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ENC2019-00175 0 rm a� O a• p UkCHAR0 CITY OF CAMPBELL Public Works Department August 22, 2019 Mr. Alex Keyser 1363 Capri Dr. Campbell, CA 95008 SUBJECT: PERMIT NO. ENC 2019-00175 1363 Capri Dr., Campbell, CA FINAL INSPECTION AND ACCEPTANCE Dear Alex: 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 Performance 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 7 ..................................... ...................... ............. ......................... ............... ............ .... ..... ............... ........................................ ......................... .......... .......... ........... ...................................... ...................................... ....................................... ................................ ...................................... CITY OF CAMPBELL VENDOR NO. 10014617 CHECK NO. 274918 6;es&iiwon- 101 2203 CRO80519 1,000.00 FPS REFUND 10014617 ALEX KEYSER 92�fjvhl W I HAICAR o1Gmo1GhwxGJcg=(;A m 0;1 k-Toi 0 4W 1111 . ...... CHECK DATE CHECK CITY DF�i:CAMPBELL 11-24 LS:FARGO BANK, N.A. 1210 08/19/19 274918 �761 FIRST STREET %v 420 MONTGOMERY STREET A Al ...SA4FRANCISCO, CA 94104 CAMPBELL'i CALIFORNIA 95008 0 0 AMOUNT ***'**j, 000 . 00* C) "Rcift.0 VOID AFTER 90 DAYS 0 PAY THE SUM OF ,ONE THOUSAND DOLLARS & ZERO CENTS di TO THE ALEX KEYSER ORDER 1363 CAPRI DR. CAMPBELL CA •: 95008 2 749 113 iin 1: 1 2 1000 2 118 L' 12 &8 S Sit I Sill MIR r., ..... .. . ........... ..................... ............ ......... .................................. .... .............. ..................... ....................................... ................ ..................................... ....................................... ................................ .................................... -....._..._......................._i. *See Reverse Side For Easy Opening Instructions* CITY OF CAMPBELL 70 NORTH FIRST STREET CAMPBELL, CALIFORNIA 95008 ALEX KEYSER 1363 CAPRI DR. CAMPBELL CA 95008 Encroachment Permit Final Sign Off Encroachment Permit# C 28t�—©ol'i a Address: 3 CAN-A D)2 Date of Final Inspection and Acceptance: Inspected by: OK to release deposits: 100% V 75% Comments: i I Refundable 'Deposit Check Request To: Finance Director f} Check Payable To: Alex Keyser 'C t i i Address-Line 1: 1363 Capri Dr. i - Line 2: City: Campbell State: CA Zip: 95008 i Description: 1803 Hurst } i ' Account Number: 101.2203 Amount: $1,000.00 1 I Account Number: 101.2203 Amount: I Account Number: 101.540.7448 Amount: t (Finance Dept only) Interest Earned (Finance Dept only) Total Payable: (Exact Amount) Purpose: FPS'Refund I Permit#: ENC2019-00175 i t _ � I - i ? Receipt#: 281701 Date: 7/10/2019 1 1 � Receipt M - Date: i Requested by: Title: City Inspector Date: Syed Wahidi I Approved.by: Title: Sr. Engineer Date: r� i Roger Storz i i Finance Dept Only: j Verified by: Title: Accounting Clerk II Date: Approved by: Title: Accountant Date: - I Special Instructions For Handling Check i . I Mail As Is: Mail in Attached Envelope: Interim Check: i 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#: ENC2019-00175 Name: Alex Keyser Property Address: 1363 Capri Dr.. Date of Final Inspection: 7/29/19 On File: Bonds CD Cash Faithful Performance: $ 1,000.00 Labor and Material: $ Construction Cash Deposit to be released: $ Other overdue deposits to be released (Description): Processed by: Administrator Reviewed by:' N -- (?, �5 Inspector Reviewed by: Land Development Engine r JAJoAnnaT\Deposit refunds\CHECKLISTS\l Checklist-Final Acceptance.doc(Rev. 10/11) r v R-1 ENCROACHMENT PERMIT CITY OF CAMPBELL (Owneroccupied residence -workwithinthe Permit No. 6uC I`t C�l�5 DEPT.OF PUBLIC WORKS X-Ref File public right-of-way<$10,000) 70 North First Street Application Date 1k,4rf Campbell,CA95008 ISSUED: 7 t d/.l` ct Application Expiration Date l to/0 Ph. (408)866-2150 Permit Expiration Date: 7 u 2-0 APN r6Q cp (p Fx.(408)376-09SS 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.) E A. Work Address: �G 3 C/ `2 ) DIR B. Nature of Work: �71(dvLD'E 12 PAv i%A-6 1N F(-,,+T OF 1D V\JY A-1TI2&\-CH C. Attach one(1)copy 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 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. JIAddress:AME OF APPLICANT: phone: Tele Mail Address: / ' he Applicant hereby confirms that this work is being done by the property owner/applicant 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 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: �Apph!5nt/ mi ee) f CIS ig5') 40PUFF' 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. 4" AC vvrr C. nP> oP G" A-C ( N=l:�I' LtF- ) 3. STANDARD AMOUNT RECEIPT NO. SECURITY FOR FAITHFUL PERFORMANCE (100%Of Engr's Est.) $ )00C) Z0 1701 g-- R-1 PERMIT FEE $ 2%TECHNOLOGY FEE $ /, C APPROVED FOR ISSUANCE: for City Engineer Date 2 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. 5. 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. Sawcut for all PCC and AC removals. All PCC removals shall be to nearest scoremark and shall be doweled to existing improvements. 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 at 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. 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. �? 11c o Appl��rt" J Bate J:\FORMS\Templates\Encroachment Permits\R-1 Encroachment Permit form.pdf Rev.IV18 PUBLIC WORKS DEPARTMENT UTILITY ENCROACHMENT, TRAFFIC & MISCELLANEOUS RECEIPT Effective July 8, 2019 TO: Finance PUBLIC.-WORKS FILE NO. �vL U I - Co(75 PROPERTY ADDRESS Please collect& receipt for the following monies: ACCT. I ITEM AMOUNT ENCROACHMENT PERMIT 4722 Utility Encroachment Permit Application Fee $574.00 4722 R-1 Encroachment Permit $234.00 2203 R-1 Faithful Performance Deposit $2,500 000 4722 Plan Check& Inspection Fee Minimum Charge Per Location $574.00 Conduits/Pipelines up to 500 Feet 3.67/ft Above 500 Linear Feet $1.84/ft Manholes/Vaults/Etc. 230.00/ea Pole Set/Removal $230.00/ea 2203 Street Tree Planting/Removal-Deposit(refundable) $500/tree 4760 Storage Container Permit(valid up to 60 days only) $182.00 4760 Engineering Maps&Plans Aerial Plot 24"x 36" $36.00 Map Research (includes max of two 24"x36"copies)$36.00 Maps and Plans 24"x 36" $36.00 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 Map(Daily Traffic Volumes) $35.00 4728 Traffic Control Plan Review Minor(Lane Closures) $230.00 Major(Detours) $918.00 4728 Signal Timing Information $230 per hour 42711 Truck Permits $16.00 per trip/Annual$90 per year 47281 No Parking Signs $1 each MISCELLANEOUS 554.4214 Technology Enhancement Fee 2%of total permit fees G 511.74241 Postage Other(Please Specify) TOTAL I 23�'i GU NAME OF APPLICANT (NAME OF PAYOR kx- PHONE ADDRESS CCI /7`—,• 0 tT ZIP - ` o�J FOR RECEIVED BY T FINANCE g PAID USE ONLY Date Receipt# �(J V l 9n ow" 5 CITY OF CAMPBELL J:TeestReceipt.Utility Enaaachment&Misc 19-20.xis AJvulaxB ar 6 •J)l//////// �w. •MI4 M 1L• PR*tNnyb IMbt 4 i ' rorolaw� —Qvms--. w --- 1 WZ>.olA•� ------- -- — u ---- G'tx lsTLIi NSId 6RM IP b�rttlL 'wr•pw 3 {/ 5.ILf•14 6MvM•M1P• b iF! •N sAs til ",A "Pm6W P1 969 2 VWF __V___ t �t�, 1 _--. .• � ? 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