92-138
..l"l'Y U.' CAKPULL
DE:Y1'. ':' PUBLIC WORKS
70 North First st.
Campba11, CA 95008
(408) 866-2150
OWNER OCCUPIED R-l
ENCROACHMENT I-ERMrT
(for working in the
public right-of-way)
($2,500 MAXIMUM VALUE OF WORK)
Permit No.
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X-Ref. file
Application Date ",,3/2. \/4 '2-
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Application expires in 3 mos.
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 permit not pUlled)
A. Work address I 3'? bO'il CS;S;-I t-J) IHJ. C I4V1A..fJ 81:(( :
B. Nature of work: W I D~A.I D~~UEw~ jj-p~(!)t'-l+ .L. PL*-E ~tJ PtPE. /1\1 fiP;eo/!KfId
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 1IIprov_enta. When approved by
the City Engineer, said drawing become. a part of this permit.
Telephone:
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D. The General Conditions for all permits are listed on the reverse side.
this permit are listed below. Failure to abide by the.e condition. and
job shut-down and/or forfeiture of Faithful Performance surety.
Name of Applicant oR 0 8-F; t<- ,( 'S' u S ~A/ -f<.. / /lJ 6-
j3! G <;H~~I rew AU C!...A-wtp 8U--L-
Special Provisions for
provisions may re.ult in
Address
Complete and attach Workers' Compensation and Contractor Information forma.
The Applicant/Permittee hereby agrees by affixing their .iqnature to this permit to hold the City of
Campbell, its officers, agents and employees fre., safe and harmle.s from any claim or demand for
damages resulting from the work covered by this permit.
The Applicant/permittee hereby acknowledges that they are the owners and occupants of the address
listed above, or are providing services for the owner occupant.
The Applicant/Permittee hereby acknowledges that they have read and understand both the front and back
of this permit, and that they will inform their contrac:tor(s) of the information.
ACCEPTED ~ol"lla P ~ 3 -(8 - 9 z..
APPl~Ca~(permit~rint!Sign Date
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NOTES: ALL WORK SHALL CONFORM WITH THE ATTACHED, APPROVED PLANS AND ALL APPLICABLE CAMPBELL STANDARD
DETAILS AND CONDITIONS.
THE CONTRACTOR MOST HAVE THIS PERMIT AND APPROVED PLANS AND MUST ARRANGE TO MEET WITH THE P.W. INSPECTOR
ON THE SITE AT LEAST TWO DAYS BEFORE STARTING WORK.
NOTICE MUST BE GIVEN TO THE P.W. INSPECTOR AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK.
SPECIAL PROVISIONS
5URETY FOR FAITHFUL PERFORMANCE
(loot OF ENG. EST.)
AMOUNT
$ .3000, ro
RECEIPT II
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303Sg.5C)7
~PPROVED FOR ISSUANCE
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for.City Eng neer
<-)- (~ 9z-
Date
Permit expires 6 months after date of issuance.
-. PW PERMIT
~evised 10/91
(SEE OTHER SIDE)
/3g~ tfllt5"FFIc=LC
PER/-'7/T 92-/3/1
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BOND NO.30388307
PREMIUM:$100.00
Fidelity and Deposit Company
HOME OFFICE OF MARYLAND BALTIMORE, MD. 21203
License and/or Permit Bond
KNOW ALL MEN BY THESE PRESENTS:
That we, 00 00 __ n~_Q~.~.Rn.~.!~.~n.~.~_Qn_~.~~_~~.n~!~.~....m.._....__.___nn....m......__.n.n...n.._._ _____.m.nn.mn_.___n.__.n.._.._.____.._...m.,
as Principal, and FIDELITY AND DEPOSIT COMPANY OF MARYLAND, incorporated under the laws of the
State of Maryland, with principal office in Baltimore, Maryland, as Surety, are .held and firmly bound unto
nnn~_rLY._.QE...9.~~?.~~.~~.m.m_.n__..__m.._.m...mm.nnmm.....n._.mm...m.______..._.__nnn.m__._.__..mmn.n._....____m.' as Obligee,
in penal sum of nmIHBEE..IHOU.s.AND.__AND._NOL.l0D.::::.7_::::_7.::::.7.::::.7_::::_7_::.C$.3...0JHJ.,_ Q!J.}_..n.n...._____. 0000_00' Dollars,
lawful money of the United States, for which payment, well and truly to be made, we bind ourselves, our heirs,
executors, administrators, successors and assigns, jointly and severally, firmly, by these presents.
WHEREAS, the above bounden Principal has obtained or is about to obtain from the said Obligee a
license or permi t for_.mI;;NC.8QAC.Ht~1J;t-nnJ}LA_C.C.QB.QANC.f;mWJIti._.C_8MJ?~f;_LJ,.n~.UN1CJJ?8.1,.___CQ.o.!;mS.E;CIWNn1J . 04
.m.mmmm___.n.__m_.n..m.m....mm_mmmn___mm_....._.__mnm.; and the term of said license or permit is as indicated
opposite the block checked below:
o Beginning the....mm._.mm_m...n_m____....day ofm....______.....n.mm.m_nm.u____....19_mm.' and
ending the..nn..nnnn.m_...m.....m_.._.day ofn..n..nnn..........nm._._.nn..nn.n.19._______.
!Xl Continuous, beginning them_.......m.._1ZIHmmm...nday of..__..___AEBI.Lnm._mm._..___.mm19nS2n'
WHEREAS, the Principal is required by law to file with_.....___._mmm.n.nm_________.._.__.__.__mm.m.......______m'mm...
___00... 00 _. 00... _ neLI-Y. .OE. .-CAMP.BELL. n__.n..n.. moo .00_00 ._______ 00 00 __0000.00__...... _ ___.._.. nn ""00 00'00" _............ ____. _ __ 00 _. "00'" ...... ... m _ _. 00 ._._..
a bond for the above indicated term and conditioned as hereinafter set forth.
NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH, That if the above
bounden Principal as such licensee or permittee shall indemnify said Obligee against all loss, costs, expenses
or damage to it caused by said Principal's non-compliance with or breach of any laws, statutes, ordinances,
rules or regulations pertaining to such license or permit issued to the Principal, which said breach or non-
compliance shall occur during the term of this bond, then this obligation shall be void, otherwise to remain in
full force and effect.
PROVIDED, that if this bond is for a fixed term, it may be continued by Certificate executed by the
Surety hereon; and
PROVIDED FURTHER, that regardless of the number of years this bond shall continue or be continued
in force and of the number of premiums that shall be payable or paid the Surety shall not be liable hereunder
for a larger amount, in the aggregate, than the amount of this bond, and
PROVIDED FURTHER, that if this is a continuous bond and the Surety shall so elect, this bond may
be cancelled by the Surety as to subsequent liability by giving thirty (30) days notice in writing to said Obligee.
Signed, sealed and dated the...m.__mn____.?DIH.m__m.n._.n_mmm.day oLn....1\P'RIL._.m_n__...mm...m........19.S2._.
ROGER KING
Principal
J519-7M,4-74 195249
Formerly G117J
By.. 00 .sn n..__..nn..nn.n...m...n.... '_"00 _.....m....m....m..n.......n
FIDELITY ANDB:_:~~#.-~~--::-~~2j.7-~-:-----__---1
CHRISTOPHER J. BUCKLE A~;~eY-in-Fact
/
Power of Attorney
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
HOME OFFICE, BAL TIMORE, MO,
KNOW ALL MEN By THESE PRESENTS: That the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, a corporation of the
State of Maryland, by C. M. PECOT, JR. , Vice-President, and C. W. ROBBINS
Assistant Secretary, in pursuance of authority granted by Article VI, Section 2, of the By-Laws of said Company, which
reads as follows:
"The Chairman of the Board, or the President, or any Executive Vice.President, or any of the Senior Vice. Presidents or Vice. Presidents
specially authorized so to do by the Board of Directors or by the Executive Committee, shall have power, by and with the concurrence of the Secretary
or anyone of the Assistant Secretaries, to appoint Resident Vice.Presidents, Assistant Vice. Presidents and Attorneys.in.Fact as the business of the
Company may require, or to authorize any person or persons to execute on behalf of the Company any bonds, undertakings, recognizances,
stipulations, policies, contracts, agreements, deeds, and releases and assignments of judgements. d~crees, mortgages and instruments in the nature of
mortgages, . . . and to affix the seal of the Company thereto."
does hereby nominate constitute and appoint Christopher J. Buckley of San Francisco, Cal ifornia..
Its true and lawful agent and Attorney-in-Fact, to make, execute, seal and deliver, for, and on its behalf as surety, and as
its act and deed: any and all bonds and undertakings.................................... ~
And the execution of such bonds or undertakings in pursuance of these presents, shall be as binding upon said
Company, as fully and amply, to all intents and purposes, as if they had been duly executed and acknowledged by the
regularly elected officers of the Company at its office in Baltimore, Md., in their own proper persons.
This power of attorney revokes that issued on behalf of Christopher J. Buckley, dated,
June 3, 1976.
A ITEST:
e
'~~~
STATE OF MARYLAND t
CITY OF BALTIMORE } SS:
On this 6 th day of June ,A.D. 19 86, before the subscriber, a Notary Public of the State of Maryland, in
and for the City of Baltimore, duly commissioned and qualified, came the above-named Vice. President and Assistant Secretary of the FIDELITY AND
DEPOSIT COMPANY OF MARYLAND, to me personally known to be the individuals and officers described in and who executed the preceding instrument,
and they each acknowledged the execution of the same, and being by me duly sworn, severally and each for himself deposeth and saith, that they are
the said officers of the Company aforesaid, and that the seal affixed to the preceding instrument is the Corporate Seal of said Company, and that the
said Corporate Seal and their signatures as such officers were duly affixed and subscribed to the said instrument by the authority and direction of the
said Corporation.
IN TESTIMONY WHEREOF, I have hereunto set my
The said Assistant Secretary does hereby certify that the aforegoing is a true copy of Article VI. Section 2, of the By. Laws of said Company, and is
now in force.
IN WITNESS WHEREOF, the said Vice. President and Assistant Secretary have hereunto subscribed their names and
affixed the Corporate Seal of the said FIDELITY AND DEPOSIT COMPANY OF MARYLAND, this ---......___~~.\:1______..._____..day
of .._____........:J\m~....................m......... , A.D. 19...~.~..
_H______He_~~~=~=SIT:~MP-A~Ye.~ARY~----
A$.SUtant Secretary ~
d affixed by OffiCial Seal, at the City of Baltimore, the day and year irst above wntten.
N~~~-Ex~i'~;.J;;iy'..j~...i~.~Q.
CERTIFICATE
I. the undersigned, Assistant Secretary of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, do hereby certify that the original Power of
Attorney of which the foregoing is a full, true and correct copy, is in full force and effect on the date of this certificate; and I do further certify that the
Vice. President who executed the said Power of Attorney was one of the additional Vice. Presidents specially authorized by the Board of Directors to
appoint any Attorney.in-Fact as provided in Article VI, Section 2 of the By.Laws of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND.
This Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the FIDELITY AND
DEPOSIT COMPANY OF MARYLAND at a meeting duly called and held on the 16th day of July, 1969.
RESOLVED: "That the facsimile or mechanically reproduced signature of any Assistant Secretary of the Company, whether made heretofore or
hereafter, wherever appearing upon a certified copy of any ~ower of attorney issued by the Company, shall be valid and binding upon the Company
with the same force and effect as though manually affixed. ' 20TH
IN TESTIMONY WHEREOF, I have hereunto subscribed my name and affixed the corporate seal of the said Company, this........__......_____. day
APRIL 92
of .................................................. , 19..........
LJ42&-C.f. 0 1 6
FOR YOUR PROTECTION LOOK FOR THE F&D WATER~1ARK
(
CITY OF CAMPBELL
70 NORTH FIRST STREET
C AMP BEL L. C A L I FOR N I A 9 5 0 0 8
(408) 866-2100
FAX # (408) 379-2572
Department: Public Works
August 26, 1992
Roger & Susan King
1386 Sheffield Avenue
Campbell, CA 95008
SUBJECT: FINAL INSPECTION AND ACCEPTANCE
PERMIT NO.: 92-138
LOCATION: 1386 SHEFFIELD AVENUE
BOND: FIDELITY AND DEPOSIT COMPANY
BOND #30388307
Dear Roger & Susan King:
We have made a final inspection of subject Public Works construction and find it
acceptable and in conformance with City standards. Accordingly, we will recommend the
acceptance of the work to the City Engineer.
You are responsible for the maintenance, repair and/or replacement of all work done
should any failures occur within one (1) year of this date.
We hereby release your faithful performance bond. Please feel free to call me at (408)
866-2165 if you have any questions.
Sin~~.._../ ~
Hen~'a
Public Works Inspector
~
HI/lr
cc: 0/ King
Maintenance Division
Bond Company
Suspense - 1 year
f:92-138
/
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
100 First Street, Suite 1700
San Francisco, CA 94105
(415) 896-0701
RECEIVED
MAR 3 1993
Public Works I EngineerinSl
NOTICE OF CANCELLATION
OBLIGEE:
CITY OF CAMPBELL
Department of Public Works
70 N. First Street
Campbell, CA 95008
Date: MARCH 1, 1993
The undersigned Surety upon a certain Encroachment bond in your favor as
follows:
Principal:
Roger King and Susan King
1386 Sheffield Avenue
Campbell, CA 95008
Bond No: 30388307
Amount of Coveraxe: $3,000.00
Effective Date: April, 17, 1992
and covering Roxer Kinx and Susan KinX hereby notifies you that it desires
to cancel and does hereby cancel said bond as an entirety.
Such cancellation to become effective April 17, 1993.
This notice is given to you in accordance with the cancellation provision
contained in said bond.
CITY OF ~LL, CITY ENGINEER'S ~ICH ESTI~TE PERMIT 00.
Pdress /..58(:;' 5,4' ~ F.F IE <' S A iJ( l1f /\.L:::... /
date
~_ ~ c~
<:;.) -
EA@ $2200.00 =$
LF @ $10.00 =$
LF @ $2.00 =$
EA@ $200.00 =$
=$
LF @ $70.00 =$
LF @ $00.00 =$
EA@ $1750.00 =$
EA@ S2500 .00 =$
EA@ $750.00 =$
=$
TOTAL ESTI~TE $
USE FCR IDD $ ~/ C}V' 00
!Uiace Ca"stru:tilJ'l
Clearirg & Gn..tbirg LUIp 9.m Est illBte
Scw:ut Ccrcrete /r- LF @ *$4.50
Ccrcrete Rarcval //2- SF @ *$3.50
Qri) & QJtter Rarcval 20 LF @ *$5.50
Inlot Drain with Pipe I EA@ $600.00
Qri) & QJtter Z~ LF @ $16.00
Sidewalk SF @ $4.50
Driveway Aj:proach ZY7 SF @ $6.00
Hlrdi~ Rarp EA@ $475.00
Extn..d:d a.rb EA@ 10.00
Barri ca:le LF @ $60.00
Street ExcavatilJ'l SF x ($0.12) x (
Ie. PllIIBIB1t SF x (0.35) x (
Adjust Mlrhole to Grade EA@ S425 .00
Adjust Ha-dlole to Grade EA@ S325 .00
Mcn.nEnt Box W/MaUIe1t EAiil $700.00
Street Tree (15-galllJ'l) EA@ t'3SO.oo
PllIIBIB1t Stripirg ($100nin) LF @ $ .75
PllIIBIB1t Legerds ($100nin) EA@ $50.00
Step, Street Nale other Si91 EA@ $140.00
PllIIBIB1t Marker EA@ $17.00
PllIIBIB1t Key CUt LF @ $10.00
!Uiace Slbtotal 'OS"
Adjust for size: "5" > $1oo,lXXl,slbtract 10X
Street Li!iltil'll
Electrol ier
CaliIi t
Carl.r::tor, pei r
Pull Box
Storm Drail'1a!:le
12- or 15" RCP
18" or 21" RCP
Street Inlet
Mlrhole
Break & Enter Mlrhole
revi sed 3m.
F:carost
=$ -----
=$ b7.5O
=$ 3Q2, f'O
=$ /'7U.Cru
=$ ~<JO.a Q
=$ ~II~.GJ
=$ ----
=$ ~ <::/.;;:3-- /' .>
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'.PAoOuclmi ..
A4U~I!It.}eeR'I"IFlqAmEf4)fINS"R-'CE)
<.: ISSUE DAT! (..../OO/VV)
,............'....,.,....,'....'n
..::,::'.:.::::<,:.:.,...".,,::::',::::::'::,:::: II In., I' 011
.......',...... ,..........
......-....... ....-..................
b~~FERS NO RIGH+~ I~~~'NU T~~ ~Efrfl~lt'A"r~'HOLDER. THIS c~~~Tc:~f
DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
POLICIES BELOW.
Compro Ins Services Inc
550 South Winchester Blvd
PO. Bax611090
Sin Jose, CA 95161-1090
408-236-3000
Cot.FANIES AFFORDNG COVERAGE
Trln~Dortltion Insurlnce
CA 95008
:~;;'" ,", ...\..;.......:....... GE;~.:<:><(tfttt})t{)j{it~(ff{j r:U:WL:;tt:t .................w......... ....,... -.. . ::>>}:??{:~:}~:::::::}::~:::~:: {fWtXdi@j}t ;;:::;:::;:~::::~~~::~~:~~r~~L~~~;~~~~;~:D~:~!;!;;;;~;;; ... .. :::;.....:. ;:;:;:;:!:;:;:;:;:;:;:;:;:;:;:;:;:::;:;:;{:
'T'HisisTO"CERTFVTHA.'ti'HE'POi:ICiES OF INSUR ANCE LIST ED BELOW HAV'EBEEN ISSUED TO T HE INSURED NAMED ABOVE FOR 'THE 'POLICYPERiOD
INDICA TED, NOTWITHST ANDING ANY REOUIREMENT, TERM OR CONDIT ION OF ANY CONTRACT OROTHER DOCLMENT WITH RESPECT TO WHICH THIS
CERTlFICA TE MAY BE ISSUED OR MAY PERT AIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO All THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, lMITS SHOWNMAY HAVE BEEN REDUCED BY PAlO CLAMS,
co TYPE Ol' IoISUAANCE POLICY NUMBER POLICY Un!CTIVE POLICY I!XPIAATIOI\
In LIMITS
DATI! (..../OO/YY) DAT! (..../OO/VV)
Gl!Nl!RAl. llABLITY GENERAL AGGREGA IE . 500000
B =xl C(Mo.1ERCIAl GENERAL lIABllIIY 206951500 8/01/91 8/01/92 PROOUCTS-ClJ,1P/OP AGG, . 500000
,Lilli I CLAIMS MADE Q OCCUR PERSONAL & A[W INJURY . 500000
P OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE . 500000
fiRE IlAMAGE (Any 0'. lire) . 50000
MEO. EXPENSE (Any 0.. pmo, . 5000
AUTOhlOBLI! lIABLITY CMINEO SINGLE .
- LIMIT
A1 ANV AUTO 906951502 8/01/91 8/01/92 500000
All OWNED AUTOS BODILY INJURY .
- IPer person)
SCHEDULED AUTOS
-
1 HIRED AUlDS BOOlY INJURY .
1 NON-OWNfD AUlDS (P.r .ccidenll
- GARAGE lIABILITY PROPERlY llAMAGE .
I!XCI!IIlIABLITY EACH OCCURRENCE .
=1!MBREllA fORM AG6REGA IE .
OIHER THAN !MBREllA fORM ..........,.,......~
WORKER'S CO_ATION I STATUIORY lIMIIS
A AND WC307829080 3/31/91 3/31/92 EACH ACCIDENT . 1000000
DISEASE-POLICY LIMIT . 1000000
I!hFl.OYI!RS'lIABLITV orSEASHACH EMPLoYEE .
OTHER
DESCRPTION Ol' OPI!JlATIONSII.OCATIONIIVl!HIClI!$lSPI!CIAl. ITI!h41
RE: ALL OPERATIONS PERFORMED BY THE NAMED INSURED
THIS INSURANCE IS PRIMARY WITH THE CITY OF CAMPBELL AS EXCESS ONLY
CERTIFICATE HOLDER}'
City of Campbell
70 N, First Street
Clmpbel I. CA 95008
. ,.~~~9,*l..A'I1g~. . ...,.........'.....'... ...//.i.....,::{::::::{ ,...,....'....... "'"
SHOULD ANY OF T I-E: ABOVE DESCRIBED POLICiES BE CANCEllED BEFORE THE
EXPIRATION DATE THEREOF. THE ISSUING COMPANY Will ENDEAVOR TO
MAil 30 DAYSWRITTENNOTICE TOTHECERTIFICATE HOlDERNAMEDTOTHE
lEFTBUTFAllURE TO MAIL SUCH NOTICE SHAll MPOSE NO OBLIGATION OR
... LIABILITY OF ANY KIN() UPON THE COMPANY,ITSAGENTSOR REPRESENT A liVES,
A:~~b~~$~;l.~~ii.~
M]$WZtWWMM1iM;wll.~~a.;:~;iM;~;~~=;;~:;