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ENC2014-00087Print Form CITY OF CAMPBELL DEPT. OF PUBLIC WORKS 70 North First Street Campbell, CA 95008 Ph. (408) 866-2150 Fx. (408) 376-0958 R-1 ENCROACHMENT PERMIT (Non-engineered work within the public right-of-way) ($10,000.00 maximum value of work) ISSUED: _ y'~(~ C Permit Expiration Date: ~fa (~ Permit No.~~~ ~ ~~ CSC j X-Ref File Application Date ~ ~ Application Expiration 1 l Date \U \ ~~ 1~ APN ;~~ C "~ Cj'1 y4 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.) /j A. Work Address: "~j y ( C.CI'G ~ -% ~'~ Cul1.~l,C~~~ ~,~ ~/~~~~ B. Nature of Work: ~ ~~,~ ~ I~D~U(X G~~>~ ``eL ^ ~~~'` C. Attach three (3) copies of a drawing showing the location, extenT"and dimensions of the work. The drawing shall 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: M ~ CL1C.~ F ~ jC)l1 ~ ~J Telephone: " + v ~ ~~ ~ ~ v Address: t /_ L~ I ~~ (a ^ ~ ~~ E-Mail Address: MIG~~CtP`SS0.\t~J C~ ~v~a.;l . ~r~ The Applicant hereby confirms that this work is being done by the pro erty 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 ~ ~C~ (Applicant/Permittee) (Sign) Date 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 4216 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 Engr's Est.) $ Z~Od Z ~ 2~t~-E I R-1 PERMIT FEE $ ~_ APPROVED FOR ISSUANCE: ~ ~- ~ ~~ L-'- I ~~j/' 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. Submit project schedule 10 days prior to proposed start of work. Special provisions may be required for work within City facilities and downtown Campbell. 5. 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. 6. Maintain safe pedestrian and vehicular crossings and free access to private driveways, fire hydrants and water valves. 7. 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. 8. Sawcut for all PCC and AC removals. All PCC removals shall be to nearest scoremark and shall be doweled to existing improvements. 9. 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. 10. The Contractor or Permittee will have a supervisory respresentative available for contact on the project at all times during construction. 11. This permit shall be kept at the site of work and must be shown to any authorized representatives ofthe City of Campbell or any law enforcement officer upon demand. 12. 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. 13. 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 bylaw. 14. This permit does not release the Permittee from any liabilities contained in other agreements or contracts with the City and any other public agency. 15. This permit is not transferable. Work must be performed by the Permittee or his designated agent or contractor as specified thereon. 16. 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. 17. 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. 18. 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. 19. 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. nt shall be responsible for ensuring that all those providing services under the applicant are aware of and understand all of the above Applicant iy Date J:\FORMS\Templates\Encroachment Permits\R-1 Encroachment Permit STATIC form2.pdf Rev. 02/14 ~! ~ ~ z~ swrcut . ~ (40S} ZS7-6081 tAX (4US) [S/-bUyb . CUS R. ~ l ~ b HM. PHONE ~~ ` ~ y~ o[ K. PHONE ADDRESS . / 1/ ~ f CITY DAT~ TRACTOR AND TRUCw~NO JACKHAMMER YES NO CONCRETE SAWING NO EXPANSION JOINT YES NO TYPE DEEP- REDWOOD. - YES NO TYPE /SIZE FINISH ROCK YES' NO TYPE /.SIZE CONCRETE ~IIIX , ES NO SACK C~~}} ~ LAMP BLACK YES NO WIRE MESH YES NO OTHER INSTRUCTIONS: CROSS STREETS /..I. 1) NOT RESPONSIBLE FOR CRACKS. FOR JOB SCHEDULING OR ANY OTHER p) NOT RESPONSIBLE FOR ANY IN GROUND TOTAL BALANCE~~/ ~,. ~~~ QUESTIONS, PLEASE CALL (408) 287-6091 .UTILITIES, IRRIGATION LINES OR SPRINKLERS. 3) THERE WILL BE AN EXTRA CHARGE FOR DOWN PAYMENTS CONCRETE REMOVAL THICKER THAN 4" ' OR STEEL REINFORCEMENT. BALANCE DUE ~''"y ____-- - 4) NOT RESPONSIBLE FOR BLOTCHINESS. X I HAVE READ AND UNDERSTAND THE ABOVE. AUTHORIZATION TO START WORK INITIAL X BALANCE DUE DAY OF POUR-INITIAL X ~ ORIGINAL PUBLIC WORKS DEF'AK I Mtn i LHrvU UGV GLVr inn ~ Effective July 1, 2013 C ~O~ ~ --1 ' PUBLIC WORKS FILE NO. ~~ ~~U TO: City Clerk PROPERTY ADDRESS ~4~~1 ~ \ ~'S Please collect & recei t for the followin monies: AMOUNT ACCT. ITEM LAND DEVELOP MENT nc roac ment ermlt Ication ee Non-Utili Encroachment Permit Ma'or ?$10 000 $377.00 Minor Encroachment Permit <$~o,ooo $215.00 Initial R-1 Permit N/C Subse uent R-1 Permits within Two Year Period $209.00 Ins ection Fee Minimum Char e er Location $377.00 Street Tree Plantin /Removal N/C 2203 $500 er Tree Plantin De osit Re uired $500.00/tree 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 $265.00 Site < 10 000 s.f. $795.00 Site ? 10 000 s.f. < 0.5 Acre $1 060.00 Site ? 0.5 Acre $1 590.00 4722 NPDES Review C3 Re uirements For projects not required to submit numeric sizing $153 00 For protects required to submit numeric sizing Im envious Area 10 000 S . Ft to 1 Acre $663.00 Im envious Area 1 Acre or more $867.00 Plan Check & Ins ection Fee Non-Utilit i t ' 4722 En r. Est. u to $250 000 ma e s Est 14% of En ineer **2203 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 Securi FPS /D of ENGR. EST. 100 * 2203 Labor and Materials Securi 100% of ENGR. EST. 4721 Storm Draina a 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 $3 775.00 + $82/lot 4722 Final Tract Ma 5 or More Lots $4 590.00 + $112/lot 2203 Monumentation Securi 100% of ENGR. EST. 4920 Parkland Dedication Fee 75%/25% Due U on Cert. of Occu anc 4722 Lot Line Ad'ustment Includes Certificate of Com liance $1 785.00 4722 Vacation of Public Streets & Easements $2 386.00 4722 Certificate of Com liance $1 764.00 4722 Certificate of Correction $530.00 4722 A eat Filin Fee $200.00 00 $10 4722 Nota Fee er si nature . 4722 Assessment Segregation or Reapportionment First S lit $846.00 Each Additional Lot $265.00 511.7424 Postage MISCELLANEOUS Other Please S eci 'Engineer's Estimate shall be as approved by the City Engineer and shall include all items of work. TAL G ~ $~' L' ~ "*Actual Cost Plu aring deposit) s 20% Overhead (Non-Interest be TO , - C ~ J \ NAME OF APP ~ _ LICANT HONE ~ ~~ ~ ~ ~ ~-~ NAME OF PAYOR P . ADDRESS ~ ` ' V7 ZIP ~ ~,~ ~~ FOR RECEIVED - 4 CITY CLERK i t # R ' ONLY ece Date ! rlatof Initials J:\FORMS\TamgateaNEminiatrelWaWaceipl Form l.aiM Dawlopmmt 1}14 kEC~=Lt ~: ~HSHI~R TL++i7h'~ r.,~r ZHAEL a S~rLTY UI~ttC~~.~~~~# Ir~g".,4I~ T.FG~r k~F j'SFC~SIi - #~'1 ~;~SCt~T GGG.{~ y -t~~! ~~~G~ G `, f t1TFta Iil~~: ~c, f~~Fl~. ~i~ i}Tli, ~.; . r ~ ~'~'.., ~~l.t~Rrlt: ~~lfi~ttiE: ~~',l:;Cit;, LL ~.~5 o~~~AM A~ A~t~ r U r 0 0 ~ ~ 6 ~ F G~ ~kCH AFO Transmittal Name: JoAnnr imason Title: Office A~_~.ant City of Campbell Department of Public Works 70 North First Street Campbell, CA 95008 Phone: (408) 866-2701 Fax: (408) 376-0958 E-Mail: Joannat~cityofcampbell.com To: Michael Salib Date: May 20, 2014 Re: Refund of Construction Deposits, Permit ENC2014-00087 ^ Urgent ^ For Review ^ Please Comment ^ Please Reply ^ For Information & Use Enclosed please find a check in the amount of $2,000.00 representing your Faithful Security Deposit for the Encroachment Permit referenced above. Thank JoAiula Office ~ cc: Project File No. ENC2014-00087 Inspector' s File J:\JoAnnallDeposit refunds\CHECK REQUESTS\Ck Transmittals\Calado 1641.Salib.DOC (Rev. 03/08) Refundable Deposit Check Request To: Finance Director Check Payable To: Michael Salib Address -Line 1: 1641 Calado Ct. Line 2: City: Campbell Description: FPS Refund ENC2014-00087 Account Number: 101.2203 Account Number: 101.2203 Account Number: 101.540.7448 (Finance Dept only) Interest Earned Total Payable: State: CA Zip: 95008 Amount: $2,000.00 Amount: Amount: (Finance Dept only) (Exact Amount) Purpose: Refund of FPS Deposit Voucher #: Permit #: ENC2014-00087 Receipt #: 252941 Date: 4/10/2014 Requested by: '""'~ _ Title: PW Inspector Date: ~ ~ (y Syed Wahidi~ ~~ Approved by: _ Lisa Title: Sr. Civil Engineer Date: S`- ~~ ~ l,~ Finance Dept Only: Verified by: Approved by: Title: Accounting Clerk II Date: Title: Accountant Date: Special Instructions For Handling Check Mail As Is: Mail in Attached Envelope: Interim Check: Needed By: Return To: JoAnna Thomason Public Works (Name) (Department) Other: f/n: Forms/excel/chkreq - Revised 05/00 i CITY OF CAMPBELL VENDOR No . 10 012 6 9 3 CHECK No. 246484 Account Purchase Order 'Invoice Numher .Amount Descri lion 101 2203 CR050914 2,000.00 ENC2014-00087 I(AI12693 MIQ1AhL SALTS • 1 1 • 1 • • • • ' / 1 ~ 1 • ii-za .o~'c~~~ CITY OF CAMPBELL wains FARGO BANK, N.A. CHECK DATE 05/19/14 CHECK NO. 246484 -~ 70 NORTH FIRST STREET 42-0 MONTGOMERY STREET 1210 ~ ~ ioa 9 ` ~ a SAN FRANCxsco, cA C r CAMPBELL., CALIFORNIA 95008 ~ *****2 00* 000 0 o AMOUNT . , •~ 1' U •°k~unR~. VOID AFTER 90 DAYS ~ o n ~. PAY THE SUM OF TWO THOUSAND DOLLARS & ZERO CENTS r F To THE MICHAEL SALIB .~ %J/~~ r v ounER 1641 CALADO CT ~ ~ ~~ ~ `' ~/~ oF CAMPBELL CA 95008 /C u'24648411' ~:L2L000248~: 412L8554L511' ,~ ' • • • ~ ~ ~~•Id'('7'I~~IK•]~6'GK•]~q'iY01~i79ga~1CUl1-qei'fa~~~9a~~:oleyi~crnlr.~acut7eatn yli2li• - I CITY OF CAMPBELL 70 NORTH FIRST STREET CAMPBELL, CALIFORNIA 95008 MICHAEL SALIB 1641 CALADO CT CAMPBELL CA 95008 ~~ r CITY of CAMPBELL Public Works Department May 5, 2014 Michael Salib 1641 Calado Ct. Campbell, CA 95008 SUBJECT: PERMIT NO. ENC 2014-00087 1641 Calado Ct., Campbell, CA FINAL INSPECTION AND ACCEPTANCE Dear Michael: The City of Campbell has made a final inspection of subject Public Works improvements and finds the work to be acceptable and in conformance with City standards. Accordingly, the City Engineer accepts the improvements. The one year maintenance period stated in the permit begins as of the date of this acceptance letter. The permittee is responsible for the repair and/or replacement of any defective work or failures that occur within one year. The City will inspect the improvements within one year and notify you, in writing, whether or not any repairs are required. Your Faithful Performance Security Deposit in the amount of $2,000.00, plus any interest due, is now being processed and will be sent to you under separate cover. If you have any questions, please call me at (408) 866-2165. Sincerely, ~_.__. ~_ Syed Wahidi Public works Inspector Cc: Inspector file Permit #ENC 2014-00087 Suspense File 7U North First Street Campbell, California 95008-1423 rEi. 408.866.2] 50 Fnx 408.376.0958 Tug 408.8CCi.2790 CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT CLEARANCE FOR FINAL INSPECTION AND ACCEPTANCE LETTER Encroachment Permit#: ENC 2014-00087 Name: Michael Salib Property Address: 1641 Calado Ct. Date of Final Inspection: On File: ^ Bonds ^ CD ^ Cash Faithful Performance: $ 2,000.00 Labor and Material: $ Construction Cash Deposit to be released: $ ^ Other overdue deposits to be released (Description): Processed by: Administrator Reviewed b `~ Y~ ..~------;. Inspector Reviewed by: nd Develdpment Engineer J:UoAnnaT\Deposit refunds\CHECKLISTS\t Checklist -Final Acceptance.doc (Rev. 10/I I ) CAF ~ ~~I,pf ,:~• ti ~ ~.~: r J , F `_. C °kcrrnxo ~~T'~' of C,1~>d3~~.~.. public Works Department May 19, 201 ~ Michael Salib 1641 Calado Ct. Campbell, CA 95008 SUBJECT: PERMIT NO. ENC 2014-00087 LOCATION: 1641 Calado Ct. ONE YEAR MAINTENNACE INSPECTION -ACCEPTANCE Dear Michael: The City of Campbell has made the final one year maintenance inspection of the subject Public Works improvements and finds that no remedial work is required. Your warranty requirements and any surety, therefore, are hereby released. Sincerely,. _. Syed Wahidi Public works Inspector Cc: Permit File: ENC 2014-00087 7E) North First Street Cam~betl, California 95008-1436 • TEL 408.866.235© `~.x 408.3?6.095t~ ~ T»i~ 408.Sofi.2?9f?