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ENC2006-00189CITY OF CAMPBELL DEPT. OF PUBLIC WORKS 70 North First St. Campbell, CA 95008 (408)866-2150 Fax (408)376-0958 E)`'r'ROACHMENT PERMIT (, orking within the public right-of-way) Issued 2 ~/`~ ~ ~ -- Permit Expiration Date ~2 ~ ~~(~ / Permit N~C1c~ ~ ~ - ~~` (~) ~'' X-Rc le Application Date ~z" Z r L~' ~`` Application Expiration Date'-,~`~`_`r- ~~ S,~ APN 'C~~°U~' ~ C:>~'~j APPLICATION -Application is hereby made for a Public Works Permit in accordance with Campbell Municipal Code, Section 11.04. (Application expires in six (6) months if the permit is not issued~J. Application Fee(isln~on~-~refundable.) A. Work address or tract # 4 ~© ~ l%wtv[l~~' ~ ~~yl~~ Utility trench B. Nawre of work _ L11 h II U5~ C. Attach four (4) copies of an engineered plan showing the location and extent of the work, and four (4) copies of the preliminary Engineer's Estimate of work. The plans shall show the relation of the proposed work to existing surface and underground improvements. When approved by the City Engineer, said plan 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 Sureties and cash deposits. (See General Permit Conditions 1 and 2.) E. The Contractor must have this permit and approved plans at the site and must notify the Public Works Department at least two days before starting work. Notice must be given to Public Works at leastQ24/h~ours before restarting any work. j ~ 2 (,. ~7 Name of Applicant ~~'~ [\l+l~Cr~~ Telephone -l ~ ~l l ~ ~ ~(~ ~~ ~. (print name) ~ Address ~ ~ ~ ~ ~X ~©~~C61~-~ /~ ~ 24-HOUR EMERGENCY TELEPHONE NO ~~ `~~ '~ ~f7 "~ ~~ Q E-Mail Address M /~ `/ ~~~ SA~w-t'~'l ~ l~-r+~l ~ 2 ~ ~ ~' ~'~'~ Is this work being done by the property owners at their own residence? Yes _~~No The ApplicandPermittee hereby agrees by affixing their signature [o this permit to hold the City of Campbell, 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 ApplicanUPet~nittee ereby acknowledges that they have read and understand both the front and back of this permit, and they will inform their contractor(s) of the information. Applicant advised that upon issuance of this permit, property owner, or property owner's successors, shall be responsible for any and all damages arising out of the conditio of any>~v`te improvements in the public right-of-way. (sib ) ~.' Date Contractor (Print Name) Date SPF,CIAL PROVISIONS _1. Street shall not be open cut for underground installations. Minimum cuts ~ be allowed for connections or exploration holes. Such cuts be s~ecificaliy anoroved by the Inspector orior to cutting. _2. Pavement may be cut for underground installations and must be restored in accordance with the Standard Details Trench Restoration Method "A", unless otherwise approved by Inspector. _3. Work to be staked by a licensed Land Surveyor or Civil Engineer and two (2) copies of the cut sheets sent to the Public Works Department before starting work. 4. Per Section 4215 of the Government Code this permit is not valid for excavations until Underground Service Alert (USA) has been notified and the inquiry identification number has been entered hereon. USA Phone 1-800-227-2600. USA TICKET NO. _5. Prior to any work, the property owner shall execute an Agreement for Private Improvements in the Public Right-of--Way, which shall be recorded. ' _G. Public Notification Requirements: 7. SEE PUBLIC WORKS FEE SCHEDULE FOR CURRENT FEES AMOUNT RECEIPT N0. PERMIT APPLICATION FEE S ' .2.~~ PLAN CHECK DEPOSIT ~ SECURITY FOR FAITHFUL PERFORMANCE/LABOR & MATERIALS $ CONSTRUCTION CASH DEPOSIT $ PLAN CHECK & INSPECTION FEE $ APPROVED FOR ISSUANCE M1 ~ /' , ~ For City Engineer ate Permit Expires 12 Months After Date of Lssuance ~~ L~`tlJ-~ ~ ~~ 1 i ` ~„ w DATE ~~ ~") / ~~ GEN. CONTR. CUSTOMER ORDER NO. ~ ~ ~~ ~ ~ ~`' _ ' ~ ~ ~ ..._ ~~ z' ~ -~ _, (S~ ~+ f ~~ ` ~ ~~ ~ '' ~~ ~~ ~. o... -~ ~ :~ i; ,~ . ~. ~ ~ ~ ~ ~ ~~~ ~~ ~~ _~ ., .~ .~. ~: ; ti ~...µ ` 1 . ~ ,~ 1" - ,v ~' a .~. ,..,~. z ~ ~~ ~ 6~ ~ t ~~x a r O O '~ b C" a z ~ , ~y r• ~~, G y~ l -- - ----------- - ------ r i i i ~ i ~ ~ _- it z z n z n o y 'i ~ '^ ~ z m z z -g ~~ o~ n ~ ~ m ~ ~ -i ~ -a ' y ' o ~ 2 A y ~/ A A A A s g d F $ _ _ N i ~ I L ~ r I ~ r iJ J J ~ i T~~ ./-7 -_ ~ f°' i Z i __ _ _ _~J /8 5 _ 1'-T~' ~ ' 1 '-7 _ 1 ~~- L ' EQ. _ i r _ L ~_ IL _ _ _ _ x 5 EQ _~1' f0' < ~ ~ ~ 18 8 ~ Q ` a w d .~ O y n C ,5. ~: __~ :~ ~ N .n~- ~= <' "i'° ~ ~ t :~-, .. s} A v ~ `{i ., ~+.A N ~ =d r~i ^~ ~ r , ~~ ~; r L~ CrJ ~~~ ~' O O ~~~ z _~ d r~ra ~,a. nun na u rMlf I MCIV I rltl:tlY1 Etteelivs July 16, 2006 //~''~~^~,~'~\~,I /\ TO: Cky Clark PUBLIC WORKS FILE NO. L.l ` ~ ~ ~ l w~ -- ~ ~~ _• (,,,. ~. ~ L. ~ ~ `~ PROPERTY ADDRESS Please collect & receipt for the following moniec: ACCT. REM ENCROACHMENT PERMfT AMOUNT 4722 Application Fee Non-Utility Encroachment Permit (5276 00) Minor Encroachment Permit <55,000 (3726 00) t R , - Flrol Permit No Fse Subs uent 3125.00 Utilk E ncroachment Permk A rtoria UCollaolor Street 5560.00 R 2209 esidential StreeVOther Areas $900.00 Pl Ch k D i ' 2203 an ec e os t 2%of En ineer a Estimate 5500 min F ithf l P rt 2209 a u e ormanee Securit FPS 100%of ENOR.EST. L b d M i l 2209 a or an eter a a Securl 700%of ENOR. EST. M t ti S i onuman e on acur 100%of ENOR.EST. 2203 Cash De sk 4%of En r. Est 5500 miN510,000 max 4722 2209 Plan Check 6 Inspection Fse (Non•Utilky) Engr.Eat. c 3250,000 (19% f ENOR EST ) E E t 47zz n r. s . >5260,000 Da osk 8%of En r. EatJS30,000 min •' uuut S1oo o00 < , Minimum Charge Per Location (3260 00) Conduka/Pipelines up to b00 Feat (5226Ht) Ab 500 L ove lnearFaat (51 atvtt) ManholesNeults/Etc. (512500/ ) P l S t/R o e e emoval (312500/ a) St t T Pl ree ree enhn amovel 3746.00 2203 Utilit >$100,000 Aetuel Coat+20%•' 4780 4760 Ston s Container Permit 3125.00 Pro' t Pl S S ifi 4760 ec ans c cetions Pro act No. St nd d 3 ifi i A a ar e cat ona Details 51m 516.60Bk 4760 Co ias o1 En Inearin Ma s 8 Plana A i l Pl l 24" 36' er a o x 564.00 A ri l P i t 8 12" 11" e a r n x 225.00 Aeri l S h F a saro ea 526.00 M d Pl 24' ' 4722 a san ena x 38 St2.00 Paneltiea: F il t t b 1722 a uro o roa oro u lic Im rovements 5700/Calendar De Munl Code Sac.11.91.010 Paneltiea: F il t 4722 a ure o correct unsa/s conditions 5700/Calendar De Work Without P it LAND DEVELOP erm s 4 Times liceble Fee MENT 4722 Lot Line Ad uatment 5800.00 4722 Parcel Ma 4 Lots or Less 53,400.00 4 575AO1 4722 4722 Final Tract Ma 5 or More Lota 54,200.00 +5100Aot C rtifi N f C li 1722 e ca o am encs 5650.00 ti}i C t f C i 4722 er ce e o orrect on $400.00 O di 8 D i Pl re n re ne a an Review Sin le Femil Lot 3200.00 si te < 1o,DOD s.i. 55DO.Do si te > 1D,ogo s.f. < Acre SeoD.DD site > 1 Aire 51,zoo.oD 4722 Note Fee sr si nature 510.00 4722 Vecaticn of Public Streets 6 Eesananis 52,200.00 4722 Fussssnlant Sagregetbn or Reapportionment First Split (5726 00) Each Additional Lot 5200.00 4721 Storm Drainage Area Fse Per Acre (R-1 52 120 00) (Multi-Rea 52,986.00) All Other 52.860.00 4920 Parkland Dedication Fea 75°6125%Due U on Csrt. o} Oceu ane 511.7424 Poste e TRAFFIC 4728 Intersection Turn Counta Two-Hour Ccunt 578.50 4725 1725 Intersection Tum Counts a m. or Saks 5160.00 T tti Fl M D i 4728 re c ow a e l Trottic Volumsa 532.00 C b ll T ffi M d am e ra c o al Full Sco Assessment Actual 1728 Cam bell Traffic Model Reduced Sco Assesament Actual 4728 Si nel Timin Inlormation S52/Hr 4271 Truck Permits S15.D0/ r tri 4728 No Perkin Si ns 51/each or 526/100 OTHER TOTAL 1 5 ~~ L~/~-" NAME OF APPLICANT - p f j y ( NAME OF PAYOR A " L~-rl ~ r `l Z ~ v l V ~~ y (,.~1. ~ - ~ J PHONE ADDRESS _L ~ ` ~' ~ 7 - ZIP 1 S - ~ `f (~ "Actual Coat Plus 20%Ovarhaad (Non•Interest b FOR CRY CLERK RECEIVED SY ONLY Data Rseai t p 'For Plan Check and Cash Deposib, send yellow - Dets/ Inkiele j:\forms\receipt Form 06-07.x1s GENERAL PERMIT CONDITIONS 1. A Constmction Cash Deposit is required. Charges will be made against this deposit if there is an emergency call-out, overtime inspection or when City ordered barricading is required. Any such costs in excess of the deposit will be billed to the Permittee. 2. A one-year maintenance period and surety are required. Such period wilt begin on date of written acceptance by the City. 3. Refund of the cash deposit balance and 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. Acceptance by the City will be made in writing to the Permittee. 5. Maintain safe pedestrian and vehicular crossings and free access to private driveways, bus stops, fire hydrants and water valves. 6. A Construction Traffic Control Pian and a Construction Schedule are required for all lane closures, detours and street closures. This plan must be reviewed and approved prior to any lane closures. 7. The Construction Traffic Control Plan shall conform to the Caltrans Manual of Traffic Controls for Construction and Maintenance Work Zones, dated 1990, available at Caltrans. Traffic control equipment shall include Type II flashing arrow signs if required. 8. Replace as directed by the City Engineer any damaged or removed improvements in accordance with City Standards and Specifications at the sole expense of the Permittee. 9. Sawcut for all PCC or AC removals. All PCC removals shall be to nearest scoremark and shall be doweled to existing improvements. 10. Prior approval of inspector is required for any work done after normal working hours, on weekends or holidays and may require reimbursement of inspection costs at the current overtime rate. 1 ] . Adequate signing and barricading is required on the job site. Failure to provide such signing and barricading may result in the City's providing signing and barricades and charging [he cost (including all labor and materials) against the cash deposit. 12. Compaction testing of subgrade, base rock, and asphalt concrete by Permittee is required unless otherwise stated by the City Engineer. 13. The Contractor or Permittee will have a supervisory representative available for contact on the project at all times during construction. Contractor or Permittee shall provide a phone number at which they can be contacted outside the hours of 8:00 a.m. to 4:00 p.m. 14. No storage of materials or equipment will be allowed near the edge of pavement, the traveled way, or within the shoulderline which would create a hazardous condition to the public. 15. 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 separate permit may he required, nor does it relieve the Permittee of any obligation to obtain any other permit required by law. 1 G. This permit does not release the Permittee from any liabilities contained in other agreements or contracts with the City and any other public agency. 17. This permit is not transferable. Work must be performed by the Permittee or his designated agent or contractor as specified thereon. 18. Call back (call out) due to emergencies regarding this permit shall be at the current overtime rate with a three (3) hour minimum charge per occurrence. 19. Pursuant to Chapter 14.02 of the Campbell Municipal Code, applicant. shall not cause to be discharged any material into the municipal storm drain system other than storm water. Applicant shall adhere to the BEST MANAGEMENT PRACTICES established by the Santa Clara Valley Urban Runoff Pollution Prevention Program. 20. If the public interest requires a modification of, or a departure from, the plans and specifications, the City shall have the authority to require or approve any modification or departure and to specify the manner in which the same is to be made for City-owned or maintained facilities. 21. Permittee must provide advance notification to all parties that may be affected by the permit activities. Notification shall be reviewed by City prior to distribution and includc dates of work and a contact name and phone number. Applicant shall a responsible for ensuring that all those providing services under the applicant are aware of and understand all of the above conditions. Applicant Date Contractor (Print Name) Date J\forms\pwperm Rev. 11 /9/05 i,i 1,i t~1' L~tl~';1'i1i.L. "~Pi F;EZ:s;is R~: .i~rtdN ri;>>ln+r"rjC``:'' [ L`1 v~LS1 fi_! ull ' ~iL1i';: i+i'aC.^.:t11 3Cfa ~;i3t!'~; ~~i~Fit'j Lft't 1't: Itn'.i~~0a`U(7 6;EGI'~TtR !tf;lt: 1"'~~'C15 T ~ i I~tE: .1 ~. :'11I :`il iat~%:Ri~TI~1fd 7~1t~` fiit~C+Ui~T r,,.-.r, ~ ~~tt .~i1i CC+i3P~ L ,JU.~L{S~a~ r.LL r y .+~y^r ~-11 ~J.L~RJ TLs t f'tL Lst~c : i';~~A?4GE: ~i`u.i1l~ ~~. /~ `~ ° ~~i' U~ O~ Cfl~~n~r r i ~ ~' UKCH ARC CITY of CAMPBELL Public Works Department TRANSMITTAL February 5, 2007 Robert Raffanti Trustee 1235 Koch Lane San Jose, CA 95125 Re: 260 E. Campbell Avenue From The Desk Of.• Marlene Pomeroy Executive Assistant (408) 866-2776 e-mail: marlenep@cityofcampbell.com Enclosed for your records please find a copy of a recordedAgreement for Private Improvements in the Public Right-of--Way in connection with your property at 260 E. Campbell Avenue. ~~ ; Marlene Pomeroy Executive Assistant Enclosure 7(~ North I first Street Campbell, Cnlitornia ')501)A-I43C~ TCI_ 408-8(i6.215(I kAk •4Ut; 375.0958 TU1~ 408 Rii6.2790 Recording Requested By: ) City of Campbell ) 70 North First Street ) Campbell, CA 95008-1423 A~'NI~~~1~1~~~-IIWI~~I Pages 4 No Fees After Recording Return To: ) REG 1 NA ALCOMENDRAS RDE ~ 001 SANTA CLARA COUNTY RECORDER 1/10/2007 Recorded at the request of 10 23 AM City Clerk ) C ~ t y City of Campbell ) 70 North First Street ) Campbell, CA 95008-1423 ) APN: 412-06-033 Address: 260 E. Campbell Avenue, Campbell, CA 95008 AGREEMENT FOR PRIVATE IMPROVEMENTS IN THE PUBLIC RIGHT-OF-WAY In consideration for granting permission to allow existing utility facilities to remain and construct private improvements in the public right-of-way, Robert L. Raffanti, Trustee of the Robert L. Raffanti Trust (property owner) enters into this Agreement with the City of Campbell. The improvements contemplated under this permit are for the benefit of the real property commonly known as 260 E. Campbell Avenue. The City of Campbell grants such permission to install iron fencing under Encroachment Permit No. 2006-00 !$9 . All conditions of Encroachment Permit 2006- 00 ~ 89 remain in full force and effect. The City of Campbell also grants such permission to allow the existing utility facilities in the public right-of-way to remain. The property owner shall be solely responsible for maintaining the improvements in a good and safe condition at all times; and the property owner shall indemnify, defend, and hold harmless the City of Campbell, the City of Campbell Redevelopment Agency, and its officers, officials, agents, volunteers, employees and attorneys from any and all claims, actions, losses, liabilities and costs (including reasonably incurred attorney's fees) arising out of or connected with; or alleged to arise out of or be connected with the installation, design or condition of the improvements, except for any claims, actions, losses, liabilities and costs proximately caused by the sole negligence or willful misconduct of the City of Campbell, City of Campbell Redevelopment Agency, and its officers, officials, agents, volunteers, employees or attorneys. This provision is intended to be the dispositive of all rights of indemnity and contribution between the parties, and property owner waives and releases any and all rights to indemnity or contribution from the City of Campbell, in law or equity, arising out of, or connected with any and all claims, actions, losses, liabilities and costs (including reasonably incul~ed attorney's fees) for which proper y' owner is obligated under this paragraph to provide indemnity or defense to the City of Campbell, City of Campbell Redevelopment Agency, and its officers, officials, volunteers, employees or attorneys. The City, in its sole discretion, may revoke the rights granted under this agreement and Encroachment Permit No. 2006-00 ($9 and remove at any time, without liability to the property owner, or require that the improvements be removed, and property owner shall have no right to compensation from City in any form. Page 1 of 2 Property owner agrees ~ maintain homeowners or general liab. ~ insurance with a limit of at least $100,000 for damages arising from the installation, design or condition of the improvements. This provision shall run with the land and be binding on the property owner's successors. ~, Executed this ~~`T~,,_ day of ~„~~,rt,E ; ~,r,; , 20 u i~ y PLEASE SEE ATrp{;RED c~n~E~TCA~~~c~ra+a NOTARY FORM ~~ ,- Robert.. Raffanti (Attach Notary Aclmowledgment) ATTEST: ~, -r Arnie Bybee, City Clerk ~ j:\forms\public r-o-w improvements aereement.doc 12/03 (rev 7/05) CITY OF CAMPBELL, a municipal Corporation .~, , ~ f ~. ~~ Robert Kass Public Works Director Page 2 of 2 ALL PURPOSE CALIFORNIA ACKNOWLEDGEMENT STATE OF: CALIFORNIA COUNTY OF: ~~, ,~ %~ On !~ , ~ before me, ~~; '~~ r J l ~ ,~~L~ -~ personally appeared personal] known to me (^•- •°a +~ ^,P ^^ +hP ~a°~~ ^f ~~+~°f"'r^,-~, P 'ir1P„~P) t be the person(~i whose named i are subscribed to the within instrument and ac wledged to me that she/they executed the same in i /her/their authorized capacity), and that by is her/their signature on the instrument the person( or the entity upon behalf of which the person acted, executed the Instrument. WITNESS my d and fic S i \ _ J. MORGAN `.., Commission # 1667889 Signature ~- ~', ~ ~ '~~ No8ant~Cliaro CouiMy a My Comm. Expires Jun 6, 2010 iV ~~~ ~' (NOTARY SEAL) v ATTENTION NOTARY: Through the information requested below is OPTIONAL, it could prevent fraudulent attachment of this certificate to another document. THIS CERTIFICATE MUST BE ATTACHED TO. Title of Document Type THE DOCUMENT DESCRIBED AT RIGHT Number of Pages Signer(s) Other Than une t CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California i SS. County of ';~:;!~ 1~--tr;~ ~. ~~.-~u - On ~ t:,(,i.,'i~i,~l:. ~' at ~l- / before me, ~ I~~L~ CL ; (, t~. /<,' ~~''> /,? > f Gt ~•~~." ~/~fLL' C' Date ' • • "~ ~ ~ ~~ Name and Title,of Officer le.e_ "JarieDoe. Notary Publib'9 personally appeared , t,,.e ;.% ~i-~. ~ -`"_, '~.'~' ` , Name(s) of Signer(s) ,personally known to me proved to me on the basis of satisfactory evidence MARLEtrE K. POMpt~1' Commigon # 1412194 I ~dfMO CfODO C~11M0 ~Oomm. ~~IAoyb. to be the person() whose name(') is/ate subscribed to the within instrument and acknowledged to me that he/sNefFl~ey executed the same in his/he~t+rrsir authorized capacity!,:as), and that by his/herl111~- signature(s„~ on the instrument the percnn(~, or the entity upon behalf of which the person(s,~ acted, executed the instrument. WITNESS my hand and official~eal. --7.') ~ '-? 1~ '. i'1. ~ ..,' Signature of Notary Public \. OPTIONAL Though the information below is not required bylaw. it may prove valuable to persons relyin_q on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Document Title or Type of Document: ~G e.i ~ ~t ~7~! -s ~ ~'~ ~: , t t C:i~ f~'~ - '~.%rts:: f'~-~u ~~Ci:~~~~ C >~ ,g ,l~~ ;r-l~.x_ v ~!~CC'~ta'c:, r/Gc r ~ ~ C:~/' L~ ~L~',C7' ,-. Document Date: rss~G[` -,,~~ f , _~C~cr>~- Number f~f Pages: ` -~-4- .t -. ~ ~-r Signer(s) Other Than Named Above: ~~~r~{ ~ ,~:~~ ~~=-~'~fi ~"~ "-- c Capacity(ies) Claimed by Signer Signer's Name: ^ Individual `] Corporate Officer -Title(s): C, Partner - ^ Limited =1 General =' Attorney-in-Fact ~~ Trustee C! Guardian or Conservator J~° Other: Signer Is Representing: C.` ~- ~; ~ lop of thumb here n 1999 National Notary Association • 9350 De Soto Ave.. P.O. Bou 2402 • Chatsworth, CA 9131&2402 • www.nationalnoiary.orq Protl. No. 5907 Feomer Call Toll-Free 1-800-876-6821 C ~ C` ~. i n ~' O O ~ m ~ ~ ~ ~ ~ `~ _~.~ ~ p ~. ~ ~ r-- ~. ~~~ r- .~ z ~_ x ~ ~ ur rr l /~~ C~ I Z • ~ vJ O z v ~ ~ ~ m ~ ~, l) '~ p In (7 ~ ~ ~ ~ ~ ~ ~~ ~ R1 I'I r- r ~a ^ m r l r n ~ Z t ` J o ~ I r--~ L r~ m ~~ t~ t) ~ ]C ~ ~ ~ ~) m ~ ~ CI7 m ~ +'' .ZJ ~ ~~ n 7> ~ D ~' O ~ C~ --a S C ! 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