ENC2018-00041 ram..®F 9�c� �tpi�
UkCHARO
CITY OF CAMPBELL
Public Works Department
June 5, 2019
Joan McAndrews
1444 Ridgeley Dr.
Campbell, CA 95008
SUBJECT: PERMIT NO. ENC 2018-00041
1444 Ridgeley Dr.
FINAL INSPECTION AND ACCEPTANCE
Dear Joan:
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.
If you have any questions, please call me at (408) 866-2165.
Sincerely,
Syed Wahidi
Public Works Inspector
70 North First Street Campbell, California 95008 • TEL 408.866.2150 • FAX 408.376.0958 • TDD 408.866.2790
Encroachment Permit Final Sign Off
Encroachment Permit# t-N L yW,LE 1
Address:_ It�{It T)
Date of Final Inspection and Acceptance: 11511�f
Inspected by:
OK to release deposits: 100% V/ 75%
Comments:
CITY OF CAMPBELL
PUBLIC WORKS DEPARTMENT
CLEARANCE FOR FINAL INSPECTION
AND ACCEPTANCE LETTER
Encroachment Permit#: ENC 2018-00041
Name: John McAndrews
Property Address: 1444 Ridgeley Dr.
Date of Final Inspection: 5/15/18
On File: Bonds CD Cash
Faithful Performance: $ Labor and Material: $
Construction Cash Deposit to be released: $
Other overdue deposits to be released (Description):
1 �
Processed by: Z3
Administrator
Reviewed by:
nspector
Reviewed by:
Land Development Engineer .
JAJoAnnaT\Deposit refunds\CHECKLISTS\Ridgeley1444 final.doc(Rev. 10/1 1)
1
of C44t
y &
•"CHARS•
CITY of CAMPBELL
Public Works Department
May 29, 20.18
Joan McAndrews
1444 Ridgeley Dr.
Campbell, CA 95008
SUBJECT: PERMIT NO. ENC 2018-00041
1444 Ridgeley Dr.
FINAL INSPECTION AND ACCEPTANCE
Dear Joan:
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 May 15, 2018. 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) 866-2165.
Sincerely,
Syed Wahidi
Public Works Inspector
Cc: Inspector/Suspense Files
Permit File ENC2018-00041
70 North First Street • Campbell, California 95008-1436 TEL 408.866.2150 • FAX 408.376.0958 • TDD 408.866.2790
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..................... ,........._ _.. _..... _...._...._.
--- ------------ - -------
CITY OF CAMPBELL VENDOR NO. 10 014 917 CHECK NO. 268042
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10014917 JOAN MCANDREWS
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*See Reverse Side For Easy Opening instructions*
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CITY OF .CAMPBELL
70 NORTH FIRST STREET
CAMPBELL, CALIFORNIA 95008
I
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JOAN MCANDREWS _
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1444 RIDGELEY DR.
CAMPBELL CA 95008
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CITY OF CAMPBELL
PUBLIC WORKS DEPARTMENT
CLEARANCE FOR FINAL INSPECTION
AND ACCEPTANCE LETTER
Encroachment Permit#: ENC 2018-00041
Name: :}o4n McAndrews
Property Address: 1444 Ridgeley Dr.
Date of Final Inspection: 5/15/18
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:
Ad ini rator
Reviewed by:
Inspector
Reviewed by: 2y�
!5 klg lca
Land Development Engineer
JAJoAnnaT\Deposit refunds\CHECKLISTS\Rid.doe(Rev. 10/11)
Refundable Deposit Check Request
To: Finance Director
Check Payable To: Joan McAndrews_ \�
Address - Line 1: 1444 Ridgeley Dr.
Line 2: -
City: Campbell State: CA Zip: 95008
Description: 1444 Ridgeley
Account Number: 101.2203 Amount: $2,000.00
Account Number: 101.2203 Amount:
Account Number: 101.540.7448 Amount:
(Finance Dept only) Interest Earned (Finance Dept only)
Total Payable: (Exact Amount)
Purpose: Plan Check and Construction Deposit Refunds
Permit M ENC2018-00041
Receipt M 273930 Date: 2/26/2018
Receipt#: Date:
Requested by: r..._ Title: Inspector Date:
Syed Wahidi
Approved by: Title: Sr. Engineer Date:!5 I°v tq
Roger Storz
Finance Dept Only:
Verified by: oun Ing er
Approved by: Title: Accountant Date:
Sped' tructions For Handlinq Check
mall As Is: man in Attacnea Envelope: interim L;necK:
Needed By:
Return JoAnna Thomason Public Works
(Name) (Department)
er: Please return check to JoAnna
Encroachment Permit Final Sign Off
Encroachment Permit# �-�C- ?�1�" Lf(
Address: L"
Date of Final Inspection and Acceptance:
Inspected by: Iw
OK to release deposits: 100% V 75%
Comments:
�r
Pri i, 'orm
CITY"OF CAMPBELL 1R-'I ENCROACf�N9E14dT°PERtUI1T Permit No. �� �i� ' ooc,- i
DEPT.OF PUBLIC WORKS (Non-engineered work within the public right-of-way) X-Ref File
)11oe#h>FiistSfiteet ($_10,000.00,maximum•valueofwork) Application•Date 02� IP
Campbellj,-CA 95008,. ApplicatiomExpiration.
Ph.(408)866-2150 ISSUED: 2/ 2'�-�� Date ��_
F'k.(408).176r095$ Perrnit iFxpiration Date. (�' APL�L:
APPISICAT161V-Appdicatfion is�hereby made for a,,PubairWorJcs PerrTfit'in accordance with°CannpbeMunicipaJ tode,'Secfion 9 4.�1
{Application expiresan 6,months.jf xhe,permit is notassueda
A. Work Address:
B. Nature of Work:
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: C Telephone:
D ,hf... .. 11LV4 D L✓_-- - [468.
Address:
E-Mail Address: 0�7 0� ,
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 sig:pature,tgtf.is perrrnfito troid the City ofCampbell,C�i y�ofCampbeil�edevglopMeiit Agency,.is
„.
officers,agents,and< mplwees free;'safe"ar�d harmless.from any claim,or demand for damages.resulting from'the work covered by.this permit.
The Applicant hereby acknowledges,tlgatthey have read and:understand both the front and.b.ackk of this.permit,.and that they willi.nform;their
contractor(s)of the information. -
ZC
ACCEPTED: 2 �r
(Applicant/Permittee) Wprved
ign) Date
NOTES: All work shall conform with the attached a plans and all applicable Campbell Standard Details and Conditions and applicable
insurance.requirements.
The CQntractor.rn,ust_have this..petmit and approved plans and must:atrange to meet with the Publie"11..brks 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 ofthedesign,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. C 8 LiC116& a
3.
'STANDARD AMOUNT REC T
SECURITY FOR FAITHFUL PERFORMANCE (100%Of Engr's Est.) $ ZOO o
t r
11-11:PERWTFEf $
APPROVED FOR ISSUANCE: LC I
or ity Engineer Date
J
Permit Expires 6 Months after Date of Issuance.
GENERAL PERMIT CONDITIONS
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 writ tvtolhe Permittee.
6. Malntainsafe-pedestrian,and vehicular.crossings,and:free,access.topdvate driveways,flrehyd rants andwater 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 ih:the C4s:providing such signing and barricades.and charging the costto:the Permittee.
10. The Contractor or:Perm ittee:will.have,asupervisoryrespresentativeavailablefor contact ontheprojectatall'tin-es.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,
w. hich,w.oulcl.c.reama hazardous condition to the public.
-13 This=permitshall not,be.construed.as authorization for excavation and grading on private property adjacenttoahe 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 bylaw. .
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.
is. This:permitis not transferable:Work-must be:performedby.the,Perm ittee.orhis.designated agent or contractor_as,specifiedthereon.
1,6. Prior approyalofinspecto,risrequired:-foranyworkdoneafternormalworking'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 mod ificatiomordeparture,andtospecify the manner in=which thesame is to.be made forrCity-ownednr
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 ensuring that all those providing services under the applicant are aware of and understand all of the above
conditions.
r 2- 2-to — A
Applicant Vw Date-
J:\FORMS\Temp tes\Encroachment Permits\R-1 Encroachment Permit STATIC form2.pdf
Rev.02/14
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F SIDEWALK
,,,—MECHANICAL
SEPARATOR CONSTRUCTION
,JOJNT
SIDEWALK WEAKENED
SEE-NOTE 5 PLANE JOINT
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WEAKENED PLANE JOINT
2 DEEP,
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8 6" CLASS A CONCRETE, TYP. °: + s''°: 6.
6" CLASS 2 AGGREGATE BASE, TYP. o
DOWEL
SECTION A—A
NflIE
1. WHEN THE DRIVEWAY IS NOT POURED AT THE SAME TIME AS THE CURB AND GUTTER, 12" OF NO. 4 REBAR AT 4'
114 ALS !SHALL` BE",INSTALLED ;AS 814DWN '(REBARS' 'TO :BE -BENT DOWN .AND COVERED.' ��L.I1 �)•.
2. SCORE MARKS SHALL NOT EXCEED 4—0" O.C., AND USE MECHANICAL SEPARATOR AT EVERY OTHER SCORE MARK.
3. DRIVEWAY APPROACHES (EXCEPT SINGLE FAMILY) SHALL HAVE A 6"X6"X10/10 WELDED WIRE FABRIC 3" ABOVE -
BOTTOM OF CONCRETE.
4. DOWEL ALL NEW CONCRETE IMPROVEMENTS TO EXISTING CONCRETE IMPROVEMENTS.
5. AT LOCATIONS WHERE NEW SIDEWALK ENDS AND MEETS AN EXISTING SIDEWALK, THE NEW SIDEWALK SHALL
TRANSITION TO MEET THE EXISTING SIDEWALK AS DETERMINED BY THE CITY ENGINEER.
of CA yyA CITY OF C"PBELL RSV DATA B SCALE:
�B �QS Residential T0 /
1 .S,.
DRAWN HY: - DATE 02iO4 Driveway Detail DETAIL
CHECKED BY: DATE
(Attached Sidewalk ) NO.
. APPROVED BY: o
°RCgASV AMY�G�B J:/Drawings/Std_Details/D 15
DANIEL D YOUNGS
1313 MILPITAS BL#200 `�
MILPITAS,CA 95035
FARMERS
INSURANCE
Home Insurance Renewal Offer
Your Farmers policy
Policy Number:98113-00-76
JOAN MCANDREWS Effective:8/3/201 7 1 2:01 AM
1444 RIDGELEY DR Expiration:8/3/2018 12:01 AM
CAMPBELL CA 95008-0706
Property insure`
1444 Ridgeley Dr
Campbell,CA 95008-0706
6/12/2017
Your Farmers Agent
DearJoan McAndrews;
Daniel D Youngs
Thank you for choosing Farmers for your homeowners insurance needs.We appreciate the 1313 Milpitas BI#200
opportunity to provide continued coverage for you and your family. Milpitas,CA 95035
(408)262-5196
Please review the renewal documents that have been enclosed: dyoungs@farmersagent:com
• Declaration page—a summary of your insurance coverages,limits,and deductibles
Detailed reconstruction cost estimate of your home To file a claim call
A summary of your premium and policy change information is shown below.With this 1-800-435-7764
renewal,you'll see an increase in your home coverage limits.This change reflects the rising
cost to replace homes in your area,including labor and construction materials. Did you know?
Premium at-a-glance
.. . . . .. . . . .. . . . . . . . . .. .. . . . . . . .. . . . . .. . . .. . .. . . . .. ... .. .. .. . .. . . .. .. .. .. Farmers Friendly Review
Policy Preevfia�m1�3g4 40 Contact your agent to learn more
about the policy discounts,coverage
options,and other product offerings
that may be available to you.
Summary of changes Farmers'Rewards Visa°'Card
Previous Renewal
Coverage:Dwelling $462,000 $469,0100 Apply today for the Farmers
- Rewards Visa card,offered by
Coverage:Loss of Use $184,800 $187,600 Comenity Bank!This program gives
....... ..... ... .......... ............ ... ... .... ....-_................ ... ....
Coverage:Personal Property $346,500 $351,750 you flexible rewards for your
Coverage:Separate Structures $46,200 $46,900 everyday activities.Learn more at
farmers.com/frv.
Terms and Conditions Apply
This is not a bill.Your bill with the amount due will be mailed separately. Go Paperless
If you prefer,you can log into farmers.com today to review your balance and make a Save stamps,time and trees....Go
payment.You can also contact us at 1-877-327-6392 or visit your agent's office with your Paperless!You can choose to
receive your Farmers policy
payment. documents and/or billing statement
electronically.Enroll at farmers.com
Sincerely, and choose the paperless options!
Farmers Insurance Group@
farmers.com
25-8164 1-14
Next Generation Homeowners Declaration R
Page INSURANCE
Policy Number: 98113-00-76 Premiums
Effective: 8/3/201712:01 AM . . .... ... ..... .. . .. .. .. .. .. . . . .. .. . . .. .... .. ..... . .. .
Expiration: 8/3/201 8 1 2:01 AM Policy Premium $1,394.40
Namedlnsured(s):Joan McAndrews.
1444 Ridgeley Dr Your policy premium includes a Total Discount Savings of$292.31
Campbell,CA95008-0706
joaniemacl214@gmail.com *also see In on Additional Fees below
Property Insured: .1444 Ridgeley Dr This is not a bill.
Campbell,CA 95008-0706 Your bill with the amount due will be mailed separately.
Underwritten By: Fire Insurance Exchange
6301 Owensmouth Ave.
Woodland Hills,CA91367
Description of Property
Year of Construction Construction Type Roof Type Number of Units Occupancy
_........................._........._.._............_.._.-.. _......._-- .... :..._.._.._..........--------......_........._........-----............. ...._.._...__._._._............_........--..........__._...._..._._..._................-....._..........._..-----—-----........._..._..... —
1956 Wood Siding Over Frame Composition-3 Tab Shingle 1 Owner
Occupied
(Primary Res.)
Property Coverage
Coverage Limit Coverage Limit
_..._.. _..-.._.. ..... . . _._........ --- - . ...... ._._._- ... ---- - ------._ --
Coverage A Dwelling $469,000 Coverage D-Loss of Use $187,600
Extended Replacement Cost $117,250 Additional Living Expense Term 24Months
.................................................................................... .... ............ .. ....- ................................................................................................................
Coverage B-Separate Structures $46,900 Identity Fraud Coverage $30,000
..................... .................... _..... . ......................._......_._... . .. ........_........................
..
Coverage C-Personal Property $351,750 Building Ordinance or Law 10%
Contents Replacement Cost Covered
Wild Fire Smoke,Soot,Char,Ash or Odor - $5,000
Damage
Liability Coverage
Coverage Limit Coverage Limit
Coverage E-Personal Liability $300,000 Coverage F-Medical Payments To Others $5,000
_-.. ....-_......._.._..... ..... .. ... . ... .............. ..,._........................
Association Loss Assessment Not Covered
Deductible
Deductible
- .._.-_.........._ _................._._..— --- ._...__.... --....--................_... ---..._.........__.._....._.........._._...__....... --- .._._....._..__._..-_......................
...---------...
Applicable to each covered loss $2,000
farmers.com Policy No. 981 13-00-76 Questions? Manage your account:
Call your agent Daniel D Youngs at Go to www.farmers.com to access
(.408)262-5196 or email your account any time!
dyoungs@farmersagent.com
56-6177 1st Edition 4-15 6/12/2017 Pagel of
Declaration Page (continued)
Discounts Applied to Policy
Discount Type DiscountType
Non Smoker Experience Rating Plan
Total Discount Savings $292.31
Policy and Endorsements
This section lists the policy form numberand any applicable endorsements that make up your insurance contract.Any endorsements
that you have purchased to extend coverage on your policy are also listed in the coverages section of this declarations document:
56-5532 3rd ed.;J6965A 1st ed.;25-8531 10-12
Other Information
® Please contact your Farmers®agent for a free Farmers Friendly Review°so that you can ensure that your family is properly protected.
Your agent can explain all of the policy discounts/credits,coverage options and our various other product offerings that maybe
available to you.
® Farmers Smart Plan Home®Policy offers less coverage than is available in the Farmers Next Generation ®Homeowners product.If
you qualify under Farmers underwriting guidelines,you may be eligible to purchase reduced coverage in the Farmers Smart Plan
Homeowners®product for a reduced premium.You may contact your Farmers®agent for additional details.
a The attorney-in-fact(AIF) or management fee for your renewed policy will never exceed 25%of the policy's premiums and will be
paid out of the premiums.You may wish to consider this information in deciding whether to accept or decline this offerto renew
your policy.
• This policy includes 10%Building Ordinance coverage(calculated as a percentage of coverage A or B)as applied per the policy.
The limit of liability for this structure(Coverage A)is based on an estimate of the cost to rebuild your home,including an approximate
cost for labor and materials in your area,and specific information that you have-provided about your home.
® Ask your Farmers°agent about flood insurance.
farmers.com Policy No. 98113-00-76 Questions? Manage your account:
Call your agent Daniel D Youngs at Go to www.farmers.com to access
(408)262-5196 or ernail your account any time!
dyoungs@farmersagent.com
56-6177 1st Edition 4-15
Page 2 of 3
Declaration Page(continued)
*Information on Additional Fees
The"Fees"stated in the"Premium/Fees"section on the front apply on a per-policy,not an account basis.The following additional fees
also apply:
1. Service Charge per installment(inconsideration of our 2. Late Fee:$10.00(applied per account)
agreement to allow you to pay in installments): 3. Returned Payment Charge:$25.00(applied per check,
For Recurring Electronic Funds Transfer(EFT) electronic transaction,or other remittance which is not
and fully enrolled online billing(paperless):$0.00 honored by your financial institution for any reason including
(applied per account) but not limited to insufficient funds or closed account)
For other Recurring EFT plans:$2.00(applied per account) 4. Reinstatement Fee:$25.00(applied per policy)
For all other payment plans:$5.00(applied per account)
One or more of the fees or charges described above may be
If this account is for more than one policy,changes in these fees deemed a part of premium under applicable state law.
are not effective until the revised fee information is provided for
each policy.
Countersignature
{
Authorized Representative
farmers.com Policy No. 98113-00-76 Questions? Manage your account:
Call youragent Daniel D Youngs at Go to www.farmers.com to access
(408)262-5196 or email your account any time!
dyoungs@farrnersagent.com
56-6177 1st Edition 4-15
Page 3 of 3
PUBLIC WORKS DEPARTMENT LAND DEVELOPMENT
Effective July 1, 2017
TO: Finance PUBLIC WORKS FILE NO. C
PROPERTY ADDRESS Natal PlXUV
Please collect&receipt for the following monies:
;Ac'c
_
-MOUNT'
LkNdbr VEL 01?MENT-
4722 Encroachment Permit Application Fee
Non-Utility Encroachment Permit Maior 2�$l 0,000 $425.00
Minor Encroachment Permit<sic,000 $240.00
Initial R-1 Permit N/C
Subseauent R-1 Permits within Two Year Period $240.00
Inspection Fee Minimum Charge per Location $420.00
Street Tree Planting/Removal - NIC
2203 ($500 per Tree Planting Deposit Required) $500.00/tree
22031 Plan Check Deposit 2%of Engineer's Estimate $500.00 min
Utility and R-1 Permits no deposit required
47221 Grading&Drainage Plan Review
Single Family Lot $295.00
Site< 10,000 s.f. $885.00
Site> 10,000 s.f. <0.5 Acre $1,185.00
Site 0.5 Acre $1,772.00
4722 NPDES Review(C3 Requirements)
For projects not required to submit numeric sizing $175.00
For projects required to submit numeric sizing
I pervious Area 10,000 Sq. Ft to 1 Acre $740.00
Impervious Area 1 Acre or more $965.00
4722 For proiects sent to Consultant for review -Consultant Cost+20%
4722 Additional treatment facilities - $315 ea
- Plan Check& Inspection-Fee(Non-Utility)
4722 Enqr. Est. <$250,000 14%of Engineer's Estimate
4722 Enqr. Est. �t$250,000 and:5$500,DOD $35,000.00+8%of Engineers Estimate
4722 Enqr. Est. >$500,000 $55,000.00+7%of Engineers Estimate
2203 Emergency Cash Deposit 4% of Enqr. Est.*($500 min/$1 0,000 Max)
2203 Faithful Performance Securi (FPS) 100% of ENGR. EST.* loco
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 Mai) (4 Lots or Less) $4,200.00+$90/lot
47221 Final Tract Map(5 or More Lots) $5,115.00+$124/lot
2203 Monumentation Security 100% of Ci!y's Monumentation Estimate
4920 Parkland Dedication Fee(75%/25% Due Upon Cert. of Occupancy)
4722 Lot Line Adjustment(includes Certificate of Compliance) $1,990.00
4722 Vacation of Public Streets& Easements $2,700.00
4722 Certificate of Compliance $1,970.00
4722 Certificate of Correction $590.00
4722 Document Recording Fees $15.00/first page$3 ea.Additional
4722 Private Improvement in Public ROW $100.00
4722 Approved Plan Revision Fee $1001sheet
4722 Appeal Filing Fee $200.00
730.49241 Notice f Improvement Obligation Payment
47T2 Assessment Segregation or Reapportionment
First Split $940.00
Each Additional Lot $295.00
511.7424 Postage
777
Other(Please Specyy)
*Engineer's Estimate shall be as approved by the City Engineer and shall include all items of work. TOTAL 2-oc) o
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NAME OF APPLICANT )k wDe 6__�
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, _I-rNAME OF PAYOR PHONE
DDRESS Zip A
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FOR RECEIVE! BY
CITY CLERK 7"
CITT F CAS ONLY Date 7
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CITY OF CA-,-MPBELL
;t;:Et:v'S� ��i i.:,St;<i-ir01000273930
REMSTER DATE: 2: 6t Ll TIME. OWO ,
j 'US -': C 01 j-ti0EEN1 ,
TOTAL BIUE-;
EMl i..tl 1.
CREDIT CARD: $2,000.00
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