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ENC2018-00274 E i i i Refundable Deposit Check Request i To: Finance Director i f Check Payable To: John Saunders i Address-Line 1: 77 S.Third St Line,2: i City: Campbell State: CA Zip 95008 ! 1 Description: 77.S.Third St Account Number: 101.2203 Amount: $5,000.00 Account'Number: 101.2203 Amount: 500.00 Account Number: 101.540.7448 Amount:. I (Finance Dept only) Interest Earned (Finance Dept only) j Total Payable: $ 5,500.00 (Exact Amount) I Purpose: FPS&Emerg Cash Deposit Refunds Permit#: ENC 2018-00274 Receipt#: 277178. Date: 9/14/2018 j Receipt#: Date: Requested by: Title: Inspector Date: Syed Wahidi qq i Approved by: Title: Sr.Engineer Date: Rog it It&Z I Approved by: Title: City Engineer Date: G Amy O a Finance Dept Only: I Verified by: Title: Accounting Clerk II Date: Approved by: Title: Accountant Date: Special Instructions For -Handling Check Mail As Is: ai•I\i Attached Envelope: Interim Check`:'.._ Needed By: Re urn To: JoAnna Thomason Public Works (Name) (Department) Other: Please return check to JoAnna ................... .................... ..................................... ................. ................... ............................ ............ ...................... ...................................... ....................................... ............ ............................... ........................................ ............................ .......... .................. CITY OF CAMPBELL VENDOR NO. 10015968 CHECK NO. 277440 ............. 101 2203 CRO12420 5,500.00 FPS EMRb DEP REFUND 'AR 10015968 JOHN SAUNDERS II T. Of;CAMPBELL WEMS]FARGO CHECK DATE: CHECK NO. N.A. i -24 02/03/20 2774 n ;4kMONTGOMERY STREET 1210 H FIRST STREET FRANCISCO, CA 94104 CAMPBELL, CALIFORNIA 95008 0 a LT&T, AMO -**5, 500 . 00* 0 VOID AFTER 90 DAYS PAY THE SUM OF FIVE THOUSAND, FIVE HUNDRED DOLLARS & ZERO CENTS 03 TO THE JOHN SAUNDERS ORDER 77 S. THIRD ST 0- CAMPBELL CA 95008 OF 112 2 774400 412100021,84 4124135541511 . ...................... ........... ............ ............ ....................................... ......................................... ............................................................................. ........................ ........................ ......................................... ....................... .......... .............. *See Reverse Side For Easy Opening Instructions* CITY OF CAMPBELL 70 NORTH FIRST STREET CAMPBELL, CALIFORNIA 95008 JOHN SAUNDERS 77 S. THIRD ST CAMPBELL CA 95008 CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT CLEARANCE FOR ONE YEAR MAINTENANCE ACCEPTANCE LETTER Encroachment Permit # ENC2018-00274 Property Address 77 S. Third St. Date of Final Inspection: 1/24/20 On File: Bonds CD Cash Faithful Performance $5,000.00 Labor and Material $ Construction Cash Deposit to be released: $500.00 Other overdue deposits to be released (Description): Processed by: 2 ao Adm istrator r Reviewed by: I t Inspector / I Reviewed by: Land eve opment Engineer` r JAJoAnnaT\Deposit refunds\CHECKLISTSMird 77.doc(Rev. 10/11) Encroachment Permit Final Sign Off Encroachment Permit# I[-MC ��l$- 1&IlLt Address: '7-7 Date of Final Inspection and Acceptance: taf Inspected by: � OK to release deposits: 100% 0 75% Comments: 2� CITY OF CAMPBELL ENCROACHMENT PERMIT Permit No.:ENC2018-00274 DEPT.OF PUBLIC WORKS (for working within the X-Ref. File 70 North First Street public right-of-waysi) Application Date 9/14/2018 Carrmpbetl,CA95008 Issued r���3 I 3/14/2019 Ph.(408)866-2150 Application Expiration Date Fx. (408)376-0958 APN Permit Expiration Date APPLICATION-Application isherebymadeforaPublicWorksPermitinaccordancewithCampbellMunicipalCode,Section11.04.(Application expires in six (6) months if the permit is not issued. Application Fee is non-refundable.) A. Work Address: 77 S Third Street B. Nature of Work/Utility Public Improvements Trench Location: ❑ 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- All workshall conform tothe Cityof6mpbell Standard Specificationsa nd Details for Public Works Construction theGeneral 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 injobshutdown 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 leasttwo days before startingwork. Notice must be given to Public works at least 24 hours before restarting any work. Nam eofApplicant: JOHN AND SHANNON SAUNDERS Telephone: Address: 77 S THIRD STREET E-Mail Address: 4 24- OUR EMERGENCY PHONE NUMBER: to ri Kim v3. �wner, ►d�e�.5 �,.a r�r�t • Ga i1Is this work being done by the property their own resi- ce? Yes ❑ 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 arising out of improvements completed in the pVblic right-of-way. Accepted: JOHN AND SHANNON SAUNDERS 9"461 l"-f2 __.. 9/14/2018 (Applicant Permittee) (sign) Date (Contractor) (Print Name) Date SPECIAL PROVISIONS: 1. Streetshall not be open cutfor underground installations.Minimum cuts may be allowed forcon nections orexpl oration holes.Suchcuts maybe tnrsrifirally approved by the Inspertor priortn rutting. 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 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 ofthe 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. S. 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: SEE PUBLIC WORKS FEE SCHEDULE FOR CURRENT FEES AMOUNVI �j�r „® RE�f��O� PERMIT APPLICATION FEE $ _0 PLAN CHECK DEPOSIT $ SECURITY FOR FAITHFUL PERFORMANCE/LABOR&MATERIALS $ CONSTRUCTION CASH DEPOSIT $ PLAN CHECK&INSPECTION FEE EMERGENCY R€RAAtCG�Ef+ L I•.'r V I1PZ p' $ ( } ' 4 APPROVED FOR ISSUANCE For City Engineer Date Permit Expires 12 Months After Date of Issuance $ tl p� Q a ' d I 0 r 9� d r n 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 against this deposit if there is an emergency call-out,overtime inspection orwhen 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%ofthe original Faithful Performance Security. S. Submit project schedule 10(ten)days priorto proposed start of work.Additional lead time maybe 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 prior to any lane closures. 9. A Construction Traffic Control Plan shall conform to the most recent version of the 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 ofthe Permittee as expeditiously as possible. 11. Sawcut for all PCC orAC 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)against the 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 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.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. 1% 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 beat 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.Applicantshall 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,ora departure from the permit,plans,special provisions and/or specifications,the Cityshall have the authority to require or approve any modification or departure and to specifythe manner in which the same is to be made. 23. Permittee must provide advance notification to all parties that may be affected bythe 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 s1fall rbrnovewaterfrom utilityvaults in accordance with the requirements of State Water 136sources Control Board WaterQualitLV OrderWQ 2.014-0174- DWQ_Said vault watershall not be discharged into the City of Campbell's storm drain system. See http://wvvw.waterboards.ca.govtwater issues/programs/npdes/utilityvaults.shtml for more information. Applicant is hereby responsible for ensuring that all those providing services under the applicant are aware of and abide by all of the above conditions. JOHN AND SHANNON SAUNDERS 9/E4/2018 Applicant Date: Contractor (Print Name) Date: J:\FORMS\Templates\Encroachment Permits\Encroachment Permit STATIC form2.pdf Rev.04/18 QR 1OF CAMPBELL qme MOO aw e e e@ AT 3dw 0 . . REGISTER *, ydd/ 9«; m:& +yQFT . . q2 »;9o0-,ag029 . : Rm 6 DSm R& F .2.0 S . Ug D: S.l .am & qD 9ER F . , q# !a G F REPOSIFeQi $ \m qq i »£ IDEP'y\ !2 . S.mG m OTHORM F9 RN lyGm ' f, ««qD: qam Gq= ai ° £ qe PUBLIC WORKS DEPARTMENT LAND DEVELOPMENT Effective July 1,2017 TO: Finance PUBLIC WORKS FILE NO. ENC2018-00274 PROPERTY ADDRESS 77 S Third.Street Please collect&receipt for the followin monies: ACCT ITEM AMOUAIT Leta DEVELOPMENT 4722 Encroachment Permit Application Fee Non-Utility Encroachment Permit Major 410,000 $425.00 Minor Encroachment Permit<$1o,000 .$240.00 $ 240.00 Initial R-1 Permit _ N/C Subse uent.R-1 Permits within Two Year Period $240.00 Inspection Fee Minimum Charge per Location $420.00 Street Tree Plantin /Removal N/C 2203 $500 per Tree Planting Deposit Required) $500.00/tree 22031 Plan Check Deposit 2%of.Engineers Estimate $500.00 min Utility and R-1 Permits no deposit required 4722 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 protects not required to submit numeric sizing $175.00 For projects required to submit numeric sizing Impervious Area 10,000 S .Ft to 1 Acre $740.00 Impervious Area 1 Acre or more $965.00 4722 For pro'ects sent to Consultant for review Consultant Cost+20% 4722 Additional treatment facilities $315 ea Plan Check,&Inspection Fee(Non-Utility). . 4722 En r.Est.<$250,000 14%of Engineers Estimate $ 700.00 47221 En r.Est.>_$250,000 and<_$500,000 $35,000.00+8%of Engineers Estimate 4722 En r.Est. >$500,DQ0 $55,000.00+7%of Engineers Estimate 2203 Emergency Cash Deposit 4%of En r.Est.* $500 min/$10,000 Max $ 500.00 -'2203 Faithful Performance Security FPS 100%of ENGR.-EST." $ 5,000.00 2203 Labor and Materials Security 1.00%of ENGR.EST.* 4721 Storm Drainage Area Fee Per Acre R-1 $2,120.00 $ 380.00 (Multi-Res$2,385.00) (AII Other$2,650.00) 4722 Parcel Ma 4 Lots or Less $4,200.00+$90/lot 4722 Final Tract Ma 5 or More Lots $5,115.00+$124/lot 2203 Monurrientation Security 100%of Ci '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 $1,070.00 4722 Certificate of Correction $590.00 4722 Document Recording Fees $15.001first 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. 730.4924 Notice of Improvement Obligation Payment Assessment Segregation or Reapportionment First Split $940.00 Each Additional Lot $295.60 511.7424 Postage Other ease pea y '- *Engineer's Estimate sha[[be as approved by the City Engineer and shall include all items of work. TOTAL $ 6,820.00 NAME OF APPLICANT NAME OF PAYOR John and Shannon Saunders PHONE ADDRESS ZIP' t c4°. FOR RECEIVED BY ITY CLERK r ONLY Date Receipt J:LLrmWe ..Chet mmnlC'.1- peC IC geLL^ Ov¢I4zl IA P1.IG^i V t 1 nae 1/24/2020 — Fees Associated With 10:43:23AM - C7 C E L Case #: ENC2018-00274 e Saar �Yrsr - __ brutes stevenue' reaiel ., u _ -- - _ = w e t L4De ;= 1C. e4 scr� tion' r° 73 tDate Amount YP. ]Date bate = P - P 9+t oclQ Accotuf f�Iumber -� F a�. _ AF04 7/l/2017 9/30/2018 PrmtAppFee R1 Sub Prmt 101.730.4722 JF 9/25/2018 240.00 0.00 PCI1 7/l/2017 9/30/2018 Non-Util Plan Ck/Insp<$ 101.740.4722 JF 9/25/2018 700.00 0.00 CASH 7/1/2017 9/30/2018 Construction Cash Deposi 101.2203 JF 9/25/2018 —.%5@'.0t ""9- 0.00 FPSD 7/1/2017 9/30/2018 Faithful Per£ Security/De 101.2203 JF 9/25/2018Sy40 ©0 0.00 SDA 7/1/2017 9/30/2018 Storm Drain Fee-R-1 209.715.4721 JF 9/25/2018 380.00 0.00 Total Due: $0.00 Page 1 of 1 CaseFees..rpt