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1306 Juanita Way
is illb ENCROACHMENT PERMIT ISSUANCE CHECK LIST City of Campbell Encroachment Permit No. ENC 7O1 I —0005(4 Department of Public Works Tract No. Address: 130(Q W 11." ITEMS REQUIRED FOR PERMIT APPLICATION: QQ Applicant section complete 41, ' Applicant signature and d front and back) � l 3. Permit Application Fee$2.:.10 paid-Receipt Number 2 L✓ `�r "� ( ik ✓ Engineer's Estimate Submitted 0 0 Plan Check Deposit Paid(2%of Engineer's Estimate $500 mi Receipt Number 6. Five Sets of Grading and Drainage Plans 0 Five Sets of Improvement Plans Submitted 8. Check Lists ITEMS REQUIRED PRIOR TO PUBLIC WORK CLEARANCE FOR BUILDING PERMITS 0 Plan Check&Inspection Fee: If Engineer's Estimate<$250,000,then lalo of Engineer's Estimate. If Engineer's Estimate >$250,000,then Actual Cost+20%. (Deposit of 8' of Engineer's Estimate required;$30,000 minimum deposit. Amount$ q3$•ct al Receipt No. 'f 1 (Q j 1 \ 10. Security for Faithful Performance and Labor and Materials, 100%ea ngineer' Estimate u plied or pa' Amount$LAW.00 Form I.D.# - ,� 5 `t! (0 r31 ( 1 11. Security for Monumentation Amount$ Receipt No. 12. Construction Emergent Cash Deposit: 4%of.En ineer's stimate.( 5 imum,$10,000 maximum) Amount$26 '.0'� Receipt No._ I ` 13 Storm Drainage Area Fee Amount$q 11.00 Receipt No.230031 01212'1 ?Ai O 14. Right of Way Documents Completed and Fees Paid. 15. Worker's Compensation Insurance Information Sheet Received for Applicant. 16. All other Public Works requirements listed in the Conditions of Approval of the development. 17. Other Fees,Payments,Deposits Amount$ Receipt No. ITEMS REQUIRED PRIOR TO ISSUANCE OF ENCROACHMENT PERMIT: gV Contractor's signature added to the permit application(front and back) 19. V Contractor's City of Campbell Business License # DO ())3& exf (*t l l l.y Worker's Compensation Insurance Information Sheet received from Contractor. 21. Certificate of Insurance with Additional Insured's Endorsement received from Applicant or Contractor. 22. One mylar set and four blueline sets of off-site plans signed by licensed engineer,stamped APPROVED FOR CONSTRUCTION. 23. Permit signed by City Engineer. WHEN ALL OF THE ABOVE ITEMS ARE COMPLETE,PERMIT MAY BE ISSUED. Issuer: Initial and date and file with permit. UPON ISSUANCE,INITIATE CHECK REQUEST FOR PLAN CHECK DEPOSIT REFUND j:\LandDev\forms\streetimprovements\EP checklist tiloMO y► CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT CLEARANCE FOR FINAL INSPECTION AND ACCEPTANCE LETTER Encroachment Permit ENC2CII - 00056 Property Address /30(0 J_c.l Jjd Date of Final Inspection: 9/Co // On File: Bonds 1 CD Cash Faithful Performance $ (017CO. (&5,ozs. 0b be, releac ) Labor and Material $ NIA X( Construction Cash Deposit to be released: $ 2 ()B, c Other overdue deposits to be released (Description): N /A Processed by: (/1/ / /rt c.,i o -i,Ytr'Ki''>'(t.L- ^ Administrator Reviewed by: __.. Inspector Reviewed by: Land Development Engineer Reviewed by: t 6 ity Engineer J:\FORMS\Templates\Administrative\Checklist-Clearance for Final Insp and Acceptance.doc(Rev.03 10) Jea ;rundman O S C A Ten :rk -> City of Campbell ' • • ; ;,1� Department of Public Works 70 North First Street o o Campbell,CA 95008 Phone:(408)866-2150 Fax:(408)376-0958 E-Mail:jeanineg@cityofcampbell.com Transmittal To: Tim Nguyen Date: 9/26/11 Company: Address: 1306 Juanita Way Campbell, CA 95008 Re: Check for funds release of permit#ENC2011-00056 O Urgent O For Review ❑ Please Comment ❑ Please Reply x O For Information & Use I have attached your check totaling $5,294.24 which represents 75% of your Faithful Performance Security(FPS)Deposit of$6,700.00 and your Construction Cash Deposit of$268.00,plus any interest due. We will continue to hold 25%of your FPS cash deposit as a maintenance surety for the project at 1306 Juanita Way. Campbell,CA 95008. Thank you, Jeanine Grundman J:\JeanineG\Transmittals\Transmittal, ENC2011-00056, 1306 Juanita Way.DOC CITY OF CAMPBELL VENDOR NO. 10011135 CHECK NO. 233671 Account Purchase Order Invoice Number Amount Description 101 2203 CR090611 5,293.00 DEPOSIT REFUND 101.540 7448 CR090611 1.24 INTEREST c in O w m P U V 1001 135 TIM NGUYEN H so TACCE TTHISCHECKUNLESSTHE INKL•CK&KEYIC•NSFA°EWHENWA MEI N1 UC NSEE HEXAG•N•SHA EST UEWTE MA KWHENHEUT.THELIGHT CITY OF CAMPBELL CHECK DATE CHECK NO. °S'CA�tr� WIiLLS FARGO BANK, N.A. 11-24 i 2 0 MONTGOMERY STREET 1210 09/26/11 233671 . �te' 70 NORTH FIRST STREET SAN FRANCISCO, CA 94104 .L ° y•,• - Fr' CAMPBELL, CALIFORNIA 95008 O 14•'` o AMOUNT $ *****5, 294 . 24* 0f ` c. " VOID AFTER 90 DAYS mi I PAY THE SUM OF FIVE THOUSAND, TWO HUNDRED NINETY FOUR DOLLARS & COI ; I 24 CENTS Fl o TO THE TIM NGUYEN (� ORDER 1306 JUANITA WAY 50'-- 1 -�� `)A . ___ - `oi *r CL 1 CAMPBELL CA 95008 O. 0 2336 7 LP I: L2L000248i: 4L2la5 St. L50 , RUB OR BREATHE ON THE PINK LOCK&KEY ICONS—COLOR WILL FADE AND THEN REAPPEAR ON AN AUTHENTIC CHECK—IF COLOR DOES NOT FADE DO NOT ACCEPT H *See Reverse Side For Easy Opening instructions' H CITY OF CAMPBELL 70 NORTH FIRST STREET CAMPBELL, CALIFORNIA 95008 TIM NGUYEN 1306 JUANITA WAY CAMPBELL CA 95008 O •CA`/I) HARO. CITY OF CAMPBELL September 6, 2011 Public Works Department Tim Nguyen 1306 Juanita Way Campbell, CA 95008 SUBJECT: PERMIT NO: ENC2011-00056 LOCATION: 1306 Juanita Way FINAL INSPECTION AND ACCEPTANCE Dear Mr. Nguyen, 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 the date of this letter. 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. 75% of your Faithful Performance Security(FPS) Deposit of$6,700.00 and your Construction Cash Deposit of$268.00, plus any interest due, is now being processed and will be sent to you under separate cover. We will continue to hold 25% of your FPS cash deposit as a maintenance surety. If you have any questions, please call me at (408) 866-2165. Sincerely, Syed Wahidi Senior Public Works Inspector MQ cc: Suspense— 11 months Permit# ENC2011-00056 Inspector File J:\JeanineG\Final Inspect. Letters\Final Inspect., ENC2011-00056.doc 70 North First Street • Campbell, California 95008-1423 • TFL 408.866.2150 • FAX 408.376.0958 • TDD 408.866.2790 r , Refundable Deposit Check Request To; Finance Director Check Payable To: Tim Nguyen Address- Line 1: Line 2: 1306 Juanita Way City: Campbell State: CA Zip: 95008 Description: Refund Deposit for ENC2011-00056 Account Number: 101.2203 Amount: $5,025.00 Account Number: 101.2203 Amount: $268.00 Account Number: 101.540.7448 Amount: (Finance Dept only) Interest Earned (Finance Dept only) Total Payable: $5,293.00 (Exact Amount) Purpose: Refund 75% Faithful Performance Security Deposit($5,025.00) Refund Construction Cash Deposit($268.00), 1306 Juanita Way Voucher#: Permit#: ENC2011-00056 Receipt#: 235416 Date: 6/3/2011 Requested by: Syed Wahidi Title: PW Inspector Date: 9/6/2011 Approved by: Ed Arango Title: Assistant Civil Engineer Date: 9/6/2011 Finance Dept Only: /`" Verified by: 11�{itt it il4 Title: Date: Approved by. Title: Date: Special Instructions For Handling Check Mail As IS: Mail in Attached Envelope: Interim Check: Needed By: Return To: Jeanine Grundman PW (Name) (Department) Other: f/n:Formslexcel/chkreq - Revised 05/00 1'age l of Jeanine Grundman • To: Ana Rios Subject: RE: Refundable deposit in wrong account Thanks so much! -Jeanine From: Ana Rios Sent: Wednesday, September 07, 2011 11:31 AM To: Jeanine Grundman Subject: RE: Refundable deposit in wrong account Not a problem, I will do a journal entry. Ana From: Jeanine Grundman Sent: Wednesday, September 07, 2011 11:30 AM To: Ana Rios Subject: Refundable deposit in wrong account Hi Ana, As we were doing a final inspection clearance for encroachment permit ENC2011-00056, we discovered that Tim Nguyen's $938.00 Plan Check and Inspection fee was in the refundable account. This was an error on our part due to our written receipt having the wrong account number on it. The cashier's receipt is#235416. Would you please transfer the funds from acct. 2203 to 4722? Thank you very much and have a good one, Jeanine 9/7/2011 es es PUBLIC WORKS DEPARTMENT LAND DEVELOPMENT&TRAFFIC RECEIPT Effective July 1,2010 TO: City Clerk PUBLIC WORKS FILE NO. r COC .J PROPERTY ADDRESS Please collect&receipt for the following monies: ACCT. ITEM I AMOUNT LAND DEVELOPMENT 4722 Encroachment Permit Application Fee Non-Utility Encroachment Permit $350.00 Minor Encroachment Permit<sto,000 $200.00 Initial R-1 Permit N/C - ' C)O Subsequent R-1 Permits within Two Year Period $200.00 * 2203 Plan Check Deposit 2%of Engineer's Estimate $500.00 min Utility and R-1 Permits no deposit required 4722 Grading&Drainage Plan Review Single Family Lot $250.00 Site< 10,000 s.f. $750.00 Site≥ 10,000 s.f. <Acre $1,000.00 Site≥ 1 Acre $1,500.00 Plan Check& Inspection Fee(Non-Utility) Q **2203 Engr. Est. up to$250,000 14%of Engineer's Estimate . q 3&..u( 4722 Engr. Est. ≥$250,000 Actual cost+20%Admin Overhead (Min$35,000 Deposit) * 2203 Emergency Cash Deposit 4%of Engr. Est.*($500 min/$10,000 Max) -.,21-, r c_JC' * 2203 Faithful Performance Security(FPS) 100%of ENGR. EST.* (c,':--/-CC,' 1 CCU * 2203 Labor and Materials Security 100%of ENGR. EST.*4721 Storm Drainage Area Fee Per Acre R-1 $2,120.00 ./1 (Multi-Res$2,385.00) (All Other$2,650.00) 4722 Parcel Map(4 Lots or Less) $3,600.00+$80/lot 4722 Final Tract Map(5 or More Lots' $4,400.00+$108/lot * 2203 • Monumentation Security 100%of ENGR. EST. 4920 Parkland Dedication Fee(75%/25%Due Upon Cert. of Occupancy) 4722 Lot Line Adjustment $1,400.00 4722 Vacation of Public Streets&Easements $2,250.00 4722 Certificate of Compliance $1,700.00 4722 Certificate of Correction $500.00 4722 Appeal Filing Fee $200.00 4722 Notary Fee(per signature) $10.00 4722 Assessment Segregation or Reapportionment First Split $800.00 Each Additional Lot $250.00 511.7424, Postage TRAFFIC 4728 Traffic Flow Map(Daily Traffic Volumes) $34.00 4728' Signal Timing Information $72.00/Hr 4271 Truck Permits $16.00/per trip 4728: No Parking Signs $1/each or$25/100 MISCELLANEOUS .. .. i Other(Please Specify) lP) / )` r 00 *Engineer's Estimate shall be as approved by the City Engineer and shall include all items of work. I V - **Actual Cost Plus 20%Overhead(Non-Interest bearing deposit) TOTAL $ NAME OF APPLICANT X `� NAME OF PAYOR -TON t \ .r- PHON i>' r ( (i-O 22 1 CI S ZIP ' ,, ADDRESS ((' � �� FOR RECEIVED BY s , __. CITY CLERK (" / ) )i ONLY Date I ,: Receipt# t + `4 I ' *For Plan Check and Cash Deposits,send yellow copy to Finance. ' Date/ Initials A..- J'\FORMS\Templates/Atl mfn,etral*e6leceipt Epfm Land Develppmenl Traffic 1O11(Rev.06110; CITY OF CAMPBELL RECVD BY: 3AZ 01000235416 PAYOR: TIM NGUYEN TODAY'S DATE: 0,6/03/1; REGISTER DATE: O6/03/11 TIME: 08:4? DESCRIPTION AMOUNT ENGR "r SUBDIV FILING F $200.00 CUST ID: EtC2011-000::6 REF DEPOSIT - 101 $938.00 CUST ID: TIM NGUYEN 68.00 m^ REF DEPOSIT - 101 $2 CUST ID: REF DEPOSIT - 101 $6.?00.00 CUST ID: 1306 3UANITA WAY TOTAL DUE: 58.106.00 CHECK, PAID: $8.106.00 CHECK NO: 1078 TENDERED: 58.106.00 CHANGE: 5.00! Print Form Permit No GIG HU C 1(. CITY OF CAMPBELL ENCROACHMENT PERMIT —000 DEPT.OF PUBLIC WORKS (for working within the public X-Ref.File 70 North First Street right-of-way) / Application Date G, Campbell,CA 95008 Issued 60/0/ C ( Application Expiration Date 1 ;I 3/{ Ph. (408)866-2150 APN {lc Fx. (408)376-0958 _ // �/2._ Permit Expiration Date CD CJ( ( ` APPLICATION-Application is hereby made for a Public Works Permit in accordance with Campbell Municipal Code,Section 11.04. (Application expires in six (6) months if the permit is not issued. Application Fee is non-refundable.) A. Work Address or Tract No.: ,l 30 E J U Gi VU 1 t.. (v&j r � VIA r(J'e e 4 9 5-OO Utility Trench Location: `/ B. Nature of Work: gLt �� c.L,a,, .6) r2s (DEL tI C ,r/w .& G�• 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 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 Sureties and cash deposits. (See General Permit Conditions 1 and 2.) 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: ; I./107-1.4y l)C -GC'(C/1( Telephone: `LF(7 d -- q 9_ v (.; Address: c1 y fri t4 (-A bR SA-I0 J°E 1 CA S I2 c, E-Mail Address: 1 f-i NO)O )Y4fOC, 60f`j 24-HOUR EMERGENCY PHONE NUMBER: `lei e- 7 9 O 6 ?- Is this work being done by the property owners at their own residence? r YES iN0 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 the condition of any private improvements in the public right-of-way. Accepted: f G 3 / (Applicant Permittee) g Date (Ylk( k,0 et 9e (: A.teS, (icr . C,t CI Mc.t (O L — 3 / (Contractor) (Print Name) Date SPECIAL PROVISIONS: 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. V 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 4215 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. 6. Public Notification Requirements: 7. SEE PUBLIC WORKS FEE SCHEDULE FOR CURRENT FEES AMOUNT s RECEIPT NO. 7 PERMITAPPLICATION FEE $ O.0O PLAN CHECK DEPOSIT $ 5r)Q r O O SECURITY FOR FAITHFUL PERFORMANCE/LABOR&MATERIALS $ (04.00 00 CONSTRUCTION CASH DEPOSIT $ $CI S23 0 EMERGENCY PERMIT $ ..D C� PLAN CHECK&INSPECTION FEE $ O APPROVED FOR ISSUANCE 'f/lJ�.2 { (zeso_ 37a For City Engineer Date Permit Expires 12 Months After Date of Issuance GENERAL PERMIT CONDITIONS 1. A Construction Cash Deposit is required. Charges 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. 2. A one-year maintenance period and surety are required. Such period will begin on date of written acceptance by the City. 3. Refund or the 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. 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. 5. Maintain safe pedestrian and vehicular crossings and free access to private driveways,bus stops,fire hydrants,and water valves. 6. 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. 7. A Construction Traffic Control Plan shall conform to the Caltrans Manual of Traffic Controls for Construction and Maintenance Work Zones,dated 1990,available at Caltrans.Traffic control equipment shall include Type II flashing arrow signs if required. 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. 9. Sawcut for all PCC or AC removals. All PCC removals shall be to the nearest scoremark and shall be doweled to existing improvements. 10. 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. 11. 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 cash deposit. 12. Compaction testing of subgrade,base rock,and asphalt concrete by Permittee is required unless otherwise stated by the City Engineer. 13. 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. 14. No storage of materials or equipment will be allowed near the edge of pavement,the traveled way,or within the shoulderline which would create a hazardous condition to the public. 15. 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. 16. This permit does not release the Permittee from any liabilities contained in other agreements or contracts with the City and any other public agency. 17. This permit is not transferable. Work must be performed by the Permittee or his designated agent or contractor as specified thereon. 18. Call back(call out)due to emeregencies regarding this permit shall be at the current overtime rate with a three(3)hour minimum charge per occurrence. 19. 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. 20. If the public interest requires a 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. 21. Permitttee 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 phone number. Applicant shall be responsible for ensuring that all those providing services under the applicant are aware and understand all of the above conditions. )11L11 � l►faie5, frvL. - 3- I i Applicant Date: Contractor (Print Name) Date: J:\FORMS\Templates\Encroachment Permits\Encroachment Permit STATIC form2.pdf Rev.09/10 S. 11. I� FILE . O 2.1 O O �o ^ PAVEMENT RESTORATION NOTE: Z O THE CITY ENGINEER RESERVES THE RIGHT TO u'' 0 O 2" C.TYPEMAXIMUM MEDIUM AMEND OR CHANGE THE PAVEMENT (N) One—Story House / 95%COMPACTION RESTORATION AREA SHOULD ANY UTILITY a 3589 st // 9"-I2" TRENCHES, CONNECTIONS, FACILITIES, ETC. N / ®GRIND PAVEMENT EEY CHANGE IN LOCATION FROM WHAT ARE ! 2.2. 2-4 DEEP:9'-I2'WIDE / SHOWN ON.THESE PLANS, OR FOR ANY e"-[O" OTHER UTILITY FACILITIES NOT SHOWN ON / THESE PLANS. ANY CHANGES THE CITY ^'`� 2'-4'Q 2 ENGINEER REQUIRES CAN INCLUDE BUT ARE 4. / ••••• rr •-s•e•s!..�a�•• �.•:ee•• !';!_ !+�.• •�:�� NOT LIMITED TO: FULL REMOVAL OF EXISTING ❑ / EXISTING AC SECTION a , PAVEMENT STRUCTURAL SECTION, 4 INSTALLATION OF PAVEMENT STRUCTURAL PAVEMENT FABRIC OVER TRENCH(PETR0TAC,PETROMAT SECTION, GRINDING AND INSTALLATION OF / ° 4 a ° OR EQUAL)11/TACK COAT PAVEMENT, OVERLAY OF PAVEMENT. / 0 2 SACK SAND/CEMENT SLURRY a 4 d BACKFILL / / a a \^) / •t. a • , V G Li I I / \ / // ///i Wit I CLASS 1 BEDDING l2" E A BEDDING•(CLEAN SAND BEDDING - •• L SHALL BE USED AROUND GAS CONDUITS) CONC. DRIVEWAY O .... a c •Z'G (N) JOINT TRENCH (CTV, `"'In 1/ 4'MIN r / TELEPHONE, GAS, ELECTRIC .•i.'•:.. ) /� MIN. WIDTH 18", MIN. DEPTH 39" (E) WATER METER TRENCH WIDTH ICe "I'"`"'' (E) SEWER CLEANOUT I"' ' W i 'D'PLUS S"YIN. y1�� 'IF PLUS 24"MAX C •9 a CENTER PIPE IN TRENCH ) O \ ,gry..5° + _- - v __ -- } a 0 75.00 46 �\ (N) JOINT TRENCH (CTV, U S78'52'00"E CLUMP... O TELEPHONE, ELECTRIC) NOTES: I0 PLACE PERMANENT PAVEMENT WITHIN FIVE(5)DAYS AFTER CLLIN0� G f * AN EXCAVATION. (STEEL PLATING REQUIRED DURING CURING�EfM7OD Off{ MIN. WIDTH 18", MIN.DEPTH 39", I UNPAVED AREA o 3 DAYS MIN. - 5 DAYS MAX.) V ��V/ ++ 1M ]41 g '? © IF EXISTING AC SECTION IS LESS THAN 4",GRIND AC KEY TO FULL D F EXISTING AC AND REPLACE I FULL DEPTH SECTION(MIN.TO .b (E) JOINT POLE 0 THIS DETAIL DOES NOT APPLY TO ELECTRICAL CONDUIT INSTALI4ION 4"... L 1 91 of (N) TRENCH FOR 1" GAS \ TRENCH RESTORATION - METHOD d0 Q .o ,5I MIN. WIDTH 12", MIN. DEPTH 34" O\s-....,„,) (SEE DETAIL 7, TRENCH Backfill and Surface Restoration.;. RESTORATION ON THIS SHEET) (E)EDGE OF COUANITA WAY PAVEMENT Q ,. 0 g s? (60' WIDTH) D _TAIL 7 LJ.I (� O a O (E)EDGE OF PAVEMENT SITE PLAN G c c G c c G c � G c G G G G c G c G-4\ cCO PROPOSED TRENCHING FOR / UNDERGROUND UTILITIES AT 1306 JUANITA WAY (N)MIN 4'x4' TAP HOLE TO CAMPBELL, CA 95008 CONNECT NEW GAS LINE TO EXIST MAIN. SIZE AND DEPTH OF TAP HOLE PER PG&E REQUIREMENTS. U V APN: 403-16-028 SCALE: 1/8" = 1'-0" INSTALLATION REQUIREMENTS for UNDERGROUND CONSTRUCTION PROCEDURES & SPECIFIC Residential — Single Family +t( TIMOTHY NGU r y ' � Ara CUSTOMER: ,T � sfrr�r M 4.CONTRACTOR: ANITA RECEIVE, 1306 JU ' LOCATION: I ' _ PG&E REPRESENTATIVE: CHA NK ;F R JUN 1 3 2n11 PUBLIC WORKS # 30812700 x !!lMalTION DATE: 12/16/2010 L GENERAL NOTES: 1. All the customer/contractor installed facilities and trenching must be inspected by a PG&E Inspector. Please make arrangements for inspections at least two working days in advance by calling (408)725-2202 or by fax (408)725-7773. 2. All materials and workmanship must meet the requirements and specification as outlined herein, and should not be installed without prior notice to the inspector. Any material or workmanship rnanner approved the �Inspector kf led, covered,be corrected o in anyway and installed in an approved concealed until it has been approved by the PG&E Inspector. 3. The Customer is required guarantee all c by PG&E n S gnature on the checklifor period of not less than 2 years after final acceptance constitutes the Customer's recognition of the requirement. TRENCH REQUIREMENTS: 1 . Trench configurations are shown on the PG&E construction sketch. This sketch shows the location, � a wilr �be b s d on the final minimum e grade.the facilities located in the trench. The minmum cover 2. A 2-inch sand bedding under and a 6-inch sand cover over the cable, conduit, or pipe is required prior to compaction. 3. Only approved backfill shall be used over the sand covering. Approved backfill is additional sand or rock-free soil. Native earth that contains small round rocks (less than 1/4" in diameter) or which would pass through a #4 screen is considered rock free. • 175' JUANITA WAY ( 60') P/L 2"HP 8 47 DE T TAP HOLE r 4'x4'x12" 3ELOW PIPE n rte" 175' co c c-, 7J -0 c o 73 1-- O I U) N I I X P CAMP3ELL 1 3 0 6 3474-A1 CPA-3412-32 NAOP 60 OF 30811565 ,`` ' ' 5AFETY PG&E WORK RECAP: -APPLICANT TO DIG 4' X 4' BELL HOLE -APPLICANT TO TRENCH & 3ACKFILL RANCH SE & PRIVATE -PG&E TO INSTALL APROX. 82' OF 1 "PL. EST: C.A. MANKILLER APPLICANT SD INSPECTOR COPY ADE; J. GAfJBUCCI CO: CI SD: SUPV: S. KISS 1 306 JUANITA WAY NOTIF: 104883472 REP: C.UANKILLER OTHER: PLNR: CAMPBELL, CA. SHT: SHEETS PM: REV. SCALEONE: DAT11�E17�10 p PACIFIC GAS AND ELECTRIC COMPANY 30811565 N APPLICANT CHECKLIST ® CONTACT UNDERGROUND SERVICE ALERT 'JSN' AT 811, AT LEAST 2 BUSINESS DAYS BEFORE EXCAVATION, TO HAVE EXISTING UNDERGROUND UT TTES MARI(ED IN FED GI OBTAIN CITY/COUNTY EXCAVATION PERMIT (F APPLICANT TO TRENCH) ID FOLLOW TRENCH INSTRUCTIONS (IF APPUC NT TO TRENCH) MI THE TOTAL NUMBER OF SWEEPS (BENOS) IN ANY ONE CONDUIT RUN NOT TO EXCEED 330', INCLUDING TIE SWEEP AT THE FEED-IN LOCATION. IC MAINTAN 3' 111MUM PARALLEL SEPARATION FROM WET FUMES (LE. WATER, SEWER, STORM), REFER TO 110 STANDARD S5453, MST B ® HAVE SUFF1OENT SAND ONSTTE PRIOR TO FINAL NSPECTION, REFER TO GREENBOOK SECTION 2.3.4 ® COORDINATE NSTNIATION OF TELEPHONE AND CABLE 1V FACUTES PER THEIR CONSTRUCTION REQUEINENTS Ea CALL (40B) 725-2202 OR FAX (408) 725-7773 FOR PG&E INSPECTION - AT LEAST 2 BUSINESS DAYS ADVANCE NOTICE ® NAB CIS HOUSELINE TO NEW LOCATION AND HAVE MUNICIPALITY NOTFY PG&E THAT GINS HOUSEIJIE HAS PASSED INSPECTION O GAS METER GUARDS PER GAS STANDARDS AND SPECFICATIONS MANIA SECTION J-95 ® PAYMENT MUST BE RECEIVED BY PG&E, BEFORE CONSTRUCTION WORK CAN BE SCHEDULED Figure 2-3 TYPICAL JOINT GAS ONLY TRENCH Figure 2-1 SERVICE TRENCH MINIMUM SEPARATION AND I- it Ill -I i- it --I CLEARANCE REQUIREMENTS ' s T T C S P ISOMOMR ,.l, 6 G11S — 12'12' 12' 6' 12' 24';30'n street 3 .., T 1ELEPtQE 12`— 1' 1" 12'1Y 24';30'n sheet • = T TELEPIg1E(BB) 12` 1' — 1' 12' 12' 24';30'n street ! ,,T C —vo— i r SW ; C CAN 12°1" 1' — 12'12' 24';30'n sheet f le COVER I V S BECIRC SUMAC 6' 12`12'12"— 3" 24';30'in sheet b , P ELM MAW 12'12'12' 12' 3' — 30'; 3 in t--+ SL SIREETUGftf 6' 12'12' 12' 1' 3' 24';30'in sheet S 6'lit—O ..:.:::r:1P:•C PER UO STANDARD S5453, EXHIBIT B Electric Meter Electric Meter — (See Note 2) (See Note 2)N O Consult the PG&E GreenBook for further information. I2'1Gn. to Outside 30"Min. to 24' Yin. From Building Corner (www.pge.com/greenbook) �.w Budding Corner 10'MinH Edge of Panel 8'Min. to Inside Bulking Corner Gas No building vent or Meter Applicant's window within AppAcant's 1 tine 18" of the Gas Regulator 72' Max. Gas Regulator Ho 1 ins Gas Regulator I 72 Max Vent unless over 10' 51' Min. Vent I Vent 51' loin. above the Regulator Vent I I i .. o ' To Finish l \ - ► 2 I To Fir Leh Ly \_______,,..,\_______,,..,Finish rGrods \_______,,.., . - 'al T r Grade No source of ignition or I I26 forced air intake within n G 26' —O Ill ' n 3' of the Gas Regulator i i * I Vent (excluding Electric �k9`Yn'1 Gos\ 9"Yin.1 12' I I I meter panel) Meter p *Gas Valve must be 9' Fmh above finish grade and .,ji \ Gas Kiser Location of the Building Vent �� Gra ` 9' out from the finish Openings Must be Below the \ I Level of the Gas Regulator i wall Vent Termination. , Riser Electric Electric Service Freer Service Freer Figure 3-1 Meter Set Separation Dimensions and Clearances AT: C. MANIOLLER ACE J. M1Cq Applicant Trenching Checklist SUPV: sass 1306 JUANITA WAY NOTIF: 104883472 REP: C.MANIOLL R OTHER Mt 4 CAMPBELL. CA. SIB: SMS SCAL ' ACIFIC GAS AND ELECTRIC COMPANY 30811565 Pik 0 N.T.S. 11/17/10 P ib, • Hyperlinks are Inactive TYPICAL TYPICAL DISTRIBUTION TRENCH SERVICE TRENCH Joint Trench - Franchise Area or P.U.E. 18 INCHES f MINIMUM 1 H 18 INCHES f / MINIMUM I STREET SIDE m z 5 (NON PG&E) N 2 T C (SEE NOTE 7) i'-/- (PREFERRED) r. O, / m ** -f- E T C SL tn E T -f i See a r .'lo "' S Min: G •v vote FIG. 2 See Note 5 t, (View facing Distribution Trench) 3"MIN_ f MINIMUM SEPARATION AND ® SL s CLEARANCE REQUIREMENTS /// DUCT DB FIG. 1 G T T C S P Placement of the Distribution Trench within a P.U.E.is the preferred method.Trenching in the G (GAS)SEE NOTES a, &13 — 12" 12" 12" 6" 12" Franchise Area should only be used when a P.U.E.is unobtainable or otherwise infeasible. T (TELEPHONE)DUCT 12" — 1" 1" 12" 12" *Increase cover to 30"in the street area(see Note 3). DIRECT T **Separation must be 12'unless a reduction(6")is mutually agreed upon by affected utilities. (TELEPHONE) 12" 1" — 1" 12" 12" BURY C (CAN 12" 1" 1" — 12" 12" STANDARD TRENCH LOCATIONS S (ELECTRIC SECONDARY) 6" 12" 12" 12" — 3" A cc P (ELECTRIC PRIMARY) 12" 12" 12" 12" 3" — w SEE r- NOTE 5 w SL (STREETLIGHT) 6" 12" 12" 12" 1" 3" A " co>z SEPARATION AND CLEARANCE DEFINITIONS o o¢w r-- z u.w¢ ow i— Cover: TYPICAL RECONSTRUCTION The term"cover"means the radial distance between the sur- TRENCH LOCATION j "' st uc of an underground cable,conduit,pipe,or other ul: v a face ture and the surface elevation(grade). y Backfill: STREET GUTTER The term"backfilr refers to the materials used to refill a cut or LI other excavation,or the act of such refilling after any needed 4Q CURB shading is performed. SIDEWALK - - - - y _RAN Shading: ® The term"shading"refers to the materials used to provide a L. measure of separation between facilities installed at different JT JT JT JT JT — JT — JT — levels within an excavation or cut. a TYPICAL NEW(4)LOCATIONLitt: cc w tu o w= The term"lift"is a layer of fill as spread or as compacted or a 2 w 0 o measurement of material depth that is the rated effective soil o cc CC W depth a compactor can achieve. v) owcc x Cl)t- Bedding: 0 u) The term"bedding"refers to the materials installed beneath • ~r facilities at the bottom of a cut or other excavation and in- tended to provide support and/or protection for those facilities. JOINT TRENCH CONFIGURATIONS 09-27-06 & OCCUPANCY GUIDE S5453, Exhibit B PACIFIC GAS AND ELECTRIC COMPANY Page 1 of 4 Hyperlinks are Inactive OTHER TYPICAL PG&E DISTRIBUTION JOINT TRENCH CONFIGURATIONS STREET A STREET STREET _ yy SIDE 36" _� a SIDE 24' a SIDE N F 30' CAN r:---71 ,. &PH0NEPH CATV &PHONE &PHONE 1T T C C T C s T C s H- ,,4,, ,, s G s - G s G s s s s p r SS s H'—• S .1_ PG&E ELECT. H-• P F) 5X-S.L FIG. 4 (PGdS&EE L HT FIG• . 3 24"Wide Joint Trench 2ND E s ELECT. r 36"Wide Joint Trench H- P /! l_,,7:PG&E 2ND t ELECT. 72. E CT. r . E2 r 1 FIG. 5 Joint Trench With Second Electric Utility • Trench Configuration Notes The trench configurations shown in this guide are to be considered"typical"only and that other trench widths,depths, as well as utility configurations(placement) may be used, provided all minimum requirements for separation, clearances, and cover are observed. In no case shall electric primary or secondary(excluding street lighting) be placed at a level higher than that of the gas and communications level. Gas shall be placed at the same level or below communications when gas is placed above the electric facilities. Special Notes for Joint Trench With Second Electric Utility A. Refer to Sheet 3 for General Notes. B. A red 3-inch wide"PG&E Electric Line in Conduit"plastic marking tape, Code 375054,shall be installed, spiral wound in a manner that allows for the tape to be readily visible every 3 feet,with each conduit intended to be used for PG&E electric facilities. An equivalent red tape marked to identify the owner shall be installed with the conduit intended to be used for the second electric facility. C. Each utility shall ensure adequate grounding between electric facilities is provided (See UO Standard S5453, "Joint Trench"). D. Provide a minimum of 2 inches of compacted PG&E approved bedding material as a trench leveling concourse,where required. See General Notes Items 11 and 12 (on Page 3),in order to obtain proper compaction. JOINT TRENCH CONFIGURATIONS 09-27-06 & OCCUPANCY GUIDE S5453, Exhibit B PACIFIC GAS AND ELECTRIC COMPANY Page 2 of 4 Hyperlinks are Inactive • General Notes 1. The preferred trench location is in a Public Utility easement(P.U.E.). 2. All depths and resulting cover requirements are measured from final grade. 3. Cover,clearances, and separation shall be as great as practicable under the circumstances,but under no circumstances shall be less than the minimum cover,clearance,and separation requirements set forth in General Order 128 and 49CFR 192.321, 49CFR 192.325,and 49CFR 192.327.All facilities shall be anchored in place prior to compaction,or other means shall be taken to ensure no motion of the facilities. Dimensional requirements for shading, leveling,'and backfilling shall be determined subsequent to compaction. 4. Trench dimensions shown are typical.Trench sizes and configurations may vary depending upon occupancy and/or field conditions. Trench size and configuration must at all times be constructed in a manner that ensures proper clearances and cover requirements are met.Any"change"to the trench width and configurations as shown in this exhibit must be designed to ensure this requirement. 5. It is preferred to have non-PG&E owned streetlights at a level other than the gas or electric level. Non-PG&E owned streetlights may be at the electric level of the trench as long as minimum clearances are provided and comply with all special notes for a joint trench with a second electric utility. 6. Non-Utility facilities are not allowed in any Joint Utility trench, e.g., irrigation control lines, building fire alarm systems, private telephone systems,outdoor electrical cable,etc. 7. When communication ducts are installed,a minimum of 12"radial separation shall be maintained from gas facilities.Exception:With mutual agreement,when 4-inch diameter or smaller gas pipe is installed,the separation may be reduced to not less than 6 inches. 8. Provide separation from trench wall and other facilities sufficient to ensure proper compaction. 9. Maintain proper separation between PG&E facilities and"wet"utility lines as described in UO Standard S5453.The minimum allowable horizontal separation between Company facilities and"wet"facilities is 3'with a minimum 1'of undisturbed earth or the installation of a suitable barrier between the facilities. If a 3'horizontal separation cannot be attained between"wet"utilities and Company dry facilities,a variance may be approved by the local Inspection Supervisor and submitted to the Service Planning Support Program Manager for approval.Separations of 1'or less are not permissible and will not be allowed.The Company may agree to waive the minimum 3'separation requirement at the request of an applicant if warranted and the need is justified.The request for a waiver must: • Be made in writing and submitted to the Company ADE during the planning and design phase of the project, • Clearly describe the conditions necessitating the waiver, • Include a proposed design, • And,include a design for a barrier between the"wet"utilities and Company dry facilities in the event 1'of undisturbed earth cannot be maintained. Note: Drain lines connected to downspouts on buildings are considered a"wet"utility for the purposes of this standard. 10. Separations shall be maintained at aboveground termination points. 11. Procedures for approving native backfill for shading of PG&E gas facilities: • Random soil samples shall be taken from a minimum of 3 locations per 1,000'of trench. 100% of the sample must pass through a 1/2"sieve and 75% must pass through a#4 screen.Additional samples must be taken if existing soil conditions change and are to be taken at the discretion of the PG&E representative on site. • The soils must not contain any rocks that have sharp edges or that may otherwise be abrasive. • The soils must not contain clods larger than 1/2"if to be used as shading, bedding,or leveling materials. • Compaction requirements must meet any applicable PG&E, Federal,State, County,or local requirements. • • At no time shall the over saturation of native soils be used to achieve these requirements. The sieves and screens shall be: • 1/2"Sieve: 8"diameter by 2"deep,stainless steel mesh screen. • #4 Screen: 8"diameter by 2"deep,stainless steel mesh screen. Notes continued on the next page JOINT TRENCH CONFIGURATIONS 09-27-06 & OCCUPANCY GUIDE S5453, Exhibit B PACIFIC GAS AND ELECTRIC COMPANY Page 3 of 4 Hyperlinks are Inactive / General Notes, continued 12. Procedures for approving native backfill for shading at PG&E electric facilities: • Random soil samples shall be taken from a minimum of 3 locations per 1,000'of trench.Additional samples must be taken if existing soil conditions change and are to be taken at the discretion of the PG&E representative on site. • Shading material containing large rock,paving material,cinders, sharply angular substances, or corrosive material shall not be placed in the trench where such material may damage the conduits and/or prevent proper compaction over or around the conduits. • Native soils containing clods not to exceed 6"in diameter may be included in the shading material provided the clods are readily breakable by hand. Note: Soils consisting primarily of adobe,hard compact (dense) clay,and bay muds shall not be used as shading material. • At no time shall the over saturation of native soils be used to achieve these requirements. • Refer to Engineering Document 062288, Item 13 on Page 2. 13. Competent native soils are preferred to be used for shading,bedding, and backfilling throughout the trench. • Where native soils exceed 1/2"minus and/or where gas is to be placed at the bottom of a trench in areas that exceed 1/2" minus soil conditions,or where the bottom of a trench is considered to consist of hard pan, PG&E approved 1/2"minus import material shall be used for shading and/or bedding of gas facilities. • PG&E approved import material is per CGT Engineering Guideline 4123. • If a leveling course is required for gas facilities,the use of native soils is preferred, but if 1/2"minus conditions are not attainable with the native soils,then the use of PG&E approved import materials is required.Bedding under gas facilities will be a minimum of 2"of compacted 1/2"minus native soils or PG&E approved import material. • For electric facilities,refer to Note 12.This applies to leveling courses as well as shading. • The minimum PG&E approved bedding material may be increased at the discretion of PG&E when warranted by existing field conditions (e.g.,rocky soils, hard pan,etc.). • The use of any imported material for backfilling purposes shall be limited to those situations when native soils do not allow for required compaction. 14. The applicant is responsible for the removal of excess spoil and associated costs. 15. Separation between gas facilities and electric facilities may be reduced to 6"when crossing. 16. Service saddles are the preferred service fittings for use throughout the joint trench project. All projects will be designed and estimated using service saddles. However,service tees may be used if all clearances, separation,and coverage requirements are maintained. Revision Notes 1. Revised Note 9 to clarify the minimum allowable horizontal separations requirements. 2. This document was revised on 09-27-2006. JOINT TRENCH CONFIGURATIONS 09-27-06 & OCCUPANCY GUIDE S5453, Exhibit B PACIFIC GAS AND ELECTRIC COMPANY Page 4 of 4 For Ware Information,Please Contact:• S U B S T R U C T v 1J S L T C 11 k j ,__ 1� W Robert Lopez/Elec Estimator:(408)725-3337 AFETY 11 Glen Fung/Elec ADE: 725-2002di v) w ((4 I SAFETY PLEDGE- Li Shelley Kiss/LH Supervisor:((408)8)725-2095 / _ Charles Manki Iler/Job Owner:(408)725-2294 / — 1 ALWAYS PUT SAFETY FIRST CI Cr) Timothy Nguyen/Applicant:(408)252-3461 • // I LOOK FOR AND ACT TO P7 , RESOLVE UNSAFE SITUATIONS / % I HELP AND ENCOURAGE CV J O ///// ., / OTHERS TO ACT SAFELY, � o �. A0. / '! DO) ~ ^ N / ) ..r �— .._. c) LEGEND �� w • L ..Lai 1306 JUANITA WAY• o 0 0 z U (/7 Z O Cr) INSTALL DESCRIPTION / 3568 SQ. FT RESIDENCE o� - NEW 4/OA TPX SERVICE CABLE 600V BY PG&E INSIDE (1) / 200 AMS (SC) 3" D6120 PVC CONDUIT INSTALLED BY APPLICANT ® LOC #2. / 3-TON // / W A/C © 100 LRA ./ Z z PG&ECI- TO INSTALL NEW 2" PVC V yMiuM % EST HOUSE DEM= 11.7 KVA • / Q SVC RISER ON POLE LOC #1. % Q ELEC VEHICLE DEM= 5.0 KVA / APPLICANT'S / TOTAL EST DEMAND= 16.7 KVA / .-. a PROPOSED NEW 200A ELECTRIC PANEL. O '�.y PG&E TO INSTALL NEW METER 0 LOC #3. /\ - / H- ✓ O = L�� 0 / ADDRESS 1316 • /// / U (N) 200 AMS // i w J C 10 3W ��e. / I..Li �) X 120/240v / � - / �—� Z ADDRESS 1280 C // / / / 0 , w a J _ '= W a rAPPLICANT TO MAINTAIN A 3' MINIMUM , Q z CO 10 SEPERATION BETWEEN PG&E UNDERGROUND T �---� ( 2 )( FACILITIES & ANY 'WET" FACILITIES. O Q Z E, c L(ie: ALL WATER LINES, DRAINAGE, ETC.) Q f=, c24 1: PROPERTY LINE ` -- \ O 1,0 • O U) 4• z WM L.� 45'-4 45'-4 v 45'-5 U� Q PG9851)4VV 1 — — — 3/4 CU _ _ — _ — — — �� F--�-� U 0 X --- — e— LCO 31791 (136') k �` ' 2/4 AR 12KV — -� �� > PINE 1. to u e (150') W U TREE m - o TO BURROWS RD, J U A N I T A V V A I .� �C U Q PROPOSED PG&E (co'Width) �II RISER QUADRANT - - ---- - - - - • -- • TO BE VERIFIED BY PG&E INSPECTOR UNDERGROUND SERVICE ALERT W 1-800-227-2600 ZIF APPLICANT NOTES: NOTIFIED U.S.A. o DATE: _ 1. APPLICANT TO TRENCH & BACKFILL ALL ONSITE & OFFSITE JOINT with ELECTRIC, GAS, TELCO & CATV. MET I Q (APPLICANT MUST APPLY & OBTAIN CITY OF CAMPBELL ENCROACHMENT PERMIT PRIOR TO TRENCHING) BY: CV 2. APPLICANT TO PROVIDE ALL ELECTRIC SERVICE CONDUIT SUBSTRUCTURES AS SHOWN. PROJECT CONDITIONS STAMP J ^ m L, W Type(s) of Work: IMPORTANT! `" J I-- 3. APPLICANT TO PROVIDE MANDREL & PERFORM MANDREL TEST with PG&E INSPECTOR ON STANDBY. El New Business IV C� S-2 Q 4. APPLICANT MUST MAINTAIN A MINIMUM 3' PARALLEL SEPERATION FROM ALL WET FACILITIES. w Cr) Z CI CONTRACTOR, ELECTRICAL CONTRACTOR ❑PG&E Maintenance & Construction a Cl) Q 5. TOTAL NUMBER OF SWEEPS IN CONDUIT RUN (INCLUDING SWEEP UP INTO PANEL) SHALL NOT EXCEED 330'. Before Be i O e._ Y M Project Conditions: g'nning Substructure Work Please Contact J Z 6. APPLICANT IS RESPONSIBLE TO ENSURE TRENCHING AND SUBSTRUCTURE INSTALLATIONS ©NONE APPARENT (if project design changes.contact ADE) PG&E Underground Trench Inspector at least two I . L=am W W MEET PG&E GREENBOOK STANDARDS. GREENBOOKS ARE AVAILABLE AT YOUR LOCAL PG&E or business days prior to requesting inspection. J J HEADQUARTERS OR CAN BE FOUND ON THE INTERNET ® WWW.PGE.COM/GREENBOOK 0 CONDITIONS APPLY: Request for inspections received after 12:00PM will m Z LJ...II - not be inspected until the 3rd working day. O PERMITS 0 TAILBOARD 0 OTHER O� r c U Z Cr) 7. PG&E TO PULL ALL SERVICE CABLES & SET NEW PERMANENT ELECTRIC METER. 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Zg5. P as s° C �" ' lows €4. .� �.S o:^� — Cz •av>o g�a P"d� Sao '7 -8- m 3 a �a•� Rp 96' ° ° '7 xa e � 5 •o w s;8 88 f � a pp 7 5 E-$ 8 8 , n IFS $ K H y a sG smo ti aaa - 8xm 8 - - -8 s- n - s 4 04`empe PLAN FOR THE IMPROVEMENT OF 0��5�Ha ._ md�'@w BLUEPRINT FORA CLEAN BAY uew b" ENCROACHMENT PERMIT NO. g - s a A � a ne sx s 3 as �' zus [" H [ H IlHit �� < a { _ I " a �6DL1N n. r 00 m � � 1 00 j uIIIuuiI1b (/ Ili IJ 00'Ogt � 1r s III n a sO LU s e LLl fh11.1m ng) I, L H0 I � Q ) i lYi :�II�I� Q mo � w s m I I 1 � 5 :T m oF.c`�^ti Project Address: '� City of Campbell / so(' Tu4n,.t« CJrtv o -���.;-• 0 WASTE .��� /O-C,�97o2 MANAGEMENT Permit No �O °kCH PLAN WMP REQUIRED BECAUSE PROJECT IS A SUBMIT TO: J Demolition ≥ 500 Sq. Ft. City of Campbell Construction/Remodel ≥ $250,000 Public Works Dept. 70 N. First St. 1r Construction/Remodel ≥ 2000 sq. ft. Campbell, CA 95008 Mon.— Fri. 8:00 am-5:00 pm INFORMATION AND SUPPORT: Public Works Dept. -408 866 2150 SECTION ONE: P.ERMIT APPLICATION This Waste Management Plan (WMP) must be completed and approved to obtain a building permit. Separate WMPs must be completed for demolition and construction at the same site unless the Building Department requires only one permit. Step 1: PROJECT INFORMATION - FILL OUT THE FOLLOWING INFORMATION Applicant's Name: Ti f10.774 Y YEN Contact Phone Number: ':"(C'4' ?-15- 0 6 7 S Fax Number: Check one: Owner ❑ Architect E Builder ❑ Owner/Builder ❑ Other Contractor.fi9/' Z5¢ 6.crsfr,.chog 41-4-d-ccarn Contact Phone Number: Yoe -31 S- 250 Z Project Type: New ❑ Remodel ❑ Addition ❑ Demolition Project Square Footage: -7 G 3 Project Description: .(1•7 (62 Sl c 7 dc's cLe t-f �c Estimated Completion Date: f 15f 2a l l Step 2: WASTE MANAGEMENT REQUIREMENTS REQUIREMENTS: You are required to recycle or re-use 50%of all construction and demolition debris. I understand that I am required by the City of Campbell Municipal Code Section 6.12 to salvage, reuse, or recycle a minimum of 50%of all construction and demolition debris (C&D). -k (Initial) J:\FORMS\Templates\Administrative\Waste Management Plan Form.doc I understand that failure to meet the requirements of Municipal Code Section 6.12 shall constitute a misdemeanor, and shall be punishable by imprisonment in the county jail for up to 6 months, or by a fine of up to $1,000, or both. In addition, a stop order on the job or a delay of final approval may occur. 77...A.) (Initial) At the completion of this project, or more frequently if required, all receipts or other equivalent documentation from salvage, recycling and waste facilities will be provided to the City of Campbell Public Works Department and I understand that I may not be issued my final inspection unless all recei is a documentation are submitted to the City of Campbell Public Works Department. (Initial) Step 3: RECYCLING CONSTRUCTION AND DEMOLITION DEBRIS - ANSWER THE QUESTIONS BELOW SALVAGE AND REUSE: What materials will be salvaged? Gti( ct?�`ct u.'cfrc .Ric, a6444/Ice., ' P & r«y,:ccie . Salvage Company (if applicable): What materials will be reused on site? IQ /.4c. How will this be documented? 12-ecel;,t'3 MATERIAL TRANSPORTATION: Will you be using a hauling company or hauling the material yourself? (Check one) ❑ West Valley Collection & Recycling Co. (WVCR)* "Self Haul * Permit Applicant is required to contact WVCR (408-283-9250) to request construction and demolition debris box service. All original receipts, weight tags and documentation for salvage, recycling, and disposal must be submitted: On Completion of proje t ❑ Other DPW Approval: Date: /2-, lO SECTIDNTWD:FINAL REPORT APPROVAL Please complete this section and have it approved by the Public Works Department no later than 30 days after completion of the demolition or construction project. This section must be completed and signed, and all original receipts or other supporting documentation must be attached in order to receive final project approval. ❑ All original receipts or equivalent documentation for salvage, recycling, and disposal are hereby attached. ❑ This project has recycled at least 50%of all construction and demolition debris generated. Applicant: `"�- Date: ° U----- 2-Si(( DPW Approval cy, 1 c iLir ,,-, c� , p1 i,,�r_ Date: /C/ 3 /// J:\FORMS\Templates\Administrative\Waste Management Plan Form.doc • - ;' WestValle`s Sewer Connection Permit. No: 39 3I 4 2 Valley F a.Sanitation p trio u Issue •Date riftsbe2 By . •, ''' . )FFICE HOURS&CONTACTS: FEES: BACKFLOW PREVENTION: 7:30 a.m.to 4:30 p.m.Monday thru Friday Connection $ Capacity A Field check required 100 E.Sunnyoaks Ave., Campbell, CA 95008 •Phone:(408)378-2407 Processing S/( /•-t4� Elevation ,z Basement Service; Advance •Information Services Department �� .e?---3`---3'° Check valve required: Yes_No )(`. .00ATION: APN '5'e' --/6':r --'C7- R.- BUILDING SEWER CONNECTIONS: Sewer Map Book Page '7& 4yr> Tract // Lot ,"` Total Due: $ ' — . Total number of connections to this Project Assmt S`4/ property: Adc'ress f°scX - l=: ri n Paid by Check No: //f) a e`' 1,/ 1. Lateral ID No.,79, -/(16:15 is located ,,,� Hillside:Yes No)k" 9 feet LO of property Jurisdiction 4.....,•5t,--7,411.4:•-.92-1, line, feet from main sewer and IUILDING TYPE: INSTRUCTIONS: -0501 feet deep. 'L Single Family •Permit is invalid if not connected within 12 Condo/Town House months of issue. Connection to Main Sewer ii 42,feet Multiple Dwelling Units •Do not connect until the main sewer is accepted Upstream from DS MH ,. aft Industrial by the District. Upstream M.H .C—e-:!;77.6,,-e r`' Commercial •Obtain a building or plumbing permit from the Pipe Type Jurisdiction listed above. :EMARKS:fst;,J ,.9LL.- =o -Street encroachment m permit is required from !'? 4' .,-a� /a,t•�,, ems.-• :.s�'r" List any additional connections on -Keep 3'radius around cleanout clear of reverse side of this form. )LD PERMIT No. 7Y/Sub No,Caj vegetation or obstruction. Original-Applicant Pink-Accounting Yellow-City/County Bldg. Inspector Card-District File CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT ENGINEERING DIVISION Revised 3'08 ENGINEER'S ESTIMATE FOR LAND DEVELOPMENT PROJECTS Ill Date: Sir 21 I 1 For File No(s): Site Address: J 30 6 5i4e1+ i'l`k G;7 , Oati,,r ENC. No. ITEM UNIT PRICES FOR PROJECT AMOUNT NO. DESCRIPTION /11 [vII <5250K >5250K /AAlutSI I.DEMOLITION/CLEARING I. CLEARING&GRUBBING LS $2,000.00 $1,500.00 ta,/ 2. SAWCUT P.C.C./A.C.(UP TO 6") 2)C z T LF $6.10 $4.10 ;4,36 I 3. P.C.C.REMOVAL SF $4.00 $3.00 4. CURB AND GUTTER REMOVAL IF $7.05 $3.45 5. MEDIAN REMOVAL SF $5.25 $2.65 6. DEMOLISH EXISTING INLET/PLUG RCP'S EA $1,800.00 $1,200.00 II.STORM DRAINAGE 1. 12"R.C.P.(CLASS V) LF $210.00 $180.00 _. 15"R.C.P.(CLASS III) LF $225.00 $195.00 3. 18"R.C.P.(CLASS III) LF $240.00 $210.00 4. 24"R.C.P.(CLASS III) LF $260.00 $240.00 5. 30"R.C.P.(CLASS III) LF $280.00 $260.00 6. T.V.INSPECTION(12") LF $1.25 $0.80 7. STD.DRAINAGE INLET(C.C.DETAIL 5) EA $2,800.00 $2,300.00 8. FLAT GRATE INLET(C.C.DETAIL 6) EA $1,620.00 $1,275.00 9. STD MANHOLE(C.S.J.DETAIL D-11) EA $5.000.00 $4,000.00 10. STD MANHOLE(C.SJ.DETAIL D-12) EA $6,500.00 $6,000.00 II. BREAK AND ENTER M.H./D.I. EA $1,000.00 $835.00 III.CONCRETE IMPROVEMENTS I. SIDEWALK SF $12.00 $8.00 2. DRIVEWAY APPROACH SF $14.00 $10.00 3. CURB AND GUTTER LF $45.00 $35.00 4. VALLEY GUTTER SF $20.00 $15.00 5. CURB RAMP EA $1,800.00 $1,500.00 6. TYPE B-I CURB LF $34.00 $29.00 7. TYPE AI-B3 CURB LF $20.00 $17.00 8. COBBLESTONE MEDIAN SURFACE SF $20.00 $15.00 9. P.C.C.DRIVEWAY CONFORM SF $8.20 $6.30 10. A.C.DRIVEWAY CONFORM ce r,y-1 SF $5.25 $4.40 tc T (pr.'v4,-) J:\FORMS\Templates\Land Development\Street Improvements\EngEst(Rev.03/08) Page 1 of 4 \\ CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT ENGINEERING DIVISION Revised 3/08 ENGINEER'S ESTIMATE FOR dommital LAND DEVELOPMENT PROJECTS Date: S//L./I I For File No(s): Site Address: 4 306 u a IAA f"G We'll ENC. No. ITEM UNIT PRICES FOR PROJECT AMOUNT NO. DESCRIPTION till I SIT <$250 K >0250K $AMOUNT IV.PAVEMENT I. ASPHALT DIGOUT AND REPLACE CF $5.80 $4.10 2. PAVEMENT WEDGE CUT(6) LF $5.00 $2.65 3. PAVEMENT GWI�IDING U ; SF $0.95 $0.63 i 2 'x 3,5 36Y 2_13 4. PAVEMENT FABff(PETROTECH) l 6 SY $2.30 $2.10 k 3 Q s y- 5. .:7 ASPHAtVCONCRETE PE A> T $210.00 $150.00 8 2 c (SW'rt'b.S'x " x115(2ce. 3 6. AGG[tEGA;E�B�.S r(CLASS 2) / 2 I $80.00 $40.00 9 6, 7. SLURRY` SEAL(TYPE PEU) , / SF $0.25 $0.20 S'3') tfie/c 3.5 SY S AC REMOVAUOFFHAULID)IS A.L 2 CF $14.00 $12.00 # 4-242 3,$x 2 x 42_ S V.TRAFFIC SIGNALS/LIGHTS L DETECTOR LOOP(6'ROUND) EA $520.00 $347.00 2. DETECTOR LOOP(6'x 30) EA $752.50 $626.25 3. DETECTOR LOOP(6'x 50') EA $1,042.00 $868.30 4. ELECfROLIER EA $4,000.00 $3500.00 5. 1 1/2"RIGID CONDUIT LF $10.40 $8.20 6. 2"RIGID TRAFFIC SIGNAL CONDUIT LF $19.70 $15.05 7. CONDUCTOR LF $0.85 $0.65 8. PULL BOX(NO.3 1/2) EA $347.00 $278.00 9. TRAFFIC SIGNAL PULL BOX(NO.5) EA $463.00 $405.25 10. PULL ROPE LF $0.57 $0.57 VI.STRIPING AND SIGNS I. REMOVE PVMT.MARKINGS(PAINT) SF $2.65 $1.60 2. REMOVE PVMT.MARKINGS(THERMO) SF $3.70 $3.40 3. REMOVEPVMTSTRIPING LF $1.50 $1.00 4. STRIPING DETAIL 9 LF $3.00 $2.00 5. STRIPING DETAIL 22 LF $3.00 $2.00 6. STRIPING DETAIL 29 LF $4.00 $3.00 7. STRIPING DETAIL 32 LF $4.00 $3.00 8. STRIPING DETAIL 37(THERMO) SF $5.00 $3.50 9. STRIPING DETAIL 38(THERMO) SF $5.00 $3.50 4J r. - = it2,G J:\FORMS\Templates\Land Development\Street Improvements\EngEst(Rev.03/08) Page 2 of 4 CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT ENGINEERING DIVISION Revised 3/08 ENGINEER'S ESTIMATE FOR LAND DEVELOPMENT PROJECTS Date: 5-1t2-/f/ For File No(s): Site Address: 1306 j ugvu _ENC. No. ITEM UNIT PRICES I.()II PP(,II AMOUNT NO. DESCRIPTION ('11 I All . ,i,r)K .5250K SAMOUNT 10. STRIPING DETAIL 39 LF $5.00 $3.00 11. LIMIT LINE LF $6.00 $4.50 12. CROSSWALK,12"WHITE LF $6.00 $4.50 13. PAVEMENT MARKINGS(PAINT) SF $3.25 $2.50 14. PAVEMENT MARKINGS(THERMO) SF $6.60 $5.05 15. PAVEMENT MARKER(NON-REFL.) EA $5.20 $3.50 16. PAVEMENT MARKER(REFLECTIVE) EA $6.95 $4.75 17. TYPE K MARKER EA $109.50 $92.50 18. TYPE N MARKER EA $109.50 $92.50 19. SALVAGE ROAD SIGN EA $99.00 $87.35 20. RELOCATE ROAD SIGN(W81 ON NEW POST) EA $115.75 $99.0() 21. INST.RD.SIGN ON EXIST.POLE EA $231.55 $168.50 22. ROAD SIGN WITH POST EA $347.30 $277.85 23. INSTALL 1226S SIGN WITH POST EA $350.00 $252.60 24. STANDARD BARRICADE LF $19.50 $15.75 VII.LANDSCAPING 1. IRRIGATION,PLANTING WORK SF $8.00 $7.35 2. PRUNE TREE ROOTS EA $147.35 $115.75 3. TREE REMOVAL EA $684.10 $526.25 4. ROOT BARRIER(12") LF $21.05 $10.50 5. ROOT BARRIER(18") LF $26.30 $15.80 6. STREET TREE EA $447.30 $342.05 7. STREET TREE(36"BOX) EA $710.40 $589.40 8. TOP SOIL BACKFILL CY $26.30 $22.60 9. IRRIGATION IS $1.368.25 $710.40 VIII.MISCELLANEOUS I. PEDESTRIAN BARRIER LF $86.85 $69.45 2. CHAIN LINK FENCE(6) LF $17.35 $13.70 To&CI 3 = 14 J:\FORMS\Templates\Land Development\Street Improvements\EngEst(Rev.03/08) Page3of 4 CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT ENGINEERING DIVISION Revised 3108 ENGINEER'S ESTIMATE FOR LAND DEVELOPMENT PROJECTS Date: Si12-f 1 i For File No(s): Site Address: I 3 O 4jj44(n.e1'G tile Gi ENC. No. ITEM UNIT PRICES FOR PROJECT AMOUNT NO. DESCRIPTION i 1 [\i i <$250 K >$250 K t AMOUNT 3. RAISE MISC.BOX TO GRADE EA $315.75 $210.50 4. RAISE MANHOLE TO GRADE EA $421.00 $364.45 5. INSTALL MONUMENT BOX EA $1,500.00 $900.00 6. MEDIAN BACKFILL CY $22.10 $19.70 xA41) �n� ` SUBTOTAL �/IL L PREPARED BY: I(KOT{{Y N Y�� 10%MOBILIZATION,CONSTRUCTION TRAFFIC CONTROUPHASING, % REVIEWED BY: CONSTRUCTION STAKING, ,7 3 CONSTRUCTION TESTING APPROVED BY: Ut 5,.3 10%CONTINGENCY 10%SECURITY ENFORCEMENT a yi 3 TOTAL FAITHFUL PERFORMANCE SECURITY - ri/""&.16“sg USE THIS AMOUNT FOR SECURITY,$aDO .O 0 ac • Re-. . ---- 6 arN d' (t3 . °D Tc.),„\;,,,:,,,\ _ ,ti4v,, ,icto ,I.). .e0,.0 N . __ t?CACI 0 . O O 5Qek)4), ,,I, -,-4f, 0 J:\FORMS\Templates\Land Development\Street Improvements\EngEst(Rev.03/08) Page 4 of 4 Tit Y. A ; .a....-•*I'ei ill ...... • ... VIP,?., • ATA 0 4 �I 4:4•174f,,.,.-c Illt. , ,.. . , . 4' 1' 1 )'.... I '' 0'''' „"1-4.., ••It .,-1W,_- r 11;; • °lc. .' • • di .4 ° -,., * If ___...,_______:_. , r AMMON.. 1 ,.,.. . .1 .. 136; Juanita Way • f . '•a .3...;., j"r 400,' ei. • �R_Yi• t . i" 1' f • s (tsY�x. 31, t R r� ` a s • —,. _ �.•/jay' •' jr• if •'^ 1 „, � .` ,fie, F. - w 'i�ik . av Z iit-1............,*- '''' 4*--<•. , - , ,e,..-,s,' ,'-.',i- vailV ' iiiht, N j �'.t . { `' 2-11M ' t A 777•+ t, .� ` l�° :tee•.. '� .'� •. • '. . • t :.. ,T .I . • - . -. -- -1• --ir,,,, .. i a . (6._!) sm o�,c` Project Address: • �� ity of Campbell jius t-La t crc/ WASTE ,/ q %. c, Permit No.ljlC,(20/0'c.�J / 70 ' MANAGEMENT •ORCHARD PLAN WMP REQUIRED BECAUSE PROJECT IS A SUBMIT TO: ❑ Demolition ≥500 Sq. Ft. City of Campbell k Construction/Remodel ≥$250,000 Public Works Dept. 70 N. First St. .gt-- Construction/Remodel ≥2000 sq. ft. Campbell, CA 95008 Mon.— Fri. 8:00 am-5:00 pm INFORMATION AND SUPPORT: Public Works Dept. -408 866 2150 SECTION This Waste Management Plan (WMP) must be completed and approved to obtain a building permit. Separate WMPs must be completed for demolition and construction at the same site unless the Building Department requires only one permit. Step.1:•PROJECT INFORMATION FILL OUT THE FOLLOWING INFORMATION Applicant's Name: Ti Holt-4Y k)c it Y N Contact Phone Number: Fax Number: Check one: IrOwner ❑ Architect ❑ Builder ❑ Owner/Builder ❑ Other Contractor: Contact Phone Number: Project Type: N-New ❑ Remodel ❑ Addition ❑ Demolition Project Square Footage: 7, t G . Project Description: .SID'"`1 re,f 1 C( Lt c:C Estimated Completion Date: far.t • 62.0 (H • Step 2:'WASTE'MANAGEMENT1EQUIREMENTS REQUIREMENTS: You are required to recycle or re-use 50%of all construction and demolition debris. I understand that I am required by the City of Campbell Municipal Code Section 6.12 to ssalvlvage, reuse, or recycle a minimum of 50%of all construction and demolition debris (C&D). (Initial) J:\FORMS\Templates\Administrative\Waste Management Plan Form.doc I understand that failure`r: ,.:eet the requirements of Municipal Code Section 6.12 shall constitute a ` misdemeanor, and shall be punishable by imprisonment in the county jail for up to 6 months, or by a fine of up to$1,000, or both. In addition, a stop order on-the job or a delay of final approval may occur. A) (Initial) At the completion of this project, or more frequently if required, all receipts or other equivalent documentation from salvage, recycling and waste facilities will be provided to the City of Campbell Public Works Department and I understand that I may not be issued my final inspection unless all recei is and documentation are submitted to the City of Campbell Public Works Department. `7-1.‘-/ (Initial) Step 3: RECYCLING CONSTRUCTION AND-DEMOLITION;DEBRIS-ANSWER"THE QUESTIONS BELOW SALVAGE AND REUSE: What materials will be salvaged? akilfliu c'`2oci wµiT<- C 6,(41,-64-^;--6"7rfi"1: ( Salvage Company (if applicable): What materials will be reused on site? 1C' /Ac How will this be documented? r-`'47't3 MATERIAL TRANSPORTATION: Will you be using a hauling company or hauling the material yourself? (Check one) ❑ West Valley Collection & Recycling Co. (WVCR)* .E1-Self Haul * Permit Applicant is required to contact WVCR (408-283-9250) to request construction and demolition debris box service. All original receipts,weight tags and documentation for salvage, recycling, and disposal must be submitted: On Completion of proje t ❑ Other DPW Approval: Date: /2--, 201O :Stc.i_IDNTWD:TI NALEPDRT-APP,RDVAL Please complete this section and have it approved by the Public Works Department no later than 30 days after completion of the demolition or construction project. This section must be completed and signed, and all original receipts or other supporting documentation must be attached in order to receive final project approval. ❑ All original receipts or equivalent documentation for salvage, recycling, and disposal are hereby attached. ❑ This project has recycled at least 50% of all construction and demolition debris generated. Applicant: Date: DPW Approval: Date: J:\FORMS\Templates\Administrative\Waste Management Plan Form.doc - Project Address: ��.oF•c�MA�� City of Campbell /3o& � '14;kt klar. Q OA -bete o ' . a WASTE MANAGEMENT Permit No. •°ken IIV PLAN WMP REQUIRED BECAUSE PROJECT IS A SUBMIT TO: ≥500 Sq. Ft. City of Campbell . ❑ Construction/Remodel≥$250,000 Public Works Dept. 70 N. First St. 0 Construction/Remodel≥2000 sq.ft. Campbell,CA 95008 Mon.--Fri. 8:00 am-5:00 pm INFORMATION AND SUPPORT: Public Works Dept. -408 866 2150 • SECTION ONE: PERMIT APPLICATION This Waste Management Plan (WMP) must be completed and approved to obtain a building permit. Separate WMPs must be completed for demolition and construction at the same site unless the Building Department requires only one permit. Step 1: PROJECT INFORMATION -FILL OUT THE FOLLOWING INFORMATION Applicant's Name: '0 (1OT-f-f y K)6-0Ye?j Contact Phone Number: '-7 -6G'-S (1 c.d.-O Fax Number: Check one: Fkr6wner ❑Architect ❑ Builder LI Owner/Builder ❑ Other Contractor: % &en (41 t j Trof-) Contact Phone Number: 6S-0-3 22- (2C"6 • Project Type: ❑ New ❑ Remodel ['Addition [Abemolition Project Square Footage: 1', Project Description: 1 1 -1 e_se 11-y4 c,147-4 Estimated Completion Date: VI S/ 2-0(( er err. r".zr— Step.2: WASTE MANAGEMENT REQUIREMENTS REQUIREMENTS:You are required to recycle or re-use 50%of all construction and demolition debris. I understand that I am required by the City of Campbell Municipal Code Section 6.12 to salvage, reuse,or recycle a minimum of 50%of all construction and demolition debris(C&D). 77--7v (Initial) J:\FORMS\Templates\Administrative\Waste Management Plan Form.doc I understand that failure to meet the requirements of Municipal Code Section 6.12 shall constitute a misdemeanor,and shall be punishable by imprisonment in the county jail for up to 6 months,or by a fine of up to S1,000,or both. In addition,a stop order on the job or a delay of final approval may occur. ''/1- (Initial) At the completion of this project,or more frequently if required,all receipts or other equivalent documentation from salvage,recycling and waste facilities will be provided to the City of Campbell Public Works Department and I understand that I may not be issued my final inspection unless all receipts and documentation are submitted to the City of Campbell Public Works Department. (Initial) Step 3: RECYCLING.CONSTRUCTION AND DEMOLITION DEBRIS-ANSWER THE QUESTIONS- BELOW. SALVAGE AND REUSE: What materials will be salvaged? ON14 Ck e"C2kL4. ItaideAr (-v'`,-(X Art. ac f — Salvage Company (if applicable): A What materials will be reused on site? How will this be documented? MATERIAL TRANSPORTATION: Will you be using a hauling company or hauling the material yourself? (Check one) ❑ West Valley Collection &Recycling Co. (WVCR)* Ielf Haul Permit Applicant is required to contact WVCR (408-283-9250)to request construction and demolition debris box service. All original receipts,weight tags and documentation for salvage,recycling,and disposal must be submitted: n� // I4On Completion of project ❑ Other • DPW Approval: Date: ID,( SECTION TWO: FINAL REPORT APPROVAL Please complete this section and have it approved by the Public Works Department no later than 30 days after completion of the demolition or construction project. This section must be completed and signed,and all original receipts or other supporting documentation must be attached in order to receive final project approval. ❑ All original receipts or equivalent documentation for salvage,recycling,and disposal are hereby attached. ❑ This project has recycled at least 50%of all construction and demolition debris generated. Applicant: Date: DPW Approval: Date: J:\FORMS\Templates\Administrative\Waste Management Plan Form.doc WEIGHMASTER CERTIFICATE_ THIS IS `fO CERTIFY that the follov�lfig described commodity was weighed, measured or counted by a weighmaster, whose signature is on this certificate, who is a recognized authority of accuracy, as prescribed by chapter 7 (commencing with section 12700) of division 5 of the California Business & Professional code, administered by the California Department of Food &Agriculture. LOCATION 1 STEVENS CREEK QUARRY, INC. LOCATION 2 12100 STEVENS CANYON ROAD,CA 95014-5415 1__ 1275 ANZAR ROAD CUPERTINPH 408 FAX 408 257-4614 �''' PH 831 623-9555 SAN JUAN •FAX 831 623-1377 AUTISTA,CA 045 DRIVER ®ON O OFF ` TICKET DATE/TIME PRODUCT HAULER/TRUCK LOCATION CUSTOMER QTY. UNIT PRODUCT PRICE AMOUNT n Z • Ji'd<zr idii : _uc;i;s 1C)QZ ' " . I'i I; 'I.. , ) . y . 1itd.a', : ' ALL ACCOUNTS ARE DUE ON THE 25TH OF THE MONTH FOLLOWING THE DATE OF PURCHASE.BUYER AGREES it..4. . f..! . 1 3 0 i;- 1 TO PAY ANY COLLECTION COSTS INCURRED BY STEVENS CREEK QUARRY INCLUDING REASONABLE co ATTORNEY'S FEES AND A SERVICE CHARGE OF 1 1/2%PER MONTH ON ALL OVERDUE BALANCES. cn DELIVER TO: -I' I !. i ,?I .i c: ;..L. f iviF..'1 R IC, i'Ui.lf'LP::: ! !!i x.31 N GROSS: {1 . 0 0 r, • ;1,;} f.T1 TARg: (1 . if'•> t.. •' . 0 V WEIGHMASTER; DRIVER NET: , ',1 . ';.' i .1 4 1 1 i. ! :I I`I ... IF DUMPING:NO HAZARDOUS CONTAMINATED OR ORGANIC MATERIAL ACCEPTED.WE RESERVE THE RIGHT TO REFUSE ANY LOAD.RESPONSIBILITY AND OWNERSHIP OF MATERIAL BELONGS TO THE CUSTOMER WHEN LOADED INTO THE TRUCK. • WEIGHMASTER CERTIFICATE IV THIS IS 'TO CERTIFY that the following described commodity was weighed, measured or counted by a weighmaster, whose signature is on this certificate, who is a recognized authority of accuracy, as prescribed by chapter 7 (commencing with section 12700) of division 5 of the California Business & Professional code, administered by the California Department of Food & Agriculture. LOCATION 1 STEVENS CREEK QUARRY, INC. LOCATION 2 12100 STEVENS CANYON ROAD 1275 ANZAR ROAD - CUPERTINO,CA 95014-5415 , SAN JUAN BAUTISTA,CA 95045 PH 408 253-2512 •FAX 408 257-4614 �'' PH 831 623-9555 •FAX 831 623-1377 DRIVER ®ON El OFF ` TICKET DATE/TIME PRODUCT HAULER/TRUCK LOCATION 02 F' 0$1 fi1'C!' ti('``L[ t;- ? ' 1.:0f' f,°0eF: F_f10F1 ¶:; 1OUC;F'EA11 1'Rk.1MG SCO — ('t1F-EF.11_F. L CUSTOMER QTY. UNIT PRODUCT PRICE AMOUNT ^ ,1�0 i.—: a . 00Lu,i, .. QCJ SIlXLE 0... 3 ' CON I 0 IOU i ...1i T1.11.1;..•. O Z 1" i,I: 'I.UI I --I O ALL ACCOUNTS ARE DUE ON THE 25TH OF THE MONTH FOLLOWING THE DATE OF PURCHASE.BUYER AGREES I.,..1 „ H . 1. :a 0 6- 1. TO PAY ANY COLLECTION COSTS INCURRED BY STEVENS CREEK QUARRY INCLUDING REASONABLE ATTORNEY'S FEES AND A SERVICE CHARGE OF 1 1/2%PER MONTH ON ALL OVERDUE BALANCES. O CFI DELIVER TO: l i"iLk: ).(: GROSS: OO TARE: WEIGHMASTER DRIVER NET: IF DUMPING:NO HAZARDOUS CONTAMINATED OR ORGANIC MATERIAL ACCEPTED.WE RESERVE THE RIGHT TO REFUSE ANY LOAD.RESPONSIBILITY AND OWNERSHIP OF MATERIAL BELONGS TO THE CUSTOMER WHEN LOADED INTO THE TRUCK. WEIGHMASTER CERTIFICATE‘II THIS IS TO CERTIFY that the follotng described commodity was weighed, measured or counted by a weighmaster, whose signature is on this certificate, who is a recognized authority of accuracy, as prescribed by chapter 7 (commencing .with section 12700) of division 5 of the California Business & Professional code, administered by the California Department of Food &Agriculture. LOCATION 1 STEVENS CREEK QUARRY, INC. LOCATION 2 b 12100 STEVENS CANYON ROAD 1275 ANZAR ROAD CUPERTINO,CA 95014-5415 0'' SAN JUAN BAUTISTA,CA 95045 PH 408 253-2512•FAX 408 257-4614 -__` PH 831 623-9555•FAX 831 623-1377 DRIVER ®ON ❑OFF TICKET DATE/TIME PRODUCT HAULER/TRUCK LOCATION . 1 '.0 I!t,i (JC:`.) I?;t L. R.. 0 si ' L.,Or NI.1I..LLnI!: ! ULILIiIi t i I:L: . t: 1,1:: . t.•ti !. CUSTOMER OTY. UNIT PRODUCT PRICE AMOUNT ''00 4to I . 0 tit i:1z t: UI:I- ;;() 5:L.E. i' ._ t.:[it i` 1011 `3;1 i:..!:ILI is f'i'?L. I a ,: .. 0 I I::t_ :i. Gt:..I —I _ j MI ALL ACCOUNTS ARE DUE ON THE 25TH OF THE MONTH FOLLOWING THE DATE OF PURCHASE.BUYER AGREES HI TO PAY ANY COLLECTION COSTS INCURRED BY STEVENS CREEK QUARRY INCLUDING REASONABLE O ATTORNEY'S FEES AND A SERVICE CHARGE OF 1 1/2%PER MONTH ON ALL OVERDUE BALANCES. (XI DELIVER TO: - ' CD GROSS: TARE: WEIGHMASTER DRIVER NET: . , ,. '.' , .:Ll...; I 1 C :I '' I'I.:. .. IF DUMPING:NO HAZARDOUS CONTAMINATED OR ORGANIC MATERIAL ACCEPTED.WE RESERVE THE RIGHT TO REFUSE ANY LOAD.RESPONSIBILITY AND OWNERSHIP OF MATERIAL BELONGS TO 'THE CUSTOMER WHEN LOADED INTO THE TRUCK. • WEIGHMASTER CERTIFICATE Mr THIS IS 'TO CERTIFY that the following described commodity was weighed, measured or counted by a weighmaster, -whose signature is on this certificate, who is a recognized authority of accuracy, as prescribed by chapter 7 (commencing with section 12700) of division 5 of the California Business & Professional code, administered by the California Department of Food & Agriculture. LOCATION 1 STEVENS CREEK QUARRY, INC. LOCATION 2 12100 STEVENS CANYON ROAD 1275 ANZAR ROAD CUPERTINO,CA 95014-5415 a'' SAN JUAN BAUTISTA,CA 95045 PH 408 253-2512 •FAX 408 257-4614 -__ PH 831 623-9555•FAX 831 623-1377 DRIVER ®ON ❑OFF TICKET DATE/TIME PRODUCT HAULER/TRUCK LOCATION ' ' UUU i'Ui. Lb Ai, S',/:.H t1l)CI! CUSTOMER QTY. UNIT PRODUCT PRICE AMOUNT 1 . t''10I._Qis(i UL.. flXLL. ,.: h:U(`f N n U it ',:4 IA ii 4,4i .4.;.-I C O I zi I U I fit_ I. t.'U 0 ALL ACCOUNTS ARE DUE ON THE 25TH OF THE MONTH FOLLOWING THE DATE OF PURCHASE.BUYER AGREES .-.. TO PAY ANY COLLECTION COSTS INCURRED BY STEVENS CREEK QUARRY INCLUDING REASONABLE `"-0 ATTORNEY'S FEES AND A SERVICE CHARGE OF 1 1/2%PER MONTH ON ALL OVERDUE BALANCES. C. l Crt DELIVER TO: 1306 �)A U,4 1 I .� W,� i 1..:•a f•1 P'r3 U L L 1 ' •A GROSS: ()/1 TARE: " ' WEIGHMASTER DRIVER NET: 00 .lA i. i• i . f.l;..`t ..Z_ IF DUMPING:NO HAZARDOUS CONTAMINATED OR ORGANIC MATERIAL ACCEPTED.WE RESERVE THE RIGHT TO REFUSE ANY LOAD.RESPONSIBILITY AND OWNERSHIP OF MATERIAL BELONGS TO THE CUSTOMER WHEN LOADED INTO THE TRUCK. • WEIGHMASTER CERTIFICATE MIiiir THIS IS •TO CERTIFY that the following described commodity was weighed, measured or counted by a weighmaster, whose signature is on this certificate, who is a recognized authority of accuracy, as prescribed by chapter 7 (commencing .with section 12700) of division 5 of the California Business & Professional code, administered by the California Department of Food &Agriculture. LOCATION 1 STEVENS CREEK QUARRY, INC. LOCATION 2 12100 STEVENS CANYON ROAD 1275 ANZAR ROAD CUPERTINO,CA 95014-5415 0' k SAN JUAN BAUTISTA,CA 95045 PH 408 253-2512•FAX 408 257-4614 PH 831 623-9555•FAX 831 623-1377 -Mill TICKET DRIVER ®ON ❑OFF ;; !; DATE/TIME PRODUCT HAULER/TRUCK LOCATION I. '- . .'010 0Et, 1. 2 . '.':' . 14.1 f p,U('`.' ',.'(1`;i. E: 0' -. ' 1.0 ? 0I;LE AF S-.1200 , i)UL. .,H : t , ' , CUSTOMER QTY. UNIT PRODUCT PRICE AMOUNT )()':6 1 . i7W_o;:r1 0( :, .;A CLL 0- ;:) ' CON N 0 , O L?t l �. i 1.i.:.1�L.;, J. P f t i,'. i �. i I.- t( Z F f•E;f.l i fL i I ,)r ..I :. r Nc : 1. ..!0 1 A X DJ 1 ; TOTAL LtE.If.- ALL ACCOUNTS ARE DUE ON THE 25TH OF THE MONTH FOLLOWING THE DATE OF PURCHASE.BUYER AGREES (3 , 1. .::!Q f. TO PAY ANY COLLECTION COSTS INCURRED BY STEVENS CREEK QUARRY INCLUDING REASONABLE ATTORNEY'S FEES AND A SERVICE CHARGE OF 1 1/2%PER MONTH ON ALL OVERDUE BALANCES. cyi DELIVER TO: 1 _ _ I I; IP:1 I ,. I..I._ CO GROSS: al TARE: WEIGHMASTER DRIVER NET: IF DUMPING:NO HAZARDOUS CONTAMINATED OR ORGANIC MATERIAL ACCEPTED.WE RESERVE THE RIGHT TO REFUSE ANY LOAD.RESPONSIBILITY AND OWNERSHIP OF MATERIAL BELONGS TO THE CUSTOMER WHEN LOADED INTO THE TRUCK. • WEIGHMASTER CERTIFICATE_ THIS IS TO CERTIFY that the following described commodity was weighed, measured or counted by a weighmaster, vyhose signature is on this certificate, who is a recognized authority of accuracy, as prescribed by chapter 7 (commencing*with section 12700) of division 5 of the California Business & Professional code, administered by the California Department of Food &Agriculttire. LOCATION 1 STEVENS CREEK QUARRY, INC. LOCATION 2 \� 12100 STEVENS CANYON ROAD 1275 ANZAR ROAD CUPERTINO,CA 95014-5415 '' ' SAN JUAN BAUTISTA,CA 95045 PH 408 253-2512•FAX 408 257-4614 -_ PH 831 623-9555•FAX 831 623-1377 DRIVER ®ON El OFF TICKET DATE/TIME PRODUCT HAULER/TRUCK LOCATION 1 , !'3 i 2 U t i; 0 IL;;., :, : 0 9 : 1 11 Phi On `.',(lX(.E_ 0- 3 ' CUM NOF.LbAR S./200 1 Cat!(;HIA11 ( ED ) R !:. CL i.:t i L 1: ' CUSTOMER QTY. UNIT PRODUCT PRICE AMOUNT 20046 l. . 00Loz ci UC•`..) 5nxu. C - ::i ' CON P' n r0U BAR EWtll: RM Nt .r.N ' O Z I EE1UII1 —I ..i.: d _. d .. l: 1U1iiL. DUE O r ALL ACCOUNTS ARE DUE ON THE 25TH OF THE MONTH FOLLOWING THE DATE OF PURCHASE.BUYER AGREES F"'" „ U ,. ... ...t-: . TO PAY ANY COLLECTION COSTS INCURRED BY STEVENS CREEK QUARRY INCLUDING REASONABLE `D ATTORNEY'S FEES AND A SERVICE CHARGE OF 1 1/2%PER MONTH ON ALL OVERDUE BALANCES. DELIVER TO: - ,,i_' d I I L i"• 1 !'H ' . f:;f .. ,_.L _ rfl IV GROSS: 0 . 00 CA) TARE: U . (}(. . WEIGHMASTER DRIVER NET: J JEN.^)IF rR HEt,NAW0t 7_ �� / It �: r �- I 7 IF DUMPING:NO HAZARDOUS CONTAMINATED OR ORGANIC MATERIAL ACCEPTED.WE RESERVE THE RIGHT TO REFUSE ANY LOAD.RESPONSIBILITY AND OWNERSHIP OF MATERIAL BELONGS TO THE CUSTOMER WHEN LOADED INTO THE TRUCK. Zanl•.er Road 1..anc:i f:i:1]. T:f.t:: l"f: 673839-3 ReV. » T ':) l...os Esteros Rd DA l l: 1.2/29/2210 Sail ,7 ose, CA 7.3134 'n:IYtE :: 4::15 Kit .._ 4:1.5 PM .$ lti, Tott Equi.p.. Re nt r **, i s ' `IOC' �9��E�., qol ' :rya.. :r.nbt .t) ; `� ` '' Roai x.:19 r s hci )P((3 .hlt :14 C ptx?1.1 TAW: '16.53T sattli S1(U f#: l..r.C:i':l ' #» ! I 9A46179 ' �:. ,g ck,, ,C:(:>h'BYE tT: 1:306 Juanita 'WI Pi... Ton (a,.E:. :. 5tJ,.00 33.01,Ff MIN c TOTtl-.u $ &L„(X. 7 DRIVER SIGNATURE By Acceptance of this Receipt, the customer certifies there are no Hazardous Materials contained within this load as defined by the California State Health Department. ZANKER ROAD LANDFILL, 705 Los Esteros Road, San Jose, CA 95134, Ph. (408) 263-2383 Hours of Operation: Mon. thru Fri. 6 AM to 5:45 PM - Sat. & Sun. 8 AM to 3:45 PM Printed on Recycled Paper t • • ' ,adaluio_ F:.ubbi3h DiEpo:i .1 Original 15999 6uaciaiu P.e Mine_ Fond T1LIcet# 811408 :--in ,in59. CA. 9`3120 Ph: ;4081 X68- 167th. Customer Marne TouBArEauipment Toy.! Bar Equip Carrier, TOIJCHATT Ticket DA.te 12 '28 '2010 '�ehic le# K69 volume Pavrn-nt Type Cr,dO. Account Container Manual Ti.c_ket# Di i ver Poute .,- . Hauling Tin ,� - ling# 0 X608 Destination r d PO ,{�, . 4 . ‘t,,„ t Time �..ator :bound Cross 5'460 lb In 12/28/20 n E ^LAZo Tare 37480 lb Out 1.2/2:8!201 U_AZO ' - Net 15980 lb Tons 7.99 Comments 1 "PWANIDSO Imo , _. Deputy Weighmaster Frank Collazo Product u 63 Origin 1 MSU—Tons—MSW Permitted M 100 7. 99 Toni CAM 2 FUEL•-Fuel. Surcharge -- La 1 %. CAM 3 EV ..i_ -Standard EnvironRie 1 l Lord CAM . Total Tax • Total Ticket i, 1 SITE SAFETY RULES Waste Management is not responsible or liable for any accident or injury to customers or their property while on these premises • NO SMOKING • NO SCAVENGING • CHILDREN&PETS MUST REMAIN IN VEHICLE • NO ALCOHOL OR DRUGS ALLOWED • NO SPEEDING OR PASSING • FOLLOW TRAFFIC DIRECTORS SIGNALS AND INSTRUCTIONS • WATCH FOR MOVING HEAVY EQUIPMENT • NO PICTURES ARE TO BE TAKEN ON THIS FACILITY WITHOUT PRIOR APPROVAL OF MANAGEMENT • TRUCK DRIVERS ARE RESPONSIBLE TO DUMP THEIR LOADS SAFELY.WASTE MANAGEMENT IS NOT RESPONSIBLE OR LIABLE FOR ANY ROLLOVERS WASTE MANAGEMENT RESERVES THE RIGHT TO REJECT ANY LOAD OR CUSTOMER WEIGHMASTER CERTIFICATE THIS IS TO CERTIFY that the following described commodity was weighed, measured, or counted by a weighmaster, whose signature is on this certificate, who is a recognized authority of accuracy, as prescribed by Chapter 7 (commencing with Section 12700) of Division 5 of the California Business and Professions Code, administered by the Division of Measurement Standards of the California Department of Food and Agriculture. • • ,,LA1t r.."2 !'iibhi _h 'Di 1.00 4i, ojlil 1'3'a'?'3 vuada i:-tp; Mine, Po 3n Jo e, Lt-i, '3':,1 ,t l:'. t 1 A iii T o q t•a E q u i p in n t T o u Bar Equip C.: i t r ,,r Tidet Date 1211, '2010 "vehicle#.. Payment Type Credit Ncc�.,r*t Container : Manual Ticket# Dri-er Pouts r . Hauling Ti. . ling Destination - # @%' 26@8 i � i Tiae at orx bound Gross In 12/28/2@ n. L.A _ Tyr O'.tt 1_2/28/2@1 a Inb ILA Net Tr.ns CoSment 5 qa �� �� � s. Deputy Weighma Ier Sergio Avila Product � . r : t-i Origin .:1 MSW-Tons-MSW Permitted M 1@@ 1@.2S Toi�=_ CAM 2 FUEL-Fuel Surcharge _. La 1@@ CAM . EUF-L-Standard Environate 100 1 Load CA i Total Talc' i ` Total Ticket, SITE SAFETY RULES Waste Management is not responsible or liable for any accident or injury - to customers or their property while on these premises • NO SMOKING • NO SCAVENGING • CHILDREN&PETS MUST REMAIN IN VEHICLE • NO ALCOHOL OR DRUGS ALLOWED • NO SPEEDING OR PASSING • FOLLOW TRAFFIC DIRECTORS SIGNALS AND INSTRUCTIONS • WATCH FOR MOVING HEAVY EQUIPMENT • NO PICTURES ARE TO BE TAKEN ON THIS FACILITY WITHOUT PRIOR APPROVAL OF MANAGEMENT • TRUCK DRIVERS ARE RESPONSIBLE TO DUMP THEIR LOADS SAFELY.WASTE MANAGEMENT IS NOT RESPONSIBLE OR LIABLE FOR ANY ROLLOVERS WASTE MANAGEMENT RESERVES THE RIGHT TO REJECT ANY LOAD OR CUSTOMER WEIGHMASTER CERTIFICATE • THIS IS TO CERTIFY that the following described commodity was weighed, measured, or counted by a weighmaster, whose signature is on this certificate, who is a recognized authority of accuracy, as prescribed by Chapter 7 (commencing with Section 12700) of Division 5 of the California Business and Professions Code, administered by the Division of Measurement Standards of the California Department of Food and Agriculture. • III. ,Ju c La 1 ,iu.,' Rubbish Di spia ;:31 Or iginal 15�9'_! G,u::,da]gape Mines Po,id Ticket# 811250 n T0se. CA. '5120 Ph: ,.i08 268-1670 t:ustomer.•, Name Tct 13 rEqui.pment Too Bar Equip'Carrier TOUCHATT i•icket Date 12=28 2 10 "ehi,^le# T-220 !!o1ume Payment Type Credit Aucoulit Container Manual Ticket# Driver Nau1ing Ti. 1Ing# 0' 2608 Destination -Id P0# i ..x gr i " Time <' 'at or � 4 bound " Gross 53120 lb Ir., 12/28/20 n, LAZO Tare 36700 l.b Out 12/28/201 Inbs LLAZ0 Net 16420 lb TonE. 8.21 Comment : Deputy Weighma.ter Frank Collazo Product r =x . �ti Originri 1 MSW-Tons-MSW Permitted M 100 8.21 Toni CAM 2 FUEL--Fuel Surcharge - La 100 % CAM 7. Et)F••L-Standard Environme 100 1 Load • CAM. :(:>...*'.....''..Q............------""" Total. TRY Total Ticke+ n.._.. a .. ,, i_• • . , • SITE SAFETY RULES Waste Management is not responsible or liable for any accident or injury - to customers or their property while on these premises • NO SMOKING • NO SCAVENGING • CHILDREN&PETS MUST REMAIN IN VEHICLE • • NO ALCOHOL OR DRUGS ALLOWED • NO SPEEDING OR PASSING • FOLLOW TRAFFIC DIRECTORS SIGNALS AND INSTRUCTIONS • WATCH FOR MOVING HEAVY EQUIPMENT • NO PICTURES ARE TO BE TAKEN ON THIS FACILITY WITHOUT PRIOR APPROVAL OF MANAGEMENT • TRUCK DRIVERS ARE RESPONSIBLE TO DUMP THEIR LOADS SAFELY.WASTE MANAGEMENT IS NOT RESPONSIBLE OR LIABLE FOR ANY ROLLOVERS WASTE MANAGEMENT RESERVES THE RIGHT TO REJECT ANY LOAD OR CUSTOMER WEIGHMASTER CERTIFICATE THIS IS TO CERTIFY that the following described commodity was weighed, measured, or counted by a weighmaster, whose signature is on this certificate, who is a recognized authority of accuracy, as prescribed by Chapter 7 (commencing with Section 12700) of Division 5 of the California Business and Professions Code, administered by the Division of Measurement Standards of the California Department of Food and Agriculture. • uldalupe Pubbiih Disposal Original 211 t� "° t r.` 1599 Guadalupe Mines Road Ticket# 811338' an Jose, CA, 95120 i Ph: (408) 268-1670 Cu_tomer Name TouBarEgt'ipment Tou Bar Equip Carrier TOUCHATT Ticket Date 12: 28;2010 Vehicle# T-220 Volume Payment Type Credit (account Container- Manual Ticket# ..Driver Route • : : Hauling Ti 4 1 ing# 0 260th rD(e���ltinat inn .` �.� � � ,. � ��� �� .� .� d � x PO# Time � U , ator , f bound Gros 61980 lb s In 12/28/20$ n. LA Tare 36700 lb i Out 12/28/20 _ .> II.N - Net 25280 lb 1 Comments Deputy Weighata,ster Sergio Avila Product ea fiat_ � .' It Origin I MSW-Tons-MSW Permitted M 100 12.64 Tons CAM 2 FUEL-Fuel Sui,ch trge -. L9 1.00 y CAM 7 EVE-L-9ta,idard Environme 14:10 Load CAM Total Tax . ... / Tii1 Ticket Driver =_ Signature • SITE SAFETY RULES Waste Management is not responsible or liable for any accident or injury to customers or their property while on these premises • NO SMOKING • NO SCAVENGING • CHILDREN&PETS MUST REMAIN IN VEHICLE • NO ALCOHOL OR DRUGS ALLOWED • NO SPEEDING OR PASSING • FOLLOW TRAFFIC DIRECTORS SIGNALS AND INSTRUCTIONS • WATCH FOR MOVING HEAVY EQUIPMENT • NO PICTURES ARE TO BE TAKEN ON THIS FACILITY WITHOUT PRIOR APPROVAL • OF MANAGEMENT • TRUCK DRIVERS ARE RESPONSIBLE TO DUMP THEIR LOADS SAFELY.WASTE MANAGEMENT IS NOT RESPONSIBLE OR LIABLE FOR ANY ROLLOVERS WASTE MANAGEMENT RESERVES THE RIGHT TO REJECT ANY LOAD OR CUSTOMER WEIGHMASTER CERTIFICATE THIS IS TO CERTIFY that the following described commodity was weighed, measured, or counted by a weighmaster, whose signature is on this certificate, who is a recognized authority of accuracy, as prescribed by Chapter 7 (commencing with Section 12700) of Division 5 of the California Business and Professions Code, administered by the Division of Measurement Standards of the California Department of Food and Agriculture. Guadalupe Rubbish Disposal Co., Inc. This letter is confirmation that your materials that have been delivered to the Guadalupe Recycling and Disposal Facility located at 15999 Guadalupe Mines Rd., in San Jose, Ca . These materials are coded and verified as eligible for recycling and/or reused in conjunction with the requirements of.the LEED program, although third party certification is required. The MRF recovery rate varies by material type delivered, and by period. For the Material Type - "Sort Material" the recovery rates are as follows: Year to Date 2010 91.28% recovered. The Guadalupe Landfill appreciates your patronage, if you have any questions regarding this letter or have specific questions in regards to the Guadalupe Landfill and/or LEED certification please feel free to contact me. Sincerely, Ccyv+,,c F-fr e4t- Cyndi Hunt Industrial Account Manager (707) 669-0738 Guadalupe Landfill 408-323-4845 C 13 / C Vve r K • , - ROU'T'E SHEET f/'3 - 0 • � k [ DPss. / 2 C..49 70(-4 ASSESSOR'S PARCEL'NUMBER: ' PLAN CHECK NUMBER: DESCRIPTION OF WORK: � c/U) SJ ECEWED °k'.4 -22010 � BUC WORKS APPROVED: NO COMA/r'NTS: c r • DA I =: J1 APPROVED. CONDITIONS BELOW. • NOT APPROVED: 1 R T R1N To BLT DING = M E T R O S CAN PROPERTY ] O F I L E _ • Santa Clara (CA) ********************************************************************************************** * * * * * * * < < < OWNERSHIP INFORMATION > > > * * * * Owner :Nguyen Timothy N Parcel Number :403 16 028 * * CoOwner :Pharr-nguyen Nancy N Bldg Id No :1 * * Site Address :1306 Juanita Way Campbell 95008 * * Mail Address :1306 Juanita Way Campbell Ca 95008 * * Phone :Owner: * * * * < < < SALES AND LOAN INFORMATION > > > * * * * Transferred :05/04/2010 Loan Amount * * Document # :20697871 Lender * * Sale Price Loan Type * * Deed Type :Grant. Deed Interest Type * * % Owned :100 Vesting Type :Married Persons * * * * < < < ASSESSMENT AND TAX INFORMATION > > > * * * * Land :$282, 600 Exempt Type • * Structure :$345,500 Exempt Amount * * Other Tax Rate Area :10005 * * Total :$628,100 09-10 Taxes :$7, 892 .68 * * % Improved :55 * * * * * * < < < PROPERTY DESCRIPTION > > > * * * * Census :Tract:5067.01 Block:3 * * Map Grid :873 B1 * * Zoning :R-1-1 * * Land Use :01 Res,Single Family Residence * * Sub/Plat :Vista De Las Montanas * * Legal :TR 311 LOT 17 * * * * MLS Area :015 * * * * < < < PROPERTY CHARACTERISTICS > > > * * * * Total Rms :5 Bldg SF :1,419 Units YearBuilt :1950 * * Bedrooms :3 Lot SF :10,454 Patio :No EffYearBlt :1950 * * Bathrooms :1. 00 UseableSF:10,500 Porch :Yes Garage Sp :2 * * Stories :1 Lot Acres : .24 Elevator : Garage SF :360 * * Dining Rm Lot Dimen:75x140 Lease SF : Bldg Cond :Avg * * Family Rm Pool :No Office SF: Bldg Class :5.5 * • * Rec Room Fireplace: Sprinkler: Bldg Shape ':L-shape * * UtilityRm Sauna 1stFlr SF:1,419. GarageTyp :Garage * * Water Src Dishwsher: 2ndFlr SF: WallHgt * * Elect Svc Tennis Ct: 3rdFlr SF: AddtionSF * * Gas Svc FrameType:Wood Rental SF: * * Cnt1Ht/Ac:Heat Only * * * ********************************************************************************************** Information compiled from various sources. Real Estate Solutions makes no representations or warranties as to the accuracy or completeness of information contained in this report. Pk IT APPLICATION PERMIT#0 CITY OF CAMPBELL-BUILDING DIVISION /i � ! DATE: 1( BUILDING ADDRESS: /3tD 6 J ci 6(.rC C/ c<w���� -� ' SUITE PERMIT TYPE: BUILDING ELECTRICAL TIc PLUMBING MECHANICAL?C- DEMOLITION SIGN GRADING >' O1'liER DESCRIPTION ryOF� WORK: (N) SFll rRES.ADD /REM (N) COMM. DEM SIGNS .r `.L?Lc�'i`�`�-'(?C�5 J,� C( �/;eA-,J :S 7i, .6 .1.e�4iu�i'L7 �' [�7-�-- f ! I' +.j y, I VALUATION f OWNER'S NAME: 77&I C, 7-1(4. E k/) PHONE#: q-(3� - 025-2_ 't I ADDRESS: 5 c(c t A-1-1f �'b LrT jJ !� 4'Cu - � l`(_ c _ S CITY: T �� C�.CE LLD: C�� ci s(2- APPLICANT'S NAME: ---CA-(-1 PHONE#: 4:1 ADDRESS: CITY: ZIP: V8--- ,� " 1(4 CONTRACTOR'S NAME: LICENSE# CONTACT PERSON: PHONE#: ADDRESS: CITY: ZIP: • ARCH1TECT/ENG NAME: 6-*R- ?:t L13)6-.7-I-- CONTACT PERSON: PHONE#: fc -- ADDRESS: PC 3 Gx CITY: 5u F � �< <, t. ZIP: C _ /O'7"-(7Z HAZARDOUS MATERIALS: USED ON SITE: YES NO STORED ON SITE: YES NO 0,-. (For use or storage of hazardous materials,provide a HazMat Information Statement to the Fire Dept.Hazardous Materials Specialist for review and comment. I'LRE SPRINKLEREII: YES NO APN # (-/-O . - / 6 — G =`' q7:71/6- i , .-- I•t- L / 1 C Wo r K Ai..4. / / zil)6- RO IT it SHEET DATE. //,3 O ` Ai)ME5S: /30 .UL,dM; 10 ASSESSOR'S PARCEL NUMBER: o3-/7 - 12,Le) _< PLAN CHECK NUMBER:xzo ,....../v97 , DE SCRIPT IONOr�WORK OU) RECEIVED J !,4 -2 2010 WORKS APPROVED. NO CON NTS: ii,o/iDA I'L 1 /3 7� r APPKO\ EI CONDiTlONS BELOW NOT APPROVED. I i F _.-..- { RE TURN TO B I`Df]U = METRO - " AN PROPERTY R O F I L E Santa Clara (CA) ********************************************************************************************** * * * * * * * < < < OWNERSHIP INFORMATION > > > * * * * Owner :Nguyen Timothy N Parcel Number :403 16 028 * * CoOwner :Pham-nguyen Nancy N Bldg Id No :1 * * Site Address :1306 Juanita Way Campbell 95008 * * Mail Address :1306 Juanita Way Campbell Ca 95008 * * Phone :Owner: * * * * < < < SALES AND LOAN INFORMATION > > > * * * * Transferred :05/04/2010 Loan Amount * * Document # :20697871 Lender * * Sale Price Loan Type * * Deed Type :Grant Deed Interest Type * * % Owned :100 Vesting Type :Married Persons * * * * < < < ASSESSMENT AND TAX INFORMATION > > > * * * * Land :$282, 600 Exempt Type * * Structure :$345, 500 Exempt Amount * * Other Tax Rate Area :10005 * * Total :$628, 100 09-10 Taxes :$7, 892 .68 * * % Improved :55 * * * * * * < < < PROPERTY DESCRIPTION > > > * * * * Census :Tract:5067.01 Block:3 * * Map Grid :873 B1 * * Zoning :R-1-1 * * Land Use :01 Res,Single Family Residence * * Sub/Plat :Vista De Las Montanas * * Legal :TR 311 LOT 17 * * * * MLS Area :015 * * * * < < < PROPERTY CHARACTERISTICS > > > * * * * Total Rms :5 Bldg SF :1,419 Units YearBuilt :1950 * Bedrooms :3 Lot SF :10,454 Patio :No EffYearBlt :1950 * * Bathrooms :1.00 UseableSF:10,500 Porch :Yes Garage Sp :2 * * Stories :1 Lot Acres: .24 Elevator : Garage SF :360 * * Dining Rm Lot Dimen:75x140 Lease SF : Bldg Cond :Avg * * Family Rm Pool :No Office SF: Bldg Class :5.5 * * Rec Room Fireplace: Sprinkler: Bldg Shape :L shape * UtilityRm Sauna lstFlr SF:1,419. GarageTyp :Garage * * Water Src Dishwsher: 2ndFlr SF: WallHgt * * Elect Svc Tennis Ct: 3rdFlr SF: AddtionSF * * Gas Svc FrameType:Wood Rental SF: * Cnt1Ht/Ac:Heat Only * * * ********************************************************************************************** Information compiled from various sources. Real Estate Solutions makes no representations or warranties as to the accuracy or completeness of information contained in this report. PERMIT APPLICATION PERMIT #& Y)(() CITY OF CAMPBELL-BUILDING DIVISION f/f/2-"c` C)DATE: BUILDING ADDRESS: 3a J����t' � �fc�c� , �� p 6` it SUITE PERMIT TYPE: BUILDING c ELECTRICAL PLUMBING - MECHANICAL DEMOLITION 1c' SIGN GRADING >( OTHER DESCRIPTION OF WORK: (N)SFD RES.ADD REM (N)COMM. DEM SIGNS t. Ch O Ga J a Gu2t-J g 71-r ( ' ALUATION OWNER'S NAME: `rl .'(G 77-4.Y i PHONE#: ceO _�5 —3 E ( .ea' 4t 4 7-9`(- t C• 7 S ADDRESS: `a (C?`t AC't(fk Pb LIB D R CITY: c {4-Cwr �J d,C� ZIP: C. i S72 j APPLICANT'S NAME: -CA---61 PHONE#: ADDRESS: 44pP ZIP: � ir �' CITY: CONTRACTOR'S NAME: ?Li /' LICENSE# CONTACT PERSON: PHONE#: ADDRESS: CITY: ZIP: ARCHITECT/ENG NAME: P" CONTACT PERSON: PHONE#: f 5 G S'S ? ADDRESS: Po is x CITY: u i C t i/vt L' ZIP: CA (t HAZARDOUS MATERIALS: USED ON SITE: YES NO �� STORED ON SITE: YES NO�. (For use or storage of hazardous materials,provide a HazMat Information Statement to the Fire Dept.Hazardous Materials Specialist for review and comment. FIRE SPRINKLERED: YES NO ) APN # / 6 O a ce PUBLIC WORKS DEPARTMENT LAND DEVELOPMENT&TRAFFIC RECEIPT Effective July 1,2010 VLJ A /Z°0 — p`�� /?/„ TO: City Clerk PUBLIC WORKS FILE NO.�( (/ I Cry PROPERTY ADDRESS / O�,(& Please collect&receipt for the following monies. ACCT. ITEM AMOU LAND DEVELOPMENT 4722 Encroachment Permit Application Fee Non-Utility Encroachment Permit $350.00 Minor Encroachment Permit<$10,000 $200.00 Initial R-1 Permit N/C Subsequent R-1 Permits within Two Year Period $200.00 * 2203 Plan Check Deposit 2%of Engineer's Estimate $500.00 min Utility and R-1 Permits no deposit required 4722 Grading&Drainage Plan Review Sin le Famil Lot $250.00 Site<10 000 s.f. $750.00 Site≥10 000 s.f. <Acre $1 000.00 Site≥ 1 Acre $1 500.00 Plan Check&Inspection Fee(Non-Utility) **2203 Engr. Est. up to$250,000 14%of Engineer's Estimate 4722 Enqr. Est.≥$250,000 Actual cost+20%Admin Overhead (Min$35,000 Deposit) * 2203 Emergency Cash Deposit 4%of Engr. Est.*($500 min/$10,000 Max)_ * 2203 Faithful Performance Security(FPS) 100%of ENGR. EST.* * 2203 Labor and Materials Securit 100%of ENGR. EST.* 4721 Storm Drainage Area Fee Per Acre R-1 $2,120.00 57/, 0O (Multi-Res$2,385.00) All Other$2 650.00 4722 Parcel Ma. 4 Lots or Less $3 600.00+$80/lot 4722 Final Tract Map(5 or More Lots) $4,400.00+$108/lot * 2203 Monumentation Securit 100%of ENGR. EST. 4920 Parkland Dedication Fee 75%/25%Due U•on Cert. of Occu•anc 4722 Lot Line Ad'ustment $1 400.00 4722 Vacation of Public Streets&Easements $2 250.00 4722 Certificate of Com•liance $1 700.00 4722 Certificate of Correction $500.00 4722 Appeal Filing Fee $200.00 4722 Nota Fee .ersi.nature $10.00 4722 Assessment Segregation or Reapportionment First Split $800.00 Each Additional Lot $250.00 511.7424 Postage TRAFFIC 4728 Traffic Flow Map (Daily Traffic Volumes) $34.00 4728 Signal Timing Information $72.00/Hr 4271 Truck Permits $16.00/per trip 4728 No Parking Signs $1/each or$25/100 MISCELLANEOUS Other(Please Specify) *Engineer's Estimate shall be as approved by the City Engineer and shall include all items of work.**Actual Cost Plus 20%Overhead(Non-Interest bearing deposit) TOTAL $ ,S7/- n g D NAME OF APPLICANT ' ll NAME OF PAYOR PHON ADDRESS ZIP `/dg FOR IRECEIVEb BY CITY CLERK i ir , ONLY I 1 `R eipt# *For Plan Check and Cash Deposits,send yellow copy to Finance. Date/ Initials • "- // y 9 =Fw+p M 2 S! :g\362 'EDT %0N q ) y' a w!W 23: qSS$ :3! 1!S 6tO-O Am viiotinc. me 71 >S) a"-m$ 26 gw @vw12< ^ . imAV «2«6a« SGl :2g j'.:io 3M SRea OT/77/01: :3IVC SAGO gm+ H1VI; • 1R w : : w2 • . , I • OF • C-44i4 U . •ORCHARD. CITY OF CAMPBELL Community Development Department September 27, 2010 Timothy Nguyen 5924 Amapola Dr. San Jose, CA 95129 Re: File No: PLN2010-196 Address: 1306 Juanita Way Application: Administrative Site and Architectural Review Permit Dear Mr.Nguyen, On September 20, 2010, the Community Development Director approved your Administrative Site & Architectural Review Permit for construction of a new single-family residence on property located at the above referenced address, subject to the enclosed Conditions of Approval. This action is effective in ten calendar days,unless appealed in writing to the City Clerk by 5:00 p.m. on September 30, 2010. If you should have any questions regarding this approval, please feel free to contact me at (408) 866-2193 or by email at danielf@cityofcampbell.com. Sincerely, Daniel Fama Assistant Planner cc: Paul Kermoyan,Planning Manager Doris C.Quai Hoi,Project Engineer Ed Arango,Associate Engineer Gary Diebel,P.O.Box 1044,Burlingame, CA 94011 encl: Conditions of Approval—PLN2010-196 70 North First Street • Campbell, California 95008-1423 • TEL 408.866.2140 • FAX 408.871.5140 • TDD 408.866.2790 City of C;.ai p p 1 APPROVED PROJECT ile#: N2�q� CONDITIONS OF APPROVAL FOR FILE NO. PLN2010-196,ype of Application: ci447;61. S i,4 /'eth'e ) Approved by. SITE ADDRESS: 1306 Juanita Way a1Community Development Director APPLICANT: Timothy Nguyen ❑Planning Commission ❑Ci Council OWNER: Timothy Nguyen Approval Date: gf .o/I6 DATE: September 20, 2010 Resolution/Ord ?# /VA- Authorized by- The applicant is hereby notified, as part of this application, that ( he is requarerto meet the following conditions in accordance with the ordinances of the City of Campbell and the State of California. The lead department with which the applicant will work is identified on each condition where necessary. Where approval by the Director of Community Development, City Engineer,Public Works Director, City Attorney, or Fire Department is required, that review shall be for compliance with all applicable conditions of approval, adopted policies and guidelines, ordinances, laws and regulations, and accepted engineering practices, for the items under review. Additionally, the applicant is hereby notified that (s)he is required to comply with all applicable Codes or Ordinances of the City of Campbell and the State of California that pertain to this development and are not herein specified: COMMUNITY DEVELOPMENT DEPARTMENT Planning Division: 1. Approved Project: Approval is granted for an Administrative Site and Architectural Review Permit(PLN2010-196) for the construction of a 3,568 square-foot single-family residence on property located at 1306 Juanita Way. The project shall substantially conform to the revised project plans and material/color board stamped as received by the Community Development Department on August 13, 2010, except as may be modified by the conditions of approval herein, 2. Planning Final Required: Planning sign off is required prior to Building Permit final. Construction not in substantial compliance with the approved project plans shall not be approved without prior authorization of the necessary approving body. 3. Site and Architectural Review Permit Approval Expiration: The Administrative Site and Architectural Review Permit approval shall be valid for two years from the date of final approval. Within this two-year period an application for a building permit must be submitted. Failure to meet this deadline will result in the Administrative Architectural Site and Review Permit being void. 4. Fences/Walls: Any newly proposed fencing and/or walls shall comply with Section 21.18.060 of the Campbell Municipal Code and shall be submitted for review and approval by the Community Development Department. 5. Contractor Contact Information Posting: The project site shall be posted with the name and contact number of the lead contractor in a location visible from the public street prior to the issuance of building permits. 70 North First Street•Campbell,CA 95008-1423•TEL(408)866-2140•FAX(408)866-5140•E-MAIL planning@cityofcampbell.com Pg. 2 6. On-Site Lighting: On-site lighting shall be shielded away from adjacent properties and directed on site. The design and type of lighting fixtures and lighting intensity of any proposed exterior lighting for the project shall be reviewed and approved by the Community Development Director prior to installation of the lighting for compliance with all applicable Conditions of Approval, ordinances, laws and regulations. Lighting fixtures shall be of a decorative design to be compatible with the residential development and shall incorporate energy saving features. 7. Construction Activities: The applicant shall abide by the following requirements during construction: a. Construction activities shall be limited to weekdays between 8:00 a.m. and 5:00 p.m. and Saturdays between 9:00 a.m. and 4:00 p.m. No construction shall take place on Sundays or holidays unless an exception is granted by the Building Official. b. All construction equipment with internal combustion engines used on the project site shall be properly muffled and maintained in good working condition. c. Unnecessary idling of internal combustion engines shall be strictly prohibited. d. All stationary noise-generating construction equipment, such as air compressors and portable power generators, shall be located as far as possible from noise-sensitive receptors such as existing residences and businesses. e. Use standard dust and erosion control measures that comply with the adopted Best Management Practices for the City of Campbell. Building Division: 8. Permits Required: A building permit application shall be required for the proposed new single family dwelling structure. The building permit shall include Electrical/Plumbing/Mechanical fees when such work is part of the permit. 9. Construction Plans: The Conditions of Approval shall be stated in full on the cover sheet of construction plans submitted for building permit. 10. Size of Plans: The minimum size of construction plans submitted for building permits shall be 24 in. X 36 in. Applicant shall also submit (1) reduced size 11"x 17" copy of plans and submit any necessary revision sheets for this copy as required. 11. Plan Preparation: This project requires plans prepared under the direction and oversight of a California licensed Engineer or Architect. Plans submitted for building permits shall be "wet stamped" and signed by the qualifying professional person. 12. Soils Report: Two copies of a current soils report, prepared to the satisfaction of the Building Official, containing foundation and retaining wall design recommendations shall be DFPA.Pi A nrr 70 North First Street•Campbell,CA 95008-1423•TEL(408)866-2140•FAX(408)866-5140•E-MAIL planning@cityofcampbell.com Pg. 3 submitted with the building permit application. This report shall be prepared by a licensed engineer specializing in soils mechanics. 13. Site Plan: Application for building permit shall include a competent site plan that identifies property and proposed structures with dimensions and elevations as appropriate. Site plan shall also include site drainage details. Elevation bench marks shall be called out at all locations that are identified as "natural grade" and intended for use to determine the height of the proposed structure. 14. Foundation Inspections: A pad certificate prepared by a licensed civil engineer or land surveyor shall be submitted to the project building inspector upon foundation inspection. This certificate shall certify compliance with the recommendations as specified in the soils report and the building pad elevation and on-site retaining wall locations and elevations are prepared according to approved plans. Horizontal and vertical controls shall be set and certified by a licensed surveyor or registered civil engineer for the following items: a. pad elevation b. finish floor elevation(first floor) c. foundation corner locations 15. Title 24 Energy Compliance: California Title 24 Energy Compliance forms shall be blue- lined on the construction plans. 8%X 11 calculations shall be submitted as well. 16. Special Inspections: When a special inspection is required by C.B.C. Chapter 17, the architect or engineer of record shall prepare an inspection program that shall be submitted to the Building Official for approval prior to issuance of the building permits, in accordance with C.B.C Appendix Chapter 1, Section 106. Please obtain City of Campbell, Special Inspection forms from the Building Inspection Division Counter. 17. Non-point Pollution Control Program: The City of Campbell, standard Santa Clara Valley Non-point Source Pollution Control Program specification sheet shall be part of plan submittal. The specification sheet (size 24" X 36") is available at the Building Division service counter. 18. Approvals Required: The project requires the following agency approval prior to issuance of the building permit: a. West Valley Sanitation District(378-2407) b. Santa Clara County Fire Department (378-4010) c. School District: i) Campbell Union School District (378-3405) ii) Campbell Union High School District (371-0960) iii) Moreland School District (379-1370) iv) Cambrian School District (377-2103) \l OF � n.a�-i�A.a ¢ i } i CA l'BELL t FIRS" ST. RRUBEEL, CA 95001 70 North First Street•Campbell,CA 95008-1423•TEL(408)866-2140•FAX(408)866-5140•E-MAIL planning@cityofcampbell.com Pg. 4 Note: To determine your school district, contact the offices identified above or visit: http://www.sccoe.k12.ca.us/resourcesfamilies/districtlocator. Obtain the School District payment form from the City Building Division, after the Division has approved the building permit application. d. Bay Area Air Quality Management District (Demolitions Only) 19. P.G.&E: Applicant is advised to contact Pacific Gas and Electric Company as early as possible in the approval process. Service installations, changes and/or relocations may require substantial scheduling time and can cause significant delays in the approval process. Applicant should also consult with P.G. and E. concerning utility easements, distribution pole locations and required conductor clearances. 20. Construction Fencing: This project shall be properly enclosed with construction fencing to prevent unauthorized access to the site during construction. The construction site shall be secured to prevent vandalism and/or theft during hours when no work is being done. All protected trees shall be fenced to prevent damage to root systems. 21. Build it Green: Applicant shall complete and submit a "Build it Green" inventory of the proposed new single family project prior to the issuance of a building permit. PUBLIC WORKS DEPARTMENT • 22. Storm Drain Area Fee: Prior to issuance of any grading or building permits for the site, the applicant shall pay the required Storm Drain Area fee, currently set at $2,120.00 per net acre, which is $511.00. 23. Utilities: All on-site utilities shall be installed underground per Section 21.18.140 of the Campbell Municipal Code for any new or remodeled buildings or additions. Applicant shall comply with all plan submittals, permitting, and fee requirements of the serving utility companies. 24. Water Meter(s) and Sewer Cleanout(s): Existing and proposed water meter(s) and sewer cleanout(s) shall be relocated or installed on private property behind the public right-of-way line. 25. Utility Coordination Plan: Prior to issuance of building permits for the site, the applicant shall submit a utility coordination plan and schedule for approval by the City Engineer for installation and/or abandonment of all utilities. The plan shall clearly show the location and size of all existing utilities and the associated main lines; indicate which utilities and services are to remain; which utilities and services are to be abandoned, and where-new utilities and services will be installed. Joint trenches for new utilities shall be used whenever possible. 26. Pavement Restoration: Based on the utility coordination plan, the applicant shall prepare a pavement restoration plan for approval by the City Engineer prior to any utility installation or PLAN W\G DEPARTMENT E rr'v 07 IL nt,.t ST A .A d N3ELL, 4tX) 70 North First Street•Campbell,CA 95008-1423•TEL(408)866-2140•FAX(408)866-5140•E-MAIL planning@cityofcampbell.com • Pg. 5 abandonment. Streets that have been reconstructed or overlaid within the previous five years will require boring and jacking for all new utility installations. Juanita Way has not been reconstructed or overlaid in the last 5 years. The pavement restoration plan shall indicate how the street pavement shall be restored following the installation or abandonment of all utilities necessary for the project. 27. Utility Encroachment Permit: Separate permits for the installation of utilities to serve the development will be required (including water, sewer, gas, electric, etc.). Applicant shall apply for and pay all necessary fees for utility permits for sanitary sewer, gas, water, electric and all other utility work. 28. Additional Street Improvements: Should it be discovered after the approval process that new utility main lines, extra utility work or other work is required to service the development, and should those facilities or other work affect any public improvements, the City may add conditions to the development/project/permit, at the discretion of the City Engineer, to restore pavement or other public improvements to the satisfaction of the City. 29. Pollution Prevention Measures: Prior to issuance of any grading or building permits, the applicant shall comply with the National Pollution Discharge Elimination System (NPDES) permit requirements, Santa Clara Valley Water District requirements, and the Campbell Municipal Code regarding stormwater pollution prevention. The primary objectives are to improve the quality and reduce the quantity of stormwater runoff to the bay. Resources to achieve these objectives include Stormwater Best Management Practices Handbook for New Development and Redevelopment ("CA BMP Handbook") by the California Stormwater Quality Association (CASQA), 2003; Start at the Source: A Design Guidance Manual for Stormwater Quality Protection ("Start at the Source") by the Bay Area Stormwater Management Agencies Association (BASMAA), 1999; and Using Site Design Techniques to Meet Development Standards for Stormwater Quality: A Companion Document to Start at the Source ("Using Site Design Techniques") by BASMAA, 2003. P�.fl J J! PO DEPART MT 1ST 3l t�e:r s BELL, CA 9 008 70 North First Street•Campbell,CA 95008-1423•TEL(408)866-2140•FAX(408)866-5140•E-MAIL planning@cityofcampbell.com . MEMORANDUM CITY OF CAMPBELL TO: Daniel Fama, Project Planner DATE: 9/8/2010 FROM: Doris C. Quai Hoi,Project Engineer Ed Arango,P.E.,Associate Enginee SUBJECT: DRC APPLICATION Site Address: 1306 Juanita Way For File No(s): PLN2010-00196 Project Description: Construction of a new one-story, 3,568 sqft single family house. Applicant: Timothy Nguyen PUBLIC WORKS DEPARTMENT CONDITIONS OF APPROVAL 1. Storm Drain Area Fee: Prior to issuance of any grading or building permits for the site the applicant shall pay the required Storm Drain Area fee, currently set at $2,120.00 per net acre,which is $511.00. 2. Utilities: All on-site utilities shall be installed underground per Section 21.18.140 of the Campbell Municipal Code for any new or remodeled buildings or additions. Applicant shall comply with all plan submittals, permitting, and fee requirements of the serving utility companies. 3. Water Meter(s) and Sewer Cleanout(s): Existing and proposed water meter(s) and sewer cleanout(s) shall be relocated or installed on private property behind the public right-of- way line. 4. Utility Coordination Plan: Prior to issuance of building permits for the site, the applicant shall submit a utility coordination plan and schedule for approval by the City Engineer for installation and/or abandonment of all utilities. The plan shall clearly show the location and size of all existing utilities and the associated main lines; indicate which utilities and services are to remain; which utilities and services are to be abandoned, and where new utilities and services will be installed. Joint trenches for new utilities shall be used • whenever possible. 5. Pavement Restoration: Based on the utility coordination plan, the applicant shall prepare a pavement restoration plan for approval by the City Engineer prior to any utility installation or abandonment. Streets that have been reconstructed or overlaid within the previous five years will require boring and jacking for all new utility installations. Juanita Way has not been reconstructed or overlaid in the last 5 years. The pavement restoration plan shall indicate how the street pavement shall be restored following the installation or abandonment of all utilities necessary for the project. Page 1 of 2 r A 1306 Juanita Way 6. Utility Encroachment Permit: Separate permits for the installation of utilities to serve the development will be required (including water, sewer, gas, electric, etc.). Applicant shall apply for and pay all necessary fees for utility permits for sanitary sewer, gas, water, electric and all other utility work. 7. Additional Street Improvements: Should it be discovered after the approval process that new utility main lines, extra utility work or other work is required to service the development, and should those facilities or other work affect any public improvements, the City may add conditions to the development/project/permit, at the discretion of the City Engineer,to restore pavement or other public improvements to the satisfaction of the City. 8. Stormwater Pollution Prevention Measures: Prior to issuance of any grading or building permits, the applicant shall comply with the National Pollution Discharge Elimination System (NPDES) permit requirements, Santa Clara Valley Water District requirements, and the Campbell Municipal Code regarding stormwater pollution prevention. The primary objectives are to improve the quality and reduce the quantity of stormwater runoff to the bay. Resources to achieve these objectives include Stormwater Best Management Practices Handbook for New Development and Redevelopment ("CA BMP Handbook") by the California Stormwater Quality Association (CASQA), 2003; Start at the Source: A Design Guidance Manual for Stormwater Quality Protection ("Start at the Source") by ' the Bay Area Stormwater Management Agencies Association (BASMAA), 1999; and Using Site Design Techniques to Meet Development Standards for Stormwater Quality: A Companion Document to Start at the Source ("Using Site Design Techniques") by BASMAA, 2003. • Page 2 of 2 OF.C4, DEVELOPMENT REVIEW COMMENT SHEET APPLICATION k(-11k." Distribution: August 17, 2010 Presentation: August 24, 2010 Completeness: August 31, 2010 Conditions: September 7, 2010 ROUTE TO: X Fire Department X Public Works Department X Building Division PROJECT DESCRIPTION Administrative Site and Architectural Review Permit for construction of a new one-story, 3,568 square-foot (3,054 sq. ft. living / 514 sq. ft. garage) in the San Tomas Area. File No.: PLN 2010-196 APN: 403-16-028 Applicant: Timothy Nguyen Property Owner: Timothy Nguyen Project Address: 1306 Juanita Way Zoning: R-1-10 (Single-Family Residential) General Plan Designation: Low Density Residential PROJECT PLANNER: Daniel Fama DEPARTMENTAL RECOMMENDATION: If it can be determined that this project will require minimal or no comments by your department/agency, please return this comment sheet with your initials to the Project Planner as soon as possible. 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Viso �+ea SA a . +>3— -%-.- oY Q7 PCL.4 • NUS 9s e`er, ,' 0.23 AC. e3m1 i.s i� ee \ 3d+a PCL 2 M' nar f.,:+"" �'- AV ' \. ¢ +�\ es. 0.29 AC. °� '6- TR.NO 6660 9G Ir. B7cf% \ 1- Tye pG�.N : 97 Sa is iF m' -3.5 0 ZC. 'a PCL e" $ s „P M -7 \--.M/ 17 �/1_� O z% 9 S400 SF 26 Yn P11'...- r. � %131.111 7"0 ABBO T i — 430,,,,-5. IMMERGE E.STONE-ASSESSOR '.M- WARM mop a osse mt moan trlX Carped under R A T.Coot Sec 727. LLA 10237400 Mall.Roll Y.ar 2007—woe Ind Development Information si Prepared by: DOH Date: 9/2/2010 Address: 1306 Juanita Way Lot size: 10,500(SF) If this project is part of a larger development(new subdivision, new townhomes)or commercial development, skip A through D. A. Existing building area(SF): B.Proposed addition area(SF): 3568 C. Total area w/addition(A+B): D. Percent increase(B/A): (if less than 50%, stop research) Tract or Parcel Map(circle one): TR311 Date recorded: 6/3/1946 (Tract#or book&page) Any found records of Storm Drain Area fee previously paid? Yes❑ (provide info below) No (Fee initiated for residential subdivisions 4 8/15/55; all developments 4 5/16/60) Date paid (file#&address or LID#) Storm Drain Area fee: 0.24 X 2120.00 = $511.00 (area in acres) (fee/acre) Any found records of building permits in last five years?Yes® (provide info below)No ❑ Was permit issued? Yes® (provide info below)No❑ Nature of Work: Replace furnace Permit Number: BLD2005-493 Within STANP? Yes® No❑ (check one) STANP Requirements: Curb❑ Gutter❑ Sidewalk❑ Rolled curb❑ None® NA❑ Existing improvements present? Curb❑ Gutter ❑ Sidewalk ❑ (check all that apply) Sidewalk dimension(BOW to FOW): Park strip dimension(FOW to BOC): Driveway dimension(s): D/W ADA compliant? Yes❑ No ❑ Street light info: JP❑ older pole❑ galvanized pole ❑ Water meter and sewer cleanout info: Street ROW half width(CL to PL): 30' Date that street had been resurfaced: Electrical panel relocation? Yes ❑ No ❑ NA Provide details and attach pictures(8.5x11), assessors map(11x17) and aerial map (8.5 x I I): J:\LandDev\Land Develop Information Sheets\Juanita Way 1306.doc