ENC2019-00088 f"?CHAWO
CITY ®F CAMPBE LL
June 14, 2019 Public Works Department
Mr. Daniel Bethahmv
1789 Hurst Ave.
San Jose,CA 95125
SUBJECT- PERMIT NO. ENC 2019-00088 f
1789 Hurst Ave— San Jose, CA
FINAL INSPECTION AND ACCEPTANCE
Dear Daniel;
The City of Campbell has made a final inspection of subject Public Works improvements
and rinds the work to be acceptable and in conformance with City standards.
Accordingly, the City Engineer accepts the improvements. j
Your Faithful Performance Security refund in the amount of$500.00 is enclosed.
If you have any questions, please call me at (408) 866-2165.
Sincerely,
Syed Wahidi
Public Works Inspector
Cpp 1 W 2019-0008'i
a
3
t
70 North First Street • Campbell, California 95008 TEL 408.866.2150 • FAX 408.376.0958 TDD 408.866.2790
.............. .......... ............................ ............................. .............. .......... ........................................
............................. ............. ................ ..................... ........ ....................... ...... .........- .............. .......
CITY OF CAMPBELL VENDOR NO. 10015532 CHECK NO. 273724
Account, ::--plirchase:QriW-.: Invoice:Nutfiffer. ' .Amount.
101 2203 CRO53119 500.00 FPS REFUND
>
10015532 DANIEL BETHAHMY
>
CITY OF:' CAMPBELL NELTS:-MRGO BANK, N.A. CHECK DATE CHECK NO.
4'26,::MONTGOMERY STREET -121-0
11-24 OG110119 273724
NORTH FIRST STREET
iiL �' AN FRANCISCO, CA 94104: CAMPBELL, CALIFORNIA,96008
> I0 .
0 AMOUNT $ *******500 . 00*
A
0!1
'VOID AFTER 90 DAYS
PAY THE SUM OF FIVE HUNDRED DOLLARS & ZERO CENTS
TO THE DANIEL BETHAHMY R
ORDER
1789 HURST AVE
OF
SAN JOSE CA 95125
fin 2 ? 3 ? 21,110 1: L 2 1000 21,84 It 12 IG S St. L Sill
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............... .......... ......... ................... ...... .. ............................
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................................... ............................. ...................................... ....................................... ................................... ...................... ........... ...................... ........................... z
*See Reverse Side For Easy Opening Instructions*
CITY OF CAMPBELL
70 NORTH FIRST STREET
CAMPBELL, CALIFORNIA 95008
DANIEL BETHAHMY
1789 HURST AVE
SAN JOSE CA 9SI25
Refundable Deposit Check Request
To: Finance Director
Check Payable To: Daniel Bethahmy
Address Line 1: 1789 Hurst Ave.
Line 2:
City: San Jose State: CA Zip: 951125
Description: 1789 Hurst Ave.
Account Number: 101.2203 Amount: $500.00
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#: ENC2019-00088
Receipt#: 280207 Date: 4/5/2019
Receipt#: Date:
Requested by: ,� Title. Inspector Date: -3111 ,
Syed Wahidi ?
Approved by: y Title: Sr. Engineer Date:
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:necK:
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#: ENC2019-00088
Name: Daniel Bethahmy
Property Address: 1789 Hurst Ave.
Date of Final Inspection: 5/29/19
On File: Bonds CD Cash
Faithful Performa ce: =SOO.00
Labor and Material: $
Construction Cash Deposit to be released: $
Other overdue deposits to be released (Description):
Processed by:
Ad inistrator
Reviewed by:
Inspec
Reviewed by: 5; \ p
Land Development Engineer
.I:UoAnnaT\Deposit refunds\CHECKLISTS\Hurst 1789.doe(Rev. 10/11)
CITY OF CAMPBELL ENCROACHMENT PERMIT Permit No.: C-NC. ?01ci- c0i
DEPT.OF PUBLIC WORKS (for working within the X-Ref. File
70 North First Street public right-of-way) Application Date
Campbell,CA 95008
Ph.(408)866-2150 Issued -1I l A 9 Application Expiration Date U (�
Fx. (408)376-0958 AP IN
Permit Expiration Date
APPLICATION-Application isherebymadefora Public Works PermitinaccordancewithCampbell Municipal Code,Section11.04.(Application expires in six
(6) months ifthe permit is not issued. Application Fee is non-refundable.)
A. WorkAddress: 1789 Hurst Avenue
Nature of Work/Utility
B. Trench Location:
eNtoV1` (J'uF �t(6i151(�A iP��= TIZr'C, (RsST,6,(L omt 2)+"$6X TOE(SrFL Ir=5
Q✓ No Fee Permit for work related to City Project Project Name: 1789 Hurst Tree Removal tc' Dt- A Pj2f?z 0 i3'C
QT'( ArZG 612-s-9
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 workshall conform tothe City ofCampbell Standard Specifications and Detailsfor 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 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: Daniel Bethlahmy Telephone: Cell: (908) 531-0842
Address: 1789 Hurst Avenue, San Jose, CA 95125 (City of Campbell)
E-Mail Address: dbethlahmy@gmail.Com 24-HOUR EMERGENCY PHONE NUMBER: (908) 531-0842
Is this work being done by the property owners at their own residence? Yes F,/� 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.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 improvements completed in the public right-of-way.
Accepted: 4/4/19
(Applicant Permi ee) (si n) Date
BrightView Matthew Sesody 4/4/19
SPECIAL PROVISIONS: (Contractor) (Print Name) Date
_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 the Engineer.
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 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.
u uirements:
�7. C i T Y T( t KEPT W iLt p�Lar 1Cj�1 '(✓ NWT(a Fog Tpice- L 2NO.
PL-� t P-6" V—�i-iC �� RECEIPT _
PERMIT APPLICATION FEE $
PLAN CHECK DEPOSIT $ <6 U
SECURITY FOR FAITHFUL PERFORMANCE/LABOR&MATERIALS $ 51 p ,
CONSTRUCTION CASH DEPOSIT $ o cl
PLAN CHECK&INSPECTION FEE $
2%TECHNOLOGY FEE $ '
TRAFFIC CONTROL REVIEW $
APPROVED FOR ISSUANCE l wit II
For City Engineer
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 for the 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.
G. 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.
i
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 http://www.waterboards.ca.gov/water issues/programs/npdes/utilityvaults.shtml for more information.
Applicant is hereby responsible for ensuring that all those providing services under the applicant are aware of and abide by all of the above conditions.
Daniel Bethlahmy 4/4/19
Applicant Date:
BrightView Matthew Sesody 4/4/19
Contractor (Print Name) Date:
J:\FORMS\Templates\Encroachment Permits\Encroachment Permit 3 29 19
GENERAL PERMIT CONDITIONS
1: The Permittee must provide evidence of insurance and Additional Insured Endorsements as required by the City.Insurance shall be maintained for the 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 http://www.waterboards.ca.gov/water issues/programs/npdes/utilitvvaults shtml for more information.
Applicant is hereby responsible for ensuring that all those providing services under the applicant are aware of and abide by all of the above conditions.
Daniel Bethlahmy 4/4/19
Applicant Date:
BrightView Matthew Sesody 4/4/19
Contractor (Print Name) Date:
J:\FORMS\Templates\Encroachment Permits\Encroachment Permit 3 29 19
Encroachment Permit Final Sign Off
Encroachment Permit# UDCmc l— GUyuu
Address: 1���
Date of Final Inspection and Acceptance:
Inspected by:
OK to release deposits: 100% ° 75%
Comments:
CITY OF CAMPBELL,
DEPARTMENT OF PUBLIC WORKS
APPLICATION FOR-PLANT REMOVAL
Date Submitted `�1� }1 1`1 Application No.
Pursuant to the terms of Chapter 11.08 of the Campbell Municipal Code,an.application.is
hereby made fora permit to remove
1. The location of the job in the public right of Nvay is as follows:
2. .The reasous-for the removal-are as follows: _ p
(use other side of sheet if necessary)
3. The applicant hereby agrees, by.affLxin-his signature to this-application,to hold the
City of.Campbell,its officers, agents and employees-free, safe and harmless:from any .
claim or demand for damages to third persons relating from the work herein
proposed. �1
Name of Applicant l '.
(signature)
"mo t-i�f l�a /P )Z
(Print your name) . —�-- --•--------- --
Address of Applicant I_7F-) 1� S
Check One: Residence O or Business ()
Telephone Number _ C U��l 31 — D �f 1f
1
FOR.OFFICE USE Date %/iiJf/ y
_..._• _
Re c ramendation ,r" '�• �� ? " f� .,,
J.
/L e- 1
(use the `side of sheet if necessary)
Applicant contacted in field? , BY
J
PUBLIC WORKS DEPARTMENT LAND DEVELOPMENT —
Effective January 1,2019
TO: Finance PUBLIC WORKS FILE NO. lJ� �'CV'�S� Avv,,
PROPERTY ADDRESS
Please collect&receipt for the following monies:
:. ,ACCT: -'ITEM- :'AMOUNT.'.
LAND.DEVELOPMENT`
4722 Encroachment Permit Application—Fee
Non-Utility Encroachment Permit $553.00
Ins ection 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 promects 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 Securi 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 $5 304.00
4722 Final Tract Map(5 or More Lots) $6,630.00+$111/lot
2203 Monumentation Securi 100%of SurveV 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 Notice of Improvement Obligifflon—Payment
554.42141 Technology Enhancement Fee 2%of total permit fees
ther leaseSpecify)
*Engineer's Estimate shall be as approved by the City Engineer and shall include all items of work. TOTAL $
NAME OF APPLICANT
NAME OF PAYOR r L PHONE D 5 —0
ADDRESSWq
FOR RECEIVE BY
FINANCE
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