ENC2019-00114 of CA�r
•UtCHpRp
CITY OF CAMPBELL
Public Works Department
August 21, 2019
Audrey Kiehtreiber
1509 Walnut Dr.
Campbell, CA 95008
SUBJECT: PERMIT NO. ENC 2019-00114
1509 Walnut Dr., Campbell, CA
FINAL INSPECTION AND ACCEPTANCE.
Dear Audrey:
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 July 29, 2019. 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 Security Perfonnance 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
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CITY OF CAMPBELL VENDOR NO. 10013563 CHECK NO. 274919
Account Rurchdse Order >'L nvok e er:fi ' '&fthib
101 2203
CRO80519 1,000.00 FPS REFUND
lof
10013563 AUDREY KIEHTREIBER
>
CHECK DATE CHECK NO.
CITY OF CAMPBELL Wi"FARGO BANK, N.A.
11-24
'420:MONTCOMERY STREET..�:,- 70;NORTH FIRST STREET 08/19/19 274919
FRANCISCO, CA 94104 1210
CAMPBEL CALIFORNIA 95008
0 0
AMOUNT 1 000 00* 0
—X
0
:::.:.VOID AFTER,90 DAYS -n
PAY THE SUM OF ONE THOUSAND DOLLARS & ZERO CENTS co
TO THE AUDREY KIEHTREIBER
ORDER
1509 WALNUT DR.
CAMPBELL CA 95008
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0- 2 7 1.q I TIN 1: 12 1000 2 alm 4 1218554 L SIP
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................. ................. .......................... ............. ........................-............ ................................ ..................................... .........
*See ReVerSe Side For Easy Opening Instructions*
CITY OF CAMPBELL
70 NORTH FIRST STREET
CAMPBELL, CALIFORNIA 95008
AUDREY KIEHTREIBER
1509 WALNUT DR.
CAMPBELL CA 95008
Refundable Deposit Check Request
To: Finance Director
d
Check Payable To: Audrey Kiehtreiber
Address-Line 1: 1509 Walnut Dr.
Line 2:
City: Campbell State: CA Zip: 95008
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Description: 1509 Walnut Dr.
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Account Number: 101.2203 Amount: $1,000.00
Account Number: 101.2203 Amount:
` Account Number: 101.640.7448 Amount:
I Finance Dept only) Interest Earned( P Y) (Finance Dept only)
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Total Payable: (Exact Amount)
fi
Purpose: FPS Refund
1
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Permit#: ENC2019-00114
Receipt#: 280814 Date: 5/15/2019
Receipt#: Date:
Requested b : --`
Q Y , Title: City.Inspector Dater l
Syed Wahidi
Approved by: � " ' Title: Sr. Engineer Date: �o
Roger Storz f
I.
a �
Finance Dept Only:
Verified by: Title: Accounting Clerk II Date:
Approved by: Title: Accountant Date:
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Special Instructions For Handling Check f
Mail As Is: Mail in Attached Envelope: Interim Check:
Needed By:
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Return To: JoAnna Thomason Public Works
(Name) (Department)
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Other: Please return check to JoAnna
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CITY OF CAMPBELL
PUBLIC WORKS DEPARTMENT
CLEARANCE FOR FINAL INSPECTION
AND ACCEPTANCE LETTER
Encroachment Permit#: ENC2019-00114
Name: Audrey Kiehtreiber
Property Address: 1509 Walnut Dr.
Date of Final Inspection: 7/29/19
On File: Bonds CD Cash
Faithful Performance:
Labor and Material: $
Construction Cash Deposit to be released:'$
Other overdue deposits to be released (Description):
Processed by: `6 r
Admi istr for l
Reviewed by:
Inspector
Reviewed by: (2111-5 .
Land Development Engineer
J:UoAnnaT\Deposit refunds\CHECKLISTS\Walnut 1509.doe(Rev. 10/11)
Encroachment Permit Final Sign Off
Encroachment Permit#_ 5�C2,ei oo 1 I'�
Address: 170 WAL y lUT �12.
Date of Final Inspection and Acceptance: 7/2-9!11
Inspected by: SW
OK to release deposits: 100% 75%
Comments:
R-1 ENCROACHMENT PERMIT 90C go.(r(--W)1't
CITY OF CAMPBELL (Owner occupied residence-work within the Permit No.
DEPT.OFPUBLICWORKS X-Ref File
public right-of-way<$10,000)
70 North FirstStreet j Application Date )�l
Campbell,CA95008 ISSUED: ( �,- Application Expiration Date
Ph. (408)866-2150 Permit Expiration Date: ��( 2e APN
Fx.(408)376-0958
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.)
A. Work Address: 1 {
B. Nature of Work: ��.� o F'1e t 1
c /
C. Attach one(1)copy of a drawing showing the location,extent and dimensions of the work.?Tr rawing shall show the relation of
the proposed work to existing improvements. When approved by the City Engineer,said drawing 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 Performance securities.
Address: Q A 10—
NAME OF APPLICANT: --- _ l� P �' AMQl- ----------------- Telephone:- ,41 V1 —
E-Mail Address:
--- --V--P- -
The Applicant hereby confirms that this work is being done by thh property owner/aNzLVant at their own residence.
The Applicant hereby agrees by affixing theirsignature to this permitto 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 hereby ackn led that they have read and understand both the front and back of this permit,and that they will inform their
contractor(s)of the inform ion. I
ACCEPTED: IN "'� 'I ,"OI
"(AC, n Per ittee) (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.
144er 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 FAITH FULPERFORMANCE (100%Of Engr's Est.) $ oon
R-1 PERMIT FEE $ 225
2%TECHNOLOGY FEE $ �fi�_5U �• (�
APPROVED FOR ISSUANCE: ~—`
/1:5,4
for City Engineer Date
GENERAL PERMIT CONDITIONS
1. The Permittee must provide evidence of insurance as required by the City.Insurance shall be maintained for the duration of the
permit work.
2. Payment of a security to ensure faithful performance and completion of the work is required. This security is refundable upon
completion of the work and written acceptance by the City.
3. 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.
4. Refund or cancellation of the Faithful Performance Surety will be initiated by the written acceptance of the work by the City.
S. Submit project schedule 10 days prior to proposed start of work.Special provisions 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 bythe City will be
made in writing to the Permittee.
7. Maintain safe pedestrian.and vehicular crossings and free access to private driveways,fire hydrants and water valves.
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 as expeditiously as possible.
9. Sawcutfor all PCCand AC removals. All PCC removals shall be to nearest scoremarkand shall be doweled to existing improvements.
E
10. 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.
11. The Contractor or Permittee will have a supervisory representative available for contact on the project at all times during
construction.
12. This permit shall be kept at the site of work and must be shown to any authorized representatives of the City of Campbell or any
law enforcement officer upon demand.
13. 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.
14. 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.
15. This permit does not release the Permittee from any liabilities contained in other agreements or contracts with the City and any other
public agency.
16. This permit is not transferable. Work must be performed by the Permittee or his designated agent or contractor as specified thereon.
17. 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.
18. Call back(call out)due to emergencies regarding this permit shall be the current overtime rate with a three(3) hour minimum
charge per occurrence.
19. If the public interest requires a modification of,or a departure from,the permit plans,special provisions, 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.
20. 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.
Applic nt is h reby res onsible for ensuring that all those providing services under the applicant are aware of and abide by all of the above
condit ns.
L4^ V I
Applicant Date 1
J:\FORMS\Templates\Encroachment Permits\R-1 Encroachment Permit form.pdf Rev.IV18
PUBLIC WORKS DEPARTMENT UTILITY ENCROACHMENT, TRAFFIC & MISCELLANEOUS RECEIPT
Effective January 1, 2019
TO: Finance �*
PUBLIC WORKS FILE NO. L�c- 2-6 Ici--oc'I I Lt
PROPERTY ADDRESS `S�`� WALN LA`T D
Please collect& receipt for the following monies:
-----
ITEM"
ENCROACHMENT-PERMIT.- : . . .
4722 Utility Encroachment Permit Application Fee $553.00
4722 R-1 Encroachment Permit $225.00 22rj
2203 R-1 Faithful Performance Deposit $2,500 loon
4722 Plan Check&Inspection Fee
Minimum Charge Per Location $553.00
Conduits/Pipelines up to 500 Feet $3.54/ft
Above 500 Linear Feet $1.77/ft
Manholes/Vaults/Etc. $221.00/ea
Pole Set/Removal $221.00/ea
2203 Street Tree Planting/Removal-Deposit(refundable) $500/tree
4760 Storage Container Permit(valid up to 60 days only) $175.00
4760 Engineering Maps&Plans
Aerial Plot 24"x 36" $35.00
Map Research(includes max of two 24"x36"copies) $35.00
Maps and Plans 24"x 36" $35.00
4722 Penalties: Failure to restore public improvements $100/Calendar Day(Muni Code Sec.11.34.010)
4722 Penalties: Failure to correct unsafe conditions $100/Calendar Day
4722 Work Without Permits 2 Times Applicable Fee
TRAFFIC
4728 Traffic Flow Ma (Daily Traffic Volumes) $35.00
4728 Traffic Control Plan Review
Minor Lane Closures) $221.00
Major(Detours) $884.00
4728 Signal Timing Information $221 per hour
4271 Truck Permits $16.00 per trip/Annual$90 per year
4728 No Parking Signs $1 each
MISCELLANEOUS;•.::
554.4214 Technology Enhancement Fee 2%of total permit fees r
511.74241 Postage
Other(Please Specify)
TOTAL 22-1•5 O
i'NAME OF APPLICANT
�1. ME OF PAYOR + b PHONE 1A- -&
IRESS l� (� �j ZIP
FOR I-RE,CEI,v.ED_B.Y
FINANCE
USE ONLY Date Receipt,
fnn
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