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CITY OF CAMPBELL R E eEl V.c wons PERMIT
DEPT. OF PUBLIC WORKS worltJ.ng J.n ~ne
70 North Firat St. public right-of-w.y)
Ca.pbell, CA 95008
(f08) 866-2150 MAY 1 6 1986
Pennit No. cgl.o - I '{ 0
Ref. file
App. date S" - I (p - q'(o
Juue date
.s 3<:: . /'-(
APPLICATION PuBLIC WOHI,S
App~l~.~J.on is hereb~ -.derf~~R~ic Works Permit in aceordanee with Campbell ~
MunleJ.pal Code, Seetl.on QlJ",".'- 1/5" S,4/V ro#1r.t1Q.(/I'~C
~ ~
A. Location of work: sW Ct:Jrn-'~ at- E/o....... A.~d 5"'.... 7;;"""'5 A~c.-<',~c> Roe<d
B. Nature of work: Ci.,L;-6 C;;" II~,.. t;;,.d.... WtA/j.. D".,'vA. WO-Y ,I.,::>Dr"e>ches (2)
D~b rn k 1-. t- ~ /.r /;1." R.~R 13,.~..' ~;E"f~;- SA /'+I.
I' ,
C. Attach three (3) copies of a drawing ahowing the loc.tion, extent and dimensions
of the work. The drawin9 8hall show the rel.tion of the proposed work to existing
surface and underground 1.provements. When approved by the City Engineer, said
drawing becomes a part of this permit.
D. The General Conditions for all permits .re listed on the reverse side. Special
Provisions for this permit are listed below. Failure to abide by these eonditions
and provisions may result in job ahut-down and/or forfeiture of Faithful
Performanee and C.sh Bonds. (See General Conditions 1 and 2).
E.
F.
An applieation fee of $35 must aeeo.pany this applic.tion. This is non-refundable
The Contraetor(a) .ust ..et the inapeetor on the site at le.st f8 hours before
st.rting work. Call 866-2150 for appointment.
Upon completion of the work, written request for final inspeetion and .eeeptance
.ust be ..de.
G.
H. Permit applieations expire in 6 ~nths.
Fees are not tr.nsferable or refundable.
Name of Applieant Kt..L!;S ~// J"J,nS"h
Address lIs, ;=:;"'~J'>'1c,rz f ~C<-Y1 J",.>-C. LIL.
,
Iasued permits expire in 12 months.
Telephone:
;1. ':J [$ -4:J. 93
Is this work being done by the property owner at his own residenee?
Complete att.ehed Workers' Compens.tion and Contractor foras.
The Permittee hereby agrees by affixing his sign.ture to this permit to hold the City
of Campbell, its offieers, agents and employees free, a.fe and harmless from any claim
or demand for damages result1ng from the work covered by this permit.
AC:CEPTED~ ~;'1 ',. w.',~e.:,^, R. ,d/..>Ct:'..cfl,.. .t!. S07/ /S- ,l-?A v Be
A n~ \t" rm~~~ee} j/ . '..' "ua~e
r/""...i./' .,.; .c-"J'" .."..-. rl..J
_yes
Kno
SPECIAL PROVISIONS
1.
Street shall not be open cut for underground inst.llations. Minimum cuts
..y be allowed for connections or exploration holes. Sueh euts must be
apecifieally approved by the Inspector.
P.vement cut for underground installations .ust be restored in aeeordance
with the Utility Treneh Restoration Standard Drawing.
Work to be done in accordanee with the attached, approved plans.
Work to be staked by . licensed Land Surveyor or Civil Engineer and two (2)
copies of the cut aheets aent to the Public WOrks Dept. before starting
work.
The hours of work are li.ited to outside the hours of 7-9 .... and 3-6 p.m.
for any work affeeting a tr.ffie lane.
2.
In
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.
0\
i/ 3.
v/ 4.
5.
6.
NOTICE MUST BE GIVEN TO PUBLIC WORKS AT LEAST f8 HOURS BEFORE BEGINNING WORK.
PERMIT APPLICATION FEE
BOND FOR FAITHFUL PERFORMANCE
CASH DEPOSIT REQUIRED
PERMIT FEE (7' of F.P. bond)
Aaount
$ 35.0D
$ L(), 300 "...<
$ 2.00(}_00
$ 1 t1J/.r)C
Reeeipt No.
Sq~7
Approved for iasuanee
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Rev. 5/85
...._-.
SJO~M D'R.4/~A-GE
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A ~fh'1/-c - II) 500 s'r.f-f:
Pee. J't t>o If
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. TO: CITY CLERK
PLEASE COLLECT AND RECE I PT
Fat 'IHE FOLLOW I NG MON I ES
P.W. FILE. NO.~
ACCT.
ITEMS
3372 ENVIRONMENTAL ASSESSMENT ('420)
3370 STatM DRAINAGE AREA FEE PER ACRE (R-I. '1.875;
MULTI-RES.. '2,060; ALL OTHER, '2.250)
3372 PLAN EXAMINATICX"I AND CCXliSTRUCTICX"I INSPECTICX"I FEE
(7'" OF VALUE)
3372 TENTATIVE PARCEL MAP FILING FEE ( '300)
3372 TENTATIVE TRACT MAP FILIN:; FEE ('290)
3372 FINAL PARCEL MAP FILING FEE ( $275)
3372 FINAL TRACT MAP FILING FEE ('275)
3372 VACATICX"I OF PUBLIC STREETS AND EASEMENTS ('455)
3372 ASSESSMENT SEGREGATICX"I at REAPPalT I ClI'INENT ( '420
FOR FIRST PLUS. '130 EACH ADDITIONAL)
3372 LOT LINE AD.JUS"n4ENT FEE/CERTIFICATE OF COMPLIANCE ('300)
3395 PARK DEDICATION IN-LIEU FEE PER UNIT ('I,097.00!)
3373 COP I ES OF ENG I NEER I NG MAPS AND PLANS ('.50 PER SQ. FT.)
3373 WORK AREA TRAFF I C CCX"IT'ROL HANDBOOK (12); ADD I T I ONAL (I I . 50 I
3373 PRO.JECT PLANS AND SPECIFlCATICXIiS (110)
3373
~
3373
MAP REV I S I C>>IS TO MAP CCIiIIPAN I ES ,( II 0 )
EXCAVATION PERMIT APPLlCATICX"I FEE (135)
GE'NEP-AL CaoH) I T I CXIiS. sm. PROV I S I ONS Be DETA I LS
($10; at 'I/PG)
3521 CASH DEPOSIT
3521 FAITHFUL PERFORMANCE DEPOSIT
352 I MA I NTENANCE BOND DEPOS I T
3520 FIRE HYDRANT MAINTENANCE ( '195/EA)
35 I 0 POSTAGE
OTHER
TOTAL
NAME Ru.55 e..-Il
Joh......s-o~
PHONE
ADDRESS
1/5Cf
Fr-- eJY-, CT'\ +
s ~ ..Jo s.e..-
FOR
CITY CLERK
CX"ILY
RECEIPT NO.
AMOUNT PAID
RECEIVED
DATE
AMOUNT
..35.00
,35".00
~4 '? - Y.;l93
ZIP q ~
.JULY 1984
CONSTRUCTION COST ESTIMATE FOR PERMIT NO. ~/jI"I0 By/Date 0/9-/(., -zf6
Name & Address 7)s- ..?;:;4. L::.,
Surface Construction
Clearing and Grubbing Lump Sum Estiaate . $ ~ 06D_ 0 ()
Sawcut Concrete L.r. @ $ 4.00 · $
Concrete Removal S.F. @ 3.00 · $
Curb & Gutter Removal L.F. @ 5.00 . $
Inlot Drain with Pipe / EA. @ 500.00 . $ 5:;>I),OlJ
Curb and Gutter 33y L.F. @ 15.00 · $ 5;O'Od)/)
Sidewalk ;:2.2'18 S.F. @ 3.50 . $ /. 8b6. {)o
Driveway Approach 17<1/ S.F. @ 5.50 . $ i ()75.~O
Handicap Ramp / EA. @ 1000.00 . $ L (JOO.OV
(
Extruded Curb L.F. @ 6.00 . $
Barricade / () L.r. @ 50.00 f. · $ ;;; O(),oo) ..,i\
Street Exoo..tion ~.F . )x($0.15 )x( f~) - $ ~~ ~: ,%:z, oJ~ '
A.C. Pavement ~3B .r. )X($0.45)X(~~') . '$ ~.l~-;; .~~ /
Adjust Manhole to Grade 2. EA. @ 300.00 · $ b GU.d'J
Adjust Handhole to Grade 2- EA. @ 200.00 . $ 4 00 ,.r~
Monument Box w Monument / EA. @ 500.00 . $ 500,.,1)
Street Tree (15 gallon) .3 EA. @ 200.00 . $ 1000-0'0
Pavement Striping ($100 min) L.F.@ 0.65 . $ /<17 o~ 0 ,)
Pavement Legends ($100 min) I EA. @ 40.00 . $ 4I~.~~
Stop.Street Name or Other Sign I EA. @ 120.00 . $ /2-d. /' .J
Pavement Harkers /0 EA. @ 15.00 · $ /50. (70
Pavement Key Cut - L.F.@ 8.00 - $ ----
t::'o;UFt?/C4h,l1,AJ's/lTOV ~99 SFtJ.ct.J;;<[I,1 ) · $ (7Q. 5:'::-
/' -
- $
Surface Subtotal liS" · $ 25:766, " cj
Adjust. for size: S $30,000 add 20%. S $100,000 subtract 10%-+-S-/S3,~S'
/
Street Lighting
Electrol1er
Conduit
Conductor, pair
Pull Box
.;:L EA. @ 3000.00
L.F.@ 12.00
L.F.@ 4.00
,2- EA. @ 200.00
Storm Drainage .s-q L.F.@
12" or 15" RCP 60.00
1811 or 2111 RCP L.F.@ 65.00
Street Inlet I EA. @ 1800.00
Manhole -- EA. @ 2000.00
Break and Enter Manhole / EA. @ 600.00
TOTAL ESTIMATE
USE FOR BOND
Revised 6/85
. $ 600- (:;.t (j
- $
- $
- $ ~.?_).
. $
'(
- $
- $
- $ /, t3.,oOJ" ;)
.
- $
. $
.-
6> (/0. t:>() )9
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. $
$ 4~3/9. t/9
$ l('l, )00 -
.