92-159
CITY OF CAMPBELL
DEPT. .JF PUBLIC WORKS
7C North First st.
campbell, CA 95008
(408) 866-2150
OWNER OCCUPIED R-l
ENCROACHMENT PERMI'l'
(for workinq in the
public riqht-of-vay)
($2,500 KAXIMOH VALUE OF WORK)
APPLICATION - Application is hereby made for a Public Works Permit in accordance with campbell
Municipal Code, Section 11.04. (Application expires in 6 months if permit not pulled)
JlbO R /Dnecc-r' DR-
1) 12 1(.JELu4-( ,4p PI2.D~C!...H
Work address
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B.
Nature of work:
C. Attach three (3) copies of a drawinq showinq the location, extent and dimensions of the work. The
drawinq shall show the relation of the propo.ed work to .xistine; iIlprov_enta. When approved by
the City Enqineer, .aid drawinq become. a part of this permit.
NaJlle of Applicant
Telephone:
3 '77 . '2.:!> 7 Y
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D.
The General Conditions for all permits are listed on the rever.e side.
this permit are listed below. Failure to abide by the.e conditions and
job shut-down and/or forfeiture of Faithful Performance Surety.
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Special Provisions for
provi.ions may result in
Address
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Complete and attach Workers' Compensation and COntractor Information forma.
The Applicant/Permittee hereby aqrees by affixinq their siqnature to this permit to hold the City of
Campbell, its officers, aqents and _ployees free, .afe and harmle.. from any claim or demand for
damaqes resultinq from the work covered by this permit.
The Applicant/permittee hereby acknowledqes that they are the owners and occupant. of the address
listed above, or are providinq services for the owner occupant.
that they have read and understand both the front and back
contractor(s) of the information.
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The Appii~;~t/p~~ifue--
of ~is permit, and that
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~rmittee)
S-""t...
Date
,
ACCI:PTl.
Nons: ALL WORK SHALL CONFORM WITH THE ATTACHED, APPROVED PIANS AND ALL APPLICABLE CAMPBELL STANDARD
DETAILS AND CONDIT~ONS.
THE CONTRACTOR MUST HAVE THIS PERMIT AND APPROVED PIANS AND MUST ARRANGE TO MEET WITH THE P.W. INSPECTOR
ON THE SIn AT LEAST TWO DAYS BEFORE STARTING WORK.
NOTICE MUST BE GIVEN TO THE P.W. INSPECTOR AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK.
SPECIAL PROVISIONS
5URETY FOR FAITHFUL PERFORMANCE
(loot OF ENG. EST.)
AMOUNT
$ j2u'),-C{!j
RECEIPT 11
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\PPROVED FOR ISSUANCE
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for City nqineer
Permit expires 6 months after date of issuance.
0' '- (-97
Date
.. PW PERMIT
~evised 10/91
(SEE OTHER SIDE)
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C or.t,acl:), muJt have these plans
on the job site du,ing cOMt,ucfion.
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CITY OF CAMPBELL
BANK OF AMERICA
CAMPBELL OFFICE
125 E. CAMPBELL AVE.
CAMPBELL, CA. 95008
11-35
1210
No.
,~.,;..; ~~ 7 C
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70 NORTH FIRST STREET
CAMPBELL, CALIFORNIA 95008
DATE
06/02/1992
CHECK NO,
30678
AMOUNT
$1,200.00
ONE THOUSAND TWO HUNDRED i\ND 00/100 DOLLARS
SIGNATURE
PAY TO
THE
ORDER
OF
I. ALNE
1160 RIDGELEY
C^MPBELL CA 95008
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1110 3 0 b ? 8 III I: l. 2 l. 0 0 0 3 5 8 I: 0 ~ l. ~ 3 III 8 0 2 0 0 III
VENDC)I~ _ 002
T. ALNE
06/02/19g2
C 11 e L Ie Ii
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DETAIL
I PURCHASE ORDER" I INVOICE #
DESCRIPTION
AMOUNT
001.00.905.0000.4662
REFUND^BLE DEPOSIT
1, ,:00_
TOTl\L
1 , .:: 0 0 '
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CITY OF CAMPBELL
70 NORTH FIRST STREET
C AMP 8 ELL, C A L I FOR N I A 9 5 0 0 8
(408) 866-2100
FAX # (408) 379-2572
Department:
Public Works
May 22, 1992
Mr. I. Alne
1160 Ridgeley Drive
Campbell, CA 95008
SUBJECT: FINAL INSPECTION AND ACCEPTANCE
PERMIT NO.: 92-159
LOCATION: 1160 RIDGELEY
Dear Mr. Alne:
We have made a final inspection of subject Public Works
construction and find it acceptable and in conformance with City
standards. Accordingly, we will recommend the acceptance of the
work to the City Engineer.
Enclosed is your faithful performance deposit of $1,200.00. Please
feel free to call me if you have any questions.
:J:l~4
Sal Duckworth-Lanzo
Senior civil Engineer
SDL/bg (wp)
f:92-159
REFUNDABLE DEPOSIT
CHECK REQUEST
TO: SANOY TERPKO
ACCOUNTS RECEIVABLE
Please issue check payable to: I. Alne
Address:
Line 1: 1160 Ridqelev
Line 2:
City: Campbell
State: CA
Zip: 95008
Description: Ref Deposit/Permit No:
Exact Amount Payable: $1,200.00
Account Number: 001.00.905.4662
92-159 INTEREST EARNED
001.05.540.4448
LOCATION:
1160 Ridqeley
DATE AND NO. OF RECEIPT:
5/4/92
#41415
PURPOSE:
Return of faithful performance (cash) deoosit
Requested by: H. Imokawa Title: P. W. Insoector Date: 5/11/92
A~ -
Approved by: J. BOlliejt\]~~itle: City Enqr Date:
v
Verified by: Title: Date:
Please put Permit No 92-159 on check.Thanks
~
SPECIAL INSTRUCTIONS FOR HANDLING CHECK:
Mail in attached envelope
Mail as is
Return to:
Public Works
(Department)
Sal
(Name)
Other:
Rev 11/21/91
CI TY (J' CAIfl8EU., CITY ENGIt.tER I S a::NSTRl.OICJ4 _ .HATE PERMIT t().
,-
Ad:t'ess / <--< ,. ~ (, 11( date .'
Strface Calstru:tim
Clearil"9 & GnJ:bil"9 luJp &In EstillBte =$
SaI<<:ut Calcrete " IF Gl *$4.50 =$ ,-
'-.
Ccrcrete REIIrN8l SF Gl *$3.50 =$
Q.rb & BJtter REIIrN8l IF Gl "SS .50 =$
Inlot Drain with Pipe !:AGl $600.00 =$
Q.rb & BJtter IF Gl $16.00 =$
Sidewalk SFGl $4.50 =$
Driveway ~ SFGl $6.00 =$
Ha-dicap Ra1p !:AGl $475.00 =$
Extru::led Q.rb EAGl 10.00 =$
Barricade IF Gl S60.oo =$
Street Excavaticn SFx (SO.12) x ") =$
/l{; PlMm!nt SF x (0.35) x ") =$
Adjl.6t Mcrhole to Grade !:Alil S425 .00 =$
Adjust Hal:hole to Grade !:AGl S325 .00 =$
Mcnment Box WIMau1Ent EAGl $700.00 =$
Street Tree (1S-gallm) !:Alil S350.oo =$
PlMm!nt Stripil"9 ($100nin) IF Gl $ .75 =$
PlMm!nt legerds ($100nin) EAGl $50.00 =$
Step, Street NaIe other SilJl EAGl $140.00 =$
PlMm!nt Marker EAGl $17.00 =$
PlMm!nt Key 0Jt IF lil $10.00 =$
=$
=$
Strface &btotal liS" =$
Adjust for size: ''5'' > $1oo,(XX),slbtract 10% =$
TO:
City Clerk
PUBLIC WORKS FILE NO.
c.; z - /. J- q
Please collect & receipt
for the fOllowing monies:
ACCT. ITEM AMOUNT RECEIPT NO.
35-3396
3372
3521
3521
Project Revenue (specify project)
Public Works Encroachment Permit Fees:
Application Fee
Plan Check Deposit
Faithful Performance (Cash) Deposit
$
3521
Other Cash Deposit (specify)
($105)
($500)
(100% of)
(ENGR. EST)
(4%of FPB)
($500 min.)
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I Zc:JCJ ()C L/ / t-f /9
3372 Plan Check & Inspection Fee ($0 - $100,000 10%;
$100,000 - $500,0009%; $500,000 and above 7%; $100 min,)
3373 Project Plans & Specifications
3373 General Conditions, Standard Provisions & Details ($10 or $1 /page)
3373 "No Parking" signs ($1/ea. or $25/100)
3373 Copies of Engineering Maps & Plans ($,50/sq.ft)
3372 Final Parcel Map Filing Fee ($475 + $21/ per lot)
3372 Final Tract Map Filing Fee ($525 + $21/ per lot)
3372 Lot Line Adjustment Fee/Certificate of Compliance ($420)
3372 Vacation of Public Streets and Easements ($500)
3372 Assessment Segregation or Reapportionment
First Split ($500)
Each Additional Lot ($150)
3370 Storm Drainage Area Fee per Acre (R-1, $1,875;
Multi-Res" $2,060; all other, $2,250)
3380 Public Works Special Projects
3395 Park Dedication In-lieu Fee
3510 Postage
TOTAL
$
/.200,00
,
NAME OF APPLICANT / t .t} L A) c
/1(.00
FOR
CITY CLERK
ONLY
f2- lOG l=:L.C-Y V Ie
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RECEIV,:? BY ~
DATE _~ -f- - 9~
PHONE 577, Z-S7Y
ZIP '7 ~ Lx.":) 8
ADDRESS