96-184
CITY OF CAMPBELL
PUBLIC WORKS DEPT.
70 N. First St.
Campbell, CA 95008
(408)866-2150
FAX (408)376-0958
OWNER OCCUPIED R-l
NO FEE ENCROACHMENT PERMIT
(for working within the
public right-of-way)
($5,000 maximu value of work)
,Permit No.
X-Ref. File
Application Date
CfIP.. J ?~
1/21 Jc]7
I
RECEIVED
ISSUED
APPLICATION - Application is hereby made for a Public Works Permit in accordance with Campbell Mutf! ~ole_on
11.04. (Application expires in 6 months if the permit is not issued.) PUbLIC \Iv',";,"
40 1..,.." .
,MJ,~Sn~A T/ON
A.
B.
C.
Work Address 11'56 NA()}Nt. D~.
Nature of Work ~e.PLACK, ~fR:&c:r 1'"ROf5 {(l"ft(jv~ 8'1 GJ'T'1
Attach three (3) copies of a drawing showing the location, extent and dimensions of the work. The drawing shall show
the relation of the proposed work to existing improvements. When approved by the City Engineer, said drawing becomes
a part of this permit.
All work shall conform to the 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 in job shut-down and/or forfeiture of Faithful Performance
securities.
D.
NAME OF APPLICANT Geo~ L. C OSGAAJ
(Print Name)
TELEPHONEr4-0f' ) 'g/'b - 077 7
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ADDRESS I/SO NAb/NO /)/(/'
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The Applicant hereby confirms that this work is being done by the property owner/applicant at their own residence.
The Applicant 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 Applicant hereby acknowledges that they have read and understand both the front and back of this permit, and that they will
inform their contractor(s) of the information. II
ACCEPTED ~ L G,~ r-,}--f-:r
Ap i ant/Permittee ( ignJ Date
NOTES: ALL WORK SHALL CONFORM WITH THE ATTACHED, APPROVED PLANS AND ALL APPLICABLE
CAMPBELL STANDARD DETAILS AND CONDITIONS.
THE CONTRACTOR MUST HAVE 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.
SECURITY FOR FAITHFUL PE
STANDARD
100% OF ENG. EST.)
AMOUNT
$tJ/A
RECEIPT NO.
N/A
/.....tll.~7'
Date
APPROVED FOR ISSUANCE
or City Engineer
6 Months After the Date of Issuance
j: forms rlperml rev.
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GENERAL PERMIT CONDITIONS
1. A SECURITY to insure FAITHFUL PERFORMANCE and completion of the work is required. This SECURITY
is refundable upon completion of the work and written acceptance by the City.
2. A ONE-YEAR MAINTENANCE PERIOD for all work is required. Such period will begin on the date of written
acceptance by the City. It is the applicant's responsibility to remove and replace unacceptable improvements within the
one-year maintenance period.
3. REFUND or cancellation of the Faithful Performance security will be initiated by the written acceptance of the work by
the City.
4. The Permittee MUST REQUEST IN WRITING a final inspection and acceptance of the work upon completion.
Acceptance by the City will be made in writing to the Permittee.
5. MAINTAIN safe pedestrian and vehicular crossings and free access to private driveways, fire hydrants and water valves.
6. REPLACE IN KIND any damaged or removed existing improvements, including planting.
7. SA WCUT for all PCC or AC removals. Prior to concrete sawcutting or washing, the Contractor shall place filter fabric
material in the flow line of the gutter to retain all construction debris. All construction debris shall be wet vacuumed,
broom swept, picked up and disposed of by the Contractor. Concrete sawcut debris shall not be swept or water hosed
into the gutter and into the storm drain system.
8. Adequate signing and lighted BARRICADING is required on the job site. Failure to provide such signing and
barricading as specified by the City Engineer may result in the City's renting such signing and barricades and charging
the cost to the permittee.
9. The Contractor or Permittee will have a SUPERVISORY REPRESENTATIVE available for contact on the project at
all times during construction.
10. This permit shall be kept at the site of work and must be shown to any authorized representative of the City of Campbell
or any law enforcement officer upon demand.
11. No STORAGE of materials or equipment will be allowed near the edge of pavement, within the traveled way, or within
the shoulderline which would create a hazardous condition to the public.
12. This permit shall not be construed as authorization for excavation and grading on private property adjacent to the work
or any other work for which a separate permit may be required, nor does it relieve the Permittee of any obligation to
obtain any other permit required by law.
13. All necessary ROAD REPAIRS resulting from the permit work shall be made in accordance with City Standards and
Specifications at the sole expense of the Permittee.
14. This permit does NOT RELEASE the Permittee from any liabilities contained in other agreements or contracts with the
City and any other public agency.
15. This permit is NOT TRANSFERRABLE. Work must be performed by the Permittee or his designated agent or
contractor as specified thereon.
16. Prior approval of inspector is required for any work done after normal working hours, on weekends or holidays and may
require reimbursement of inspection costs at the current overtime rate.
17. Call back (call out) due to emergencies regarding this permit, shall be at the current overtime rate with a three (3) hour
minimum charge per occurrence.
Applicant shall be responsible for ensuring that all those providing services under the applicant are aware of and understand all
of the above conditions.
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CITY OF CAMPBELL
Public Works Department
January 14, 1997
Beverly Coggan
1150 Nadine Drive
Campbell, CA 95008
Re: Encroachment Permit Application No. 96-184
Dear Mrs. Coggan:
As discussed, enclosed is an application for an R-l permit to replace your street tree. Please
sign both pages of the application and return it to us, so we can issue the permit.
Please note that you may plant either a Raywood Ash or an Ornamental Pear tree, as noted in
the permit application.
No security deposit will be required due to the circumstances surrounding the removal of the
original tree. Please remember to give me advance notification prior to planting the tree.
We have enclosed a copy of our letter to you dated June 24, 1996, for your reference. Please
contact me if you have any questions concerning this matter.
Sincerely,
EJ~otf
Public Works Inspector
Enclosures
File: 96-184
H:\1150NAD.L TR(JD)(WP)
70 North First Street' Campbell, California 95008,1413 ' TEL 408.866,1150 ' FAX 408,379,1571 . TDD 408.866.1790
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CITY OF CAMPBELL
Public Works Department
June 24, 1996
C~3CW\.
Beverly Coglin
1150 Nadine Drive
Campbell, Ca 95008
Re: Tree Planting
Dear Mrs. Coglin:
In response to your request for information about street tree planting, the City has reviewed the
trees in your area and determined that the variety of tree to be planted shall be a Raywood Ash.
Please be reminded that an R-1 Encroachment Permit must be completed by you and issued by
the City prior to any work being done. There is no fee for this permit; however, depending
upon the scope of the work, a refundable surety deposit may be required.
When returning the Encroachment Permit, please submit a simple scale drawing of the area
between the curb and sidewalk, and indicate where you desire to plant. Once the permit has
been issued, please contact me to arrange for inspection of the work.
If you have any questions, I can be contacted at 866-2165.
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Public Works Inspector
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h: 1150nadine.tre
70 North First Street' Campbell, California 95008.1423 . TEL 408.866.2150 . FAX 408.379.2572 . TOD 408.866.2790
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CITY OF CAMPBELL
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May 29, 1996
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Beverly Coglin
1150 Nadine Drive
Campbell, Ca 95008
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Re: Tree Planting
Dear Mrs. Coglin:
Thank you for your recent telephone inquiry regarding street tree planting. Enclosed is an
application for an R-1 Encroachment Permit which must be completed by you and issued by the
City's Public Works Department prior to commencing work. There is no fee for this permit;
however, depending upon the scope of the work, a refundable security deposit may be required.
Also enclosed are the City's approved Tree List and planting requirements. The City requires
that you plant a tree from the list which is consistent with the trees already planted on your
street. We will review the trees in your area within two weeks and provide suggestions as to
acceptable varieties.
When returning the Encroachment Permit application, please include a simple scaled drawing
depicting the general area and the relationship of your proposed improvements to existing streets,
sidewalk, driveways, utilities, adjacent trees, and other facilities located in the immediate area.
It is very important to establish that the placement of the new plantings will not interfere or
damage existing improvements. Once the Permit has been issued, please contact me to arrange
for inspection of the work.
If you have any questions, please call me at 866-2165.
~lY~ )~#
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Public Works Inspector
Enclosures
cc: Vince Huppe, Park Maintenance Supervisor I
70 North First Street. Campbell, California 95008,1423 ' TEL 408.866.2150 . FAX 408.379.2572 . TDD 408.866.2790
NEW PW FAX #
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