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Home My WebLink About1205 Cabrillo Avenue - PW22-0518 - Standard501 PRIMROSE ROAD, BURLINGAME, CA 94010 CITY OF BURLINGAME Public Works Department STREET AND PUBLIC RIGHT-OF-WAY ENCROACHMENT PERMIT WORK LOCATION ADDRESS: 1205 CABRILLO AVE OWNER: PADE STEVEN W TR GOMERY JANE C TR APPLICANT'S NAME BELL PLUMBING OF SAN MATEO ADDRESS 611 INDUSTRIAL ROAD UNIT 8 CITY/STATE/ZIP SAN CARLOS/CA/94070 PHONE (650)697-3000 CONTRACTOR'S NAME BELL PLUMBING OF SAN MATEO ADDRESS 611 INDUSTRIAL ROAD UNIT 8 CITY/STATE/ZIP SAN CARLOS/CA/94070 PHONE (650)697-3000 CALIFORNIA CONTRACTOR LICENSE BURLINGAME BUSINESS LICENSE NO. 918519 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 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 ($753.00) □ 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. JC1 BOND AMOUNT: $1,000.00 FUND & RECEIPT NO. DATE: 09/07/2022 □ BOND NO. □ INSPECTIONS REQUIRED BY: PW ENCROACHMENT INSPECTED BY DATE PW FINAL INSPECTED BY DATE OTHER INSPECTED BY DATE BOND REFUNDED BY CARLA TALAVERA AMOUNT $1,000.00 DATE 01/24/2023 PERMIT NO: PW22-0518 Cash Register Receipt City of Burlingame Receipt Number B41352 DESCRIPTION ACCOUNT QTY PAID PermitTRAK ($1,000.00) PW22-0518 PW-OTHER UTILITIES Address: 1205 CABRILLO AVE APN: 026171140 ($1,000.00) Owner: PADE STEVEN W TR GOMERY JANE C TR Applicant: BELL PLUMBING OF SAN MATEO Contractor: BELL PLUMBING OF SAN MATEO Construction Cost: $0 PUBLIC WORKS REFUNDABLE BONDS ($1,000.00) 1/24/2023: PW0910 101 25320 96 0 ($1,000.00) TOTAL FEES PAID BY RECEIPT: B41352 ($1,000.00) Printed: Tuesday, January 24, 2023 2:59 PM Date Paid: Tuesday, January 24, 2023 Paid By: BELL PLUMBING OF SAN MATEO Pay Method: CHECK 1 of 1 Cashier: CPT Cash Register Receipt City of Burlingame Receipt Number B40100 DESCRIPTION ACCOUNT QTY PAID PermitTRAK $1,247.00 PW22-0518 PW-OTHER UTILITIES Address: 1205 CABRILLO AVE APN: 026171140 $1,247.00 Owner: PADE STEVEN W TR GOMERY JANE C TR Applicant: BELL PLUMBING OF SAN MATEO Contractor: BELL PLUMBING OF SAN MATEO Construction Cost: $0 ENCROACHMENT PERMITS $247.00 DEMO PG&E PERMIT PW0301 101310 43301 91 0 $247.00 PUBLIC WORKS REFUNDABLE BONDS $1,000.00 RFD BOND-CONCRETE SIDEWLK CITY ROW PW0910 101 25320 96 0 $1,000.00 TOTAL FEES PAID BY RECEIPT: B40100 $1,247.00 Printed: Wednesday, September 7, 2022 10:27 AM Date Paid: Wednesday, September 07, 2022 Paid By: BELL PLUMBING OF SAN MATEO Pay Method: ONLINE CC 01775G 1 of 1 Cashier: JC1 9/7/22, 9:27 AM PW Reviews Application burlfiche/Forms/form/approval/9ee7dcaf-f8b2-4a1b-b6a8-28fb005c72ec?hideHeader=true 1/5 City of Burlingame Street and Public Rightof Way Encroachment Permit Application Permit fees will be assessed according to the master fee schedule in effect at the time the permit is issued. Review Public Works Procedures Initial* Check All that Apply *(?) Description of work: Initial below after you have reviewed the Public Works Encroachment Permit Procedures, Conditions for Issuance, and Standards for Insurance. MB What kind of work are you seeking to perform in the public right of way? Parking Sewer Test Sewer Lateral Replacement Remove and Replace Utilites for new residence or construction Sidewalk/Curb & Gutter/Driveway Curb Drain Water Service PG&E Permit Telecommunications Utility Permit Fire Service Sidewalk Closure Traffic Control Other Excavation for a gas line installation Excavation of a trench for gas installation in the backyard easement. All construction work shall be done in accordance with the most current City of Burlingame Municipal Codes, City Standard Details and Specifications, APWA-AGC Standard Specifications for Public Works Construction, and the California Stormwater Quality Association’s Stormwater Best Management Practice Handbook. 9/7/22, 9:27 AM PW Reviews Application burlfiche/Forms/form/approval/9ee7dcaf-f8b2-4a1b-b6a8-28fb005c72ec?hideHeader=true 2/5 Start Date End Date Work Location Street Number * Work Location Street Name * Applicant's Name* Is the work address the same as your home address? Applicant's Address Applicant's Email * Timeline 8/31/2022 10/31/2022 Work Information 1205 Cabrillo Avenue Maribel Yes No City San Carlos State / Province / Region California Postal / Zip Code 94070 Country USA Street Address 611 Industrial Road Unit 8 Address Line 2 maribel@yourbellplumbing.com 9/7/22, 9:27 AM PW Reviews Application burlfiche/Forms/form/approval/9ee7dcaf-f8b2-4a1b-b6a8-28fb005c72ec?hideHeader=true 3/5 Applicant Phone Number* Is a contractor is working on your project? Is there sidewalk work on your project? Contractor's Name Contractor's Address Contractor's Email California Contractor License Number License Class 6506973000 Yes No Yes No Contractor's Information Greg Dixon City San Carlos State / Province / Region California Postal / Zip Code 94070 Country USA Street Address 611 Industrial Road Unit 8 Address Line 2 approvals@yourbellplumbing.com 821604 A General Engineering Contractor B General Building Contractor C Specialty Contractor If C - list the type of Specialty Contractor 9/7/22, 9:27 AM PW Reviews Application burlfiche/Forms/form/approval/9ee7dcaf-f8b2-4a1b-b6a8-28fb005c72ec?hideHeader=true 4/5 Burlingame Business License No.: U.S.A. 1-800-227-2600 Reference Number Provide drawing(s), traffic control plans or approved plans of proposed work including, but not limited to location and dimensions of all affected area within the public right-of-way per the requirements outlined in encroachment permit procedures and conditions for issuance. Please upload proof of insurance. Insurance Who shall we refund the bond to if needed? 918,519 Uploads × Upload PGE construction plans 6-27-2022-lShU6XhLYpx_GyvuRyPx.pdf 752.39KB Insurance Upload × Upload Burlingame Insurance.pdf 3.65MB Public Works staff may require additional documentation such as a certificate of insurance prior to the issuance of an encroachment permit. Click here for the standards of insurance. Refunds and Signatures Bell Plumbing of San Mateo 9/7/22, 9:27 AM PW Reviews Application burlfiche/Forms/form/approval/9ee7dcaf-f8b2-4a1b-b6a8-28fb005c72ec?hideHeader=true 5/5 Signature Date * Date Permit Issued APN Number PW Permit Number Bond Refunded Date-finaled Comments Approve Reject In Submitting This Application, I/We Agree To Accept And Comply With All Procedures And Conditions Set Forth In This Permit Application, And Agree That Said Procedures And Conditions Shall Be Binding On Permittee(S), Contractors And Subcontractors Performing The Work, Co- Owners, Heirs, Assigns, Transferees And Successors Of Interest Of Every Nature. I/We Agree To Save, Keep, And Hold Harmless, Indemnify And Defend The City Of Burlingame, Its Officers, Employees, Authorized Agents From Any And All Damages, Claims, Liabilities, Penalties, Cost, Or Expense In Law Or Equality That May At Any Time Arise, Result From, Related To, Or Be Set Up Because Of Damages To Property Or Personal Injury Received By Reason Of, In Whole Or In Part, The Negligence, Recklessness, Or Willful Misconduct Of My/Our Officers, Employees, Contractor, Subcontractor, Or Agents. I/We Hereby Affirm Under Penalty Of Perjury That The Above Information Is True To The Best Of My Knowledge. 8/30/2022