96-182
CITY OF CAMPBELL
PUBLIC WORKS DEPT.
70 N. rust St.
Campbell, CA 95008
(408)866-2150
FAX (408)376-0958
~~
OWNER OCCUP R-t
NO FEE ENCROACHM P
(for working within tile
public right-of-way)
($5,000 maximum value of work)
Permit No. CJf::, -/B.:z rR-/)
X-Ref. File
Application Dare
ISSUED
fd / '/ / '1to
.
APPLICATION - Application is hereby made for a Public Works Permit in accordaDce with Campbell Municipal Code, Section
11.04. (Application expires in 6 months if the permit is DOt issued.)
A. Work Address
B. Nature of Work of s!/t!f2.
C. Attach three (3) copies of a drawing owing tile location, cxtcDt and dimensions fthe work. The dra' sbaIl show fr'ee ,
the relation of the proposed work to existing improvements. When approved by the City EDgineer, said drawing becomes
a part of this permit.
D. All work shall conform to tbe City of Campbell Standard Specifications and Details for Public Works Construction; the
General Permit Conditions listed on the reverse side; and the Special Provisions for this permit, listed below. Failure
to abide by these conditions and provisions may result injob shut-down and/or forfei1ure ofFaitb1W Performance Sureties
and cash deposits. (See General Permit Cooditions 1 and 2.)
NAME OF APPLICANT <;;'4A1 j::jP-AA}e/\ TELEPHONE..y',,~ 37JE;J..7/Lf
(Print Name)
fd>DRESS 178..9 ~/U&C>,l)J!.. ~'J/ , Qf. 9-~i!Jtl.
Complete and attach Workers' Compensation and Contractor Information forms.
The ApplicantIPermittce hereby agrees by affixing their signature to this permit to hold the City of Campbell, its officers, agents
and employees free, safe and harmless from any claim or demand for damages resulting from the work covered by this permit.
The ApplicantIPermittce hereby acknowledges that they have read and UDderstand both the front and bact of this permit, and that
they will inform their contr3Ctor(s) of the information.
ACCEI'I'ED _~~ ~L~
/ ApplicantIPermittce (Sign) ~ I Date
NOTES: ALL WORK SHALL CONFORM WITH TIlE ATrACHED, APPROVED PLANS AND ALL APPLICABLE
CAMPBELL STANDARD DETAILS AND CONDmONS.
THE CONTRACTOR MUST HA VB THIS PERMIT AND APPROVED PLANS AND MUST ARRANGE TO MEET WITH
THE PUBLIC WORKS INSPECTOR AT THE SITE AT LEAST TWO DAYS BEFORE STARTING WORK.
NOTICE MUST BE GIVEN TO PUBLIC WORKS AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK.
PER SECTION 4215 OF THE GOVERNMENT CODE THIS PERMIT IS NOT VALID FOR EXCAVATIONS UNTIL
UNDERGROUND SERVICE ALERT (USA) HAS BEEN NOTIFIED AND THE INQUIRY IDENTIFICATION NUMBER
(TICKET NO,) HAS BEEN ENTERED HEREON. USA PHONE: 1-800-227-2600. TICKET NO.
SPECIAL PROVISIONS, '
. y;~c rype ~ fra: M.lJ.sr k 17,1<f}~ovt:':d .POv- ,4, 11f.5"/zL/Ia-fU.-
STANDARD
SURETY FOR FAITHFUL PERFORMANCE (100% OF ENG. EST.)
APPROVED FOR ISSUANCE ~Iw'.t& {r?.(.v"~
for City Engineer
Permit Expires 6 Months After the ate of Issuance
AMOUNT
$ 5"OO~
RECEIPT NO.
ar "373 e
G/~ti0
Date
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( SEE 01HER SIDE)
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Ci..j of Cam-pbelI - Check RejJuest
To: Accounts Receivable
Please Issue Check
Payable to:
Address - Line 1:
Sam Francis
1789 Silacci Drive
Line 2:
City:
Campbell
State: CA
Zip: 95008
Description:
Amount Payable:
Account Number:
REFUNDABLE DEPOSIT
Finance On.y:
INTEREST EARNED
$ 500.00
101.2203
101.540.7448
ate and Receipt No:
Permit No:
6/4/96 #93738
96-182
Purpose:
Refund Faithful Performance Surety on R-l Permit
Requested by:
Randy Westfall
Michelle Quinney /c{(
Title: PW Inspector
Date: 7/29/96
Approved by:
Title: ci ty Engineer
Date: 7/29/96
FINANCE ONLY:
Verified by:
Title:
Date:--1
Date: __ I
Approved by:
Title:
Special Instructions For Handling Check
Mail As Is:
x
Mail in Attached Envelope:
Return To:
.'
...
(NAME)
(Department)
Other:
,.,
rev: 3/25/95
TO: City Clerk
PUBLIC WORKS DEPARTMENT RECEIPT
Effective July 1, 1995
PUBLIC WORKS FILE NO. CJ fa - I B '2...
I7B"'l St\&llL" IX,vf..
^CCf.
""OllNT
~
I
I
I
I
I
Utilitv Encroachment Permit
Anerial/Collector Street ($325) I
Residential Street/Other Areas ($225) I
220 Plan Check DeDosit ($500) I
220 Faithful Performance Surety (FPS) (100% of ENGR.EST.)
220 Monumentation Surety (100% of ENGR.EST.)
220 Cash DeDosit (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 Encr.Est. > $250,000 (DeDosit 15% of ENGR. EST.)"
472 Utility < $100.000 I
Conduits/Pipelines up to 500 Feet ($1 .60/ft.) (MIN. $105)
Above 500 Feet ($1.10/ft.)
Manholes/Vaults/Etc. ($105/ea)
Pole Set/Removal ($105/ea)
Minimum Charge Per Location ($120)
Street Tree Plantino/Removal ($105/tree)
.. 220 Utility> $100,000 (DeDosit 15% of ENGR. EST.)"
476 Proiect Plans & Soecifications Proiect No.
476 Standard SDecifications & Details ($1/Pn $12/Book)
476 CODies of Enoineerino MaDs & Plans ($.50/so.tt.)
472 Penalties: Failure to restore Dublic imDrovements ($1 OO/Calendar Dav)
(Muni Code Section 11.34.010)
472 Penalties: Failure to correct unsafe conditions ($100/Calendar Dav)
LAND DEVELOPMENT
4722 Lot Line Adiustment ($500)
472 Parcel Mao (4 Lots or Less) ($1 060 + $25/Lot)
I 472 Final Tract MaD (5 or More Lots) ($1 380 + $25/Lot)
I 472 Cenificate of ComDliance ($400)
I 472 Cenificate of Correction ($300)
472 Vacation of Public Streets & Easements ($550)
472 Assessment Segregation or Reaooonionment
First Solit ($550)
Each Additional Lot ($1701
472 Storm Drainage Area Fee Per Acre (R-1, $2,000)
(Multi-Res, $2,250)
(All Ot'her, $2,5001
492( Parkland Dedication Fee (75%/25% Due UDon Cen. of OccuDancv)
496 Postaoe
TRAFFIC
472 Intersection Turn Counts (Two-Hour Count) ($60)
472 Intersection Turn Counts (a.m. or O.m. Deaks) ($125)
472 Traffic Flow MaD (Dailv Traffic Volumes) ($27)
472 CamDbell Traffic Model (Full ScoDe Assessment) ($2250)
472 Camnbell Traffic Model (Reduced ScoDe Assessrr($7401
427 Truck Permits ( $35/triD)
472 No Parkina Sinns ($1/each or $25/100)
OTHER
i
INAME OF APPLICANT SllM R-~s
I
I NAME OF PAYOR SCX-W\
I ADDRESS a...CL', Or \ Ve-
i
.. Actual Cost Plus 20% Overhead (Non-Interest bearin
TOTAL
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$ S7){) D Y-
roo
CITY CLERX
ONLY
"For Plan Check and Cash Deposits, send yellow copy to Finance,
h:\recfrm3.wk3(mp)rev.1/9/96
PHONE 37'0 -.;l. 71 -I
ZIP q s-co6
RECEIVED
JUN 0 It 1996
CITY CLERK'S OFFICE
Of'CA-it
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CITY OF CAMPBELL
Public Works Department
June 6, 1997
Mr. Sam Francis
1789 Silaccci Drive
Campbell, CA 95008
SUBJECT: PERMIT NO. 96-182
LOCATION: 1789 Silacci Drive
ONE YEAR MAINTENANCE INSPECTION - ACCEPTANCE
Dear Mr. Francis:
The City of Campbell has made the fmal one year maintenance inspection of subject Public
Works improvements and find that no maintenance is required.
Your warranty requirements and any surety, therefore, are hereby released.
?!l~1~
Public Works Inspector
f-MQ
cc: Permit 96-182
Public Works/Parks Division
H: \ WORD\PERMITS\96182ACCGd)
70 North First Street. Campbell, California 95008.1423 . TEL 408.866.2150 . FAX 408.376.0958 . TDD 408.866.2790
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CITY OF CAMPBELL
Public Works Department
July 29, 1996
Mr. Sam Francis
1789 Silacci Drive
Campbell, CA 95008
Re: Permit No. 96-182 (R-l)
1789 Silacci Drive
Final Inspection and Acceptance
Dear Mr. Francis:
The City of Campbell has made a final inspection of subject Public Wodes
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 repair and/or maintenance of any
defective work or failure 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.
Your Faithful Performance Surety (FPS) cash deposit of $500.00, plus any interest due,
is' now being processed and will be sent to you under separate cover.
If you have any questions, please call mat at (408)866-2165.
;;2:'Y'
RaOO~=:t~
Public Wodes Inspector
.'
~? ~t,& Permit 96-182
Suspense - 11 months
h:\96182fnl(mp)wd
70 North First Street' CampbelI, California 95008.14'23 . TEL 408.866.'2150 . FAX 408.379.'257'2 . TOO 408.866,:2790
NEW PW FAX:#
408.376.0958
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CITY OF CAMPBELL
Public Works Department
July 9, 1996
Sam Francis
1789 Silacci Drive
Campbell, CA 95008
Re: Tree Planting - Permit 96-182
Dear Mr. Francis:
In response to your request regarding planting a new street tree, the City has reviewed the trees
in your area and determined that the variety of tree to be planted shall be a Chinese Pistache
tree.
Please contact me to arrange for approval of the tree prior to planting and inspection of the
work.
If you have any questions, please call me at 866-2165.
70 North First Street' Campbell, California 95008,1413 ' TEL 408,866,1150 ' FAX 408,379,1571 ' TOO 408.866.1790
NEW PW FAX #
~08-376-0953
CITY OF CAMPBELL
1/(9 )'!c1Cc1
5~ :(r~j~ ~ 375- ~7/tr
CONTRACTOR: f2 ~ !
PROJECT NO. 96..../(1-
REPORT NO:
FIELD ENGINEER'S DAILY REPORT
DATE: l---/0-9&
WEATHER: PAIR.
INSPECTOR: K. ~G:.SrfALL
ITEM
DESCRIPTION
Irrtt ~
CUI'\Co
CC:
PAGE: I
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