88-232
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CITY OW CAMPBELL
DEft. OW PUBLIC woau
70 Kortb Wirst st.
Caapbell, CA .5008
(408) 8"-2150
perait No.
ff-c23 )--
BNCROACHMENT PBRMI'!'
(for workinq in the
pUblic riqbt-of-vay)
Issued .;2/; / f' 9
perait expires in 12 aoa.
I-Ref. file
Applioation Date ;?~~~j/f/
Applioation expire. n' ao..
APP~CATION - Application is bereby aade for a Publio Works perait in aocordanoe with Caapbell
Munioipal Code, seotion 11.0.. (Application expire. in , aontb. if perait not pulledl
A. Work address or tract .
L.\ \ CD
l ~.D v ~ l.e..x f'o<::-L ~\ .
utility trencb 10oatioD
B. lIature of work: -::'5'L::>.:s:-\..'-"t-~K- ./ 4:>t:L\..-.:!~ L~~J
C. Attaob five (51 oopie. of a drawinq .bowinq tbe looation, extent and diaen.ion. of tbe work
The drawinq shall sbow tbe relation of the proposed work to existinq surfaoe and underqround
iaprov..ents. When approved by tbe city Jnqineer, said drawinq beooaes a part of tbi. perait.
D. The General Conditions for all perait. are li.ted on the rever.e .ide. speoial provi.ion. for
this perait are listed below. Wailure to abide by tbese oonditions and provi.ions aay re.ult
in jo~ .hut-down and/or forfeiture of Waithful Perforllanoe Bonde and oa.h depoeite. (8ee
General Condition. 1 and 21.
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B. AD applioation fee au.t aooo.pany thi. applioation. Thi. i. non-refundable.
lI..e of Applioant ~ --;S lZ~,.J Telephone: 4Of6-.3'7tt-Sl~ \
Address 2.Ll-67- t---\.~ ~ \ \..l...E:'" L,.../.p.~ ~ ..JO~t it t=-. .
I. tbi. vork ~einq done ~y tbe property owner at their own re.idenoe? ____yea ~o
Coaplete and attacb Worker.' Coapen.ation and Contraotor Inforaation foras.
The Applioant/Peraittee bere~y aqrees by affixinq tbeir .iqnature to this perait to hold the City
of
C..pbell, its officer., aqents and ..ployee. free, .afe and barale.. froa any olaia or d..and for
d..aqe. re.ultinq froa the vork covered by tbis perait.
The Applloant/Peraittee bere~y aoknowledqes tbat tbey bave read and underetand both tbe front and
baok of tbis perait, and tbat tbey vill infora tbeir oontractor(sl of the inforaation.
ACCBftBD ~~ _S; __ ~~~ L:>~J'!7 r~~ ~D+- (p,1?8B
Applioant (Peraittee) pr nt/. qn Date
KO'1'BS: ALL WOIUt SHALL CODORM WITH '1'RB AftACBBD, APPROVBD PLAMS AND ALL APPLICABLB CUPBBLL
STANDARD DRAWIIIGS AND CONDITIONS.
UB COll'1'aAC'l'OR MUST BAVB UIS PBRMIT AND APPROVBD PLAMS AND MUST DBT WITH '1'RB P.W. IIISP:lCTOR ON
'1'HB SITB A'l' LBAST no DAYS RBWOU STAIlTIKG WOIUt.
KaTICB MUST BB G%VBK '1'0 PUBLIC woau AT LBAS'l' U HOURS BBNU RBSTAIlTIIIG AllY WOIUt.
SPBCIAL PROVI8IOll8
_1.
~street sball Dot be open out for underqround installations. Miniaua out...y be allowed
for oonneotion. or exploration boles. suob outs aust be speoificallY approved by the
Inspeotor.
'av..ent aay be out for underqround installations and aust be restored in accordanoe witb
tbe Utility Trenob aestoration Standard Drawinq.
Work to be staked by a lioensed Land surveyor or Civil Bnqineer and two (2) copies of tbe
out sbeets sent to tbe Publio Work Deptartaent before startinq work.
'1'be bours of work are lialted to outside tbe bours of 7-' a.a. and 3-' p.a. for any work
affeotinq a traffio lane.
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PERMIT APPLICA'1'IOII WBB
PLAM CBBCK DEPOSIT
BOND .oR WU'l'RWUL PBRNItIIAIICB
(R-1)
($U.OOI
AKOUII't
8'1'AHDARD
$50.00
$~.l:.c-....
/') lJ tJ Lf
CASH DBPOSI'f
($200.00)
$500.00 r ~::Cf'). ~
(lOn OW DG. BS'1'.) K $ ~q{) .00
(., OW BOND, $500 MINI $ .s~,d6
OW W.P. BOND, $35 HIli I , 6Go.t7b
PLAM CHBCK ,
,......,.. ~ ~.
ISSUANCB 4
for City Bnq n r
APPROVBD WOR
f: PW'BRMIT
Revieed 8/88
ENCROACHMENT PERMIT ISSUANCE CHECK LIST
City of Campbell Encroachment Permit No. gf.-2?;,Z
Department of Public Works
V/ Applicant section complete
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....~~ v' Five sets of improvement plans submitted
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~ Applicant signature and date
~ Permit Application fee $50.00 ($35.00 for R-I Homeowner),
paid. Receipt number {Joe '-I
~ Plan check deposit, $500.00 (waived for R-I Homeowner),
paid. Receipt number 000 '/,
~Bond for faithful performance, 100\ of City Engineer's
estimate, (waived for R-l Homeowner), supplied or paid.
Amount $ g,OC'Q Form I . D. #
? Cash Deposit: /~'"~<'~tb:t9$~0 min. ($200 for R-l
Homeowner), pa!d.
Amount $tAn-~ Receipt No.
G/ Plan Check & Inspection fee of 7' of FP bond, $35.00 min.,
(waived for R-l Homeowner) paid.
Amount $ :) 0CJ, OD Rece ipt No. ,;) 5/ ~~
V
Worker's compensation information received for Applicant
(see Information Sheet for Encroachment Permits)
All other Public Works requiremenes listed in the
Conditions of Approval of the development.
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Contractor (see Information Sheet for Encroachment Permits)
y/ Certificate of Insurance with Additional Insured's
Endorsment received from Contractor (see General Summary of
Insurance Requirements for Encroachment Permits)
~ Three sets of off-site plans, stamped APPROVED (Tract or
Development and Public Works Permit number and property
address on plans)
~erm1t signed for City Engineer
WEN ALL OF THE ABOVE ITEMS ARE COMPLETE, PERKIT MAY BE ISSUED
Issuer: Initial and date and file with permit
J~UPON ISSUANCE, INITIATE CHECK REQUEST FOR PLAN CHECK DEPOSIT REFUND
8/88
permchklst
CITY OF ~~' CITY ENGINEER'S C~UCTlON COST E;fMATE Permit No~-d~
AddresA- \ -rV\fll,l ;S \~ \ ~ . by~date , {-( ~-f5. ~
Surface Construction
Clearing & Grubbing Lump Sum Estimate - $ -3QJ" (U,
Sawcut Concrete ~ LF@ $ 4.00 - $ :;() . eFO
--
Concrete Removal SF @ 3.00 - $
Curb & Gutter Removal 10 LF@ 5.00 - $ zoo.oo
In10t Drain with Pipe I EA@ 600.00 - $ (poo- c!rt)
Curb & Gutter Llo LF@ 14.00 - $ 5"0- () 0
Sidewalk 90 SF @ 4.00 - $ 1lPO. cJ;)
Driveway Approach 3dr( SF @ 5.50 - $ ~ ~77,~ef)
Handicap lUmp EA@ 400.00 - $
Extruded Curb LF@ 8.50 - $
Rarricade LF@ 50.00 - $
Street Excavation SF)x($0.10)x(____") - $
AC Pavement SF)x($0.30)x(____") - $
Adjust Manhole to Grade EA@ 375.00 - $
Adjust Hanclho1e to Grade EA@ 275.00 - $
Konument Rox w!Konument -
EA@ 600.00 - $
Street Tree (15-gallon) 2- EA@ 300.00 - $ r:?'6o, C :)
Pavement Striping ($100 min) LF@ 0.65 - $
Pavement Legends ($100 min) EA@ 40.00 - $
Stop, Street Name or Other Sign EA@ 120.00 - $
Pavement Markers EA@ 15.00 - $
Pavement Key Cut LF@ 10.00 - $
- $
- $
Surface Subtotal 'S" - $ .L(3/ l. bO
Adjust for size: "5"<$30,000 add 20', "S">$100,OOO subtract 10' (+ or -) $ Z62 - yo
Street Lhhtinl!:
E1ectrol1er / EA@ 2,000.00 - $ 2, ct:.X> ( , -~
Conduit ~O LF@ 10.00 - $ 5"'00,." 0
Conductor, pair ~O LF@ 2.00 - $ 100. t>'()
Pull Rox I Ea @ 200.00 - $ "2..00'ou
- $
Storm Draina2.e
12- or 15' RCP LF@ 60.00 - $
18" or 21" RCP c:..-. - -
LF@ 70.00 - $
Street Inlet -- EA@ 1,600.00 $
-
Manhole EA@ 2,400.00 - $
Rreak & Enter Manhole EA@ 650.00 - $
- $
TOTAL ESTIKAtE $ ~ 97(/' '10
USE FOR &OND $ ~/J .00. C {j
reviaed 6/88
~/l"'.nn_~ft.t:..lI!l.t
TO' Cj~y Clerk
PUBLI C WORKS F J LE NO. <l ~ - ~:3 ":2-
Please collect & receipt
for the following monies:
project)
PVU"!'lLt e.M:
R-] :
($'35)
:t elL:
($ 50)
'( 500)
( % of FPB)
($500 min.)
(T7u of FPB)
($ 35 min.)
Depos i t
Plan Check & Inspection Fee
3521 Other Cash Deposit (specify)
3373
3373
3372 Tentative Parcel Map Fil ing Fee ($350)
3372 Final Parcel Map Fil in Fee ($300)
3372 Tentative Tract Map Fil ing Fee $ 00
3372 Final Tract Ma Fil in Fee ($350)
3372 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 0 the r, $2,250)
3395 Park Dedication In-l ieu Fee per Unit ($1,132)
3380 Public Works Special Projects
3510 Postage
AMOUtn
$
~6.c?C?
s-e;v.. c:> 0 *'
oe
NAME :L:>;""'r--J ~
ADDRESS 2 ~ .)2..
TOTAL
c;;;:, 1<:' ~Qr..J.-J ( uYC i) CUb:') 'Cs)PH;lNE
p1fl///~ 0~ .5.).
$ ~5"5tJ( '-
57'-(-57$>1
ZIP 9s-1 <0
RECEIPT NO.
+-41;f
FOR
C I TV CLERK
Q.ll.Y
~ PAID
DOO~
5~u .)9
Q-7">\
Y <;;.7 y ~
RECE I VED BY
DATE
July, 1987
REFUNDABLE DEPOSIT
CHECK REQUEST
TO: FINANCE DIRECTOR
CITY OF CAMPBELL
Please issue check payable to: WOOD CLASSICS
Description:
,REFUNDABLE DEPOSIT
(30 spaces)
(30 spaces)
(30 spaces)
State: ~ Zip: 95130
(2) (10 spaces)
(24 spaces)
Address:
Line 1: 2452 MELVILLE WAY
Line 2:
City :
SAN JOSE
(20 spaces)
,
Exact Amount Payable:
$500.00
Account Number:
001.00.905.0000.4662
PURPOSE:
RELEASE OF CASH DEPOSIT FOR EXCAVATION PERMIT NO. 88-232. SEE
RECEIPT # 0004 DATED 9-27-88.
Requested by:
Approved by:
Verified by:
DON KING
Title: ENGR. TECH II
Date: 2-1-89
DON 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)
(Name)
Other:
08/24/88
CITY OF CAMPBELL
Permit No.
Applicant
INFORMATION SHEET FOR ENCROACHMENT PERMITS
A separate form must be completed for the applicant and each contractor
that will work under this permit.
WORKERS' COMPENSATION INSURANCE INFORMATION
Name of Contractor/Applicant 'T:::>~1.....J 't-~
!<~~2..K~Cl~
One of the following must be on file with the Public Works Department:
A Certificate of Consent to Self-insure issued by
the Director of Industrial Relations; OR
A Certificate of Workers' Compensation Insurance
Insurance Co.
Policy No. Expiration date
; OR
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
This Certificate of Exemption from the Workers' Compensation
laws printed below (certificate must be signed).
CERTIFICATE OF EXEMPTION
I certify that in the performance of the work for this permit, I
shall not employ any person in any manner so as to become subject
to the Workers' Compensation Laws of California.
,--. /
/- i A;;.
U::J';7;7 ,',.- ~/ U?l.a~---
Date
5eP! k/ 198B
Signed
NOTICE TO CONTRACTOR/APPLICANT: If, after signing this Certificate
of Exemption, you should become subject to the Workers' Compensation
provision of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
. .
.. ...... ..... ...... ................................ ... . .. ... ....... . . . . . ...
CONTRACTORS INFORMATION
Note that all contractors must have current City of Campbell Business
License, State Contractor's License and Workers' Compensation Insurance.
Name of Contractor
Address
Telephone
State Contractor License No.
City Business License No.
Expiration Date
Will do the following types of work:
underground ________P.C. concrete ________A.C. paving ________electrical
________other (specify)
f:PERMINFO
REV. 8/88
REFUNDABLE DEPOSIT
CHECK REQUEST
TO: FINANCE DIRECTOR
CITY OF CAMPBELL
Please issue check payable to:
Dana Karren
Address:
Line 1:
2452 Melville Way
(30 spaces)
(30 spaces)
(30 spaces)
State: CA Zip: 95130
(2) (10 spaces)
(24 spaces)
Line 2:
City:
San Jose
(20 spaces)
Description:
Cash Deposit Rafund
Exact Amount Payable:
$2,000.00
Account Number:
905.4662
Release of cash deposit for excavation permit nO. 88-232.
PURPOSE:
See receipt #2914 dated 1/31/89.
Requested by:
Bill Helms
Title:
Engr. Manager
Date:
6/15/90
Approved by:
Bill Helms
Title:
Engr. Manager
Date:
6/15/90
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
(..
REFUNDABLE DEPOSIT
CHECK REQUEST
TO: FINANCE DIRECTOR
CITY OF CAMPBELL
~
Please. issue check payable to:
DANA KARREN
Address:
Line 1:
2452 Melville Way
(30 spaces)
(30 spaces)
(30 spaces)
Line 2:
City :
San Jose
(20 spaces)
Cash Deposit Refund
State: CA Zip:
(2)
95130
(10 spaces)
Description:
"
(24 spaces)
Exact Amount Payable:
$6,000.00
Account Number:
001.00.905.0000.4662
PURPOSE:
Release of 75% of cash deposit for Excav~tion Permit No. 88-232.
See receipt #2914 dated 1/31/89. We will retain 25% ($2,000.00)
to cover the one year maintenance bond requirement.
Requested by: Gregg Eaton
Title: P . W. Inspector
Date: 6/27/89
Approved by: Donald C. Wimberly
Title: P. W. Director
Date:
Verified by:
Accounts Receivable
Date:
SPECIAL INSTRUCTIONS FOR HANDLING CHECK:
Mail as is
xx
Mail in attached envelope
Return to:
(Department)
(Name)
Other:
08/24/88
TO: City Clerk
PUBLIC WORKS FILE NO. j/f'-cl32.J
Please collect & receipt
for the following monies:
ACCT.
35-3396
'3372
3521
3521
@:..
projec t)
PeJr..r.l-U eM :
R-] :
($'35)
(S200)
(Cash) D~pos it
Plan Check & Inspection Fee
21 '
Other Cash Deposit
3373
3373
Project
General
&
3372 Tentative Parcel Map Fil ing Fee ($350)
3372 Final Parcel Map Fil in Fee ($300)
3372 Tentative Tract Map Fil ing Fee $ 00
)372 Final Tract Map Fil in Fee ($350)
3372 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)
l395 Park Dedication In-lieu Fee per Unit ($1,132)
3380 Public Works Special Projects
3510 Postage
TOTAL
NAME
V'1 lL) A ~, /2 A:! t:- ^-)
PHONE
~;';;7<1-5/3/
ADDRESS
";)'-I5~ If 7 E. 1-- VI LLF 1.( I flY.
"
ZIP
SJ.
FOR
CITY CLERK
a-u. y
RECEIPT NO.
~/h:;,/4
,
J..-{J
J/:tJI/tq
I
AMOl.HT PAID
RECE 'VED BY
DATE'
AMOUNT
$
5.,0&0 f1'1/~
f {lCC>, cc,. '714]
"
$ ?5(oO ~
July, 1987
r-
CITY OF CAMPBELL
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
HELMS
DISCARD
\ WIMBERLY
JOCSG-N
KRUBER
PENOYER
Department:
Public Works
June 14, 1990
Mr. Dana Karren
2452 Melville Way
San Jose, CA 95130
SUBJECT: ONE YEAR MAINTENANCE ACCEPTANCE
~ PERMIT NO.: 88-232
LOCATION: 418 Industrial Street
We have made a one year maintenance inspection of subject public
works improvements and find that no maintenance is required.
Your cash deposit of $2,000.00 will be refunded under a separate
cover.
Sincerely,
Gregg Eaton
Public Works Inspector
GE:sd
f:88-232-2 (permits)
DAte L)/ J ~ Jqo .
f r j
Address 41. .
PUBLIC WORKS INSPECTION REPORT
Permit or Project No. 8:?' - :J3~
'~nd0U2/L~
Typt: of work; StreetL Storm
Othc:r (describe)
SAnitAry
ElectricAl
[JPRELIMINARY INSPECTION WITH DEFICIENCY LIST (AttAched)
[JFINAL INSPECTION WITH DEFICIENCY LIST (AttAched)
o FINAL INSPECTION - ACCEPTANCE
Signed plAnii"? Y N (If uigned, Council AcceptAnce.)
ChArges AgAinst deposit? y
Overtime: hrs. @ $
DAte {, reAlOon:
N
/hr.
-
$
BArriCAde rentAl (AttAch invoice)?
DAte {, reAson;
Y
N
$
Other?
$
$
TotAl chArges deducted from deposita
(CAsh Deposit $ le8s chArges $
$
- Refund $
[JONE YEAR MAINTENANCE WITH DEFICIENCY LIST (AttAched)
~ONE YEAR MAINTENANCE - ACCEPTANCE
(RelcA8e'm.intenAnce bond. Check Request if CAsh.)
ck. r eq . )
Inspector
,:1
r
CITY OF CAMPBEll
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
Department:
Public Works
June 27, 1989
Mr. Dana Karren
2452 Melville Way
San Jose, CA 95130
RE: Final Inspection and Acceptance
Permit No.: 88-232
Location: 418 Industrial
Maintenance Bond Amount: $2,000.00
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. To
guarantee this, you must post a maintenance bond in the amount indicated
above. We will retain 25% of the $8,000.00 faithful performance bond you
posted as your maintenance bond and refund the remaining $6,000.00 under a
separate cover.
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.
~incerely,
~
~ M. Jocson
~;;~~ate Civil Enginneer
CMJ : sd
cc: G. Eaton, P.W. Inspector
Suspense - I year
PUBLIC WORKS INSPECTION REPORT
DAte ~4Z~i Permit or Project No. 8~ -Z.3L
Address 4-18- "..::z:;:; DU5r7t.d'4' '-
Type of work:
Stre.t Storm
Other (describe)
SAnitAry
~ c.. e.. ~./.,._~
ElectricAl ____
o PRELIMINARY INSPECTION WITH DEFICIENCY LIST (AttAched)
o FINAL INSPECTION WITH DEFICIENCY LIST (AttAched)
~ INSPECTION - ACCEPTANCE
Signed plans? y ~ (If signed, Council AcceptAnce.)
Charges AgAinst deposit? y
Overtime. hrs. @ $
DAte , reason:
~
/hr.
-
$
BarricAde rentAl (Attach invoice)? y
DAte , reAson.
~
$
Other?
$
$
/)
/'C/..'/)I/fr.' c.-
;/. ('C'('
(,1 ('.
'")
(71 /J.
TotAl ChArge. deducted from deposit.
(Cash Deposit $ le.s chArges $
$
- Refund $
DONE YEAR MAINTENANCE WITH DEFICIENCY LIST (Attached)
o ONE YEAR MAINTENANCE - ACCEPTANCE
(ReleAae'maintenAnce bond. Check Request if CAsh.)
~~~
ineer
~
Inspector
ek. req.)
. .
"
!)ate
PUBLIC WORKS INSPECTION REPORT
Addre..
4/8
. .. --. - - .-
- .::z::;:; D u5 77t", '4' '--
Permit or Project No. 8~ -23-i-
~pe o~ work. Stre..t StoZ'm Sanitary ElectricAl ___
Other (deacribe) ~('..&." "-~_~
o PRELIMINARY INSPECTION WITH DEFICIENCY LIST (AttAched)
C FINAL XNSPECTION WITH DEFICIENCY LIST (Attached)
~ INSPECTION - ACCEPTANCE
Signed Flana'? Y C!::) (If .igned, Council acceptance.)
Charge. agAinst deposit? y
Overtime. hrs. . ,
D4te '.reason.
l!:)
Ihr.
-
,
'."
BArricade rental (attach Lnvoice)? y
!)ate , reAaon.
cD
,
Other?
,
,
,
· Refund $
Total charge. deducted from deposit.
(Cash Deposit , leas charge. $
DONE YEAR MAINTENANCE WITH DEFICIENCY LIST (AttaChed)
.0 ONE YEAR MAINTENANCE - ACCEPTANCE
(Rele.8e'..inten~nce bond. Check Request if CAsh.)
cJt. req.)
Engineer
~
Inspector
....-
CITY OF CAMPBELL
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 # (4 0 8) 3 7 9 - 2 5 72
;'JlUGER
tPENOVER
Department:
Public Works
June 2, 1989
Dana Karren
Wood Classics
2452 Melville
San Jose, CA
Way
95130
RE: Final Inspection - Deficiencies
Permit No.: 88-232
Location: 418 Industrial Street
Gentlemen:
You have requested a final inspection on subject construction work.
There are deficiencies in the work which are indicated on the
enclosed list. These deficiencies must be corrected to the
satisfaction of Public Works Inspector Gregg Eaton before we can make
a Final Inspection or acceptance of the work.
Upon completion of the corrective work, please submit a written
request for a Final Inspection and acceptance.
Sincerely,
Carlos M. Jocson
Associate Civil Engineer
CMJ:t
cc: G. Eaton
Enc.
88-232
PUBLIC WORKS
PERMIT 88-232
MAY 30, 1989
RE: 418 INDUSTRIAL
ELECTRIC INSPECTION DEFICIENCIES
1. Install 30 amp fuses and fuse holder in City splice box
2. Straighten street light fixture
3. Grout pole base
4. Ground rod to high-cut level with conduit
5. Install 3 amp fuses in pull box next to street light standard
6. All pull box lids shall have hold down bolts
7. All pull box lids shall read "Street light"
RSL/t
88-232
~A9-
Date ~~':
PUBLIC WORKS INSPECTION REPORT
Permit or Project No. /i8 -2,32-'
Address 4/8 ~;tusne/4L
~pe of work: Street V Storm
Other (describe)
Sanitary
Electrical ---
[JPRELIMINARY INSPECTION WITH DEFICIENCY LIST (attached)
~NAL INSPECTION WITH DEFICIENCY LIST (attached)
o FINAL INSPECTION - ACCEPTANCE
Signed plans? Y N (If signed, Council acceptance.)
Charges against deposit? Y
Overtime z hrs. @ $
Date" rea&on:
N
/hr.
-
$
Barricade rental (attach invoice)? y
Date " reason:
N
$
Other?
$
$
$
- Refund $
~otal charges deducted from depositz
(Cash Deposit $ less charges $
ck. req.)
DONE YEAR MAINTENANCE WITH DEFICIENCY LIST (attached)
o ONE YEAR MAINTENANCE - ACCEPTANCE
(Release'maintenance bond. Check Reque&t if cash.)
~
~neer
InsS
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-j CITY OF CAMPBEll
Department of Public Works
CONTRACT IDENTIFICATION
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PROJECT INSPECTOR'S
DAILY REPORT
Page I of I
Date 5" - 30 -<6"- 7
Project or
~ Permit No.
Name or
Location
I
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CITY ENGINEER
PROJECT ENGINEER
~Sp<~
PROJECT INSPECTOR
PRODUCER
Wendy Hong Insurance Services
Nationwide Insurance Co.
2041 Ringwood Ave.
San Jose, CA 95131
(408) 433-5205
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND,
EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
COMPANY A
LEITER Nationwide Insurance Co.
INSURED
COMPANY B
LEITER
R.S. Steed Construction, Inc.
155-A Moffet Park Drive
Suite 240
Sunnyvale, CA 94089
COMPANY C
LEITER
RECEIVED
fEB 01 1989
PUBLIC WORKS
COMPANY D
LEITER
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY
BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDI-
TIONS OF SUCH POLICIES.
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EffECTIVE
OA TE (MMiOONYi
POLICY EXPIRATION
OATE (MMiOONY)
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS MAOE [X] OCCURRENCE 74 PR 506-584-0001
OWNER S & CONTRACTORS PROTECTIVE
10-25-88
10-25-89
GENERAL AGGREGA TE
PRODUCTSCOMP/0PS AGGREGATE
PERSONAL & ADVERTISING iNJURY
EACH OCCURRENCE
fiRE DAMAGE IANY ONE fiRE)
MEDICAL EXPENSE (ANY ONE PERSON)
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
CSL
$ 2,000,
74 BA 506-584-0002
10-25-88
10-25-89
BOOIL Y
INJURY
(PEg PERSON) $
BOOIL Y
INJURY
tcEC~OENT) $
74 CD 506-584-0003
10-25-88
10-25-89
EACH
OCCURRENCE
OTHER THAN UMBRELLA FORM
WORKERS' COMPENSATION
AND
EMPLOYERS' LIABILITY
$
$
$
(DISEASE POliCY LIMIT)
IDISEASE-EACH EMPLOYEE)
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I RESTRICTIONS I SPECIAL ITEMS
Certificate holder and its respective officers, agents and employees are also named as
additional insureds as per form CG 20101185 attached.
City of Campbell
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EX-
PIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES,
AU(;J~ESENTATlVk~
POLICY NUMBER:
506-584
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS (FORM B)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
Name of Person or Organization: The City of Campbell
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations
as applicable to this endorsement.)
WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the
Schedule, but only with respect to liability arising out of "your work" for that insured by or for you.
The City of Campbell and its respective officers, agents and
employees are named as additional isnureds from and against
any claims, loss liability, cost or expense arising out of or
in any way connected with the construction of the project. This
coverage shall be primary and any coverage carried by additional
insured shall be excess insurance only.
Insured: R.S. Steed Construction, Inc.
155-A Moffet Park Drive
Suite 240
Sunnyvale, CA 94089
CG 20 10 11 85
Copyright, Insurance ~ervices Office, Inc., 1984
D
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"-...
CITY OF CAMPBELL
70 NORTH FIRST STREET
CAMPBELL, CALIFORNIA 95008
(408) 866-2100
Department: Planning
July 28, 1988
Mr. Robert Varrelmann
564 Jesse James Dr.
San Jose, CA 95123
Mr. Dana Karren
2452 Melville Way
San Jose, CA 95130
RE: OUR FILE NO.: S 88-07
SITE ADDRESS: 418 INDUSTRIAL ST.
APPLICANT: R. VARRELMAN
Conditions attached to "s" approval of the above-referenced project are
attached as Exhibit A - Conditions of Approval.
Section 21.42.090 of the Campbell Municipal Code provides that any approval
granted under this section shall expire one (1) year after the date upon which
such approval was granted, unless an extension or reinstatement is approved.
Approval is effective ten (10) days after decision of approval of the Planning
Commission, unless an appeal is filed.
GRANTED BY THE CITY OF CAMPBELL PLANNING COMMISSION AT A REGULAR MEETING HELD
ON: July 26, 1988.
CITY OF CAMPBELL
PLANNING COMMISSION
d'.4.'&~
ARTHUR A. KEE
SECRETARY
ld/lj
Attachment: Conditions of Approval
..-----'
'-
CONDITIONS OF APPROVAL ~ILE # S 88-07
SITE ADDRESS: 418 INDUSTRIAL ST.
APPLICANT: VARRELMAN, R.
PC MTG DATE: 7-26-88
~/
The applicant is hereby notified, as part of this application. that he/she is
required to meet the following conditions in accordance with the Ordinances of
the City of Campbell and the Laws of the State of California. Additionally.
the applicant is hereby notified that he/she is required to comply with all
applicable Codes or Ordinances of the City of Campbell and the State of
California which pertain to this development and are not herein specified.
1. Property to be fenced and landscaped as indicated and/or added in red on
the plans. Landscaping and fencing shall be maintained in accordance with
the approved plans.
2. Landscaping plan indicating type and size of plant material, and location
of irrigation system to be submitted to the Planning Department and
approved by the Site and Architectural Review Committee and/or Planning
Commission prior to issuance of a building permit.
3. Fencing plan indicating location and design details of fencing to be
submitted to the Planning Department and approved by the Planning Director
prior to issuance of a building permit.
4. Applicant to either (1) post a faithful performance bond in the amount of
$5,000.00 to insure landscaping, fencing. and striping of parking areas
within 3 months of completion of constructionj or (2) file written
agreement to complete landscaping. fencing. and striping of parking areas.
Bond or agreement to be filed with the Planning Department prior to
application for a building permit.
5. Applicant to submit a plan to the Planning Department, prior to
installation of PG&E utility (transformer) boxes, indicating the location
of the boxes and screening (if boxes are above ground) for approval of the
Planning Director.
6. Applicant to submit a letter to the Planning Department. satisfactory to
the City Attorney. prior to application for building permit. limiting the
use of the property as follows: 425 sq. ft. of office usej and, 2.432
sq. ft. of industrial/warehouse use.
7. All mechanical equipment on roofs and all utility meters to be screened as
approved by the Planning Director.
8. Building occupancy will not be allowed until public improvements are
installed.
9. All parking and driveway areas to be developed.in compliance with Chapter
21.50 of the Campbell Municipal Code. All parking spaces to be provided
with appropriate concrete curbs or bumper guards.
CONDITIONS OF APPROVAL~FILE U S
SITE ADDRESS: 418 INDUSTRIAL ST.
APPLICANT: VARRELMAN, R.
PAGE 2.
88-07
"'--
10. Underground utilities to be provided as required by Section 20.36.150 of
the Campbell Municipal Code.
11. Plans submitted to the Building Department for plan check shall indicate
clearly the location of all connections for underground utilities including
water, sewer, electric, telephone and television cables, etc.
12. Sign application to be submitted in accordance with provisions of the Sign
Ordinance for all signs. No sign to be installed until application is
approved and permit issued by Planning and Building Departments (Section
21.53 of the Campbell Municipal Code).
13. Ordinance No. 782 of the Campbell Municipal Code stipulates that any
contract for the collection and disposal of refuse, garbage, wet garbage
and rubbish produced within the limits of the City of Campbell shall be
made with Green Valley Disposal Company. This requirement applies to all
Single-family dwellings, multiple apartment units, to all commercial,
business, industrial, manufacturing, and construction establishments.
14. Trash container(s) of a size and quantity necessary to serve the
development shall be located in area(s) approved by the Fire Department.
Unless otherwise noted, enclosure(s) shall consist of a concrete floor
surrounded by a solid wall or fence and have self-closing doors of a size
specified by the Fire Department. All enclosures to be constructed at grade
level and have a level area adjacent to the trash enclosure area to service
these containers.
15. Applicant shall comply with all appropriate State and City requirements for
the handicapped.
16. The applicant is hereby notified that the property is to be maintained free
of any combustible trash, debris and weeds, until the time that actual
construction commences. All existing structures shall be secured by having
windows boarded up and doors sealed shut, or be demolished or removed from
the property. Sect. 11.201 & 11.414. 1979 Ed. Uniform Fire Code.
FIRE DEPARTMENT
17. Building shall conform to requirements for H-3 occupancy which requires two
conforming exits.
18. Provide information regarding the use and storage of any hazardous
materials. File "Declaration of Hazard Materials".
PUBLIC WORKS DEPARTMENT
19. Obtain an excavation permit, pay fees, and post surety to install an
electrolier, a 5-ft. wide sidewalk, and a driveway approach (8 ft. x 25 ft.
with 4 ft. wide slopes at each end).
BUILDING DEPARTMENT
No comments at this time.