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Home My WebLink About1321 De Soto Avenue - PW21-0100 - Standard501 PRIMROSE ROAD, BURLINGAME, CA 94010 CITY OF BURLINGAME Public Works Department STREET AND PUBLIC RIGHT-OF-WAY ENCROACHMENT PERMIT WORK LOCATION ADDRESS: 1321 DE SOTO OWNER: WELCH DAVID APPLICANT'S NAME WELCH DAVID ADDRESS PO BOX 2685 CITY/STATE/ZIP EL GRANADA/CA/94018 PHONE CONTRACTOR'S NAME Mossa excavation ADDRESS Po BOX 370668 CITY/STATE/ZIP Montara/CA/94018 PHONE (650)868-9673 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; -const. new Cleanout w/ Box, Frame and Cover; -Inst. new water service / meter to house; - Remove & Replace SW, Curb/Gutter, Dwy approach; REFUND BOND TO TODD WEIDMER 1326 Vallejo St SF CA 94109 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 ($15,383.00) □ 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. AH BOND AMOUNT: $17,000.00 FUND & RECEIPT NO. DATE: 03/09/2021 □ BOND NO. □ INSPECTIONS REQUIRED BY: SEWER INSPECTED BY DATE CY SEWER INSPECTION INSPECTED BY DATE PW ENCROACHMENT INSPECTED BY DATE PW SEWER INSPECTED BY DATE PW SIDEWALK - FINAL INSPECTED BY DATE PW UTILITY INSPECTED BY DATE PW FINAL INSPECTED BY DATE OTHER INSPECTED BY DATE BOND REFUNDED BY CARLA TALAVERA AMOUNT $17,000.00 DATE 02/10/2023 PERMIT NO: PW21-0100 Cash Register Receipt City of Burlingame Receipt Number B41525 DESCRIPTION ACCOUNT QTY PAID PermitTRAK ($17,000.00) PW21-0100 PW REM RPL UTILITY Address: 1321 DE SOTO APN: 027152160 ($17,000.00) Owner: WELCH DAVID Applicant: WELCH DAVID Contractor: Mossa excavation Construction Cost: $0 Job Description: N SFD PUBLIC WORKS REFUNDABLE BONDS FY12-13 ($17,000.00) 2/10/2023: OK TO RELEASE 10125320 96 0 ($10,000.00) RFD BOND-CONCRETE SIDEWLK CITY ROW 12-13 10125320 96 0 ($6,000.00) REFUNDABLE BOND-UNPAVED CITY ROW 12 -13 10125320 96 0 ($1,000.00) TOTAL FEES PAID BY RECEIPT: B41525 ($17,000.00) Printed: Friday, February 10, 2023 8:38 AM Date Paid: Friday, February 10, 2023 Paid By: TODD WEIDMER Pay Method: CHECK 1 of 1 Cashier: CPT FEES_CHARGED WORK LOCATION ADDRESS: 1321 DE SOTO OWNER'S NAME ADDRESS CITY/STATE/ZIP PHONE CITY OF BURLINGAME Public Works Department 501 Primrose Road Burlingame, CA94010 STREET AND PUBLIC RIGHT-OF-WAY ENCROACHMENT PERMIT CONTRACTOR'S NAME Mossa excavation ADDRESS Po BOX 370668 CITY/STATE/ZIP Montara, CA94018 PHONE (650) 868-9673 CALIFORNIA CONTRACTOR LICENSE BURLINGAME BUSINESS LICENSE N U.S.A. (800-227-2600) REFERENCE NO. NO:CLASS: REFUND BOND TO: CURB 558-7230 FIRE LINE 558-7600 STORM DRAIN 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 WITHIN10 DAYS OF OPENING. REFUND OF CALL 650/558-7230 IF DEPOSIT REFUND NOT RECEIVED IN 30 DAYS. PERMIT INVALID30 DAYS AFTER EST. COMPLETION DATE. EST. START DATE EST. COMPLETION DATE SIGNATURE(OWNER/AGENT) PRINT NAME AS WRITTEN REPRESENTING DATETITLE DO NOT WRITE BELOW THIS LINE-FOR USE OF CITY STAFF ONLYPERMIT FEE: FUND & RECEIPT NO. APPROVED BY: DATE: BOND IS REQUIRED EXCAVATION IN UNIMPROVED STREET OR EASEMENT BOND IS NOT REQUIRED EXCAVATION IN IMPROVED STREET OR EASEMENT REQUIRED RESTORATION AREA OF EXCAVATION: LENGTH X WIDTH =S.F. BOND AMOUNT:$17,000.00 FUND & RECEIPT NO. : BOND NO. INSPECTIONS REQUIRED BY: BOND REFUNDED BY AMOUNT DATE PERMIT NO.PW21-0100 WELCH DAVID PO BOX 2685 EL GRANADA, CA 94018 (3/8/2021 3:54 PM AH) -Cap sewer in City R.O.W.before any work-Remove & Replace sewer pipe to main; -const. new Cleanout w/ Box, Frame and Cover; -Inst. new water service / meter to house; - Remove & Replace SW, Curb/Gutter, Dwy approach; REFUND BOND TO TODD WEIDMER 1326 Vallejo St SF CA 94109 000          INSPECTED BY:Date: OTHER:INSPECTED BY:Date: $ 1,617.00 DocuSign Envelope ID: 5C2A6B02-495A-4872-ADCF-8DABB142041E Todd Weidmer CITY OF BURLINGAME PUBLIC WORKS DEPARTMENT ENGINEERING DIVISION 501 Primrose Road Burlingame, CA 94010-3997 Email: dpw@burlingame.org Phone: (650) 558-7230 Fax: (650) 685-9310 Page 1 of 5 Rev. 5/6/2020 STREET AND PUBLIC RIGHT-OF-WAY ENCROACHMENT PERMIT APPLICATION WORK LOCATION ADDRESS: PERMIT FEES WILL BE ASSESSED ACCORDING TO THE MASTER FEE SCHEDULE IN EFFECT AT THE TIME THE PERMIT IS ISSUED. APPLICANT’S NAME: ADDRESS:CITY/STATE/ZIP:PHONE: CONTRACTOR’S NAME: ADDRESS:CITY/STATE/ZIP:PHONE: *CALIFORNIA CONTRACTOR LICENSE NO.: *BURLINGAME BUSINESS LICENSE NO.: U.S.A (800-227-2600) REFERENCE NO: REFUND BOND TO: DESCRIPTION OF WORK: 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. 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. CHECK ALL THAT APPLIES: □SIDEWALK, TOTAL ___________ SQ FT, ATTACH DRAWING OR PER APPROVED BUILDING PERMIT PLANS □CURB □CURB AND GUTTER □DRIVEWAY □CURB DRAIN □FIRE SERVICE, FOR NON SINGLE FAMILY HOMES - INCLUDE APPROVED UNDERGROUND FIRE SYSTEM PLANS □PARKING PERMIT, START DATE: __________________________________ END DATE:______________________________________ RESTRICTIONS: _______________________________________________________________________________________________ □TRAFFIC CONTROL, START DATE: _________________________________ END DATE:_____________________________________ RESTRICTIONS: _______________________________________________________________________________________________ ______________________________________________________________________________________________________________ □SIDEWALK CLOSURE/PEDESTRAINPROTECTION, START DATE: ________________________ END DATE:_____________________ RESTRICTIONS: _______________________________________________________________________________________________ ______________________________________________________________________________________________________________ □WATER MAIN MODIFICATION □SEWER MAIN MODIFICATION □STORM DRAIN MODIFICATION □STREET ROADWAY OPENING, ___________ SQ FT, ATTACH DRAWING OR PER APPROVED BUILDING PERMIT PLANS 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. _______________________________________________________________________________________________________________________ Applicant Signature Date *Exempt if owner-builder is applying for encroachment permit. APPLICANT’S EMAIL: CONTRACTOR’S EMAIL: 1321 DeSoto Ave David Welch PO Box 2685 El Granada, CA 94018 650-867-4327 Mossa Excavaction PO BOX 370688 Montara, CA 94018 650-868-9673 814702 Owner builder Todd Weidmer, 1326 Vallejo Street, San Francisco CA 94109 Install new sewer lateral and connect to sewer for new house on permit B20-0306 4 DocuSign Envelope ID: 9420CDA2-8E3D-4948-921C-08B19AA0B363 03/02/21 CITY OF BURLINGAME PUBLIC WORKS DEPARTMENT APPLICANT WAIVER OF REVIEW TIMELINES I understand that the City of Burlingame’s Public Works Department is operating under a City-Wide State of Emergency due to the COVID-19 pandemic. I further understand that this pandemic has forced most City employees to work from home, and has disrupted government operations not only at the local level, but throughout all of California. I understand that during this State of Emergency, City Staff will not be able to meet regular plan review and permitting timelines and time limits for encroachment permits, map applications, including, but not limited to, provisions contained in the California Permit Streamlining Act, the California Environmental Quality Act, the California Subdivision Map Act, and regulations in the City of Burlingame Municipal Code, establishing review deadlines. Knowing this, I still ask that the City accept my application at this time. I acknowledge and agree that by submitting my application during a State of Emergency, I waive any right I may have against the City of Burlingame for not meeting any local, state or federal regulation regarding time limits, including, but not limited to, each of those listed in the paragraph above. I further acknowledge and agree that my application will not be “deemed approved” under California Government Code § 65956(b), or any other law requiring automatic approval by a government agency after a designated period of time, during the local State of Emergency, or within the three months following its expiration. I Hereby Waive Any Claim Against the City of Burlingame for Failing to Meet Review Timelines Applicant’s signature: Date: Property Address: PUBLIC WORKS DEPARTMENT 501 PRIMROSE ROAD  BURLINGAME, CA 94010 (650) 558-7230  dpw@burlingame.org www.burlingame.org DocuSign Envelope ID: 9420CDA2-8E3D-4948-921C-08B19AA0B363 03/02/21 1321 DeSoto Ave, Burlingame