95-259
aTY OP CANPBEU ENCROAawENT PERMIT
DEPT. OP PUBUC WORICS (for wortiDs within tbe
70 North Pint St. public riabt4-way)
=2~ 9SCD IIAed / /- 16--- 9t; --. J AppIieaticm Date (IJ I C;.Lj '>'
Pemait ap- iD 12 rt/JIfJ&. J7J W AppIieatioa apirea iD 6 ....
APPUCAll0N - AppIicatioa II baeby ID8de for a Public Worb Pemait iD 8CCOI'duce witb CuIpbcU MuaicipaI Code, Secdaa IUN. (~ieetioa apUea
iD 6 IDOIltbl if tbe permit II DOt iIIued).
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Utility tracb Iocatioa
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A. wort IIdcIrea or tnIl:t *-
B. Nature of WOIt
C. Attacb four (4) CIllpia of aD CIIIiaeaed clnwiq IbowiDc tbe Ioc:adoa, CItat aDd ctiIIIe___ of tbe work. Tbe clnwiq IIWI ... tbe ftIatioD of tbe
Jb'OPC*d WOIt to aIIaiDi IUIface ucl UDdcIp'ouDd impmvcmealL WIleD approved by tbe Cty &p.ecr, aid clnwiq bccomeI a put of tbiI permit.
D. AD wort IbaI1 caaIorm to tbe Cty'1 GeDeIaI Caaditica, SIaadard CcaItructioa PnM&aI ucl SIaadard CoaItructioa DetaiI& for Public WOIb
CoaItructioa; tbe GcDeza1 Pemait CoDditiolllliltecl 011 tbe nMlIK Iide; ucl tbe Special PnM&aI for tbiI permit, IiItecI below. Failure to abide by
tbac CIODditioaI ad prc:wiIioaa may ftlIUlt iD job lbut4lwD aDd/or foIfeiture of Paitblul ~ Sureties RDd CIIb depoIiIL (See GeDeral
Pemait CODClitioalI aDd 2.)
E. A IlOIII'CfuDdabIe appIicaticm fee mUlt aoo{WI''f'"'OY tbiI ~......
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AddftII f/1r- 9 'f X'I lJt..vl- LA'1(~i..J"L LA~~
Is tbiI wort beiDa doae by tbe property OMICr at tbeir 0W1l raidcDce? Yea
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Name of AppIic:aDt
Complete aDd attIIcb WOJtas' CompellUticm ucl Coatrador IDformatioa fonDI.
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The J\ppIicaIlt/Permittee baeby apeeI by aftb:iDa tbeir IipatUI'C to tbiI permit to bold tbe Cty of CampbeU, ita olficen, apIlta ucl empIoyeeI flee, ute
ucl barmlcII from any claim or demaDd for damap IClUltiDg from tbe WOIt covaed by tbiI permit.
The AppIic:aDtfPamittee bcreby IICkIlowIcdpI that they ~ read aDd UDdeIItaDd both tbe fnlat aDd bid of tbiI permit, aDd they will inform tbeir
COIltnctor(l) of tbe iDformatioD. :.b/2
_ lJ.-\<.MA J ;J ~ 62-1 <.hI' l J::J::2f of 't /J. r hr
(ApplicaDt (Permittee) priDt/1ip I ( Date' ,
NC>'I'eS: ALL WORK SHALL CONFORM WllH 11IE ATfAamD, APPROVED PLANS AND ALL APPUCABLE CAMPBELL STANDARD
DRAWINGS AND CONDmONS.
11IE CONrRAcroR MUST HAVE nus PERMIT AND APPROVED PLANS AT 11IE SITE AND MUST NOTIFY 11IE PUBUC WORKS
DEPARTMENr AT LEAST 1WO DAYS BEFORE STAR11NG WORK.
NanCE MUST BE GIVEN TO PUBUC WORKS AT LEAST 24 HOURS BEFORE RESTAR11NG ANY WORK.
SPECIAL PROVISIONS
_I.
Street IbalIIIOt be opeD cut for UDdCJpouDd iDRaIIatioIII MiDimum cull may be aIIcJM:d for COIl~ or ezpIomioa boIcL Such cuts must
be mecific:aDy atJmUVed bv the IDsoector Drior to c:uttia
PnaDcat may be cut for uadcrpouDd iDItaIIatioal aDd mUlt be reatored ill aa::ordaDce with tbe Utility TJe8Cb Ratmatioa Studard DmwiDg.
Work to be Itabd by a IiccDIed Lucl SuIYeyor or Civil &,iDeer aDd two (2) CIllpia of tbe cut 1IIeetI1CIl~ to tbe Public WOlD Department
before ItartiDa wort.
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STANDARD
AMOUNT
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Date
REf"RT1'T NO.
1030 g
566
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PBRMIT APPUCAll0N PEE $210.00
PLAN amcK DEPOSIT ssoo.oo
SURElY FOR PAmIPUL PERFORMANCE (10095> OP ENG. ESI'.)
CASH DEPOSIT (4~ OP SURETY, S500 MIN)
PLAN amcK It INSPBCIlON PEE (FIRSI' ~,OOO 14~;
Next S30,lJOO.$8O,OOO 10%; AmouD~'cr than $80,000 "', S200 miD)
APPROVED FOR ISSUANCEicJ).;5V(/ dJ
~ ~ Eqincer
b:PW PERMITfRev.4,194
USA phone (800) 642-2444
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TICKET NO.
/./> Please collect & for the
~~ """A"~1(fr::iect Revenue (SDecifv nraiectl
ENCROACHMENT PERMIT
472 Application Fee
Non-Utility Encroachment Permit ($225)
R-1 First Permit (No Fee), Subseauent PermitlYr ($100)
Utilitv Encroachment Permit
Arterial/Collector Street
Residential Street/Other Areas
Plan Check Deoasit
Faithful Performance Suretv (FPS)
Monumentation Surety
Cash DeDosit
Labor and Material Suretv
Plan Check & Inspection Fee (Non-Utility)
Engr.Est. < $250,000
Enar.Est. > $250,000
Utilitv < $100 000
Conduits/Pipelines up ta 500 Feet ($1.60/ft.)
Above 500 Feet ($1.1 O/ft,)
ManholesNaults/Etc. ($1 05/ea)
Pole Set/Removal ($105/ea)
Minimum Charge Per Location ($120)
Street Tree P1antina/Removal ($105/tree)
Utilitv> $100,000 (DeDosit 15% of ENGR, EST.)"
Proiect Plans & SDecifications Proiect No.
Standard SDecificatians & Details ($1/Pa $12/BDOk)
CODies of Enaineerina MaDS & Plans ($.50/sa.ft,)
Penalties: Failure to restore Dublic imoravements ($1 OO/Calendar Dav)
(Muni Code Sectian 11.34.010)
472 Penalties: Failure ta correct unsafe conditions ($100/Calendar Dav)
LAND DEVELOPMENT
4722 Lot Line Adiustment
472 Parcel MaD (4 Lots or Less)
472 Final Tract MaD (5 or Mare Lots)
472 Certificate af ComDliance
472 Certificate of Correctian
472 Vacatian af Public Streets & Easements
472 Assessment Segregatian ar Reapportionment
First Split
Each Additional Lat
472 Starm Drainaae Area Fee Per Acre
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NAME OF PAYOR 5~ ~-,A..u.J. I " I P " .A." "" ~ A 7; ~.;; PHONE I, 5" S -.;;; r-t7?J
ADDRESS 97 g J A A .1 ~~~ J.. '" .... d... "':i.A H ZIP q !,IC.q-,jo
** Actual Cost Plus 20% Overh ad (Nan-Interest beari!a deDosit)~ 1ft..l /}.
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I.... .......... ..... .... ........... ....... -\...... ..... ... .. ..... ...... ......<d
TO: City Clerk
..
492C
496~
TRAFFIC
472
472
472
472
472
427
472
OTHER
PUBLIC WORKS DEPARTMENT RECEIPT
Effective July 1, 1995
PUBLIC WORKS FILE NO. q 5 ' ~5" CJ
PROPERTY ADDRESS "f ~~ ll1 z.~
monies:
'1.-!1 ~-
220
220
220
220
220
($325)
($225)
($500)
(100% of ENGR.EST.)
(100% of ENGR.EST.1
(4% of FPS)($500 min.)
(100% of ENGR. EST.)
472.
220
472
(12% of ENGR. EST.)
(DeDosit 15% of ENGR. EST.)**
220
476
476
476
472
($500)
($1,060 + $25/Lot)
($1,380 + $25/Lot)
($400)
($3001
($550)
($550)
($170)
(R-1, $2,000)
(Multi-Res, $2,250)
(All Other, $2,5001
Parkland Dedication Fee (75%/25% Due UDan Cert. of OccuDancv)
Postaoe
Intersectian Turn Counts (Twa-Hour Count) ($601
Intersectian Turn Caunts (a.m. ar p.m. Deaks) ($125)
Traffic Flaw MaD (Dailv Traffic Valumes) ($271
Camnbell Traffic Model (Full ScaDe Assessment) ($2250)
CamDbell Traffic Model (Reduced Sea De Assessni$740)
Truck Permits ($35/triD)
No Parkino Sians ($1/each or $25/100)
TOTAL
$ .-:J~ 11\_
NAME OF APPLICANT
roR
ern CLEB
ONLY
RECEIVED
JAM 1 81996
CITY CLERK'S OFFICE
h:\recfrm3. wk3(mp)rev, 1/9/96