222 (1998 PCN98-531)MEMORANDUM CtT¥ OF CAMPBELL PUBLIC WORKS DEPARTMENT
TO:
FROM:
Frank Cauthorn,
Building Division Manager/Building Official
/
Harold Housley, Land Development Enginee~
Chuck Gomez, Assistant Engineer
Site Address:
Plan Check Number:
File No(s):
iTHIS DEPARTMENT HAS NO OBJECTION TO ISSUANCE OF GRADING.
DRAINAGE, OR BUILDING PERMITS FOR WI-IE ABOVE REFERENCED PLAN
CHECK ~fl~lB~ tiER. ~ ~-~- ~ '~ i.
BY: ~,J/-[~(--/-~~ _~C~~ DATE: ~"'F'g~'~/
ICONDITIONS OF APPROVAL ARE SUMMARIZED BELOW FOR CLEARANCE OFI
BUILDENG PERMIT(S) TO CONSTRUCT A NEW RESIDENTIAL STRUCTURE OR
AN ADDITION OR ALTERATION THAT ADDS 50% OR MORE SQUARE FEET OF
STRUCTURAL COVERAGE (SECTION 11.24.182).
Storm Drain Area Fee: Prior to issuance of any grading, drainage, or building permits
for the site, the applicant shall pay the required Storm Drain Area fee. The current fee
is * ~~ per acre or $ ,~"~',~, ~
Unsecured Deferred Street Improvement Agreement: Prior to issuance of any grading,
drainage, or building permits for the site, the owner shall execute an unsecured street
improvement agreement for construction of street improvements.
Street Improvements: Prior to issuance of any grading, drainage or building permits
for the site, the applicant shall cause plans for public Street Improvements to be
prepared by a registered civil engineer, pay fees, execute a street improvement
agreement, post security and provide insurance necessary to obtain an encroachment
permit for construction of the improvements, as required by the City Engineer. The
plans shall include the following:
Preliminary Title Report: Prior to issuance of any grading, drainage, or building
permits for the site, the applicant shall provide a current Preliminary Title Repo~.
Page 1 of 2
PLAN CHECK NUMBER:
_,d~ Riaht-of-W'a¥ for Public Street Purposes:
or building permits for the site,
Prior to issuance of any grading, drainage,
the applicant shall grant additional
Right-of-Way for Public Street Purposes along the
frontage(s) to accommodate
Applicant shall cause to be prepared all documents necessary to record dedication and
submit to the City for review
Public Service Easement: Prior to issuance of any grading, drainage, or building
permits for the site, the owner shall grant a
Public Service Easement on private property contiguous with the public right-of-way
along the
frontage. The applicant shall cause all documents to be prepared by a registered civil
engineer/surveyor and submitted to the City for review and recordation.
Utilitw Installation Plan: Prior to issuance of building permits, the applicant shall
submit a Utility Installation Plan and Schedule for approval by the City Engineer for
installation of any new utilities. [Streets which have been resuffaced within the
previous 5 years may require installation beneath pavement by boring and jacking
method and will also require a pavement restoration plan for approval by the City
Engineer prior to any utility installation.]
Legal Lot: The applicant shall provide documentation to ascertain that the lot was
legally created, or prepare a parcel map to create the parcel shown.
I RECEIVED A COPY OF THESE CONDITIONS OF APPROVAL:
Owner'} Signature Print
Date
TltE CDD SHALL PROVIDE THE PWD A SIGNED COPY: YES NO
CC.'
Land Development File
Harold Housley
Chron File
Michelle Quinney
j:\forms\bldgapp
Rev. 7/1/98
Page 2 of 2
PUBLIC WORKS DEPARTMENT RECEIPT
Eff~cfivc July 1,
TO: City Clcrk PUBLIC WORKS FILE
Please collect ~ rc~iM for ~ follm*~$
4722 Application Fee
Non-Utility ,~:toad~eat Permit ($22~)
Utility Eac..mmcluneut Permit
Rcside~6al Seee~/Oeet Areas
2203 Labor and Materials ,~.'cutity (100% o£ ~]qGIL EST.)
2203 Monumenta6on Sccurity ( I 0(P/, of ENGIL EST.)
4722 ~n~t.~.ZL < $2~0,000 (12% of ENGB. F.~T.)
*o 2203 Engr. Est.>$2$O.000 (Deposit 8% of ENGIL EST~30.OOO
Conduits/P~pctin~ up to 500 Feet
Above 500 Feet
4722 Assessment Segregation or ReappOrm~nment
,Multi-Res. S2.2.~0)
'*Actual Cost Plu~ 2(}~/o Overhead fNon-lntj:~q~n$ de~t) a ___~'"'"-
FOR
CITY CLERK
ONLY
Dalef Initimls
h:~rcc ffln4(cxc )rap( rcy I/'2~7)
ReceJ
No. 0
RECEIVED FROM
~ FOR RENT
'~oR
FROM,
DOLLARS
TO.
cash
check".~'7~.~]
money BY
order
PUBLIC WORKS
PLAN REVIEW ROUTE SHEET
APPROVED / NO COMMENTS:
DATE:
APPROVED / CONDITIONS BELOW:
DATE:
NOTES:
[RETURN TO DARLEEN BECK. ER, BUILDING DMSION ]
PERMIT APPLICATION
CITY OF CAMPBELL
BUILDING DWISION PERMIT NO.: q ~- ~ ~ i DATE:
PERMIT TYPE:
BUILDING r//"'ELEC ~ MECH
DEMO~ SIGN GRADING
BUILDING ADDRESS:
OWNER'S NAME:
ADDRESS:
PLUMBING
OTHER
SUITE
-'
APPLICANT'S NAME:
ADDRESS:
DESCRIPTION OF WORK:
CONTRACTOR:
COMPANY NAME:
t,.4
TI SIGN DEMO
OTHER
CONTACT PERSON:
ADDRESS:
PHONE NO.:
ARCHITECT/ENGINEER:
COMPANY NAME:
CONTACT PERSON:
ADDRESS:
PHONE NO.:
( )
Use or storage of ha~..ardous materials requires a Hazardous Materials Information Statement
to be submitted to the Fire Department for review and comment at time of building permit
application. Failure to provide the HMIS will hold up building permit approval.
FIRE SPRINKLERED: YES (~
CITY OF CAMPBELL
BUILDING DIVISION
VALUATION DATA AND MISCELLANEOUS INFORMATION
PERMIT NUMBER:
ADDRESS:
BUILDING INFORMATION:
SFD/RES. ALTERATION ·
GARAGE:
TENANT IMPROVEMENT: SQ.FT.
GRADING: CU. YDS.
CONTRACT VALUE:
TOTAL VALUATION:
ADJUSTMENTS I MISCELLANEOUS INFORMATION: