ENC2019-00058 . . ......... .............................. ............. ........... .......... ..........
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CITY OF CAMPBELL VENDOR NO. 10015524 CHECK NO. 273662
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101 2203 CRO52319 1,000.00 FPS REFUND
10015524 JOSE MARQUEZ
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CHECK DATE CHECK NO.
lo!�CA -:DF.:�CAMPBELL CITY WELL TARGO BAIM, N.A.
11-24
06/03/19 273662
420�14ONTGOMERY STREET 1210
.7.0::NORTH FIRST STREET
SAW:FRANCISCO, CA 94104
CAMPBELL,"CALIFORNIA 96008
AMOUNT *****1, 000 . 00*
f
...I_VOID, AFTER 90 DAYS O
>
PAY THE SUM OF ONE THOUSAND DOLLARS & ZERO CENTS Ulf
TO THE JOSE MARQUEZ
ORDER
1690 PHANTOM AVE
CAMPBELL CA , 95008
I'm 2 ? 3 G G 2110 1: 121000248i: 4L2L8554 & 511m
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*See Reverse Side For Easy Opening Instructions*
CITY OF CAMPBELL
70 NORTH FIRST STREET
CAMPBELL, CALIFORNIA 95008
JOSE MARQUEZ
1690 PHANTOM AVE
CAMPBELL CA 95008
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CITY ®F CAMPBELL
Public Works Department
June 4, 2019
Jose Marquez
1690 Phantom Ave.
Campbell, CA 95008
SUBJECT: PERMIT NO. ENC 2019-00058
1690 Phantom Ave.
FINAL INSPECTION AND ACCEPTANCE
Dear Jose:
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.
Your Faithful Security Deposit Refund in the amount of$1,000.00 is enclosed.
If you have any questions, please call me at(408) 866-2165.
Sincerely,
Syed Wahidi--
Public Works Inspector
70 North First Street Campbell, California 95008 • TEL 408.866.2150 • FAX 408.376.0958 •'TDD 408.866.2790
Refundable Deposit Check Request
To: Finance Director
Check Payable To: Jose Marquez --�
Address-Line 1: 1690 Phantom Ave.
Line 2:
City: Campbell State: CA Zip: 95008
Description: 1690 Phantom Ave.
Account Number: 101.2203 Amount: $1,000.00
Account Number: 101.2203 Amount:
Account Number: 101.540.7448 Amount:
(Finance Dept only) Interest Earned (Finance Dept only)
Total Payable: (Exact Amount)
Purpose: FPS Refund
Permit#: ENC2019-00058
Receipt#: 279823 Date: 3/12/2019
Receipt#: Date:
Requested by: � Title: Inspector Date: 7/2 3
Syed Wahidii eY:s
Approved by: Title: Sr. Engineer Date: Z-3
Roger Storz
Finance Dept Only:
Verified by: Title: Accounting Clerk II Date:
Approved by: Title: Accountant Date:
Special Instructions For Handling Check
Mall As Is: Mail in Attached Envelope: Interim C:heCK:
Needed By:
Return To: JoAnna Thomason Public Works
(Name) (Department)
Other: Please return check to JoAnna
CITY OF CAMPBELL
PUBLIC WORKS DEPARTMENT
CLEARANCE FOR FINAL INSPECTION
AND ACCEPTANCE LETTER
Encroachment Permit#: ENC2019-00056
Name: ]ose Marquez
Property Address: 1690 Phantom Ave.
Date of Final Inspection:
On File: Bonds CD Cash
Faithful Performance2 1 RG'D90ft
Labor and Material: $
Construction Cash Deposit to be released: $
Other overdue deposits to be released (Description):
Processed by:
(Admi istrator
Reviewed by:
Insliedor /l
Reviewed by:
Land Development Engineer
J:UoAnnaT\Deposit refunds\CHECKLISTS\l Checklist-Final Acceptance.doc(Rev. 10/1 1)
Encroachment Permit Final Sign Off
Encroachment Permit# �-NC � «- C)0055
Ad d ress �(0 C �.�' �"(�. lvI !r"U
Date of Final Inspection and Acceptance:
Inspected by:
OK to release deposits: 100% 75%
Comments:
V
CITY OF CAMPBELL
ENCROACHMENT PERMIT Permit No.: I[N C Lq—Gcly-I 5
DEPT.OF PUBLIC WORKS (for working within the X-Ref. File
70 North First Street public right-of-way) Application Date �J
Campbell,CA 95008 2: C SSA l
Ph.(408)866-2150 Issued Application Expiration Date .�
Fx. (408)376-0958 �j42 APN Z �dg �. b4 5
Permit Expiration Date
APPLICATION-Application is hereby made fora Public Works Permit in accordance with Campbell Municipal Code,Section11.04.(Application expires in six
(6) months if the permit is not issued. Application Fee is neon-refundable.) l
A. Work Address: I G10 J-)RA --\ A
Nature of Work/Utility
B. Trench Location: Nr c,T e L 2 jrw
Iot�av ol to s
❑ No Fee Permit for work related to City Project Project Name:
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 apart of this permit.
D. Allworkshall conform to the CityofCampbell Standard Speci fica Lions and Details forPublicWorks Construction;theGeneral 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
injob shutdown and/or forfeiture of Faithful Performance Sureties and cash deposits.
E. The Contractor 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 given to Public Works at least 24 hours before restarting any work.
Name of Applicant: \�O Mcm— - 1—"2� Telephone: ,►6(J `-7_ 7PS-75 �
Address: ( / c 1�H A N-CG� A/Lz `/�b /
E-Mail Address: ���rq q p %y) CoryJ4-HOUR EMERGENCY PHONE NUMBER: S��
Is this work being done by the property o ners at their own residence? ® Yes ❑ No
The Applicant/Permittee 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.Appli ant is advised that upon issuance of this permit, property owner, or property owner's successors, shall be responsible
(y for any and all damage ris 17— (1/&h� —
g out provements completed in the public right-of-way. �
LAccepted:
(Ap lic t rmittee) (sign) Date
(Contractor) (Print Name) Date
SPECIAL PROVISIONS:
L Street shall not be open cut for underground installations. Minimum Cuts maybe allowed for connections or exploration holes.Suchcutsmaybe
g erg ifirnllynnnrn� veri by ihr Inspector prior to rutting.
2. Pavement.may be cut for unde.r;;round installations and rnuSt be restored in accordance with the Standard Details Trench Restoration Method
"A",unless otherwise approved by the Engineer.
3. Work to be stiketl by o licensed Lind Surveyor or Civii Engineer and two(2)copies of the cut sheets sent to the Public Works Department
before starting work.
4. 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 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.
o. Public Notification Requirements:
�7. i.l_ I-OF— �� �NS�L=CTt CtN—FPLc �'r� h� �fC
SEE PUBLIC WORKS FEE SCHEDULE FOR CURRENT FEES AMOUNT RECEIPT NO.
PERMIT APPLICATION PEE $— 06
PLAN CHECK DEPOSIT S
SECURITY FOR FAITHFUL PERFORMANCE/LABOR&MATERIALS $ CJGU
CONSTRUCTION CASH DEPOSIT $
PLAN CHECK&INSPECTION PEE $
2%TECHNOLOGY FEE $
TRAFFIC CONTROL REVIEW $
APPROVED FOR ISSUANCE 12 A C!
For City Engineer Date
Permit Expires 12 Months After Date of Issuance
GENERAL PERMIT CONDITIONS'
1. The Permittee must provide evidence of insurance and Additional Insured Endorsements as required by the City.Insurance shall be maintained forth e duration of the
permit work.
2. A Construction Cash Deposit is required.Changes 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.
3. Refund of the construction 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. A one-year maintenance period and surety are required.Such period will begin on date of written acceptance by the City.Surety posted shall be equal to 25%of the
original Faithful Performance Security.
5. Submit project schedule 10(ten)days prior to proposed start of work.Additional lead time may be required for work within City facilities and downtown Campbell.
6. 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.
7. Maintain safe pedestrian and vehicular crossings and free access to private driveways,bus stops,fire hydrants,and water valves.
8. 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.
9. A Construction Traffic Control Plan shall conform to the most recent version of the California Manual on Uniform Traffic Control Devices(MUTCD).
10. 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 as expeditiously as possible.
11. Sawcut for all PCC or AC removals.All PCC removals shall be to the nearest scoremark and new PCC shall be doweled to existing improvements.
12. Prior approval of inspector is required for any work proposed after normal working hours,on weekends or holidays and may require reimbursement of inspection
costs at the current overtime rate.
13. Work on arterials and collectors may require the use of changeable message boards.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 cost(including all labor and materials)against the construction
cash deposit.
14. Compaction testing of subgrade,base rock,and asphalt concrete by Permittee is required unless otherwise stated by the City Engineer.
15. 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.and on weekends.
16. No storage of materials or equipment will be allowed near the edge of the pavement,the traveled way,or within the shoulderline which would create a hazardous
condition to the public.
17. 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.
18. This permit does not release the Permittee from any liabilities contained in other agreements or contracts with the City and any other public agency.
19. This permit is not transferable.Work must be performed by the Permittee or his designated agent or contractor as specified thereon.
20. 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.
21. 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.
22. If the public interest requires a modification of,or a departure from the permit,plans,special provisions and/or 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.
23. Permittee must provide advance notification to all parties that may be affected by the permit activities.Notification shall be reviewed by the City prior to distribution
and include dates of work and a contact name and a phone number.
24. Applicant shall remove water from utility vaults in accordance with the requirements of State Water Resources Control Board Water Quality Order WQ 2014-0174-
DWQ. Said vault water shall not be discharged into the City of Campbell's storm drain system.
See tittp://www.waterboards.ca.gov/water issues/proprams/npdes/utilityvaults.shtml for more information.
Applicant is hereby responn1boensu�in7tat all those providing services under the applicant are aware of and abide by all of the above conditions
3
Applicant Date: �2
Contractor (Print Name) Date:
J:\FORMS\Templates\Encroachment Permits\Encroachment Permit 129 19
PUBLIC WORKS DEPARTMENT LAND DEVELOPMENT
Effective January 1,2019
TO: Finance PUBLIC WORKS FILE NO. 1-1-i C-2<D 19 —0(:n • .59
PROPERTY ADDRESS t,AGlvi A
Please collect&receipt for the following monies:
`.ACCT.,; ITEM AMOUNT
LAND DEVELOPMENT
4722 Encroachment Permit Application Fee
Non-Utility Encroachment Permit $553.00
Inspection Fee Minimum Charge per Location $553.00
2203 Plan Check Deposit 2%of Engineer's Estimate $500.00 min
4722 Grading&Drainage Plan Review
Site< 10,000 s.f. $1 326.00
Site>_ 10,000 s.f. <0.5 Acre $1,768.00
Site>_0.5 Acre $2 210.00 first acre
Each additional acre $442.00
4722 NPDES Review C3 Requirements)
For projects not required to submit numeric sizing $442.00
For projects required to submit numeric sizing
Impervious Area up to 1 Acre $1 326.00
Impervious Area over 1 Acre $1 768.00
Each additional acre $442.00
Pervious Pavement/Concrete/Asphalt
First 5,000 SF $2 210.00
Each Additional 2,500 SF $663.00
4722 For Proiects sent to Consultant for review Pass through+20%
4722 Additional treatment facilities $442 ea
4722 Stormwater Treatment Features Operations& $275.00
Maintenance Inspection
Plan Check& Inspection Fee(Non-Utility)
4722 En r. Est. <$250 000 14%of En rs.Estimate-minimum$3536
4722 En r. Est.?$250 000 and<_$500,000 $35,000.00+8%of Engineers Estimate
4722 En r. Est. >$500 000 $55 000.00+7%of Engineers Estimate
2203 Emergencv Cash Deposit 4%of En r. Est.`($500 min/$10,000 Max)
2203 Faithful Performance Security FPS 100%of ENGR. EST.' OC�G
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 $5 304.00
4722 Final Tract Map(5 or More Lots) $6,630.00+$111/lot
2203 Monumentation Security 100%of Survey Cost Estimate
4920 Parkland Dedication Fee(75%/25% Due Upon Cert. of Occupancy)
4722 Lot Line Adjustment/Parcel Merger $3,315.00 includes Cert.of Correction
4722 Vacation of Public Streets&Easements
Summary Vacation $3,536.00
All Other Vacations $221/hour
4722 Certificate of Compliance $2,210.00
4722 Certificate of Correction $774.00
4722 Street/Easement Dedications
Homeowner Occupied R-1 $0
All Others $1,105.00
4722 Private Improvement in Public ROW Agreement $165.00
4722 Approved Plan Revision Fee $111/sheet
730.49241 ovement b i" ation Payment
554.42141 Technoloqv Enhancement Fee 2%of total permit fees
Other easeSpecify)
'Engineer's Estimate shall be as approved by the City Engineer and shall include all items of work. TOTAL $ t000
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NAME OF APPLICANT J� _ o\ Ue
NAME OF PAYOR 56v()L PHQffE
ADDRESS i C -{ a M Ue-- ZIP I.
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FOR RECEIV BY.
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FINANCE :: . :.,' _ G•: �I.. A ;r,� �+� .�� ' ;
USE ONLY Date ' Receipf# '
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