95-262
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~ or CAMPBELL
DZP'l'. or PUBLIC 1IORD
70 North rira~ S~.
caapbell, Cl 95008
(408) 866-2150
JIID ~r.uiU Il-l
.JO Pm!: D~Ac:RImIft' PmIIIrI'
(for work1ncJ witll1ll tile
public r19b~-of__y) X-Jtaf. file
($3,500 -v:t... value of work) // "'!J a..c---
~.8Ued /l- ,.-:;)cJ -7__"'5-/. jApplicaUcm Deq L:. - <:::::S..'(} - L..-:~
~tV' Applicaticm apina ill 3 _.
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APPLICl'l'ION - ApplicaUon 1a b.reby _de for. Public WOrb Pu1I1~ ill accordaftce ritb CUipbell
llUnicipal Code, Se~ion 11.04. (Applica~ion expiru ill , ~ if ~ pua1t 18 DOt 18.ued)
110d. R;d.9,fllLil)-1" ~~~ll, Ca.
A. Work .ddre..
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8. ..~ur. of work:
C. A~tach tbre. (3) copie. of a drawinv abowinv tIl. loca~icm, aten~ and .u..n.lou of ~ work.
'!'be drawing aball abow tile rel.tion of tile propoHd work to ex1atiDv iaprovaenu. When
.pproved by tIl. ci~ En9ineer, Aid drawin9 becoae8 . pan: of tbi. peDl1~.
All work lIball confora ~o tbe Ci~y'. General CoDdi~iou, st.aDdard Conatmct1cm lTov1alou and
Standard COna~ru~ion Detail. for Public .orb COnatruct1on, '!'be GeDeral "rai~ CandiUou
li.ted on tIl. rev.r.. .id., and Special Provl8iona for tbia pua1t, ll8ted belov. hilure to
abide by the.. concUUona and prov1aiona _y nault ill jGb abut-dovn aDd/or forf.itan of
r.itllful Perforaance Surety.
Addr...
'I'elepbanaa 4- o&' - ~ 71 - ~ S'S- 0
~ok'
COmplet. and attach .orbra' Coapenaa~ion and ccmtractor IDfor.aticm toa..
'the Applicant/Permitte. bereby aCJ1"H. by .ff1xi.n9 ~1r .ipatura to tbia perait to bold tbe Cl~ of
Campbell, i~. officera, .genu and .-ploy", free, Afe and baral... fraa any claia or daaDd for
damag.. r..ulting fro. tile work covered by tbi. pera1t.
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bereby .cknowledge. that tIley bave read. and underat:ud both ..~ front and
tbat tIl.y will infora tIle1r contractor(.) of tile 1Ilfo~~icm.
11-::2{;' -7J.-
Deq
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NOTES: ALL WOIUt SHALL CONFORM WITH TIlE AT'l'ACBED, APPkIVBD PI.AHI AlII) ALL APPLtCUI.J: CAIIPIIILL
STANDARD DETAILS AND CONDITIOHS.
THE CONTRACTOR MOST HAVE THIS PERMIT AND APPROVED PLUS AlII) lIDS'!' DlWfGB '1'0 IIDT 1rI'1'B '1'BZ ....
INSPECTOR AT THE SITE AT LEAST TWO DAYS UPOD STAR'l'IIfG ~.
NO'l'ICE IIDST BE GIVEN '1'0 PUBLIC WORKS AT LDST 24 BOOBS IIUORE RIS'1'AR!'I1fc: All'! 1IOIUt.
SPECIAL PROViSIONS
(,).$6 j/-r'HANi,/1JfJ.....,) 'f/M,t/\ /U'w:,/t. CJPUJ -rOo bJW. ^(j,J6't.. INr6 e.Jt/jiJJr-
rANC-. wiT.) #4 ~. (4J fJFfi.. IJwc.J ~~/lF~tI't: J/t,Ij !2ePLACIJ -rG
N~-r r;t....tU;A1J4.;1.)L,. USe CAcTttA,./> CL A Co/Vc.tJ:f;'l; Cb s,fU ""'l)(,) .
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SORETY FOR rA%"1'DUL
APPROVEn FOR ISSUANCE
(100t or aG. ~.)
..~C()o.o 0
f: R1 PERKI'1'
-.viaed 6/92
(sa 0'1'IID SDlIB)
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To: Accounts Receivable
Please Issue Check
Payable to:
Address - Line 1:
Line 2:
City:
Description:
Amount Payable:
Account Number:
ate and Receipt No:
Permit No:
Purpose:
Requested by:
Approved by:
Cil. of CampbeIl- Chet:A: Reqnest
A. E. Stephenson
1192 Ridgeley Drive
Campbell
State: CA
Zip: 9 5 0 0 8
REFUNDABLE DEPOSIT
Finance OnlY1
INTEREST EARNED
$500.00
101.2203
101.540.7448
11/20/95 #88859
95-262
Refund of Remaining 25% of Faithful Performance
Surety.
Robert Phillips ~~ ~Tit1e: Project Inspector Date: 4/4/97
}\i2
Michelle Quinney
FINANCF. ONLY:
Verified by:
Title: City Enqineer
Date:..! I /c, 7
Title:
Approved by:
Date:
Title:
Mail As Is:
**
Return To:
Date:
Special Instructions For HandIing Check
Mail in Attached Envelope:
(NAME)
(Department)
Other:
rev: 3/25/95
PROPERlY ADDRESS
.!><<f.4":.3..'..5>.:'5::...3..:.:5<.:.4<9?2}Y::'Pro;' 0 _~~rve>n::::ua000.rq.:::...<qf~rroJr':e::....c:..':..t;:!1':;0m~}~~e,~i.tl.~.:..... .. ....................,.,.,., "'.',',',',',','/","""""""""""""""""""""""",,"""""'"~cecco"~"~ ............~........:::::::'.,.,',',
Z1 )HtC( "'" ,1__ ...... [J . q..........q...............,.,.,.,.'.'...'l'.'.'.,... ..q..... qq
ENCROACHMENT PERMIT
472. ADDliclltion Fee
Non-Utllitv Encroachment Permit ($2251
R-1 Fnt Permit (No Feel Sub.eauent Permit/Yrl$1001
Utllitv Encroechment Permit
ArterI8I/Collector Street
Resld.ntlal Street/Other Ar...
Plan Check Deaosit
Faithful Perfonn8nc. Surety CFPS)
Monumentetion Surehl
C..h DePO.it
Labor IIf1d Materilll Surety
Plan Check '" InSll8Ction F.. (Non-Utilityl
472~ Enar.Est. < $250.000
220 Enar.Est. > $250.000
472 Utllitv < $100.000
Conduit./PIP.Kne. UP to 500 F..t '.1.60/ft.1
Above 500 Feet ( $1 .1 O/ft.)
ManhoIe.Nault./Etc. '.'05/eal
Pole SetJRemoval (.,05/.al
Minimum Qlarg. Per Location ,.,201
Street Tree P1ent1-;;;;JR.movel '.,05Jt",81
Utilitv > .,00 000 D.ao.it 15% of EN GR. EST.I"
Proiect Plan. IlL S.....,iflc8tion. I'mioIcl: No.
Standard S.....,iflclltion. IlL Detail. (."Po .'2JBookl
CoPie. of E Maa. IlL Plan. '..50/.a.ft.)
Penaltle.: F8iIunI to restore Dubllc imarovement. '., OO/ealendar Davl
MWII Cod. Section 11.34.0101
472 Penaltle.: FIIiIure to correct un.af. condition. ,.,00 Calendar Davl
LAND DEVELOPMENT
4722 Lot Una Adiustment
472 Parc.1 Maa 14loU or L...I
472 Final Trect MaD 15 or More Lot.1
472 Certificat. of ComDIianc.
472 Certlflcat. of Correc:tlon
472 Vecation of PubHc Su-t. IlL Ea..ment.
472 A....ament Seareaation or R.apportionment
Firat Split
Each Additional Lot
472 Storm Drainage A..a Fee Per Acre
NAME OF APOlICANT Cl c;' . ~ 1- >0i) I. -
. / U
NAME OF PAYOR R, F. S'; e (J ~ e YL-. (l/l.--
/19;2. J!:;1ceJ e w llv
I
TO: City Clerk
4965
TRAFFIC
472
472
472
472
472
427
4721
OTHER
ADDRESS
PUBUC WORKS DEPARTMENT RECEIPT
Effective July 1. 1995
PUBLIC WORKS FILE NO. q~ .... :J. {p ~
/J 91. 12 1/]t:.1::' ~'/ 11 fl. .
220
220
220
220
220
.3251
$2251
.5001
100% of ENGR.EST.
100% of ENGR.EST.I
4% of FPSH.500 m1n.1
100% of ENGR. EST.I
:1060.00
(12% of ENGR. EST.I
'D.po.it 15% of ENGR. EST.I"
220
476
476
476
472
.500
., 060 + $25/Lotl
., 380 + $25/Lotl
.4001
.3001
"5501
(.5501
'.,701
(R-1. $2.0001
(Multi-R... $2.2501
IAN Other $2 500)
Postm.
Int.ruction Turn Count. /Two-Hour Countl (.601
Int....ection Turn Count. 'a.m. or a.m. a.ak.1 '.,251
Traffic Flow MaD IDaHv Traffic Volume.1 1$211
C......beH TI'1IffIc Model Full ScoP. A.....ment ($2 2501
C8mabeH Traffic ModellR.duced Scoa. A.....mlt7401
Truck Permits . 36ltriftl
No Parklnn ~n. 1.' leech or $25/1001
TOTAL
. d-C)dO. OD
9---
PHONE l./O>f '1') 1-1 'b f,t;
ZIP q~6r)~- () 7 u 6
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RECEIVED
NOV 2 01995
C Tt CLERK'S OFFICE
h:\recfrm3, wk3(mplrev. 8/1 0/95
ern OF CAMPBEIL
FEr
I. 95 -.)0 ~
~ SHKlf:I- FtR ~ J.oIII:HIII'.I~
WORKERs' cntPENSATION INSURANCE mFORMATION
Name of Ccntractcr/~ 0 ~ ( S- + ~ ~~ ~
One of the folladn; lIIJSt be an file with the ~ Works Department:
_ A Certificate of o:msent to Self-insure ie.c:l1ad by the Direct:cr of
In:iustrial. Relati.cns; QB
_ A Certificate of Wo1:Xers' 0 "''1~ticn Insurance
Insurance Ce.
Policy No. Expizati.cn Date ; OR
~ 'Ibis Certificate of EXempti.cn tran the Workers' 0 ""1 ~tion
laws pri.ntai belCM (certificate must be signed).
UJ<J.'J.l'.l.CATE OF EXEMPl'ION
I certify that in the perfcmnarx:e of the wcrk fer this pemi.t,
I shallr>:>t :1f; per.san in IIItf manner so as to. be:) 1,.-
subj"'1\to ' ~~ raws of caillami.a.
S~~, + ~ ' Dite 11-::(0- q~~
NOI'ICE 'It) cx:NIP.ACroR/APPLICAN1': If, after si.9nin1 this
certificate of ~, you shculd ~ subject to the
workers' 0 .Ill'!. .elJSation prevision of the Iabcr 0Xie, you DI1St
forthwith ccmply with such prcvisi.a1s er this pemit shall be
~ revoked.
CDNl'RAcroRS INFORM1lTION
Note that all C01Ib.~ctors arxi sub-ccntractorS must have c:mrent City of
~ aIsiness License, state Ccntractor's License arxi Workers'
ce:mpmsation Insurance.
Name of Ccntractcr
AddreS$
Tel~
State O.luLLactcr License No.
City 8.1Siness License No.
Will do the folla..rin:J types of work:
Expizaticn Date
~ _p.e. o::n...~te _A.e.Pavin}
other (specify)
Electrical
f:pe.minfo
Revised 8/92
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CITY OF CAMPBELL
Public Works Department
April 3, 1997
Mr. Arthur E. Stephenson
1192 Ridgeley Drive
Campbell, CA 95008
SUBJECT: PERMIT NO. 95-262
LOCATION: 1192 Ridgeley Drive
ONE YEAR MAINTENANCE INSPECTION - ACCEPTANCE
Dear Mr. Stephenson:
The City of Campbell has made the final one year maintenance inspection of subject Public
Works improvements and find that no maintenance is required.
Your warranty requirements and any surety, therefore, are hereby released.
Your warranty deposit of $500.00, plus any interest due, will be sent directly to you from our
Finance Department
Sincerely,
~~.
Robert Phillips
Project Inspector
MQVL-
cc: Permit 95-262
Public Works/Maintenance Division
H: \ WORD\PERMITS\95262ACC(JD)
70 North First Street' Campbell, California 95008,1423 . TEL 408,866.2150 . FAX 408,376,0958 ' TOD 408.866,2790
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o"CHAIlO.
CITY OF CAMPBELL
Public Works Department
January 23, 1996
Mr. Arthur E. Stephenson
1192 Ridgeley Drive
Campbell, CA 95008
SUBJECT: PERMIT NO. 95-262
LOCATION: 1192 RIDGELEY DRIVE
FINAL INSPECTION AND ACCEPTANCE
Dear Mr. Stephenson:
The City of Campbell has made a fInal inspection of subject Public Works improvements and
fmds the work to be acceptable and in conformance with City standards. Accordingly, the City
Engineer accepts the improvements.
The one year maintenance period stated in the permit begins as of the date of this acceptance
letter. The permittee is responsible for the repair and/or replacement of any defective work or
failures that occur within one year. The City will inspect the improvements within one year and
notify you, in writing, whether or not any repairs are required.
75% of your Faithful Performance Surety (FPS) cash deposit of $2,000.00, plus any interest
due, is now being processed and will be sent to you under separate cover. We will continue to
hold 25 % of your FPS cash deposit as a maintenance surety.
If you have any questions, please call Randy Westfall, Public Works Inspector, at (408) 866-
2165.
Sincerely,
~~
Michelle Quinney
City Engineer
~
RRW
cc: Suspense - 11 months
Permit #95-262
h:95-262(mw)6.0
70 North First Street. Campbell, California 95008,1423 ' TEL 408,866,2150 ' FAX 408,379,2572 ' TOD 408,866,2790
NEW PW FAX #
A.nO_'2""~ .no~n
CITY OF CAMPBELL
jY[ l2.i.t(f I~ Or
//1~
PROJECT NO. 9f.2hL-
REPORT NO:
FIELD ENGINEER'S DAILY REPORT
CONTRACTOR: Vii v-e.; r(/v ~Jc~ l^-J '
DATE: j-!2-1b
WEATHER: fc,.; /
INSPECTOR: K. ~~51fALL
ITEM
DESCRIPTION
~~
CONe. L Odt-S.
011..
cc:
PAGE: I
OF I
~ OF CAMPBELL
FIELD ENGINEER' S DAILY REPORT
ITEM
cc:
/112- r< ,'j,?.el.ey Dr.
CONTRACTOR:
DESCRIPTION
v". ,. v( W'',7
,4- II"" "-;. ~
PROJECT 110. 9';- 262
REPORT 110: / /
DATE: 1'2./'2 t/9r
WEATHER: C. / Q u.,L., II? I};....
INSPECTOR: -t; -/ C;Y" t"J ~
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