96-234
em. Of CAMP~~
DEPT. OF PUB .. ;;, 1;,r ...,
70 Nonh First St.
Campbell, CA 95008 SEP 1
(408) 866-2150 61996 Issued '1-/7- ?~~ Application Date 1-( ~ - ~h
Fax (408) 376-0958 l-u..,_..... h ,-,',.1\. Pennit expires in 12 m~~ Application expires in 6 mos.
APPUCA nON - Appitca~t.J\f~iI~~,r.IQ&: for a Public Works Permit in accordance with Campbell Municipal Code, Section 11.04.
~NCROACHMENT PERMIT
(for working within the
.~ public right-of-way)
Pet'h." No,
X-Ref. File
C16-~.B~
expires in 6 months if the permit is not issued Application Fee is non-refundable).
(Application
A. Work address or tract #
Utility trench location
B. Nature of work
C. Attach four (4) copies of engineered plans showing the location and extent of the work, and four (4) copies of the preliminary Engineer's
Estimate of work. The plans shall show the relation of the proposed work to existing surface and underground improvements. When approved by
the City Engineer, said plans become a part of this pennit.
D. 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 pennit, listed below. Failure to abide by these conditions and provisions may result in
job shut~own and/or forfeiture of Faithful Performance Sureties and cash deposits. (See General Permit Conditions 1 and 2.)
E. TIlE CONTRACTOR MUST HAVE TInS PERMIT AND APPROVED PLANS AT TIlE SITE AND MUST NOTIFY THE PUBUC WORKS
DEPARTMENT AT LEASf TWO DAYS BEFQRE STMTING WORX,O N01jICE MUST BE GIVEN TO PUBUC WORKS AT LEAST 24 HOURS
BEFORE RESTARTING ANY WORK. "II, OMCA.C rh....."M.....~ (/ ~'.~ fJ,o """$) 7;b- 3 05"0
NameofApplicantlPermittee wp,zf lIo'/(ev ~.1~-ffi:... D>~-I.;~-/- Telephone 51~-02'lrJ-1-'
Address 0 E: 5unn ~ Ill/~ ~'~I ,fell ~
Is this work being done by the prope owner at their own residence? Yes
The ApplicantlPermittee 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.
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'UBLlC WORKS DEPARTMENT RECEIPT
Effective July I, 1996
TO: City Clerk PUBUC WORKS F1LE NO. 9b - :J. 34--
PROPEllTY ADDRESS {,oo Ch(J../j~ fj,.
Pi.... collect &: receipt for the followina monies: ,
Acer. I :1'l':EM:::::::................... . .:AidoiJNr
43S.S3S.4921 Proiect Revenue {mec;fv oroiectl S
ENCROACHMENT PERMIT
4722 AppliClllion Fee
Non-Utility Enctoeohment Permit ($22S)
R-I Fint Permit {No Feel. Subleouent PermitlYr (Slool
Utilitv En~t Permit
ArteriaIICollector Street S32S)
Residential StreetIOther Area S22S ;,z~~
2203 PI811 Check Donosit. 2% ofENOR. EST. SSOO min) .
2203 Faithful PerfOI'llUllK:O Securitv lFPSl 100% ofENOR.EST.) .
2203 Labor 8IId MlIlerial. Securitv 100'4 ofENOR. EST.l
2203 Monumentation Securitv 100% ofENOR.EST.) .
2203 Cub Denasit 4% ofENOR.EST.lCSSoo minlSlO 000 IIIIX) .
2203 Labor and MlIleriaI Securitv 100'4ofENOR. EST.) .
PI811 Check &: lnJpection Fee (Non-Utility)
4722 Engr.EIl. < $2S0.000 (12% ofENOR. EST.)
.. 2203 EnlU.EIl.>S25O 000 IDeoosit8% ofENOR. EST.1S30 000 min. .. .
4722 Utilitv < Sloo 000 (8"4) I:J. () -"
Minimum Charge Per Location (SI20)
ConduitslPipelines up to 500 Feet (SI.601ft)
Above SOO Feet (SI.IOIft.)
MenholesIV aultsIEtc. (SIOSI08)
Pole SetlRemoval ($105108)
Street Tree PI8IItinRlRemoval SIOSltreel
.. 2203 Utilitv > Sloo 000 Ac:luII COIl + 20% .. .
4760 Proiect PI8IIs &. SoecifiClllion. Proiect No.
4760 Standard SoecifiClllions &: Details {S IlPa S 12/Book
4760 Copies ofEnaineenna MIDs &: PI8IIs (S.sO/so.ft.)
4722 Penalties: Failure to restore nublic imorovements (SloolCalendar Dav)
{Muni Code Section 11.34.01Ol
4722 Penalties: Failure to comet unsafe conditions (SloolCalendar Davl
LAND DEVELOPMENT
4722 Lot Line Ad' ustment S500
4722 Parcel MID (4 Lots or Less) SI 060 + $25/Lot)
4722 Final Tract Man (S or More Lots) SI 380 + S2S/Lotl
4722 Certificate of Comoli8llce SSOO
4722 Certificate of Correction $300)
4722 Vacation of Public Streets &: Euements 5S50)
4722 Assessment Segregation or Reapportionment
Fint Split ($550)
Each Additional Lot 5170\
4721 Stonn Drainoge Area Fee Per Acre (R-I. $2,000)
(Multi-Res, $2,2S0)
(All Other 52.SOO)
4920 Parkl8lld Dedication Fee
496S Po......e
TRAFFIC
4728 mmwroonT=Coo~rr~H~C~m) $60)
4728 mteneclion T= Counts (a.m. or o.m. oeaksl 512Sl
4728 Traffic Flow MID (Dailv Traffic Volumes) 527)
4728 Camnbell Traffic Model (Full Scone A_tl .$2.250)
4728 Camnbell Traffic Model (Reduced Scone Asoessmentl 5740)
4271 Truck Permits 53Sltrip)
4728 No Parlcina SilU1s SIIeach or 52SII00
OTHER
TOTAL s345.60
;JL~;!th'~ ~. . ~./ t<.JJlsA
NAME OF APPUCANT oJ.,/
11 .f6rrtJ A.A h, /V\/ /, , .., tJ LJ .
NAME OF PAYOR to. PHONE '7 0&'" 30~
.:1~/ ~. ~JJ L .L- 4HL7 9rt03?
ADDRESS ';j . ZIP
.. Ac:luII Coil Plus 20% Overhead {Non-Interest M.ma dennsitl tJ A '"A'~
V
FOR
CtTY CLERK
ONLY
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RECEIVED
SEP 1 71996
ClTY CLERK'S OFFICE!
I*For PIanCbeck and Cash Ileposits,serid yellow copy to Finance. .
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CITY OF CAMPBELL
Public Works Department
May 30, 1997
Mr. David Thomas
Thomas Plumbing
321 East Washington Ave.
Sunnyvale, CA 94086
RE: 600 Chapman Dr. Campbell, CA.
1'1
Dear Mr. Thomas
Regarding the work performed by your company on beh of West Valley
Sanitation District at 600 Chapman Drive (permit number 96- 31). Pursuant to phone
messages placed by both Randy Westfall and myself, I would like to reiterate that the
work performed at the aforementioned location was never completed. Specifically, as
written on the encroachment permit issued to you, upon final trench restoration please
provide a chip seal surface to match the existing street. It is the City's policy that all
work performed in the public-right-of-way be completed within a 30 day time period
unless approved otherwise. The penalty for work not performed in a timely manner is
$100.00 per day for every day the condition persists.
Please contact me at your earliest convenience to schedule this work so as to
avoid any penalty assessments. Should you have any questions regarding this matter,
please feel free to contact me at your earliest convenience.
Sincerely,
~~
Robert Phillips
Project Inspector
(408) 866-2168
70 North First Street. Campbell, California 95008.1423 . TEL 408.866.2150 . FAX 408.376.0958 . TOD 408.866.2790
CITY OF CAMPBELL
FIELD ENGINEER'S DAILY REPORT
{,Od C~VV\~.
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PROJECT NO. CJt- J ~ 4-
REPORT NO: I
DATE: 7, I 7&
WEATHER: PAIR.
INSPECTOR: K. ~G..-:>-rrA.LL
CONTRACTOR: ~ Lk.tv rJ, t -'Y\l;J .
ITEM DESCRIPTION
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AI NUMBER YR96"12~
DA TE ISSUED: september 1~, 1996
COMMERCIAL GENERAL L1ABlLlTY
POLICY NUMBER: A'11?'1€l9461
INSURED: THOMAS PLUM81NG
THIS ENDORSEMENT C.HANCES THE POliCY. PLEASE READ iT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS (FOrm B)
TI1Ir; endo'sement modlfJes Insurance provided ':Jnder the f:Jllo\,ving'
COMMERCIAL CENERAl LlA81L1TY COVERAOE PART
SCHEDUlE
'\lame Of person or organizatIon. west vaite\? sanItation District, City of C,aITlpbell, Town Of
LOS Gatos, City of Monte sereno, City Of sarato:j,;J and County of Santa clara, Its officers and
employees in the-!r caplcitv as such
W!th respects to. .,0./1 operatIons Of the in5IJred in which the certiflcat.~ holder has an
insurat)le interest
(If no entry appears a~)ove, information reouired to complete this endorsement win be
shown In the Declarations as appllr:ab:e to this enaorsement.:
WHO IS AN INSURED (Section III Is amended to inrlude :as an !/lsured tt1e person (')r
organization Shown in the Schedule, r)ut <,rdy wIth rf"spect to /labl!!ty arIsIng out of "your
...,york" for that Insured tiV or for yeu,
PRiMARY ~N$URANCE
"It Is further agreea that suCh Insura!1ce as Is afforOed t>'1 this pOlicy' for tl"lG benefit of the
above additional Insured shaP be prlmarv Insurance as re~pects any claIm. loss or lIabillty
arising out of the named Insured's operations, and any otl;€,r !t'lsurance maintained b\i the
addItional insured st,all or excess and non.contrlbutor.'/ with the Insurance provided
hereunder.
CC 20 '10 11 85
Copyright, Insurance ':;ervlce Office. 111('.1984
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