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PUBLIC WORU PIRMIT 'erait 10. B8 - IS 2- 0
,~gr worKlntj Ion t:n. 80 .-r7' ("' / to
public ri9~ht-Of~-W y) X-Ref. fUe o-IIS /j;~.</\ Ltrl,
rasued ~ / 3 ~cP Application Date wifi:fiiil.. n
Perait ue n lot lIOa. expirea In. 0
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APPLICATION - Application ia hereby aade for a PUblic Works Perait in accordance with Ca.pbell- ~
MuniCipal Code, Section 11.04. ~
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CITY 0' CAMPBELL
DEPT. OF PUBLIC WORKS
70 North firat It.
Ca.pbellt CA 'S008
(408) 8"-2150
A.
Work addu.. or tract' ~-r ~/I)1..
tBADU?M Avb.
Nature of work:/i-.tS:rIttA..- 2c>t h: C(? '''/I.J~ MAt/....) )~ uJr(v!ft0 8A5..~ .Ave.-'
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
improvementa. When approved by the City Engineer, aaid drawing become a a part of this perait.
The General Conditiona for all permits are listed on the reverae aide. Special Proviaions for
this perlllit are Hsted below. 'aUure to abide by ,these conditions and provisions MY result
in jOb shut-down and/or forfeiture of faithful 'erformance Bonds and cash deposita. (See
General Conditions land 2).
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Utility trench location
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E. An applicaUon_ fae...must accompany this application. This is non-refundable.
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Is thia work being done by the property owner at their own residence? ____yea ~no
Complete attached Workers' Compensation and Contractor for.s.
The Applicant/Permittee hereby agrees by affixing their signature to this permit to hold the City of
Campbell, ita officers, agent. and employees free, safe and harmless from any claim or demand for
damages resulting from the work covered by this permit.
The Applican /Permi tee h reby acknowledges that they have read and understand both the front and
back of this permi , and hat they will inform their contractor(s) of the in ormation.
ACCEPTED Zce, $;
NOTES: WIel flHM!'lIJ6'.J~~~M ~N~!~~EOi~~~1'~DC,L1}~R~~~Y1JLANS 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 BEPORE STARTING WORK.
NOTICE MUST BE GIVEN TO PUBLIC WORKS AT LEAST 24 HOURS BEPORE RESTARTING ANY WORK.
SPECIAL PROVISIONS
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Street shall not be open cut for underground installations. Minimum cuts may be allowed
for connections or exploration holes. Such cuts must be specifically approved by the
Inspector.
yavement .ay be cut for underground installations and must be restored 1n accordance with
the Utility Trench Restoration Standard DraWing.
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 Deft. before starting work.
The hours of work are limited to outs de the hours of 7-9 a.m. and 3-6 p.m. for any work
affecting a traffic lane.
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(a-I) STANDARD
PERMIT APPLICATION PEl ($35.00) $50.00
PLAN CHECK DEPOSIT $500.00
BOND FOR fAITHFUL PERFORMANCE (100' OP ENG. 1ST.)
P. P. (CASU) DEPOSIT ($200) (n OP BOND,$SOO MIN)
PERMIT PEE ~.. g (n or P.P. BOND
$3S.00 tUN) I
APPROVED POR ISSUANCE ".
AMOONT
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RECEIPT NO.
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f: PWPERMIT
Revised 7/87
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REFUNDABLE DEPOSIT
CHECK REQUEST
TO: FINANCE DIRECTOR
CITY OF CAMPBELL
Please issue check payable to:
Telesis Construction Co.
(30 spaces)
Address:
Line 1:
19601 McKean Rd.
(30 spaces)
(30 spaces)
State: CA Zip: 95120
(2) (10 spaces)
(24 spaces)
Line 2:
City :
San Jose
(20 spaces)
Description:
Cash Deposit R~und
Exact Amount Payable:
$500.00
Account Number:
905.4662
PURPOSE:
Release of cash deposit for Excavation Permit No. 88-182.
See receipt #19900 dated 7/14/88.
Req uested by:
Gregg Eaton
Title: P. W. Inspector
Date: 8/16/89
Approved by:
D.C. Wimberly
Title: P.W. Director
Date:
Verified by:
Accounts Receivable
Date:
SPECIAL INSTRUCTIONS FOR HANDLING CHECK:
Mail as is
xx
Mail in attached envelope
Return to:
(Department)
(Name)
Other:
08/24/88
TO: City C I e rk
PUBLIC WORKS FILE NO. 8g.... / t 2-
Please collect & receipt
for the following monies:
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-----
35-)396
3372
3521
3521
(specify pro.ect)
p eJlr.l-i.;t eu :
R-1 :
($'35)
( $200)
.t elL:
($ 50)
{ 500)
(4% of FPB)
($500 min.)
(7'7v of FPB)
($35min.)
( Cash) Depos i t
3372
Plan Check & Inspection Fee
3521 Other Cash Deposit (specify)
J373
3373
3372 Tentative Parcel Map Fil ing Fee ($350)
3372 Final Parcel Map Fil ing Fee ($300)
12 Tentative Tract Map Fil ing Fee ($400)
?j/2 Final Tract Ma Fil in Fee ($350)
3372 Lot Line Ad.ustment Fee/Certificate of CampI 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)
J395 Park Dedication In-lieu Fee per Unit ($1,132)
3380 Public Works Special Projects
3510 Postage
AMOUNT
$
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NAME
ADDRESS /9!.-Ol Ma/~~~d' -S'~
$ j~cY;)
2.. ~ ~ - / / (:S-O
'7 ;::,- / L 0
PHONE
ZIP
FOR
CITY CLERK
ClliLY
RECEIPT NO. I 9 9' 0-0
AMOI.Nr PA I D ..5"]' ~ ~
RECEIVED BY ~
DATE '7-/ y;~ ~q
July, 1987
CITY OF CAMPBELL
70 NORTH FIRST STREET
CAMPBELL, CALIFORNIA 95008
(408) 866-2100
Department:
Public Works
August 16, 1989
West Valley Sanitation District #4
100 E. Sunnyoaks Ave.
Campbell, CA 95008
RE: Final Inspection and Acceptance
Permit No.: 88-182
Location: Tract 8152, 3675 S. Bascom Ave.
We have made a Final Inspection of subject public works construction and
find it acceptable and in conformance with City standards. Accordingly,
the work is hereby accepted subject to the one-year maintenance
requirement indicated below.
You are responsible for the maintenance, repair and/or replacement of all
work done should any failures occur within one (1) year of this date. We
will inspect the work in one year and advise you whether or not
maintenance is needed.
Please feel free to call the undersigned if you have any questions.
Sincerely,
~ ~___ r.---
Car1o~M. Jocson
Associate Civil Enginneer
CMJ : sd
cc: G. Eaton, P.W. Inspector
Suspense - 1 year
EMAMI-WU
DEVELOPMENT
COMPANY
%f " /g'u
QUALITY HOME BUILDERS
.EC"V
APR 2 0 198
PUBLIC WORKS
ENGINEERING
f)
April 20, 1989
City of Campbell
Public Works Dept
70 North First st
Campbell Ca 95008
Ladies and Gentlemen
This is a request for Final Inspection of Bascom Square Townhomes
located at 3675 So Bascom Ave, Campbell, Ca. The Tract number is
8152.
There are a total of fourteen units.
Thank you
~// ~/
~/~/?~Z_.._
Robert Emami
Emami/wu Development
19601 McKean Road/San Jose, California 95120
(408) 268-4173
In USA (800) 242-7653
FAX (408) 268-0462
r'~A[---r?L-~<' /~_/
~
DAte 8~/;f;? Permit or Project No. ,88 -/8 "Z-
... ~
Address .3675 S :~C-DM
PUBLIC WORKS INSPECTION REPORT
Type of work z Stre~t Storm
Other (describe)
SAnitAry ~ Electrical
o PRELIMINARY INSPECTION WITH DEFICIENCY LIST (attached)
o FINAL INSPECTION WITH DEFICIENCY LIST (Attached)
~INAL INSPE~ION - ACCEPT~
Signed plans?, Y ~(If signed, Council acceptance.)
Charges Against deposit? Y
OVertimez hrs. @ $
Date '.rea5onz
~
.
$
Barricade rental (attach invoice)? y
Date , reAsonz
v
$
Other?
$
$
$
· Refund $
~otal charges deducted from deposita
(Cash Deposit $ less charges $
[JONE YEAR MAINTENANCE WITH DEFICIENCY LIST (attached)
ek. req.)
o ONE YEAR MAINTENANCE - ACCEPTANCE
(Release'maintenance bond. Check Request if cash.)
.~
~gineer
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