ENC2018-00128 Ile
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(CITY OF CAMPBELL
Public Works Department
August 7, 2019
Deborah Follmar
20770 Montalvo Ln.
Saratoga, CA 95070
SUBJECT: PERMIT NO. ENC 2018-00128
14511 S. Bascom Ave., Campbell, CA
FINAL INSPECTION AND ACCEPTANCE
Dear Deborah:
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 ou have any questions, please call me at (408) 866-2165.
Si cerely,
S •d Wahidi
Pu is Works Inspector
70 North First Street • Campbell, California 95008 TEL 408.866.2150 • Fnx 408.376.0958 TDD 408.866,2790
Encroachment Permit Final Sign Off
Encroachment Permit# tom- 2'e- W12v
Address: ILfSI[ 5 �A$c-,M.
Date of Final Inspection and Acceptance:
Inspected by: �LJ
OK to release deposits: 100% 75%
Comments:
ov , Cq�A
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CITY,OF CAMPBELL
Public Works Department
August 7, 2018
Deborah Follmar
20770 Montalvo Ln.
-Saratoga, CA 95070
SUBJECT: PERMIT NO. ENC 2018-00128
14511 S. Bascom Ave., Campbell, CA
FINAL INSPECTION AND ACCEPTANCE
Dear Deborah:
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 July 19, 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 Performance Deposit in the amount of$2,000.00 is enclosed.
If you have any questions, please call me at(408) 866-2165.
Sincerely, -
Sy ed Wahidi
Public Works Inspector
Cc: Inspector/Suspense Files
Permit File ENC2018-00128
70 North First Street • Campbell, California 95008-1436 TEL 408,866,2150 FAX 408.376.0958_ TDD 408.866.2790
* ENCROACHMENT PERMIT Permit No.: L Zo(8—Ou
CITY OF CAMPBELL X-Ref. File
DEPT.OF PUBLIC WORKS (for working within the /
70 North First Street public right-of-way.) Application Date 6 i29( (�
Campbell,CA 95008 Issued " U Application Expiration Date
Ph.(408)866-2150 APN
Fx. (408)376-0958 '7 �-
Permit Expiration Date
APPLICATION-Application is hereby made fora Public Works Permit! accordance with Campbell Municipal Code,Section 11.04..(Application expires in six
(6) months if the permit is not issued. Application Fee is non-refundable.)
A. Work Address:
Nature of Work/Utility I
B. Trench Location: �Z ADA `e� P A rA T I� V�1� APR { '
❑ No Fee,Permit for work related to City Project Project Name:
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. Allworkshall conform totheCityofCampbellStandardSpecificationsandDetailsforPublicWorks 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
injob shutdown and/or forfeiture of Faithful Performance Sureties and cash deposits.
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 ,2 \
starting work. Notice must be given to Public Works at least 24 hours before restarting any work. C U 90 76 !`Jr_3 Ze J
Name of Applicant: ' Telephone: ,- 040
Address: I t+5 0 S' UaseOM lbe— J_o. C- � C 1'7 go, 2
E Mail Address: �e�� l l a�� -� c,bjVFUR EMERGENCY PHONE NUMBER; ( ) �/ —904
Is this work being done by the property owners at their own residence? ❑ Yes n No
The Applicant/Permittee hereby agrees by affixing their signature to 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 Applicant/Permittee hereby 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 is advised that upon issuance of this permit, property owner, or property owner's successors, shall be responsible
for any and all damages ' ing out of improvements com lete i the public right-of-way.
Accepted:
(Applicant Permittee) (sign) Date
haj,CS
(Contractor) (Print Name) Date
SPECIAL PROVISIONS:
1. Street shal[not be o pen cut for underground i ristaltations.Minimum cuts maybe a Rowed for connections or exploration holes.Such cuts maybe
cparifirally annrnvad by the Int Pn rtnr prim to ci tting.
2. Pavement may be cut for underground installations and must be restored in accordance with the Standard Details Trench Restoration Method
"A",uniess otherwise approved by the Engineer.
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 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 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.
6. Public Notification Requirements:
cTJ
7.
SEE PUBLIC WORKS FEE SCHEDULE FOR CURRENT FEES AMOUNT RECEIPT NO.
Jn�
PERMIT APPLICATION FEE $ Lf&
PLAN CHECK DEPOSIT $
SECURITY FOR FAITHFUL PERFORMANCE/LABOR&MATERIALS $ 2C)o G ell.
CONSTRUCTION CASH"DEPOSIT -- $
PLAN CHECK&INSPECTiON,FEE,. -
EMERGENCY PERMIT FEE $
�--=�-
APPROVED FaP.ISSUANCE 7/2/1.5�
Fbr ityEngineer Date
W
Permit Expires 12 Months After Date of Issuance
GENERAL PERMIT CONDITIONS
1. The Permittee must provide evidence of insurance and Additional Insured Endorsements as required by the City.Insurance shall be maintained for the duration,of the
permit work.
2. A Construction Cash Deposit is required.Changes will be made againstthis 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.
3. Refund of the construction cash deposit balance and refund or cancellation of the Faithful Performance Surety will be initiated by the written acceptance ofthe work
by the City.
4. A one-year maintenance period and surety are required.Such period will begin on date of written'acceptance by the City.Surety posted shall be equal to 25%of the
original Faithful Performance Security.
5. Submit project schedule 10(ten)days prior to proposed start of work.Additional lead time may be required for work within City facilities and downtown Campbell.
6. 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.
7. Maintain safe pedestrian and vehicular crossings and free access to private driveways,bus stops,fire hydrants,and water valves.
8. A Construction Traffic Control Plan and a Construction Schedule are required for all lane closures,detours,and street closures.This plan must be reviewed and
approved priorto any lane closures.
9. A Construction Traffic Control Plan shall conform to the 2006 California Manual on Uniform Traffic Control Devices(MUTCD). '
10. 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 as expeditiously as possible.
11. Sawcut for all PCC or AC removals.All PCC removals shall be to the nearest scoremark and new PCC shall be doweled to existing improvements.
12. Prior approval of inspector is required for any work proposed after normal working hours,on weekends or holidays and may require reimbursement of inspection
costs at the current overtime rate.
13. Work on arterials and collectors may require the use of changeable message boards.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 the cost(including all labor and materials)againstthe construction
cash deposit.
14. Compaction testing of subgrade,base rock,and asphalt concrete by Permittee is required unless otherwise stated by the City Engineer.
15. The Contractor or Permittee will have a supervisory representative available#or 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.and on weekends.
16. No storage of materials or equipment will be allowed near the edge of the pavement,the traveled way,or within the shoulderline which would create a hazardous
condition to the public.
17. 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.
18. This permit does not release the Permittee from any liabilities contained in other agreements or contracts with the City and any other public agency.
19. .This permit is not transferable.work must be performed by the Permittee or his designated agent or contractor as specified thereon.
20. 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.
21. 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.
22. If the public interest requires a modification of,or a departure from the permit,plans,special provisions and/or.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.
23. Permittee,must.provide advance notification to all parties that may be affected by the permit activities.Notification shall be reviewed by the City prior to distribution
and include dates of work and a contact name and a phone number.
24. Applicant shall remove water from utility vaults in accordance with the requirements of State Water Resources Control Board Water Quality Order WQ 2014-0174-
DWQ. Said vault water shall not be discharged into the City of Campbell's storm drain system.
See http://www.waterboards.ca gov(water issues/programs/npdes/utilityvaults shtml for more information.
Applican ' ereby responsible for ensuring that all those providing services underthe applicant are aware of and abide by all of the above conditions.
App icant Date:
Contractor (Print Name) Date:
J:\FORMS\Templates\Encroachment Permits\Encroachment Permit STATIC form2.pdf
Rev.02/18
PUBLIC WORKS DEPARTMENT LAND DEVELOPMENT
Effective July 1,2017 ax 2_�
TO: Finwce PUBLIC WORKS FILE NO.
PROPERTY ADDRESS
Please collect& receipt for the following monies:
_0
LANDDEVELOPMENT......
4122 Encroachment Hermit Application Fee
Non-Utility Encroachment $425.00
Minor Encroachment Permit<sl o,000 $240.00
Initial R-1 Permit N/C
Subsequent R-1 Permits within Two Year Period $240.00
Inspection Fee Minimum Charge per Location $420.00
Street Tree Plantinq/Removal - NIC
2203 ($500 per Tree Planting Deposit Required) $500.00/tree
2203 Plan Check Deposit 2%of Engineer's Estimate $500.00 min
rJ
Utility and R-1 Permits no deposit required
Fj j4722 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 Z:0.5 Acre $1,772.00
4722 NPIDES Review(C3 Requirements)
For projects not required to submit numeric sizing $175.00
For projects required to submit numeric sting
Impervious Area 10,000 Sq. Ft to I Acre $740.00
Im ervious Area I Acre or more $965.00
4722 For projects sent to Consultant for review Consultant Cost+20%
4722 Additional treatment facilities $315-ea
Plan Check& Ins pection.Fee(Non-Utility)
4722 Enqr. Est. <$250i000 14%of Enclineer's Estimate
4722 Enqr. Est. >$250,D00 and 5$500,000 $35,000.-00+8%of Engineers Estimate
4722 Enqr. Est. >$500,000 $55,000.00+7%of Engineers Estimate
2203 Emergency Cash.De posit 4% of Enqr. Est*($500 min/$10,000 Max)
2203 Faithful Performance SecuritV(FPS) 100% of ENGR-. EST.*,
2203 Labor and Materials Securi 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) .$4,200-00+$90/lot
4722 Final Trbct,Mar)(5 or More Lots) $5,115.00+.$124/lot
2203 Monumentation Security 100%of Cityls 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 $100/sheet
4722 Appeal Filing Fee $200.00
730.4024 Notice of Improvement Obligation Payment
472-2 ssessmentbegregation or ReapportioEment
First Split $940.00
Each Additional Lot $295.00
511.7424 Postage
S7C MI
Other(Please Specity)
*Engineer's Estimate shall be as approved by the City Engineer and shall include all items of work, TOTAL $
�(NAME OF APPLICANT J)�k ro—b
NAME OF PAYOR PHONE I"b" (o 7
UDDRESS ZIP '7607L0,j,-,
U
A
ai
7
FOR
g
CITY CLERK
ONLY DateReceipt
;,c
JoAnna Thomason
From: JoAnna Thomason
Sent: Thursday, September 27, 2018 11:28 AM
To: Ana Rios
Cc: Joy Francois
Subject: Deposit correction
Attachments: SKMBT_50118092711210.pdf
Hi Ana,The attached receipt shows a deposit for$455.00 and is listed on the refundable deposit report. I verified with
Syed that it is actually a plan check inspection fee, and the receipt is incorrect.
Can you make that adjustment please?
Let me know if you have any questions.
Thanks
JoAnna
.OF-CAI, JoAnna Thomason
Office Specialist
U r City ol'Campbell Public. Works Department
0 lip o 70 N. First Street; Campbell,CA 95008
` '�:'..c,t�%c>,fca.mhhi ll_corn 1 408.866.2l.50
•�RCHAR9.
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CITY of CAMPBELL
Public Works Department
August 7, 2018,
Deborah Follmar
20770 Montalvo Ln.
Saratoga, CA 95070
SUBJECT: PERMIT NO. ENC 2018-00128
14511 S. Bascom Ave., Campbell, CA
FINAL INSPECTION AND ACCEPTANCE
Dear Deborah:
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 July 19, 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 Performance 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 ENC2018-00128
70 North First Street • Campbell, California 95008-1436 TEL 408.866.2150 FAx 408.376.0958 TDD 408.866.2790
............ .......... ........................ .................................................. ....... ..........................
.......... .............. ...........................
.................
CITY OF CAMPBELL VENDOR No.j 10015061 CHECK NO. 269210
voice ton,
101 2203 CR073018 2 '0 0 0.00 FPS REFUND
10015061 DE90RAH FOLLMAR
X�`DATE "-,q-HECY z,NO.CHEC
W81,L S
.:;�ARGO BANK, N.A.
Z 4 2`4:MONTGOMERY STREET 11-24 2-69210
1210
U8/06/i
WT FIRST STREET -4A::FRAN'Cl'SC0, CA .9 jil 0 4
CAMPBELL CALIFORNIA 96008
o.
AMOUNT '�,'H,'Q -00*`—
VOID AFTER 90 DAYS o
PAY THE,�SUM'O'F,e THOUSAND DOLLARS & ZERO CENTS To 'THE 'DEBORAH FOLLMAR
ORDER-` 20770 MONTA.LVO,.'�LN
'
wr
SARATOGA CA 95070 ;
'):'l 21-0,00,-2484 269 2 1,218-5-54�1,S ........
... .......
- ---- - ------------- -------
. .............................. ...............-............ .................. ................
.............................. ................ ............. ....................................... ................................ .....................................3 A.................................... ..................
*See Reverse Side For Easy Opening Instructions*
--- - ----------- - - ---- ------ -- -
CITY OF CAMPBELL
70 NORTH FIRSTSTREET
CAMPBELL, CALIFORNIA 95008
DEBORAH FOLLMAR
20770 MONTALVO LN
SARATOGA CA 95070
'Refundable-,De.posit Check. Request \
To; Finance Director'
Check Payable'To: ` : Deborah F611mar
Address-'Line'1: i6770 Montalvo Ln
Line 2: S i
City: Saratoga State: CA Zip: 95070
Description- FPS"refund
Account Number 101.2203 Amount: $2,000.00
Account:Number; 101.2203 Amount:
Account Number: 1;01.540.7448 Amount:
(Finance Dept only) Interest Earned (Finance Dept only)
Total Payable: (Exact Amount)
Purpose:
Deposit refund
Permit# ENC2018-001.213
Receipt#: 21,5968 Date: 6/.2912018
i
Receipt#: Date:
Requested by.:° Title: Inspector Date: 712E/
Syed Wahidi
_ c9
Approved by: _ Title: St. Engineet, Date: ` Q.
Roger'Storz,
Finance Dept Oril.y:
Verified by: - Title: Accounting Clerk II Date:
Approved by: - Title: Accountant Date: „
S ;ecial Instructions For :H:andlin Check
Mail As It: _ Mail in.Attach6d Envelope Intetim_Check:
Needed By:
Return To:, .,JoAnne Thomason Public,Works
(Name) ; (Department)"
Other: Please return check,to JoAnne
CITY OF CAMPBELL
PUBLIC WORKS DEPARTMENT
CLEARANCE FOR FINAL INSPECTION
AND ACCEPTANCE LETTER
Encroachment Permit#: ENC 2018-00128
Name: Deborah Follmar
Property Address: 14511 S. Bascom Ave.
Date of Final Inspection:
On File: Bonds CD Cash
Fa.i.thful P` rfo ance,: �0�d0�0°0
Labor and Material: $
Construction Cash Deposit to be released: $
Other overdue deposits to be released (Description):
Processed by:
Admi 'strator ?
Reviewed by:
Inspector
Reviewed by:
Land Development Engineer C�
JAJoAnnaT\Depositrefunds\CHECKLISTS\Bascom 1451 Ldoc(Rev. 10/11)
Encroachrrient Permit Final Sign Off
Encroachment Permit# C-- 2-.1P, -GQ I 2-F,
Address:
Date of Final Inspection and Acceptance: 71 111 6
Inspected by:
OK to release deposits: 100% V 75%
Comments: � o�