91-160
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CI'l'Y or CAMPBELL
DEPT. or PUBLIC WORD
70 North rlrlt st.
C8J1pbeU, CA .5001
(401) 111-2150
PeraJ.t .0. CZ' I ~ / ib 0
X-bf. fUe-3.,t - \~ ~
Applicat:1on Date
Application upina In , _.
BIICROACIDIEIft' ~
(for workin9 in th.
public rlvbt-of-vay)
Illued
Puait uplna In. 12 110I.
APPLICAUO. - Applioation 18 bereby _d. for a Publio Worb Perait 1ft aocordanoe with CUlpbell
Municipal Cod., 8.ction 11.04. (Applioation u:piru in I IIOfttlul if perait not pulled)
A Work adelr... or u.=, .5 0 t!-.4 /;::) Lpp t-7-7 ~ /' b ~ LL oW- 7.5>- U () cr-
. ,- I -
utility trench locat:1on L--'~J~, - ~.-/
B. .ature of worka c--u..e~ ~ , .-I2~/c.a--!
C. Attach flve (5) oopiel of a elravinv Bowi.. the locat:1on, extent amd diaeneione of the work
'!'be elrawin9 .ball BOW the relation of the propo.ed work to ..iltinv .urfaca and und.~
iaprov_enta. lIben .pproved by th. city bCJin..r, Aid dnwiDlJ becoael a part of thia per1l1t.
D. '!'b. Gen.ral COndition. for all peraita are U.ted on the rev.ra. .id.. Special Prov18iona for
thil permit ara li.t.d balow. raUure to abld. by th... concS1tiona and provll1onl ..y re.ult
in job .but-dovn .nd/or forfeiture of raithful Perforu.~ ~ and caIb depo.ita. (8ee
General COnditione 1 and 2).
.. An appUoation f.. ..t aocaapany thi. .pplioaUon. ~i. ie non-refundable.
.... of Applicant V {C k '.s ~? '/P'L.i./NE-- CtA-- s]Pc L'cr; iJ/Ij T-AJC 'h1epboftla 9.23 -<sa ??
Adelr... Js--u H RI-c.I.? u .z c-- f..tj,<9 if .S /J-/lJ v,?l,s rl [/..;2 7" ~ - / J ""?
I ( ,
I. thia work being don. by th. property own.r at th.ir awn ruidenoa? -Y" ~
Co.pl.t. and .ttach Work.r.' Coapan.ation and COntraetor Inforaation foraa.
'!'be Applicant/Permittee bereby .l)ree. by .ftixin9 their lignature to thia penalt to bold the City of
Campbell, it. officer., .gent. and ~loyee. free, I.fe and banal... frea any cl.ia or d~ for
da.ag.. r.su1tin9 froa the work covered by thi. penait.
The Applicant/Permitt.e hereby acknowledge. th.t they have read and under.tand both the front and
ba.. ot th~., ,... that thoy vUl 1o<0m thair contro_r(o' ot tha lot..... _tio. n. ,
ACCEPl'ED/~~ -.-'. - ~3/7 /
ppl cant (Penaitt..) print/119ft / /
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NOTES: ALL WORK SHALL CONFORM WI'l'B '1'BB A'l"l'ACllBD, APPROVBD PLUS AlII) ALL APPLICABLE CUCPBBLL
STANDARD DRAWINGS AND COlfDITIO.S.
'1'HE COlf'l'RAC'l'OR MOST HAVE 'l'BIS PERMIT AND APPROVED PLUS AlII) IIU8'1' IIDT WI'l'B onm .... DSPBCTOR ON
'l'BE SITE AT LEAST TWO DAYS BEFORB 8TAR'l'DG WORIt.
.OTICE MOST BZ GIVD '1'0 JlUBLIC WORD AT LBA8'l 24 8OUR8 BU'ORB D8'1'AIl'l'DfG AllY WRIt.
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SPECIAL PROVISIONS
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Street abaU not be open cut for undeJ:'l)r01lftd inatallation.. JUniau:a auta ..y be allowed
for conneetiona or exploration bol... such cuta mI.t be .aecificallv aDllraved bv the
In.Deetor.
pav..ent _y be cut for undeJ:'l)r01lftd inatall.tiona and auat be rutored in .ocordanoa with
th. Utility Trench Re.toration 8tandard Drawin9'
Work to b. .taked by a licen.ad Land 8U1'Veyor or Civil Bn91n..r and Ufo (2) copi.. of the
cut .beets .ent to the Public Work Deptartaent before atartin9 work.
'!'be bour. of work .re lia1ted to autaide the boura of 7-' .... and 3-1 p... for any work
.ff.ctift9 a tr.ffic lane.
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PLU CBBCIt DDOSl'l' "00.00 .
BOlfD roa pAI'1'BftJL PBIU'ORIWICB (loot OP DG. ]1ft.) .
CUB DDOSl'l' (4t or .-0, '500 lID) . .5 ()7) <0 ,;zr I Y ;-.
PLU CllBCI: , D81'BC'nOM Fa . lov dO ,;2.. cy I <(9
,
APPROVED FOR ISSUANCE 5- Z s - 9/
Dat.
f: PWPERMIT
Revised 4/91
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Public WcrlulIEnl:ljl1omjn~
CITY OF CAMPBELL
PUBLIC WORKS
~1 i - /(,()
~;{; C::,A!ALP~
DATE
COMMENTS
5/2s')91 l/jCk,~ I-~,i/-'/:- LJ//c:~ (" ")A i::-'-' /1: ; (. 0::l) ;' ,.~ A ^ i /r/::)/? Y .')F \/,/ t.: P
LA ""'"/::k"' A L _ _-7./ (
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5-)5 () jJ/ / I Ii .A /-- - I~.'
/ / ;-/ /
JANUARY 1989
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CITY OF CAMPBEll
Department: Publ ic Works
~~~t~;Rl' .~f;;~f~QR~H ~-0-
! BOLLIER f\:\NOI_!['i:3 r!
~ ------.--.- ---..
lf~RUCER I~E r~~:"i__J}L-'
I! Q\'I'Jj-lr\( I 11:11 C :]
" J l i: , ~ c _ __I.___-1_:_~= .____ _~_I.
70 NORTH FIRST STREET
C AMP BEL L. C A L I FOR N I A 9 5 0 0 8
(408) 866-2100
FAX # (408) 379-2572
~.,\
C"-1 ( - t <'-0
July 23, 1991
vick's Pipeline Construction, Inc.
350 Marburg Way
San Jose, CA 95133
RE; FINAL INSPECTION AND ACCEPTANCE
PERMIT NO. 91-160
LOCATION: 50 CATALPA
Gentlemen:
We have made a final inspection of subject Public Works
construction and find it acceptable and in conformance with
City standards. Accordingly, 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,
Cruz S. Gomez
Assistant Engineer
CG/AS:djr
F: 91-160
. TO:". SANDY TERPKO
ACCOUNTS RECEIVABLE
"
,,?,,--
~ Please iis~e check payable ;fo:
Address:
. City :.
, J
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''10".-,\;,,'
Descriptio~:: .
_--'\:
Exact Amount
PERMIT NO:
LOCATION:
DATE AND NO.
PURPOSE:
Requested by:
Approved by:
Verified by:
,
J
SPECIAL INSTRUCTIONS FOR HANDLING
Mail as is
Xyy
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Return to:
(
, \oS
(Department)
'....
Other:
\;, 4:x~P::'1
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04/18/91
\C;'"
TO:
City Clerk
"')
PUBLIC WORKS FILE NO. 9 / - / b c/
35-3396
ACCT ITEM AMOUNT RECEIPT NO
Please collect & receipt
for the following monies:
3372
3521
3521
3521
Project Revenues (specify project)
Public Works Excavation Permit Fees:
Application Fee
Plan Check Deposit
Faithful Performance (Cash) Deposit
R-t:
($50)
Other:
($100)
($500)
(100% of)
(ENGR. EST)
(4% of FPB)
($500 min.)
50 c)
Other Cash Deposit (specify)
($200)
,.q\
trD
,...'\\
c.ra
3372
Cr-L1
3373
3373
3373
3373
3373
3372
3372
3372
3372
3372
3395
3370
3380
3510
Plan Check & Inspection Fee ($0 - $100,000 10%;
$100,000 - $500,000 9%; $500,000 and above 7%; $100 min.)
Project Plans & Specifications ($10)
General Conditions, Standard Provisions & Details ($10 or $1Ipage)
"No Parking" signs ($1Iea. or $25/100)
Work Area Traffic Control Handbook ($5)
Copies of Engineering Maps & Plans ($.50/sq.ft.)
Final Parcel Map Filing Fee ($450 + $20 per lot)
Final Tract Map Filing Fee ($500 + $20 per lot)
Lot Line Adjustment Fee/Certificate of Compliance ($400)
Vacation of Public Streets and Easements ($500)
Assessment Segregation or Reapportionment
First Split ($500)
Each Additional Lot ($150)
Park Dedication In-lieu Fee per Unit ($4,548)
storm Drainaqe Area Fee
Public Works Special Projects
Postage
..m
TOTAL
$ hoo
PHONE J79~ ~?7C'7
~.. T, ZIP f~-13()
~
NAME OF APPLICANT HI/( C SA 19/( E /2... (
ADDRESS 19bO !l411/J...T~A.J /lVE STL,2/V
FOR I RECEIVED BY~. .
CITY CLERK
ONLY . OAT. '5/"-'// 'II '
TO:
City Clerk
(}J2/t-r.z.--<.-4-7T' ? / -- / 4~ 0
PUBLIC WORKS FILE NO.
ACCT ITEM AMOUNT RECEIPT NO
Please collect & receipt
for the following monies:
35-3396
3372
3521
3521
Project Revenues (specify project)
Public Works Excavation Permit Fees:
Application Fee
Plan Check Deposit
Faithful Performance (Cash) Deposit
$
R-1:
($50)
Other:
($100)
($500)
(100% of)
(ENGR. ESn
(4% of FPB)
($500 min.)
/ ()() 00 9q Oq3
3521
Other Cash Deposit (specify)
($200)
3372 Plan Check & Inspection Fee ($0 - $100,000 10%;
$100,000 - $500,000 9%; $500,000 and above 7%; $100 min.)
3373 Project Plans & Specifications ($10)
3373 General Conditions, Standard Provisions & Details ($10 or $1/page)
3373 "No Parking" signs ($1/ea. or $25/100)
3373 Work Area Traffic Control Handbook ($5)
3373 Copies of Engineering Maps & Plans ($.50/sq.ft.)
3372 Final Parcel Map Filing Fee ($450 + $20 per lot)
3372 Final Tract Map Filing Fee ($500 + $20 per lot)
3372 Lot Line Adjustment FeelCertificate of Compliance ($400)
3372 Vacation of Public Streets and Easements ($500)
3372 Assessment Segregation or Reapportionment
First Split ($500)
Each Additional Lot ($150)
3395 Park Dedication In-lieu Fee per Unit ($4,548)
3370 storm Drainaqe Area Fee
3380 Public Works Special Projects
3510 Postage
RECEIVED BY
DATE
qva.,LV vVtonfD~
~)Jd3/91
.. , ~
(J'D
$ /Civ
9.2-] -3.:l 'ili,. o. .... .
ZIP 9>-/ J 3 --~I ~ Kg
rr1 fW 2 /1 1991
ClIY CLERK'S OFFICE
TOTAL
NAME OF APPLICANT If I c.. /( ~ ;p Ip~1-/~( {~N0//t uc (7 tJ.J ~- PHONE
v /)-
ADDRESS -1 ;- () It /J /E. b U /l" A- i-U /9- v.3/1 A....J ;:::rz:, S c-/ C-:9-
/
FOR
CITY CLERK
ONLY
-/ .1. ~'-" '-'-' .L '-' - L......... Y.L ......~. _ , .... __..., ._
PR(\POSAL and CONTRACT
$-2.~-
Dab~
. I' <\ ,
TO M~T LD
__._..':ir_____.... .
l..JG
pmpo.",' III furnh;h (~Il nlllll'l'i"ls (illd p(lrform nlllatx,r necoolUlry to r.omplete the followinc'
~ /' . ---- ,.. /'1..... .A
.:.J~- .~.'L'1--1)\ [" \ N ..ft: .' _, . ~~. _c.4..1:A-- ~ ~ A-\I E l ~ _ ~' ~ EL~
__':I- ~,_~J ..l'_b:..!=-. _....~~.~n~ .... 1':..1'..,::__ ~,fLnc ,~~;.0:, ~ "\ 'D __r '(b.u t"/14f' (2. ~ ~ I ~ ".~,~
.....U:!n:.h...,,___~s. t.. ~~.\..........O_~T....s.._._~~~!;1~, ~...~O CJr!.W"p +c..'-+ ~,__
~.~.~ <;. ~, . . r~ t~ \~ . ~~..I. t:-\ 5_..~..~.~ .~~ .'. ~..-:\:~~k.:.I:_,~~ <::) tt... ~~h1-
_C_~;~J.'~,~_~~=,~c.~' .:,_\__L'l:._._~~.\(~:..~,..~~.._.~w(\.A.. -f~.- Bo~.___
____L.l.. l:+._.._.(..~.fl\ l'~ :\=:..
Dear Sir
..-.u~:_~ L t) ~
c ~_~ c.... r"l..k--~
~ ~ ~.,..L.~ L.,;'-I~
,<\11 elf III.' :11'011" wClrk to tll' "':"111"""'" III:' ,'IIo.~lilllli,ftlltIUI wOl'kmanlikl~ IlItllltl<<.'r lll"l-ordhtg lo swndard praellcl!~ fol' t~
tiJI-
SlIIll .,1 ............. ...... "._h__.._n__._____.__~__. J)nlln~~' ~~_'
I'rll,l(n','; paVllll'lll!t 10 III' III ,d.
:" Ih(' vallll' ,,'
!UlllJllIll 011."111. ilC\ I,' II" plIIII \\":11111\
. .........~.._._~_~,___ ll~ lilt. work prllJ!rl'~H\'<;
___ IM'I" I'enl f ..,~. _. ,,_p~ I of all w(lrk c~III11J",.h!d Thj~ ,'nO,','
. . .,_...n... _ dllYS .fter (,UJllplc'I.IO't
1\I1.V i1l1l'l'atiim or llt!VIUliulI 1.."ln IIII' Hl>ll\'t~ 1I,.~drk;IIi",~.. i,~vlllvh1l( elllw <:'1"\1 "f HlU IR-rla I or lobot will unl)' hto ,'xl",\\t'!f1
tlp'1I1 wrich:J1 ol'l1c'rs for !'ttllTI.', and willl.('t"'lY\f ;111 "xl'";t I'Il;lrMr. f1\1I~t Ihe SIIIll m'mlioll[![l in I.hls contnu:t. All a<<~m..uh mn!';1
t)t' rn Q ell" III oATil hW,
Nallll' ;Itul 1t"/(I'H/'/lI.1II11 Nurnlol'l hi ;\lIY 'i;al''':p''n:oll whll
Sulll:II,:d f... /ll'goliatl-d this '.I/'llr;II I
Nanw _.);.~lf.jJ.J..___.t.!J.{I~. (. !~-.'.:'~I'
('onlnH'lor" lIre rl'quh'c'd h~ hlw tll hc' Ik..mwd
and "regulllt...1 h.l' lilt ('olltr..dol"s ~ah~ Lkt"Us/'
Uo.rd. An)' q..c:.;lIons toncnl\lll~ II conl..attOf. nUl)'
bt referred to the r(l~lstr'al' fir till' board who!;f'
\Iddrr.~1f;!i is:
nmlrad!)I"" Slu{c' I ,II'''"'\(, Iloanl.
11'120 N Slrc't>t,
Slilctl"lIt~nlo. CalUornia !l$)l14
H\~~\II!C:tllIl1v '!uhmllt,.".
Ilv VI'~~S t?,'(2.<3.-.LL1Y...c"
J. .?P.. '. O\..Ii.tJ3...!1. ~ ;:1.-- ,. ~.'Y..
.<\ cmrelllfl
. ..... .,.,. ...,.,.. .q...(;llioJ.t?.11..-----,.. ,......
I. :onln!Jd\lr'~ Sl~lp Ll(,~ No ...,...S.,. tl..,-,.~ r
You, Ihe h4lYt~r, may cancel this transatti')r\ at
;lIlY tim~~ prior 10 midnight of the thiM oosl.oo!is day
aftor lhe dale ullhis tranSAction,
t\l'UWTANCJo:
You lIr" Iwrcby .1lllhorlzt'd 10 furnish l.dllllllkrial!l and labor n..'<I\'ir~d to Cl)ltll)ltle the work mlmHoned In the
abHVI' pf'oJl'l"al, 1111 whkh _.._..~,. .. ...... .... ,",__ ...__ ;!,~I'I"'IHPIlY lhf.!llim'lHril mtmh(mNtit'l!lllidl'r'){}fll!>;RI,
:lnd (\(~(-ordi'IR to (tc ll!f'n>>lh~H~Hf - CJ
.'&'CCEPT"~I' ___..~. ..... ..... ".'.'_'._'_'__.'__'_ J.lalJ' .~.....,.d_L~J,__. I!J ....J___..
,n...... - "m . ..... NOTIf";~ T(~-(.WN''';R .... . '..............----....-.'.-.......'....'...1
I I
"l
lllld{', lIi' M..ch:ulli". '.II'T! 1,;111I", ;lI'J" ""lltr':;d'\1
~lIh,"I'\fr:lrl.'~I' l;oI)1lt'(~I', 1It:''''l'iilhll:t11 '''' "th'T JlcP,Orl \! /,1,
hl'lll'; ''''lIlprl'\'' ..11.1 11l'()IH~ll' i'!I{! ." II'I'I':Il.l fot h- 11I;'l!l,
i ';('rvil"'<' p:. 1!1..\:,'f\i11 h:I'. .'1 I il~hl h.I /'1111"1'(' hi'; !":~ill1
~t~:{Jtl~'j ~'fJ'~' ~W~t;:},.t'l'"
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CITY OF CAMPBELL
PUBLIC WORKS INSPECTION REPORT
DATE: 1 ,:J3, q / PERMIT/PROJECT NO.:
q j-/f.t;DTRACT
NO.
ADDRESS: 5D (]a:f~
TYPE OF WORK: STREET:
STORM:
SANITARY:~ ELEe:
OTHER:
P.C.C.:
PARKWAY:
[] PRELIMINARY INSPECTION WITH DEFICIENCY LIST
[] FINAL INSPECTION WITH DEFICIENCY LIST
~ FINAL INSPECTION ACCEPTANCE
SIGNED PLANS ? YES
:f
COUNCIL ACTION ?
YES
CHARGES AGAINST DEPOSIT? YES
NO
OVERTIME:
HRS. @ $
PER HOUR
s
EQUIPMENT RENTAL: TYPE:
AMOUNT: $
DATE:
,
,
REASON:
TOTAL CHARGES:$
[] ONE YEAR MAINTENANCE WITH DEFICIENCY LIST
[] ONE YEAR MAINTENANCE ACCEPTANCE