96-157
CTY OF CA,\fPE::,L
DEPT. OF PUBLIC WORKS
70 North First St.
Campbell. CA 95008
(408) 866-2150
Fax (408) 376-0958
ENCROACHME~"T PER..\HT
(for working within the
public right-of-way) .. /~. .,)
Issued 5 J 3Jc)(p i ffj/
Permit expires in 12 mos~/
Pnmit No.
X-Ref. file
96 -)57
Application Date 4"'/?- ~ b
Application expires in 6 mos.
APPUCATION . Applicltion is bereby IIIIde for. Public worts hrmit in accordaDce wjb c;aq,ben Municipal CocIc. Secticm 11.04. (Applicatioa expires in 6 IIIODlbs
if'!he permit is DOt issued. Application Fee is IIOD-refuudable.) lNOjIUJ Fi.:rb/ h 37b"'3S" 4-()
A. W......... .... ,-11-6'0 O"tp.< ; 0 La-. 1" 200 AI. s,.. -7<JMA,S /J~IA.. ;>1<> M.
Ulility lI'eIICb location 2 5T. -frl.o./S -Ic:. ~ i/l~dLt.f !Jilt a 7(1-//' I ~ (l'''l-fC4~ I wlf~ /rl'iqtJ.fJ',,"\.
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B. NlIIUre of work
C. Aaach four (4) copies of an enaineered plans Ihowm, !he location IIId extent of lbe wort. IIId four (4) CIllpies of lbe preliminary EDaiDeer's EstimaIe of work. The
plans sball sbow the relltion of Ibe proposed work to cUtina sunKC IIId \IIIderr.IrOUDd iqll'OYallellll. Wben Ipproved by lbe City EuaiDeer, Slid plan becomes a part of
Ibis permit.
D. All work sblll amfonn to lbe City of CIqlbeII Standard SpeclfICllions IIId DeWIs for Public Worts COIIItnIC:don; lbe GeaenI Permit CoIIdicions listed on lbe reverse
side; and the Special Provisions for Ibis permit. listed below. Failure to Ibide by these conditioas and provisions IIIIy resuk in job sbut-down lIIdIor forfeiture of Flitbful
Perfonnance Sureties and cash deposits. (See GenenI Permit Conditions 1 IIId 2.)
E. THE CONTRACTOR MUST HA VB TlDS PERMIT AND APPROVED PLANS AT THE SITE AND MUST NOTIFY THE PUBUC WORKS DEPARTMENT AT
LEAST TWO DAYS BEFORE STARTING WORK. NOTICE MUST BE GIVEN TO PUBUC WORKS AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK.
NII1le of AppliWll ~ MOv~ fetx 9t. p- 017/ T*9bone(4-/f!1/;?-&//7
24 HOUR EMERGENCY
Address J./90 C,ri-#..",!lti'l La...v...,#1. /J-elN ,eA 9fo4-.J TELEPHONE NO.
.
Is Ibis work being done by the property owner II their own residence?
Yes
X No
The Appliram/Permiaee hereby agrees by afflXm, their sipature to Ibis permit to bold lbe City of CIqJbe1I, its off"JCeI'S, IpIIlS IIId elllployees free, life and blnnleu from
any claim or demand for darnlaes resultina from lbe work lXlVefed by Ibis permit.
Tbe ApplicantlPmnittee hereby lCknow1edaes lbIl they hive read and undentand bolb lbe front IIId bide of this permit, IIId they wW inform their COIIII'ICtDr(s) of the
infomwion.
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(AppliclDtlPmniaee) printlsian
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PERMIT APPLlCATlONF'EE;.. .... ....... .. . .................... . ...... .......d....
~ CHECK DEPOSIT _:-'- -,' - ,: ':::-:::::::::>:< :>.:,:::::::::::::<</<<.>:::::}::::<':: :':: :'_ ;": .',' ,.. .. '.'-, .-:-:-:':::.::::::::::::::::::':-/::.::::::-::::::/;:::-::::.:.....
SURETY FOR FAITHFUL PERFORMANca {lOO," .OJI. &NO. EST .) .... ~)( . i?"~:':<" .
CONSTRUCTION CASH DEPOSIT ..... .. ... ...... <. .. <.... . .... . ............. . ......... .... .... ... . ... ..
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CITY OF CAMPBELL
14~O ol\fa.-.r: 01 L~,
PROJECT NO. <% -' ) t;7
REPORT NO: (
FIELD ENGINEER'S DAILY REPORT
CONTRACTOR: r1a.t-- vv11>vV'5 '
DATE: 6.. ')'-1&
WEATHER: rurr
INSPECTOR: K. ~51fALL
ITEM
DES CRI Pl'ION
cc:
PAGE: I
OF I
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O-'CH A"".
CITY OF CAMPBELL
Public Works Department
May 16, 1997
Mr. Wayne Fischer
82 Shereen Place
Campbell, CA 95008
SUBJECT: PERMIT NO. 96-157
LOCATION: 1480 Ontario Lane
ONE YEAR MAINTENANCE INSPECTION - ACCEPTANCE
Dear Mr. Fischer:
The City of Campbell has made the final one year maintenance inspection of subject Public
Works improvements and fmd that no maintenance is required.
Your warranty requirements and any surety, therefore, are hereby released. Your warranty
deposit of $262.50, plus any interest due, will be sent directly to you from our Finance
Department.
~y,
Ran~:t4
Public Works Inspector
MQ LtI.l
cc: Permit #96-157
Public Works/Maintenance Division
H:\ WORD\PERMITS\96157 ACC(JD)
70 North First Street. Campbell, California 95008.1423 . TEL 408.866.2150 . FAX 408.376.0958 . TOO 408.866.2790
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CITY OF CAMPBELL
Public Works Department
June 10, 1996
./ J Mr. Wayne Fischer
::7cR _mShereen Place
vV' Yampbell, CA 95008
SUBJECT:
PERMIT NO. 96-157
LOCATION: 1480 Ontario Lane
FINAL INSPECTION AND ACCEPTANCE
Dear Mr. Fischer:
The City of Campbell has made a fmal inspection of subject Public Works improvements and fmds the work to
be acceptable and in conformance with City standards. Accordingly, the City Engineer accepts the improvements.
The one year maintenance period stated in the permit begins as of the date of this acceptance letter. The permittee
is responsible for the repair and/or replacement of any defective work or failures that occur within one year. The
City will inspect the improvements within one year and notify you, in writing, whether or not any repairs are
required.
75% of your Faithful Performance Surety (FPS) cash deposit of $1,050.00, plus any interest due, is now being
processed and will be sent to you under separate cover. We will continue to hold 25% of your FPS cash deposit
as a maintenance surety.
If you have any questions, please call Randy Westfall, Public Works Inspector, at (408) 866-2165.
Sincerely,
~~rf~~
City Eng~ee~ )
RRW jqW
cc: Tree Movers, 2190 Crittenden Lane, Mountain View, CA 94043
Suspense - 11 months
Pennit #96-157
H:\14800NT.FIN(JD)
70 North First Street, Campbell, California 95008.1423 . TEL 408.866,2150 ' FAX 408.379.2572 ' TOO 408,866,2790
NEW PW FAX if
&~~-n._ ~l: "'7 ~_:\n:::: c
To: Accounts Receivable
Please Issue Check
Payable to:
Address - Line 1:
Line 2:
City:
Description:
Amount Payable:
Account Number:
ate and Receipt No:
Permit No:
Purpose:
Cit., of Campbell - Che\._~ Request
Wayne Fischer
82 Shereen Place
CarnDbell
State: CA Zip: 9 5 0 0 8
REFUNDABLE DEPOSIT
Finance On.y:
INTEREST EARNED
$262.50
101.2203
101.540.7448
4/17/96 #92607
96-157
Refund Maintenance Surety deposit
Requested by: Title: PW Inspector
Approved by: Title: City Engineer
FINANCE ONLY:
Verified by: Title:
Approved by: Title:
Mail As Is:
Return To:
(NAME)
Other:
rev: 3/25/95
Date:
Date:
Date:
Date:
Special Instructions For Handling Check
xx
Mail in Attached Envelope:
(Department)
To: Accounts Receivable
Please Issue Check
Payable to:
Address - Line I:
Line 2:
City:
Description:
Amount Payable:
Account Number:
ate and Receipt No:
Permit No:
Purpose:
Requested by:
Approved by:
FINANCE ONLY:
Verified by:
Approved by:
Mail As Is:
Return To:
Other:
rev: 3/25/95
0t: / 't(
I(~"'""''''^'' / .:
City of Campbell - Check Request
Wayne Fischer
82 Shere en Place
Campbell
State: CA Zip:
Finance Only:
INTEREST EARNED
REFUNDABLE DEPOSIT
$787.50
101.2203 101.540.7448
4/17/96 4/:92607
95008
Qf\-1r::.7
Refund 75% of Faithful Performance Surety deposit
Rand Westfall
/iJfvLt ~ ~'~
M1C elle u1nney
Title: PW Inspector
Th~:City Engineer
Title:
Title:
Date:
.,,).
."~,' "-,> <,
Date: 6/10/96
Date:
Date:
Special Instructions For Handling Check
xx
(NAME)
Mail in Attached Envelope:
(Department)
.
PROPERTY ADDRESS
Please collect & receipt for the following monies:
ACCI', 11EM
435.535.49211 Proiect Revenue (sDecify project)
ENCROACHMENT PERMIT
472 Application Fee
NDn-Utility Encroachment Permit ($225)
R-l First Permit (No Fee), SubseQuent Permit/Yr ($100)
Utilitv Encroachment Permit
Arterial/Collector Street
Residential Street/Other Areas
Plan Check DeDosit
Faithful Performance Suretv (FPS)
Monumentation Surety
Cash DeDosit
Labor and Material Surety
Plan Check & Inspection Fee (Non-Utility)
Engr.Est. < $250,000
Enor.Est. > $250,000
Utilitv < $100000
Conduits/Pipelines up to 500 Feet ($1.60/ft.) (MIN. $105)
Above 500 Feet ($1.1 O/ft.)
Manholes/Vaults/Etc. ($1 05/ea)
Pole Set/Removal ($1 05/ea)
Minimum Charge Per Location ($120)
Street Tree Planting/Removal ($1 05/tree)
Utilitv> $100,000 (Deposit 15% of ENGR. EST.)"
Pro'ect Plans & Specifications Proiect No.
Standard Specifications & Details ($l/Pa $12/Book)
CODies of Enoineering Maps & Plans ($.50/sQ.ft.)
Penalties: Failure to restore public improvements ($l00/Calendar Dav)
(Muni Code Section 11.34.010)
4722 Penalties: Failure to correct unsafe conditions ($1 OO/Calendar Dav)
LAND DEVELOPMENT
4722 Lot Line Adiustment
472 Parcel MaD (4 Lots or Less)
472 Final Tract MaD (5 or More Lots)
472 Certificate of Compliance
472 Certificate of Correction
472 Vacation of Public Streets & Easements
472 Assessment Segregation or Reapportionment
First Split
Each Additional Lot
472 Storm Drainage Area Fee Per Acre
TO: City Clerk
4920
4966
TRAFFIC
4728
4728
472
472
472
427
472
OTHER
PUBLIC WORKS DEPARTMENT RECEIPT
Effective July 1, 1995
PUBLIC WORKS FILE NO.
2203
2203
2203
2203
2203
472J
2203
4722
!
($325)
($225)
($500)
(100% of ENGR.EST.)
(100% of ENGR.EST.)
(4% of FPS)($500 min.)
(100% of ENGR. EST.)
(12% of ENGR. EST.)
(DeDosit 15% of ENGR. EST.)"
220
476
476C
4760
4722
($500)
($1,060 + $25/Lot)
($1,380 + $25/Lot)
($400)
($300)
($550)
($550)
($170)
(R-l, $2,000)
(Multi-Res, $2,250)
(All Other, $2,500)
Parkland Dedication Fee (75%/25% Due UDon Cert. of Occupancy)
Postaae
Intersection Turn Counts (Two-Hour Count) ($60)
Intersection Turn Counts (a.m. or a.m. aeaks) ($125)
Traffic Flow MaD (Dailv Traffic Volumes) ($27)
CamDbell Traffic Model (Full ScaDe Assessment) ($2 250)
Campbell Traffic Model (Reduced ScoDe Assessni$74O)
Truck Permits ($35/trip)
No Parkino Sians ($1Ieach or $25/100)
TOTAL
NAME OF APPLICANT /1J.f-E. tyJ6Vt:;,.(l.6
NAME OF PAYOR vJo.r ~ Ff! J"../
ADDRESS Jr. tel 5~~ P/a..u-: Co-fx1R ~
.. Actual Cost Plus 20% Overhead (Non-Interest bearino deposit)
h:\recfrm3. wk3(mp)rev. 1/9/96
9'fo.... J r:i 1
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AMOUNT
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$ /3? 5. uU I
PHONE 40;>- 37 /.. - j 5' !PC
ZIP 9s1.iO 2 I
RECEIVED
APR 1 71996
CITY CLERK'S OFFICE
0;y14/96
14:07
FLORISTS*MUTUAL*INSURANCE*CO**** ~ 408 3760958
NO. 947 Gl01
Fax Transmission
To: f( q "L ,g.t We s TtJ h Ce.) ,f) 'D' ~~ . I... From: n:rnlETII VON FORELL
Company: C'/;~ 2ilC(Li.64fvd.l -r~-L. ~S Date: ~-I'f-?h
Fax I: '37,~tJ<t~'8"
You should receive/7page(s) including this one.
If you do not receive al}--paqQS, please call (408) 455-2003.
Message: {)tA..Jl ~~~ u.'~76 ~ 15
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Florists' Insurance Services, Inc
FAXt (408) 455-2013
05/14/96
FLoRISTS*MUTUAL*INSURANCE*Co**** ~ 408 3760958
..1. .....~" ~ ~.I'""" ~tJ.. I 1_'-""- ~ .;>, .;]I t'iL' 1 L' ..a\__
NO. 947 ~02
iU,:)'j~;",LlfI.).1I ...I' "
14:07
POLICY NUMBER:
COMMERCIAL GENERAl LIABILITY
THIS ENDORSEMENT CHANGES TI-E POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - FORM B
This endorsement modifies insur.nce provided under the following:
COMMERCIAL GENERAl LIABILITY COVERAGE PART.
Name of Person or Organl%ation:
SCHEDULE
(If no entry. appears above. information required to complete this endorsement will be shown In
the Declarations as applicable to this endorsement)
WHO IS AN INSURED (Sect.on III is emended to ,nclude as an insured the persorJ or organization
shown .11 the Schedule. but only with respect to liability arising out of "vour work"' for that in-
sured by or for you
......\
CG 20 10 11 85
Copyright Insurance Services Qffiee. Inc.. 1984
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