ENC2002-00105
CITY OF CAMPBELL
DEPT. OF PUBLIC WORKS
70 North First St.
Campbell, CA 95008
(408) 866-2 I 50
Fax (408) 376-0958
OWNER OCCUPIJ):D R-I
NO FEE ENCROACHMENT PERMIT
(for working within the public
right-of-way)
($5,000 maximum value of work)
Permit No ENe 2002. - 0 Q \ 05
X-Ref. File
Application Date~
ISSUED
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 the permit is not issued.)
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C. Attach three (3) copies of a drawing showing the location, extent and dimensions of the work. The drawing shall show the
relation of the proposed worked to existing improvements. When approved by the City Engineer, said drawing becomes a
part of this permit.
D. All work shall conform to the City of Campbell Standard Specifications and Details for Public Works Construction; the General Permit
Conditions listed on the reverse side; and the Special Provisions for this permit, listed below. Failure to abide by these conditions and
provisions may result in job shutdown and/or forfeiture of Faithful Performance securities.
c~ 4r:J8' -6c)J-.SS/ I
NAME OF APPLICANT !1tcht1e/ ~h-?J TELEm~~Y-J9'J S~2'7
J (print name)
ADDRESS 3~~Y /l4/#~/?t1'~1'" ~y C~~ C~ ~J2?af
The Applicant hereby confirms that this work is being done by the property owner/applicant at their own residence.
The Applicant hereby agrees by affixing their signature to this permit to hold the City of CampbelL City of Campbell Redevelopment .\gency.
its officers. agents and employees free. safe and harmless from any claim or demand for damages resulting from the work covered by this
permit.
The Applicant hereby acknowledges that they have read and understand both the front and back of this permit, and that they will inform their
contractor( s) of the information.
^CCEPTED~ ~#d'a6'/ /~J
, (Applicant/Permittee) (Sign)
(lJ ~7 ;7,;;47-
Date
NOTES: ALL WORK SHALL CONFORM WITH THE ATTACHED. APPROVED PLANS AND ALL APPLICABLE CAMPBELL
STANDARD DETAILS AND CONDITIONS.
THE CONTRACTOR MUST HAVE THIS PERMIT AND APPROVED PLANS AND MUST ARRANGE TO MEET WITH THE PL'BLlC
WORKS INSPECTOR AT THE SITE AT LEAST TWO DA YS BEFORE STARTING WORK.
NOTICE MUST BE GIVEN TO PUBLIC WORKS AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK.
PER SECTION 42 I 5 OF THE GOVERNMENT CODE THIS PERMIT IS NOT VALID FOR EXCA V A TIONS UNTIL UNDERGROUND
SERVICE ALERT (USA) HAS BEEN NOTIFIED AND THE INQUIRY IDENTIFICATION NUMBER (TICKET NO,) HAS BEE]\;
ENTERED HEREON. USA PHONE: 1-800-227-2600. TICKET NO.:
SPECIAL PROVISIONS
5T ANDARD
AMOUNT
RECEIPT NO.
SECURITY FOR FAITHFUL PERFORMANCE
(100% OF ENG. EST.)
$
..
APPROVED FOR ISSUANCE
o~
City Engineer
Date
onths After Date of Issuance.
J:lformslrl permitlrev.2/0 I
GENERAL PERMIT CONDITIONS
I. A SECURITY to insure FAITHFUL PERFORMANCE and completion of the work is required. This SECURITY is refundable
upon completion of the work and written acceptance by the City.
2, A ONE-YEAR MAINTENANCE PERIOD for all work is required. Such period will begin on date of written acceptance by the
City. It is the applicant"s responsibility to remove and replace unacceptable improvements within the one-year maintenance
period.
3. REFUND or cancellation of the Faithful Performance Surety will be initiated by the written acceptance of the work by the City.
4. The Permittee MUST REQUEST IN WRITING a final inspection and acceptance of the work upon completion. Acceptancl: by
the City will be made in writing to the Permittee.
5. MAINTAIN safe pedestrian and vehicular crossings and free access to private driveways. fire hydrants and water valves.
6. REPLACE IN KIND any damaged or removed existing improvements. including planting.
7. SA WCUT for all PCC or AC removals. Prior to concrete sawcutting or washing. the Contractor shall place filter fabric material
in the tlow line of the gutter to retain all construction debris. All construction debris shall be wet vacuumed. broom swept, picked
up and disposed of by the Contractor. Concretesawcut debris shall not be swept or water hosed into the gutter and into the storm
drain system.
8. Adequate signing and lighted BARRICADING is required on the job site. Failure to provide such signing and barricading as
specified by the City Engineer may result in the City's renting such signing and barricades and charging the cost to the permittee.
9. The Contractor or Permittee will have a SUPER VISORY REPRESENTATIVE available for contact on the project at all times
during construction.
10. This permit shall be kept at the site of\\ork and mLlst be shown to any authorized representative of the City of Campbell or any
law enforcement officer upon demand.
II. No STORAGE of materials or equipment will be allowed near the edge of pavement. within the traveled way. or within the
shoulderline. which would create a hazardous condition to the public.
12. This permit shall not be construed as authorization for excavation and grading on private property adjacent to the work or any
other work for which a scparate permit may be required, nor does it relieve the Permittee of any obligation to obtain any other
permit rcquired by law.
13. All necessary ROAD REPAIRS resulting from the permit work shall be made in accordance with City Standards and
Specification at the sole expense of the Permittee.
14. This permit does NOT RELEASE the Permittee from any liabilities contained in other agreements or contracts with the City and
any other public agency. .
15. This permit is NOT TRANSFERRABLE. Work must be performed by the Permittee or his designated agent or contractor as
specified thereon.
16. Prior approval of inspector is required for any work done after normal working hours. on weekends or holidays and may require
reimbursement of inspcction costs at thc current overtime rate.
17. CALL BACK (callout) due to emergencies regarding this permit shall be at the current overtiml: rate with a three (3) hour
minimum charge per occurrence.
Applicant shall be responsible for ensuring that all those providing services under the applicant are aware of and understand all of the
"b:;:ti:t /l/'C~dP'/Lfi'L
~ Appl icant
0&/2?-/ (iJ2
Date
J :\forl11s\r I permit\rev.2/0 I
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ORCH!\R'O
CITY OF CAMPBELL
Public Works Department
April 21, 2006
Michael Samak
367 Nottingham Way
Campbell, CA 95008
Re: Notice of Expiration - ENC 2002-00105
367 Nottingham Way
Dear Mr. Samak:
It has come to our attention the abovementioned permit application was applied for on
June 27, 2002, and no action has been taken by the applicant to complete the
requirements for issuance. The City allows a period of six months for an applicant to
fulfill permit requirements for issuance. Your time and grace period of six months has
expired and the permit process has now been terminated.
Upon a site visit on April 19, 2006, it was discovered the nature of the work for the
permit had been completed without Public Works inspection or permit issuance. This
correspondence is to notify you that the improvements are in violation of Campbell
Municipal Code, Section 11.04.
The concrete improvements on the driveway and curb/gutter are now considered
nonconforming. Therefore, the City will not take future responsibility for the integrity of
the material and workmanship. The property owner of 367 Nottingham Way is hereby
notified that it is your responsibility to maintain the concrete work in a safe state. If the
work fails, the City will have the right to have the work corrected either through the
property owner of record or through the City with action for recompensation.
If you wish to have any discussion, you can call me at 408-866-2168.
SincerelY/.J }r L//
U&~t'-
Alan Horn
Senior PW Inspector
cc: Michelle Quinney
Syed Wahidi
ENC2002-00 105
H:\WORD\PERMITS\Per exp 2002-00105.docGd)
70 North First Street . Camphell, California 9500S,1436 . TEl 40S,S(,6.2150 . FAX 40S376095S . Tim 40S.S66.2790