ENC2010-00146Print Form
CITY OF CAMPBELL R-1 ENCROACHMENT PERMIT Permit No, tc~ ~"~ L' ~ C%C'
DEPT.OF PUBLIC WORKS (Non-engineered work within the public right-of-way) X-Ref File
70 North First Street ($10,000.00 maximum value of work) Application Date C 'ZI ~:
Campbell, CA 95008 Application Expiration
Ph. (408) 866-2150 ISSUED: ~ 21 ZC;~ ~ Date ~ ( 1
Fx. (408) 376-0958 Permit Expiration Date: to 2c-' l APN 6ZC
APPLICATION -Application is hereby made for a Public Works Permit in accordance with Campbell Municipal Code, Section 11.04.
(Application expires in 6 months if the permit is not issued.)
A. Work Address: ~ ~~ ~ Z 7 ~/~ ~ UGC /~ (~ ~/J"1 r7 ~/:" uc `-'~`7' I S- ~.0
B. Nature of Work: ~ I~''~~p1`-- L4,L b^24~(U~Ci~ J-~I"t1~-}--y'y'-~CZ
C. Attach three (3) copies of a drawing showing the loccation, extent and dimensions of the work. The drawing shall show the relation of
the proposed work to existing improvements. When approved by the City Engineer, said drawing become 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 securities.
NAME OF APPLICANT:
~~ ct~w~. ~ -- ~ ~ 12Tt +J
Telephone: ~~ ~~~ ~j 7 ~-~%Z ~- Z-
Address: ~ ~ (~ Z 7 (~~•C ~~e.C.e~i C~
E-Mail Address: ~~ Cx-n~ae ~ ~ ~j ,tj ~ Sh c ~L U b Af- • N
The Applicant hereby confirms that this work is being done by the property owner/applicant at their own residence.
The Applicant hereby agrees by affixing their signature to this permit to hold the City of Campbell, City of Campbell Redevelopment Agency, 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 Applicant hereby acknowledges that they have read and understand both the front and back of this permit, and that they will inform their
contractor(s) of the information.
ACCEPTED:
~y
~pplicant/Permittee) (ign) ( ( D(?ate
~~f .° ~/QGt. IYC~- ~c:.tGC ~~3 ~ ~l ~1 ~c~-~~1 ~>.> ~j j~ - '1 ~~
NOTES: All work shall co orm with the attache approved plays and all applicable Campbell Standard Details and Conditions and applicable
insurance requirements.
The Contractor must have this permit and approved plans and must arrange to meet with the Public Works Inspector at the site at least two days
before starting work. Notice must be given to Public Works at least 24 hours before restarting any work.
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 (Ticket No.) has been entered hereon. USA Phone: 1-800-227-2600. Ticket No.:
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 design, installation or condition of private improvements in the public right-of-way.
SPECIAL PROVISIONS
1. Prior to any work, the property owner shall execute an Agreement for Private Improvements in the Public Right-of-Way, which shall be
2.
3.
STAND AMOUNT cz~ RECEIPT N0.`
SECURITY FOR FAITHFUL PERFORMANCE (100 o ngr's Est.) $ ~~~ 2-~U('~ 1
R-1 PERMIT FEE $ ~'~~~ i
~~ 'Z/ /Z1
APPROVED FOR ISSUANCE:
f City Engineer D to
Permit Expires 6 Months after Date of Issuance.
~, ~ j /
GENERAL PERMIT CONDITIONS
1. Payment of a security to insure faithful performance and completion of the work is required. This security is refundable upon
completion of the work and written acceptance by the City.
2. A one-year maintenance period for all work is required. Such period will begin on date of acceptance by the City. It is the applicant's
responsibility to remove and replace unacceptable improvements within the one-year maintenance period.
3, Refund or cancellation of the Faithful Performance Surety will be initiated by the written acceptance of the work by the City.
4. The Permittee must request in writing a final inspection and acceptance of the work upon completion. Acceptance by the City will be
made in writing to the Permittee.
5. Maintain safe pedestrian and vehicular crossings and free access to private driveways, fire hydrants and water valves.
6. Replace as directed by the City Engineer any damaged or removed improvements in accordance with City Standards and
Specifications at the sole expense of the Permittee.
7. Sawcut for all PCC and AC removals. All PCC removals shall be to nearest scoremark and shall be doweled to existing improvements.
8. Adequate signing and barricading is required on the job site. Failure to provide such signing and barricading as specified by the City
Engineer may result in the City's providing such signing and barricades and charging the cost to the Permittee.
9. The Contractor or Permittee will have a supervisory respresentative available for contact on the project at all times during
construction.
10. This permit shall be kept at the site of work and must be shown to any authorized representatives of the City of Campbell or a.ny
law enforcement officer upon demand.
11. No storage of materials or equipment will be allowed near the edge of pavement, within the traveled way, or within the shoulderline,
which would create a hazardous condition to the public.
12. This permit shalt not be construed as authorization for excavation and grading on private property adjacent to the work or any other
work for which a separate permit may be required, nor does it relieve the Permittee of any obligation to obtain any other permit
required bylaw.
13. This permit does not release the Permittee from any liabilities contained in other agreements or contracts with the City and any other
public agency.
14. This permit is not transferable. Work must be performed by the Permittee or his designated agent or contractor as specified thereon.
15. Prior approval of inspector is required for any work done after normal working hours, on weekends or holidays and may require
reimbursement of inspection costs at the current overtime rate.
16. Call back (call out) due to emergencies regarding this permit shall be at the current overtime rate with a three (3) hour minimum
charge per occurrence.
17. If the public interest requires a modification of, or a departure from, the plans and specifications, the City shall have the authority to
require or approve any modification or departure and to specify the manner in which the same is to be made for City-owned or
maintained facilities.
18. Pursuant to Chapter 14.02 of the Campbell Municipal Code, applicant shall not cause to be discharged any material into the
municipal storm drain system other than storm water. Applicant shall adhere to the BEST MANAGEMENT PRACTICES established by
the Santa Clara Valley Urban Runoff Pollution Prevention Program.
Applicant shall be responsible for ensuring that all those providing services under the applicant are aware of and understand all of the above
conditions.
Appl
Date
J:\FORMS\Templates\Encroachment Permits\R-1 Encroachment Permit STATIC form2.pdf
Rev. 3/10
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PUBLIC WORKS DEPARTMENT LAND DEVELOPMENT & TRAFFIC RECEIPT ~/L~
Effective July 1, 2010 ~Tv~ ~~, ii _
TO: City Clerk PUBLIC WORKS FILE NO. l C '
PROPERTY ADDRESS C,'2-~ -t"r lC i/--I ~T
Please collect & recei t for the followin monies
ACCT. ITEM AMOUNT
LAND DEVELOPMENT '
ncroac ment ermit ication ee
Non-Utilit Encroachment Permit
$350.00
Minor Encroachment Permit <$io,ooo $200.00
Initial R-1 Permit N/C '
Subse uent R-1 Permits within Two Year Period $200.OG
22031 Plan Check De osit 2% of En ineer's Estimate $500.00 min
Utility and R-1 Permits no deposit required
4722' Gradin & Draina e Plan Review
Sin le Famil Lot
$250.00 '
Site < 10,000 s.f. $750.00
I Site >_ 10.000 s.f. < Acre $1.000.00
I Site ? 1 Acre $1,500.00
Plan Check & Ins ection Fee Non-Utilit
'"`2203' En r. Est. u to $250,000 14% of En ineer's Estimate
'
4722 En r. Est. ?$250,000 Actual cost +20% Admin Overhead
Min $35,000 De osit _
22031 Emer enc Cash De osit 4% of En r. Est.' $500 min/$10,000 Max
22031
2203! Faithful Performance Securit FPS
Labor and Materials Securit 100% of ENGR. EST.'
100% of ENGR. EST." _
~"~~ =-
4721 i Storm Drainage Area Fee Per Acre R-1 $2 120.00
~~ (Multi-Res $2 385.00)
All Other $2.650.00
47221 Parcel Ma 4 Lots or Less $3.600.00 + $80/lot
4722 Final Tract Ma 5 or More Lots $4,400.00 + $108/lot
2203 Monumentation Securit 100% of ENGR. EST.
4920 Parkland Dedication Fee 75%/25% Due U on Cert. of Occu anc
4722 Lot Line Ad ustment $1.400.00
4722 Vacation of Public Streets & Easements $2,250.00
4722' Certificate of Com liance $1 700.00
4722 Certificate of Correction $500.00
47221 A eal Filin Fee $200.00
47221 Nota Fee er si nature $10.00 _
4722 ~ Assessment Segregation or Reapportionment
First Spli+ $800.00
Each Additional Lot $250.00
511.7424
TRAFFIC
47281 Postage
Traffic Flow Ma Dail Traffic Volumes
$34.00
4728 Si nal Timin Information $72.00/Hr
4271 Truck Permits $16.00/ er tri I
4728 No Parking Signs
EOUS
MISCELLAN __ $1leach or $25/100 I
Other (Please S eci
Engineer's Estimate shall be as approved by the City Engineer and shall include all items of work.
"Actual Cost Plus 20% Overhead (Non-Interest bearing de7p~os~it)~ , ~ ~ TOTAL
NAME OF APPLICANT G /~t-~ - /' 1'~~`~"' -.~o v
$ ~~C>
~
NAME OF PA YOR ~-~/~~ ~~ /9~%(.)~ PHONE 0~ 3 ~ ~ Z ~L
ADDRESS -Q - ~U It ~7 ~ ~ ZIP
9 so <<- ~ ~ EIVED'
FOR RECEfVE BY
CITY CLERK
ONLY - nn
'DatelQ ~ ~ Recei t # ~rJi% I
~
For Plan Ch eck and Cash Deposits, send yellow cop y to Finance.
Date/ Initials
tt MrmM•r of lehrnp bt~mtid Gmnp
SAFECO INSURANCE COMPANY OF ILLINOIS
2800 W. Higgins Road, Suite 1100, Hoffman Estates, Illinois 60195 (A stock insurance company.)
QUALITY-PLUS HOMEOWNERS POLICY DECLARATIONS
INSURED: POLICY NUMBER: OA2680617
JOANNE G MARTIN POLICY PERIOD FROM: NOV. 26 2010
PO BOX 111735 AT: 12:01 A.M.
CAMPBELL CA 95011-1735 TO: NOV. 26 2011
AGENT:
DAVID L TOWLE INSURANCE AGENCY
RESIDENCE PREMISES: 1202 MERIDIAN AVE
1027 PATRICIA CT SAN JOSE CA 95125-5209
CAMPBELL CA 95008-6434
TELEPHONE: (408) 817-9400
~ ~ .~
- Your policy has renewed effective November 26, 2010.
- THIS POLICY DOES NOT PROVIDE EARTHQUAKE COVERAGE.
- The limit of liability for this structure (Coverage A) is based on an estimate of
the cost to rebuild your home, including an approximate cost for labor and
materials in your area, and specific information that you have provided about your
home.
SECTION I - PROPERTY COVERAGES
A - Dwelling S 234,800 S 577.00
B - Other Structures 23,480
C - Personal Property 164,360
D - Loss of Use 24 INGNjHS
SECTION II - LIABILITY COVERAGES
E - Personal Liability (each occurrence) 100,000
F - Medical Payments (each person) 1,000
INCLUDED COVERAGES
Building Ordinance or Law Coverage Included
Included in limit applicable to Coverage A
Full Value on Personal Property Included
Extended Dwelling Coverage Amount 117,400 Included
438-B.F.U. Included
Private Residence Employees Included
m Workers Compensation - Occasional
P U
Option ID - Identity Recovery - $250 deductible S 25,000 S 12.00
Burglar Alarm Credit
10% S -58.00
Section I
CHO-6000/EP 9/06
C`~ ~/ ,
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CONTINUED ~ ~ _ ~ ORIGINAL
Page 1 of 2 DATE PREPA D SEPT 27 2010
Client: 572639 BAYAREAT DATE (MMroomYY)
ACORDrv CERTIFICATE OF LIABILITY INSURANCE ~o/olnolo
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFtRMATNELY OR NEGATNELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. TH13 CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATNE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certi cafe holder Is an ADDI NAL IN URED, the policy(ies) must be endorsed. if SUBROGATION IS WANED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certiflcate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER NAME:
Hub International ~ Ne ~„ 805-966-4101 „~ Ne; 805-832-6581
HUB Int'1 Insurance Serv. Inc, ADDRESS:
P.O. Sox 3310
C ST I
Santa Barbara, CA 93130-3310 INSURERI81 AFFORDING COVERAGE Nac ar
INauRED
Bay Aroa Troa Spedalists
Richard Smith
3315 San Felipe Rd., #PMB 159
San Jose, CA 95135
~r~
.American
20613
19720
COVERAGES
CERTIFICATE NUMBER:
Company
D:
REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWRHSTANDINO ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN. IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LNu1R3 SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPE OF WSURANCE POLICY NUMBER MiD EFF OLX: E LIMITS
A OENERALLIABILITY 021CP00246 4/07/2010 Q4/OT/2011 EACH OCCURRENCE s1 000000
X COMMERCIAL GENERAL UAB~rrY PREMISES orxurrence Y100 OOt)
CLAIMS-NAPE a OCCUR MED EXP (Any one person) S5 LIDO
PERSONAL S ADV INJURY E1 OOO OOO
OENERALAGGREGATE 52,000,000
OEN'LAGGRE OATEUMRAPPLIE9PER: PRODUCTS-COMPIOPA00 S2,000,OOO
POLICY ~D~ LOC =
A AUT OMOBILE UABILnY 021 CP00246 4/07/201 O 04/07/2011 COMeINEO SINGLE LIMIT =
(Ee ecddenl) 1 QQQ 000
X ANY AUTO BODILY INJURY (Per person) S
ALL OWNED ALR09 8001LY INJURY (Per ecddent) S
SCHEDULED AUTOS PROPERTY DAMAGE
S
X HIRED AUTOS
(Perecddenl)
X NON-DWNEDAUTOS s
5
g uMBRELU uAB ~~ 60A2U60003642 4107/2010 04/0712011 EACH occuRRENCE a1 000 000 __
EXCESSLIAB CLgIM3-MADE AGGREGATE t1,000,00~
DEDUCTIBLE s
X ON 10 000
C woRXERS cokmENennoN 021 WK00057 0!01/2010 10/01/2011 X WC sTATU- °
AND EMPLOYERS' UABWTY
ANY PROPRIETORIPARTNERlEXECUT Y / N
El. EACH ACCIDENT
51 OOO OOO
OFFiCER1FAEMBEREXCLLIDED?
(Mandatory In NH) N!A
E.L. DISEASE - EA EMPLOYEE
f1,DDD ~~~
nyee daaalbs under
EBf:R OF RA below
E.L DISEASE - POLICY LIMrf
:1 UOO,OUO
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Atpeh ACORD 101, Addtlbnal Remarks 8dudub, M mono apace le rsgWred)
'* Workers Comp Info ** Excluded: Richard Smith, Owner
Excess Liablflty coverage does not apply to the Business Auto coverage. ,
(See Attached Descriptions)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPNtATNNd DATE THEREOF, NOTICE WILL BE DELIVERED IN
Access Assoclatlon Services ACCORDANCE wml THE POLICY PROVISNNIS.
Attn: Rachel Valenzuela
10264 Church St. ate 102 ^'nHO1~O1~P~~A~
Morgan HIIi, CA 95037-0000 „ _ _ n~f _
®1988-2009 ACORD CORPORATION, All nghts reserves.
ACORD 25 (2009/09) 1 of 2 The ACORD name and logo are registered marks of ACORD
ffS8676201M867810 DV43
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ugust 23, 2011
Joanne G. Martin
P.O. Box 111735
Campbell, CA 95011-1735
CITY of CANiI'BELL
Public Worla I)epa~runent
SUBJECT: PERMIT NO: ENC2010-00146
LOCATION: 1027 Patricia Ct.
FINAL INSPECTION AND ACCEPTANCE
Dear Ms. Martin,
The City of Campbell has made a finala nnp onformance w th Cty standard mprovements
and finds the work to be acceptable a
Accordingly, the City Engineer accepts the improvements.
The one year maintenance period stated in the permit begins as of the date of this letter.
The permittee is responsible for the repair and/or replacement of any defective work or
failures that occur within one year. The City will inspect the improvements within one
year and notify you, in writing, whether or not any repairs are required.
Your Faithful Performance Security (FPS) deposit of $500.00, plus any interest due, is
now being processed and will be sent to you under separate cover.
If you have any questions, please call me at (408) 866-2165.
Sincerely,
s°-
Syed Wahidi
Senior Public Works Inspector
MQ
~~
cc: Suspense - 11 months
Permit # ENC2010-000146
Inspector File
J:\JeanineG\Final Inspection Letter, ENC2010-000146, 1027 Patricia Ct..doc
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S DEPARTMENT LAND DEVELOPMENT & TRAFFIC RECtIr i
Effective July 1, 2010 •~%~
F~ 2.~ ~ C ,~ _ GCS
,
PUBLIC WORKS FILE NO -
PROPERTY ADDRESS (C%~-~ ~~ A"~r' t r //a ~T
~/ino monies: f AMOUNT
e $350.00 'i
000 $200.00
N/C
wo Year Period $200.00
eer's Estimate $500.00 min
no deposit required
$250.00
$750.00
$1,000.00
$1.500.00
Illt
14% of En ineer's Estimate
Actual cost +20% Admin Overhead
Min 335.000 De osit -
• 4% of En r. Est.` $500 min/$10.000 Max
S 100% of ENGR. EST.`
`
~~~
100% of ENGR. EST.
00
, , , , e R-1 $2.120.
:
:
.
,
_ u
(Multi Res $2 385 00) ~
1 ~
00
650 I
.
All Other $2.
I
4722 Parcel Ma (4 Lots or Less $3.600.00 + 38011ot
00 + $108/lot
400
$4
4722 .
.
Final Tract Ma (5 or More Lots
100% of ENGR. EST.
2203 Monumentation Securit
4920 nc
Parkland Dedication Fee 75%/25% Due U on Cert. $
4722 1 400.OO
Lot Line Ad ustment
00
250
32 I
4722 .
.
Vacation of Public Streets & Easements I
47221 Certificate of Compliance $1,700.00
!
4722 Certificate of Correction 3500.00
$200.00 I
4722 A eal Filino Fee
00
$10 I
47221
~ 4722 .
Notarv Fee er si nature)
Assessment Segregation or Reapportionment I
First S lit $800.00
I 325G.00
Each Additional Lot
511.7424 Postage
FIC
RA
F
T
47281 $34.00
Traffic Flow Ma (Dail Traffic Volumes $72 OOIHr
I
4728
min Information
al T
Si n
i
00/ er tr
316.
~
1 4271 k Permits
Truc $1leach or $25/100 I
4728 ~ No Parking Signs
MISCELLANEO US
Otner (Please Soeci
d shall include all items of work.
n
*Engineer's Estimate shall be as approved by the City Engineer a TOTAL
---- , ~.,~ ~-'
3 ~-'C'C~
"'Actual Cost Plus 20% Overhead (Non-Interest bearing deposit)
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wFor Plan`Ch eck and'Cash'Deposits, send yellow copy to Finance. Date! Initials
SAFECO INSURANCE COMPANY OF ILLINOIS
QUALITY-PLUS HOMEOWNERS POLICY DECLARATIONS
POLICY NUMBER: OA2680617
CONTINUED
You may pay your premium in full or in installments. There is no installment fee if
you pay in full. There is a fee for each installment. If more than one policy is
billed on the installment bill, only the highest fee is charged. The fee is:
50.00 per installment for recurring automatic deduction (EFT)
50.00 per installment for recurring credit card or debit card
52.00 per installment for all other payment methods
LNSURA$1:E: INTERE8T8.;::~ ~>:;;..: '::>:;:` >;::::::;; :: ..;:::: <;:;:~; :::..:: .:.
SERVICING MORTGAGEE
PROVIDENT FUNDING ASSOCIATES,
LP
ITS SUCCESSORS AND/OR ASSIGNS
P 0 BOX 5914
SANTA ROSA CA 95402
LOAN NUMBER: 6120080294
CHO-6001/EP 7/97 Page 2 of 2 DATE PREPARED SEPT 27 2010
G4
City of Campbell -Refundable Deposit Check Request
To: Finance Director
Check Payable To: ~~-~1;,'\.,~"r;~ ~ ~ ~C=TI ice:
Address -Line 1: ~~, ~ ~X ~ ~ I,~ ~ LJ
Line 2:
City: ~ ~ j~ti'F'"~(,,~ State: ~A Zip: C~5 L% l I -' 17~~
Description: Refund Deposit
Total Payable: ~~~? `~,- (Exact Amount)
Account Number:
1 ~ ~ '22i/ ~~
Amount: G,
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Account Number: Amount:
Account Number: 101.540.7448 Amount:
(finance Dept only) Interest Earned (Finance Dept only)
Purpose: i~'7
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Permit#: PVC.. ~%i0 --tC'?l~
Date: (L~ (Z i ~ (~
Title: ~ ~L~'~~~i~~-TLyZDate: L~ ~ (/ 1,
Approved by: Title: Date:
Verified by: Title: Accounting Clerk II Date:
Special Instructions For Handling Check
Mail As Is: Mail in Attached Envelope: Interim Check:
Needed By:
Return To:
(Name) (Department)
Other:
f/n: Forms/excel/chkreq - Revised 02100
CITY OF CAMPBELL
PUBLIC WORKS DEPARTMENT
CLEARANCE FOR FINAL INSPECTION
AND ACCEPTANCE LETTEP.
Encroachment Permit #
~~1C 2C:IG ~Gl`~l~
Property Address
~ ~,% ~ 7 }~=a-1Yt ~~ ~ c~ ~ ~
Date of Final Inspection: ~ ~ ~ ~ ~ ~ ~
On File: -Bonds CD - Cash
~G Faithful Performance $ `~ ~ ~~- .
~i Labor and Material $ Rv / A
Construction Cash Deposit to be released: $ NjA
Other overdue deposits to be released (Description): N~'F~
Processed by:
Reviewed by:
z ti~
Administrator
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Inspector ~ 2 Zt~L1
P.evie4ved by:
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Land~IIeGelopment Engineer
Reviewed by: ~~~ r~~ j,~
City EngJneer
J:AFORMS\Templates\AdtninistrauveAC~heckiist -Clearance for Final ~isP and Acceptance.do: (ker. 03 I O i
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CITY OF CAMPBELL vErIDOR rao. 10011104 CHECK wo. 233495
account Purc%ta.re Order Invoice Number aniOLlnj Descri Ginn
101 2203
101.540 ?448
I CR082311
CR082311 500.00
.38 REFUND DEPOSIT
INTERES'T'
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ti~ ~C 70 NORTH FIRST STREET a2n morrrcomERY sTaEET 1zlo 09~12~11 233495
~ SAN FRANCISCO, CA 94104
• L .r CAMPBELL, CALIFORNIA 95008
AMOUNT ~ *******500.38* ~
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PAY THE SUM OF FIVE HUNDRED DOLLARS & 38 CENTS ~!
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To Tr~E JOANNE MARTIN ~~,,
ORDER PQ BOX 1117 3 5 ~ S. ~ A ~`---
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CITY OF CAMPBELL
?0 NORTH FIRST STREET
CAMPBELL, CALIFORNIA 95008
JOANNE MARTIN
PO BOX 111735
CAMPBELL CA 95011-1735
Ref undnble ~e-posit Check Request
To: Finance Director
Check Payable To:
Address -Line 1:
Line 2:
City:
Description
Account Number:
Account Number:
Account Number:
(Finance Dept only)
Total Payable:
Purpose:
Joanne G. Martin
P.O. Box 111735
Campbell
Refund Deposit for ENC2010-00146
101.2203
101.540.7448
State: CA
Amount:
Amount:
Amount:
Zip: 95011-1735
$500.00
Interest Earned (Finance Dept only)
$500,00 (Exact Amount)
Refund Faithful Performance Security Deposit ($500.00)
Voucher #: Permit #: ENC2010-00146
Receipt #: 230001 Date: 10/21/2010
Requested by: Syed Wahidi -" Title: PW inspector Date: 8/23/2011
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Approved by: Ed Arango~'f=~ Title: Assistant Civil Engineer Date: 8/23/2011
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Finance Dept Only: ,
Verified by: Title: Date:
Approved by: Title: Date:
Special Instructions For Handling Check
Mail As Is: Mail in Attached Envelope: Interim Check:
Needed By:
Return To: Jeanine Grundman PW
(Name)
Other:
(Department)
f/n: Forms/excel/chkreq - Revised OS/00 - -
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Transmittal
' ~ Grundman
assistant
City of Campbell
Department of Public Works
70 North First Street
Campbell, CA 95008
Phone: (408) 866-2150
Fax: (408) 376-0958
E-Mail: jeanineg@cityofcampbell.com
To: Joanne Martin Date: 9/12/11
Company:
Address: P.O. Box 111735
Campbell, CA 95011-1735
Re: Check for funds release of permit #ENC2010-00146
^ Urgent ^ For Review ^ Please Comment ^ Please Reply x ^ For Information & Use
I have attached your check totaling $500.38 of funds released for the project at 1027 Patricia Ct.,
Campbell, CA 95008. This check represents your Faithful Performance Security (FPS) deposit of
$500.00, plus any interest due.
Thank you,
Jeanine Grundman
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August 23, 2011
Joanne G. Martin
P.O. Box 111735
Campbell, CA 95011-1735
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CI'1'v'Y of CAMPBE>vL
Public Work, I)eparul~ei~r
SUBJECT: PERMIT NO: ENC2010-00146
LOCATION: 1027 Patricia Ct.
FINAL INSPECTION AND ACCEPTANCE
Dear Ms. Martin,
The City of Campbell has made a final inspection of subject Public Works improvements
and finds the work to be acceptable and in conformance with City standards.
Accordingly, the City Engineer accepts the improvements.
The one year maintenance period stated in the permit begins as of the date of this letter.
The permittee is responsible for the repair and/or replacement of any defective work or
failures that occur within one year. The City will inspect the improvements within one
year and notify you, in writing, whether or not any repairs are required.
Your Faithful Performance Security (FPS) deposit of $500.00, plus any interest due, is
now being processed and will be sent to you under separate cover.
If you have any questions, please call me at (408) 866-2165.
Sincerely,
Syed Wahidi
Senior Public Works Inspector
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cc: Suspense - 11 months
Permit # ENC2010-000146
Inspector File
J:\JeanineG\Final Inspection Letter, ENC2010-000146, 1027 Patricia Ct..doc
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