88-169
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'UBLIC WORItS PERMIT Perait 110. f ~- / ~ r
'lor _or.ln9 In ~ne
publlc r19ht-or-2Y) X-aef. flle
tuued '~I .J' ~ Application Date
'eralt ea re. n .0.. expire.
APPLICATION - Appllcation i. hereby ..de for a PUblic Work. 'eralt in accordance wlth Ca.pbell-
Municlpal Code, lectlon 11.04.
A. Work addn.. or tract' ~ 1 '\
Utility trench location
B. "ature of work I ~\1~ "Lc; ~ ~. 4-" Lb.."l1dAct- ~lC. ~rt~\.;-\ tk~\o~
C. Attach five (5) copies of a drawing .howing the location, extent and di.en.lon. of the work
The drawlng .hall .how the relation of the propo.ed work to exi.ting .urface and underground
improvement.. When approved by the City Engineer, .aid drawing become. a part of this perait.
D. The General Conditiona for all permita are liated on the reverae aide. Special Proviaions for
this permit are 11sted below. Pailure to abide by these conditiona and proviaiona aay re8ult
in jOb ahut-down and/or forfeiture of Faithful 'erforaance Bonda and caah deposltl. (See
General Condltion. land 2).
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8
CITY OP CAMPBELL
DEPT. or PUBLIC WORIS
70 North Pi rat It.
Campbell! CA '5001
e.OB I 1611-2150
It Iii! d' r
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E. An applicat~e~-.QCOIIlpany-th1a application. Thia 11 non-refundable.
liame of APPHcarWEST VALLEY SM'HTAT!ON DISTRICT Or- S'VFi\ CU,f\.i'J. CO;nHYTelephone: '?1e,.Z4-o-r
Address \00 ,. ~^'-'~io~~ ~ ~r?~~
la thia work being done by the property owner at their own residence? ____yes ~no
Complete attached Workera' Compensation and Contractor for.a.
The Applicant/Permittee hereby agreea by affixing their aignature to thia permit to hold the City of
Campbell. its officers, agents and employees free, .afe and harmle.. from any claia or deaand for
damages resulting from the work covered by thia permit.
The Ap~licant/Per.itt reby acknowledges that they have r.ad and underatand both the front and
back of thil ermlt that they will inform their contr.ctor(s) of the ~i formation.
ACCEPTED c../Z.L _'YO
. .- Ala
NOTE~pTA;JCl ~~tlP'l!S~~o~ii1h;J ~iESi~~c~k~;I\J~~6WD PLANS AND ALL APPLICABLE CAMPBELL
STANDARD DRAWl GS AND CONDITIONS.
THE CONTRACTOR MUST HAVE THIS PERMIT AND APPROVED PLANS AND MUST MEET WITH THE P.W. INSPECTOR ON
THE SITE AT LEAST TWO DAYS BEFORE STARTING WORK.
NOTICE MUST BE GIVEN TO PUBLIC WORKS AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK.
SPECIAL PROVISIONS
~
o
1.
Street ahall not be open cut for underground in8tallations. Minimum cuts may be allowed
for connections or.exploration holes. Such cuts must be 8pecifically approved by the
Inspector.
y.vemen~ ..y be cut for underground 1nstallations and must be restored in accordance with
the Uti11ty Trencb Restor.tion Standard Drawing.
Work to be .taked by a licensed Land Surveyor or Civil Engineer and two (2) copies of the
cut sheets sent to the PUblic Work Deft. before atarting work.
The hours of work are limited to outs de the hours of 7-9 .... and 3-6 p.m. for .ny work
affecting a traffic lane.
~) RES~.eE: "TIP E"l\.Jtt4 Pei'R.. A-rr-A<.t-\~ D~/I-
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PERMIT APPLICATION rEI .
PLAN CHECK DEPOSIT
(a-1)
($35.00 )
RECEIPT NO.
/9 S III
STAliDARD
AIIOONT
$ SD.oo
.
$
$ ~.oo
_J'""^""
$50.00
$500.00
(100' or ING. 1ST.)
($200) (4. or IOND,$500 MIN)
(7. or P.P. BOND
_ ! /'~,. 515.00 MIN)
r, ,~11 ("~ ({A/1 rr~
J:or y 1ft n
IOND POR FAITHFUL PERPORMANCE
P. P. (CASH) DEPOSIT
If r I Y
I f)- I Y
f: / '2 I (if
I I
~
(p/k.(e
PERMIT PEE
, .35'. co
APPROVED POR ISSUANCE
f: PWPERMIT
.eviled 7/87
110.,.,
0+10
('0)
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120.00
4-2-4
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TO: (' i ty C 1 e rk
PUBLIC WORKS fILE NO. cfJ'- / ~ /
$
2.. 'i 1- 2 , 0 :l
7' ~- (.) ~... /
Please collect & receipt
for the following monies:
(specify project)
PeJl.m-U: eM:
R-l :
($'35)
($200)
(Cash) Deposit
Plan Check & Inspection Fee
Other Cash Deposit (specify)
~373
3373
3372 Tentative Parcel Map Filing Fee ($350)
'~i2 Final Parcel Map Fil ing Fee ($300)
2 Tentative Tract Map Fil ing Fee ($400)
}j72 Final Tract Ma Fil in Fee ($350)
3372 Lot Line Ad'ustment Fee/Certificate of Compl iance
3372 Vacation of Publ ic Streets and Easements
3372 Assessment Segregation or Reapportionment
First Split ($500)
Each Additional Lot ($150)
3372 Environmental Assessment:
Categorical Exemption
Ne ative Declaration
3370 Storm Drainage Area Fee per Acre Multi-Res.,
$2,060; all other, $2,250)
3395 Pa rk Oed i ca t i on I n-l i eu Fee pe r Un i t ($1, I 32)
3380 Public Works Special Projects
3510 Postage
NAME
~~~~ --
2 Y' Y f...I ~~ -:#- 7' 0 ~.~
ZIP
ADDRESS
"'OR
C I TV CLERK
ONLY
RECEIPT NO.
i 7 s-;;../
-515S<>o
02.-rrJ
b,)-;.-ff6
AMOt.NT PAID
RECE r VED BY
DATE'
AMOUNT
$
J- () -
S4 () -
3 :J--
':)?S--
July, 1987
r
CITY OF CAMPBEll
70 NORTH FIRST STREET
CAMPBELL, CALIFORNIA 95008
(408) 866-2100
v
6" f ~ /6 '1 4-.
Department:
· Publ ic Works
July 7, 1988
West Valley Sanitation District
of Santa Clara County
100 East Sunnyoaks Avenue
Campbell, CA 95008
RE: FINAL INSPECTION AND ACCEPTANCE
PERKIT NO. 88-169
LOCATION: 877 ROBIN LANE
We have made a final inspection of' subJect Public Works construction
and find it acceptable a.nd in conformance wi th City standards.. Ac-
cordingly, the work is hereby accepted.
You are responsible for the maintenance, repair and/or replacement
of all work done should any failures occur. .
We will inspect the work periodically and advise you whether or
not maintenance is needed.
Please feel free to call If you have any questions.
Sincerely,
(j{li(/
David N. Valkenaar
Associate Civil Engineer
DNV /1 e
cc: G. Eaton, Public Works Inspector
CR
Gray Eagle Construction, 2464 El Camino Real, #90, Santa Clara 95051
, '
C H E C K R E QUE S T
TO: ' FINANCE DIRECTOR
City of Campbell,
Please issue check payable to:,
Address: Street:'
City:
(20 spaces)
(20 spaces)
(15 spaces)
State: ~(2 spaces)
Zip: ~(5 spaces)
. ,
Description: (20 spaces)
Exact Amount Payable: $500.00
I '
Account Number:
01446290500
Purpose:
RELEASE OF CASH DEPOSIT FOR EXCAVATION PERMIT NO. 88-169. SEE.
RECEIPT NO. 19514 DATED 6/22/88.
SPECIAL INSTRUCTIONS FOR HANDLING CHECK:
Title: Assoc. Civil Engr. Date: 7/7/88
Title: P.w. Director Date: 7/7/88
Requested by.
Approved by:
"'
Mail as is
Return to:
X
Ma'il in attached envelope
Department
Name
Ot~er:
~
REV 4/22/83
PUBLIC WORKS FILE NO. cfJ'- / ~ /
Depos i t
QEV'
3521
Plan Check & Inspection Fee
Other Cash Deposit (specify)
3373
3373
&
3372
~ ~ "7.,2
Tentative Parcel Hap Filing Fee ($350)
Final Parcel Hap Filing Fee ($300)
Tentative Tract Map Filing Fee ($400)
Final Tract Ma Fil in Fee ($350)
Lot Line Ad'ustment Fee/Certificate of Com liance
Vacation of Public Streets and Easements
Assessment Segregation or Reapportionment
First Split ($500)
Each Additional Lot ($150)
Environmental Assessment:.
Categorical Exemption
Ne ative Declaration
Storm Drainage Area Fee per Acre Multi-Res.,
$2,060; all other. $2,250)
Park Dedication In-lieu Fee per Unit ($1,132)
. 2
3372
3372
3372
3372
3372
3370
J395
3380
3510
Public Works Special Projects
Pos tage
AMOUI~T
$
J- () -
.$'"4 () -
3~-_
~E
TOTAL
~ ['r ~:.<Z.. --
2. '1' l./ ~ ~..... 1 ~ -# 7' 0 ~.~
$ S-~5--
L. 'i 1- 2 2. 0 3
ZIP 7',- (J ~- /
~DRESS
A -
~ FOR
,~ CITY CLERK
ClNL Y
RECEIPT NO.
I '7S7~
..s- 8~O
~
b . ') ,. -f!-t
AMOl.Hr PAID
RECE'VED II\'
DATr
July, 1987
~te ~;j ~8
Address 8 7 7
PUBLIC WORKS INSPECTION REPORT
Permit or Project No. 'S 8 - / C:, 'j
~~/,d
Type of work: Street Storm
Other (describe)
Sanitary ~ Electrical
[JPRELIMINARY INSPECTION WITH DEFICIENCY LIST (attached)
[]FINAL INSPECTION WITH DEFICIENCY LIST (attached)
~INAL INSPECTION - ACCEPT~
Signed plans? Y ~ (If signed, Council acceptance.)
Charges against deposit? Y ~
Overtime: hrs. @ $ /~ _ $
Date 5 reason:
Barricade rental (attach invoice)? Y
Date 5 reason:
()
$
Other?
$
$
Total charges deducted from deposita
(Cash Deposit $ less charges $
$
- Refund $
ck. req.)
[JONE YEAR MAINTENANCE WITH DEFICIENCY LIST (attached)
o ONE YEAR MAINTENANCE - ACCEPTANCE
(Release' maintenance bond. Check Request if cash.)
Engineer
~
GRAY EAGLE
CONSTRUCTION COMPANY
2464 EL CAMINO REAL. STE. 90. SANTA CLARA. CA 95051 (408) 241-2203
June 29, 1988
Department
Street
95008
~;1"
jUt,
. ..,
...,
Greg Eaton
Public Works
70 North 1st
Campbell, CA
1988
"S
~.. . . T 1\
'-'."iI', .
'-'oil'/G
RE: 877 Robin Lane
Sewer Lateral Installation
Dear Greg:
We are requesting a "Final Inspection" regarding the above referenced
job; along with the return of our $500.00 "Faithful Performance" deposit
as required by your department for this work.
Your immediate consideration is greatly appreciated.
Sincerely,
,.,
I
~~/~
Barbara Silva //
Co-Owner
GRAY EAGLE CONSTRUCTION CO.
Lie. No. 383766
:bds
C H E C K R E QUE S T
TO: ' FINANCE DIRECTOR
Cj ty of Camp be 11 '
Please issue check payable to~
Address:
Street ;'
City:
(20 spaces)
(20 spaces)
(15 spaces)
State: ~(2 spaces)
4, ~ip:, ~(5 spaces)
Description: (20 spaces)
Exact Amount Payable: $500.00
Account Number:
01446290500
Purpose:
RELEASE OF CASH DEPOSIT FOR EXCAVATION PERMIT NO. 88-169. SEE.
RECEIPT NO. 19514 DATED 6/22/88.
Requested by:
Approved by:
D. Valkenaar
,
Title: Assoc. civil Engr.
Title: P.W. Director
D. Wimberly
Date: 7/7/88
Date: 7/7/88
,"
SPECIAL INSTRUCTIONS FOR HANDLING CHECK:
Mail as is
Return to:
X
Ma'il in attached envelope
Department
Name
Ot~er:
REV 4/22/83