95-276
an' OP CAMPBELL
DEPT. Of PUBUC WORKS
10 North Pil'It St.
Campbc1l. CA 95(D
(a) ~2lSO
m<<:RQAawENT PERMIT
(for wortiq witbill tbe
public ript-af-way)
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PaBIit apr. iD U IIIOL/ h'
h:nDit No. 95-- d l-J {P
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(VG') ~~IA )
ApplicatioD Date I J.. 7 / <] "5
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APPUCATION. AppIicatioD illIcNby" lor a Public WadII PaBIit ill acllOIduacc wida r..."...-. Muaic:ipaI Code, SectioD tUN. (AflIIIic"tioe....
ill 6 IDClDtbI if tbe permit illICIt iIIued~ .JJ;
A. Wort addIaI or tntt # I ro. v t g =t 'I g
Utility treadllocatioD see; "'Y'''O ve~",,1 ~ /A,^~
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propclICd work to ClliI&iDIIUIfIlcc ad UDdcIJlOUDd id&pt~ WbeIl ~o.ed bJ' tile Oty EqiDecr, aid dIwwiDc ....... a put ol tbiI pamit. r-
D. AD work IbaII CDDform to tbe Cty'1 Gcacral ~ SCUdud c.a.tr.diDo ~ IDd StMdud CodItIuc:tioa DclaillIor hbIie Worb C
CoaItructioD; the Geaenl Permit CoDctitioallilted OIl the ~ aide; IDd the Special Provilioal lor dliI permit, lilted bebr. p-.. to Ibidc bJ' e.
tbeIc CODCIitioal ad pnMIioaI may reau1t ill job ....... lDd/or forfeiture ol Paitbf1II PcrfonDIDce SuretielIDd CMIa dcpoIitL (See Geaenl ~
Permit CoDditioall ad 1.) r: b4- /0;) I ~
E. A DOIII'CfuDdablc appIicatioD fee milium.,.., tU AflIlIicatiaa. '1; ""\e;t.X. J 6' ~
Name d Applicant :e f 0.1 c)'1'I1"/a. ii '0 rt ~r 6-1"'00,... ~ f~ /7"'08-:J' jlB-,;;l 'ItFf ~
AddraI/aJ G: >VI1r~y'c kr /lve,/, ~~~. /'fiaL-~.~ . ~
Is tJIiI work beiq doDe by tbe PJOPCItY oner at their 0WII1eIidcDce? Yea ~"... C~../~- .JlP.A~ ~
Compicte IDd attacb Worbrs' CompclllatiOD IDd Coatnctor bformatioD formI. i:
The AppIicaDt/perminec bcreby ackDow\edpl tbat they MYC read IDd UDdc!ItIDd bodl tbe float IDd beck ol tU permit. IDd tbcy wiD iDfonD tbcir
CClIltnc:tOr(S) of !be iDformatiOD. m
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Tbc AppIkaDttpcrminee beftby -.r- bJ' aIIilliD& tbcir lipahlle to tbiI penDit to IKIId tile Cty f1I c-~ iIa ofticers".....1Dd .IDf"'lJ" fnc,_c
IDd bumIca from IDY daim or dctDlDd for daIDapI reaultin& from tbe work covered by tU permiL
1~~<11S
NO"I'ES: AU. WORK SHAlL CONPORM wrm 1HE AlTACIED, APPROVED PLANS AND AU. APPUCABLE CAMPBELL STANDARD
DRAWINGS AND CONDmONS.
1HE CONTRACfOR MUST HAVE nns PERMIT AND APPROVED PLANS AT 1HE srre AND MUST N011PY 1HE PUBUC WORKS
DEPARTMENT AT LEAST NO DAYS BFPORE STAR11NG WORK.
NOTICE MUST BE GIVEN TO PUBUC WORKS AT LEAST 24 HOURS BEfORE RESI'AR11NG ANY WORK.
SPECAL PROVISIONS
,
_2
_3.
-1..
Street sbalI DOt be opeD cut for uadc1'pOUDd iDItalIatioaL MiDimum cutI may be aIIoMld lor CClIlaertV- or apIoIaIiOD..... Sudl eutI.IUII!
be mecificaIJv anorcM:d bv !be Inmcc:tor mior to cuttin2.
hwmcat may be cut for uadcl'pOUDd iDItaIIatiODllDd mlllt be n:atond ill ICXXll'dIDce witb tbe Utility TreadI ~ SIaadIId 0JniD&.
Work to be Ilaked by a IicaIed LaDd SwYeyor or Civil EqiDccr IDd two (2) copica ol* cut .... ICDt to tbc Public WadII DcpartmeDt
before Itattiq work.
a4~~ ;:: ~~/% ';A c~r~~~ r~~: ~ :~ flOI~~'~~:~t~tJJJ~ IF<;/~~~/N~~WP~U0
fllMflc' I ~ ftN~ MvING.
STANDARD AMOUNI' RPLPIPT NO.
_I.
* *
PERMIT APPUCATION FEE ~
PlAN amcx DEPOSIT SSOO.oo
SURETY FOR PArIHPUL PERFORMANCE (1~ OP ENO. EST.)
CASH DEPOSIT (4" OP SUREl'Y, SSOO MIN)
PlAN amcx ct INSPEC110N~~(PIRSl' >>-$30,000 14,.;
Next $3O,()(>>'S80,OOO 10%; AmouDt r oo~ S200 miD)
APPROVED FOR ISSUANCE v --'f::L..
for Ci EqiJlecr
h:PW PERMIT/Rev.4/94 (ICe otbcr Iidc)
USA phone (800) 642-2444 TICKET NO.
If'50't-fItNoJ..Lrl./..o/rr j., f'/u<;-/_JI ~ ~4o J:':"
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PUBUC WORKS DEPARTMENT RECEIPT
Effeetlve July 1. 1995
PUBUC WORKS FIlE NO. 9'5 --.::( 7(0
PROPERTY ADDRESS ,lAC! f 7 Jf Y ~ ~ '5. T.
'=~g;~:l~i~::::::~!;i;!!.:_:::m~!;~~ji~:.~?~~::::::::::::::::::::::ttt::::::::::::::::::::::::t:tt:::::::::::::::t:::::::::::::::::::::::::::::::::::::::::::::::::::tt:::.:::~::tt:tt::::::'.
ENCROACHMENT PERMIT
472 ADDlIc.uon Fee
NorHJtII/ty EncrolChment Permit IU251
R-1 FIrwt Permit INo Feel. Sub.eauent PermitlYr 111001
UtIIitv Encraechment Permit
ArbtrtIlllCollec:tor Street
Rnidentlel S-/Other AI'1I"
Plan a.ck o.-8it
Faithful Perfomlll_
Monumentation Sunttv
C..h DeDOIit
Labor and Mat... Sunttv
Plan Check . InQec:tlon Fee (Non-UtilitYl
472~ Enar.Est. < t260,OOO
220 Emlr.Eat. > U60 000
472 UtIlitY < "00.000
Cond . un to 600 Feet 111.60/ft.
AbaVII 600 Feet :".'0/ft.1
ManhoIMNaultalEtc. _ "06/eal
Pole Set/Removel (t106/eal
Minimum amaa Per Location 111201
StrMt T,.. P1Mtinn/Removel 1t1061tree1
2;20 Utllitv > .,00 000 Deno.it 16% of ENGR. EST.l"
47 Proiaet Plana. s-.iflftation. Proiect No.
47 Standard S .. Detail. II1IPa 112/Bookl
47 Con.. of E M.a.. Plan. 1t.60/'a.ft.1
472 Penaltie.: Faikn to ~ nubile imDroVllment. InOO/c.'-nd_ 0-1
IMunI Code SactIon 11.34.0101
472 PenaJtiee: F__ to comICt un.af. condition. 1.,000CeJend_ 0-1
LAND DEVELOPMENT
4722 Lot Une Ad
472 Parcel Man 14l.ota or Le..1
472 Anal Tract M. 15 or MoI'1l Lot.1
472 CeJtlficate of e
472 CerUficate of eon.ctIon
472 VlC.uon of PublIc StrMta . Ea..ment.
472 A....-nt Seal'1lllatlon or RaallDOrtIonment
Flm S_
Each Additionai Lot
472 Stonn Drainage A_ Fee Per Acl'1l
TO: CIty Clerk
4961
TRAFFIC
472
472
472
472
472
427
472
OTHER
A.It.
220
220
220
220
220
1326
U251
1600
100% of ENGR.EST.I
100% of ENGR.ESTJ
4% of FPSIII600 min.1
100% of ENGR. EST.
"(,. ...... (j t)
FPS
(12% of ENGR. EST.I
(DeDO.it 16% of ENGR. EST.I"
4t:) .DC.
1.1'5 Lr
/ '-fA'
ISOOI
n 060 + t25/lad
11 380 + 125/Lot1
1400
13001
15601
1'6601
1.1701
(Re1, U.OOOI
(~. U.2501
(AI Other U 6001
Postea.
Interaac:tion Tum Count. ITwo-Hour Countl .601
InteRactIon Tum Counts la.m. or n.m. _aka 1251
Traffic Flow M. ID8IIv Traffic Volume.1 U7I
Camabell TI'1IffIc Model FuH Scone A.....mentl t2 250
Traffic Model IReduced ScoDe A.....'" .7401
Truck Permita 136/tr1DI
No Parkina SIan. '1/aach or U6/100
TOTAL
I 7o:L~ 0 ()
NAME OF APPLICANT lSil!AoJ;.,1.I C;MiJA11~~ /)/)rJ~,ILT /:
J~ - /J _ . / ,/.1A/?/7'..A (';'//'A'.?-A- ~
NAMEOFPAYORV~~ C'A.~o. ~~Y-PHONE_--:{L.i~--' /76'7
'/u7)?\.. J1 b fL/!~r1IP.d~ /?L.. ZIP /J~/"')'k:>
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ADDRESS
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RECEIVED
DEe 0 81995
CITY CLERK'S OFFICE
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h:\recfrm3. wk3Impll'1lv.8/1 0196
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CITY OF CAMPBELL, CA
REClJIt BY: .JANH
01000089225
PAYOR: SANTA CLARA DEVJ8RA
TODAY:S DATE~ 12/08/95
REGISTER DATE: 12/08/95 TIME: 13:29:38
DESCRIPTIuN AMUUNT
ENGR & SUBDIV FilING F $325.00
ENGR & SUBTIIV FILING F $40i.OO
TOTAL DUE:
$7261:00
CHECK PA!D;
CHEC\{ NO: 3249
TENDEREn=
CHANGE;
$726.00
$726.00
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