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ENC2000-00108
CITY OF CAMPBELL PLT~LIC WORKS DEPT. 70 N. Fire St. Campbell, CA 9500S (~0S)S66-2150 FAX (40S)376-09SS OWNER OCCUPn~n R-1 NO FEE ENCROAC'HMENT PERMTF (for working within the public right-of-way) ($$,000 maximum value of work) X-P~f. File Application Date Permit APPLICATION - Application is hereby made for a Public Works Permit in accordance with Campbell Municipal Code, Section ll.0a. (Application expires in 6 months if the permit h not issued.) B. Nature ofWork- te~ vt.gc.~ vO ~ s u c- ,.o e~ v, /q p c ~2,:3,,s c.<r C. Attach three (3) copies of a drawing showing the location, extent and dimensions of the work. The drawing shall show the relation of the proposed work to existing improvements. When approved by the City Engineer, said drawing becomes a part of this permit. D. All work shall conform to the City of Campbell Standard Specifications and Details for Public Works Construction; the General Permit Conditions listed on the reverse side; and tbe Special Provisions for this permit, lismd below. Failure to abide by these conditions and provisions may result in job shut-down and/or forfeiture of Faltlfful Performance securities. NAME OF APPLICANT A~D~SS i ~ '-7 ~3 (Print Name) &- t b6ec.c-w D TELEPHONE ~'~ '~ '~ -Oc~ '.2. '"7 The Applicant hereby confirms that this work is being done by the property owner/applicant at their own residence. The Applicant hereby agrees by affixing their signature to t/tis permit to hold the Cig of Campbell, its officers, agents and employees free, safe and harmless from any claim or demand for damages resulting from the work covered by ~ permit. The Applicant hereby acknowledges that they have read and understand both the front and ba~k of this permit, and that they will in£orm their contr~r(s) o£ the information. //~qA(~ ApplicantfPermittee (Sign) /Dam- NOTES: ALL WORK SHALL CONFORM VeTrH TIlE ATTACHED, APPROVED PLANS AND ALL APPLICABLE CAMPBELL STANDARD DETAILS AND CONDITIONS. THE CONTRACTOR MUST HAVE THIS PERMIT AND APPROVED PLANS AND MUST ARRANGE TO MEET WT'FH THE PUBLIC WORKS INSPECTOR AT THE SITE AT LEAST TWO DAYS BEFORE STARTING WORK. NOTICE MUST BE GIVEN TO PUBLIC WORKS AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK. PER SECTION 4215 OF THE GOVERNMENT CODE THIS PERMIT IS NOT VALID FOR EXCAVATIONS UNTIL UNDERGROL'ND SERVICE ALERT ('USA) HAS BEEN NOTIFIED AND THE INQUIRY IDENTIFICATION NUMBER. (TICKET NO.) HAS BEEN ENTERED HEREON. USA PHONE: 1400-227-2600. TICKET NO. SPECIAL PROVISIONS /,~-3. ~. u~ .r,..,~3 a.g~ ~-/',4c. ~ e.;~'~c d-is a.4? ,4s ,,,,,z&,/,',, /,6. ~,~j,/ ~ ~ ~ ~./~ ,l/ifa,'/$ , / ! SECURITY FOR FAITHFUL PEP/;QRMANCE (100% OF ENG. EST.) APPROVED FOR ISSUANCE,.. -,~/ for ~tity Engineer Permit Expires 6 Months After the Date of Issuance : \forms ~r I permit/rev. 6/'96 ( SEE OTHER SIDE) AMOUNT I~CEH~F NO. Date GENERAL PERMIT CONDITIONS A SECURITY m insure FAITHFUL PERFO~C~ a~l completion of u~ work is required. This is refundable upon completion of the work and wilton acceptance by the City. A ONE-YEAR MAINTENANCE PERIOD for all work is required. Such period will .begin .on the date of wriuen acceptance by' the City. It is the applicant's responsibility to remove ,nd replace unacceptable improvements within the one-year maintenance period. REFUND or cancellation of the Faithful Performance security will be initiated by the wriuen accep~ce of the work by the City. The Perminee 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 Perminee. MAINTAIN safe pedestrian and vehicular crossings and free access to private driveways, fire hydra~ts and wate~- valves. 6. REPLACE IN KIND any damaged or removed existing improvements, including planting. .7. SAWCUT for all PCC or AC removals. Prior to concrete sawcutting or washing, the Contractor ~hal! place filter fabric material in the flow line of the gutter to retain all consmiction debris. All construction debris shall be wet vacuumed, broom swept, picked up and disposed of by the Contractor. Concrete sawcut debris sba!l not be swept or water hosed into the guuer and into the storm drain system. go Adequate signing and lighted BARRICADING is required on the job site. Failure to provide such signing and barricading as ~pecified by the City Engineer may result in the City's renting such signing and barricades and charging the cost to the permittee. The Contractor or Permittee will have a SUPERVISORY REPKF~ENTATIV~ available for contact on the project at ail ~nes during construction. I0. This permit shall be kept at the site of work and must be shown to any a~uthorized representative of the City of Campbell or any law enforcement officer upon demand. I1. No STORAGE of materials or equipment will be allowed near the edge of pavement, withi~ the traveled way, or within the shoulderline which would create a hazardous condition to the public. I2. 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 Perminee of any obligation to obtain any other permit required by law. 13. Ail necessary ROAD REPAIRS resulting from the permit work shall be made in accordance with City Standards and Specifications at the sole expense of the Permittee. 14. This permit does NOT RELEASE the Permi~e from any liabilities contained in other agreements or contracts with the City and any 'other public agency. 15. This permit is NOT TRANSFERRABLE. Work must be performed by the Permittee or his designated agent or con~ractor as specified thereon. I6. 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. 17. Call back (call out) due to emergencies regarding this permit, shall be at the current overtime rate with a Wee (3) hour minimum charge per occurrence. Applicant shall be responsible for ensuring that all those providing services under the applicant are aware of and understand all of t~ve condition. / APPROVED Public FO~CONSTRUCTION. C" '~i'~heii on the job site during cons"truction. CITY OF CAMPBELL Public ~/'orks Department December 5, 2000 Gloria and David Calkins ! 178 Ridgeley Drive Campbell, CA 95008 SUBJECT: PERMIT NO. ENC2000-00108 LOCATION: 1178 Ridgeley Drive FINAL INSPECTION AND ACCEPTANCE Dear Ms. Calkins: 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 acceptance 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. Your Construction Cash Deposit of $1,500.00, plus any interest due, is now being processed and will be sent to you under separate cover. If you have any questions, please call me at (408) 866-2168. Since~c., (~/ Alan Horn Public Works Inspector cc: Suspense- ii months Permit #ENC2000-00108 Inspector File J:\FORMS\FINALFRM99(WORD) 70 North First Street · Campbell, California 95008-1423 · T£L 408.866.2 150 · Fxx 408.376.0958 · TDD 408.866.2790 City of Campbell - Refundable Deposit Check Request To: Finance Director Check Payable To: Address - Line 1: Line 2: City: Description: Total Payable: Account Number: Account Number: Account Number: (Finance Dept only) Purpose: Gloria Calkins 1178 Ridgeley Drive Campbell State: CA 95008 Refund Deposit $t ,500.00 101.2203 101.540.7448 Interest Earned Refund Construction Cash Deposit (Exac~ Amount) Amount: $1,500.00 Amount: Amount: (Finance Dept only) Voucher #: Receipt #: _ 132272 Requested by:~~f- ALan Ham Approved by: ~d Mi~h~l~- Q-u]nn~y Finance Dept Only: Verified by: Approved by: Title: Title: Title: Title: Permit #: ENC2000-00t08 Date: 07114/2000 PW Inspector Date: City Engineer Date: Accounting Clerk II Date: Accountant Date: Special ]:nstructions For Handling 'Check Mail As Is: Return To: X Mail in Attached Envelope: Interim Check: Needed By: (Name) (Department) 12/0512000 12/0512000 Other: f/n: Forms/excel/chkreq Revised 02/00 ; WORKS DEPARTMENT RECEIPT Effective August 1, 1999 To: C,erk PU ,C 435.535.4~1 [ ~oj~t Revenue {s~ify pro~t) ENCROAC~NT P~ff 4~2 Appli~tion F~ Non-UtiliW Emr~chment Permit {$236.~) Minor E~r~chment Permit < $5,~ ($50.~) R-1 Fi~t Permit ~No F~} Sub~quent Pemi~Yr ~$105} Utility E~roachment Pe~it Ar~rial/Coll~tor S~t ($341.25) R~idential S~a~er Ar~ ($236.~) ~ Plan Ch<k Depmit - 2 % of ENGR. EST. ($5~ rain} ~ ~203 ) Faithful Performa~e S~urity (FPS} (1~% of ENGR.EST.) 2203 ~r and Materials S~uri~ (1~ of ENGR. ~T.) 2203 Monumen~tion S~uri~ ~1~ of ENGR.~T.) 2203 C~h De.sit ~4~ of ENGR.~T,)($5~ mi~SlO~ 2203 ~bor a~ Material S~uri~ (1~ of ENGR. Plan Ch~k & [ns~don F~ (Non-Utili~) 4~2 Engr,Est. < $250~ ~12~ of ENGR. EST.) ** 2203 Engr.~t.>$~0~ (De.it 8~ of ENGR. ~T,/$30~ min.)** 4~2 Utili~ < $1~ (8%) Minimum Ch~e P~r ~ation Condui~/Pi~li~ up to 5~ F~t ($1.75fft) A~ve 5~ Lin~ F~t ($1.15/~) Manholes/Vaul~/E~. ($110.25/es) Pole Se~Removal ($110.25/~) St~et Tree Pt~ting/Remowl ($1 ~ 2203 Utility ~ Sl~ Actual Cost + 20~ 4~2 S~reet Tree Planting/Removal Permit ($110.25) 47~ Pro,ecl Pta~ & S~ifi~tion~ Pro~t No. 47~ S~nd~d S~ificatio~ & De.ils ($1/Pg $12.50~k~ 47~ Copies o~ Engineering Maps & Aerial Plot 24' x 36' Aerial Prim 8 1/2" x 11' ($15~ Maps and P~a~ 24" x 36" ($5) 4~2 Penalties: Failure m restore public improvemen~ ($1~/Calend~ Day) ~M~ C~e S~.~ 134.mm ~722 Penalties: Failure to co~t u~afe conditio~ ($1~/Cale~ Day) LA~ DE~LOPMENT 4~2 ~t Lin~ Adjustment 4~2[ P~cel Map (4 ~ or ~s~) ($I~125 + $25/~t) 4722[ Fi~l Tr~ Map (5 or More ~) ($1~450 + $25/~t) 4~2 Ce~ifi~te o~ Complia~e ($525) 4~2 Cenifica~ of Co~ection ($315) ~2 No~y F~ (~r signature) 4~2 Va~tion of Public S~ & ~men~ ($577.50) 4~2 Assessment Segregation or R~rtionment Fi~t Split ($5~.50~ ~ch Additio~l ~t ($178.50~ ~1 Storm D~inage Ar~ F~ Per Acre (R-I, (Multi-Rea~ $2~250} (All Other, 4~0 Parkland Dedication F~ (75~/25~ Due U~n Cch. of ~upancy) 4965 Posmge ~C 4~8[ lmers~tion Turn Counm (Tw~Hour CounO 4~8 Intersection Turn Counm (a.m. or p.m. ~aks) ($131.25) 4728 Traffic Flow Map (Daily T~ffic Volume) ($28.35) 4~8 Camp~ll Traffic M~el (Full Scope Assessment) ($2,362.50) 4~8 Campbell Traffic M~el (Reduc~ Sc~ Assessment) 4271 Truck Permi~ ($36.75/~ip) ~728 No P~king Signs ($1/e~h or $25/1~) O~ ~oT~ S //~ ~~ ~f ~ ZIP *'Actual Cos~ Plus 20~ Overbid (Non-[~ ~ing de~siQ )% Overhead (Non-I~ ~ ~eanng oep _ ~ ~ C1TY CLERK IJ~J~g-'~EI~ ................................................................................................. i .................................................................... i:::::::::!'::] [: .......................................................... :::::::::::::::::::::::::::::::::::: ::: :::::::::::::::::::::::::::::::::::::::::::::::::::::: ::::: :::::::::~:~::f~:: / ~ ~:~i~:::: :~:~: ~:::: ::::::-:::~::::::~: ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: h:WormsX~ffm4.xls rev. 7/13/~ (rap) T©~A?S ~ATE~ 07/14/00 REGISTER ~ATE~ 07/i~/00 ~ESCRiF'T!ON CHECK TEN~ESE~: 07/!4/2000 3:~,,.46 PM PAYMENT HISTORY FOR CASE ENC2000-00108 Fee Type: FPSD Description: Faithful Perf. Security/Dep Date Paid Receip~ Check~ Recorded By 07/14/2000 132272 4434 JD Total Paid: Totals for ENC2000-00108: $1,500.00 Paid: Fees: $1,500.00 Due: Total Fee: Amount Paid $1,500.00 $1,500.00 Due: $1,500.00 $0.00 $0.00 Page 1 of 1