88-133
110......
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CITY 0' CA"PU~LL
D~PT. or ~UULIC WOkK~
'0 Nocth 'lc~t it. .
C..pb~ll, CA '~OO'
hOlll IIh-21 ~O
tf3-/3'3
P.c.lt Mo.
l-iter. t 11.
ApplH:atlon O.t. Y - b - l?.?
..plr.. JO' . aol.
I.
~1
PUIILIC WOlt1tS PE1Ut!f
~rlln~ In'TnJ
p~b1lc Cl~ht-ot-w.~1
I;:~:~t~.~~ ~n~~ aOI.
to-
P:
APPLICATIOH - Application ia h.eeby ..d. loe a '~b1Ic Woekl '.e.lt In accordanc. with Caa~b.ll-
Kunh:lpal CQd., i.Ctloll 11.0..
'l'
I
l'
A.
Wock a40re.. oe tract '-1~f:,7 ~ A~.
Ut IUty te.nch loc.tlon u:
Nat~u ot woell:jl~-f'~YA.L..1:A'v1I'-J(, @~~~~~_
AttaCh tlv. e~1 copl.a ot a 4rawlng ahowlni tbe location, e.tent anO 41.enlLonl ot the wOck 2
The drawIng Ihall atlo" the relation ot the propo..d work to ..lltlng l~rtIC. and underground
l.proveaenta. Whln approved by the City tngln..r, aal4 deawing OICO..I a pact ot Chll per.lt.
('.
c
M.
C.
l'
D. The General Condition. tor all pereltl are lilted on the rev.rae 11de. Special Provl.lona tor
thl1 peralt arc lilted below. ta11~rl to abide by the.e condltionl and pcovl.lonl aAY ee.ult
in 10b Ih~t-down and/or torteiture ot r.ltht~l Pertor..nce bond. and ca.h dcpo.it.. iSce
G.neral Condition. I and ~l.
;;-
'\
'\.
I"
E.
r.
;.-
OWnee at thell Own eeildenCel ___y..
CO.plete attaChed Wockee.' Compen.ation and Conteactoc tOI.a.
The Appllcant/~cr.lttec hceeby agr... by affiXing their li~n.ture to thl. per.it to hold the City ot
C...ptlcll. lta; Oltlceca, a'lellt. and ...ploy.e. te.e, liat. and har.le.. It". any cla1a oc dc.alld foc
4...9.:. fe.ultln.,. tCOIII tile work covcreO by thl. peelllt.
The AppllCant/Perlllttee hereby aCknowledge~ ChaC they have r..d and ~nder.tand both the
bacll ot lh~i c.l nd h t they will lntor. thell contracture.) of the lnfoe.atlon.
tI/.O b I!!; ((
IT.
tront and
ALL'WOkK SHALL CON,Ok" WITlt THt ATTACHED, APPkOVtD PLANS AND ALL APPLICAbLl CAKPb~LL
D DkAWINCS AND CONOIT10N~.
Till: CONTkACTOk KUST ltAV~ TillS P~kKJT AND APPkOVt:D PLANS ANlI "UST "t:t:T 1lI1TH THE P.llI. INSi't:CTOk ON
Till: SITE AT Lt:A:OT 'l'WO DAYS 1I~"Okl: STAltTJNG WORK.
NOTICE KU~T bE GIVEN TO PUbLIC WORKS ~T LEAST 2. HOURS b~rOkE RESTARTING ANY WORK.
SPECIAL PROVISIONS
'")
r
-'
_1.
Strect IillAll not be open C~t for ~ndce9round Inlit.llacioni. "Inll1~" Cutl lIay be Illowcd
for connection:> Of caploealion holell. :t~ch Cutli "Ullt be IIfl~cdlcolly opprovcd by the
I "t.r'"Cl lor.
PAVl.e~..y be cut tor undecgrounQ lnlltallationa .nd .~.t be rCllored In accoedanCe wltn
the Utll1ty Thnch Itelitoration Standard Drawing.
W~rk co Uc IItaked by a lLcen.cd Land Surveyor 01 Clvil ~n91n.er and two e21 COple~ ot tile
cut IlIeelll lIenL tQ the I'utllie Work Dc[)t. beturc .tartlng WOCk.
TI~ houri of wor. ace Itaitcd to out.ldc the houri ot 1-~ .... And )-~ p... tor any wor~
aftectlng a Hat.he 1an..(. C' . ,j A
/"1 _4.:.t.-z~ ~
III
c:.
I'
u.:
0;.
I'.
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~
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p-;
-~.
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~~kHIT ~"LIC~TION ,~.
,LAN CUtCK DEPOSIT
..oND rOR rAITlIfUL ~&:RrORKAHCE
,. r. (CASU) Ot~SJT
P~ka17 1'1:1::
ea-ll
e U~.OO 1
,
ST~DAJtD
$~O.OO
$~OO.OO
C100' 0' ENG. tST.1
e., 0.. MONU,$~OO MIMI
0' '.P. ..oNO
H.OO "JNI
AMOUNT
$ :!ic)
, ~o 0
$~~~~OO-
$ O\~. t!H"'t
c nOD)
kt:Ct:JI'T HO.
I S' 3 ~., .r
'I!? S c-j?
~""t1 ......
O~tt c.t..> .
\~,~
{I.
....
~.
..;
APPMOV~D fOR l~SUANCt:
..O(.'f.-f:. C'^-'
.1'1\";;.6<'> 1~''2];
7/2.. u't- 1:.
t: PWPtK'U T
Ii.vla.a "J/b"J
.-~-\~~
CONS~UCTION CO~T ESTIMATE roa PEIlHIT NO. Iy/Date 6.---"2... I - ~
J \ f=-F'-( \....L)a..~ \~-u.....:>r.:::.~\.D~ t-
Name' Addrus \.~~.., C!.L--... ~~~Pk j
Surface Construction
Clearing ADd Grubbing Lump Sum Eati..te · $ \ O~-
Savcut Concrete ~L.F. @ $ 4.00 · $ 'l.~--
Concrete Removal "'1.~ s.r. @ 3.00 . $~
Curb' Gutter Removal 4~ L.r. @ 5.00 · $ 'L'1..t:;:-
Inlot Drab vith Pipe \ EA. @ 500.00 . $ ~~-
Curb ADd Gutter 4~ L.r. @ 15.00 . $ ~~_ *
Sidevalk \~O S.F. @ 3.50 . $ ~"l.S: - _;:1' --"'8f-"
Drivevay Approach 4Sl.. S.Y. @ 5.50 · $1-r-~\-
Handicap Ramp \ EA. @ 1000.00 . $ \ ~~ -
Extruded Curb L.r. @ 6.00 . $ ___
Barricade L.r. @ 50.00 . $ -
W;~r4,t(.~~~a~LA."-t (- S.F.)x($O.lS)x(_"). $ -
A.C. Pavement <Z-iUOf(::)...~ ( S.F.)x($0.4S)lt(\,,") · '$ ""'5l.,-
Adjult Hanhole to Grade 1 EA. @ 300.00 . $ ~,V-\-
Adjust Bandhole to Grade I EA. @ 200.00 . $ "') ~-
Monullent Bolt v Monument I EA. @ 500.00 . $ ~-
Street Tree (15 lallon) ~ EA. @ 200.00 · $ (,,00-
Pavement Striping ($100 ain) L.r.@ 0.65 . $ \~-
Pavement Legends ($100 ain) - EA. @ 40.00 . $
Stop.Street Name or Other Sign EA. @ 120.00 . $
Pavellent Harken 4. EA. @ 15.00 · $ <-6-
ravement lCey Cut ~ 00 L.r.@ 8.00 · $ tz..40~ -
P~\.te""eL..n" Il.eIL>CZ. ~P.:G.,"~ \...-0::; · $ ~-
KoClt! (,JALL .e:.N'lc..JAL L....c::;. · $ 3Elo -
Surface Subtotal "5". $ ,~. (..~, - ''-I ?c,4--
Adjult. for .be: 5<$30.000 add 20%. 5'> $100.000 lubtract 10%
\
Street LiRhting
Electrol1er
Conduit
'G-tlnductor. pair
Pull lox
~e ~l,)..Jo~<"=It:iii
"t.. EA. @ 3000.00
~ L.r.' 12.00
~O L.r.' 4.00
, EA.' 200.00
'-~
Storm Drdnage
12" or 15" RCP L.r.@ 60.00
18" or 21" RCP L.r.@ 65.00
Street Inlet EA. @ 1800.00
\ Manhole EA. @ 2000.00
Ir.ak ADd Enter Hanhole EA. , 600.00
TOTAL ESTIMATE
USE rOR BOND
____6__~ L lac
· $ (.,000-
. $ ~~-
· $ \20-
· $ '1.~ -
· $ \e:;{"~-
. $ --
. $
. $
. $
, . $
. $
$ ~ ~44 -
$ '2..4 \ ~~~-
46/0 a:;o. (YO
/
I t-rn~;{
Date /~o
Address /3'e 17
PUBLIC WORKS INSPECTION REPORT
Permit or Project No. ~-/~~
~4F:
Type of work: Street ,...- Storm
Other (describe)
Sanitary
Electrical
[JPRELIMINARY INSPECTION WITH DEFICIENCY LIST (attached)
[)FINAL INSPECTION WITH DEFICIENCY LIST (attached)
o FINAL INSPECTION - ACCEPTANCE
Signed plan6? Y N (If signed, Council acceptance.)
Charges against deposit? Y
Overtime I hrs. @ $
Date' realion:
N
/hr.
-
$
BArricade rental (attach invoice)? Y N
Date' reason: $
Other? $
$
Total charges deducted from deposit J $
(CAsh Deposit .$ leas charges $ - Refund $ ck. req.)
[JaNE YEAR MAINTENANCE WITH DEFICIENCY LIST (attached)
~ YEAR MAINTENANCE - ACCEPTANCE
(Release'ma1ntenance bond. Check Request if cash.)
.
~n~
~
Inspector
-, J- 13':>
Permit No. ~ ./
Applicant ~ ~~
INFORMATION SHEET FOR PUBLIC WORKS PERMITS
A separate form must be completed for the applicant and each contractor
that will work under this permit.
CONTRACTORS INFORMATION
Note that all contractors must have current City of Campbell Business
License, State Contractor's License and Workers' Compensation Insurance.
}-~Ao.G'\k\ 'Rc13r2J~ P B/\ . .... __ =
Name of Contractor TM ~ f\"\ U Ii OEfl.S it'l/( Telephone 7/V-d61- 7/6:5
Address IO,d;),cO fl.), M~.lJLHJ.M6rt 11U fNIf! C~ Lt f Q(7..7 r~
State Contractor License N04<;?67 b
City Business License No.~-~~D3'8g-'-.
Expiration Date ~- 3l- '6"7
Will do the following types of work:
underground _____P.C. concrete _____A.C. paving _____electrical
other (specify)
WORKERS' COMPENSATION INSURANCE INFORMATION
Name of Contractor/Applicant -/e 'fA:::; Mi. ~1 ~ u / Cd f/1....S /Nc...
One of the following must be on file with the Public Works Department:
A Certificate of Consent to Self-insure issued by the
Director of Industrial Relations; OR
A Certificate of Workers' Compensation Insurance
Insurance co..,-t<~~5' t~N~~Ilf:-Nr:4L Policy No. VJC7oo~::s 5-73(7
Expiration date ---: '-:2 ~ '- __ ; OR
The Certificate of Exemption from the Workers'
Compensation laws printed below (certificate must be
signed) .
CERTIFICATE OF EXEMPTION
I certify that in the performance of the
employ any person in any manner so as to
Compensation Laws of C fornia.
J
work for this permit, I shall not
become subject to the Workers'
Signed
Date C\ \oCt (0~
,
NOTICE TO CONTRAC OR/APPLICANT: If, after signing this Certificate of
Exemption, you should become subject to the Workers' Compensation
provision of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
f:PERMINFO
REV. 11/87
.-, ( f' ,
t, :' i (J \ \.
I J ''4 ',J
I I 1
\ "
)j
---- I ! "7,
, ! l? /'
t
HELMS
.-
.<
CITY OF CAMPBEll
70 NORTH FIRST STREET
CAMPBELL, CALIFORNIA 95008
(408) 866-2100
FAX # (408) 379-2572
WIMBERlY
Public Works
JOCSON
KR1)[,ER
l PE~~~~~~__
Department:
January 8, 1990
Mr. Jim Borden
Jiffy Lube International
23161 Mill Creek Rd., #100
Laguna Hills, CA 92653
RE: One Year Maintenance Acceptance
Permit No.: 88-133
Location: 1387 Camden Ave.
Dear Mr. Borden:
We have made a one year maintenance inspection of subject public
works improvements and find that no maintenance is required.
Sincerely,
Carlos M. Jocson
Associate Civil Engineer
CMJ : sd
cc: G. Eaton
CITY OF CAMPBEll
70 NORTH FIRST
CAMPBELL, CALIFORNIA
(408) 866-2100
STREET
95008
Department:
Public Works
February 1, 1989
Mr. Jim Borden
Jiffy Lube International
23161 Mill Creek Rd., #100
Laguna Hills, CA 92653
RE: Final Inspection and Acceptance
Permit No.: 88-133
Location: 1387 Camden Ave.
Maintenance Bond Amount: $6,125.00
We have made a Final Inspection of subject public works construction and
find it acceptable and in conformance with City standards. Accordingly,
the work is hereby accepted subject to the one-year maintenance
requirement indicated below.
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. To
guarantee this, you must either post a maintenance bond in the amount
indicated above, or maintain your existing faithful performance bond. If
you post a separate maintenance bond, your current bond will be released
by separate action.
We will inspect the work in one year and advise you whether or not
maintenance is needed.
Please feel free to call the undersigned if you have any questions.
Sincerely,
Public
GE:sd
cc: Suspense - 1 year
Date ~/k'
/ I -
Address / .38?
PUBLIC WORKS INSPECTION REPORT
Permit or Project No. '88 "/3:3
~?JE>>
~pe of work: Street Storm
Other (describe)
Sanitary
Electrical
[)PRELIMINARY INSPECTION WITH DEFICIENCY LIST (attached)
[JFINAL INSPECTION WITH DEFICIENCY LIST (attached)
.dJ ~ I~S:,(}~
I
~FINAL INSPE~TION - ACCEPT~
Signed plans? Y ~ (If signed, Council Acceptance.)
Charges AgAinst deposit? Y
Overtime I hrs. @ $
Date 5 reason:
~
/hr.
-
$
ti)
BarricAde rental (attach invoice)? Y
DAte 5 reason:
$
Other?
$
$
Total charges deducted from depositl
(Cash Deposit $ less charges $
$
- Refund $
ck. req.)
[JONE YEAR MAINTENANCE WITH DEFICIENCY LIST (Attached)
o ONE YEAR MAINTENANCE - ACCEPTANCE
(Release'maintenance bond. Check Request if cash.)
Engineer
@r
TO: City Clerk
~CCT~.
35-] 6
3372
3521
3521
3372
( --35-21 )
2373
3373
3373
3373
3373
1180
]373
3373
]520
3372
"172
72
\~J 72
3372
3372
3372
3372
3370
]395
3380
3510
Please collect & receipt
for the following monies:
PUBLIC ~'ORKS FILE NO. 2?g -/3 ~
/387 ~lJ~
AMOUIH
$
R-l: t ~:
($'35) ($ 50)
SOD
Deposit ( % of FPB)
($500 min,)
Plan Check & Inspection Fee 17~ of FPB)
(S35min.)
Other Cash Dep~s i, t ,(seed fy ).:#=2 ~-f'01 ~ GrFY\~' ~_ vfJ.f) "...,,,', ( i /(~. /)()() 0'0
tPPL- (;AQ:/<;;l f' <;.-~
Project Plans & Specifications ($10) C/
General Conditions. Standard Provisions &
Details ($10 or $I/page)
i'No Parking" signs lSI/ea. or S25/100
Work Area Traffic Control Handbook ($S)
T r a ff i c F'I ow Ha '( $ I 0 )
Traffic Data Services' $ O/hr. + material costs
Ma 'Revisions 'to Ha'p Compa'nies ($10)
Co ies of En ineerin Maps & Plans
Fire Hydrant MaIntenance ~195/ea.
. . ,......-..-, ~
Tentative Parcel Fee l$350)
Final Parcel Ha~ Filin Fee ($300)
Tentative Tract' Hap FII ing Fee $ 00
Final'Tract Map FiI in Fee ($3S0) .
Lot Line Ad'ustment Fee/Certificate of Com I iance
Vacation of Pub) ic street's arid Easements
Assessment Segregation or Reapportionment
First Split ($SOO)
Each Additional Lot ($ISO)
Envi ronmenial Assessment: '
Categorical Exemption ($SOO plus actual cost
f Negative Declaration 'above $500)
Storm Drainage 'Are'a Fee per Acre (R-I. $1.875; Mul ti-Res"
$2 060; all other, $2,250)
Park Dedication I~-rieu Fee per Unit
Publ ic Works Special Proj.ects
Pos tage .
ra.- ~ f(~ Lu be..... .
~ /' '
f:) 0 <;"o..",,^ <:- ( -" "- ~
NAME
TOTAL
$ J{) 000, 06
PH:INE ;J...? 'I., 5Y 2.! ' (1~(7Jt.f)Zbl- 7/b3
ADDRESS &> 33 1 ~~ ~ -r C:;L'<-.A.. J;;~ CA
,
ZIP '1' <.)12 ::))
""OR
~ I TV CLERK
ClNLY
RECErPT NO.' ~Ot/..~ ~
AMCU>n' PA I D 10 J cr--o-t). ()-o
'D
RECE lVED BY L -W
DA~ ~/I~/_
I
July, 1907
The
~
Companies
FIDELITY AND DEPOSIT COMPANY OF MARYLAND .
FIDELITY AND DEPOSIT COMPANY dJiL u/.Jlu ~
HOME OFFICES: BALTIMORE, MD. 21203 6'6- / 33
City of Campbell
'O'ffic,e' 'o'f' tit.y. .Cl'erk.............
70 North First Street
. . !'<. I? ~. ~ ~. . . ,~~ .'. . . . . . . . . . . . . . . . . ., 19.?Q.
Campbell, California 95008
h d . . Bond For Faithful Performance d
T e un efSlgned Surety upon a certam ..............,...,.....,............,..,."........ Bon
Overlay A/C Paving At Parson Avenue Frontage For Jiffy Lube At 1387
in your favor as follows: Camden Avenue
PRINCIPAL
BOND No.
AMOUNT
OF
COVERAGE
EFFECTIVE DATE
T M & M Builders, Inc.
30163749
$24,500.
5/3/88
and covering (1) .P.F.~~.~ip.~~. ~ $. .?d,<;lJ.~P,~ .:... .~f.2,Q..W~. .~.c.I)!,!.~~.q~.1:;........................
Irving, California 92714
............................................................................................... .
hereby notifies you that it desires to kJlJIti>>l ~1I:~nd does hereby wmiuratl Q{said bond as an entirety.
cance cance
SUChJtor~1 t~~to become effective (2) .. ~.~~.r.~y.. ~.~Y.~. .<l:~~.l7~.. ~.~~. .~~.<7~.~P.~...........
cance a IOn
of this notice.
"BOND NO LONGER NEEDED."
ACKNOWLEDGED
By:
.............,...............,......................' 9.~ ~y.. ~.~. .C;~?).pp,~~.~..,.,..."..,....,..
XM~K<XH:Kj;~~KX<X)UXlXi>>X1X<X>Xdai~~t%1Kmn>>~"\1iM<>>KiXiJ~Xi>>}f)lQKlX~ll,
cc: Financial Guardian Inc
1177 West Loop South, Suite 1825
Houston, Tx 77027 fi FIDELITY AND DEPOSIT COMPANY OF MARYLAND
o FIDELITY AND DEPOSIT COMPANY
Surety
li.lt~:-<O~~~...
W1tness
C,cJ-Z- {td4~
By,....................................,...,. .
Attorney-In-Fact
. . .. .~ ,.Q , . . ~ P.~. .1 9.Q 4- .8. , . . , . . . . . . . . . . . . . . . . .
Houston, Tx 77224-9048
BIO.
Notice of Cancelation or Termination.
(Branch Office Address)
nDI~I"" A I T^ I"\DII~CC
~ONll rOR FAITHFUL PI';R1"(JI'~.1l\NCr;
KNOW ALL 1,1EN BY TIl~'~SE PRl.~SENTS:
Thill _..,_Lt1_& 11 Bu il der2..,-1D..L-._..__~ Dr;.
Principal, anc1_~.ide12ty and Deposit Company of ~1.aryla~d
incorpOI'ated tllldl'r tllU l,lws uf tho Slale! of r.1aryland
and <mOlor i z(~d to (.X("(;ll\;.(~ bondR and unc1c:rlnld ng~; -'~o'rcSUJ:C'ty. are he lei
alld firmly b0\1n(1 unto the Ci ty of Ci:lmpbe]) t i:l mu,1icip<:l1 corponlt ion of
the State of Cal.ifornia, in t:hl~ sum of lli.e.otyJ.o.u.c_Iho'I"Qnd Fivp HllI1rlrprl
Dollars And No/lOa's
Dollars (S 24.50~L_OlL...-) for the pClyrnont th(;!n:~of. well and truly to be
ll'li'l<1c. Si}j(l princip;l] nn<1 Suret.y bind themf:elves.. tlwi:r Hdl1linJnU'Llt.orfl.
SUCCCSRors Dnd nssigns, jointly and severDlly. firmly by theRe preAents.
Tho condd.i(Jl) of lhc~ foregoing obligation ir-: s\.1ch tn.'lt.: \':})(lrCHIS
thn <Jbov(,.' boun(1c:n Pl-jncipal has entered. or ir. about to (~Ilt~r. inlo [)
certain contract with the City of Campbell. entitled
Overlay A. C J>av.iag ilt Pjl.r:.sLU1 Avp.nqf' frQDtagPJOt::: ,liff.}' IlJhp i'lt 13R7
Camden Avenue
atrueand 'correct copy of which agre~m('.nt if:; prescnlly 0111 ilcl'Tn thc
office of n,c City Clerk of the City of CCllllpbell. which Solid ilgr.acmcnt
is hereby raferrod to ~nd m~dc a part hereof.
NC.M. TlII:REFORl:, if the tlbove boUUtlE-H1 PI' inc: j p<ll fi}).l J 1 we] 1 anCl
t,ru ly rx:r1orm the wOl-k contracted to be performed ull<ll~r sod d contract t
thon this obligation Shil]) be void. otherwise to romi:lin ill full [orcc
and effect.
No pr~paYIllC'nl or delay in payment olnd no chong(Hl. e:xtennionr.;.
~c1di lion or ,J 1 t(!r.;,J1. j OJ) of any provision of sa id cont ruct. or in ftny
pl::lt)E; 1111d ~Pl~(;ifictltionl:; n!forred to herein, and no forebf:'11((Il'lC(! on
th~ part of the City shell.l (.)pond_(~ to rc]ni:lsc th('~ Surety fl.olll l.inbi) ity
ot) thi5 Bond. arid COTl5(>.nt to ll\;JJ~'1 s\lch L1H.C!rutionn wltho\lt hlrU)C!l:"
!loti!,;\.'! l.O or (;(jIIS~!llt. by l}H"': Sllr0ly i:::; he-reby ~Iiven. and th(: O\d'c;ty
hercby wnives t.he provisions of Section 281<) of tIlt;,! Civil C:(ld~! of. the
Stale of C~lifornia.
Di:ltcd thir. . .J.f..d.". day of
May
.19Jlli.__
T M & M Builders, Inc.
{~>~lNCfPA-Ll-- .. .._~-
By..
~r~~
ny._.___..._._.__.__
(A 1..1.. ilC:h l\cl~ nowl ccl<.lfL\'.11 t ~,
(Bot}) I>rincir~l '~; <1:'ld )
(Surety's Attorney in F~ct)
__fj.deJitL.9l1g__Depo~_Llio_lllP.iillY.....JlJ r,1a ryl and
(SURETY)
DY~~..~'~
Richard M. Heidbrink
-:7
ATTORNEY- IN-'NtCT
The
mw
CompanIes
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
FIDELITY AND DEPOSIT COMPANY
HOME OFFICES: BALTIMORE. MD. 21203
POWER OF ATTORNEY
KNOW Au MEN BY THESE PRESENTS: That the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, and the FIDLLlTY AND
DEPOSIT COMPANY, corporations 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 respective By-Laws of said Companies, which are set forth on the reverse side hereof and are hereby certified to be in
full force and effect of the date thereof, do hereby nominate, constitute, and appointLarry Sull ivan Richard
H. Heidbrink and Theodore W. Tracy, all of Houston, Texas, EACH.........:.......
e true and lawful agent and Attorney-in-Fact of each, 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, each in a penalty not
to exceed the sum of ONE HUNDRED THOUSAND DOLLARS ($IOO,OOO)...EXCEPT bonds on
behalf of Independent Executors, Community Survivors and Community Guardians....
n the execution of such bonds or undertakings in pursuance of these presents. shall be as binding upon said
Companies. 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 respective Companies at their offices in Baltimore. Md., in their own proper persons.
IN WITNESS WHERE-oF. the said Vice,Presidents and Assistant Secretaries have hereunto subscribed their names and
affixed the Corporate Seals of the said FIDELITY AND DEPOSIT COMPANY OF MARYLAND and the FIDELITY AND DEPOSIT
COMPANY this .......................fJ~.t................................. day of ..................M.ar.c.h..............._...____.__.......A.D. 19_85..___....._
ArrEST:
~
Q.~...R~=y.~~~.~EPOSI:y~~~........
A..i.tant &cre/ary Vtce.Pre"dent
FIDELIT~~D DtOSIT COMPANY
Cn~___R~~n..nn BY~~nnnnnnn
A ..iJtant &cretary VIU- President
STATEOrMARYLAND ) .
CITY or BALTIMORE i'"
On thia 2181: day of March ,A.D_ 19 85, before the subscriber. a Notarr Public of theState of Maryland, in and
for the City of Baltimore. duly commissioned and qualified. came the above. named Vlce.Presldents and ASSIstant Secretanes of the FIDELITY AND
DEPOSIT COMPANY OF MARYLAND and the FIDELITY AND DEPOSIT COMP ANY, to me personally known to be the individuals and officers
described herein and who executed the preceding inatrument, and they each acknowledged Ihe execution of the same, and bei~g by me duly sworn,
severally and each for himaelf deposeth and ..ilh, that they are the said officers of the Compames aforesaId, and Ihat the sealsaff,xed 10 the preceding
instrument are the Corporate Seals of ..id Companies. a~d that the said Corporate Seals and thell signatures as such officers were duly affixed and
subscribed to the ..id instrument by the authority and dlfectlOn of the said Corporahons.
IN TESTIMONY WHEROOF, I .... h....," ~ my h.,d ." ,II.."" my 0If".1.'"-" ~~'ty timore the ~d year fllst above
written. ~ ~
.. '4~ ..__.(. __.. -------- --. . ..-'-~-- ...-.-..--.--..:~... -------------------
'" 110"", . . owy PubliC
. .
. ..
1-1...~ '~.:' My commission expires __.J.~Jy..J_,..J.9.~_Q..________..._..._.___._
.:rD.! Co'
CERTIFICATE
I, the undersigned Assistant Secretary of Ihe FIDELITY AND DEPOSIT COMPANY OF MARYLAND and the .FIDELlTY AND DEPOSIT
COMPANY do hereby certify Ihat the original Power of Attorney of which the foregOing IS a fulLtrue and correct copy, IS UI full force and eff,'ct on Ihe.
date of this cerlificate; and I do further certify that the Vice-Presidents who executed the said Power of Attorney w.ere Vlc,'.PreSldenl~ speCIally
aulhorized by the Boards of Directors 10 appoint any Attorney-in-Fact as providt'd In Arllcle VI. Secllon 2 of the respeclive By.Laws of the ~ IDELlT)
AND DEPOSIT COMPANY OF MARYLAND and the FIDELITY AND DEPOSIT COMPANY, ... '
This certificate may be sisned by facsimile under and by authority of resolutions of the Board of Dllectors of the FlD~_LlTY ANI~ DU OSIT
COMPANY OF MARYLAND at a meetins duly called and held on the 16th day of July. 1969 and of the Board of Directors of the FlOt.LlT) ANI>
DEPOSIT COMPANY al a meeling duly called and held on the 2nd day of November. 1978.
RESOLVED: "That the facsimile or mechanically reproduced Slgnalure of anv ASSIstant ~enelary of the Company. whelher made here...fore ,or
hereafter. whenever appearing upon a certified copy of an~J)ower of attorney issued bv the Company. shall be val,d and blllel,n/( upon Ihe (,ompan\
wilh the ..me force and effect as though manually aff,xed. - . 3 rd
IN TESTIMONY WHEREOF, I have hereunto subscribed my name and affIxed the corporale seals of the saId (.ompallles. II",
May
day OLH"H
L14190fTXI-uf -170-3200
88
....19
FOR \Ol R PH.(l 1
, i
TO: FINANCE DIRECTOR
CITY OF CAMPBELL
"
REFUNDABLE DEPOSIT
CHECK REQUEST
\'
Please issue check payabl~ to:
Rosann Ginn
(30. spaces)
(30 spa,ces)
(30 8~~C~S)
State: CAZip: 95128
, (2) \ (10 s~aces)
(24 I spaces)
Address:
638 Teatree Co~rt
Line 1:
Line 2:
City .:
San Jose
Description:
(20 spaces)
Cash Deposit Refund
Exact Amount Payable:
$10,000.00
Account Number:
001.00.905.0000.4662
'.
PURPOSE:
Release of cash deposit for excavation permit #88-133.
'.
See receipt #20462 dated 8/15/88.
Requested by: Gregg Eat.on Title: P.W. Inspector Date: 2/1/89
Approved by: Don Wimberly Title: P.W. Director Date;
VeI1fie.d by: Accounts Receivable Date:
,
SPECIAL INSTRUCTIONS FOR HANDLING CHECK:
"
\.,",
Maij asia
xx
Mail in attached envelope
';;. "'
Return to:
(Department)
(Name)
Other: '
.k'
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. y
08/24/88
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TO: City Clerk
PUBLIC ~'ORKS FILE NO. 2?g -/3 ~
Please collect & receipt
for the following monies:
.CCT .
35- 3396"--
3372
3521
3521
(specify project)
PVWI-<.-t FeM:
R-l :
($'35)
($200)
Depos i t
3372 Plan Check & Inspection Fee
Other Cash Deposit
J373
3373
G~:)!J
Project
General
&
3372 Tentative Parcel Map Fil ing Fee ($350)
)372 Final Parcel Map Fil ing Fee ($300)
72 Tentative Tract Map Fil ing Fee ($400)
~ J 72 Fin a 1 T r act Ma F i 1 i n Fe e ( $ 350 )
3372 Lot Line Ad'ustment Fee/Certificate of Compl iance
3372 Vacation of Publ ic Streets and Easements
3372 Assessment Segregation or Reapportionment
First Spl it ($500)
Each Additional Lot ($150)
3372 Environmental Assessment:'
Categorical Exemption cost
Ne ative Declaration
3370 Storm Drainage Area Fee per Acre Multi-Res.,
$2,060; all other, $2,250)
J395 Park Dedication 'PI-lieu Fee per Unit ($1,132)
3380 Publ ic Works Special Projects
3510 Postage
F:-a ~ --:s-; F{y Lu be
TOTAL
AMOUNT
$
I I(),. ~DO, 00
NAME
<> C"
1\ D <)(<4"'.11., <::... 'Y'( ,,, r-.....
$ID UUD, {)Q
~ <-7 <I' 5 C/2( " (1(<,.(7 )t.f)zt,1 7/b3
PHONE
ADDRESS Co 33 1J,ZJ,;jrc~
Cn-<~ --t
I
).<.v,- 7 q:;..,,--
(~~/~
ZIP ?~ 123)
""OR
.1 TY CLERK
a-iLY
RECE I PT NO. ::L [) if &.." ;;z...
/0 ~ 0'-0
AMOI"R'Iff PA I D t I ) (,' U (...J ,
, --:-7
RECEIVED BY L ~
DATE ~/IS;/
July, 1987
r"
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REFUNDABLE DEPOSIT
CHECK REQUEST
TO: FINANCE DIRECTOR
CITY OF CAMPBELL
Please issue check payable to:
Jiffy Lube
Address:
, Line 1:
23161 Mill Creek Rd., #100
(30 spaces)
(30 spac~s)
(30 spaces)
'r
State: CA Zip: 92653
(2) , (10 spaces)
,;.
"
Line 2:
City :
Laguna Hills
(20 spaces)
Desc~iption :
Cash Deposit Refund
I
(24 sp~ces)
Exact Amount payable:
Account ~umber:
$1,480.00
001.00.905.0000.4662
, "
PURPOSE: Release of cash deposit for excavation permit #88-133.
.I r
See receipt #18308 for $500.00 dated 4/6/88 and receipt #18795,'
\" for $980.00, dated 5/5/88.
.,1.
\, I~
.'_ :1
Requested by: Gregg Eaton
Title: P . vl. Inspector
Date:
2/1/89,'
Approved by: Don Wimberly
Title: P . W. Director
Date:
Verified by:
Accounts Receivable
Date:
SPECIAL INSTRUCTIONS FOR HANDLING CHECK:
Mail as is
xx
Mail in, attached envelopt;',
;..'.
-,
Return to:
(Department)
(Name)
',1
Other:
i
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JJ
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d
08/24/88
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TO: City Clerk
\'E-\L...<A-~ I. T ~ B l~
PUBLIC WORKS FILE NO. - '-~
ACCT.
35-) 96
Please collect & receipt
for the following monies:
Depos it
Plan Check & Inspection Fee
Other Cash Deposit (specify)
J373
3373
Proj ec t
Gene ra I
3372
3372
3372
"372
3372
3372
3372
3372
3370'
1395
3380
3510
NAME
Tentative Parcel Map Filing Fee ($350)
Final Parcel Map Fil in Fee ($300)
Tentative Tract Map Fil ing Fee $ 00
Final Tract Map Fil in Fee ($350)
Lot Line Ad.ustment Fee/Certificate of Com I iance
Vacation of Publ ic Streets and Easements
Assessment Segregation or Reapportionment
Fi rst Spl it ($500)
Each Additional Lot ($150)
Environmental Assessment:
Categorical Exemption
Ne' ative Declaration
Storm Drainage Area Fee per Acre Multi-Res..
$2,060; all other, $2,250)
Park Dedication In-I ieu Fee per Unit ($1.132)
Public Works Special Projects
Pos tage
TOTAL
PH:lNE
ADDRESS
AMOUNT
$
-
CS C\ <e..c:. ,CC)
<=1t \~ ,CDO
$
ZIP
FOR
C I TV CLERK
OiLY
RECEIPT NO.
AMOIMr PA I e :J) {.-;c{ S- d'iJ
RECE I VEe BY L- -p
DAn SJs,f R K
July, 1987
TO: City C 1 e rk
PUBLIC WORKS FILE NO. J' J' -/33
$ S-S-O-
1-157 ? :;/6 - 3 2/ cJ
I
Please collect & receipt
for the following monies:
. ,..;T.
3$-3396
3372
3521
3521
R-] :
($'35)
($200)
project)
pvz.mU eM:
(Cash) Depos i t
3372 Plan Check & Inspection Fee
3521 Other Cash Deposit (specify)
3373 Project
3373 General
3372 Tentative Parcel Map Fil ing Fee ($350)
1172 Final Parcel Map Fil ing Fee ($300)
'2 Tentative Tract Map Fil ing Fee ($400)
'j72 Final Tract Ma Fil in Fee ($350)
3372 Lot Line Ad'ustment Fee/Certificate of Compl iance
3372 Vacation of Publ ic Streets and Easements
3372 Assessment Segregation or Reapportionment
First Spl it ($500)
Each Additional Lot ($150)
3372 Envi ronmental Assessment:'
Categorical Exemption
Ne ative Declaration
3370 Storm Drainage Area Fee per Acre Multi-Res.,
$2,060; all other, $2,250)
3395 Park Dedication In-lieu Fee per Unit ($1,132)
3380 Public Works Special Projects
3510 Postage
s~~ ~~ TOTAL
NAME 9th ~ '1.2~-- ~ -<-
ADDRE~S )f~s-'// 1~~.,t;f ~t;"'- U A_ 11 2 s l-.
~ ~" ( M'!( c.~k: ~ *\c:o I t...acytt'-'tOl ~ d b ~ Cl(.a~ 8
RECEIPT NO. J ~ ~ g'
~ '-.-..r. 0.9
AMOUNT PAID ~ ~L/
RECE 'VED BY a..... y;J-)
4-/0 . g; <j
PHONE
ZIP
FOR
C I TV CLERK
CNLY
DATE:
AMOUIJT
$
5"0
:roo
July, 1987
I
CITY OF CAMI)IIELI
70 NORTH FIRST STREET
CAMPBELL, CALIFORNIA 95008
(408) 866-2100
Department: Public Works
November 7, 1988
T M & M Builders
2 Clark Dr., #307
San Mateo, CA 94401
RE: FINAL INSPECTION - DEFICIENCIES
PERMIT NO.: 88-133
LOCATION: 1387 Camden
You have requested a final inspection on subject construction work. There
are deficiencies in the work which are indicated on the enclosed list.
These deficiencies must be corrected to the satisfaction of Public Works
Inspector Gregg Eaton before we can make final inspection for acceptance
of the work.
Upon completion of the corrective work, please submit a written request
for a final inspection and acceptance.
.
~/
Gr g aton
Public works Inspector
GE/sd
Permit No. 88-133
1387 Camden
November 7, 1988
Deficiency List
1) Fuse holders shall be HEX, not HEB
2) All splices should be in pull boxes (not in hand hole)
3) Weather proof all splices in pull boxes
4) Why are there three wires going to the fixtures?
5) All fusing shall be in pull boxes
6) Standards are painted the wrong color
A) Existing paint shall be removed from pole and verified by the
City
B) Re-prime and re-paint poles per the State of California Standard
Specifications 1988 Section 86
7) Stencil location and pole numbers
A) Bottom number should start at the 10 foot level
B) Should be 3 inch stencils
8) Lights are not working
A) Parsons
la) Conduit in pull box is rigid, however when it reaches the
PG&E service point it is PVC, All conduit should be rigid
galvanized steel
2a) Pull box lid needs to be replaced (including hold down
bolts)
3a) Fixture looks burned up, Needs to be replaced
B) Camden
lb) Pole is not plumb
2b) Fixture is not acceptable. Needs to be a model 400A with
light distribution M-C-III
*NOTE: Notify Bob Long at 866-2150 when work is to begin. Any
questions should also be directed to Bob,
PUBLIC WORKS INSPECTION REPORT
Ate / I - 7 - (:;t'~
f.-' ~~, ,- ;" 3 -:::?
'--.) L_,' ~
Permit or Project No.
Address
"7.-;- 7
I-'")L.c;_._
/ -.~ c..; .
C)]771Zt.,/lj'
Type of work: Street Storm
Other (describe)
SAnitAry
Electrical .~
o PRELIMINARY INSPECTION WITH DEFICIENCY LIST (attached)
~ INSPECTION WITH DEFICIENCY LIST (attached)
o FINAL INSPECTION - ACCEPTANCE
Signed plans? Y N (If signed, Council acceptAnce.)
Charges against deposit? y
Overtime: hrs. @ $
Date ~ reason:
N
/hr.
-
$
Barricade rental (attach invoice)?
Date ~ reason:
Y
N
$
Other?
$
$
Total charges deducted from deposit:
(Cash Deposit $ less charges $
$
- Refund $
ck. req.)
[JONE YEAR MAINTENANCE WITH DEFICIENCY LIST (attached)
o ONE YEAR MAINTENANCE - ACCEPTANCE
(Release'maintenance bond. Check Request if cash.)
.@2;
Ins
Engineer
o /,;< ~ {/(.--!
I
ENDORSEMENT
RECEIVED
MAY 1 01988
PUBUC WORKS
ENGINEERING
"..-
IN CONSIDERATION OF
AN ADDITIONAL L
..
PREMIUM OF $
A RETURN
ADDITIONAL INSURED
IT IS HEREBY AGREED Ta~T THE CITY OF CAMPBELL AND ITS RESPECTIVE
OFFICERS, AGENTS AND EMPLOYEES ARE NAMED AS ADfITION.A.L INSURED
FROM AND AGAINST ANY CLAIMS, LOSS LIABILITY, COST OR EXPENSE
ARISING OUT OF OR IN ANY WAY CONNECTED lrTITH fT1HE CONSTRUC'T'ION
OF THE PROJECT, THIS COVERAGE SHALL BE PRIMARY AND ANY COV-
ERAGE CARRIED BY ADDITIONAL INSURED SHALL BE EXCESS INSURANCE
'0 NLY .
THIS ENDORSEMENT FORMS A PART OF AND IS FOR ATTACH HE NT TO THE FOLLOlUNG
DESCRIBED POLICY .
ISSUED BY
POLICY NO.
TRANSCONTINENTAL INSURANCE COMPANY
CCP 300335733
ISSUED TO
Texas H&H Builders, Inc.
EFFECfIVE
.
5-5-88
Under<<ri ter
DATE
5-6-88
ENDORSEMEwr NO.
Fonn # FG-9
(~-\~~
CONS'{RUCTION CO!iT ESTIMATE rOi PERMIT NO. By/Date 6.---"2..1 _ ~
J \ ~"f \......Ofb~ \~~~<'\lD~L
Name' Addrus \~~-, ~ ,,",,-~~L J
Surface Construction
Clearing and Grubbing Lump Sum Eni.-te _ $ \ ~_
Sawcut Coocrete t.:.C\ L.F. @ $ 4.00 - $ 'l.. fL. -
Concrete lemoval .,,').~ S.F. @ 3.00 _ $~
Curb' Gutter Removal 4--:, L.F. @ 5.00 - $ 'L 1..~-
Inlot Drain with Pipe \ EA. @ 500.00 - $ 'ii;'~-
Curb and Gutter 4~ L.F. @ 15.00 _ $ ~~_
Sidewalk \~OS.F.@ 3.50 -$ ~1...S;-
Driveway Approach 48'l.. S.F. @ 5.50 - $ "'1-fc.~\ -
Handicap Ramp \ EA. @ 1000.00 _ $ \ ~~ _
Extruded Curb L.F. @ 6.00 _ $ ___
Barricade L.F. @ 50.00 _ $
I Street Excavation ( - s.r. )x($0.15)x(_") _ $ ___
\ h.",\., c. ()\.I6f~ v... "-
A.C. Pavement ~iucb....... ( S.F.)x($0.45)x(\,,") _ '$ \,~.,-
Adjust Manhole to Grade 1 EA. @ 300.00 _ $ ~'''"'_
Adjust Handhole to Grade I EA. @ 200.00 _ $ "') i'Y'\-
Honullent Box v Monument tEA. @ 500.00 _ $ ~_
Street Tree (15 sallon) ~ EA. @ 200.00 - $ (,,00-
Pavement Striping ($100 min) L.F.@ 0.65 _ $ \~-
Pavement Legends ($100 min) -- EA. @ 40.00 _ $
Stop.Street Name or Other Sign EA. @ 120.00 _ $
Pavellent Markers A. EA. @ 15.00 - $ <..c:!t-
Pavement Key Cut ~ 00 L.r.@ 8.00 - $ -L40e, -
PI&\.te""'eL.."'l n.e1L>F:, ~P.;.Q.t.~ '-S - $ ~~-
- $
Surface Subtotal "5" - $ ,~. (..~, - '~I ?c,.,4-
Adjust. for .be: S<$30.000 add 20%. S,> $100.000 aubtract 10%
Street Lighting
Electrolier
Conduit
tkIoductor. pair
Pull Box
~McNce ~LV"""~
"l.... EA.' 3000.00
~ L.r., i2.00
~O L.r.@ 4.00
, EA. @ 200.00
'-c;;..
Storm Drainage
12" or 15" Rep
18" or 21" Rep
Street Inlet
Kanhole
Break and Enter Manhole
L.r.@ 60.00
L.F.@ 65.00
EA. , 1800.00
EA. @ 2000.00
EA. @ 600.00
'!'OTAL ESTIMATE
USE rOR BOND
Revised 6185
- $ ~OOO-
-$ ""2-
- $ \20-
- $ .",,"" -
- $ \S{~-
. $ ---
- $
- $
- $
- $
- $
$ ~, "S. 4-4 -
$ ~4\ ~oD-
Permit No. '8<'B,.-- \~~
\?-::>~, C-btv-'l~ ~''-''~
Tract No. or A6dress
IMPROVE1-:Et;T PLAN CHECK LI ST
DEVELOPtlENTS
CHECKtD:
ITEl-1:
C~ 1) Permi t number and prop-
erty address on plan?
c:~~~ 2) Site review completed?
~~ 3) Applicable standard notes
c...S~ 4) Engineer's Stamp, Signa-
ture and Expiration Date
~~ 5) Conformance with City
standard specifications
and details
~~~ 6) Street geometries
~~C~ 7) Street grading plan con-
fornity with overall
street grades and/or
official grading plan
<::~~ B) Approved roadway
structural section
c..s~
9) Street lighting
requirements
c:.~
e~~
10) Storm Sewer design
11) All relevant conditions
of approval have been
met
c..~Gq
12) Traffic review
~~ 13) Service Center review
Plan check co~pleted by
Recommeded for approval
Send originals for signing
cm':lEtJTS:
"-.\DT W~~t~
U/h
G--~ ".-l...l-~~
'..
Bill M. Helms Date
Engineering i.1anager
Donald C. ~imberly Date
Birector of Public Works
t!J8
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PUBLIC WORKS PERMIT ISSUANCE CHECK LIST
City of Campbell
Public Works Permit No. ~- \~~
.~ Applicant
~Applicant
section complete
8
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~----------------------------------------------------------------------
signature and date
~Permit Application fee, $35.00 for R-I, $50.00 for
standard, paid. Receipt number \~-=.. D~~
~Plan check deposit, $500.00 for standard only, paid,
Receipt number l~~~~~~
~'Five sets of improvement plans submitted
v'
Bond for faithful performance, 100% of City Engineer's
estimate for standard only, posted and appropriately noted
Amount $~ ~ ~ Form <;.un~-r-f 1. D. # tz:..l t;:::~_l "'1"'-1' '\-
. t:l~ (:::F-";,. \."'r C-f>
Cash Deposit: $200.00 for R-I; 4% of FP bond, $500 min.
for standard, posted.
Amount $6t~.6(> Receipt No, ~~-lC::t'S;:-
~. Permit fee of 7% of FP bond, $35.00 min., paid.
Amount $ \'1 \S'. ()D Receipt No. \. ~-'lqc:::-
/
~Worker's compensation information received for Applicant
(see Information Sheet for Public Works Permits)
~ All other Public Works requirements listed in the Con-
ditions of Approval of the development.
---------------------------------------------------------------------------
~ Worker's comp and Contractor's Information received for
Contractor (see Information Sheet for Public Works Permits)
~ Certificate of Insurance with Additional
Endorsment received from Contractor (see
Insurance Requirements for Public Works
Insured's
General Summary of
Permits)
~ Three sets of off-site plans, stamped APPROVED (Tract or
Development and Public Works Permit number and property
address on plans)
Permit signed for City Engineer
WEN ALL OF THE ABOVE ITEMS ARE COMPLETE, PERMIT MAY BE ISSUED
Issuer: Initial _____ and date and file with permit
UPON ISSUANCE, INITIATE PLAN CHECK DEPOSIT REFUND CHECK REQUEST.
6/88
f/permchklst