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CITY of CAMPBELL
Public Works Department
April 17, 2018
Jeff Galdes
57 Carlyn Ave.
Campbell, CA 95008
SUBJECT: PERMIT NO. ENC 2017-00075
57 Carlyn Ave. Campbell, CA
FINAL INSPECTION AND ACCEPTANCE
Dear Jeff:
The City of Campbell has made the final inspection of the subject Public Works
improvements and finds that no remedial work is required.
Your warranty requirements and any surety, therefore, are hereby released.
Sincerely,
Syed Wahidi
Public works Inspector
70 North First Street • Campbell, California 95008-1436 TEL 408.866.2150 • FAX 408.376.0958 • TDD 408.866.2790
Encroachment Permit Final Sign Off
Encroachment Per mit#�— 2G i7�vec-�S
Address: �� C✓(`� V,
Date of Final Inspection and Acceptance:
Inspected by:
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OK to release deposits: 100% �5%
Comments:
Encroachment Permit Final Sign Off
Encroachment Permit #��
Address: �h /vc
Date of Final Inspection and Acceptance:
Inspected by:
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OK to release deposits: 100% V 75%
Comments:
i
CITY OF CAMPBELL
PUBLIC WORKS DEPARTMENT
CLEARANCE FOR FINAL INSPECTION
AND ACCEPTANCE LETTER
Encroachment Permit#: ENC 2017-00075
Name: Jeff Galdes
Property Address: 57 Carlyn Ave.
Date of Final Inspection:
On.File: Bonds CD Cash
Faithful Performance: $ 2,000.00
Labor and Material: $
Construction Cash Deposit to be released: $
Other overdue deposits to be released (Description):
Processed by:
Reviewed by:
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Reviewed by: 1K
"I-Iolt� I
Land Development Engineer
JAJoAnnaT\Deposit refunds\CHECKLISTS\Carlyn 57..doe (Rev. 10/11)
1
CITY of CAMPBELL
Public Works Department
April 17, 2017
Jeff Galdes
57 Carlyn Ave.
Campbell, CA 95008
SUBJECT: PERMIT NO. ENC 2017-00075
57 Carlyn Ave., Campbell, CA
FINAL INSPECTION AND ACCEPTANCE
Dear Jeff:
The City of Campbell has made a final inspection of subject Public Works improvements
and finds 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 March 29, 2017. 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.
Your Faithful Security Deposit in the amount of $2,000.00 is enclosed.
If you have any questions, please call me at (408) 866-2168.
Sincerely,
John Burchfiel
Sr. Public Works Inspector
Cc: Inspector /Suspense Files
Permit File ENC2017-00075
70 North First Street • Campbell, California 95008-1436 • TEL 408.866.2150 • FAx 408.376.0958 • TDD 408.866.2790
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Ref urndable Deposit Check' Request - _
'
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'To: Finance`Director, `
Check Payable l o.es. Jeff Gald_
'Address• -,Lune '1: : 57'Carlyn Ave.: ,
Line 2: ;
City Campbell State: ,CA Zip:• 95008
Description: . 57 ,Carlym Ave:
Account Number.: . 101.2203.,_, Amount: _ $2;000:00
_
Account Number: 101.2203_ Amount:
_
Account'Nurnb'er: .401.540.7448- Amount:
(Finance Dept on Interest Earned (Finance Dept only)
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Total Payable: (Exact Amount)
`
rpose: •ENCZ017-'00075
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Permit #: ENC2017-00075.
Receipt.#::.: .__ .. 268554 ._ Date: 3/14/201,7
Receipt # , Date:
Requested s T.Itle: Sr. Inspector- : Date: 3=3('.1
ohn' . urclifiel -
:'
Approved tiy: � Title: Sr.'.Engineeu. Date:-
Roger S-torz
Finance Dept.Only: -
Verified by . : Title: _Accounting Clerk-.R :: -'Date:
Approved by:. , .. _ Title: Accountant. Date: '
S ecal: I4nstrucfiions _For Hariddlifn Check. .
Mail -•As Is% .' Mail''in Attached Envelope:-. Interim/Check: _
'Needed,ft '
Return To: J,oAnna Thomason. .. ,. - Public' Works . -
(Name) (Doodrtment),
'Other: _Please4'retutn check-_to:JoAnria
'.`Print Form
CITY OF CAMPBELL R-11 ENCROACHMENT PERMrr Permit No.
DEPT. OF PUBLIC WORKS X-Ref File
(Non -engineered work within the public right-of-way)
70 North First Street ($10,000.00 aximum value of work) Application Date
Campbell, CA 95008 Application Expiration
Ph. (408) 866-2150 ISSUED: r a Date
Fx. (408) 376-0958 Permit Expiration ate: APNS
APPLICATION - Application is hereby made for a Public Works Permit in accordance with Campbell Municipal Code, Section 11.04.
(Application expires in 6 months if the permit is not issued.)
A. Work Address: 57 Carlyn Avenue
B. Nature of Work: (Widening Driveway approach
C. Attach three (3) copies of a drawing showing the location, extent and dimensions of the work. The drawing shall show the relation of
the proposed work to existing improvements. When approved by the City Engineer, said drawing become 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 securities.
NAME OF APPLICANT: Jeff Galdes Telephone: (408) 833 5046
Address: 57 Carlyn Avenue
E-Mail Address: jjgaldes@gmail.com
The Applicant hereby confirms that this work is being done by the property owner/applicant at their own residence.
The Applicant hereby agrees by affixing their signature to this permit to hold the City of Campbell, City of Campbell Redevelopment Agency, 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 Applicant hereby acknowledges that they have read and understand both the front and back of this permit, and that they will inform their
contractor(s) of the information. - i I/ 7 /
ACCEPTED: c
(Appl
NOTES: All work shall conform with the attached approved plans and all applicable Campbell Standard Details and Conditions and applicable
insurance requirements.
The Contractor must have this permit and approved plans and must arrange to meet with the Public Works Inspector at the site at least two days
before starting work. Notice must be given to Public Works at least 24 hours before restarting any work.
Per Section 4216 of the Government Code this permit is not valid for excavations until Underground Service Alert (USA) has been notified and the
inquiry identification number (Ticket No.) has been entered hereon. USA Phone: 1-800-227-2600. Ticket No.:
Applicant is 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 design, installation or condition of private improvements in the public right-of-way.
SPECIAL PROVISIONS
1. Prior to any work, the property owner shall execute an Agreement for Private Improvements in the Public Right -of -Way, which shall be
recorded.
2.
9
STANDARD AMOUNT RECEIP1 NO.
SECURITY FOR FAITHFUL PERFORMANCE 000%Of Engr's Est.) $17,60ZAO 'Lbi55q
R-1 PERMIT FEE $
APPROVED FOR ISSUANCE:
for City Engineer lbatel
Permit Expires 6 Months after Date of Issuance.
GENERAL PERMIT CONDOTIONS
1. Payment of a security to insure faithful performance and completion of the work is required. This security is refundable upon
completion of the work and written acceptance by the City.
2. A one-year maintenance period for all work is required. Such period will begin on date of acceptance by the City. It is the applicant's
responsibility to remove and replace unacceptable improvements within the one-year maintenance period.
3. Refund or cancellation of the Faithful Performance Surety will be initiated by the written acceptance of the work by the City.
4. Submit project schedule 10 days prior to proposed start of work. Special provisions may be required for work within City facilities
and downtown Campbell.
5. 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.
6. Maintain safe pedestrian and vehicular crossings and free access to private driveways, fire hydrants and water valves.
7. 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.
8. Sawcut for all PCC and AC removals. All PCC removals shall be to nearest scoremark and shall be doweled to existing improvements.
9. Adequate signing and barricading is required on the job site. Failure to provide such signing and 'barricading as specified by the City
Engineer may result in the City's providing such signing and barricades and charging the cost to the Permittee.
10. The Contractor or Permittee will have a supervisory respresentative available for contact on the project at all times during
construction.
11. This permit shall be kept at the site of work and must be shown to any authorized representatives of the City of Campbell or any
law enforcement officer upon demand.
12. No storage of materials or equipment will be allowed near the edge of pavement, within the traveled way, or within the shoulderline,
which would create a hazardous condition to the public.
13. 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 be required, nor does it relieve the Permittee of any obligation to obtain any other permit
required by law.
14. This permit does not release the Permittee from any liabilities contained in other agreements or contracts with the City and any other
public agency.,
15. This permit is not transferable. Work must be performed by the Permittee or his designated agent or contractor as specified thereon.
16. 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.
17. 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.
18. 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.
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.
Applicant shall be responsible for ensuringthat all those providing services under the applicant are aware of and understand all of the above
conditions.
Applicant Date
J:\FORMS\Templates\Encroachment Permits\R-1 Encroachment Permit STATIC form2.pdf
Rev. 02/14
-47..
PUBLIC WORKS DEPARTMENT LAND DEVELOPMENT
Effective July 1, 2016
TO: Finance
PUBLIC WORKS FILE NO.
ENC2017-00075
PROPERTY ADDRESS
57 Carlyn Avenue
Please collect & receipt for the following monies:
77
4722 Encroachment Permit Application Fee
Non -Utility Encroachment Permit Major ?$l 0,000
Minor Encroachment Permit <sio,000
Initial R-1 Permit
Subsequent R-1 Permits within Two Year Period
Inspection Fee Minimum Charqe per Location
Street Tree Plantinq/Removal
2203
($500 per Tree Plantinq Deposit Required)
2203
Plan Check Deposit 2% of Engineer's Estimate
Utility and R-1 Permits
4722
Gradinq & Drainage Plan Review
Sinqle Family Lot
Site < 10,000 s.f.
Site 10,000 s.f. < 0.5 Acre
C3 cr_ LU
Li.1 CM r
Site 0.5 Acre
J
4722 NPDES Review (C3 Requirements)
w I-- C1.1
For projects not required to submit numeric sizinq
LL. IT r-,
For projects required to submit numeric sizing
LU C.n
Q- I— =,
Impervious Area 10,000 Sq. Ft to I Acre
UJ
J-U
Cxz
Impervious Area 1 Acre or more
rl—n
::1 =1 IT C.)
Cn Lj—
1=4
4722
For projects sent to Consultant for review
UJ �X W Lij a'Ld
= -X W Iz
LX LU
4722
Additional treatment facilities
Plan Check & Inspection Fee (Non -Utility)
4722
Enqr. Est. < $250,000
14% of Enqineer's Estimate
4722
Enqr. Est. >_1250,000 and :5$500,000
$35,000 + 8% of Engineers Estimate
4722
Enqr. Est. >$500,000
$55,000 + 7% of Enqineers Estimate
2203
Emerqency Cash Deposit
4% of Enqr. Est.* ($500 min/$10,000 Max)
2203
Faithful Performance Security (FPS)
100% of ENGR. EST.*
$2,000.00
2203
Labor and Materials Security
100% of ENGR. EST.*
4721
Storm Drainage Area Fee Per Acre
R-1 $2,120.00
(Multi -Res $2,385.00)
All Other $2,650.00)
4722
Parcel Map (4 —Lots or Less)
$4009.00 + $87/lot
4722
Final Tract Map (5 or More Lots)
$4,871.00 + $118/lot
2203
Monumentation Security
100% of City's Monumentation Estimate
4920
Parkland Dedication Fee (75%/25% Due Upon Cert.
of Occupancy)
4722
Lot Line Adjustment (includes Certificate of Compliance)
$1,893.00
4722
Vacation of Public Streets & Easements
$2,530.00
4722
Certificate of Compliance
$1,877.00
4722
Certificate of Correction
$561.00
4722
Document Recording Fees
$15.00/first page $3 ea. Additional
4722
Private Improvement in Public ROW
$50.00
4722
Approved Plan Revision Fee
$100/sheet
4722
Appeal Filing Fee
$200.00
4722
Notary Fee (per siqnature)
$10.00
4722
Assessment Seqreqation or Reapportionment
First Split
$895.00
Each Additional Lot
$281.00
511.7424
Postage
MISCELLANEOUS,.7--
-
7-7
101.730.4924
NOI Reimbursement for
*Engineer's Estimate
shall be as approved by the City Engineer and shall
include all items of work. TOTAL
$2,000.00
NAME OF APPLICANT Feg 6,q ,Jkr,
NAME OF PAYOR a,
-3 S
PHONE
ADDRESS
Aleai,e
ZIP
FOR
RECEIVED, Ely
CITY CLERK
OE
ONLY
Date Receipt#
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