88-131
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CITY OP CAMPBELL
DEPT. or PUBLIC WORIS
70 North Pirat It.
Campbell. CA tSOOI
(408 I 8h-2UD
'UILIC WORn PIRMIT Perait Mo. cf? cY -/ 3> /
,for WO~Klni In ~n.
public ri9ht-of~wa ) X-Ref. file
tuued t./ /:s- cr cY Application Date V<~ .P ~
'erai~ e.plre l~ .oa. expirea In .
'erait in accordance with Ca.pbell-
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APPLICATION - Application ia hereby ..de for a 'ublic Worka
Municipal Code, lection 11.04.
L. A J.: 4-l0
A. Work addn.. or tract '..!.ltAQ.l ~ lo'6 I tA~1k Vw-. !,~iv ~t.
Utility trench location ~ ~1~~ 'Q",~ I
8. Natun of work:JtJC.{ML. . . N(gfllwt~r'lV k...n \ MW~cn~ ~t. ~ ~I~.
C. Attach five (5) copiea of a drawing ahowing the location, extent and diaenaiona of the work
The drawing ahall ahow the relation of the proposed work to exiating aurface and underground
iaprovementa. When approved by the City Engineer, aaid draving become. a part of thia perait.
D. The General Condition. for all permit. are liated on the reverse .ide. Special Provisions for
this permit are liated below. 'ailure to abide by these condition. and proviaions may result
in jOb shut-down and/or forfeiture of 'aithful Performance Bonda and caah deposita. (See
General Condi Hons 1 and 2). I (
V c..~ ..s
accompany this application. ll~his is
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non-refundable. ~
Tel.Phon.:~ ~
oolb
Name of
Address
Is this he property at their own reaidence? ____yes no
Complete attached Workers' Compensation and Contractor foras.
The Applicant/Permittee hereby agrees by affiXing their signature to this permit to hold the City of
Campbell, its officers, agents and employees free, aafe and haraless from any clai. 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 thi per it, and tha they viII inform their contractor(s) of the information.
ACCEPTED ~;f ~~~~
f 1.-.-.' ".'''',_ ,M. ,.'~~ ,'-'" ~."" i: ,...~ rr. 'r:~'
NOTES: ALf wbkiIP~H~Lt. 'g~~FORH. Wi'TH';TH~\~AC~E~,APPROVED PLANS AND ALL APPLICABLE CAMPBELL
STANDARD DRAWINGS AND CONDITIONS.
THE CONTRACTOR MUST HAVE THIS PERMIT AND APPROVED PLANS AND MUST MEET WITH THE P.W. INSPECTOR ON
THE SITE AT LEAST TWO DAYS BEFORE STARTING WORK.
NOTICE MUST BE GIVEN TO PUBLIC WORKS AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK.
SPECIAL PROVISIONS
~ 1. Street shall not be open cut for underground installations. Minimum cuts aay be allowed
for connections or exploration holes. Such cuts must be specifically approved by the
Inspector.
2. ~avement may be cut for underground installations and must be restored in accordance vith
the Utility Trench Restoration Standard DraWing.
_____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 Work Dept. before starting vork.
_____4. The hours of work are limited to outside the hours of 7-9 a.m. and 3-6 p.m. for any work
affecting a traffic lane.
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PERMIT APPLICATION PEl
PLAN CHECK DEPOSIT
(R-I)
($35.00)
$
,
$
$
~
STANDARD
/$50.00
$500.00
(100' OF ING. 1ST.)
AMOONT
":-;>-0 -
RECEIPT NO.
J'2u>/
BOND FOR PAITHFOL PERFORMANCE
F. P. (CASH) DEPOSIT
PERMIT FEE
~.
APPROVED FOR ISSUANCE
($200) (4' OF BOND,$500 MIN)~
(7, OP P .P. BOND.......
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$
'<'-()O- /cY2~)
35"- /cP27C
4-~-er~
uate
f: PWPERMIT
Revhed 7/87
TO : C i t Y C I e r k
PUBLIC WORKS FILE NO.
Please collect & receipt
for the following monies:
~CT.
35 -=' -' 96
CllZ2J
3521
3521
R-l :
($-35)
($200)
;t elL:
($ 50)
~ 500)
(4% of FPB)
($500 min.)
(7'7u of FPB)
($ 35 min.)
eM:
Depos i t
3372
3521
Plan Check & Inspection Fee
Other Cash Deposit (specify)
J373
3373
Project
General
&
3372 Tentative Parcel Map Fil ing Fee ($350)
3372 Final Parcel Map Fil ing Fee ($300)
}372 Tentative Tract Map Fil ing Fee ($400)
2 Final Tract Ma Fil in Fee ($350)
J~/2 Lot Line Ad'ustment Fee/Certificate of Compl iance
3372 Vacation of Publ ic Streets and Easements
3372 Assessment Segregation or Reapportionment
Fi rst Spl it ($500)
Each Additional Lot ($150)
3372 Environmental Assessment:.
Categorical Exemption
Ne ative Declaration
3370 Storm Drainage Area Fee per Acre Multi-Res.,
$2,060; all other, $2,250)
3395 Park Dedication In-I ieu Fee per Unit ($1,132)
3380 Public Works Special Projects
3510 Postage
7~-/31
AMOUNT
$
'3 S--
NAME
TOTAL
j/;cK';' ?/~EL(,A../C:
/? 2--;;-0 ~ ~
$ 3S--
-3 S' b - 73 3.::.-
7' jO 3. u
AfONE
LG-
ADDRESS
ZIP
FOR
C I TV CLERK
.:I'lLY
RECEIPT NO.
/~;;:L7C,
-3 S;-OCJ
G-)'P")
;.j - ~- - <? V
AMCX,NT PAID
RECE 'VED BY
DATE'
July, 1987
TO: C i tyc C I e rk
PUBLIC WORKS FILE NO. cPi' ~ I 3. (
Plf"'Jse collect & receipt
for the following monies:
. -CT.
35 'z...36
ITEM
Project Revenues (specify project)
PubUc. ('Jo,'LIZ-6 Exc.ava.-tion PeJLr.1-U fe.M:
Ap I i ca t i on Fee
Plan Check Deposit
Faithful Performance Deposit
OthV1.:
($ 50)
. 500)
( % of FPB)
($500 min.)
(TIu of FPB)
($35min.)
R-1 :
($35)
3372
3521
Plan Check & Inspection Fee
Other Cash Deposit (specify)
J373
3373
3372 Tentative Parcel Map Fil ing Fee ($350)
3372 Final Parcel Map Fil ing Fee ($300)
3372 Tentative Tract Map Fil ing Fee ($400)
- "2 Final Tract Map Filin Fee ($350)
)~/2 Lot Line Ad'ustment Fee/Certificate of Compl iance
3372 Vacation of Publ ic Streets and Easements
3372 Assessment Segregation or Reapportionment
First Spl it ($500)
Each Additional Lot ($150)
3372 Environmental Assessment:
Categorical Exemption
Ne ative Declaration
3370 Storm Drainage Area Fee per Acre Multi-Res.,
$2,060; all other, $2,250)
3395 Park Dedication In-I ieu Fee per Unit ($1,132)
3380 Public Works Special Projects
3510 Postage
-----
AMourn
$
~-o -
~ f' 0 C)
$ S-S-O-
'3 SC 7 3>"'3~
TOTAL
NAME h C /<- 5- jJ I pO ~ I rU c:=-
~~~
ADDRESS / ~ z.. 5' U
PHONE
L-Cl
9"~"O '32- ZIP
,
I h}
,/ \
1..-;
FOR
C I TV CLERK
a-ll.Y
RECEIPT NO.
/ <if .;;L to /
-S::-r-. a 0
~ "') :;) '-'.
AMOI.R'n' PAID
RECE I VED BY a... r:>t
DATE' q- S- - 'l S/
,l ,;
fi} ~j (I'
/,(",'
,-11
I, '
July, 1987
REFUNDABLE DEPOSIT
CHECK REQUEST
TO: FINANCE DIRECTOR
CITY OF CAMPBELL
Please issue check payable to: VICK's PIPELINE CONSTRUCTION
(30 spaces)
(30 spaces)
350 MARBURG'WAY #B (30 spaces)
Address:
Line 1:
Line 2:
City :
SAN JOSE State: CA Zip: 95133
(20 spaces) (2) (10 spaces)
CASH DEP. REFUND 88-13~ (24 spaces)
Description:
Exact Amount Payable: $500.00
Account Number: 905.4662
PURPOSE: RELEASE OF CASH DEPOSIT FOR EXCAVATION PERMIT 88-13~.
SEE RECEIPT #18261 DATED 4/5/88
Requested by:
G, EATON
Title: P. W. I NSP
Date: 5/4/89
Approved by:
Verified by:
D. WIMBERLY
Ti tle :
D I R, OF PUB. WKS Date:
Accounts Receivable
Date:
SPECIAL INSTRUCTIONS FOR HANDLING CHECK:
Mail as is
X
Mail in attached envelope
Return to:
(Department)
(Name)
Other:
08/24/88
"
_0- "_____ _ .. _._._.___
PUBLIC WORKS INSPECTION REPORT
Pendt or Project 110. .p, B-132;4131
Date ~~~~
Address
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7ype of work a Street Storm.,.". Sani tary
Other (desc:ribe)
Elec:tric:al
o PRELIMINARY INSPECTION WITH DEFICIENCY LIST (attac:hed)
o FINAL INSPECTION WITH DEFICIENCY LIST (attac:hed)
~AL INSPECTION - ACCEPTANCE
Signed plans? y ~ (If signed, Counc:il ac:c:eptanc:e.)
Charges against deposit? y
OVertime a hrs. @ $
Date , reasona
~
.
$
Barric:ade rental (attac:h invoic:e)? y
Date , reasona
~
$'
Other?
$
$
$
· Refund r:57y)"c- ck. req.)
~otal charges deducted from deposita
(Cash nepod t $ ''5b(})(;) less charges $
o ONE YEAR MAINTENANCE WITH DEFICIENCY LIST (attached)
o ONE TEAR MAINTENANCE - ACCEPTANCE
(Releas"lIAint~nc:e bond. Check Request if CAsh.)
Engineer
~
Ins or
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~MiT'1t 85-(3\
T Transamenoa
Insurance Services
Transamerica Premier Insurance Company
AJJmlOlSlratlYe a'f1ee If"9II08. Cahlorma
TRANSAMERICA PREMIER INSURANCE COMPANY
c/o Commercial Surety Bonding Agency
r Ci ty of Campbell
70 N. First St.
Campbell, CA 95008
L
o Northern California
1265 S. Bascom Ave.. Suite 108.
San Jose. CA 95128 ,,. _.-_
14081 298-C~A,).,~
SUBDIVISION STATUS INQUIRY ..Ia C ~ '#l-
I ,.0(1. ~ DO ~
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~#~~:04>..f:I
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o Southern California
630 The City Dr.. Suite 120.
Orange, CA 92668
17141 971-CSBA 127221
BOND NUMBER
TPI 779638
SUBDIVIDER
Sea Breeze Villas
TRACT NUMBER TRACT NAME
Tract 8105 Sea Breeze Villas- Darryl Drive
IMPROVEMENTS
Sanitary Sewer Improvements
I PLEASE ANSWER THE QUESTIONS BELOW AND RETURN THIS FORM.
rWJJ 1. Has this work been fully completed and accepted? D Ves ~ No
2, If accepted. on what date?
3, If not accepted. is work progressing satisfactorily?
If no. explain
4, Percentage completed? 7.s-
l!- Ves
DNo
REMARKS
.
~D --r-o RE{Y\,A',!'J ;~ E:FfE"'-T.
Above information furnished by: (signature)
c=.. ~-,-r:yJ'
Title
;?".8~"L Wo,~~ ::z;:;