978 Bucknam Ave. (99-909)
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MEMORANDUM
CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT
TO:
DATE: <e,-~ \-c--....p,
q,ce:~ ~e..\c-\-1f';:::..~\
Site Address:
Plan Check Number: CA - 909
File No(s):
1---- ......(E
Bill B ruckart
Building Official
~
4//
FROM: Harold Housley, L. D. Engineer/p'
Chuck Gomez, Assistant Engineer
c::..~
THIS DEPARTl\tIENT HAS NO OBJECTION TO ISSUANCE OF GRADING,
DRAINAGE, OR BUILDING PERMITS FOR THE ABOVE REFERENCED PLAN
CHECK NUlVIBER.
BY:
DATE:
CONDITIONS OF APPROVAL 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).
~o 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:
~~-~ 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.
Page 1 of 3
PLAN CHECK NUMBER:
~D Unsecured Deferred Street Improvement Agreement: Prior to issuance of any grading,
drainage, or building permits for the site, the owner shan execute an unsecured street
improvement agreement for construction of street improvements.
\...\C Right-of-Way for Public Street Purposes: Prior to issuance of any grading, drainage,
or building permits for the site, the applicant shall grant additional
Right-at-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
~ 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.
~ 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 $ per acre which is $
~ b Proof of Ownership: 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.
~<b Utilitv Installation Plan: Prior to issuance of building permits, the applicant shall
submit a Utility Installation 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 may 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.
~ Legal Lot: The applicant shall provide documentation to ascertain that the lot was
legally created, or prepare a parcel map to create the parcel shown.
\-1D Site Plan: Prior to issuance of an encroachment permit, 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:
I RECEIVED A COpy OF THESE CONDITIONS OF APPROVAL:
Owner's Signature
Print
Date
cc: Alan Horn, PWD Inspector
j: \forms\bldgapp
Rev. 6/30/99
Page 3 of 3
PUBLIC WORKS
PLAN REVIEW ROUTE SHEET
I ADDRESS: q7 8 BVCkt0AM
I PLAN CHECK NUMBER:
q cr 90 q
IAPPROVED I NO COMMENTS:
DATE:
APPROVED ICONDnnONS BELOW:
DATE:
~ECEI\IEO
MJG ~ , '999
U81..\C .,.OAKS
:DM\N\8'tRA1\Ott
NOTES:
I RETURN TO DARLEEN BECKER, BUILDING DMSION
PERMIT APPUCATION
cm OF CAMPBELL 'If --9f'9 DATE: AIJ6 'D, 1m
BUILDING DIVISION PERMIT NO.: . L.!
..............................................................................................
PEU&f lYPE: BUILDING . /" ELEe / MECH < rLUMBING /'
DEMO / SIGN GRADING - OI'HER E.\'JE.O
~€.c 999
~UILDING ADDRESS: ~g .tO~M IV. sum: ~~~ ~ ,~ \C.9
OWNER'S NAME: ~~/.MR~ 6\1"( ~ ~U&\..~~a~~~\O~
~e~
47t ~ocl<l'~j{ ,.(Vj:, ~EL~ ~M&,
APPUCANT'S NAME: =1 lII\L.[>tZ
ADDRESS: ~ _ 6v'~fl fR1=M'v1tt PHONECSI~)7crL-7277
CJtS' 4-L
ADDRESS:
{f'BONRFWORK: @ n SI~
cx!/1d rt!( - /350 f7
O~
DEMO
OTHER
CO~ -rR~CTOR:
COMP A':\"'Y NAME:
CO!\"TACT PERSON:
/
/'
/
//
/
/
//
/
ADDRESS:
PHO!\r: NO.:
(
)
a~~T ~ r~1J
J
VAL
CO~"ACTPERSON: .
ADDRESS:
PHONE NO.:
HAZARDOUS MATERIALS: !;TO~
usmON~. YES ~
Us~ or storag~ of hazardous materials requires a HazarcloUl Materials Information Statement
to b~ submitted to the Fire Department for review and comment at time of buiJdina permit
application. Failure to provide the HMlS will holel up bulldina permit approvaL
FIRE SPRll\'l<lERED: YES ~
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