ENC2006-00041CITY OF CAMPBELL
DEPT. OF PUBLIC WORKS
70 North First St.
Campbell, CA 95008
(408)866-2150
Fax (408)376-0958
CROACHMENT PERMIT
itor working within the public
right-of-way)f
Issued ~/ 2 LI ~ ~~'
Permit Expiration Date ~ ~~"~ L~
Pt ~No ~NL 2~'~ _ U~c'4~.
X-kei. File
Application Date ~ 2 ~ ~' ~'
Application Expiration ate ~
APN ~~~ .-S'~ "
APPLICATION -Application is hereby made for a Public Works Permit in accordance with Campbell Municipal Code, Section 11.04. (Application expires in six (6)
months if the permit is not issued. Application Fee` is non-refundlable.) 1,
A. Work address or tract # v~ `~' ~ ~ L~ ~" ~~
Utility trench location
B. Nature of work N~~V ~ `N v 1
C. Attach four (4) copies of an engineered plan showing the location and extent of the work, and four (4) copies of the preliminary Engineer's Estimate of work. The
plans shall show the relation of the proposed work to existing surface and underground improvements. When approved by the City Engineer, said plan becomes a
part of this permit.
D. All work shall conform to the City of Campbell Standard Specifications and Details for Public Works Construction; the General Permit Conditions listed on the
reverse side; and the Special Provisions for this permit, listed below. Failure to abide by these conditions and provisions may result in job shutdown and/or forfeiture
of Faithful Performance Sureties and cash deposits. (See General Permit Conditions 1 and 2.)
E. The Contractor must have this permit and approved plans at the site and must notify the Public Works Department at least two days before starting work. Notice
must be given to Public Works at least 24 hours before restarting/a'ny work.
Name of Applicant ~~~~~ ~f n~G~~ ~~h ` Telephone~~ ~~' ~~~~
~, ~f ~- (print name
Address- ~ ~~ ~ /Z'1'(~((~~~~~~ ~ ~P~~~4~HOUR EMERGENCY TELEPHONE NO.
E-Mail Address
Is this work being done by the property owners at their own residence? Yes __~No
The ApplicanUPermi[tee hereby agrees by affixing their signature to this permit to hold the City of Campbell, its officers, agents and employees free, safe and harmless
from any claim or demand for damages resulting from the work covered by this permit.
The ApplicanUPermittee hereby acknowledges that they have read and understand both the front and back of this permit, and they will inform their contractor(s) of the
information. Applicant is advised that upon issuance of this permit, property owner, or property owner's successors, shall be responsible for any and all damages
arising out of the condition of any private improvements in the public right-of-way. ~~
(Applicant Permittee)
Date
SPECIAL PROVISIONS
_1. Street shall not be open cut for underground installations. Minimum cuts ~ be allowed for connections or exploration holes. Such cuts
be specifically annroved by the Inspector prior to cuttine.
_2. Pavement may be cut for underground installations and must be restored in accordance with the Standard Details Trench Restoration Method
"A", unless otherwise approved by Inspector.
3. Work to be staked by a licensed Land Surveyor or Civil Engineer and two (2) copies of the cut sheets sent to the Public Works Department
before starting work.
4. Per Section 4215 of the Government Code this permit is not valid for excavations until Underground Service Alert (USA) has been notified and
the inquiry identification number has been entered hereon. USA Phone 1-800-227-2600. USA TICKET NO.
_5 Prior to any work, the property owner shall execute an Agreement for Private Improvements in the Public Right-of-Way, which shall be
recorded.
6. Public Notification Requirements:
7.
SEE PUBLIC WORKS FEE SCHEDULE FOR CURRENT FEES AMOUNT RECEIPT NO.
PERMTI' APPLICATION FEE $ Z~ ~ > >~ ~ 2
PLAN CHECK DEPOSIT $
SECURITY FOR FAITHFUL PERFORMANCE/LABOR & MATERIALS $
CONSTRUCTION CASH DEPOSIT ~ $--~~ 1 ~~~ 12
PLAN CHECK & INSPECTION FEE ~ !IL"_-
APPROVED FOR ISSUANCE
For City Ergin~eer Date
- ~, Permit Ex Tres 12 Months After Date of Issuance
^/ \ ~
b
o°'o
0
n
w
b
d
5
x
y
rt,
v~
N
8
b
a
N
C
O
H
O
H
r
a
G~
d
&4
O
0
~d ny ~
b
~
t x
S8 88 8
00 00 0
W W W W W
~
~
~~ ~~
~
i ~
~
i
i
N V C
ii V
i A
_ p
p
~ i
N O A V
i
W
N ~W
p
p
ll~ A ~-' N
O O 0 0 O
car ~~z n~~
`~° c ° ~ ° ° cC9o ~
o
~ ~ ~ x ~ R
G. n
a
~ A
~
~
~ w ~
~
y
>v~~ n a
y
~ ~?
N o
.
~ ~ ~
o ° o'
r: ~
w
to w A to N
W 00 VI J
O~ N ~D V~
80 8S 8
W
l!~ W ~ (!~ N
w oo v~ ~
O~ N ~O Cn
O S S S S
~ ~ ~ ~ ~
N .r ~ ~ .+
A ~ O~ O~ O~
N
S8 8
~ 8
~~ ~
xx xx x
~~ ~~ ~
~~ ~~ r~
.r ~-
v~i C~h t~ii vii 1
t/i N N N I
N ~ ~ ~ ~
~ ~ ~
L L L L
O ~ ~ ~ ~
O O O O c
00 $$ <
~I
`/
m
v
~ ~
.. ~,
z
~ x
N vj•
O ~
~ ~
0 O
W ~
J
w
N A
~ N
~o
~°
PUBLIC .S DEPARTMENT RECEIPT
E2feetive JWy 5, 2005
City Clerk
PUNLIC WORKS FILE NO. ;j ~~j~/~, /'~y~~
~~/~„
~'"F.~
~
'IL
~~C./
~~
/
y `
PROPERTY ADDRESS 7
'y
e-
C
~ /
~
Q
f~
~/ / W~/ yI /V ~V t~J~/~/ ~~Ga..'
%eanv eolbef & receipt Por IM folbxing rtnnfes,
T :ITEM ' ~ ..:AMOUNT '.'
ROACHMENT PERMIT
4722 Application Fee /''~~~
~
Non-Utility Encroachment Permit (5275.00) '7~ V 1./
~
Minor Encroachment Permt c 55,000 (561.00)
R•1 First Permft fNo Fee) Su uent (5135.00)
IlUllty Encroachment Permit
ArterWVCNIeMOr S1met (f5.10.W )
Residential StrecUOtMr Arexc (5291.00)
2203 FalthfW t'erforrrunce Security (RPS) (10096 °f ENGR.EST.) ^s (T(J
2203 Labor and Materiak Security (100%of ENGR. EST.) ,~ _~'~fy
22U3 Monumentatton Security fllhl96 of EN(;R.FSTJ ) ~
2203 Cach Deposit (4% of Engr. FAY)(55011 miN51U,000 max) J
4722 Plan Check & impection Fee (Non-Utility)
Engr.Ea. <5250,000 (13%af ENGR.FST.) ,(~~/,!~~-~ / /~j
/ ~/ ~ (/ V
220:1 Engr. Fsl. >f250,0110 (Deposit 890 of Engr. Fi1J530,0110 minter
4722 Utility <5100,000
MlNttatm Clurgc Per I.oalion (S18U.00)
CaWWLSIPipelinex up to 500 Fect (52.25111)
Ahove SOU Wnear Feet (5135/R)
ManhokslVaWts/Etc. (SI25.OOlea1
PWe SeNNemoval (SI25.OII/ca)
Street Trtc Plantin fJRennval (f 135.00)
203 Utility>f100,OW Actual Cast+209F ••
4760 Sto C°Malner 1}rmll (5125.00)
4760 1'roJect Batts & Specifications 1'roJect No.
4760 Standard S el0catiom & Uelails ISI/1'g f15.5tVRk1
4760 Copies of Engineering Maps & %am
Aeral Plot 2d"x36" 1554.00)
Aerial F'rin18 112" x Il" (522.00)
Maw aM Ram 24" z 36" (SIt.251
UEVEI.OI'M EM'
4722 Lot Line AdfusYment (5900.110)
4722 Parcel Ma (41.ols or Leas) (53,100.011+f751bq
4722 Flnal'ftact Ma (S or Morc Lotc) (54,21MLW +SII8Ulo0
4722 CerUficatc of C liancc 56511.011)
4722 Certificate of Correc(bn (54011.00)
0722 Notary Fec (per sigoature) (SI0.00)
4722 Vacation of Public Slrtcu & Excemcnls (f2,21a1.Ita)
4722 Asxensmnt Segreplion or Reapporttonntenf
Nlrxt Split
(f725.W)
FJCh Addllbtul I.ol (5200.00)
4721 Storm Uraioagc Area Fee I}r Acre fR•1 f2,120.00)
(MWtI-Res S2.i85.W)
(All O/hrr f2fi50.110)
4725 Campbe117'nfik Model (FWI Sco r Anxxvmenl)
d728 Campbell Traflle Model (Neduced Scope AxseACmeo
4725 Sigmtl TiMt1g IMnrmation
4271 Truck PermRc
4728 No Parking Signs
t
OF APPLICANT ~4" /~~^- ~.11
TOTAL 5 ~ ~ IG /O.
5~,;~ .Av' C ,
FOR /'MT f ].',r'~
CITY CLERK RECEJ HY ~1~f`'`-_'' - - i
ONLY
rr N7
~'ForPWtCheek and Cash lkpaN[s, send yellow~capy t°Flnance-. i way.-'. w•..a.w...w w ~~a wari
j:\lurmaeceipt form 05-06 rev.62I AS
i~ H ! _... U,_.. _ ~ . .. s.
PUBLIC S DEPARTMENT RECEIPT
~leeDve JWy 5, 2005 /) f C
City Ckrk PUBLIC WORKS FILE NO. ~' l." ~/ ~~~F/ `- r~
PROPERTY ADDRESS
Rene rdltet & rreefpt for the fdMwfllR Illoldes~
Applfcatbn Fee
Non-UWlly EncroxhmeW Permit (S275.OO)
Minor Fxroaehment Permit <f5.000 (561.00)
R•1 Fuel Permit (No Fee) &Ihsetplent (5135.00)
1111111.. R.........1......1 R...JI
ArterW/CWlcetor Street
RealdenlW StleetlOlher Areu
Plan Check Deposit 2%
FWthtW Performallcc S
Plan Cheek & inspeetbn Ere (Nat-Utility)
EnBr.FBt. <SZ50,000
(l3%of ENGR.FST.)
EIIFr. FBI. >f250.000 (Depoxl[ B% of EoRr. EsUS30.OW IWn)••
Utility <5100,000
MWIIaun Clurle Per I.ocatbn
_CandWislPipeOees up to 500 Feet
(5780.00)
(52.25AU
Above 500 Linlear Feet BIJSIR)
ManbkelVadtslEtc. (f125.00ha)
Pole Set/Removal (5125.00/ea)
Street Tree PlomfgyltemovW (SI35.00)
UtiOty > Sloo,ooo Aelual Cost + 20% ••
Standard Speellkatbre & Deulk
Copfne of EnRfneerblt Maps & P4u
Aerial Pbt 24"x36"
Aerint Print 8 VZ" x 11" (522.00)
~~ Maps aal Plow 24"x36" (58.25)
d722 Penallfnl: Fallurr to Ixxtore pubOc improvemeMS (S100ICakIWar Day) 1st.r c.ae I~II_v.olol
1722 Parcel Ma (4lOts or lees) (S3AOO.W+S75Ibt)
d722 Final Tract Map (5 or Mort lots) (SOZOO.W + f101Vlot)
VacaDoo of Publk Streets & Easemeras (S2,2otl.bd)
Aausalent SeBreplbn or Reapportionment
First Split (5725.00)
Each Addllfaal lot (5200.00)
Storm Drabatle Arcs Fee Pcr Aire (R•i 52,120.00)
(MWti-Res 52,.'165.00)
(AB Other f2,650.00)
Parkland Dedkatbn Fee (75%/25% Due Upon Cerl of Occuoanrvl
Tragic Flow Map
Ca1lglbell Tralik
Camobell Traflfc
d728 No Parkfne SIB (SUeaeh or S25I1001
APPLICANT
TOTAL
PIIONF; K V ~ 1~~'[ r ~ ~'1
•F'or-FRio (;k~~ iell l;ab Ikprlla,-amd ye.IMwsopnlo i3uacc
- - -~
j:Uorlln4xeipt (am 05-(16 rev.621/OS
PUBLIC i2KS DEPARTMENT RECEIPT
Ettectlve Jwy s, 2005
City Clerk PUBLIC WORKS F1LE NO.
' ~ ( , `
~
'
PROPERTY ADDRESS ~ J ) Ni
~ J
Please rnliect & rxrciW ~ r rM fdbwina monies:
r. 'iT _.. AMCHmri;`
ROACHMENT PERMIT
d722 Application Fn ~/y
`
Non-Utility Encroachment Permit (f275.00) 1
Minor Ertcroulunent Permit <55,000 (S6L00)
R-1 First Permit (No Feel Subsequent (5135.00)
Utility Ercroachment Pelmlt
ArterlaUColletlor Street (5530.00)
Residential StreeUOlher Areas (5291.00)
2203 Plan Check Deooall 2% of Fitefner's F~Nmau (5500 min)
Carh DepoNt (1 % of EoBr. Fbt)(f500 minIS10,000 max)
Plan Cheek & Inspeetbn Fee (Non-UWtty)
Fs6r.Fet. < 5250,000
(13% of ENGR.ESI'.)
EttRr. Esl. >5250,0181 (Depadt 8% of Eo0r. F6tJf30,000 mIN'•
Ut81ty < 5100,000
Mldmmt CbarRe Per I.ocatbn
Caniwts/Plpellaes nP l0 500 Feel
(5100.00)
(523518)
Above S00 Linear Feet (S135A4)
Manhdea/VawWEtc. (SI25.ONea1
Pok SeURemoval (SI25.OOka)
4760 ProJeet Plain & S tblts Pro set No.
0760 Sutdard 8katbre & Details (fl/F'p SIS.SOIBk)
d760 C of nee Ma & Plans
AerW Plot 24"x36" (554.00)
Aerial Prim 81/2" x It" fS2200)
Macs aad PWm 20"x36" (58.25)
{722
Certilkate of
4722 Assesmtenl SeBreplbn or Reappertbnmenl
First Splil (5725.00)
Fnch Add81ona1 Lot (5200.00)
4721 Storm Draitta(;e Area Fee Per Acre (K-1 52,120.00)
(M Wtl-Res 52,385.00)
Imcrsection Tom Caums
Imersectlan Tttm Catmts
TraRk Fbw Map (Dally"
Campbell Trallk Madel
Cantohell Trallk Madel l
or
NAME OF APPLICANT
~~
NAME OF PAYOR / -~ _/n /, Qty PIIONF. {- y A
,.. ADDRESS ~ ` / ~ ~,(Q/,/ lC ~ ~~ ~ Y ~ t / /?'Ir- 7.IP
j:Uorm;4eceipi form 05-06 rev.621105
~~
a~
~~~'
~:
-
~
.
~
~- ~
V
~-
~J ~~
~~ l~c~
1~~
~~
f
~ \
= MET R O C A N P R O P E R T Y R O F 2 L E
Santa Clara (CA)
**********************************************************************************************
* *
* *
* *
* < < < OWNERSHIP INFORMATION > > >
* *
* Owner :Lee Chu-hwa Et Al Parcel N umber :307 54 044
* CoOwner Bldg Id No :1
* Site Address :87 Jim Elder Dr Campbell 95008
* Mail Address :4810 Seasons Dr Troy Mi 48098
* Phone :Owner:
* *
* < < < SALES AND LOAN INFORMATION > > >
* *
* Transferred :01/29/1988 Loan Amount
* Document # :9584964 Lender
* Sale Price Loan Type
* Deed Type Interest Type
* ~ Owned Vesting Type
* *
* < < < ASSESSMENT AND TAX INFORMATION > > >
* *
* Land :$130,447 Exempt Type
* Structure :$199,110 Exempt Amount
* Other Tax Rate Area :10003
* Total :$329,557 05-06 Taxes :$4,317.58
* ~ Improved :60
* *
* *
* < < < PROPERTY DESCRIPTION > > >
* *
* Census :Tract:5066.06 Block:2
* Map Grid :85 3 C6
* Zoning :R- 1-6
* Land Use :O1 Res,Single Family Residence
* Sub/Plat :Rancho Del Prado
* Legal :TR 5234 LOT 14
* *
* MLS Area :01 5
* *
* < < < PROPERTY CHARACTERISTICS > > >
* *
* Total Rms :8 Bldg SF :2,021 Units YearBuilt :1973
* Bedrooms :4 Lot SF :5,663 Patio :No EffYearBlt :1973
* Bathrooms :2. 00 UseableSF:6,050 Porch :Yes Garage Sp :2
* Stories :2 Lot Acres:.13 Elevator Garage SF :439
* Dining Rm :1 Lot Dimen:55x110 Lease SF Bldg Cond :Avg
* Family Rm :1 Pool :Yes Office SF: Bldg Class :6.5
* Rec Room Fireplace: Sprinkler: Bldg Shape :H-shape
* UtilityRm :1 Sauna 1stFlr SF:1,373 GarageTyp :Garage
* Water Src Dishwsher: 2ndFlr SF:648 Wa11Hgt
* Elect Svc Tennis Ct: 3rdFlr SF: AddtionSF
* Gas Svc FrameType:Wood Rental SF:
* Cnt1Ht/Ac:Heat Only
* *
** **************** **************************** ********************** *********************** ***
Information compile! from various sources. Real Estate Solutions makes no representations
or warranties as to the accuracy or completeness ojinjormntion contnined in this report.
Mar 24 06 11:34a Tom Tran 408-946-4509 p.l
Date Entered: 10/7 /2005
Policy Number: 6320011857-1 DATE(NOwoorrrvYl
ACORD,~ CERTIFICATE CAF LIABILITY INSURANCE 10/7/2005
PRODUCER KALISIAIC INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
25401 cAeoT ROAD #105 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
LAGLTNA HILLS, CA 92653 pLOTER THE COVERAGE AFFORDED BYOTH~POLICIEES BELOW
(949) 457-8213 INSURERS AFFORDING COVERAGE NAIC #
INSURERA:LINCOLN GENERAL' INS'URILNCE
INSURED ~E~~I,[S PLU[rIDING
INSURER 8: r-
TOM TRAM
3513 2~,DRID DRIVE INSURER C:
SAN JOSE, CA 95132 INSURER D:
WSURER E:
COVERAGES
ANY REQUIREMEN7STERM OR CON 0 TON OF ANY CONTRACT OR OTHER DOCUMENT WI H RESPECTOTO WHICHITHIS CERTIF CATETMAY BE S IUED OR OIN
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALt THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIM'S. EFFECrne POLCYE7[P1RA710N LMITS
GENERAL LIABILITY
COMMERCIAL GENERAL LIAAILITY
CLAIMS MADE ®OCCUR
AGGREGATE LIMIT APPLIES PER:
INbSU-E LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
GARAGE LIABILITY
ANY AUTO
EXCESSlUMBRFJ..LA LIABILITY
OCCUR ~ CLAlMS MADE
DEDUCTIBLE
RETENTION S
WORKERS COMPENSATION AND
ENPLAYERS LABILITY
ANY PROPRIETOR/PpRTNERlEXEGU7NE
OFFICERIMEMBER EXCLUDED?
Ir yea, doecriM undo
SPECUU. PROVISIONS below'
orHER
011857-1 ~ 10/13/20051 10/13/2006
E.L. DISEASE • EA EMPLOYEE E
E.L. DISEASE -POLICY LIMB S
DESCRIPTION OF OPERATIONS I LOCATIONS ! VEWCLES 1 EXCLUSIONS ADDED DY ENDORSEMENT! SPECIAL PROVISIONS dr 10 DAYS NON PAY
JOB: ALL CALIFORNIA OPERATIONS
' SAMPLE C&ATIFICATE
ACH OCCURRENCE S SOO , OOO
I
'RE
QED
'ER
eEN
PRODUCTS-COMPIOP AGG S
COMBINED SINGLE LIMIT S
(Eaacadenq ___
E 1= D S 100, 000
MIS Ee oaeurence -
EXP (Arty one Person) S 5 , 000
SONAL & ADV INJURY S 500 r DOD
FJtAL AGGREGATE s l ,ODD , 000
INCLUDED
BODILY INJURY ~ S
(Per parson)
BOD1LV INJURY S
(Per accident)
PROPERTY DAMAGE S
(Per acddeM)
AUTO ONLY - EA ACCIDENT S
OTHER THAN EA ACC E
AUTO ONLY. AGG S
f
f
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MWL30* UAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAKED TO THE LEFT, BUT FAILURE YO DO SO SHALL
IMPOSE NO OBLIGATION OR LUIBILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTAT{VES.
AUTFIORIZED REPp:ESENTATNE
~/
p ACORO CORPORATION 1961
ACORD 25