92-162
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lU1Ud _ 7 / q ~ Applicatlcm Dab 5' 1:,/'7 L-
Perait u.. /iIl 12 _. Appllcat:1cm upiru 1h 6 _.
APPLICA'1'10R - _lication b bereby _de tor a Pablio worD "'~t iD ~W~ll
llUnicipal COde, Sect:ion 11.06. (Application ap~na ill 6 IIOftt:bII if pera1t not: Ill.... I: I V" 0
A. Work addnae or tract: t-LJfY( AuVJ~ ~ -u b . {..AMlP~' Mtl' . (J
Utility trench location ~ ' r :> l:;j~l
(\ iubli w
B. .atun of worJu (fJ...5~1AU- "z<?:!;. M. (;l:. ~~lU7it....J~ <-:hN1::IL. c orlcs/Enain_pi"",
C. Attach fiv. (5) oopi.. of a drawift9 laboviftCJ t:be location, aunt: and d1Muicna of the work
'!'he drawinq eball Iabov th. relaUon of the propoeed work t:o exiat1Dq aurtaca and unc1.qround
aprov_enu. When .pproved by th. City Bnqineer, Aid drawineJ be~ a part of thb perait.
DEP'l'. ur ~UG...... ~
70 Horth "irat St.
ClUIPbell, CI. '500'
(608) 866-2150
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D. '!'h. can.r.l COnditione tor all peralta .re liat:ed on the ~.ra. aide. Special Pravieione for
thi. permit are li.ted belovo "ailure to abide by t:beee conditione and proviaion. ..y re.ult
in job ehut-dovn and/or forfeiture of Faithful Perforaanca Benda and CUb apo.ita. (S..
Gen.ral COndi Ucna 1 &lid 2).
B. An application fe. IlUt aeeo.pany thb appllcat:1cm. '1'Il1a 18 non-raflmdab1..
::.::~f~~~ I~~~ __.CiIt.><b}~1~-Z4e1.
Ie thb work being don. by th. property owner at their own naidence? --::t.. ~
co.plet. and .ttach Worker.' COapena.ticn and contractor Inforaation foraa.
Th. Applicant/Permitte. b.raby aqr... by aftixing their eiqnature t:o thia perait to bold the City at
Campbell, it. otticere, agent. and employ... tr.e, .ate and baral... fro. any olat. or deaand tor
damagee reaulting fro. the work covered by tbi. ~t.
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NOTES: ALL WORK SHALL CONFORM WITH 'l'HB A'l"l'ACBBD, APPROVZD PI.AHS AlII) ALL APPLICABLB CAXPULL
STANDARD DRAWINGS AND CONDITIONS.
THE CONTRACTOR MOST HAVE THIS PERMIT AND APPROVED PLUS UD IIIJ8'1' IIDT WIm ':JIB P. W. IJIBPBC'1'CR ON
THE SITE AT Ll:AST TWO DAYS Ul'ORB STARTIHG WORJt.
ROTICE MOST BI GIVIH 'l'O PUBLIC WORD AT LDS'1' 24 IIOOJt8 BUOD ItU'l'AIlTDG Aft 1IORI:.
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SPECIAL PROVISIONS
_1.
Stre.t Iaball not be open cut for undar;roand 1ut:allat1ona. IUni.aua cut:a _y be alloved
for connect:10na or exploration bol... Sucb cut:a mlet: be eaeciticallv aaaroved bv the
Ins"eetor.
Pav...nt ..y be c:at: for undervround 1ut:allatione and IlUt be rut:ored in acccrdanca with
the Utility Trench R..t:oraUon Standard onwinq.
Work to be ataked by a licenaed Land Surveyor or Civil Bnv1neer &ftd two (2) copi.. of th.
cut abeet. aent to th. Public Work Deptartaent before atart:ineJ work.
'!'he boura of work are 11aited t:o wuid. the boar8 of 7-1 .... and 3-' p... for any work
aftecting a traffic lan..
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S'l'AHIDIlD
AMOOJI'l'
RlitEIVwO
~ APPLIc:eImr ra
MAY 0 5 1992
PLAR CIIBCI: DBPOSft poo.oo
BOND POll PAITBrUL ~WorkIJEngineer~'l~ot 01' aa. BlI'l'.)
UCEIPT NO.
~
810'00
. /05-.00
-
.
.
. 500.00
. 105-,00
CUB DBPOSft
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~/7/70
oat.
(4t 01' .-D, $SOO UIf)
PLAN CBBCK , IKSPBCTIOR ra ('0-$100,000 lot,
$100,000 - $500,000 .',~o~,ooo aDd abave 7', $100 KXR)
APPROVED FOR ISSUANCE m, '\J2.., ~ ~'.
tor city Enqin.er
t: PWPERMIT
R..vi...d 4 "1
TO:
City Clerk
PUBLIC WORKS FILE NO.
Please collect & receipt
for the following monies:
9~-/~
35-3396
ACCT. ITEM AMOUNT RECEIPT NO.
3372
3521
3521
3521
Project Revenue (specify project)
Public Works Encroachment Permit Fees:
Application Fee
Plan Check Deposit
Faithful Performance (Cash) Deposit
($105)
($500)
(100% of)
(ENGR. EST)
(4%of FPB)
($500 min.)
Other Cash Deposit (specify)
3372
3373
3373
3373
3373
3372
3372
3372
3372
3372
3370
3380
3395
3510
Plan Check & Inspection Fee ($0 - $100,000 10%; ,_
$100,000 - $500,0009%; $500,000 and above 7%; $~:'min.)
Project Plans & Specifications
General Conditions, Standard Provisions & Details ($10 or $1 /page)
"No Parking" signs ($1/ea. or $25/100)
Copies of Engineering Maps & Plans ($.50/sq.ft.)
Final Parcel Map Filing Fee ($475 + $21/ per lot)
Final Tract Map Filing Fee ($525 + $21/ per lot)
Lot Line Adjustment Fee/Certificate of Compliance ($420)
Vacation of Public Streets and Easements ($500)
Assessment Segregation or Reapportionment
First Split ($500)
Each Additional Lot ($150)
Storm Drainage Area Fee per Acre (R-1, $1,875;
Multi-Res., $2,060; all other, $2,250)
Public Works Special Projects
Park Dedication In-lieu Fee
Postage
$
/('}S /)0 t+1&;").1
SOD 00 Y-/0;;2;
/ as-. on lflhJ.B
M6LLO
PI PEL/iV€S
(rot. LV U5 i~ )
$ 7/0.oP
~7 7-6/03
TOTAL
PHONE
ZIP
RECEIVED BY
DATE
~
5 --16 -1d-..
NAME OF APPLICANT
ADDRESS
FOR
CITY CLERK
ONLY
(
I
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
August 25, 1992
Mello Pipelines
260 McGlincey Lane
Campbell, CA 95008
SUBJECT: FINAL INSPECTION
PERMIT NO.: 92-162
LOCATION: 1189 AUDREY
Dear Mr. Mello:
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.
Your cash deposit of $500.00 plus interest was mailed to you on August 4, 1992. The
check number is 32239. Please feel free to call me at (408) 866-2165 if you have any
questions.
Sincerely, () I
~~~
Henry Imokawa
Public Works Inspector
ft&
HIjMQ:lr
cc: File (92-162)
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WEST VALLEY SANITATION DISTRICT
SANTA CLARA COUNTY
100 E. Sunnyoaks Ave., Campbell, CA 95008
(408) 378-2407
31060
B/bl
LOCATI N:
"A.P.N.
Sewer Location: Bk.
Tract
Proj.
Address :
Jurisdictio
BU LDING TYPE:
Single Family
_ Condominium/Town Houses
_ Multiple Dwelling
Number of Units
_ Commercial
_ Industrial
Other Information: . ~
Change in Status:
Issue Date
FEES:
Acreage
Frontage
Service Advance
Processing
Other:
Capacity
$
BUILDING SEWER CONNECTION:
_ Feet of Property
line ___ feet from Main Sewer
and _ feet deep.
Connection to Main Sewer
Feet upstream from M.H.~
Using t;!J.1 \.-1/4.J (.II .
BACKFLOW PROTECTION:
_ Field Check Required
_ Call District for foundation survey
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60-
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TOTAL
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Disposition;
~ Zone I~
INSTRUCTIONS:
Device Required;
Type:
Yes_ No
o Street encroachment permit required from
o Permit invalid if not connected within 12 months of issue.
o Do not connect until main sewer is accepted by District.. )
o Obtain a building or plumbing permit from the jurisdiction listed fT'~ 'i , " ...
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'fHt~ fW411 l.Kf'tA-cec;
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PERMIT COpy
WEST V ALLEY SANITATION DISTRICT
SANTA CLARA COUNTY
100 E. Sunnyoaks Ave., Campbell, CA 95008
(408) 378-2407
.
LOCA~
A.P.N. "'1k-<>>a
Sewer Location: Bk. ~ Pg. 7?
Tract Lot ~
Proj. 1iiIiJmt.~
Address:{ {'BCf . ~
Jurisdiction .&AI-1f~~
BUILDING TYPE:
'::t.... Single Family
_ Condominium/Town Houses
_ Multiple Dwelling
Number of Units
_ Commercial
_ Industrial IJrhJJ
Other Information:
Change in Status:
SEWER CONNECTION
fiT NUMBER
Issue Date Sftr
31061
BYUb.
FEES:
Acreage
Frontage
Service Advance
Processing
Other:
Capacity
$
BUILDING SEWER CONNECTION:
_ Feet of Property
line _ feet from...Mi!.Ln Se~~
and _ feet deep7 0 ~ ~ Jt:.J_
Connection to Main Sewer I~~I ~~~.
Feet upstream from M.H.
Using
BACK FLOW PROTECTION:
_ Field Check Required
_ Call District for foundation survey
~
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1150 6.1
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TOTAL
Disposition;
~ Zone ~
INSTRUCTIONS:
o Street encroachment permit required from -.CI}I-11'15~
o Permit invalid if not connected within 12 months of issue.
o Do not connect until main sewer is accepted by District.
o Obtain a building or plumbing permit from the jurisdiction listed above.
Device Required;
Type:
Yes_ No
PL.MIT COpy
REFUNDABLE DEPOSIT
CHECK REQUEST
TO: SANDY TERPKO
ACCOUNTS RECEIVABLE
Please issue check payable to: Mello Pipelines
Address:
Line 1: 260 McGlincey Lane
Line 2:
City: Campbell
State: --9L Zip: 95008
Description: Ref Deposit/Permit No: 92-162
Exact Amount Payable: $ 5 0 0 . 00
Account Number: 001.00.905.4662
INTEREST EARNED
001.05.540.4448
LOCATION:
1189 Audrey
DATE AND NO. OF RECEIPT: 5-8-92 #41629
PURPOSE:
Return of cash deposit
Requested by: H. Imokawa P::(J- Title: P.W. Inspector Date: 7-9-92
Approved by: Michelle Quinney Title: Sr. Civil Eng. Date:
Verified by:
Title:
Date:
SPECIAL INSTRUCTIONS FOR HANDLING CHECK:
Ma il as i s
Mail in attached envelope
Return to: Public Works
(Department)
Michelle QUinner
(Name
Other:
Rev 11/21/91
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