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ENC2015-00257Pnnt Form. - CITY OF CAMPBELL R-1 ENCROACHMENT PERMIT Permit No. 'E.Zake-- -mz&-j DEPT. OF PUBLIC WORKS (Non -engineered work within the public right-of-way) - X-Ref File 70 North First Street ($10,000.00 maxi um value of work) Application Date Campbell; CA 95008 Application Expiration Ph. (408) 866-2150 ISSUED: � k � Date i 8 _ Fx. (408) 376-0958 Permit Expiration ate: APN 'J�s'.?3 -OS-3 APPLICATION - Application is hereby made fora Public Works Permit in accordance With CampbellMunicipal Code, Section 11.04. (Application expires in 6 months if the permit is not issued.) A. Work Address: a �. (� Cl::, T l �V P B. Nature of Work: v e C. Attach three (3) copies of a drawing showing the location, 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 theSpecial 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- p)µi.Q�Qu4\�U�k�ur -- _-^ Telephone: Address: [-I(.Sq —Tu. v�t) �f, �u�n �r)SP CA S/off ��iµ E-Mail Address: VN 1C1Acs�� to �hvcQ�Siq L4, Crj The Applicant hereby confirms that this work is being done by the property owner/applicantat 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; safeand 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 informa ion. a44, M ///!iL e f ACCEPTED: ./Jl.n�� (Applicant/Perihittee) (Sign) V' Date:. NOTES: All work shall conform with the attached approved plans 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.h'ours before restarting.any work. Per Section 42T6 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 NoJ h.as.been entered hereon. USA Phone: 1-800-227-2600. Ticket No.: Applicant is advised that:upon issuance.ofthis permit, propertyowner, or,property'owner's successors, shall be responsible forany 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 Privatelmprovernents in the Public -of-Way, which shall be recorded. _ 2. 3. STANDARD AMOUNT RECEIPT N0 SECURITY FOR FAITHFUL PERFORMANCE . (100% Of Engr's Est.) .. $ �, UCho,I R-1 PERMIT FEE $ APPROVED FOR ISSUANCE: 2 �- c a t for.City.Engineer te.. Permit Expires.6 Months -after Date of Issuance:. 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. Submit project schedule 10 days prior to proposed start of work. Special provisions may be required for work within City facilities and downtown Campbell. 5. 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. 6. Maintain safe pedestrian and vehicular crossings and free access to private driveways, fire hydrants and water valves. 7. 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. 8. Sawcut for all PCC and AC removals. All PCC removals shall be to nearest scoremark and shall be doweled to existing improvements. 9. 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. 10. The Contractor or Permittee will have a supervisory respresentative available for contact on the project at all times during construction. 11. This permit shall be kept at the site of work and must be shown to any authorized representatives of the City of Campbell or any law enforcement officer upon demand. 12. 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. 13. This permit shall 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 by law. 14. This permit does not release the Permittee from any liabilities contained in other agreements or contracts with the City and any other public agency. 15. This permit is not transferable. Work must be performed by the Permittee or his designated agent or contractor as specified thereon. 16. 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. 17. 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. 18. 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. 19. 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 ensur' g that all those providing services under the applicant are aware of and understand all of the above conditions. *at Date J.\FORMS\Templates\Encroachment Permits\R-1 Encroachment Permit STATIC form2.pdf Rev. 02/ 14 OF CA y �A, mod' U . • �k CHARS • , CITY OF CAMPBELL Public Works Department February 12, 2018 Kenneth and Wendy Walker 210 Carlyn Ave. Campbell, CA 95008 SUBJECT: PERMIT NO. ENC 2015-00257 210 Carlyn Ave. Campbell, CA FINAL INSPECTION AND ACCEPTANCE Dear Kenneth and Wendy: The City of Campbell has made the final inspection of the subject Public Works improvements and finds that no remedial work is required. Your warranty requirements and any surety, therefore, are hereby released. Sincerely, Syed Wah- i Public works Inspector 70 North First Street • Campbell, California 95008-1436 • TEL 408.866.2150 • FAx 408.376.0958 • TDD 408.866.2790 Encroachment Permit Final Sign Off Encroachment Permit # Address: Cw � - Date of Final Inspection and Acceptance: Inspected by: OK to release deposits: 100%' 75 Comments: ®V C44f U ram., •'kCHAV CITY OF CAMPBELL Public Works Department March 13, 2017 Kenneth and Wendy Walker 210 Carlyn Ave. Campbell, CA 95038 SUBJECT: PERMIT NO. ENC 2015-00257 210 Carlyn Ave. FINAL INSPECTION AND ACCEPTANCE Dear Kenneth and Wendy: 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 February 22, 2017. 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 Security Deposit in the amount of $2,000.00 is enclosed. If you have any questions, please call me at (408) 866-2165. Sincerely, 41 -- Syed W'14i Public Works Inspector Cc: Inspector/Suspense Files Permit File 70 North First Street • Campbell, California 95008-1436 • TEL 408.866.2150 • FAX 408.376.0958 TDD 408.866.2790 i" 0\iL-91V1.C,1D.�L` FARGO HANK. N.A. CHECK `DATE CHECK NO.* _: TT 420MONTGOMERY STREET 1210 NORT.H.FIRST STREET SAN ;FRANCISCO, CA 94104 - 0 3 / 13 / 1 �% 261590 f " CAMPBEL# CALIFORNIA 95008 o b�. AMOUNT 1 G - • a. '.. _ o RrlinR� • .VOID'AFTER 90 DAYS 0I >i PAY THE SUM OF TWO THOUSAND DOLLARS & ZERO CENTS ; m � r Ta THE •�KENNETH WALKER I ORDER - 210 CARLYN 'AVER „i/� CAMPBELL CA 95008 ,. �. z iI■,: 2 6 L 5:9 0']I■ a:.b 2 30 0 2'4 8 J.1' ,2L 8 ;5:5 4 I 5 a■. - e le, - A p- e .............. ._..._.._.................... ................... / ......... J ............................... ...... .... ..... ..... ...................... ..... .... _........ ........... _...... - ................ ............ ... .. . *See Reverse Side For Easy Opening r€ ion * ------------------------ ,------ ------ --- ------------ CITY OF CAMPBELL 70 NORTH FIRST STREET CAMPBELL, CALIFORNIA 95008 KENNETH WALKER, 210 CARLYN AVE CAMPBELL CA 95008 ACORO® EVIDENCE.OF PROPERTY INSURINSURANCEDATE (MMIDDIYYYY) 07/16/2015 THIS EVIDENCE OF PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ADDITIONAL INTEREST NAMED BELOW. THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS EVIDENCE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE ADDITIONAL INTEREST. AGENCY I PRCN o E , 400-255-3212 COMPANY NAIL# 25151 $tateFarm WHITTAKER INSURANCE AGENCY ING lic#0723052 IIC#0468490 State Farm General Insurance Company • s 20395 PACIFICA DR SUITE 108 CUPERTINO,CA 05014 INSURED KENNETH E WALKER 1684TUPOLO DR SAN JOSE, CA'95124 NKL)FtKIY INI-UKnnA-IIUIV LOCATIONIDES CRIPTION 210 CARLYN AVE, CAMPBELL, CA 95008 LOAN NUMBER 05-BA-T3354- EFFECTIVE DATE EXPIRATION DATE I �CONTINUED UNTIL 07/16/2015 06/06/2016 I x I TERMINATED IF CHECKED THIS REPLACES PRIOR EVIDENCE DATED: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS EVIDENCE OF PROPERTY INSURANCE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. COVERAGE INFORMATION COVERAGE I PERILS I FORMS AMOUNT OF INSURANCE DEDUCTIBLE HOMEOWNER POLICY FORM FP-7955 CA 1,525,000 2,000 GENERAL LIABILITY 1,000,000 NONE FE-7342.3 DWELLING UNDER CONSTRUCTIONENDORSEMENT FE-3607-BUILDING MATERIALS THEFT ENDORSEMENT (California FE-3422 HO-W POL END KtMAKKJ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE I DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS: ADDITIONAL INTEREST �/ NAME AND ADDRESS X I MORTGAGEE ADDITIONAL INSURED WESTERN ALLIANCE BANK AN ARIZONA CORPORATION 55 ALMADEN BLVD SAN JOSE LOAN It 21591-3 AUTHORIZED REF £A 95113 , n r 27 (2009112) - 01993-2009 AC, The ACORD name and logo. registered marks of ACORD CORPORATION. All rights reserved. 1004363 142988.1 01-28-2013 � ate- Ap 14, ps pector 7. rNte IA ppro en _ CM OF CAMPBELL PUBLIC WORKS (DEPARTMENT CLEARANCE FOR FINAL INSPECTION AND ACCEPTANCE LETTER Encroachment Permit#: ENC 2015-00257 Name: Kenn & Wendy Walker Property Address: 210 Carlyn Ave. Date of Final Inspection: On File: Bonds CD Cash Faithful Performance: $ 2,000.00 Labor and Material: $ Construction Cash Deposit to be released: $ Other overdue deposits to be released (Description): Processed by: Z 21 \ dministrator Reviewed by: Reviewed by: pector `. 2,1 1z I 1-i Land Development Engin er J:VoAnna'Meposit refunds\CHECKLISTS\car1yn210.doc (Rev. 10/1 l) Encroachment Permit # Address: 210 Encroachment Permit Final Sign Off 1,—©.tc 2e;0025-7 Date of Final Inspection and Acceptance: 2 I Inspected by: JW OK to release deposits: 100% v 75% Comments: -'C/ PUBLIC WORKS DEPARTMENT LAND DEVELOPMENT Effective July 1, 2015 TO: Finance PUBLIC WORKS FILE NO. PROPERTY ADDRESS ��� Qjt�'��i Please collect & receipt for the followingmonies: ACCT. ITEM AMOUNT LAND DEVELOPMENT 4722 Encroachment Permit Application Fee Non -Utility Encroachment Permit Major >_$10,000 $395.00 gyred I.J.- 1•11 c�3y_y :^ r,.i [)') tth 'k.. w. �'C: Gtit i:.:+ PIS -1476 or to ineer's Estimate 2203 2203 4722 4722 4722 4722 4722 4722 Enqr. Est. >_$250,000 and :5$500,000 $35,000 + 8% of Enqineers Estimate 4722 _Enqr. Est. >$500,000 $55,000 + 7% of Engineers Estimate 2203 Emergency Cash Deposit 4% of Enqr. Est.* ($500 min/$10,000 Max) 2203 Faithful Performance Security (FPS) 100% of ENGR. EST.* 2203 Labor and Materials Security 100% of ENGR. EST.* 4721 Storm Drainage Area Fee Per Acre R-1 $2,120.00 (Multi -Res $2,385.00) (All Other $2,650.00) 4722 Parcel Map (4 Lots or Less) $3,930.00 + $85/lot 4722 Final Tract Map (5 or More Lots) $4,775.00 + $116/lot 2203 Monumentation Security 100% of City's Monumentation Estimate 4920 Parkland Dedication Fee (75%/25% Due Upon Cert. of Occupancy) 4722 Lot Line Adjustment (Includes CertifiVate of Compliance) $1,856.00 4722 Vacation of Public Streets & Easements $2,480.00 4722 Certificate of Compliance $1,840.00 4722 Certificate of Correction $550.00 4722 Document Recording Fees $15.00/first page $3 ea. Additional 4722 Private Improvement in Public ROW $50.00 4722 Approved Plan Revision Fee $100/sheet 4722 Appeal Filing Fee $200.00 4722 Notary Fee (per signature) $10.00 4722 Assessment Segregation or Reapportionment First Split $877.00 Each Additional Lot $275.00 511.74241 Postage MISCELLANEOUS Other (Please Specify) *Engineer's Estimate shall be as approved by the City Engineer and shall include all items of work. TOTAL $ ©� r NAME OF APPLICANT NAME OF PAYOR ��i , �� :r; .r=, �PH_ONE ADDRESS zip 9 Sop FOR RECEIVED B CITY CLERK ONLY ( " Date Receipt #�f3 J:TORMSIT—pla - DOCUMENT: 21498242 Pages: 2 Fees.... ie.00 Recording Requested By IIIII IIIIII IIIIIIIIII IIIIIIIIII IIIIIIIIIIIIIIIIIIII IIIIIIII 649.00 Copies _ . North American Title Company, Inc. 0021498242 AMT PAID 667.00 File No. 56007-1105768-11 REGINA ALCOMENDRAS RDE # 007 AND WHEN RECORDED MAIL TO: SANTA CLARA COUNTY RECORDER 1/1312012 Name: Kenneth E Walker and Wendy D. Recorded at the request of 10:18 AM Walker Accounting Customer Street Address 210 Carlyn Avenue City &State Campbell, CA 95008 v� v SPACE' ABOVE THIS LINE FOR RECORDER'S DEED USE A.P. No. 305-23-057 GRANT The Undersigned Grantor(s) Dedare(s): DOCUMENTARY TRANSFER TAX $649.00; CITY TRANSFER TAX $ D X computed on the consideration or full value of property conveyed, OR computed on the consideration or full value less value of liens and/or encumbrances remaining at time of sale, unincorporated area; [ X J City of Campbell, and FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Julie Ann Wilson, an unmarried woman hereby GRANTS to Kenneth E Walker and Wendy D. Walker, husband and wife as joint tenants the following described property in the City of Campbell, County.of Santa Clara, State of California: Legal Description attached hereto as Exhibit."A" and incorporated herein by this reference Dated: QC11,1/2012 STATE OF C COUNTY OF On before me, l rl_L�r V I.0 , Notary Public, personally bl appeared �� J� ` % t`i V) iI � k Y—) who proved to me on the basis of satisfactory evidence to be the person(s)_ whose name(s) is/are subscribed to the within instrument and acknowledged -to me that he/she/they executed the same in his/her/their authorized capacity(ies) and that by his/her/their signature(s) on the instrument the person(s) or the entity upon behalf of which the person(s) acted, executed the instrument:: I Certify under PENALTY OF PERJURY under the laws of the State of.Califomia that the foregoing paragraph is true and correct. WITNESS my hand and offi ial seal Signature ` MAJ This area for ofBaal notarial seal -�Yie Ann Wilson. 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