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Home My WebLink AboutENC2013-00047 Print Form CITY OF CAMPBELL R-1 ENCROACHMENT PERMIT Permit No. Ffi\l C 26B 3"'CJGO � 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 3h2- Campbell,CA 95008 / 3 Application Expiration Ph.(408)866-2150 ISSUED: 31 ( 2—/1 Date - )Z Fx.(408)376-0958 Permit Expiration Date: 24 LZ/f APN Cl/ q -I-- 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 1 o &. S u YO/ S L B. Nature of Work: 11S}-"NA yiCC 1_ .,NeY di C� 1�viaUj) ('�' per^ S h C. Attach three(3)copies of a drawing showing the location,extent and mensions of the work. The drawing shall show t e relation of the proposed work to existing improvements. When approved by the City Engineer,said drawing become a part of this permit. D. All work shall conform to the City of Campbell Standard Specifications and Details for Public Works Construction;the General Permit Conditions listed on the reverse side;and the Special Provisions for this permit,listed below. Failure to abide by these conditions and provisions may result in job shutdown and/or forfeiture of Faithful Performance securities. NAME OF APPLICANT: Telephone: (2 )Z7 2-f-3 Address: y� E-Mail Address: J-/L e-e_ 2-3 7 Z> Y/7/reel& C.e /si 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 the have read and understand both the front and back of this permit,and that they will inform their contractor(s)of the information. u� ACCEPTED: 3 (Applican /Permittee) (Sign) 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 4215 of the Government Code this permit is not valid for excavations until Underground Service Alert(USA)has been notified and the inquiry identification number(Ticket No.)has been entered hereon. USA Phone: 1-800-227-2600. Ticket No.: Applicant is advised that upon issuance of this permit,property owner,or property owner's successors,shall be responsible for any and all damages arising out of the design,installation or condition of private improvements in the public right-of-way. SPECIAL PROVISIONS 1. Prior to any work,the property owner shall execute an Agreement for Private Improvements in the Public Right-of-Way,which shall be recorded. 2. 3. STANDARD AMOUN RECEIPT NO. SECURITY FOR FAITHFUL PERFORMANCE (100%Of Engr's Est.) $ �j R-1 PERMIT FEE $ APPROVED FOR ISSUANCE: 3(1 24 3 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. The Permittee must request in writing a final inspection and acceptance of the work upon completion. Acceptance by the City will be made in writing to the Permittee. 5. Maintain safe pedestrian and vehicular crossings and free access to private driveways,fire hydrants and water valves. 6. Replace as directed by the City Engineer any damaged or removed improvements in accordance with City Standards and Specifications at the sole expense of the Permittee. 7. Sawcut for all PCC and AC removals. All PCC removals shall be to nearest scoremark and shall be doweled to existing improvements. 8. Adequate signing and barricading is required on the job site. Failure to provide such signing and barricading as specified by the City Engineer may result in the City's providing such signing and barricades and charging the cost to the Permittee. 9. The Contractor or Permittee will have a supervisory respresentative available for contact on the project at all times during construction. 10. This permit shall be kept at the site of work and must be shown to any authorized representatives of the City of Campbell or any law enforcement officer upon demand. 11. No storage of materials or equipment will be allowed near the edge of pavement,within the traveled way,or within the shoulderline, which would create a hazardous condition to the public. 12. This permit 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. 13. This permit does not release the Permittee from any liabilities contained in other agreements or contracts with the City and any other public agency. 14. This permit is not transferable. Work must be performed by the Permittee or his designated agent or contractor as specified thereon. 15. Prior approval of inspector is required for any work done after normal working hours,on weekends or holidays and may require reimbursement of inspection costs at the current overtime rate. 16. Call back(call out)due to emergencies regarding this permit shall be at the current overtime rate with a three(3)hour minimum charge per occurrence. 17. If the public interest requires a modification of,or a departure from,the plans and specifications,the City shall have the authority to require or approve any modification or departure and to specify the manner in which the same is to be made for City-owned or maintained facilities. 18. Pursuant to Chapter 14.02 of the Campbell Municipal Code,applicant shall not cause to be discharged any material into the municipal storm drain system other than storm water. Applicant shall adhere to the BEST MANAGEMENT PRACTICES established by the Santa Clara Valley Urban Runoff Pollution Prevention Program. Applicant shall be responsible for ensuring that all those providing services under the applicant are aware of and understand all of the above conditions. 7-'3' 3/(2-72-1 i nt Date J:\FORMS\Templates\Encroachment Permits\R-1 Encroachment Permit STATIC form2.pdf Rev.3/10 State Farm General Insu____ _.e Company A Stock Company With Home Offices in Bloomington, Illinois DECLARATIONS PAGE AMENDED MAR 26 2012 900 Old River Rd. Policy Number 05-D6-6272-8 Bakersfield, CA 93311-6000 Addl Insured-Sections I & II Policy Period Effective Date Expiration Date AT1 K-02-2302-F163 H F 12 Months JUL 5 2011 JUL 5 2012 000682 0046 The policy.period begins and ends at 12:01 am HARVEY KWONG LEE AND IRENE standard tme at the residence premises. KAY LEE, TRUSTEES OF THE HIL-99 TRUST DATED 12/18/99 PO BOX 23472 W. SAN JOSE CA 95153-3472 Named Insured LEE, HARVEY K & IRENE PO BOX 23472 SAN JOSE CA 95153-3472 0 0 0 (9 il (Os HOMEOWNERS POLICY Automatic Renewal - If the policy period is shown as 12 months, this policy will be renewed automatically subject to the premiums, rules and forms in effect for each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee/Lienholderwritten notice in compliance with the policy provisions or as required by law. Location of Residence Premises Your policy is amended MAR 26 2012 710 W SUNNYOAKS AVE 1ST MORTGAGEE LOAN NUMBER CHANGED CAMPBELL CA 95008-6065 1ST MORTGAGEE NAME/ADDRESS CHANGED This policy does not provide coverage for loss by earthquake This policy includes Building Code Upgrade Coverage of$ 52,600 Coverages & Property Limits of Liability Inflation Coverage Index: 289.5 SECTION I Deductibles -Section I A Dwelling S 526,000 All Losses $ 1,000 Dwelling Extension up to S 52,600 B Personal Property 5 394,500 C Loss of Use Actual Coss Sustained SECTION II L Personal Liability $ 100,000 (Each Occurrence) Damage to Property In case of loss under this policy, the deductibles will be applied of Others $ 500 per occurrence and will be deducted from the amount of the M Medical Payments to loss. Other deductibles may apply -refer to policy. Others (Each Person) $ 1,000 Loss Settlement Provision (See Policy) Endorsement Premium NONE Al Replacement Cost - Similar Construction B1 Limited Replacement Cost - Coverage B Discounts Applied: Home Alert Forms, Options, & Endorsements Home/Auto Homeowners Policy FP-7955.CA CA Utility Rating Cr Coy 'A' Loss Settlement FE-5363 Claim Record Seepage or Leakage Exclusion FE-5400 $5,000 Fungus (Intl Mold) Limt FE-5427 Motor Vehicle Endorsement FE-5452 Amendatory Debris Removal FE-5480 Fungus (Including Mold) Excl FE-5424 Telecommuter Coverage FE-5831 Mandatory Reportng Endorsement FE-5801 Other limits and exclusions may apply- refer to your policy Your policy consists of this page, any endorsements and the policy form. Please keep these together. FP-7018C Continued on Reverse ST1833 2 51 Al 650-697-3100 EHNCHAN 20 N Prepared MAR 27 2012 555-7020 CA 555-7020.1 Rev.10-2002 (o1f039fc) CONTINUED FROM FRONT S Forms, Options, & Endorsements Loan#8000966435 Policy Endorsement FE-5320 MortFREMONT 8ae BANK Registered Domestic Partnrship FE-5383 ITS SUCCESSORS AND/OR ASSIGNS Lenders Loss Payable 438-BFU.NS PO BOX 7295 Jewelry and Furs $2,500 Each Option JF FREMONT CA 94537-7295 Article/$5,000 Aggregate Increase Dwlg Up to$ 105,200 Option ID Ordinance/Law 10%/$ 52,600 Option OL Additional Insured Option AI 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. Important Notice . . . California law requires us to provide you with information for filing complaints with the State Insurance Department regarding the coverage and service provided under this policy. Complaints should be filed only after you and State Farmeor your agent or other company representative have failed to reach a satisfactory agreement on a problem. Please forward such complaints to: California Department of Insurance Consumer Services Division 300 South Spring Street Los Angeles, CA 90013 Or call toll free 1-800-927-HELP o1f0396g Rev.09-2005