HomeMy WebLinkAboutENC2013-00145 'TO BE RECORDED WITHOUT FEE DOCUMENT• 2 2 3 5 2 5 ..
SgCTION 6103 GOVERNMENT CODE - Pages -
AT THE REQUEST OF CITY OF CAMPBELL Nu 11111 1,
Fees. - No Fees
Recording Requested By: ) Taxes
' City of Campbell ) Copies
AMT PAID
REGINA ALCOMENDRAS RDE # 006
SANTA CLARA COUNTY RECORDER 8/14/2013
After Recording Return To: ) Recorded at the request of II 47 AM
City
City Clerk )
City of Campbell )
70 North First Street )
Campbell, CA 95008-1423 )
APN: 41-207-027 (Space Above for Recorder's Use Only)
Address: 346 E.Campbell Ave.
AGREEMENT FOR PRIVATE IMPROVEMENTS
IN THE PUBLIC RIGHT-OF-WAY
In consideration for granting permission to construct improvements in the public right-of-way,
Julie Davey (property owner) enters into this Agreement with the City of Campbell. The
improvements contemplated under this permit are for the benefit of the real property commonly known
as 346 E. Campbell Ave. The City of Campbell grants such permission to install A Sanitary Sewer
Line and Appurtenances within the Public Right-of-Way beneath existing City sidewalk under
Encroachment Permit No. _ENC 2013-00145. All conditions of Encroachment Permit ENC 2013-
00145 remain in full force and effect. v
The property owner shall be solely responsible for maintaining the improvements in a good and
safe condition at all times; and the property owner shall indemnify, defend, and hold harmless the City
of Campbell, its officers, officials, agents, volunteers, employees and attorneys from any and all claims,
actions, losses, liabilities and costs (including reasonably incurred attorney's fees) arising out of or
connected with, or alleged to arise out of or be connected with the installation, design or condition of the
improvements, except for any claims, actions, losses, liabilities and costs proximately caused by the sole
negligence or willful misconduct of the City of Campbell, its officers, officials, agents, volunteers,
employees or attorneys. This provision is intended to be the dispositive of all rights of indemnity and
contribution between the parties, and property owner waives and releases any and all rights to indemnity
or contribution from the City of Campbell, in law or equity, arising out of, or connected with any and all
claims, actions, losses, liabilities and costs (including reasonably incurred attorney's fees) for which
property owner is obligated under this paragraph to provide indemnity or defense to the City of
Campbell, its officers, officials, volunteers, employees or attorneys.
The City, in its sole discretion, may revoke the rights granted under Encroachment Permit No.
ENC 2013-00145 and remove the improvements installed under Encroachment Permit No. ENC 2013-
00145 at any time, without liability to the property owner, or require that the improvements be
removed, and property owner shall have no right to compensation from City in any form.
THE FOREGOING INSTRUMENT IS A TRUE
AND CORRECT CO°V OF THE ORIGINAL
ON FILE IN THIS 01-TICE
ATTEST. ANNE EYLEE. CITY CLERK
4)CI rY of PBE L CA
By -� al ojer
� Page 1 of 3
DATED Clk/ay t
hi the event that Owner fails to reimburse the City for the costs of removing the improvement
("default") as required by this Agreement,the City shall have and may execute the absolute right, at the
City's option and without demand or notice to Owner, to claim and impose a lien, attached as Exhibit A
and incorporated herein by this reference ("Lien"), on said real property(also referred to herein as
"Collateral"). City's failure to exercise this option will not constitute a waiver of the right to exercise it
in the event of any subsequent default.
(a) Amount of Lien: The Lien shall be for the entire amounts then owing under this
Agreement.
(b) Recordation: City is authorized to record the Lien in the appropriate Recorder's
Office(s).
(c) City shall have full authority to perform all acts and things that City may consider
necessary or advisable to impose,maintain and enforce the Lien.
(d) Debtors' Warranty: OWNERS WARRANT that they are the owners of the Collateral and
Owners have the right to make this Lien Agreement.
(e) Debtors' Covenants: Owners agree:
(i) To pay City all amounts payable pursuant to this Agreement on or before the due
date when due and payable, and to perform all terms of this Agreement;
(ii) To defend the Collateral against claims and de ands of all persons and entities;
(iii) To keep the Collateral in good condition; to perform other acts that may be
necessary to preserve the Collateral and protect the Collateral against
unreasonable loss and all hazards, and;
(iv) To immediately notify the City in writing when Owners become aware of any
event that substantially affects the value of the Collateral, or the rights and
remedies of City in relation to the Collateral.
(f) Prohibitions: Without the prior written consent of the City, Owners will not permit any
liens or security interests (other than the City's Lien) to attach to the Collateral;permit the
Collateral to be levied on under legal process; dispose of the Collateral; or permit
anything to be done that may impair the value of the Collateral or of the Lien, which is
the subject of this Agreement.
(g) Notices: Any notice, demand or request required hereunder, or by law, shall be given in
writing(at the addresses set forth below)by any of the following means: (a) personal
service; (b) facsimile; (c) overnight courier or delivery service; or(d)registered or
certified, first class U.S. mail, return receipt requested.
Page 2 of 3
Property owner agrees to maintain homeowners or general liability insurance with a limit of at
least$100,000 for damages arising from the installation, design or condition of the improvements.
This provision shall run with the land and be binding on the property owner's successors.
Executed this p_ci day of � , 20 1
G'‘.\)-VA
Property Owner
Property Owner
(Attach Notary Acknowledgment
For All Parties)
CITY OF CAMPBELL, a municipal
Corporation
Michelle Quinney
City Engineer, City of C bell
ATTEST:
e Bybee, City Clerk
Page 3 of 3
Exhibit A
• Recording Requested By: ) .
)
• City of Campbell )
)
When Recorded Mail To: )
)
City Clerk )
City of Campbell )
70 N. First Street )
Campbell, CA 95008 )
)
)
Space above this line for Recorder's use only
CLAIM OF LIEN
I, , City Engineer fof the City of Campbell, a California Municipal
Corporation("City"), do hereby certify:
A. On or about , 20_, ("Debtors")
executed an Agreement for Private Improvement in the Public Right of Way with the City of Campbell
("Agreement").
B. The Agreement was recorded in the Santa Clara County Recorder's Office on or about
20 Document Number
C. The Agreement allowed the Debtor's to provide, construct, and/or install certain private
improvements in front of their property at , Campbell, California, at their
own costs and expense. Pursuant to the terms of the Agreement, the Debtors expressly agreed that if
they failed to comply with the Agreement, the City was authorized to remove said improvements and
recover the full cost and expense thereof from the Debtors or their successors.
D. The Debtors did not remove the improvements after being notified to do so. Therefore,
the City removed said improvements.
E. In , 20 , the City informed the Debtors about the improvements
that would be removed pursuant to the Agreement.
F. The City subsequently completed the work. On or about , 20 , the
City sent the Debtors an invoice for said work in the amount of$
G. Pursuant to the terms of the Agreement, the Debtors expressly agreed that the City is
authorized to, at the City's option and without demand or notice to the Debtors, immediately claim and
impose a lien on the real property commonly known as , Campbell, California,
APN Number , for the entire amounts then owing under, or incurred
pursuant to, the Agreement, including without limitation, the entire unpaid principal amount.
Page 1 of 2
• WHEREFORE, the City of Campbell, A California municipal corporation, pursuant to the
Agreement, hereby claims a lien upon the work of improvement and the land upon which it is situated,
' namely, the real property commonly known as , Campbell,
California, APN Number , in the amount of $
and said amount shall constitute a lien against said property until paid in full.
IN WITNESS WHEREOF the City of Campbell, California, a California Municipal Corporation,
has duly authorized the undersigned to execute this instrument in its name.
Dated: By:
for the CITY OF CAMPBELL, a California municipal corporation
(Notary Acknowledgement Required for Signatures)
Page 2 of 2
iF
� CALIFORNIA ALL-PURPOSE ii
CERTIFICATE OF ACKNOWLEDGMENT
i
State of California
1
County of 3: \c& C2CQ(0—
i
On �i Del) .O\3 before me, ,_. ..c,N v\.(\ � c: Ni\` 1V alcok•I i PL.) I�
...Ai ,
(Here insert name and title of the officer)
personally appeared „ t,)"t\Ct r. \ J 1
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who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to
the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized i
capacity(ies), and that by his/her/their signature(s)on the instrument the person(s), or the entity upon behalf of
which the person(s) acted,executed the instrument.
&
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph
is true and correct.
JOANN THOMASON
WI SS my hand and official seal. '�!'r commission* 1930612
•.:I r Notary Public-Calilornia 1
\: / Santa Clara County
M Gomm.Ex as Mar 28.2015
(Notary Seal)
Sig ture of Nos tic
4
ADDITIONAL OPTIONAL INFORMATION
INSTRUCTIONS FOR COMPLETING THIS FORM I
Any acknowledgment completed in California must contain verbiage exactly as
DESCRIPTION OF THE ATTACHED DOCUMENT appears above in the notary section or a separate acknowledgment form must be
properly completed and attached to that document. The only exception is f ACV(E'r
� �Jq document is to be recorded outside of California.In such instances,any alternative 1
� acknowledgment verbiage as may be printed on such a document so long as the I
(Title or description of attached document)
verbiage does not require the notary to do something that is illegal for a notary in
��� �C\1 e .c` .5.,c\ �f1`lv t� g ,,c,�,� California (i.e. certifying the authorized capacity of the signer). Please check the
(Title or description of attached document continue ld.) document carefully for proper notarial wording and attach this form if required.
I
• State and County information must be the State and County where the document
Number of Pages Document Date signer(s)personally appeared before the notary public for acknowledgment. I
• Date of notarization must be the date that the signer(s)personally appeared which
must also be the same date the acknowledgment is completed. I
(Additional information) • The notary public must print his or her name as it appears within his or her
commission followed by a comma and then your title(notary public).
• Print the name(s) of document signer(s) who personally appear at the time of
I notarization.
' CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms(i.e.
❑ Individual(s) be/she/theyt is/afe)or circling the correct forms.Failure to correctly indicate this
information may lead to rejection of document recording.
❑ Corporate Officer • The notary seal impression must be clear and photographically reproducible.
Impression must not cover text or lines.If seal impression smudges,re-seal if a
(Title) sufficient area permits,otherwise complete a different acknowledgment form.
❑ Partner(s) • Signature of the notary public must match the signature on file with the office of
the county clerk. 1 i
iO Attorney-in-Fact Additional information is not required but could help to ensure this
❑ Trustee(s) acknowledgment is not misused or attached to a different document.
Indicate title or type of attached document,number of pages and date. I'
❑ Other Indicate the capacity claimed by the signer. If the claimed capacity is a
corporate officer,indicate the title(i.e.CEO,CFO,Secretary).
• Securely attach this document to the signed document
I
I • I
2008 Version CAPA v12.10.07 800-873-9865 www.NotaryClasses.com
I CALIFORNIA ALL-PURPOSEll
• CERTIFICATE OF ACKNOWLEDGMENT ii
ll
State of California
County of N C,V.,,•CO
On k.) - Z ZA\?)before me, ,k\r,,N. 3x,r\t✓ 5(1.1`_. ` IscAck4 1 Puk k\e . ,
(Here insert name and title of the officer)
personally appeared �',V e\\e , Q)\,w,i\e
who proved to me on the basis of satisfactory evidence to e the person(s)whose names)is/are subscribed to
the within instrument and acknowledged to me that he/sh /they executed the same in his/her/their authorized
capacity(ies), and that by his/her/their signature(s)on the instrument the person(s), or the entity upon behalf of
which the person(s) acted, executed the instrument.
O
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph
is true and correct.
J0/1NN TH0MAS0N
:O f i%. Commission• 1930682 _
ESS my hand and official seal. _ Notary Public-California
`1',*,f Santa Clara County
My Comm.Expires Mar 28_2015 !
� - �.^� '1 -�►•.-- (Notary Seal)
Signa
o No Public
. 4
`\
ADDITIONAL OPTIONAL INFORMATION
INSTRUCTIONS FOR COMPLETING THIS FORM
Any acknowledgment completed in California must contain verbiage exactly as !
DESCRIPTION OF THE ATTACHED DOCUMENT appears above in the notary section or a separate acknowledgment form must be
properly completed and attached to that document The only exception is f a
� PN\Q�� �`�a � document is to be recorded outside of California.In such instances,any alternative I
Tt\ 1 acknowledgment verbiage as may be printed on such a document so long as the
(Title or description of attached document) �7 verbiage does not require the notary to do something that is illegal for a notary in
M p(C�1P�MOY�� S �Cl ��ih��C \\��'W California (i.e. certifying the authorized capacity of the signer). Please check the
document carefully for proper notarial wording and attach this form if required.
("Title r(or description of attached document continued)
• State and County information must be the State and County where the document
Number of Pages Document Date signer(s)personally appeared before the notary public for acknowledgment.
• Date of notarization must be the date that the signer(s)personally appeared which
must also be the same date the acknowledgment is completed.
(Additional information) • The notary public must print his or her name as it appears within his or her
commission followed by a comma and then your title(notary public).
• Print the name(s) of document signer(s) who personally appear at the time of
I notarization.
• Indicate the correct singular or plural forms by crossing off incorrect forms(i.e. �!
CAPACITY CLAIMED BY THE SIGNERlie/she/theyr is/are)or circling the correct forms.Failure to correctly indicate this i
❑ Individual s
( ) information may lead to rejection of document recording.
❑ Corporate Officer • The notary seal impression must be clear and photographically reproducible.
Impression must not cover text or lines.If seal impression smudges,re-seal if a I
(Title) sufficient area permits,otherwise complete a different acknowledgment form.
❑ Partner(s) • Signature of the notary public must match the signature on file with the office of
the county clerk.
❑ Attorney-in-Fact Additional information is not required but could help to ensure this 1
❑ Trustee(s) acknowledgment is not misused or attached to a different document.
❑ Other Indicate title or type of attached document,number of pages and date.
Indicate the capacity claimed by the signer. If the claimed capacity is a
corporate officer,indicate the title(i.e.CEO,CFO,Secretary).
• Securely attach this document to the signed document
— --_
1
2008 Version CAPA v12.10.07 800-873-9865 www.NotaryClasses.com
JoAnna Tl ;on
OC4 A1A Office Ass
City of Campbell
Department of Public Works
U *'r .'- r 70 North First Street
• •
• e'1,'4 o Campbell,CA 95008
..•
Phone:(408)866-2701
a v• Fax:(408)376-0958
CHAR
E-Mail:Joannat@cityofcampbell.com
Transmittal
To: Julie Davey Date: October 25,2013
Address:
346. E.Campbell Ave.
Re: Agreement for Private Improvements in the Public Right of Way
O Urgent O For Review O Please Comment O Please Reply O For Information&Use
Please fmd enclosed your copy of the recorded Agreement for Private Improvements in the Public
Right of Way for your property located at 346 E.Campbell Ave.,Campbell,CA 95008
you,
f "
(s'
Jo_ . Tho r: on
Office
cc: Project File No. ENC2013-00145
J:\JoAnnaT\Templates\recorded doc return.DOC(Rev.03/08)
•
Print Form
ENCROACHMENT PERMIT Permit No EN C 2—D 13 -G&I 4}3
CITY OF CAMPBELL X-Ref.File
DEPT.OF PUBLIC WORKS (for working within the public �I� �'
70 North First Street right-of-way) Application Date
Campbell,CA 95008 7%`1 i/ 3 Application Expiration Date 1 2-1/DI
I
Ph. (408)866-2150 Issued APN L A\ - -b-1O.-Z.1
Fx. (408)376-0958 7f 2et 111-
Permit Expiration Date
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.: 3 4-L Ci - '2, iA__. ,"'c vk
Utility Trench Location:
B. Nature of Work: f N.S77sLL L� ,. 2 5p r)
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: J Telephone: 4 o T.
as � .y,
/J� 1-� rt s`t
Address: J+6 e , CG+s. � p _ N _3L,
1
E-Mail Address: ,4 �C ^ CiLA )'s ^ 24-HOUR EMERGENCY PHONE NUMBER: 50.E e.
�V n pp
Is this work being done the property own sat their own resilient C � r YES r NO
The Applicant/Permittee hereby agrees by affixing their signature to this permit to hold the City of Campbell,its officers,agents,and employees free,safe
and harmless from any claim or demand for damages resulting from the work covered by this permit.
The Applicant/Permittee hereby acknowledges that they have read and understand both the front and back of this permit, and they will inform their
contractor(s) of the information. Applicant is advised that upon issuance of this permit, property owner, or property owner's successors, shall be
responsible for any and all damages arising out of the condition of any private improvements in the public right-of-way.
Accepted:
3o'- G. .-"s4=4061 a_o` 13
(Applcant Permittee) (sign) Date
4C-4:1 Qt►r•bi �odMa•(1 So coo le.1--,
ractor) (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.
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 Notific- 'on Requirements: _ — ���
V 7. a • ,OX". • t. : - i Ihc''' e 5 e elU S �5).-..___...(..L
SEE PUBLIC WORKS FEE SCHEDULE FOR CURRENT FEES AMOUN RECEIPT NO.
PERMIT APPLICATION FEE $ 3 7 7 '2'.-s1 7-C S
PLAN CHECK DEPOSIT $
SECURITY FOR FAITHFUL PERFORMANCE/LABOR&MATERIALS $
CONSTRUCTION CASH DEPOSIT $
PLAN CHECK&INSPECTION FEE $ 3 7 7 2 '.2- S/
EMERGENCY PERMIT FEE $
APPROVED FOR ISSUANCE 7(2-1/13
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. Submit project schedule 10(ten)days prior to proposed start of work.Special provisions may be required for work within City facilities and
downtown Campbell.
5. 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.
6. Maintain safe pedestrian and vehicular crossings and free access to private driveways,bus stops,fire hydrants,and water valves.
7. 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.
8. 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.
9. 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.
10. Sawcut for all PCC or AC removals. All PCC removals shall be to the nearest scoremark and shall be doweled to existing improvements.
11. 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.
12. 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.
13. Compaction testing of subgrade,base rock,and asphalt concrete by Permittee is required unless otherwise stated by the City Engineer.
14. 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.
15. 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.
16. 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.
17. This permit does not release the Permittee from any liabilities contained in other agreements or contracts with the City and any other public agency.
18. This permit is not transferable.Work must be performed by the Permittee or his designated agent or contractor as specified thereon.
19. 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.
20. Pursuant to Chapter 14.02 of the Campbell Municipal Code,applicant shall not cause to be discharged any material into the municipal storm drain
system other than storm water. Applicant shall adhere to the BEST MANAGEMENT PRACTICES established by the Santa Clara Valley Urban Runoff
Pollution Prevention Program.
21. 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.
22. 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.
Applicant Date:
vy_v-„t, _
Contractor (Print Name) Date:
J:\FORMS\Templates\Encroachment Permits\Encroachment Permit STATIC form2.pdf
Rev.03/13
•
PUBLIC WORKS DEPARTMENT LAND DEVELOPMENT
Effective July 1,2013
TO: City Clerk PUBLIC WORKS FILE NO. �'�1 2019, -0014S.
PROPERTY ADDRESS
Please collect&receipt for the following monies.
ACCT. I ITEM ( AMOUNT
LAND DEVELOPMENT
4722 Encroachment Permit Application Fee
Non-Utility Encroachment Permit Major≥$10,000 $377.00 °71
Minor Encroachment Permit<sio,000 $215.00
Initial R-1 Permit N/C
Subsequent R-1 Permits within Two Year Period $209.00
Street Tree Planting/Removal N/C
2203 ($500 per Tree Planting Deposit Required) $500.00/tree
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 $265.00
Site< 10,000 s.f. $795.00
Site z 10,000 s.f. <0.5 Acre $1,060.00
Site z 0.5 Acre $1,590.00
4722 NPDES Review(C3 Requirements)
For projects not required to submit numeric sizing $153.00
For projects required to submit numeric sizing
Impervious Area 10,000 Sq. Ft to 1 Acre $663.00
Impervious Area 1 Acre or more $867.00
Plan Check&Inspection Fee(Non-Utility) -3 77
4722 Engr. Est. up to$250,000 14%of Engineer's Estimate
**2203 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)
2203 Faithful Performance Security(FPS) 100%of ENGR. EST.*
2203 Labor and Materials Security 100%of ENGR. EST.*
4721 Storm Drainage Area Fee Per Acre R-1 $2,120.00
(Multi-Res$2,385.00)
(All Other$2,650.00)
4722 Parcel Map(4 Lots or Less) $3,775.00+$82/lot
4722 Final Tract Map(5 or More Lots) $4,590.00+$112/lot
2203 Monumentation Security 100%of ENGR. EST.
4920 Parkland Dedication Fee(75%/25% Due Upon Cert. of Occupancy)
4722 Lot Line Adjustment(Includes Certificate of Compliance) $1,785.00
4722 Vacation of Public Streets&Easements $2,386.00
4722 Certificate of Compliance $1,764.00
4722 Certificate of Correction $530.00
4722 Appeal Filing Fee $200.00
4722 Notary Fee(per signature) $10.00
4722 Assessment Segregation or Reapportionment
First Split $846.00
Each Additional Lot $265.00
511.7424 Postage
MISCELLANEOUS
I Other(Please Specify)
*Engineer's Estimate shall be as approved by the City Engineer and shall include all items of work. -7
**Actual Cost Plus 20%Overhead(Non-Interest bearing deposit) TOTAL $
NAME OF APPLICANT \'‘ e " " 1
NAME OF PAYOR J V�rQ PHONE 4-c 25O 14-4544'
_ ADDRESS 31-4ilza e.. Cgt,ti p\2 V C Pr , ZIP aLSOQ%'
•
FOR RECEIVED BY
CITY CLERK -�
ONLY Date Receipt# G`� ill rt
i
d) 1 l '� " �'�•n d � r
'Date%fnitials
J:\FORMS\Tempraawamhwrwrewac.,q Farm land Development 13.10
CITY OF CAMPBELL
RECVD BY: JAZ 01000249285
PRYOR: JULIE DAVEY
TODAY'S DATE: 07;29/13
REGISTER DATE: 07/29/13 TIME: 10:59
DESCRIPTION AMOUNT
ENGR & SUBDIV FILING F $377.00
CUST ID: 346 E CAMPBELL 13-145
ENGR & SUBDIV FILING F $377.00
CUST ID: 346 E CAMPBELL 13-145
TOTAL DUE: $754.00
CHECK PAID: $754.00
CHECK NO: 3122
TENDERED: $754.00
CHANGE: 3.00
346 E. Campbell Avenue,
Campbell, CA. 95008 146
r.
Enc: 2013-00145
Not to scale:
346
■ Water main
,p7)
• . •
PGE Main
Sewer Backflow E. Campbell
valve
West Valley i ,,
5401
San}tatIon.Dis Oct wer Connection Permit No. `_
C �/ al‘, Issue Date: , I, t ; By: r; —
OFFICE HOURS & CONTACTS: FEES: • BACKFLOW PREVENTION:
7:a0 a.m. to 4:30 p.m. Monday thru Friday Connection $
100 E. Sunnyoaks Ave., Campbell, CA 95008 Capacity ► i . , ' i Field check required
• Phone: (408) 378-2407 Processing r. Basement
Service Advance
• Information Services Department , , , Check valve required: Yes .< No __
LOCATION:
' APN I '
Sewer Map Book I' Page 1 ,
BUILDING SEWER CONNECTIONS:
, Tract Lot Total Due: $ I • ' , Total number of connections to this
Project Assmt property: [.
Address ,. J' . Paid by Check No: _ i I,...
1. Lateral ID No. ," is located
Hillside: Yes No
Jurisdiction feet of property
line, feet from main sewer and
BUILDING TYPE: INSTRUCTIONS: feet deep.
Single Family • Permit is invalid if not connected within 12
Condo/Town House months of issue. Connection to Main Sewer feet
Multiple Dwelling Units • Do not connect until the main sewer is accepted US from DS MH ,.: , , I
' Industrial by the District. US MH ..
Commercial. • Obtain a building or plumbing permit from the
• ''� Jurisdiction listed above. Pipe Type
REMARKS; faylgriii.LL' . MVO +w
_ � U ! ,• Street encroachment Permit is required from
L 4TH eA ft. C List any additional connections on
reverse side of this form.
• Keep 3' radius around cleanout clear of
OLD PERMIT No. Sub No. vegetation or obstruction.
Original—Applicant Pink—Accounting Yellow—City/County Bldg. Inspector Y Yp Card — District File