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ENC2016-00216 or c444( U 3 � '".r - UNCfi,1HV CITY OF CAMPBELL Public Works Department April 1, 2019 Mr. Omid Shakeri The Ridgecrest Group 2878 Joseph Ave.- San Jose, CA 95126 SUBJECT: PERMIT NO. ENC 2016-00216 1.323 Parsons Ave., Campbell, CA FINAL INSPECTION AND ACCEPTANCE Dear Omid: 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. Enclosed are your deposit refunds which include the Monumentation Deposit for $1.6,000.00 and the remaining 25%of your Faithful Performance Deposit in the amount i of$11,750.00. If you have any questions.please call me at(408) 866-2157 Sincerely, Syed Wahidi Public Works Inspector Cc: Pcrinit File:ENC2016-00216 #' r, E { 70 North First Street• Campbell, California 95008 •TEL 408.866.2150 • PAa 408.376.0958 •TDll 408.866.2790 G a x City of Campbell Department of Public Works .70 North First Street Campbell,CA 95008 SUBJECT: MONUMENT BOND RELEASE TRACT MAP NO, 10392 Recorded in Book 903 of Maps,at page(s)31 and 32 Dear City Engineer: In conformance with the requirements of Section 66497 of the Subdivision Map Act,.please be advised that the.Engineer/Surveyor has been paid in full for setting the monuments within the above described subdivision.It is requested that Monument Bond Num '..a�j=p.G�1.'�..................:........ be released. Deve oper/Agee 3 Z� Date of signature of this document CERTIFICATE OF ENGINEER OR SURVEYOR I,Sarkiss Parvin certify that all monuments as shown on the map of the above described subdivision are now set and that payment in full for this work has been received. Land Surveyor 8261 License number 12/24/18 Date of signature of this document NOTE:Processing of the bond release cannot occur unless all of the above information is complete. CITY OF CAMP ELL 3/627�`( City Inspector Date Comments: cc:Bonding Company Rev.09/201.4 PUBLIC WORKS DEPARTMENT LAND DEVELOPMENT Effective July 1,2016 TO: Finance PUBLIC WORKS FILE Ni ENC 2016-216 PROPERTY ADDRESS 1323 PARSONS AVENUE Please collect&receipt for the following monies: ACCT. ITEM AMOUNT LAND DEVELOPMENT ncroac ment ermit Application Fee Non-Utility Encroachment Permit Major>_$10,000 $403.00 Minor Encroachment Permit<$10,000 $230.00 Initial R-1 Permit N/C Subsequent R-1 Permits within Two Year Period $230.00 Inspection Fee Minimum Charge per Location. $398.00 Street Tree Planting/Removal N/C 2203 ($500 per Tree Planting Deposit Required) $500.00/tree 22031 Plan Check Deposit 2%of Engineer's Estimate $500.00 min Utility and R-1 Permits no deposit required 4722 Grading& Drainage Plan Review Single Family Lot $281.00 Site< 10,000 s.f. $841.00 Site>_10,000 s.f. <0.—Acre $1,127.00 Site>0.5 Acre $1,688.00 4722 NPDES Review(C3 Requirements) For projects not required to submit numeric sizing $163.00 For projects required to submit numeric sizing Impervious Area 10,000 Sq. Ft to 1 Acre $704.00 Impervious Area 1 Acre or more $918.00 . 4722 For projects sent to Consultant for review Consultant Cost+20% 4722 Additional treatment facilities $300 ea Plan Check&Inspection Fee(Non-Utility) 4722 Engr. Est. <$250,000 14%of Engineer's Estimate $ 4722 Engr.'Est.?$250,000 and<_$500,000 $35,000+8%of Engineers Estimate 4722 Engr. Est. >$500,000 $55,000+7%of Engineers Estimate 2203 Emergency Cash Deposit 4%of Engr. Est.`($500 min/$10,000 Max) $ 2203 Faithful Performance Security(FPS) 100%of ENGR. EST.* $ ( 47,000.OQ 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) $4009. 00+$87/lot 4722 Final Tract Map(5 or More Lots) $4,871.00+$118/lot 2203 Monumentation Security 100%of City's Mon umentation Estimate $ < 16,000..00 4920 Parkland Dedication Fee(75%/25%Due Upon Cert. of Occupancy) $ '-40,839.75 4722 Lot Line Adjustment(Includes Certificate of Compliance) $1,893.00 4722 Vacation of Public Streets&Easements $2,530.00 4722 Certificate of Compliance $1,877.00 4722 Certificate of Correction $561.00 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 $895.00 Each Additional Lot $281.00 511.7424 Postage MISCELLANEOUS Other(Please Specify) n r `Engineer's Estimate shall be as approved by the City Engineer and shall include all items of work. TOTAL $ NAME OF APPLICANT OMID SHAKERI NAME OF PAYOR PHONE' a,-- ADDRESS zl FOR RECEIVED BY ITY CLERK ONLY Date Receipt# J:LL.D.vl[.checke CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT CLEARANCE TO REFUND MONUMENTATION DEPOSIT Parcel Map book and page: 9 �� Z or Tract Number: �- Encroachment Permit # O1(-Q Property Address: 3 ��5 S 7899 Letter received from Surveyor (Name): 4,)g A S Dated: a(o 1 Date of City Inspection: 3 By: �y On File: Bonds CD Cash Amount of Monumentation Deposit $ Processed by: Administrator Reviewed by: S e� Land Development Engineer (Zjc- Reviewed by: f Y , / City Engineer �eieaS� - a � s-of� �s J:VoAnnaT\Deposit refunds\C HECK LISTS\Checklist-Clearance to refund Monumentation Deposit.doc ............................ ............... .............. ................ ......................... ............. .......... ......... ................................... ................. ....................................... ---------------- CITY OF CAMPBELL; VENDOR NO. 10015121 CHECK NO. 269818 nvoice: iiniber:.:*:.*::::.:::::.:::':::'::::':::::,.:: .. . ...........o i. I Account i '101 2203 CR091018 37,630.00 1323 PARSONS .TRC10392 I 'P, > 10015121 THE RIDGECREST GROUP 'CHECK E CHECK --'-:-- W-!::0VCAMPBELL -24 :,�AL4�i]FARGO BANK, N.A. CIT 9.i.-.T4ONTGOME�Y ST 2,69818 :ij -i-210 REET STREET 7,FR7CISCO, CA 94104 CALIFORNIA 95 008 AMOUNT z,t`*;:*J 7�,-`6 3 0'O'Cl _0� 1 .'VOID AFTER 9 0 '0�DAYSI '10 PAY THE SUM OFTHIRTYSEVEN THOUSAND, SIX HUNDRED THIRTY DOLIM- 8 ' "ZERO' 'CENTS TO-THE THE RIDGECREST-GROUP ORDER ix 2898 JOSEPH AVE' F CAMPBELL CA 95008 : k 21 il S 5-4 15 0 , 9,8 1:8 lim' 1240,0 0 2 It 8 2 N Ail • -------------- ------- ------ ................ ................ ............................. .......... .......... ........... . ............................ .................................... ....................................... % ............... .............. .................................... ............................ .................................... *See Reverse Side For Easy Opening Instructions* CITY OF CAMPBELL 70 NORTH FIRST STREET CAMPBELL, CALIFORNIA-95008 THE RIDGECREST GROUP 2898 JOSEPH AVE CAMPBELL CA 95008 OF CAA •UkCH ARO CITY OF CAMPBE1.L Public Works.Department September 17; 2018 Mr. Omid Shakeri 2898 Joseph Ave. Campbell, CA 95008 SUBJECT: PERMIT NO. ENC 2016-00216 1323 Parsons Ave. FINAL INSPECTION AND ACCEPTANCE Dear Omid: 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 April 19, 2018. 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. 75% of your Faithful Performance Surety (FPS) cash deposit in the amount of$35,250.00 is enclosed. We will continue to hold the remaining 25% ($11,750.00) of your FPS cash deposit as a maintenance surety. Your Monumentation Deposit Refund will be returned once we receive a release letter from your surveyor. Your Construction Cash Deposit in the amount of$1,880.00, and your Plan Check Deposit in the amount of$500.00 are also enclosed. If you have any questions,please call me at(408) 866-2165. Sincerely, Syed Wahidi Public Works Inspector Cc: Inspector/Suspense Files Permit File: ENC2016-00216 70 North First Street • Campbell, California 95008-1436 TEL 408.866.2150 FAX 408.376.0958 TDD 408.866.2790 Refundable Deposit -Check Request } To' Finance Director - Check Payable,To: The Ridgecrest Group " Address Line 1: 2898 Joseph Ave. . . City: Campbell State: CA Zip: :96008. Description: 1323 Parsons,,,Tract#10392 '. Account Nlamber: 101.2203- Amount:. $37,630.00 , Account-.Num6er:_ 101.2203 Amount:, Account Number: 101.540.7448 Amount: Finance,De t only) (Finance Deptonly,) "" Interest Earned ' _ ( P . . Y) - Total Payable: _ (ExactAmoint) Purpose•' PC,;FPS and CC deposit refunds Permit#: - . -ENC20.16-00211; , Receipt# 266605..,— Date:' , L 10/27/2016 _f Receip## 267978 '' \ �5�0°`�. Date: 213/2017. - $ pD= Date: . '. 211/2017 - _ Receipt M . � - . 26793�4.._ .Jsr Z� - - , Re nested by:' Title: Inspector ,, ' .Date; q Syed Wahidi Approved by: Title:° Sr. Engineer Date:, Roger. rz = Approved by.- Title: City Engineer Date Finance Dept Orly: Verrfled.by Title: Accounting Clerk II Date:. -Approved by: _ Title: Accountant_ - Date, - S eca:I Instructions F:or: Hand'Iin Check `nnali Avis: ' man m•Atiadieu envelope:,_ .Interim t;necic`. Needed By: . , Return To:.. - JoAnna Thomason Public Works ; (Name) .(Department) , Other: Please return'check:to JoAnne.'-., Y " a F _._,-IC WORKS DEPARTMENT LAND DEVELOF ,___,IT Effective July 1,2016 TO: Finance PUBLIC WORKS FILE NO. ENC 2016- 1 PROPERTY ADDRESS 1323 PARSONS AVENUE Please collect&receipt for the following monies: ACCT. ITEM AMOUNT LAND DEVELOPMENT Encroachment Fermi pp ica ion Fee Non-Utility Encroachment Permit Major>_$10,000 $403.00 $ 403.00 Minor Encroachment Permit<$10,000 $230.00 Initial R-1 Permit N/C Subsequent R-1 Permits within Two Year Period $230.00 Inspection Fee Minimum Charge per Location $398.00 Street Tree Planting/Removal N/C 2203 ($500 per Tree Planting Deposit Required) $500.00/tree 2203 Plan Check Deposit 2%of Engineer's Estimate $500.00 min $ 500.00 Utility and R-1 Permits no deposit required 4722 Grading&Drainage Plan Review Single Family Lot $281.00 Site< 10,000 s.f. $841.00 Site z 10,00.0 s.f. <0.5 Acre $1,127.00 Site a 0.5 Acre $1,688.00 $ 1,688.00 4722 NPDES Review C3 Requirements) For projects not required to submit numeric sizing $163.00 For projects required to submit numeric sizing Impervious Area 10,000 S . Ft to 1 Acre $704.00 $ 704.00 Impervious Area 1 Acre or more $918.00 4722 For projects sent to Consultant for review Consultant Cost+20% 4722 Additional treatment facilities $300 ea Plan Check&Inspection Fee(Non-Utility) 4722 En r. Est. <$250,000 14%of Engineers Estimate 4722 Engr. Est.>_$250,000 and 15$500,000 $35,000+8%of Engineers Estimate 4722 En r. Est. >$500,000 $55,000+7%of Engineers Estimate 2203 Emergency Cash Deposit 4%of En r.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 $ 1,717.00 (Multi-Res$2,385.00) All Other$2,650.00 4722 Parcel a 4 Lots or $4UU9.U0+ 87 lot 47 Final ract a 5 or ore Lots 4, 7 .0 + 8 lot 5,4 .00 2203 Monumentation Security 100%of Ci 's Monumentation Estimate 4920 Parkland Dedication Fee 75%/25%Due Upon Cert.of Occupancy) 4722 Lot Line Adjustment(includes Certificate or compliance) $1,893.00 4722 Vacation of Public Streets&Easements $2,530.00 4722 Certificate of Compliance $1,877.00 4722 Certificate of Correction $561.00 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 er signature) $10.00 4722 Assessment Segregation or Reapportionment First Split $895.00 Each Additional Lot $281.00 511.74241 Postage MISCELLANEOUS Other Please Specify *Engineer's Estimate shall be as approved by the City Engineer and shall include all items of work. TOTAL $ 10,473.00 NAME OF APPLICANT OMID SHAKERI NAME OF PAYOR PHONE ADDRESS ZIP r PA a 27 2010 FOR RECEIVED BY ITYCLERK A I Y UF �, �V�Pk k�l� ONLY Date Receipt# �j V JAI-andDeOPlao Check COmmentell-SpaciOc Projects-Ache Project In Prog—Tamons 13231Copy of Receipt Form Lend Da Iopmenl 18-17 z _ Q2 OF G&kw +q» BY: CASHIER Qmwk25 PAGQ THE Sm £S qm . eb«2 +a; 1,0/3da R2;y! DATE: 1y2 16 TIME: ±:D Ryg.IA AMOUR m# D;aG016-6216 GmaAgD GSmF $qam mq m; &mo FRmgl - l% lmG+ mq D: WOO am a m2& FILING «.qG 00 ma 3: 1.000 Gklmq& FILING E 904.00 mq G= 1.000 #ma RQw RS 7 2 $1/g.00 CAA q: amo Dm & m»D GEyBF a.aG« �,�---�— mGE DUE: gG4S.m TENDERED: «GQ&m CHANGE: MESH CHECK : g\q&m' REF WIN- aG PUBLIC WORKS DEPARTMENT LAND DEVELUPMEN i Effective July 1,2016 _�•_ TO: Finance PUBLIC WORKS FILE Nt ENC 2016-216 PROPERTY ADDRESS 1323 PARSONS AVENUE Please collect&receipt for the following monies: ACCT. ITEM AMOUNT LAND DEVELOPMENT 4722 Encroachment Permit App lcatlon ee Non-Utility Encroachment Permit C, _ ,._. , Minor Encroachment Permit<$10,G. a _� _ `' r: Initial R-1 Permit Subsequent R-1 Permits within Tw- :. yI Inspection Fee Minimum Charge p- Street Tree Planting/Removal .3 2203 ($500 per Tree Planting Dep.`i 22031 Plan Check Deposit 2%of Engine(- -1 Utility and R-1 Permits 4722 Grading&Drainage Plan Review t =' Single Family Lot Site< 10,000 s.f. c r. 71 j Site>_10,000 s.f.<0.5 Acre c:_t ,t 1•"3 iSite>_0.5 Acre ,. w rn 4722 NPDES Review(C3 Requirements)For projects not required to submi For projects required to submit nu - F: Impervious Area 10,000 Sc Impervious Area 1 Acre or j 4722 For projects sent to Consultant fo; i i—v .t .r.a t. ' 4722 Additional treatment facilities $300 ea Plan Check&Inspection Fee(Non-Utility) 4722 Engr. Est.<$250,000 14%of Engineer's Estimate $ 6,580.00. 4722 Engr.Est.>_$250,000 and<_$500,000 $35,000+8%of Engineers Estimate 4722 Engr. Est. >$500,000 $55,000+7%of Engineers Estimate 2203 Emergency Cash Deposit 4%of Engr. Est.*($500 min/$10,000 Max) $ 1,880.00 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) $4009.00+$87/lot 4722 Final Tract Map(5 or More Lots) $4,871.00+$118/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 Certificate of Compliance) $1,893.00 4722 Vacation of Public Streets&Easements $2,530.00 4722 Certificate of Compliance $1,877.00 4722 Certificate of Correction $561.00 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 $895.00 Each Additional Lot $281.00 511.74241 Postage MISCELLANEOUS Other(Please Specify) *Engineer's Estimate shall be as approved by the City Engineer and shall include all items of work. TOTAL $ 8,460.00 NAME OF APPLICANT OMID SHAKER[ NAME OF PAYOR PHONE ADDRESS ~ ZIPj FOR RECEIVED BY ITY CLERK C.-Ak M ONLY Date Receipt# r� / lland0eNPlan Check C nmenMl-Sp ffic Projects-Active Project in Prag—e Parsms 13231F—Tarsms Fees Ih Encroachment Permit Final Sign Off ,qA A�6/0� Z! L o s9q�Encroachment Permit# 2-I6 - 21& ,sfr Address: S RFC q Fa Date of Final Inspection and Acceptance: ( � lyorks 2�J� q Inspected by: OK to release deposits: 100% 75% V on Comments: 1.uv1 C�nfC_l�C c�� a�t'c- S Via? - (.0S�C7S__. , Z� �tQ D 9— LA -I.Z_ D �r � Oc�o r . V,\� �sl �� of C 4,- U� fie, F. r •"?CHAO CITY OF CAMPBEL,L, Public Works Department September 17, 2018 Mr. Omid Shakeri 2898 Joseph Ave. Campbell, CA 95008 SUBJECT: PERMIT NO. ENC 2016-00216 1323 Parsons Ave. FINAL INSPECTION AND ACCEPTANCE Dear Omid: 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 (f April 19, 20 The permittee is responsible for the repair and/or replacement of any defeot-i 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. 75% of your Faithful Performance Surety (FPS) cash deposit in the amount of$35,250.00 is enclosed. We will continue to.hold the remaining 25%-($11,750.00) of your FPS cash deposit as a maintenance surety. Your Monumentation Deposit Refund will be returned once we receive a release letter from your surveyor. Your Construction Cash Deposit in the amount of$1,880.00, and your Plan Check Deposit in the amount of$500.00 are also enclosed. If you have any questions,please call me at(408) 866-2165. Sincerely, _ lJ Syed Wahidi Public Works Inspector Cc: Inspector/Suspense Files - Permit File: ENC2016-00216 70 North First Street • Campbell, California 95008-1436 TEL 408.866.2150 FAX 408.376.0958 TDD 408.866.2790 � 4/)%019 ' Fees Associated With 10:25:08AM L Case ENC2016-00216 rans Du FPSD 7/1/2016 690/2017 Faithful Puc[ Security/De 1012203 JT 2/2/2017 7,000.00 0.00 M0NU 7/1/2016 680/2017 Mon.Seo.DeplO0%ofCdy 101.2203 JT 2/2/ 0)7 6,000.00 0.00 PCll 7/1/2015 6/30/2017 Noo'Dd|Plan Ck/bmp<$ 101.740.4722 JT 2/6/2017 6'580.00 0.00 CASH 7/1/2016 680/2017 Construction Cash Depooi 101.2203 JT 2/6/2017 1,880.00 0.00 AF02 7/1/2016 6/30/2017 PnuU\pyFoe'Majo,'BogE 101.730.4722_ JT 880/2018 403.00 0.00 9CD9 7/1/2016 6/30/2017 Plan Check Deposit 1012203 }T 880/2018 - 0.00 CABl 7/1/2016 68O/20|7 Cooy�udionCash Dep. E |Ol22O3 JT 9/l�2Ol8 0.00 FPSD 7/1/2016 68O/2Ol7 Faithful Per� Sccuzh�/Quf l0>2203 JT 9/17/2018 0.00 CASl 7/}/20]6 6/30/2017 Conu�uctiouCash Dep. D \Ol2203 JT 9/17/2018 0.00 Total Due: $0.00 I t � , I , I � J' 1 I 1 S' i w 1 CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT CLEARANCE FOR FINAL INSPECTION AND ACCEPTANCE LETTER Encroachment Permit#: ENC 2018-00216 Name: The Ridgecrest Group Property Address: Tact 10392 (1323 Parsons Ave.) Date of Final Inspection: On File: Bonds CD Cash eck 5Vl_ Faithful Performance JkmWw. $ 47,000.00 (25% _ $11,750.00) ©� Plan Check Deposit $500.00 V 5�lC: : 3Sr Z Sd Construction Cash Deposit to be released: $1,880.00 Other overdue deposits to be released (Description): Processed by: Administrator Reviewed by: Inspector Reviewed by: � \ n �, 0, p Lan Development Engineer J:UoAnnaT\Deposit refunds\CHECKLISTSTarsons I 323.doe(Rev. 10/1 I) From: Syed Wahidi Sent: Thursday, August 30, 2018 12:10 PM To: Doris Quai Hoi; 'ECCO Builders Inc' Cc: JoAnna Thomason Subject: RE: As built Offsite 1323 parson ave Doris, Street monument was installed. Are we good to release monument deposit? OV•CA., Syed Wahidi A;!P Public Works Inspector City of Campbell . Public Works Department 0 0 70 N. First Street I Campbell,CA 95008 w%vw.citN-ofcam.pbell_com 1 408.866.2165 From: Doris Quai Hoi Sent: Thursday, August 30, 2018 9:18 AM To: Syed Wahidi; 'ECCO Builders Inc' Subject: RE: As built Offsite 1323 parson ave JoAnna is working on them. From: Syed Wahidi Sent: Thursday, August 30, 2018 8:30 AM To: 'ECCO Builders Inc'; Doris Quai Hoi Subject: RE: As built Offsite 1323 parson ave As builts are good. Doris, shall we process the close out? of•CA,yA Syed Wahidi 41 Public Works Inspector U r City of Campbell I Public Works Department 0 o 70 N. First Street'I Campbell,CA 95008 s� G` www.cityofcam belLcom 1408.8Ei6.?165 From: ECCO Builders Inc [mailto:omid(&eccobuilders.com] Sent: Wednesday, August 22, 2018 11:03 AM To: Syed Wahidi Subject: FW: As built Offsite 1323 parson ave Syed: Attached find the as build plans. I will provide you with a hard copy as soon as it is ready. omid 2 aEcr v b - Print Form CITY OF CAMPBELL ENCROACHMENT PERMIT Permit No [C0— 02_t OCT, 27 2�'1'6 for working within the public X-Ref.File — DEPT.OF PUBLIC WORKS v Q� 70 North First Street right-of way) Application Date Campbell,CA 9500Public Works Adrriin1St%pq 2, i Application Ex irat Date ,�r P� Ph. (408)866-2150 APN ` � — Fx. (408)376-0958 Wance Permit Expiration DateL.JAPPLICATION-Application is hereby made for a Public Works Permit in Campbell Municipal Code,Section 11.04. (Application expires in six (6) months if the permit is not issued. Application Fee is non-refundable.) A. Work Address or Tract No.: ��,3qZ % .M 3 &6- a✓is Ave Utility Trench Location: B. Nature of Work: 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 apart 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 any work. Name of Applicant: �� A® /-r,&t /,2" Telephone: Address: 2�!`��J �a� HIf 5:4,"f6 ( q y`;wcb, E-Mail Address: ��q�� HOUR EMERGENCY PHONE NUMBER: HAn l" �°n�c:T' Is this work being done by the property owners at their own residence? r YES �r NO The Applicant/Permittee 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 Applicant/Permittee 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 arisingout of r ate improvements in the public right-of-way. Accepted: 61^,C> -!�Tk4 "ti-V'j' , (Applicant Permittee) (sign) Date (Contractor) (Print Name) Date SPECIAL PROVISIONS: 1. Street shall not be open cut for underground installations. Minimum cuts may be allowed for connections or exploration holes. Such cuts maybe specifically approved by the Inspector prior to cutting. 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 the Engineer. 3. Workto 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. _X-4. Per Section 4216 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 R E T !O. PERMIT APPLICATION FEE $ e s PLAN CHECK DEPOSIT $ SECURITY FOR FAITHFUL PERFORMANCE/LABOR&MATERIALS $ CONSTRUCTION CASH DEPOSIT $ PLAN CHECK&INSPECTION FEE $ EMERGENCY PERMIT FEE $ APPROVED FOR ISSUANCE 6 �:5W__ Z For City Eligineer Date Permit Expires 12 Months After Date of Issuance GENERAL PERMIT CONDITIONS 1. A Construction Cash Deposit is required. Charges will be made against this deposit if there is an emergency call-out,overtime inspection or when City ordered barricading is required. Any such costs in excess ofthe deposit will be billed to the Permittee. 2. A one-year maintenance period and surety are required. Such period will begin on date of written acceptance by the City. 3. Refund or the cash deposit balance and 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(ten)days prior to proposed start of work.Special provisions may be required for work within City facilities and downtown Campbell. S. 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,bus stops,fire hydrants,and water valves. 7. A Construction Traffic Control Plan and a Construction Schedule are required for all lane closures,detours,and street closures.This plan must be reviewed and approved prior to any lane closures. 8. A Construction Traffic Control Plan shall conform to the Caltrans Manual of Traffic Controls for Construction and Maintenance Work Zones,dated 1990,available at Caltrans.Traffic control equipment shall include Type II flashing arrow signs if required. 9. 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. 10. Sawcut for all PCC or AC removals. All PCC removals shall be to the nearest scoremark and shall be doweled to existing improvements. 11. 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. 12. Adequate signing and barricading is required on thejob site. Failure to provide such signing and barricading may result in the City's providing signing and barricades and charging the cost(including all labor and materials)against the cash deposit. 13. Compaction testing of subgrade,base rock,and asphalt concrete by Permittee is required unless otherwise stated by the City Engineer. 14. The Contractor or Permittee will have a supervisory representative available for contact on the project at all times during construction. Contractor or Permittee shall provide a phone number at which they can be contacted outside the hours of 8:00 a.m.to 4:00 p.m. 15. No storage of materials or equipment will be allowed near the edge of pavement,the traveled way,or within the shoulderline which would create a hazardous condition to the public. 16. 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. 17. This permit does not release the Permittee from any liabilities contained in other agreements or contracts with the City and any other public agency. 18. This permit is not transferable. Work must be performed by the Permittee or his designated agent or contractor as specified thereon. 19. Call back(call out)due to emeregencies regarding this permit shall be at the current overtime rate with a three(3)hour minimum charge per occurrence. 20. 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. 21. 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. 22. Permitttee must provide advance notification to all parties that may be affected by the permit activities. Notification shall be reviewed by the City prior to distribution and include dates of work and a contact name and phone number. Applicant shall be responsible for ensuring that all those providing services under the applicant are aware and understand all of the above conditions. Applicant Date: 17 Contractor (Print Name) Date: J:\FORMS\Templates\Encroachment Permits\Encroachment Permit STATIC form2.pdf Rev.02/14 r ; y .. ti4 - f t _ a Syed Wahidi From: Doris Quai Hoi Sent: Tuesday, May 09, 2017 8:22 AM To: Syed Wahidi Subject: RE CNN Parsons Am Yes. Usually during design, I like to have this on the SI Plans. But since he didn't get back to me, and I needed to issue the permit, I just used the generic information "street tree". I sent him a set of plans with the permit stating that you will be calling him for the species type. You should have the SI plans, please write the species type so you know since the developer is unaware. Thanks, Doris From: Syed Wahidi Sent: Tuesday, May 09, 2017 7:12 AM To: Bob Siudzinski Cc: Doris Quai Hoi Subject: RE: 1323 Parsons Ave Thx Bob. Doris, did you ask Bob for it? Syed Wahidi I Public Works Inspector City of Campbell I Public Works Dept. syedwQ)cityofcamr)bell.com 408.866.2165 I AR 408.376-0958 70. N.First Street I Campbell,CA 95008 www.CityofCampbell.com From: Bob Siudzinski Sent: Monday, May 08, 2017 1:29 PM To: Syed Wahidi Cc: Doris Quai Hoi Subject: 1323 Parsons Ave Hi Syed, A 15 gallon NRinu- ame:ricana 'Autumn purple' Ash tree is the best fit for the site. I apologize for the late notice. Thank you, Bob 1 ACC? CERTIFICATE OF LIABILITY INSURANCE 7�/18/2017 TE(MMIDD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Leslie Brown Moore & Miller Insurance RECE►�/E® PHONE (831)462-6900 X108 Fa (831)462-3884 C A/C No Ext: A!X No 3333 Soquel Drive E-MAIL ADDRESS:leslie@inooremiller.com JUL 20 2017 INSURER(S)AFFORDING COVERAGE NAIC# Soquel 95073 INSURERA:Gemini Insurance Co. INSURED orksAdministration INSURERB:Nationwide Mutual Insurance Cc 23787 Mello Pipelines, Inc. INSURERc:State Compensation Insurance Fund 260 McGlincey Lane INSURER DAmerican Contractors Indemnit I INSURER E: ' Campbell CA 95008 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1771808131 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. NOTWITHSTANDING 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 POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER - LTR TYPE OF INSURANCEINSQ.-Mk POLICY NUMBER MMIDD/YYYY) (MM/DDIYYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE ❑X OCCUR DAMAGE TO RENTED - 000 PREMISES Ea occurrence $ r _ X Contractual Liability X "GP022066 12/1/2016 12/1/2017, MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000, _ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑ PRO- JECT 7 LOC PRODUCTS-COMP/OP AGG $ 2,000,00d OTHER: $ AUTOMOBILE LIABILITY O aBINEDtSINGLE LIMIT $ 1,000,000 (EaB ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED ACP7854805179 12 1 2016 12/1/2017' BODILY INJURY Per accident $ AUTOS AUTOS / / ( ) X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS. Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ i DED RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY YIN I STATUTE ER ANY PPOPRIETOn/PAk'(NER/EXECUTIVE I— E.L.EACH ACCIDENT ,s 1,000,000 OFFICER/MEMBER EXCLUDED? NIA _11 C (Mandatory in NH) 909655517 B/1/2017 8/1/2018 E.L.DISEASE-EA EMPLOYE $ 1,000,OUO I If yes,describe under — DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ 1,000,000 D Contractor's License Bond 9055069 8/9/2017 8/9/2020 Bond Amount $12,500 D Contractor's License Bond 9055068 1/31/2017 1/31/2020 Bond Amount $15,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The City, the City of Campbell Redevelopment Agency, its officers, employees and volunteers are named as additional insured with respect to liability arising out of autos owned, leased hired or borrowed. This insurance is primary. There will be ten (10) days notice of cancellation for non payment of premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Campbell THE EXPIRATION) DATE THEREOF, NOTICE WILL BE DELIVERED IN 70 North First Street ACCORDANCE WITH THE POLICY PROVISIONS. Campbell, CA 95008 AUTHORIZED REPRESENTATIVE ` Leslie Brown/LB ©1988-2014 ACORD CORPORATION. All rights reserved.. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(201401) 2 Iu`-Z-C _ REED & GRAHAM, INC. TAG No: J07870 CONTRACTORS LIC. C12-158410 AMENA ROAD OILS-ASPHALTS-OVERKOTE PRODUCTS IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII IIII IIIIIIIIIIIII 690 SUNOL STREET - SAN JOSE,CA 95126 ME sr - ezeze 1 TELEPHONE(408)287-1400 FAX(408)294-3696 WEIGHED k WWW.RGINC.COM 690 SUNOL STREET CUSTOMER: WEIGHMASTER CERTIFICATE K&M ASPHALT MAINTENANCE THIS IS TO CERTIFY that the following described unted (011031) SPECIALISTS, INC. commodity asteras ,ghee signature measured or his by ma weighmaster,whose signature is on this 14897 LOS GATOS ALMADEN RD. certificate,whoisarecognozed authority of LOS GATOS CA 95032 accuracy,as prescribed by Chapter 7(commencing r with Section 12700)of Division 5 of the California Business and Professions Code administered by JOB NO.: the Division of Measurement Standards ofthe 9295 California Department of Food and Agriculture. JOB DESC.: PEARSON AVE -CAMPBELL REED &GRAHAM, INC. WEIGHMASTER PURCHASE ORDER: CUSTOMER TRUCK: XJOSE ESPINOSA R&G JOB NUMBER: 3913135 R&G TRUCK NO.: RG-11388 DEPUTY WEIGHMASTER TARE IN: 10:09AM -03/19/2018 GROSS TONS 23.1 0 LOAD OUT: 10:13AM -03/19/2018 TARE TONS 10.43 JOB LOADS JOB TONS NET TONS 12.67 DAILY 1 12.67 TOTAL 1 12.67 DRIVER- ON DESCRIPTION UOM QUANTITY PRICE TOTAL ASPHALT 1/2 MEDIUM TON 12.67 ABOVE LINE CONY. TO METRIC TONS MT 11 .49 BROKEN AC-TEN WHEELER MIS 1 .00 WARNING THE ABOVE Products may contain chemicals which are RECEIVED BY: X known to the State of California to cause CUSTOMER COPY* cancer,birth defects or other reproductive harm. CA Health&Safety Code Section 25249.5 SAN JOSE PLANT GILROY PLANT. i+'sp]'�2y8 18 READY MIXED / M `�/ 1404 SOUTH 7TH STREET 6475 AUTO MALL PARKWAY \ WARNING o SAN JOSE, CA 95112 GILROY,CA 95020 (408) 848-1560 IRRITATION TO THE SKIN AND EYES ACCOUNTING: (408) 947-0669 Contains Portland Cement.Wear Rubber Boots and Gloves.PROLONGED CONTACT MAY ❑AI-171'CONCRETE CAUSE BURNS:Avoid Contact with Eyes and Prolonged Contact With Skin.In Case of FAX: (408) 947 0434 MORGAN HILL PLANT Contact With Skin or Eyes,Flush Thoroughly With Water.It Irritation Persists,Get DISPATCH: (408,) 947-0159 199 MAST S'T. Medical Attention.KEEP CHILDREN AWAY,. FAX: (408) 947-0193 MORGAN HILL,CA 95037 SOLD TO: (408)779-2520 SHIP TO: TIME FORMULA LOADSI2E YARDSORDERED USE DRIVER/TRUCK MAPCOORDINATE PLANT TRANSACTION# DATE CHARGE C.O.D. LOAD# YARDS DEL. BATCH# WATERTRIM SLUMP TICKET NUMBER ,t PROPERTY DAMAGE RELEASE WEIGHMASTER CERTIFICATE Excessive Water is Detrimental to Concrete Performance (TO BE SIGNED IF DELIVERY TO BE MADE INSIDE CURB LINE) Dear Customer-The driver of this truck is presenting this RELEASE to you for yuur'signature is of the opinion THIS IS TO CERTIFY that the fOlI0WI0 described COt11� H 0 Added B Re t/Authorized B that the size and weight of his truck may possibly cause damage to the premises and/or adjacent property g O a y Q nes y it he places the material in this load where you desire Lift is our wish to help you in every way that we can, ,mOdlty Was Weighed,measured,Of Counted by a but order to do this the driver is requesting that you sign this RELEASE relieving his and his supplier from any responsibility from any damage that may occur to the premisses and/or adjacent property,buildings, �Welghmaster,.whose signature IS on this Certificate,Who GAL sidewalks,drive-ways,curbs,etc.,by the delivery.of this material,and tnbt you also agree to help him IS a recognized authority of accuracy,as prescribed b remove mud from the wheels of his vehicle so that he will not litter the public street.Further,as additional U Y Y p y CONCRETE is a PERISHABLE COMMODITY and BECOMES the PROPERTY of the PUR- consideratlon,the undersigned agrees to indemnity and hold harmless the driver of tmstruck and this supplier Chapter 7(commencing with section 12700)of Division CHASER WHEN TRUCK IS LOADED.ANY CHANGES or CANCELLATIONS of ORIGINAL for any and all damage to the premises andter adjacent property which may be claimed by anyone to have INSTRUCTIONS MUST he TELEPHONED to the OFFICE BEFORE LOADING STARTS. arisen out ni delivery of this order.Jurisdiction and Venue:Sellerand Buyer agree that exclusive jurisdiction and 5 Of California Business and Professions Code,admID15- venuearisingoutof and related to the subject matter of this credit application and any sale of goods from Seller to The undersigned promises to pay all costs,including reasonable attorneys'fees, tered by the Division of Measurement Standards of the Buyer shall lie in the Superior Court of the State of California, otSanta Clara. - incurred in collecting any sums awed. SIVED California Department Of Food and Agriculture. All COD-s not.paid at time of delivery will be charged a$50.00 Service Charge and bear interest at the rate of 10%per annum. r r r r WEIGHMASTER Not responsible for Reactive Aggregate or Color Quality.No Claims For Such Allowed Unless Made at Time Material is Delivered. r r A$50.00 Service Charge and Loss of Cash Discount will be Collected on all Returned LOAD RECEIVED BV: Checks., XExcess Delay Time Charged®S2.00/per minute QUANTITY CODE DESCRIPTION UNIT PRICE EXTENDED PRICE *THERE WAS NO CONCRETE OR CEMENTITIQUS MATERIAL LEFT IN STREET OR STORM DRAIN BY STAR CONCRETE X `( RETURNED TO PLANT. LEFT JOB FINISH UNLOADING DELAY EXPLANATION/CYLINDERTEST TIMEALLOWED 1.JOB NOT READY 6.TRUCK BROKE DOWN 2.SLOW POUR OR PUMP 7.ACCIDENT - 3.TRUCK AHEAD ON JOB 8.CITATION - i 4.CONTRACTOR BROKE DOWN 9.ADDRESS LEFT PLANT ARRIVEDJOB STARTUNLOADING 5.ADDED WATER 10.OTHER TIME DUE } ADDITIONAL CHARGE 1 ERROR IN PRICE,EXTENSION AND ADD ITION SU BJECTTO COR RE TIO N. TOTAL ROUND TRIP TOTALATJOB. UNLOAD TIME DELAYTIME ADDITIONAL CHARGE 2 sn PUMPER COPY SUGGESTIONS FOR PLACING CONCRETE SLAB TO MINIMIZE RANDOM CRACKING WHAT YOtJ .DO WHY YOU DO IT SI hP 1. Level and compact sub grade, place 4" of STEP 1, The sand provides a cushion for the concrete darnp sand and grade so concrete and good drainage. poured is a consistent depth. 12. STIT2 ST E 1 . Separate your new concrete from all. The felt separates your new concrete from. existing concrete with 1/2" felt. Felt must existing, so it may shrink, expand, move Lip match the depth of your new slab. or down without a detrimental affect. S1 L.11 3. Screen Off your concrete. S TFP3. Make sure there are no low spots. s rip 4. Roller bug your concrete. STI P4, Once over the surface, it helps vibrate, con- solidate and give you a better finish. Float concrete wilth wood bull float ST1,P 5. STIT 5. t only. Wood keeps the surface open and allows the concrete to bleed preventing water entrapment and discoloration and/or plastic cracking. Cut control joints perpendicular frorn edge S1 1"P 6. These joints should allow the concrete to crack 1,14 the depth of the slab, using appropriate in the joint taking the path of least resistance. spacing, 4" slab would b� 8'x.8'. f FP 7. Allow all bleed water to evaporate from the STEP 7. If you do not wait for all bleed water to surface, then you can finish the concrete evaporate, you end tip troweling your bleed with metal trowels. water back Into the surface, dramatically changing your water/cement ratio, on the surface, causing a weaker surface. When surface is finished,spray with a concrete This protects the concrete from wind, heat cure., if the concrete is colored you must use a and allows your slab to cure on its own cure formulated for colored concrete. giving you a much better finished product. STEM Never add water or drycement to the STEPQ. These two things also change water/cement In surface of your slab. ratio on the surface and can ruin your slab. SOLD BY: MILPITAS MATERIALS COMPANY WEIGHED/ - MEASURED AT-.1 125 N. MILPITAS BLVD. MILPITAS, CA 95035 '1,,0 1:="*'�I,' PHONE: 408-262-0656 510-656-2619 650-969-4401 TRUCK# T DRIVER FAX: 408-942-0826 ;''. ' , ! ' `-C, WE MAKE ALL DELIVERIES INSIDE CURB AND ON LOT AT CUSTOMERS RISK ONLY TIME LOADED AND ACCEPT NO RESPONSIBILITY FOR DAMAGES RESULTING FROM SUCH DELIVERY. IT IS CUSTOMERS RESPONSIBILITY TO HANDLE THESE MATERIALS SAFELY AND ARRIVE JOB. .•'r, PROPERLY. WARNING: Materials are irritating to the skin and eyes because they contain Portland Cement,so wear rubber boots and START POUR gloves. Prolonged contact may cause burns. Avoid contact with eyes and prolonged contact with skin. In case of contact with skin or eyes flush thoroughly with water. If irritation persists,get medical attention. Precaution must be observed because alkali burns occur with little warning and little heat is sensed. END POUR / tJ WEIGHMASTER CERTIFICATE k r THIS IS TO CERTIFY that the following described commodity was weighed,measured,or counted by a weighmaster,whose signature is on this certificate,who is a recognized authority of accuracy,as prescribed by Chapter 7(commencing with Section 12700)of Division 5 of the California Business and Professions Code, ARRIVE PLANT administered by the Division of Measurement Standards of the California Department of Food and Agriculture. MILPITAS MATERIALS CO. ; WATER ADDED AT JOB: GALLONS DEPUTY WEIGHMASTER CUSTOMER ID PHONE NUMBER JOB/P.O.NUMBER DATE TICKET (i>ii,lit(;!i i (f( " :'i:('; :17e9 04 :•f r: a= 'I (:•'i SOLD TO DELIVER TO +'>: L'I C��.;y:,lY'tG: �. y ,1.91i::1• .'<C�:_. �^ i`•(`'..i(..11``•t . �t�t.... LOAD# SLUMP L f-':N!•:,T EL...i._ QUANTITY QUANTITY PRODUCT PRODUCT UNIT OF UNIT EXTENDED THIS LOAD DELIVERED CODE DESCRIPTION MEASURE PRICE PRICE [:•: t.l fir( ::"u ,,lia .. i' :,t l'q ryl'~I I''�.� ;::��....L..}I'•;i:.0 i .;'i�'I1-7 �."1 d c:..•-_f+„ ��I��1 _}�".fi tr'• Ali� i., ILI'i :L• i;'It;t =l.'; (: l-'.�1. :?TZ fit:?i"1'I :.. ??i� ?•:� ;! is": l u I(117 ;j>; c.7 o Iffil1 STAND BY TOTAL MINUTES ALLOWED MINUTES CHARGED MINUTES SUB TOTAL CHARGE @ 0171MINUTE I buyer fails to a the amount owed when due,buyer agrees to a month) service charges equal to 11 2%per z I.F;, 'r _, SALES TAX Y PY Y 9, PY Y 9 q month (18%per annum)of the outstanding balance of principal due as liquidated damages. A SERVICE CHARGE of$20 will be charged on any returned check. Necessary ATTORNEY FEES,COLLECTION AND SUIT COSTS will be STAND BY charged on any unpaid bills. Milpitas Materials will not be held liable or responsible for the removal or replacement of any material once it is accepted and placed at the'obsite. OTHER our%=1\/GI'1 RV• A TOTAL �� "G 2 sf No. 5528073 WEIGHMASTER CERTIFICATE THIS IS TO CERTIFY that the following described commodity was weighed,measured,or --_ counted by a walghmaster,whose signature is on this certificate,who Is a recognized PLANT LOCATION authority of accuracy,as prescribed by Chapter 7(commencing With Section 12700)of 1 - 12100 STEVENS CANYON RD,CUPERTINO CA 95014 STEVENS CREEK QUARRY,INC. 2-1275 ANZAR RD,SAN JUAN BAUTISTA CA 95045 MAILING ADDRESS: 12100"STEVENS CANYON ROAD 6-55 HILLSDALE AVE, SAN JOSE CA 95136 CUPERTINO, CA 95014 7-SHERIDAN ROAD/MISSION ROAD, SUNOL, CA 94586 PH (408)253-2512 FAX(408)257-4614 8-501 CARL DR.,SUNNYVALE CA 94089 CUSTOMER: CUSTOMER NO: CUSTOMER COPY CHARGE ACCT CHARGE Weighed At: Weighmaster VISA/MASTERCARD/DISCOVER/AMEX 1 DIANA LOPEZ ORDER P.O. TRUCK CODE PRODUCT DESCRIPTION VENICE S10933 ALDAZ TRKING (ED) #2S #2 STONE METRIC POUNDS TONS Gross: 32.01 70560 35.28 Scale 1 Deliver To: VENICE TILE &MARBLE Tare: 14.58 * 32140 * 16.07 " HAYDEN SARJI 408-452-1.114. Net: 17.43 38420 19.21 ARMEN ODESHO *Predetermined Tare Loads Today: 3 Acc. Amount: 63.16 Unit Price: 35.00 Warning:This product may contain crystalline silica.Crystalline silica is a Subtotal: 672.35 common naturally occurring mineral found in sand and rock.Prolonged and repeated breathing exposure may and are known to the State of Freight: 0.00 Califomia to cause respiratory and other health problems including lung Tax: 60.51 disease and cancer that may result in permanent injury or death. 12/1/2017 1:39:OOPM Total: 732.86 DRIVER ON AT GROSS AND TARE WEIGHMASTER CERTIFICATE 1 00 0WN THIS IS TOCERBFY that the following described commodity was weighed,measured,or No 5532185 counted b a wet hmasler,whose signature is on Oils cerfificale,who Is a recognized ■ authority of accuracy,as prescribed by Chapter 7(commencing with Section f 2700)of _, PLANT LOCATION 1.-12100 STEVENS CANYON RD,CUPERTINO CA 95014 STEVENS CREEK QUARRY,INC. 2-1275 ANZAR RD,SAN JUAN BAUTISTA CA 95045 MAILING ADDRESS: 12100 STEVENS CANYON ROAD 6-55 HILLSDALE AVE, SAN JOSE CA 95136 CUPERTINO, CA 95014 7-SHERIDAN ROAD/MISSION ROAD, SUNOL, CA 94586 PH (408)253-2512 FAX(408)257-4614 8-501 CARL DR.,SUNNYVALE CA 94089 CUSTOMER: CUSTOMER NO: ORIGINAL CHARGE ACCT CHARGE Weighed At: Weighmaster VISA/MASTERCARD/DISCOVER/AMEX 1 DIANA LOPEZ ORDER P.O. TRUCK CODE PR;DUCT DESCRIPTION VENICE S3888 RICKY LOK TRKING CORI .75C 3/411.COARSE DRAIN ROC METRIC POUNDS TONS Gross: 35.87 79080 39.54 Scale 1 Deliver To: VENICE TILE& MARBLE Tare: 14.22 * 31360 * 15.68 * HAYDEN SARJI 408-452-1114 Net: 21.65 47720 23.86 ARMEN ODESHO o- *Predetermined Tare Loads Today: 2 Acc. Amount: 35.96 Unit Price: 21.00Naming:This product may contain crystalline silica.Crystalline silica is a Subtotal: 501.06 ommon naturally occurring mineral found in sand and rock.Prolonged nd repeated breathing exposure may and are known to the State of Freight: 0.00 alifomia to cause respiratory and other health problems including lung Tax: 45.10 Jisease and cancer that may result in permanent injury or death. 12/13/2017 9:19:OOAM Total: 546.16 DRIVER ON AT GROSS AND TARE Refundable Deposit Check Request To: Finance Director I� Check Payable To: The Ridgecrest Group \ Address - Line 1: 2898 Joseph Ave. I City: Campbell State: CA Zip: 95008 Description: 1323 Parsons, Tract#10392 Account Number: 101.2203 Amount: $27,750.00 Account Number: 101.2203 Amount: Account Number: 101.540.7448 Amount: (Finance Dept only) Interest Earned (Finance Dept only) Total Payable: (Exact Amount) Purpose: _ Monumentation and remaining 25% FPS Refunds Permit#: ENC2016-00216 1 Receipt#: -269M )(A `1344 Date: le/2-MG4,6- I ' Receipt#:. 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Checked by: S.R. E-MNL.: SMPENGINEERS@ z - ":", - Il 'l i PlHoo'com m w (A SMP Job No. 215091 No. Revision Date By Chkd POROUS AC PAVEMENT FOR COMMON LOT DRIVEWAY REVISED TO 8/4/d'201 7 S. R. PERVIOUS PAVERS, PER DEVELOPER