73 Virginia Ave. (99-575)
MEMORANDUM
CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT
Frank Mills, DATE: to \l~ \C1q
Acting Building Official h~ "-J t~ \ U J'f-.:- 'f--.-~
Site Address:
FROM: Harold Housley, L. D. Engineer Plan Check Number: ~ - ~ ~
Chuck Gomez, Assistant Engineer File No(s):
c::--~
THIS DEPARTMENT HAS NO OBJECTION TO ISSUANCE OF GRADING,
DRAINAGE, OR B D TS FOR THE ABOVE REFERENCED PLAN
CHE /
BY DATE: ~ -..~ :; - fl/
TO:
CONDITIONS OF APPROV AL ARE SUMMARIZED BELOW FOR CLEARANCE OF
BUILDING PERMIT(S) TO CONSTRUCT A NEW RESIDENTIAL STRUCTURE OR
AN ADDITION OR ALTERATION THAT ADDS 50% OR MORE SQUARE FEET OF
STRUCTURAL COVERAGE (SECTION 11.24.182).
we. Street Improvements: Prior to issuance of any grading, drainage or building permits
for the site, the applicant shall cause plans for public Street Improvements to be
prepared by a registered civil engineer, pay fees, execute a street improvement
agreement, post security and provide insurance necessary to obtain an encroachment
permit for construction of the improvements, as required by the City Engineer. The
plans shall include the following:
"-lE::::":::Street Improvements an R-l/Minor Encroachment Permit: Prior to issuance of an
encroachment permit for construction of any public street improvements in the public
Right-of-Way the applicant shall cause plans to be prepared, post security, and provide
insurance, all as required by the City Engineer.
RECEIVED
,-: ~.: ; ,/ ~?~J
BUILDING DiVISION
Page 1 of 3
PLAN CHECK NUMBER:
\.1.0 Unsecured Deferred Street Improvement Agreement: Prior to issuance of any grading,
drainage, or building permits for the site, the owner shall execute an unsecured street
improvement agreement for construction of street improvements.
DD Right-of-Wav for Public Street Pul1'oses: Prior to issuance of any grading, drainage,
or building pennits for the site, the applicant shall grant additional
Right-of-Way
for
Public
Street
Purposes
along
the
frontage(s) to accommodate
Applicant shall cause to be prepared all documents necessary to record dedication and
submit to the City for review
WO Public Service Easement: Prior to issuance of any grading, drainage, or building
permits for the site, the owner shall grant a
Public Service Easement on private property contiguous with the public right-of-way
along the
frontage. The applicant shall cause all documents to be prepared by a registered civil
engineer/surveyor and submitted to the City for review and recordation.
ttL- ~ Storm Drain Area Fee: Prior to issuance of any grading, drainage, or building permits
for the site, the applicant shall pay the required Storm Drain Area fee. The current fee
is n--~,. ot:J per acre which is $ -S;:~ . CO
t--l D Proof of Ownershio: Prior to issuance of any grading, drainage, or building permits
for the site, the applicant shall provide a current preliminary title report, grant deed, or
other proof of ownership.
~..:::..Utility Installation Plan: Prior to issuance of building permits, the applicant shall
submit a Utility L'lStallation Plan and Schedule for approval by the City Engineer for
installation of any new utilities. Streets which have been resurfaced within the previous
5 years-rnay require installation beneath pavement by boring and jacking method and
will also require a pavement restoration plan for approval by the City Engineer prior to
any utility installation. ~
:I vJ'~ .-&0\ l...scs..",~ A,..N NEW \,)T\\4\lE..~. 8~
WO Le~al Lot: The applicant shall provide documentation to ascertain that the lot was
legally created, or prepare a parcel map to create the parcel shown.
"'-Je Site Plan: Prior to issuance of an encroachment pennit, the applicant shall provide a
complete and accurate Site Plan in accordance with the Planning Division's checklist.
Page 2 of 3
..
PLAN CHECK NUMBER:
cc: Alan Horn, PWD Inspector
j: \forms\bldgapp
Rev. 3/18/99
.. CONDITIONSOFAPPRC)VA.L:',;'r'"
My l.,E5 CO ~rJ.'92-0
Print
Page 3 of 3
TO: City Clerk
.UBUC WORKS DEPARTMENT RECEIPT
ElTective July I. 1996
Please collecl .t rcccipl for tho folJowia._:
ACCT. ITEM
4JS.lJH921 I Projecl Revenue (specify project)
ENCROACHMENT PERMIT
.. n2 ApplicDtion Fee
22UJ
22UJ
22U3
22UJ
22lJ3
.722
.. 22U3
H22
/101- Of/
PUBLIC WORKS FILE NO. ~
PROPERTY ADDRESS 1 ~ ))Ik (U /) I ;J (!t I ~
'P6'C{c(;.,.,:sf;;-' AM6uNr>'
S
NOlI-Utility EnctoKhm.... Permi. (S22S)
R.I Fint Pcnnit(No Foe), S~ PcnnillYr(SIUO)
Utility Encroachmeat Permit
22UJ
.722
4160
H60
4760
.722
Ar1crUoVCoIIcctar SIrCCI
RcsidcotiaJ SII<efIOthcr Alas
Plan Check Deposil . 2". of ENGR EST.
F.ilhful Performance Security (FPS)
Labor and M.lcriab Sccuri~
~onumenliujon Security
C.uh Deposit
Plan Check.t In_lion Fee (NOlI-Utility)
EnIf.Est < S2SU.OOO
Engr.EsL>S2'O,OOO
Utility < SIOO.nOO
Minimum Chane Per Loc:.atioll
ConduitsfPipclincs till 10 300 Feet
Above '00 Feet
ManholcslV aullslEtc.
PQI. _val
Street: Tree Ptantin&lRcmovaJ
Utility> SWO.'MN'
SRct Tree Plantin~mov.l Permit
Projcct Plans &. SpcciflCllUons
Standard Specifteation, &: Details
Copies of En!lincerinl Maps &. Plans
Penalties: F:r.i1urc to rescore public improvements
(Muni Code Section 11.34.(10)
Penalties: F3ilurc to corf'CCl unsafe condition.
4722
LAND DEVELOPMENT
4122 Lot Line Adjustment
4722 PllrCcl Map (4 Loti or Less)
.722 Final TI1JCI Map (S or Mo.. Loll)
4122 CertifICAte of Compliance
4722 CcrtiflCale ofCorrcction
4722 Vacation of Public sb'cetI &. Easements
4722 Assessment Segreption or Rclpponionmcnt
First Split
Each Additional Lot
4721 SlOm DnIinage Area Fcc Per Acre
TRAFFIC
OTHER
NAME OF APPLICANT
4920 ?:Inland Dedication Fcc
49M Postage
.721
.721
.721
.721
.721
.271
.721
lntenection Tum Counts (Two.HoW' Count)
Inccrseetion Tum Counll (I.m. Of p.m~)
Tr.lffic Row Map (Oailv TrtirlC Valuaaes)
Campbell TtlIlTlC Modol (Full Scope "-SIa...,)
Campbell T..tTIC Modol (Reduced Scope A.......enl)
Truck Permits
No Parkin~ SiBn..
(SJ25)
(S22')
(S'IMlmia)
(lOO%ofENGREST.)
(I(J(W.ofENGR EST.)
(lOlW.ofENGREST.)
(4".ofENGREST.XS'00 minlSlO.OOO max)
(12% of ENGR EST.)
(Dcposil 8". of ENGR. EST JS30,OOO miD.)"
(SI20)
(SI.6OIIl)
(Sl.IllI\\.)
(SIO"ea)
(SIOS/ea)
(SIO'_)
AcruaJ Coil + 20% ..
(SIO')
Projocl No.
(SlIP. S12IBook)
(S.'OI....ft.)
(SlfMlICa_ Doy)
(SIUO/Calcndllr Day)
(SSllO)
(SI.U60 + W/Lot)
(S1.310 + W/Lot)
(S"lO)
(SJllO)
(SSSO)
("SO)
(SI70)
(R-I. S2.()(lO)
(Multi-ReI, S2.250)
(All Other. S2..1(1))
(S60)
(SI2S)
(S27)
($2,250)
(S74O)
(SJ,IIriD)
(SI/each or S25/loo)
TOTAL
/lJnl,A./ (lf1 ,1/; h/hb
1:d I/I/> (k/UP th/i? (~.A'
/'
NAME OF PAYOR
FOR
CITY CLERK
ONLY
OalC
.For PI"D Chcc:k.and Cnn Deposits., scndycUow copyta-f'mance.;
h,_fna<l(ac)mP(rev 11W7)
,,~#/
Dalef - b.iliils
7'17 ./ ~ _
S 5t)3~
PHONE
ZIP
f?S0g
r
{ C
.)
J
U (. (!/
STOR~ DRAIN rttt r~_
$503:00
~.
CITY OF CAMPBELL,
,...
i..H
RECVD BY; Hf~NEB
PAYOR; MYLES CO~hcRD
TuDAY~S DATE; 06/22/99
0100Q122113
........"................. '1'\......... ^~~"............. _...",..... ...._""...._"
rt.tttl~!t~ !i~~t.; i}~i:;':"/"-!7 !!r!t; !:J;::!0;~tJ
I~E8[RI PTID~
AMDUN7
----------------
TOTAL DUE~
(~{'i~ {if,
'W'\.tVlJ. '\," \.'
~u~".u ['ATn.
~nr.t.f. In...,~
CHECK HO~ i20
-:-c:r!~ I\r1
."';\1";. \IV
--..............-......
!t.NVtt>:t.!i:
~503:00
l"liiA;j,;,"":,.
",nHfiU'::. ~
... l\~".
L;.'V
6!
RECE'V~D
~~~' :~:l
ADMINISTRATION
PUBLIC WORKS
PLAN REVIEW ROUTE SHEET
IADDREss: 7. s V I f<&r I N /:tr. A-v b
IpLAN CHECK NUMBER: errs? J
IAPPROVED I NO COMMENTS:
DATE:
APPROVED I CONDITIONS BELOW:
DATE:
NOTES:
IRETURN TO DARLEEN BECKER, BUllDING DIVISION
CITY OF CAMPBELL
BUILDING DIVISION
<'; 'Y'3~~J .". ;;.
. .~ ..~'. -.'
:'~;':~?~~J;: -~~../ <.".
DATE: ~\q \,,~ .
..............................................................................................
PERMIT NO.:
PERMIT TYPE:
ELEC _ MECH - PLUMBRECEIVED
SIGN - GRADING - OTHER JtJN' 5 1999
. PUBLIC WORKS
SUITEADMINISTRATION
BUILDING
DEMO
BUILDING ADDRESS:
OWNER'S NAME:
ADDRESS:
APPLICANT'S NAME:
ADDRESS:
DESC~ON 51F~ORKi'
eJf4i.1t ~-i/./II ,{:&.
CONTRACTOR:
COMPANY NAME:
CONTACT PERSON:
ADDRESS:
PHONE NO.:
ARCHITECT /ENGINEER:
COMPANY NAME:
CONTACT PERSON:
ADDRESS:
PHONE NO.:
M "f Lf. S co,^, ~ E.f2..0
'1." \./ l ~\~ \A A -.J'E G A tv\. ~ ~S-LcA
~5cOe
/VJ Y c...EC; GovJ ~
. cAMf1)7B.-L- c.A ~ S~.o 8
..J 5 ~ \ abt r-Jl A A.\/:G. PHONE ~ ~'OCfe) 3~
RA
II
SIGN
DEMO
OTHER
(
)
,,\~U)
~~~
q~ c.b.M~ ME cAMP~l-1 ~ cA Qt5'oo-o
(~e gffi-8\ e~
HAZARDOUS MATERIAlS: STORED: YES NO USED ON SITE: YES NO
Use or storage of hazardous materials requires a Hazardous Materials Information Statement
to be submitted to the Fire Department for review and comment at time of building permit
application. Failure to provide the HMIS will hold up building permit approval.
FIRE SPRINKLERED:
YES
NO