HomeMy WebLinkAbout1151 Rosedale Avenue - PW21-0494 - Standard501 PRIMROSE ROAD,
BURLINGAME, CA 94010
CITY OF BURLINGAME
Public Works Department
STREET AND PUBLIC RIGHT-OF-WAY ENCROACHMENT PERMIT
WORK LOCATION ADDRESS: 1151 ROSEDALE AVE OWNER: SAPPHIRE HUEY
APPLICANT'S NAME
SAPPHIRE HUEY
ADDRESS
1151 ROSEDALE AVE
CITY/STATE/ZIP
BURLINGAME/CA/94010
PHONE
(415)971-8684
CONTRACTOR'S NAME ADDRESS
CITY/STATE/ZIP
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PHONE
CALIFORNIA CONTRACTOR LICENSE BURLINGAME BUSINESS LICENSE NO.U.S.A. (800-227-2600) REFERENCE NO.
REFUND BOND TO:
□ CURB 558-7230 □ FIRELINE 558-7600 □ STORMDRAIN 558-7230
□ CURB/GUTTER 558-7230 □ SEWER 558-7670 □ WATER SERVICE 558-7676
□ DRIVEWAY 558-7230 □ SIDEWALK 558-7230 □ OTHER 558-7676
-Cap sewer in City R.O.W.before any work-Remove & Replace sewer pipe to main; where sewer lateral is to be abandoned, lateral must be properly capped at
the main; -const. new Cleanout w/ Box, Frame and Cover; -Inst. new water service / meter to house; - Remove & Replace SW, Curb/Gutter, Dwy approach;
PG&E AND CURB DRAIN NOT INCLUDED
ALL TRAFFIC LANE CLOSURES MUST BE APPROVED BY THE PUBLIC WORKS DEPT. PEAK HOUR RESTRICTION WILL APPLY TO MAJOR
ROADWAYS. CONSULT WITH PARK DEPT. BEFORE CUTTING ROOTS OVER 2" IN DIAMETER -650/558-7330. NO EXCAVATIONS OVER 5' WITHOUT
OSHA PERMIT. WORK IN ACCORDANCE WITH STD DRAWING # □ BUILDING PLANS □ SPECIAL PERMIT □ PARKING STRIP PAVING PERMIT. CITY
BUSINESS LICENSE AND STATE LICENSE IS REQUIRED FOR ALL WORK DONE BY A CONTRACTOR. I AGREE THAT CONSTRUCTION WORK SHALL
BE DONE IN ACCORDANCE WITH CURRENT BURLINGAME CITY STANDARDS, WITH 24 HOURS MINIMUM NOTICE TO THE CITY PRIOR TO START OF
WORK AND 24 HOURS PRIOR TO EACH REQUIRED INSPECTION. FINAL SURFACE REPLACEMENT SHALL BE COMPLETED WITHIN 10 DAYS OF
OPENING. REFUND OF DEPOST WILL BE MADE AFTER FINAL INSPECTION APPROVAL.
CALL 650/558-7230 IF DEPOSIT REFUND NOT RECEIVED IN 30 DAYS.
PERMIT INVALID 30 DAYS AFTER EST. COMPLETION DATE.
EST. START DATE EST. COMPLETION DATE
SIGNATURE (OWNER/AGENT)TITLE REPRESENTING DATE
PRINT NAME AS WRITTEN
DO NOT WRITE BELOW THIS LINE - FOR USE OF CITY STAFF ONLY
PERMIT FEE: □ BOND IS REQUIRED □ BOND IS NOT REQUIRED
($9,357.00) □ EXCAVATION IN UNIMPROVED STREET OR EASEMENT □ EXCAVATION IN IMPROVED STREET OR EASEMENT
FUND & RECEIPT NO.
REQUIRED
RESTORATION
APPROVED BY:AREA OF EXCAVATION: LENGTH 0 X WIDTH 0 =0 S.F.
PMC BOND
AMOUNT:
$11,000.00 FUND & RECEIPT NO.
DATE:
09/17/2021 □ BOND NO. □
INSPECTIONS REQUIRED BY:
PW SIDEWALK - PREPOUR INSPECTED BY DATE
PW SIDEWALK - FINAL INSPECTED BY DATE
OTHER INSPECTED BY DATE
BOND REFUNDED BY CARLA TALAVERA AMOUNT $11,000.00 DATE 03/22/2023 PERMIT NO: PW21-0494
Cash Register Receipt
City of Burlingame
Receipt Number
B41906
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK ($11,000.00)
PW21-0494 PW REM RPL UTILITY Address: 1151 ROSEDALE AVE APN: 025243010 ($11,000.00)
Owner: SAPPHIRE HUEY Applicant: SAPPHIRE HUEY
Construction Cost: $0 Job Description: REMOVE AND REPLACE UTILITY
PUBLIC WORKS REFUNDABLE BONDS FY12-13 ($11,000.00)
3/22/2023: OK to release 10125320 96 0 ($1,000.00)
BOND-SEWER MAIN AND STORM DRAIN
MOD 12-1 10125320 96 0 ($10,000.00)
TOTAL FEES PAID BY RECEIPT: B41906 ($11,000.00)
Printed: Wednesday, March 22, 2023 5:20 PM
Date Paid: Wednesday, March 22, 2023
Paid By: SAPPHIRE HUEY
Pay Method: CHECK
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Cashier: CPT