method
"A", unless otherwise approved by Inspector.
3. Work to be staked by a licensed Land Surveyor or Civil Engineer and two (2) copies of the cut sheets sent to the Public Works Department
before starting work.
_4. Per Section 4215 of [he Government Code this permit is not valid for excavations until Underground Service Alert (USA) has been notified and
[he inquiry identification number has been entered hereon. USA Phone 1-800-227-2600. USA TICKET NO.
_5. Prior to any work, the property owner shall execute an Agreement for Private Improvements in the Public Right-of-Way, which shall be
recorded.
_6. Public Notification Requirements:
SEE PUBLIC WORKS FEE SCHEDULE FOR CURRENT FEES AMOUNT RECEIPT NO.
PERMIT APPLICATION FEE $ ~'(~'~ ,. ~3'~(OSZ--
PLAN CHECK DEPOSIT $
SECURITY FOR FAITHFUL PERFORMANCE/LABOR & MATERIALS S~~
CONSTRUCTION CASH DEPOSIT $
PLAN CHECK & INSPECTION FEE $
APPROVED FOR ISSUANCE
For City Engineer Date
Permit Expires 12 Months After Date of Issuance
i
GENERAL PERMIT CONDITIONS
1. A Construction Cash Deposit is required. Charges will be made against this deposit if there is an emergency call-out, overtime inspection or when City
ordered barricading is required. Any such costs in excess of the deposit will be billed to the Permittee.
2. A one-year maintenance period and surety are required. Such period will begin on date of written acceptance by the City.
3. Refund of the cash deposit balance and 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, bus stops, fire hydrants and water valves.
G. A Construction Traffic Control Plan and a Construction Schedule are required for all lane closures, detours and street closures. This plan must be
reviewed and approved prior to any lane closures.
7. The Construction Traffic Control Plan shall conform to the Caltrans Manual of Traffic Controls for Construction and Maintenance Work Zones, dated
1990, available at Caltrans. Traffic control equipment shall include Type II flashing arrow signs if required.
8. 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.
9. Sawcut for all PCC or AC removals. All PCC removals shall be to nearest scoremark and shall be doweled to existing improvements.
10. 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.
1 1. Adequate signing and barricading is required on the job site. Failure to provide such signing and barricading may result in the City's providing signing
and barricades and charging the cos[ (including all labor and materials) against the cash deposit.
12. Compaction testing of subgrade, base rock, and asphalt concrete by Permittee is required unless otherwise stated by the City Engineer.
13. The Contractor or Permittee will have a supervisory representative available for contact on the project at all times during construction. Contractor or
Permittee shall provide a phone number at which they can be contacted outside the hours of 8:00 a.m. to 4:00 p.m.
14. No storage of materials or equipment will be allowed near the edge of pavement, the traveled way, or within the shoulderline which would create a
hazardous condition to [he public.
15. 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 law.
1 G. This permit does not release the Permittee from any liabilities contained in other agreements or contracts with the City and any other public agency.
17. This permit is not transferable. Work must be performed by the Permittee or his designated agent or contractor as specified thereon.
18. 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.
l9. Pursuant to Chapter 14.02 of the Campbell Municipal Code, applicant shall not cause Co 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.
20. 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.
21. Permittee must provide advance notification to all parties that may be affected by the permit activities. Notification shall be reviewed by City prior to
distribution and include dates of work and a contact name and phone number.
Applicant shall be responsible for ensuring that all those providing services under the applicant are aware of and understand all of the above conditions.
~~ ~1
Applicant
Contractor (Print Name)
3//G///
Date
Date
]\forms\pwperm
Rev. I 1 /9/05
_ PUBLIC WORKS DEPARTMENT LAND DEVELOPMENT & TRAFFIC RECEIPT
Effective July 1, 2010
TO: City Clerk PUBLIC WORKS FILE NO. Zd ~ ~ ''
PROPERTY ADDRESS ~ ,/ I
Please collect & recei t for the followin monies:
,ACCT. ITEM
LAND DEVELOPMENT AMOUNT
ncroac ment ermit ication ee
Non-Utilit Encroachment Permit $350.00
Minor Encroachment Permit <$to,ooo $200.00
Initial R-1 Permit N/C
Subse uent R-1 Permits within Two Year Period $200.00
2203 Plan Check De osit 2% of En ineer's Estimate $500.00 min
Utility and R-1 Permits no deposit required
4722 Gradin & Draina a Plan Review
Sin le Famil Lot $250.00
Site < 10 000 s.f. $750.00
Site ? 10 000 s.f. < Acre $1 000.00
Site >_ 1 Acre $1 500.00
Pl an Check & Ins ection Fee Non-Utili
**2203 En r. Est. u to $250 000 14% of En ineer's Estimate
4722 En r. Est. ?$250 000 Actual cost +20% Admin Overhead
Min $35 000 De osit
2203 Emer enc Cash De osit 4% of En r. Est.* $500 min/$10 000 Max
* 2203 Faithful Performance Securit FPS 100% of ENGR. EST.* ~
2203 Labor and Materials Securit 100% of ENGR. EST.*
4721 Storm Drainage Area Fee Per Acre R-1 $2 120.00
(Multi-Res $2,385.00)
All Other $2 650.00
4722 Parcel Ma 4 Lots or Less $3 600.00 + $80/lot
4722 Final Tract Ma 5 or More Lots $4 400.00 + $108/lot
2203 Monumentation Securit 100% of ENGR. EST.
4920 Parkland Dedication Fee 75%/25% Due U on Ce rt. of Occu anc
4722 Lot Line Ad ustment $1 400.00
4722 Vacation of Public Streets & Easements $2 250.00
4722 Certificate of Com liance $1 700.00
4722 Certificate of Correction $500.00
4722 A eal Filin Fee $200.00
4722 Nota Fee er si nature $10.00
4722 Assessment Segregation or Reapportionment
First Split
$800.00
Each Additional Lot $250.00
511.7424
TRAFFIC
4728 Postage
Traffic Flow Ma Dail Traffic Volumes
'
$34.00
~
4728 Si nal Timin Information $72.00/Hr
4271 Truck Permits $16.00/ er tri
4728 No Parking Signs
MISCELLANEQUS $1/each or $25/100
n
Other Please S eci --~
*Engineer's Estimate shall be as approved by the City Engineer and shal
**Actual Cost Plus 20% O^veih~ead/ (•/N-on-Interest bearing deposit)
NAME OF APPLICANT 1 ~4C~F 1r I ~ Z '~
l include all items of work. Za O
~Tn n ~ .fit ~
° rn ~ "~
NAME OF PAYOR PH ~
ADDRESS (I'/l~- ZIP OZ~
r-
FOR RECEIVED BY L~~ ~--~-- ~ /
CITY CLERK
ONLY I ~ _
..Date ;~ I Recei t #
"For Plan Check and Cash Deposits, send yellow copy to Finance.
Date/ Initials
J'.FORMS\TamplabarAtlmiNS\raUVaWawip\ Fam Lantl Dwabpmanl Tral(tc 10-11 (Rw. OBI10)
rutsuc wurcres utrAK i MtN 1 LAND DEVELOPMENT & TRAFFIC RECEIPT
Effective July 1, 2010
TO: City Clerk PUBLIC WORKS FILE NO. Zak ~ " G~~~ __
PROPERTY ADDRESS ~~~~ ~• ~~~~D~ _______
Please collect & recei t for the followin monies.
..ACCT. ITEM
LAND"DEVELOPMENT I AMOUNT
4 22 ncroac ment ermlt A ication ee
Non-Utilit Encroachment Permit
$350.00 !~
Minor Encroachment Permit <sio,ooo $200.00 ~~ ~--
Initial R-1 Permit N/C
Subse vent R-1 Permits within Two Year Period _
$200.00
2.203
Plan Check Deposit 2% of Engineer's Estimate ___ _
$500.00 min
-`
Utility and R-1 Permits _
no deposit required
4722
Gradin & Draina e Plan Review __
Sin le Famil Lot _ _
__ --- -
$250.00 ~!
Site < 10 000 s.f.
Site ? 10,000 s.f < Acre _
Site >_ 1 Acre $750.00 _ ~ --
$1 000.00 _ '~ _ _
$1,500.00 ~
Plan Check & Ins ection Fee Non-Utility -- - --
"2203i En r. Est. u to $250,000 14% of Engineer's Estimate
--
4722 En r. Est. ?$250 000 __ _
Actual cost +20% Admin Overhead ~l
_ _____
(Min $35,000 Deposit) -
2203 Emer enc Cash De osit _ 4% of Enqr. Est.` ($500 min/$10 000 Max
) I
22031
Faithful Performance Securit FPS) _
__ ______ _
100% of ENGR. EST.` - -
2203 _ Labor and Materials Security 100% of ENGR. EST.'
- ' ----
4721 Storm Drainage Area Fee Per Acre
- --- __ _
R-1 $2 120.00 ~ ----
---
~ __
(Multi-Res $2 385.00) '-
(All Other $2,650.00)
4722 Parcel Map (4 Lots or Less) _
4722' Flnal Tract Map (5 or More Lots) _ $3.600.00 + $80/lot __ _-_ - ---- -
$4,400.00 + $108/lot
- --_- ---
2203 Monumentation Securit __ _ _
100% of ENGR. EST. ~ - -- --
4920~
4722. Parkland Dedication Fee 75%/25% Due Upon Cert. of Occupancyy~_ _ '~_ _ _
i _
Lot Line Ad ustment $1.400.00
4722 Vacation of Public Streets & Easements _____
$2,250.00
~ ----
4722'
4722' Certificate of Com liance
Certificate of Correction _ _
$1,700.00 _ _ __ - -----
$500.00
'~ - ------ -----
4722 A eal Filin Fee _ _
I~ - ---
$200.00
4722
4722 i Nota Fee er si nature _
Assessment Segregation or Reapportionment
First Split ___
$10.00 ~I -- ----
`- -----------
$800.00
Each Additional Lot __ $250.00
511.7424',
TRAFFIC
4728'
Postage
Traffic Flow Ma Dail Traffic Volumes) ___
--
$34.00
4728 Si nal Timin Information $72.00/Hr -- - - --
4271 ~ Truck Permits $16.00/pertnp
~~ - --
4728, No Parking Signs
MISCELLANEOUS' _
$1/each or $25/100 ~--- ---
Other (Please Specify) -
`Engineer's Estimate shall be as approved by the City Engineer and shall
"Actual Cost Plus 20% Ove^rh~ead (Non-Interest bearing deposit)
NAME OF APPLICANT , `(P ~I (~ ~_ ~ I C~ ~ _
NAME OF PAYOR
~~ include all items of work.
TOTAL $ 2~ ~~
PHONE ~~ -Z 3~} - (~ l
ADDRESS ~~
Z I T.%(l ~~~C~ ~ -~1 ,~ f l G~ ~~'O Q,{(~ ZIP ~~ Z~) ---
J
FOR RECEIVED Y
CITY CLERK
ONLY ~~ ~~
Date
MAR ],
*For Plan Ch eck and Cash Deposits, send yellow:copy to Finan ced
DateL nitials
._
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Page 1 of 1
Syed Wahidi
From: Syed Wahidi
Sent: Wednesday, November 19, 2014 2:05 PM
To: Michelle Quinney
Cc: Alex Mordwinow; Vince Huppe
Subject: 591 WHamilton -Tree Issue
Attachments: CAM03583.jpg
Michelle,
Property owner installed a 'Ginko' tree a year ago without permit (Picture attached). He actually started permit
process at that time, paid the deposit ($500) but for some reason permit was never issued.
I had Bob S check it out who informed that the tree roots never got established and it's leaning towards the street.
Bob suggested it need to be taken out and a new tree to be planted. When I talked to the property owner, he said
that City installed the tree (?). I reminded him that City will not install tree when property owner has applied for
permit. He then said he will not replace the tree and it's ak for the City to keep his deposit.
Syed Wahidi ~ Public Works Inspector
Gity of Gampbell ~ Public Works Dept.
sye. dw@cit~rofc_a_mpbell.com
'S'd' 408.866.2165 ~ ~~ 408,376-0958
70. N. First Street ~ Gampbell, GA 95008
www.GityofGampbell.cam
11 /20/2014
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