96-100
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l:%'l'Y 01' CAMPBELl..
DZP'l'. 01' PUBLIC IfORltS
70 Horth l'ir8~ S~.
caapball, CA '5008
(408) 866-2150
omID ~r.Lml ..1
.0 PEE II!II(!ROAemmIft' --.n'I'
(for workint vit.hill t!ae
public l'19h~-of.....y)
($3,500 _vi~ value of .ork)
~..ued 1- J 1- 9/1)
1"- /t7t?
..
~ 110.
Z-"f. f11.
ApplicaUoD Date /, -'1- t??
Application ap1n8 ill 3 _.
APPLICATXON - Application i. hereby ..de for a Public Warb ~~ ill acccmIanae vi~ CUipbe11
IlUnlclpal COde, SecUon 11.04. (Appl1caUon upiru ill 6 JIDIlt:ba if tile pemit 18 not 18auad)
A. Work addre.. /t!)/t!) - /o/L ~I'?~e bR. C!Am1?,lje,/..I. ,sz,l:)<!J
B. .a~ure of work: J/tJ::MI,Qk'( - /?z:P1tWC ~ Rt!?)>~ t?6 ..S4?N'~ Fc:7:7'")
C. Attach three (3) copie. of a dravinq Dowinq the location, extent aDd cliMnaiona of tile wrk.
The drawing &hall &how ~e rela~ion of ~e propoeed work ~ exiatiD9 t.p~. tIben
approved by ~e Clty Enqilleer, aald drav1ll9 becaIIe. a part of thi. pem1~.
D. All work Ulall confon ~o ~e Ci~y'. General cond1~iOlUl, standard ~ion PrDv18i0ft8 and
Standard COna~rucUon Detail. for Public Worb conauuct1on, 'ftle General ..nit Conditt0ft8
11.ted on the rever.e .ide, and Speclal ProY18i0ft8 for ~ pem1t, l1ated belovo htlan ~
ablde by the.e condlUon. and prov1alO1U1 ..y naul~ ill job uut-dovn UIdIor forfeiture of
l'aithful Perforaance Sure~y.
.... of Applicant f{t;J.L.Ey 4na.eEn;
/tJ.2o ~q-,cr ~
Addr...
~ ..Il:J.S€
'I'e1epboDea ~g - .2~?-bO? /
9S-//~
Complete and a~tach WorUra I COIIpenaa~lon and cont.ra~ XDrorutJ.CIIIl foz.a.
'!'he Appl1cant/Per1lll~~ee bereby agr... by aff1.xin9 their .ilJft&tur8 ~ ~ perait to bold the City of
Campbell, 1~. officere, agenu and eaploy... free, aafe and baral... fZaa any c1.aia or deaand for
damaqe. re.ulUftlJ from the work covered by thi. pemit.
HOTES: ALL WOU SHALL COlfP'ORM n'lB TIlE A'1"l'ACBED, APPIIINBD PLUS &lID ALL UPLICULE CAIIPIIELL
STANDARD DETAILS AND CONDITIONS.
'!'HE CONTRACTOR MOST HAVE THIS PERMIT AHD APPROVED PLUfS AIID MOST UlWfGE '1'0 IIDT WI'1'II 'nIB ....
INSPECTOR AT THE SITE AT LEAST TWO DAYS BEl'ORE STAR'l'IHG WOB.
HOTXCE MOST BE GIVEN '1'0 PUBLIC WORD AT I.EAS'1' 24 BOORS IIU'ORE RBII'l'ARftlfG AllY ~.
SPECIAL PROVISIONS
r.4NIC/M"'.~"\Il'; + 1J6/tAC(f" -1'0 Nt--AH.r, f~'~-r AI jl/l/Jtf'G.lI;1)
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D~ 110.
9013~
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Date
APftUVED FOR XSSUARCE
f: R1 PERMI'l'
a.v1Hcl 6/92 (SD 0'1'BER BUlB)
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1020 RUFF DRIVE
SAN JOSE, CA 95110
SOURCE /11/1
CUSTOMER
ADDRESS
/~/LJ - /~/L
TRACTOR AND TRUCK
JACKHAMMER
DISPOSAL LOAD
YES NO
YES NO
YES NO
LAMP BLACK
NO. PINTS PER YARD
WIRE MESH
OTHER INSTRUCTIONS:
YES 0
@NO
CROSS STREETS
/#lmJLnW
f
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~ALe
. NOT RESPONSIBLE FOR ANY
IN-GROUND lJTIU1lES/IRRIGATION UNES
,
oncrete, Inc.
(408) 287-6091 · FAX (408) 287-6095
3~ ~///uI /(//9/
DIAGRAM
~ 95ZJS/
_Y;~U'/ ~~";E" Mis
(As Ild. ~/#6
~h .Ct/~77~6
~ .&Ii> ~RAt.-
~R 4# ;?//~.K
H.;!)~ ~/t:7- ~ x~
___ ~ A:/...~J./
CM~ 'A5 ~rr
CbTJ t:heb7lF ~
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STATE L1C. #603078
IN BUSINESS SINCE 1978
INVOICE
DATE/L_/.:J~
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/1.!/%
/J/GSH
IU/ d;)82f17 cS7O/N~
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L;;rR/~H/ &P tJd/ ~~7V6'.(k
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DATE TO START (WEATHER PERMITTING)
APPROVAL
TOTAL BALANCE ,2 ~()S
DOWN PAYMENTS (/!) ~
r;;10tJS'
FOR JOB SCHEDUUNG OR
ANY OTHER QUESTIONS
CALL 287- 6091
EXTRA CHARGE FOR CONCRETE REMOVAL
THICKER THAN 4" OR STEEL REINFORCED
*COD BALANCE
~
DAY OF POUR
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fi'
'P~~/
PerM-;+:If 910- )06
,
JO/O-J~ ILGak br.
NO DbwW jtJ)O D) IN .
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O~CHA\l'O.L>
CITY OF CAMPBELL
Public Works Department
February 10, 1998
Michael Stonehouse
Valley Concrete
1020 Ruff Drive
San Jose, CA 95110
SUBJECT: PERMIT NO. 96-100
LOCATION: 1010-1012 Gale Drive
ONE YEAR MAINTENANCE INSPECTION - ACCEPTANCE
Dear Mr. Stonehouse:
The City of Campbell has made the fInal one year maintenance inspection of subject Public
Works improvements and fmd that no remedial work is required.
Your warranty requirements and any surety, therefore, are hereby released.
Your warranty deposit of $134.00, plus any interest due, will be sent directly to you from our
Finance Department."
A Horn
Public Works Inspector
MQ
cc: Permit 96-100
Public Wodes/Maintenance Division
H:\ WORD\PERMITS\961ooACC(JD)
70 North First Street. Campbell, California 95008.1423 . TEL 408.866.2150 . FAX 408.376.0958 . TOO 408.866.2790
City of Campbell - Refundable Deposit Check Request
Interim Check Required:
To: Finance Director Return Check to:
Please Issue Check V AU-t:.'( ~ceeT"E. ~. Department:
Payable to:
Address - Line 1: ..J 0 '2.0 ':R1AFf=~
Line 2:
~~S q~ /to
City: State: CA Zip: 95888
Finance Use Onlv
Description: ~e:yt(N"A&t-e.. -x~(
Amount Payable: ~ \"?t.OO
(Exact Amount) Interest Earned
Account Number: \ot. 'Z:Z.O~ 101.540.7448
Purpose: ~e.~D ~rTH~L.-
~€.~~ ~~e'T"{
Voucher #: Permit #: q(p -ICO
Receipt #: q 0 l~?.. Date: '/\,1'1(.
I
Requested by: AC-.PN ~M. Title: ,?lA,j ::tNs.'f' ec. 'lC~ Date: 'Z,.- z-crs
Approved by: 1M- Title: ('4C~ Date: 2..- lO-7S
Verified by: Title: Account Clerk II Date:
Approved by: Title: Date:
Special Instructions For Ha~dling Check
Mail As Is: X Mail in Attached Envelope:
Other:
I7n: S:/exceUchkreq . Revised 1/98
PUBLIC WORKS DEPARTMENT RECEIPT
Effective July 1, 1995
TO: City Clerk PUBLIC WORKS FILE NO. CJb ..../W.
PROPERTY ADDRESS /ffJ1tJ ;":::,"'/,. ^ (' .
Please collect & for the monies:
~';"~".,,, AO"1i Proiect: Revenue (specifv proiect) ............................. ..............
ENCROACHMENT PERMIT
472 Application Fee
Non-Utility Encroachment Permit ($225)
R-1 First Permit (No Fee), Subseauent Permit/Vr ($100)
Utilitv Encroachment Permit I
Arterial/Collector Street ($325)
Residential Street/Other Areas ($225)
. ~ Plan Check Denosit ($500)
( 220j l=aithful Performance Surety (FPS) (100% of ENGR.EST.) / ,-l[ <)"
~ Monumentation Surety (100% of ENGR.EST.)
220 Cash Denosit (4% of FPS)($500 min.)
220 Labor and Material Surety (100% of ENGR. EST.)
Plan Check & Inspection Fee (Non-Utility)
472;, Engr.Est. < $250,000 (12% of ENGR. EST.)
.. 220 Enar.Est. > $250,000 (DeDosit 15% of ENGR. EST.)"
472 Utilitv < $100000
Conduits/Pipelines up to 500 Feet ($1.60/ft.)
Above 500 Feet ($1.10/ft.)
Manholes/Vaults/Etc. ($105/ea)
Pole Set/Removal ($105/ea)
Minimum Charge Per Location ($120)
Street Tree Plantina/Removal ($105/tree)
.. 220 Utilitv > $100,000 (Deposit 15% of ENGR. EST.)"
476 Proiect Plans & Specifications Proiect No.
476 Standard SDecifications & Details ($1/Pa $12/Book)
476 Conies of Enaineerino Maps & Plans ($.50/sa.ft.)
472 Penalties: Failure to restore oublic imDrovements ($100/Calendar Dav)
(Muni Cade Section 11.34.010)
472 Penalties: Failure to correct unsafe conditions ($100/Calendar Dav)
LAND DEVELOPMENT
4722 Lot Line Adiustment ($500)
47221 Parcel Man (4 Lots ar Less) ($1,060 + $25/Lot)
472 Final Tract MaD (5 or More Lots) ($1,380 + $25/Lot)
472 Certificate of ComDliance ($400)
472 Certificate of Correction ($300)
472 Vacation of Public Streets & Easements ($550)
472 Assessment Segregation or Reapportionment
First Split ($550)
Each Additional Lot ($170)
472 Storm Drainage Area Fee Per Acre (R-1, $2,000)
(Multi-Res, $2,250)
(All Other, $2,500)
492C Parkland Dedication Fee (75%/25% Due UDon Cert. of Occupancy)
496E Postaae
TRAFFIC
472 Intersection Turn Counts (Two-Hour Count) ($60)
472 Intersection Turn Counts (a.m. or D.m. Deaks) ($125)
472 Traffic Flow Map (Dailv Traffic Volumes) ($27)
472 CamDbell Traffic Model (Full ScoDe Assessment) ($2 250)
472 Campbell Traffic Model (Reduced Scope Assessrr($740)
427 Truck Permits ( $35/triD)
472 No Parkina Sians ($1/each or $25/100)
OTHER ,
TOTAL $ ( 3ft. () () I
NAME OF APPLICANT ~i ~lae/;>7l? .IAJc2
I
NAME OF PAVOR r4tl/!'/ ~ ceb-n= .LXJ,/ PHONE 2 t!31- &, 0'1/ I
ADDRESS /l/20 IKu-fP. /)e Q ZIP tlSI/O
.. Actual Cost Plus 20% Overhead (Non-Interest bearina denosit)
roo
CITY CLERK
ONLY
h:\recfrm3. wk3(mp)rev. 1/9/96
RECEIVED
JAM' , 1996
c~ rY CLERK'S OFFICE
.
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