ENC2014-00198 :Print Form
CITY OF CAMPBELL R-1 ENCROACHMENT PERMIT Permit No.
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 1y 2R
Campbell,CA 95008 ) Application Expiration
Ph.(408)866-2150 ISSUED: �o/ Date L(4 I I
Fx.(408)376-0958 Permit Expiration Date: F— APN
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: 17(�,(o E—N S)EN AC)A DR-
B. Nature of Work: JzGM�y C �� �2-EC-N STIR-U CT DPWt-wAy /'�PI p A- c 1.A
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 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.
rA
NAME OF APPLICANT: � ��� Telephone:
Address:
-Mail Address: e_ UA1'_ � co( ram--� k�
a_ ._.._ _e..._.
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 th y have read and understand both the front and back of this permit,and that they will inform their
contractor(s)of the information.
ACCEPTED: /C / �// �
(Applican /P a (Sin 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 hours before restarting any work.
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(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
recorded.
2.
3.
STANDARD _AMOUNT RECEIPT NO.
SECURITY FOR FAITHFUL PERFORMANCE (100%Of Engr's Est.) $ 200(, ZS S'?I�
R-1 PERMIT FEE $ —APPROVED FOR ISSUANCE: ' r i'
for City Engineer Date
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 responsib a for ensuring that all those providing services under the applicant are aware of and understand all of the above
conditions.
Applicant Date
J:\FORMS\Templates\Encroachment Permits\R-1 Encroachment Permit STATIC form2.pdf
Rev.02/14
r•
Homeowners Policy Evidence of Insurance
AAA Northern California,Nevada&Utah Insurance Exchange
P.O.Box 22221,Oakland,CA 94623-2221
NAMED INSURED AND MAILING ADDRESS HOMEOWNERS POLICY NUMBER
ZEPEDA MIGUEV ZEPEDA KERI
1766 ENSENADA DR
CAMPBELL, CA 95008 HO -XJ16964
Amended as of:
LOCATION OF PROPERTY(IF OTHER THAN ABOVE) POLICY PERIOD-FROM 03/25/2014 TO 03/25/2015
1766 ENSENADA DR
CAMPBELL, CA 95008 12:01 A.M. Pacific Time.
A Homeowners Policy with a lender's loss payable endorsement
in favor of the mortgagee named below is in force.
DWELLING REPLACEMENT LIMIT: $ $271,900.00 TOTAL ANNUAL PREMIUM: $ 683
❑x HO-3 Homeowners Policy-Special Form 0 Paid in Full, Date 03/25/2014
❑x Policy Deductible: $1,000.00 El HO-28 Limited Home Replacement Cost Endorsement
❑ Other: (150% of Coverage A limit)
MORTGAGE SERVICING COMPANY/MORTGAGEE SECOND MORTGAGEE
RUSHMORE LOAN MNGMNT SVS
ISAOA/ATIMA
PO BOX 692409
SAN ANTONIO,TX 78269
FIRST MORTGAGEE NAME IF OTHER THAN MTG.SVC.CO.
LOAN NUMBER LOAN NUMBER
7600021725
The Policy provides replacement cost limits of insurance for dwellings. It does not cover land. California Civil Code §2955.5 states that
mortgage lenders are prohibited from requiring a borrower to provide insurance with limits that exceed the replacement value of the
dwelling and buildings on the property.
This Certificate of Insurance does not expand, diminish or change any of the coverages, exclusions, terms or conditions of the policy.
The coverages, exclusions,terms and conditions are expressed in the declarations, policy booklet and endorsements.
PREPARED BY BRANCH OFFICE DATE
MARY ANN COLCLASURE WESTGATE OFFICE 10/28/2014
F506(Rev.Dec 2007) COPY-MORTGAGEEITITLE CO.,MAIN OFFICE,INSURED,BRANCH OFFICE [(gmacoIcJ066)10/28/201410:12 AM]
PUBLIC WORKS DEPARTMENT LAND DEVELOPMENT
Effective July 1,2014 �
TO: City Clerk PUBLIC WORKS FILE NO.
PROPERTY ADDRESS -7 '-�Dps-
gy
Please collect&receipt for the following monies:
ACCT. ` ITEM
< - AMOUNT
LAND DEVELOPMENT
.
4722 Encroachment Permit Application Fee
Non-Utility Encroachment Permit Ma'or>_$10 000 $385.00
Minor Encroachment Permit<$1o,000 $220.00
Initial R-1 Permit N/C
Subsequent R-1 Permits within Two Year Period $220.00
Inspection Fee Minimum Charge per Location $385.00
Street Tree Pl anti n /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 Gradinq&Drainage Plan Review
Single Family Lot $270.00
Site<10,000 s.f. $810.00
Site? 10,000 s.f.<0.5 Acre' $1 081.00
Site>_0.5 Acre $1 621.00
4722 NPDES Review C3 Requirements)
For projects not required to submit numeric sizing $156.00
For projects required to submit numeric sizing
Impervious Area 10,000 S . Ft to 1 Acre $676.00.
Impervious Area 1 Acre or more $884.00
4722 For projects sent to Consultant for review Consultant Cost+20%
Plan Check&Inspection Fee(Non-Utility)
4722 En r. Est. <$250 000 14%of Engineer's Estimate
2203 En r. Est.>_$250 000 and<$500,000 $35 000+8%of Engineers Estimate
2203 En r. Est. >_$500 000 $55 000+7%of Engineers Estimate
2203 Ememency 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
(Multi-Res$2 385.00)
All Other$2,650.00
4722 Parcel Ma 4 Lots or Less $3 850.00+$83/lot
4722 Final Tract Ma 5 or More Lots $4 6-8-1-0-0+ 114/lot
2203 Monumentation Security 100%of Cit 's Monumentation Estimate
4920 Parkland Dedication Fee 75%/25% Due Upon Cert.of Occupancy)
4722 Lot Line Ad'ustment Includes Certificate of Compliance) $1 820.00
4722 Vacation of Public Streets&Easements $2 434.00
4722 Certificate of Compliance $1 800.00
4722 Certificate of Correction $540.00
4722 Appeal Filing Fee $200.00
4722 Notary Fee(per signature) $10.00
4722 Assessment Segregation or Reapportionment
First Split $860.00
Each Additional Lot $270.00
5117424 Postage
[VIISCELL4NEOUS
Other Please Specify)
*Engineer's Estimate shall be as approved by the City Engineer and shall include all items of work. TOTAL $
NAME OF APPLICANT 911-ihialid Hee %
NAME OF PAYOR i- ' �—C PHONE
ADDRESS ZIP 0)
FOR RECEIVED BY
CITY CLERK (`,
ONLY Date Recei t# J
Date/.Initials
11FOWSXTamplat.,WdmlolshaS,\R,«ipt F—Lord Development 14-15
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CITY OF CAMPBELL
Public Works Department
January 16, 2020
Mr. Miguel Zepeda
Highland Electrical
Campbell, CA 95008
SUBJECT: PERMIT NO. ENC 2014-00198
1766 Ensenada Dr., Campbell, CA 95008
FINAL INSPECTION AND ACCEPTANCE
Dear Miguel:
The City of Campbell has made the final one year maintenance 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.
If you have any questions, please call me at (408) 866-2165.
Sincerely, .
w _ L
Syed Wahidi
Public Works Inspector
70 North First Street • Campbell, California 95008 .TEL 403.866.2150 • rAx 408.376,0958 TDD 408.866.2790
Encroachment Permit Final Sign Off
Encroachment Permit#
Address:
Date of Final Inspection and Acceptance:
Inspected by: 15W
OK to release deposits: 100% v 7501
Comments:
x
ou.,
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CITY OF CAMPBELL VENDOR NO. 1.0015298 CHECK No. 271388
Amount Descri't�i7n.,
jl 101' 2203 CR122718 2,000.001. - ENC201400198 ENSENADA I
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10015298 HIGHLAND ELECTRIC _ )
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16TIN11.1 gAll 113 1181111 1!• 1
CHECK DATE CHECK NO'.
Q +� CAMPBELL WELAB FARGO HANK. N:A. 11-24 i
3 42b MONTGOMERY STREET 1210 0 1/0.7 19 .�' 2 713$8
70 NOR CH FIRST STREET ' FRANclsco cA 941oa
r* CAMPBELL CALIFORNIA 95008 r j
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AMOUNT * 01
VOID AFTER 90 DAYS
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PAY THY M
E SUM:'OF TWO THOUSAND DOLLARS &. ZERO CENTS WI
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j To mxE FiIGHLANID ELECTRIC r
-w 1766 ,ENSENADA DR �}
UF-
AMPBELL--CA 950Q8 r !.
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*See Reverse Side For Easy Opening Instructions
CITY OF CAMPBELL
7'0 NORTH FIRST STREET
CAMPBELL, CALIFORNIA 95008
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HIGHLAND ELECTRIC '
, 1766 ENSENADA DR.
CAMPBELL CA 95008
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CITY of CAMMPBELL
Public Works Department
January 7, 2019
Mr. Miguel Zepeda
Highland Electrical
1766 Ensenada Dr.
Campbell, CA 95008
SUBJECT: PERMIT NO. ENC 2014-00198
1766 Ensenada Dr. Campbell, CA
FINAL INSPECTION AND ACCEPTANCE
Dear Miguel:
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 December 14, 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.
Your Faithful Security Performance Deposit refund in the amount of$2,000.00 is
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 ENC2014-00198
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: Highland Electric /jl
Address- Line 1: 1766 Ensenada Dr.
Line 2:
City: Campbell State: CA Zip: 95008
Description: ENC2014-00198, Ensenada
Account Number: 101.2203 Amount: $2,000.00
Account Number: 101.2203 Amount:
Account Number: 101.540.7448 Amount:
(Finance Dept only) Interest Earned (Finance Dept only)
00
Total Payable: 00o 0 (exact Amount)
Purpose: _
Permit#: ENC2014-00198
Receipt#: 255899: _. _. _ Date:. _ _ _ 10/29/2014
Receipt#: Date:
Requested by: Title: Inspector Dater�r l
Syed Wahiidi
Approved by: Title: Sr. Engineer Date:
Roger Storz
Finance Dept Only:
Verified by: Title: Accounting Clerk II Date:
Approved by: Title: Accountant Date:
Special Instructions For Handling Check,
Mail As Is: Mail in Attach eck:
Needed By:
Return To: JoAnna Thomason Public Works
(Name) (Department)
CITY OF CAMPBELL
PUBLIC WORKS DEPARTMENT
CLEARANCE FOR FINAL INSPECTION
AND ACCEPTANCE LETTER
Encroachment Permit#: ENC 2014-00198
e
Name: Miguel Zepeda L ����.�,�b Eder C�,A
Property Address: 1766 Ensenada Dr.
Date of Final Inspection: 12/14/18
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:
�1d. inistrator
Reviewed by:
Inspector
Reviewed by:
Land Development Engineer
J:VoAnnaT\Deposit refunds\CHECKLISTS\l Checklist-Final Acceptance.doc(Rev. 10/11)
Encroachment Permit Final Sign Off
Encroachment Permit# �
Address: "l �� y
Date of Final Inspection and Acceptance:
Irnspected.by:
OK to release de osits: 100% 75%
Comments:
JoAnna Thomason
From: Miguel Zepeda <zepeda_m@comcast.net>
Sent: Monday, December 17, 2018 4:33 PM
To: JoAnna Thomason
Subject: Re: Deposit Refund for Driveway Repair
WARNING: This email originated from an external sender!
Can you make it out to
Miguel Zepeda
1766 Ensenada Dr
Campbell CA.95008
Thank you
Highland is no longer available.
Merry Christmas
Sent from my Whone
Miguel Zepeda
Highland Electrical Const.
On Dec 17, 2018, at 3:40 PM,JoAnna Thomason<joannat@cityofcampbell.com>wrote:
Good afternoon, I am processing your deposit refund for the driveway repair work at 1766 Ensenada
Dr. I show the payee as Highland Electrical. I would like to confirm the address of where the check
should be sent to. Should I mail the check to the Ensenada address or is there another address?
Thank you
JoAnna
<image002.png>JoAnna Thomason
Office Specialist
City of'Campbell I Public Works Department
70 N. First Street; Campbell.CA 95008
_,cil.y fic mphe.11.c:c7m 1 408.866.21 50
1
MEMORANDUM CITY OF CAMPBELL
TO: Bill Bruckart, Building Official DATE: 09/02/14
FROM: Roger Storz, Senior Civil Engineer (408) 866-2190
CC:
SUBJECT: BUILDING PERMIT APPLICATION
Site Address: 1766 Ensenada Drive
For File No(s): BLD2014-00841
Project Description: SFR Major Addition
Applicant: Miguel Zepeda
PUBLIC WORKS DEPARTMENT CONDITIONS OF APPROVAL
1. Private Improvements Agreement: The plans as submitted do not show an existing wall /
fence that has been constructed within the public right-of-way along the Rio Serena Avenue
frontage. If the applicant wishes to keep that wall/fence within the public right-of-way, then
prior to issuance of any grading or building permits for the site, the owner shall execute an
"Agreement for Private Improvements in the Public Right of Way". This agreement will also
allow the existing water meter box to remain in the public right-of-way, provided the water
service is not being upsized or upgraded as part of this project.
2. Water Meter: The existing water meter can remain in its current location provided the
service is not being upgraded or modified, otherwise it shall be relocated onto the property
outside of the right-of-way. See previous condition.
3. Driveway: The plan shows a decorative stamped concrete driveway extending into the
public right-of-way up to the existing sidewalk. Revise the limits of the stamped concrete to
the right-of-way line. The existing driveway curb cut is not ADA compliant and needs to be
replaced with a City standard driveway as shown in this detail:
http://www.ei.campbell.ca.us/DocumentCenter/View/2312 This driveway with the deeper
ramp should have the added benefit of reducing any bottoming out of the resident's vehicles.
The owner will also need to replace the damaged sidewalk to the right of the driveway. Prior
to issuance of and grading or building permits for the site, the applicant shall apply for and be
issued an Encroachment permit to construct these driveway and sidewalk improvements.
4. Proof of Ownership: Prior to issuance of any grading or building permits for the site, the
applicant shall provide a current Preliminary Title Report, grant deed, or other satisfactory
proof of ownership.
C:\Users\SyedW\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\NIAFAMTH\Ensenada 1766.doe
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1766 Ensenada Drive (BLD2014-00841)
5. Storm Drain Area Fee: Prior to issuance of any grading or building permits for the site the
applicant shall pay the required Storm Drain Area fee, currently set at$2,120.00 per net acre,
which is $360.40 (set for R-1 land use).
6. Utilities: All on-site utilities shall be installed underground per Section 21.18.140 of the
Campbell Municipal Code for any new or remodeled buildings or additions. Applicant shall
comply with all plan submittals, permitting, and fee requirements of the serving utility
companies.
7. Utility Coordination Plan: Prior to issuance of building permits for the site, the applicant
shall submit a utility coordination plan and schedule for approval by the City Engineer for
installation and/or abandonment of all utilities. The plan shall clearly show the location and
size of all existing utilities and the associated main lines; indicate which utilities and services
are to remain; which utilities and services are to be abandoned, and where new utilities and
services will be installed.
8. Pavement Restoration: Based on the utility coordination plan, the applicant shall prepare a
pavement restoration plan for approval by the City Engineer prior to any utility installation or
abandonment. The pavement restoration plan shall indicate how the street pavement shall be
restored following the installation or abandonment of all utilities necessary for the project.
9. Street Improvements Completed for Occupancy and Building Permit Final: Prior to allowing
occupancy and/or final building permit signoff for any and/or all buildings, the applicant
shall have the required street improvements and pavement restoration installed and accepted
by the City, and the design engineer shall submit as-built drawings to the City.
i
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