88-183
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AItOONT aJ:CUPT 110.
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CITY 0' CAftPBtLL '
DCPT. 0' 'U~LIC ~Ii
'0 1I0lth 'lll' i,.
ClmpbcllL CA '~OO'
(tea) II. .~ao
~S-183.
I-ad. t u. @, 8 - (40
&ppHc:auCNI Dat. 7.t< 3~BB
..pir.a in .u.
APPLJCATJON - Application 1, h.r.by ..d, tor a '~blic Mork. '.ralt 1n accordane. wlth eaapbell
.~nlclpal Code, 'ectlCN1 11.04.
PUbL1C WORkS .ERftlT
"ur vurclnv In cne
publlc ri9ht-of..ayl
"aud '1. - ~ ~ - }/ :r
..'.1 I PI.. .n &4 .0..
'"ai t "0.
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C.
A. Mork addl'.' or tract .
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il.
Atlach live C~) Coplel ot a dr.wlng ahowing the location, alt.nt .nd diaanllona of the work
The dlawlng ahlll 'how the r.ll,lon of the propoled work to .llating aurtac. and undelground
laprove..nt.. Wh.n approv.d Dy tbe Cltl ~niln.'r. ..id drawing blcoae' . parl of Lhl' peralt.
The ~enel.1 Condltionl for all parait. are lletad on the r.verae .idc. 'peci.l 'rovi,lonl tor
thl. perai, .re lia'ed below. 'allure to .bld, bl lhe.e condition. and provl,lon. ..y r.lult
ln job ahut-down and/or forfeiture of ralthful '.rfor..nce .ondl and c..h depolitl. IS'e
wnerll Cond'"on. 1 and ~I.
It.
toddre..
II thl. wock Dclng done by th. pcopartl own.r at tb.lr own r.ald.ncel .......y.. ao
Coapl.t. attached Work.r.' Coapen.atlon and COntraclor loraa.
The AppllClnt/Peralttee her.by agc.ee by attillng their .Ignlture to thil perait to bold the City ot
CI.puell, ltl offlcec.. .g.nll Ind eaploy.el fcec. a.fe and blr.l.al fro. any clala or d...nd tOI
d...g.. r.lulting fcu. the Wock covec.d by lhll perall.
The Appllcan
Dack of etll.
ACCEPTt:D
.e hereby aCknowledlel tbat tbey beve r.ad and underetand both the
and t tbey wll1 nfor. th.lr contraCtor I.) of ~' infor..rlon.
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I ... r.w
front and
IIOTtS: ALL WOR" SHALL COHfOllft ."1 TH THt ATTACHED. APPROVED '~S AIID ALL APPLICA.8Lf CMPaf:LL
.TANDARD DRAWJNGS AND CONDITJONS.
TilE CONTRACTOR IIUST HAVE Till S PERftIT AND APPROVED 'LAMS AND IIUST en' "12'1 THE .. .W. UUiPCCTC.ltl ON
TIi[ SITE AT LUST ",.0 DUS IIE'Okt: STo\JlTlNG WOR".
IIOT J ca: ROST Bt: (;1 Vt:H TO PUBLJ C NOII..S AT LU.ST ~. MOURS UfOllE IltSTAlITI HG ANY MOIlI.
SPECIAL PROVISJONS
_1.
5tr.et 'hell not be open cut tor underground inltlll.tionl. 1I1niaua cuta ..y be allowed
tor connectlon. or acploration holel. SUCh C~te au.' be lpeC"lCllJy approved by the
Ino;~Clol.
~~mfnr-"r bI cut tor underground lnallllatlonl and auel be r.ator.d ln accordanc. Wlth
lh. U',11'y TrenCh a.ltorl'lon 51lndlcd DClwlng.
Work to be atlked by I )Icen..d Land Surveyor or Civil tngin.er and cwo (2) c:opi.e ot the
cur .n..ll aen, to the Publ,c Work Dep'. b.fore .tartlng work.
The houri of work ar. llalled to outaldc the bOUl. ot l-t .... and J-6 p.a. tor any worl
att.cllng a trarflc l.n..
'5€E AlTACHEA 77eEN.Crl iCE<'T7VcAT7'OA1 D FT'A ; L
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.EkMIT APPLlCATJON rEE
rLAN ClltCI Dt~IT
80MD rOR 'AITH'UL .cafORMANCf:
C.-l)
CU~.OOI
aTAIIDAJlD
UO.OO
1:'00.00
ClOO\ or EM(;. EST.)
r. .. CCIo&HI DEPOSJT C$~OOI C., 0' aoND,5~00 IIJM)
rEllIIJ T rEf /.. 0' 0' r. P. IIOHD
137 ~.F. -= Sooer. e .2.0et4/237 L.F';:g5". ~q, u:..OO. Ill")
APPIlOVED rOIl J:>SUANCE ~-Gh. Ii /e_---.... ____-
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C '"~ ",cl,)r m'~st hove these plans
)!' 1!'tC' ;nb <;h'f' during construction.
CANTA CLARA COU~~TY E:AP'HTATIO"J DIE:TRlCT "JO. .(
BOOK PAGE SCALE CORRECTED TO BY
6
54
1" = 100
FE;':' '82
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70 NORTH FIRST STREET
C AMP BEL L, C A L I FOR N I A 9 5 0 0 8
(408) 866-2100
FAX # (408) 379-2572
Public Works
Department:
October 31, 1989
Mello Pipelines
260 McGlincey Lane
Campbell, CA 95008
RE: FINAL INSPECTION AND ACCEPTANCE
PERMIT NO.: &9-183
LOCATION: 1381 Harriet
We have made final inspection of subject Public Works construction
and find the work is satisfactorily completed in conformance with
City standards.
Your cash deposit will be refunded under separate cover.
Please feel free to call me if you have any questions.
Sincerely,
~~
Associate Civil Engineer
CMJ : sd
cc: Gregg Eaton, P. W. Inspector
- .__.~~_.. - .. . -- ...-
PUBLIC WORKS INSPECTION REPORT
Date /t:>a 7. /~ 1 Permit 01' Project No. . ES 8 - Ie .3
r I
Address /.J 8 I .;. J.-./.".{t.~,'rr
Type of worka Stre.t Storm
Other (describe)
Sani tary ..----nectrical
o PJU:LIMINARY INSPECTION WITH DEFICIENCY LIST (attached)
[J FINAL XNSPECTION WITH DEFICIENCY LIST (attached)
~ INSPE~ION - ACCEPT~~
. Signed ~lans? Y lll-J(If signed, Council acceptance.)
Charges against deposit? y
Overtime. hrs. @ $
Date '.reallona
G0
/hI' .
-
$
.,
Barricade rental (attach invoice)? y
Date , reason.
~
$
Other?
[JONE YEAR MAINTENANCE WITH DEFICIENCY LIST (attached)
o ONE YEAR MAINTENANCE - ACCEPTANCE
(Release'maintenance bond. Check Request if cash.)
$
$
$
- Refund $
~otal charges deducted from deposit.
(Cash Deposit $ l.ss charges $
ck. req.)
~.~
ineer
In6
REFUNDABLE DEPOSIT
CHECK REQUEST
TO: FINANCE DIRECTOR
CITY OF CAMPBELL
Please issue check payable to:
Mello Pipelines
260 McGlincey Lane
(30 spaces)
(30 spaces)
(30 spaces)
State: CA Zip: 95008
(2) (10 spaces)
(24 spaces)
Address:
Line 1:
Line 2:
City :
Campbell
(20 spaces)
Description:
Cash Deposit Refund
Exact Amount Payable:
$500.00
Account Number:
905.4662
PURPOSE:
Release of cash deposit for P.W. Permit 88-183.
See receipt #20031 dated 7/21/88.
Requested by:
Gregg Eaton
Title: P. W. Inspector
Date: 10/31/89
Approved by:
Verified by:
Donald C. Wimberly
Title: P.W. Director
Date:
Accounts Receivable
Date:
SPECIAL INSTRUCTIONS FOR HANDLING CHECK:
Mail as is
x
Mail in attached envelope
Return to:
(Department)
(N ame)
Other:
08/24/88
TO: City Clerk
~T.
J5-3 96
3372
3521
3521.
3372
3521
Please collect & receipt
for the following monies:
project)
P eJl..P.1U eM :
R-1 :
($'35)
($200)
PUBLIC WORKS FILE NO. ~g -IR3
AMOUNT
$
t elL:
($ 50)
'( $500)
(4% of FPB)
($500 min.)
(7% of FPB)
($ 35 min.)
Depos i t
S' O. 0 0
5'DO ' 00
/?;~,j;$
2373
3373
3373 . .
3373
Plan Check & Inspection Fee
Other Cash Deposit' (specify)
&
3372 Tentative Parcel Map Fil ing Fee ($350)
)372 Final Parcel Map Fil in Fee ($300)
'2 Tentative Tract Map Fil ing Fee $ 00
~J12 Final Tract Ma Fil in Fee ($350)
3372 Lot Line Adjustment Fee/Certificate of Compl iance
3372 Vacation of Publ ic Streets and Easements ($500)
3372 Assessment Segregation or Reapportionment
First Split ($500)
Each Additional Lot ($150)
3372 Environmental Assessment:
Categorical Exemption ($500 plus actual cost
Negative Declaration 'above $500)
3370 Storm Drainage Area Fee per Acre (R-l, $1,875; Multi-Res.,
$2,060; all other, $2,250)
3395 Park Dedication In-lieu Fee per Unit ($1,132)
1373
3373
1520
3380 Public Works Special Projects
3510 Postage
TOTAL $ 085,;5 S-
NAME r4~UOvJ !"~E L~:VE<" C7O.JV1V!€LLOW) PHONE 377- c,.,/o 3
/ /
ADDRESS 2~O - M~ GLI~c.e--l LN. - (' A-MtJi3ELL C.A. ZIP ~.5lJo B
/ 'I'
RECEIPT NO.
d?-CYn?J{
0~;/~~
L--- .
I
FOR
C I TV CLERK
a-n. y
AMOUNT PAID
DATE
July, 1987