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CITY OF CAMPBELL R-1 ENCROACHMENT PERMIT Permit No. gtsk. 2cd4 •voa i 0
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 II( [tit
Campbell,CA 95008 VC
/ ` Application Expiration I,
Date
Ph.(408)866-2150 ISSUED: /
Fx.(408)376-0958 Permit Expiration Date: I! . I 5 APN Lk°3 t Coot
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: �� �7
/ t o/ll'rd /ed
B. Nature of Work: /e,'iovGE ` iIcca,LG,1 t. Q/'1 vQ(l, /i,S/c/' c way
C. Attar h three(3)copies of a drawing showing the location,extent and dimensions of the work. The drawing shall show the rel,,tion of
the proposed work to existing improvements. When approved by the City Engineer,said drawing becomea 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: ` N Telephone: L1O8'_ 3 - a3
t-Z:7 ��
Address: I K L Po L t a-01_ Pot
E-Mail Address:
The Applicant hereby confirms that this work is being done by the property owner/applicant at their own residence.
The Applicant hereby acirees by affixing their signature to this permit to hold theCity of Campbell,City of Campbell Redevelopment Agency,its
officers,agents,and employees free,safe and harm less 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. �. n ACCEPTED: I
��( Lt/►.� �-�t�(�C,(. " (Q - 1 Y
(Applicant/Permittee) (Sign) V Date
NOTES: Alt 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 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 isadvised 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. 11„9"-ee/nep.1 CCvdteet
2.
3.
STANDARD AMOUNT RE( EIPTNO.
SECURITY FOR FAITHFUL PERFORMANCE (100%Of Engr's Est.) S
R-1 PERMIT FEE S [0
APPROVED FOR ISSUANCE: 1/O14
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 corn pletion 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 rem oveand 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 thework 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 Cam pbel 1.
S. The Perm ittee must request in writing a final inspection and acceptance of the work upon corn plet ion. 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 Perm ittee.
8. Sawcut for all PCC and AC removals. All PCC removals shall beto nearest scorem ark 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 theCity's providing such signing and barricades and charging the cost to the Perm ittee.
10. The Contractor or Perm ittee will have a supervisory respresentativeavailable 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 shoulder)ire,
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 Pennittee of any obligation to obtain any other permit
required by law.
14. This permit does not release the Perm ittee from any liabilities contained in other agreements or contracts with the City and any other
public agency.
15. This permit is not transferable. Work m ust 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 beat 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 ensuring that all those providing services under the applicant are aware of and understand all of the above
conditions.
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Applicant Date
J:IFORMS\Templates\Encroachment Permits\R-1 Encroachment Permit STATIC form2.pdf
Rev.03/13
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�l11NGaRRNCE`' FARMER S
FARMERS NEXT GENERATION HOMEOWNERS POLICY DECLARATIONS
MID-CENTURY INSURANCE COMPANY, LOS ANGELES, CALIFORNIA HOMEOWNERS
A Stock Company Replaces all prior Declarations,if any
TRANSACTION TYPE: AMENDED DECLARATIONS EFF: 10/13/2 013
The Policy Period is effective as shown below and after the time for which applied.
POLICY NUMBER ! POLICY PERIOD POLICY EDITION ISSUING OFFICE:
FROM: TO: STANDARD TIME 23175 NW Bennett St.
93670-16-21 10-13-2013 10-13-2014 12:01 A.M. 03 Hillsboro, OR 97124
This policy will continue for successive policy periods, if: (1) we elect to continue this insurance, and (2) if you pay the renewal premium for each
successive policy period as required by our rates,rules,forms and premium plans then in effect.
NAMED INSURED AND MAILING ADDRESS: LOCATION OR DESCRIPTION OF RESIDENCE PREMISES:
LAURA JANE SCHIRLE I R LE (Same as mailing address unless otherwise stated.)
1449 POLLARD RD,
CAMPBELL CA 95008-6311
COVERAGES-We insure you for the coverages and limits indicated as covered by a specific limit or other notation.Those Section I-Extensions of
Coverage and Section II-Liability Extensions of Coverage that are not shown below apply as described in the policy.
SECTION I-PROPERTY SECTION II'-LIABILITY
A-DWELLING B-SEPARATE STRUCTURES C•PERSONAL PROPERTY D -LOSS OF USE E PERSONAL LIABILITY F MEDICAL PAYMENTS TO OTHERS
Each Occurrence Each Person
$272,000 $27,200 $204,000 $108,800 $300,000 $1,000
SECTION I-EXTENSIONS OF COVERAGE SECTION Il-LIABILITY EXTENSIONS
OF COVERAGE ANNUAL
EXTENDED REPLACEMENT CONTENTS REPLACEMENT BUILDING ORDINANCE PREMIUM
COST COVERAGE A COST COVERAGE C OR LAW IDENTITY FRAUD COVERAGE PERSONAL INJURY LOSS ASSESSMENT
$68,000 COVERED 10% $30,000 NOT COVERED NOT COVERED $614.49
ENDORSEMENTS
ENDORSEMENT NUMBER EDITION NUMBER DESCRIPTION
258531 1012 CALIFORNIA NOTICE OF INFORMATION PRACTICES
DISCOUNTS
AUTO/HOME, NON SMOKER, AND EXPERIENCE RATING PLAN DISCOUNTS HAVE BEEN APPLIED TO YOUR
POLICY.
DEDUCTIBLES POLICY ACTIVITY
Deductible applicable to each covered loss:
$ Previous Balance
$1,000
Premium ANY 'TOTAL' BALANCE OR
Fees* CREDIT 57.00 OR LESS WILL
BE APPLIED TO YOUR NEXT
BRING. BALANCES OVER
Payments or Credits 57.00 ARE DUE UPON RECEIPT.
Total* INSURED PAYS
*SEE ADDITIONAL FEE INFORMATION BELOW
This Declarations page is part of your policy. It supersedes and controls Countersignature
anything to the contrary. It is otherwise subject to all other terms of the policy.
,g5---)
AGENT: KEVIN W. CROWLEY I/It
•
AGENT PHONE: (408) 782-1233 AGENT NUMBER: 9 6 63 37 8 Authorized Representative
56-5479 5TH EDITION 10-11 9 3 6 7 0-16-21 (Continued on the Reverse Side) 08-28-2013 (5479511
Additional Premises Section II-Liability Coverage.Purpose of use is residential,unless stated otherwise.
MESSAGES
INCLUDES 10% BUILDING ORDINANCE COVERAGE (CALCULATED AS A PERCENTAGE OF COVERAGE
A OR B) AS APPLIED PER THE POLICY.
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.
ASK YOUR FARMERS AGENT ABOUT FLOOD INSURANCE.
INSURED PAYS PREMIUM.
IN THE EVENT OF A LOSS, AT ANY TIME, CALL US AT 1-800-HELPPOINT (1-800-435-7764)
MORTGAGEE OR OTHER INTEREST: ADDITIONAL MORTGAGEE OR OTHER INTEREST:
}. , MORTGAGEE DEDUCTIBLE CLAUSE
THE FOLLOWING PROVISION APPLIES ONLY IF A MORTGAGEE IS NAMED IN THE POLICY:
FOR ANY LOSS IN WHICH ONLY THE MORTGAGEE'S INTEREST IS ADJUSTED AND SETTLED,NOT INCLUDING
ANY INTEREST YOU MAY HAVE IN THE PROPERTY OR LOSS,THE APPLICABLE DEDUCTIBLE WILL BE THE
SMALLEST OF THE FOLLOWING AMOUNTS:
1. THE DEDUCTIBLE STATED IN THE DECLARATIONS OR RENEWAL NOTICE,OR
2. $1,000.
THE POLICY DEDUCTIBLE STATED IN THE DECLARATIONS OR RENEWAL NOTICE WILL APPLY TO
SETTLEMENT OF ANY INTEREST YOU MAY HAVE IN THE PROPERTY OR LOSS.
Additional Fee Information
The "Fees" identified in the "Policy Activity" section above apply on a per-policy, not an account basis. The following
additional fees also apply.
In consideration of our agreement to allow you to pay in installments,the following service fee(s)will apply:
For the Monthly Recurring Electronic Funds Transfer (EF1) and fully enrolled in on-line billing (paperless)
option,a service charge of$0. 00 per installment is applied per account.
For other Monthly EFT payment plans,a service charge of$2. 00 per installment is applied per account.
For all payment plans other than those listed above, a service charge of$5. 00 per installment is applied per
account.
If your account is for the payment of premiums on more than one policy, any change in these fees will not be effective
until the updated service fee information is provided for each of the policies.
In addition,the following fees also apply:
LATE FEE:$10. 00 (applied per account)
RETURNED PAYMENT CHARGE:$25. 00 (applied per each check, electronic transaction or other
remittance which is not honored by your financial institution for any reason including but not limited to
insufficient funds or a closed account)
REINSTATEMENT FEE:$25. 00 (applied per policy)
One or more of the fees or charges described above may be deemed a part of premium under applicable law.
56-5479 5TH EDITION 10-1 I [5479512
FARMERS.
UR N FARMERS®
REGARDING YOUR POLICY NUMBER: 93670-16-21
NOT AN ADVERTISEMENT-PLEASE READ CAREFULLY
RECONSTRUCTION COST AND YOUR COVERAGE A(DWELLING)AMOUNT
This document contains important information about your insurance coverage. Please review this
information carefully.
Do You Think You Have Enough Coverage?
Your policy provides $2 0 4 per square foot to rebuild your home. (This does not include any additional amount
added by extension or endorsement to your policy.)
Farmers® uses an estimating program, and information provided and /or confirmed by you to assist in calculating a
• reconstruction cost estimate for your home. This is an estimate,not a guarantee of reconstruction costs. You can use
this estimate as a guide to help you choose the amount of coverage you want for your home. Please review this
estimate to make sure the details about your home are correct. Let me know if you want to change any of those
details or if there is anything unique about your home that would affect the estimate. Feel free to contact me at any
time if you want to make a change to the amount for which your home is insured.
Your reconstruction cost estimate includes the estimated cost categories described at a) through e) below:
Amount for which your home is insured(Coverage A) $ 272,000
a. Cost of labor, materials, and supplies $ 177,580
b.Architect's Fees and Permits $ 8,705
c. Contractor Overhead and Profit $ 50,347
d.Demolition and Debris Removal $ 8,339
e. Other Fees and Taxes $ 6,764
Reconstruction Cost Estimate $ 252,000
It's important to understand that reconstruction cost is not the same as the market value of your home.
Reconstruction Cost Market Value
Reconstruction cost is the amount it would cost to Market value is the price a buyer would pay to
rebuild your home if it were destroyed. It includes purchase the home,including the land and
the types of costs noted in categories (a through e) vs. property,in its current condition. It takes into
above. It is not what a buyer would pay for your account changes in the housing market,and the
home,or the amount of your mortgage.It does economy. It does not take into account the cost
not include the value or cost of the land. to rebuild the home.
Do You Need Help?
As your Farmers Agent I am happy to help you with any questions you have. I can provide guidance as to the
coverage options available,but I cannot choose your coverage amounts for you. Ultimately it is your responsibility to
make sure you have purchased sufficient insurance coverage to rebuild your home and replace your personal
property.
If you have questions about your coverage or the estimated reconstruction cost please contact my office,at
4 08-78 2-12 3 3 . As your Farmers Agent,I am committed to providing you excellent service.
Sincerely,
KEVIN W. CROWLEY
25-8860 1-13 (Continued Next Page) A8860201
Questions to consider when you choose how much coverage you want:
• Is the square footage accurate?
• Have you remodeled your kitchen,bathrooms or any other part of your home?
• What is the overall quality of your home? (See the Quality Grade definitions later in this document.)
Information Used to Estimate the Reconstruction Cost of your Home:
Your review of this information should start with comparing your selected Coverage A amount with the
Reconstruction Cost Estimate developed by the estimating program. Keep in mind that the estimate is just that, an
estimate. It is not a guarantee of reconstruction costs. Again, feel free to contact me if you want to make a change to
your Coverage A amount.
ZIP Code: 95008
Year Built: 1954
Square Footage: 1,332
Style or Number of Stories: 1 STORY
Dwelling Quality Grade: STANDARD
Foundation Type: PIER AND BEAM - CLOSED
Foundation Shape: 4-5 CORNERS - SQUARE/RECTANGLE
Property Slope: NONE (0 - 15 DEGREES)
Roof Material: STEEL (TILE OR SHINGLE)
Roof Shape or Type: GABLE
Garage Type: DETACHED
WOOD SIDING, STUCCO ON FRAME
; Exterior Wall Cover:
WOOD FRAMING
Type of Frame:
Average Wall Height: 8 FEET
DRYWALL
Interior Wall Construction Material:
PAINT
Interior Wall Cover:
CARPET, SHEET VINYL
Floor Covering:
Kitchen: 1 STANDARD
No.of Full Baths: 2 STANDARD
No.of Half Baths: NONE
No.of Rooms with Cathedral Ceilings: NONE
No.of Rooms with Coved Ceilings: NONE
NONE
Cooling System:
FORCED AIR
Heating System:
Number of Fireplaces: 1
Basement: NO
Number of Units: 1
25-8860 1-13 (Continued Next Page) A8860202