97-130
CITY OF CAMPBELL
DEPT. OF PUBLIC WORKS
70 North First 51.
Campbell, CA 95008
(408) 866-2150
Fax (408) 376-0958
ENCROACHMENT PERMIT
(for working within the
public righl-O~l
Issued !l -/;0/9 7 !}7n'"::J
Permit expires in 2 months
Permit No.
X-Ref. file
97-/30
Application Date 3/ ~J <;'7
Application expires in 6' months
APPUCA TION - Application is hereby made for a Public Works Pennit in accordance with Campbell Municipal Code. Section 11.04. (Application expires in 6 months
if the permit is not issued. Application Fee is non-refundable.)
~lJCkI\ALI R'i)
(I) r1 K /(e\
'~5~
t-.,~F
(Jrd
fro. ,1r /; r.f~ ~!t~
On
k!. f Nt
Lour~ j
A. Work address or tract #
Utility trench location
,,-,;, I'
B. Nature of work I C ( I (
sA,)
Ii>
lcPl~/le
R/fr! (, t cr- ~
l~M-;E--f:
:\fAc,Jt:t
C. Attach four (4) copies of an 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 plan becomes a pan of
this permit.
D. All work shall conform 10 the City of Campbell Standard Specifications and Details for Public Works Construction; the General Pennit 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 forfeiwre of Faithful
Performance Sureties and cash deposits. (See General Permit Conditions I and 2.)
E. THE CONTRACTOR MUST HAVE THIS PERMIT AND APPROVED PLANS AT THE SITE AND MUST NOTIFY THE PUBLIC WORKS DEPARTMENT AT
LEAST TWO DAYS BEFORE STARTING WORK. NOTICE MUST BE GIVEN TO PUBLIC WORKS AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK.
Name of Applicant ~". t<. \COa.'\ f\fvl ~1? v -e I O(i In e,,,,,T') Telephone '31'1 - '-I S <-II
j (prin\rr;e) _ ~
Address I~ 30 l.ve~\ ('f\fY'I?~<2 JfJc , 24 HOUR EMERGENCY TELEPHONE NO.
Is this work being done by the propeny owner at their own residence? X' Yes
No
The ApplicanllPennittee hereby agrees by affixing their signatUre 10 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 pennit.
The ApplicantlPenniuee hereby acknowledges that they have read and understand both the front and back of this permit. and they will inform their contraclOr{s) of the
information.
Accepted
- 7(~~Q A~ ~
(ApplicantlPennittee)
(sign)
3'-l,-C'{t
Date
SPECIAL PROVISIONS
-1.
Streel shall nol be open CUI for underground installations. Minimum cuts.!!]!l be allowed for connections or exploration hoIes. Such cUts mav be soecifieally
aooroved by the Insoector oriorto cutting.
Pavemenl may be CUI for underground installations and must be restored in accordance with the Utility Trench Restorabon. Standard Details. Method 'A' Backfin,
unless otherwise approved by Inspector.
Work 10 be staked by a licensed Land Surveyor or Civil Engineer and two (2) copies of the cut sheets sent to the Public Works Dcpartlllellt before staning work..
Per Section 4215 of the Government Code this permit is not valid for excavations until Underground Service Alen (USA) has been notified and the inquiry
identifICation number has be;n red hereon. USA Phone 1-800-227-2600. USA TICKET NO.
~ I '" ~ '!J, 'viTI> '{)/A"v, Jc))AT{'<tM.J'a. L..
- <. /
-Otm
_2.
_3.
1
SEE PUBLIC WORKS FEE SCHEDULE FOR CURRENT FEES
:mg
AMOUNT
RECEIPT NO.
j})() J. 55'
PERMIT APPLICATION FEE
PLAN CHECK DEPOSIT
SECURITY FOR FAITHFUL PERFORMANCE/LABOR &: MATERIALS
CONSTRUCTION CASH DEPOSIT
PLAN CHECK &: INSPECTION F
--'
APPROVED FOR ISSUANCE
/ "~J.. 5'3;'
for Cily Engineer
TO: City Clerk
..
4722
220J
4 22
,.
220J
4760
4760
4760
4760
4722
TRAFFIC
OTHER
NAME OF APPLICANT
NAME OF PAYOR
ADDRESS
PUBLIC WORKS DEPAR
Effective July I, 1996
220J
220J
220J
220J
220J
4721
4920 Parkland Dedlcanon tee
4965 Postage
4728
4728
4728
4728
4728
42 1
4728
IntersectIon Turn Counts (Two--Hour count)
Intersection Turn Counts (a.m. or p.m. peaks)
Trarnc Flow Map \uauy rarnc vOlumes)
ampnell tralllc Model (rull Scope Assessment)
ampbell Traltic Model (Reduced Scope Assessment)
ruck Pemuts
No ParklOg SignS
('lease collect & "e'
~~~~i~~i:;>'-" .
>:Nl.:KOAl.:HMEN P>:RMIT
4/22 Appl.cahon tee
Non-Unllty !:ncroacl1ment I'ernut (~22')
R-I Fu'St Permit (No Fee), Subsequent PemutIYr (SIOO)
Ubllty Encroachment Pemut
ArtenallCollector Street
ResidentIal Street/Other Areas
Plan Check DepoSlt- 2'Y. of ENGR. EST.
Falthlul Pertonnance Secunly (rPS)
Labor and Malenals Secunly
Monumentabon Secunty
I,-asn Deposit
P an Check & Inspecoon Fee Non-un .ly)
!:ngr.bit < ~2'O,OOO
Engr.Est>S250,ooO
Un Ily < )100,000
Minimum Charge Per Local1on
Conduits/Pipelines up to 500 Feet
Above 500 Feet
ManholesIV aultsIEtc.
Pole SetlRemovaJ
Street Tree PlanbngIRemovai
Uoilly> S 100,000
Street Tree Planong/Kemovall'ernut
Project Plans & Specmcanons
Stanl:Jarcl Specl leahons & Uetalls
op.es of EnglOeenng Maps & Plans
PenaltIes: Fal ure to restore PUblIC Improvements
(Munll.:Ode Secllon 11.34.010)
4722 Penalnes: fallure to correct unsafe condlllons
LAND Dr. VELuPMEN I
4722 Lot LlOe Adjustment
4722 Parcel Map (4 Lots or Less)
4722 FlOal tract Map (S or More Lots)
4722 ertificate of Comp lance
4722 ertit;cale of Correcnon
4722 Vacation of PuDIIC ,treets /!(;.t:.asements
4722 Assessment :Segreganon or Keapportaonment
filS! Split
Each AddlhOnal Lot
Stonn Drainage Area Fee Per Acre
PROPERTY ADDRESS
9"7--) J6
I [,:';9 AtA'~Vl~,n
{2J,
PUBLIC WORKS FILE NO.
S
...l.2.lj _
(S325)
(S22S)
()5oo nun)
(100'10 ofENGR.EST..
(100'10 ot ENuK. l:, I.
(100'/0 01 l:NuK."" 1..
(4'1001l:N
mlO/~ 10,000 maxI
(12'Y.o
(Deposit 8'10 of ENGR. EST./SJO,ooo nun.)"
:.:2.,),),,\,-,
(SI20)
(SI.60/ft)
(SI.IO/ft.)
(SIOS/03)
(SIOS/03)
(SIOS/tree)
Actual Cost + 20'10
(SI05)
Project No.
(~llPg ~lZ!lIook)
(S.50/sq.ft.)
(~Ioo/l.:alendar Day)
(>Ioo/Calendar Day)
(~)oo)
(S I ,060 + S25/Lot)
\)1.380 + )2S/Lot
()SOO)
(SJoo)
(),SO)
(>>'0
(SI70)
(R-I, S2,OOO)
(Muln-Res, S2,250)
(All Other, S2,5oo)
(~60)
SI2S)
2/)
2,2S0)
>140)
J>llnP)
( I/each Dr ~2"100)
TOTAL
S 4-.1'7.00
{()"k,(: tJ-v... .An (}Of}W\D....._,
, b
K; Ilt..u r / (I--v- f-:/I;fU') / ; ~A
Ib~ LA). c~kLP ~.
.. Actual Cost Plus 20010 Overhead (Non-Interest bearing deposit)
c4--
PHONE ~ fJ ~7 9- I(lJlt7
ZIP 950. P
FOR
CITY CLERK
ONLY
...
,
Date
Receipt #
I" lJ 0'" ,"
.1,.; ,,,;
;, ' .,
,II t (;LErHrs Uti,
To: . at)' Clerk
PIeue c ~ and ncelpt
for the fc,,,"wing monies.
-"AIeV4 ;JIlt-
ItJ B^ I
.~ ..
HAl? D 61AA7
OilY CLERK'S OFcr
Exception for Major Projects: It is anticipated that the application processing costs of
selected major projects will significantly exceed the above fees. In these cases, the
Community Development Director may collect a deposit and charge actual time spent to
process the application based upon current hourly rates.
J'U!M
I. .tdUu:&
A. 1+ acres -General Plan A1nmdment
Zone Qanp
Planned ~t Permit
EIR Review
AMCIJNJ'
14,425
4,42S
4,42S
4,425
3,225
3,225
3,22S
3,225
B. 0-1 acre GenenJ Plan Amendment
Zone Oanp
Planned ~t Permit
EJRReview
II. MiIm&
A. Subdivision Map (5+ lots)
Site and ArchitecturaJ10+ K S.P.
Tentative Parcel Map (4<Lots)
B. Site and Architectural 0-10 k S.P.
Variance (Non-residential)
Text Amendments
Use Permit
3,225
2,150
2,150
1,550
1,550
1,sso
1,550
III. Miscellaneous:
A. Variance (Residential)
Modifications of Approval
Modification PO Permit
Reinstatements
Revised Development Schedule
Extensions of Time
960
960
960
960
960
960
B. Lot Une Adjustments 500
Site and Architectural (Res.) (Each House) W
Signs (Each Sign) W
Fence Exception W
Promotional Events W
C. Appeals 0
Downtown Development Permit 0
Historic Preservation Zone, Use Permit, liP Permit 0
IV. ~
Maps
General Plan Text
Zoning Ordinance
Copies (per page)
Refundable Deposit - Account 2203
Fire Department Review - Account 01.303.3322
Architectural Approval
Project Plan Review
Subdivision
Park Impact Fee - Account 295.535.4920
6.25
18.00
22
1
50
150
100+ 10 per Jot/unit
For City Oerk Only:
RsceiptNo.: \ 00 %)55
=~~nkuA
Date:
Note Adopted by Resolution No. 8841 by Oty Council, Oty of Campbell, 6/20/95.
h-,'LS
CITY OF CAMPBELL
~s ~ !jIMJt-. M .
PROJECT NO. 97 '" /~
REPORT NO: I
DATE: 'i - / / ... 9
WEATHER: PAIR..
INSPECTOR: K. ;JG:-~1fA.LL
FIELD ENGINEER'S DAILY REPORT
CONTRACTOR: l~~(ILAr;~J
ITEM
DESCRIPTION
cc:
PAGE: I
OF I