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ENC2018-00016oF.� U 4 r - - •UkCHAR�• CITY OF CAWB>ELL Public Works Department October 23, 2018 Ben Austin 2478 St. Lawrence Dr: San Jose, CA 95124 SUBJECT: PERMIT NO. ENC 2018-00016 983 Whitehall Ave., San'Jose, CA FINAL INSPECTION AND ACCEPTANCE Dear Ben: The City of Campbell has made the final 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. Your Faithful Performance Security Deposit in the amount, of $500.00 is enclosed. Sincerely, Syed Wahidi Public works Inspector. 70 North First Street - Campbell, California 95008-1436 TEL 408.866.2150 FAX 408.376.0958 TDD 408.866.2790 "Refundable De;posit__Check _Reques't 'To: Finance,, i�ecfor Check`Payable To: " Ben Austin..' Address .Line.1: 2478 St. Lawrence,Dr-.. .i Line.,2: City: SanJose State: CA. Zip: 95124 Description: -:ENC201'8-Q00.16,Deposit Refnd_ Account; Number: I01;.2203 Amount: $506.00. Account Number: ..101-.2203 Amount: : Account"Number: 101540.7"8; Amount; (EinanceDepl only) `Interest Earned (Finance'Dept only ; Total Payable; (Exe5 Amount) Purpose FRS Deposh efund " Permit M , - ENC2018-00016, Receipt`#:. 27346o. ._ Date: 112612011 Receipt*: Date: Requested 6y: Title: Inspe.-cto� Date;: �1 qjCQ Syed`Wahidr Appro"ved oy:. fr Title: Sr: Engineer' " Date �a _RogetSfori ! Finance Dept Only: Venfed by: „ Title: Accounti'ngcClerk•ll Date:. Approved _by: Title:, ACcountant Date: = S:pecial.:Itstructions' -For;_Handling Check Mill As' is: im:erim i:necic: J Ret n To: '"JoAnne Thomason . -Pu c Works (Name) " (Dep , men t L _ - 4 -Other: Please,retun check,to JoAnne„ Encroachment Permit Final Sign Off Encroachment Permit#� 2�-o6G [� Address: Date of Final Inspection and Acceptance: Inspected by: )� OK to release deposits: 100% 75 _Comments: RECE 1VE® JAN � 520i� Public Print Form CITY OF CAMPBELL R-1 ENCROACHMENT PERMIT Works dministratiit No. DEPT. OF PUBLIC WORKS (Non -engineered work within the public right-of-way) X-Ref File 70 North First Street ($10,000.00 maximum value of work) Application Date Campbell, CA 95008 J _ Application Expiration Ph. (409) 866-2150 155UFD: �! Z7 / ? Date , Z — Fx. (466) 376-0958 Permit Expiration Date: r lzo /C, APN APPLICATION -Application is hereby made fora Public Works Permit in accordance with Campbell Municipal Code, Section 11.04. (Application expires in 6 months if the permit is not issued-) X. Work Address: / �3 FC— /%14,.. 14l�G� SSA -16sC'A...9 S12.9 B. Nature of Work r 01J ,L r C U � O �� ��� 7d2� � , �le,� S7 (P 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 forthis permit, listed below. Failure to abide bythese conditions and provisions may result in job shutdown and/or forfeiture of Faithful Performance securities. (/ NAME OF.APPLICANT: '0z /_/. J�E�A f1 f/_,,, ) % /�_....._......_........!`-',........W......�.........�/.."'.._...... .._. Telephone: !Y-0 ..'.37 7.-._�..) Address: E-Mail. Address:. _ ...... ........ ......... .. ....... ...._................. .. ...... ......... ..... .....-........ .. _............ ............ ._. 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: (Appl ica nt/Permittee) '- ;2-Z/-: 0Q Date NOTES: All work shall conform with the attached approved plans and all applicable Campbell Standard Details and Conditions and applicable insurance requirements. V / 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 nquiry identification number (Ticket No.) has been ehtered hereon. USA Phone: 1-800-227-2600. Ticket 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- me-�o- :CURiTY FOR FAITHFUL PERFORMA 1 PERMIT FEE APPROVED FOR !SSUANCE: STANDARD AMOUNT RECEIPT (100% Of Engr's Est.) ilZ-57/18 for City Engineer Permit Expires 6 Months after Date of issuance. Date GEitERAL PERMIT CONDITiONS 1. Payment of a 5ecuriiyto insure faithful performance:and completion ofthe.workis. required. This security is refundable upon - completion of the work and written acceptance by the city. 1 A one year maintenance period for all work is required. Such period will, begiin'on date ofaccepiance 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 i 0 days prior to proposed start of work. Special provisions may be required for work within City facilities acid downtown Campbell.. S. 'The PeYmjttee 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.. MAintaih safe pedestrian and vehicularcrossfngs and free access to private driveways, fire.hyHianis and water valves, 7: RePlace.as directed- by Ytie City Engineer any damaged or removed irrrpioVernents in accordance with:Cq kandaid-and Specification's. at tfiie sole. expehse of the PermAv-ie: 81 Sawcut for all PCC and ACremovals; All PCC removals shall, be to nearest scoremark.and. shall Ike, doweled to ei56tt'ing lmpToveirientS. 9. Adequatesjahing Arid barricading is required on thejob site.. Failure to provide.sueh signing and barijisadirig as,specified bythe' City Engineer may result in the City's providing such signing and barricades and chargiirig the cost to the Permitfee. 10. The. Contractor or Permittee will. have a supervisory reso . ritative availablefnr contact on tife project at alltiines during construction. .. 11. This" permit sfiaU be kept at the sheaf v✓a'rk and rriust be sfiQ.wn to_ inyauthofted. repies, fives of the. C ty'of airipbell Arany law. enforcement officer updri dphiand. 12. No. storage of materials ar equipment- will b.e' aliowed nearthe edge of pavemerit; Wh.Nn the traveled iyay�.or Within ihe.shoulderiine; which would create a hazardous con. tion,to the Diibllt 13. This permit shall not be cbfisttued as authorization for excavation. and grading on private. property adja.tf r to. ftwoc k-or ariy i7ikzer workfor which a separate permit rhay he required; nor does it relieve the: Permittee of anyobiigation to obtain ariy other permit required by lava; 14: This permit does not release the Permittee from any liabil[ties 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 holiday$ 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 witha three (3) hour minimum charge per occurrence. 18. if the public interest requires ak 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. Pursuantto 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 Crater, 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. i 4 4. �E' • .J. CITY OF CANWRELL nrI' kR.TMENT OF PUBLIC WORKS r=1 -r Date Submitted ; r � �..„ .4., '_ t� I �; Application No. Pursuant to the terms of Chapter 11_08 of the Campbcll Municipal Code, an application -is rll. hercbv madefor.a permit tti remo've_. +�.�.��J�r+'�t: �, �... �„�;•��: _ ........ % � `'� u%'.s�:�.�r.iS:�.t L. t{ i7•Ll •i�.�' +'� __L.._.4�„a7,,.as. 1 _The location of the jots hi the public right of way is as follows: r� •'L' i �,, � .f jam- �'"„- %1/ 1=��'r t 1` Ott, ..�.r�.,_,•,i��.r�'.lf�✓�; f�"i.,...�..^'..�.._. 3- �-; , The reasons. 'for the cnov: l.are as -fellows: , f � ! / Z� fuse otber Ade of sheet of aecciwury) 1 3. The Explicat►f. `hereby .ag re s, )y .a�ftixyttg his signature to tl�is.�r�plicarion, to.halrl the City. ai' C to bell, its offis:ers;.al snits an+� eaipl�yc�.s'free, safe •and. kmrmless`from.an : elui n or dema3nd for damages a es to third perstom relatiq� from the work herein, pmposed, Name of Applicant .. »�.F...Y � 1 '� � �� � ���'� : si .aturyt ! 71) (pratet ��ouir Yiatne. ` r cl�dress ��f.r ,pls6icant Cheek One- Re--sadence or Dnsiae;; Telephone Number �;�; ��% r' •- S / �%r kst�:_4se4s + k01w A x 44 4 k 4 k k kkK' t si N M k •kigV freVAat ev FOR OFFICE USE mate %�, :1 �. . `Reeozn.mcxrclatian C . - arse otherdde of sheet if neeessal Annlioint contacted in meld'? BY __��� Date r0: Finance e Minor Encroachrr Initial R-1 Permit Subse uentR-1 Ins ection Fee M Street Tree Plant 2203 ($500 per 22031 Plan Check Depc Utility and 4722 Grading & Draina Single Fan Site < 1 D O Site ? 10,0 Site >_ 0.5 f 4722 NPDES Review C3 F For projects not re For projects regul Im erviou� Impervious 4722 For Drojects sent 4722 Additional treatmE Plan Check & Inspect 4722 En r- Est. 4722 Enqr. Est. 2203 Faithful Performs 2203 Labor and Mlateri< 4721 Storm Drainage P 4920 Parkland Dedicati 4722 Lot Line AdjustmE 4722 Vacation of Public 4722 Certificate of Con 4722 Certificate,of Cori 4722 Document Recon 4722 Private Improverr 4722 Approved Plan R 4722 Appeal Filing Fee 730.4924 Notice of Improve 4 Assessment Segi First Split Each Addi 511.7424 Postage_ PUBLIC WOKKO utrAm I mmry 1 —1—�+� • ���, ••� Effective July 1, 2017 Effective �` PUBLIC WORKS FILE NO. � l� PROPERTY ADDRESS - al t for the followm monies ' y c J �-' '`3"- . �, t ' '�' e-,` r '�.Fa ' i Y f .. A s.?4+'. '+• ;4C '" y a t -Application Fee �chment Permit Major >_$10 000 $425.00 ant Permit-sio,000 $240.00 Permits within Two Year Period $240.00 ii nimum Charge per Location $4C0 00 n /Removal Tree Plantinq De osit Required) $500.00/tree , — , s 2% of Engineer's Estimate $500.00 min F21 Permits no deposit required e Plan Review i i llLot $295.00 00 s.f- $885.00 00 s.f. < 0.5 Acre $1,185.00 kcre $1 772.00 , e uirements wired to submit numeric sizing$175.00 red to submit numeric sizing Area 10 D00 S . Ft to 1 Acre $740.00 Area 1 Acre or more $965.00 _o Consultant for review Consultant Cost +20% ;ptfacilities $315 ea on Fee (Non -Utility) c l3200,00D 14% of Engineer's Estimate >$250,000 and <_$500,00.0 . - $35 000.00 + 8% of Enqineers Estimate >$500 000 $55 000.00 + 7% of Engineers Estimate pe osit 4% of Enqr- Est.' ($500 minl$10 000 Max ice SecurityFPS 100%'of ENGR. EST." ,Is Seburi 100% of ENGR. EST.' rea Fee Per Acre R-1 $2,120.00 (Multi -Res $2,385.00) (All Other $2,650.00) s or Less) $4,200.00 + $90/10t or More Lots) $5,115.00 + $124/lot ecurity 100% of City Monumentation Estimate on Fee (75%/25"o Due Upon Cert. of Occupancy) ,nt (Includes Certificate of compliance) $1,99.D.00 Streets & Easements $2,700..00 ipliance $1,970.00 ection $590.00 ling Fees $1.5.00/first page $3 ea. Additional ent in Public ROW $100.00 ,vision Fee $100/sheet $200.00 merit Obligation Payment egatlon or eapportlonment $940.00 Tonal Lot $295.00 Engineer and shall include all items of work. TOTAL by th\\e roved JCity j 'Engineer's Estimate shall be as app NAME OF APPLICANT NAME OF PAYOR ADDRESS c t A _ ck v��( PHONE zip ��� LA FOR '4E6E11/ Q:BY. CITY CLERK M11 Y ®a{e Wahidi 141 (44�. ANIe From: Syed Wahidi Sent: Wednesday, January 17, 2018 2:16 PM To: Bob Siudzinski Cc: phylben @comcast.net'; John Burchfiel Subject: Tree Removal & Replacement . Attachments: R-1 ENCROACHMENT PERMIT.pdf Hi Phyllis, What's the project address? To obtain the no fee permit, please submit: -. .R-1 permitapplication (attached) Copy of homeowners insurance - $500 refundable deposit Bob has approved the tree removal and will let us know the type of new tree to be installed. o-V •CA4tt, Syed Wahidi Public Works Inspector City of Campbell I Public Works Department 0 o 70 N. First,Street l Cah bell, CA 95008 ati� G`C' www.cityofcambell.co408.866.2165 From: Bob Siudzinski Sent: Wednesday, January 17, 2018 1:43 PM To: Syed Wahidi cc: 'phylben@comcast.net' Subject: FW: Hi Syed, FYI: Above is an attached approved tree removal application for your review. Can you assist the resident with the no -fee encroachment permit. I will provide the replacement species soon. To make it communication easier I copied her email on this. Thank you, Bob From: ServiceCopier(abcityofcampbell.com[mailto:ServiceCopier(abcityofcampbell.com] Sent: Wednesday, January 17, 2018 1:38 PM To: Bob Siudzinski Subject: