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O~PT. 'or YUbLIC NQKI~ .
lONOClhl1Utilt. .
C._I.b.ll, CA '~QOI
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PUbLIC WOkKS PtR"JT '.'alt MO.
l'flfrVarrnr,. 1 n-t'n. , () \ ~ !;.
P"bl1c li'llr.t-ot-w.~) X-llet. Uh\l(.:\...h;~(~'~ ~.A. r:
'..IA.d /tJ~~/rp ApplH:ation Dat. C.- 2-2- -<FYI.
".'all .1" .. In ,,~ ao.. ..pir.. lrr Ii 11Io.. (
APPLICATIO~ - AppliC.tion ia ba'aby aade lor a 'wbIlc Work. '.ralt in accordanc. .ith Ca.~b.ll- ~
"wnlC:ip.l coca., II.Ctloll 11.0.. :'
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WO'k .odre.. or tract . fa '5
Utility treaCA l~atlon
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C. Attacb tlv. f~) COpl.. ot . dra.lng ahowLnv tb. location, ..tant and dl.en.10n. ot the WOCk
Tbc dravLn~ .'"all ahow the r.latlon 01 the PIOpO..d WOlk to .Ii.ting .u,t.c. .nd ynderglound
1.prove..nu. Whan approv.d &ly tb. Cuy tngLn.cr, ..ld dr..,lng b.co... a part ot Chl. pee.u.
Q. Tne General Condition. tor all per.ita arc 11.t.d on tb. r.v.,.e .lde. Speci.l ~rovi.lon. tor
thia pelalt are Ii.red below. tailule to abi4e by the.e condition. .nd P,ovi.lon. "Y' re.wl,
Ln jOb IhlAl-down and/or turteltwle 01 'aLthlul Pcrto'..nCe bond. and Ca." depo.i,~. ~.e
Gene'.l Condition. 1 and 2). , ~~ ~,~
~. An .ppliCatlon 18 non-:;n'ifJ~e. ~q ~_ \q.-,.. ,
Na.. ot AppUC:ant -") Tel.Pllon.: (40f:)~11- (6 '~~ _
Adduu L . r:L q $
h thl. WOrk bcln9 done 'by the property ChIn., at their Own r.ildencd _YaM Ano ~~4- ~~ \~
Coapl.te .tt.Ch.d WOlller.' COapen..tion and Contr.cto, tor... ~
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The Applic:.nt/~cr.ittee beteby agr... by attiling tbelt .i~n.twre to thi. per.it to hold the Clry ot
C..plocU. llli oltlc:el~, .'lem. an&J ...ploy... tr.e, ...t. and ...r.l.... 110. any c:l.1a 0' de_,.d ten
d....9.:. le~u1tln'J tro.. the WOtk COVer.d by thL. l'Cr.lt.
Tne A~~IIC:.f1t/~el.1ttee bereby aCknowledge5 th.t they h.". I.ad .nd lAn4erltand both the Ironr .1'4
"'Ck ./ 'ni. p."." .... .... ~... .." h~"4- '~'u'I" ./ ... ..to,~.....
ACCt:I"Tt:D A~ C~"c: ~~ ~O Q ~ f,;-- Z2- gy
PIJ~.~ . ~~.
NOT~S; ALL'WORI SHALL CON,OkK WIT" THt ATTACHED, APPMOVtD 'loANS AND ALL A~~LICAbLt CAKPb~LL
STANDAkD DkAWINC$ AND CONDITION~.
Tilt: CONTkACTOJr MUST Il.\V~ TillS PCk"IT AND APPftOVfD PLANS ANII "UST "i:t:T IIIIT" T"& P.W. IN~rt:croK ON
Tilt: $JTt AT Lt:A:iT 1'WU DAVS llt:l0kt: 'sT.utTING ..oU.
NOTICE "U~T Ilt: GIVeN TO PUIlLIC ..oRIS AT LEAST ~4 HOUkS b~YOJrE kfSTAkTINC ANY WOkl.
S~fCIAL PHOVISIONS
1.
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Street ..hall not be open cut tor underground 1n~t.ll.tion~. "Lnl.u. CWtll "'1 be allw.cd
tOl COnllect1on~ oc ..plolation bolel/. :tlleh CUt. aUllt be IlPtrC1l1Cally oppro".,d by III&'
l"IOPeCt"".
Yav.*~..y be ClAt tor und.r~lownd 1n.tallationa .nd .u.t be ce.tored 1n aCcOrd.nCe ~1tn
the UtLlhy Tecnch ltutoratloA 'standald Drawing.
W~Ik to Uc Ilt._cd by · lLc.n.cd 1.&n4 S",vcYQr 01 Civil tngin.., and two f2) c:oplc~ ot the
CUI .lIcCl. .CIIL to Lhe "ublic WOI" Dept. beture araltLng Vork.
The tIOUI. ot WOII .te haited 10 outa;ide the houra ot 1->> .... and J-li p.a. tor cny WOlk
~{t.ctlny a rl.tjlc lane.
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FROM 000000110011
8.21,1992 14:25
p, 1
II
LOU JONES
8& ASSOCIATES
RE"'VEIJ
AUG 211992
IlATfo: :
RE:
<isIZ11'i2.
FAX r.OVE1~ SlIF.F,']'
"-uo"c W 'u
or_I Engineering
tJJ I II, ~~ _.__S,. . CtEr
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FROH:
l'LEASE DE IVL:;--' 'i'HI:.: I-'ULLUW1N<'~-'- "fti..o '-"-p^cfEs'-CWi,T{HlficIuv'Es' -;rj.i[s- 'COVER SHEET)
10 . If YOU DO NOT RECEiVE ALL THE rAGKS)
PLEA'S't: Gi v 1:: ME A CALL AT THE' NUMB't"R LI~TEn BELOW,
C~lI c.. h.
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411 DOREL AVENUE. SUITE 410, SAN MATEO. CA 94402
P.O, BOX 1327, SAN MATEO. CA 94401
(415) 349-9515 FAX: (415) J4~-9553
.~
n~'lan3l
, ", InSUMancp ~
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FROM 000000110011
8,21.1992 14:25
, fl:.1C....Jo^ I ,
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RECEIVED
FEB 271989
PUBLIC WORKS
P. O. Box 1327 . San MalEtNGll<<lmfltG1
(415) 340.0397
'\
RECEIVED
FE 8 2.t1....i'jb~
FINANCE DEPT.
,
SUBDIVISION STATUS INQUIRY
r , Lou Jones
& Associat.es
The City of Campbell p, 0, BOX 1327
70 N. First St. SAN MATEO, CAl.IFORNIA. 94401
Campbell, CA 95008 ENVELOPE ENCLOSED
l. oJ
BOND NUMBER. SUBDIVIDER
35M 713 578 00 William S. ClIff, Cynthia Denise Cliff & Alfred G. D'Amico
TRACT NllMBEB. TRACT NAME
PM 88-07 65 Shelley Avenue
IMP ROVEXENTS
Subdivicion Improvements
1. Baa chis work been fully completed, accepted
~Ye5
DNo
2. If accepted, an what date?
.z. <'-.28 #C?
3. If Dot accepted f is work. progressin~ S&t1slacLodly ". < D"i.es -, .- CJ !tQ...-_
~.Percentage_~ompleted
REXA.RKS
"(7Ie F"/I/P..,'-;=ULL /r:!7f!..rt:r~.,.,z.q;vc~ &"rJ-j) ~Sr &.c
i?6!L-A-C.e:t:> ~ 4 rn.4-/N~~...uC-r2 ,.:3v/o../D (c.s ~~ o~ T7-/-G
r- - /J F' A '\ ~ /.) /1 /Je-"X:-'I'o D 0 F
p-;4--, n{,c~,-,I.... rert. U,r,...~"qtVc...~ ,.--0"-" I
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.3rz 4f8( ZS-. 00.
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SEE ME
,\~
C}"
FORMATION FURNISHED BY (61gnatur~)
C/ /'
~ ~ C-.a70"/
TITLE
~at"(... ~ ~ ~
DATE
- / I _
BO~D DEPARTXENT
Daniel Jones
--
~ ~4~o
/
Address t.?:)
PUBLIC WORKS INSPECTION REPORT
Permit or Project No.
"
fSe-/70
~s~;y' 4vE.
Type of work; Street"'--- Storm
Other (describe)
SAnitAry
ElectricAl
[JPRELIMINARY INSPECTION WITH DEFICIENCY LIST (attAched)
[JFINAL INSPECTION WITH DEFICIENCY LIST (attached)
o FINAL INSPECTION - ACCEPTANCE
Si9ned plana"? Y N (If tiigned. Council AcceptAnce.)
ChArges AgAinst deposit? Y
Overtime I hrs. @ $
DAte" reAlion;
N
/hr.
-
$
BArriCAde rental (AttAch invoice)?
DAte " reAson;
Y
N
$
Other?
$
$
TotAl charges deducted from depositl
(CAsh Deposit $ leas chArges $
~YEAR MAINTENANCE WITH DEFICIENCY LIST
$
- Refund $
ck. req.)
(AttAched)
[JONE YEAR MAINTENANCE - ACCEPTANCE
(Release'maintenance bond. Check Requelit if CAsh.)
Engineer
~
In6pector
88 - ItD
AMERICAN MOTORISTS INSURANCE COMPANY
Long Grvve, IL 60049
,/: ,~'; ;.,,': :;::::.~'~
Iren1peR
, .~. . 1 j.~:"
inSURanCe
compam2B
RECEIVED
APR 11 1989
PUBLIC WORKS
ENGINEERING
Bond No. 35M 717 726 00
$163.00
PREMIUM:
MAINTENANCE BOND
KNOW ALL MEN BY THESE PRESENTS:
That we, W_illiam s. c1iff, Cynthia Denise Cliff & Alfred , as Principal,
G. D'~ico
and AMERICAN MOTORISTS INSURANCE CO... a corporation organ~zed under the laws
of the State of ILLINOIS. and duly authorized to transact business
in the State of California, as Surety, are held and firmly bound unto
The City of Campbell
(.hereinafter called the Obligee) in the just and full sum of
EIGHT THOUSAND ONE HUNDRED TWENTY FIVE AND NO CENTS ------------ ($8,125.00*******),
lawful money of the United States of America, for the payment of which,
well and truly to be made, we hereby bind ourselves and our successors
and assigns, jointly and severally, firmly by these presents.
~ereas, on the day of , 19
the said principal ,as contractor, entered'-into'a' contract for' the
Subdivision Improvements on PM 88-07 Known as 65 Shelley Avenue
Whereas~ under the terms of-the" specifications7~for said work~"~
the said principal is:required to give" a bond in the' amount of __
EIGHT THOUSAND ONE HUNDRED TWENTY FIVE AND NO CENTS--------- ( $8",125.00****** ),
to guarantee the replacement and repair"of defective -materials or faulty
workmanship furnished or installed by the said principal, for a period
of ONE YEAR from and after the date of the
completion and acceptance of same, namely, until February 28 19 90
Now, Therefore, if the said principal shall for a period of
ONE YEAR from and after - the date of the co:npletion
/'
and acceptance of tne said work by" said obI igee repl ace" and repair
any and all defective materials or faulty workmanship in said ~~rk,
then the above obligation to be.' void: othen-lise to remain in' full
force and effect.
S2aled with our seals and dated this
April , 19 89 .
BOND TO BE EFFECTIVE FEBRUARY 28, 1989.
6th
day of
William S. Cliff
B'J\ I/}l~ S ~-
Cynthia Denis,e Cliff . /11 #//
B~ ~~A.7J! IJ~L ~
1Alfred G. D'A 'co
AMERICAN MOTORISTS INSURANCE COMPANY
//") .~-~-~
BY : 4L ..,
)1 ,'\t torney- in-f act
Daniel Jones
~:.
.
..
AMERICAN MOTORISTS INSURANCE COMPANY
Home Office: Long Grove, IL 60049
POWER OF ATTORNEY
Know All Men By These Presents:
That the American Motorists Insurance Company, a corporation organized and existing under the laws of the State of Illinois, and
having its principal office in Long Grove, Illinois, does hereby appoint * ** * * ** * ** ** ** ** ** * ** ** * * ** ** * ** * *** * * ** ** **
Daniel Jones of San Mateo, California*************************************
. naTlDnil. I
Pi!:
mmpames
. .
its true and lawful agent(s) and attorney(s)-in-fact, to make, execute, seal, and deliver during the period beginning with the date of
issuance of this power and ending December 31, 1990, unless sooner revoked for and on its behalf as surety, and as its act and
deed: Any and all bonds and undertakings provided the amount of no one bond
or undertaking exceeds ONE MILLION DOLLARS ($1,000,000.00)****************
EXCEPTION: NO AUTHORITY is granted to make, execute, seal and deliver any bond or undertaking which guarantees the
payment or collection of any promissory note, check, draft or letter of credit.
This authority does not permit the same obligation to be split into two or more bonds in order to bring each such bond within the
dollar limit of authority as set forth herein.
This appointment may be revoked at any time by the American Motorists Insurance Company.
The execution of such bonds and undertakings in pursuance of these presents shall be as binding upon the said American Motorists
Insurance Company as fully and amply to all intents and purposes, as if the same had been duly executed and acknowledged by its
regularly elected officers at its principal office in Long Grove, Illinois.
THIS APPOINTMENT SHALL CEASE AND TERMINATE WITHOUT NOTICE AS OF DECEMBER 31,1990.
This Power of Attorney is executed by authority of a resolution adopted by the Executive Committee of the Board of Directors of
said American Motorists Insurance Company on February 23, 1988 at Long Grove, Illinois, a true and accurate copy of which is
hereinafter set forth and is hereby certified to by the undersigned Secretary as being in full force and effect:
"VOTED, That the Chairman of the Board, the President, or any Vice President, or their appointees designated in writing and filed with the
Secretary, or the Secretary shall have the power and authority to appoint agents and attorneys-in-fact, and to authorize them to execute on behalf
of the Company, and attach the seal of the Company thereto, bonds and undertakings, recognizances, contracts of indemnity and other writings,
obligatory in the nature thereof, and any such officers of the Company may appoint agents for acceptance of process:'
This Power of Attorney is signed, sealed and certified by facsimile under and by authority of the following resolution adopted by
the Executive Committee of the Board of Directors of the Company at a meeting duly called and held on the 23rd day of February,
1988:
"VOTED, That the signature of the Chairman of the Board, the President, any Vice President, or their appointees designated in writing and filed
with the Secretary, and the signature of the Secretary, the seal of the Company and certifications by the Secretary, may be affixed by facsimile on
any pOvVEr of attomey Oi bond executed pur~uant to resolution adopted by the Executive Committee of the Board of Directors on February 13,
1988 and any such power so executed, sealed and certified with respect to any bond or undertaking to which it is attached, shall continue to be
valid and binding upon the Company:'
In Testimony Whereof, the American Motorists Insurance Company has caused this instrument to ~9Signed and its corporate seal
to be affixed by its authorized officers, this 15th day of March , 19 .
Attested and Certified: AMERICAN MOTORISTS INSURANCE COMPANY
7c-#~
F. c. McCullough, Secretary
STATE OF ILLINOIS ~s
COUNTY OF LAKE ;)
I, Rose K. Rayner, a Notary Public, do hereby certify thatJ. S. Kemper, III and F. C. McCullough personally known to me to be the
same persons whose names are respectively as Senior Vice President and Secretary of the American Motorists Insurance Company,
a Corporation of the State of Illinois, subscribed to the foregoing instrument, appeared before me this day in person and severally
acknowledged that they being thereunto duly authorized signed, sealed with the corporate seal and delivered the said instrument
as the free and voluntary act of said corporation and as their own free and voluntary act for the uses and purposes therein set forth.
~.,,~...,.
.~,' ..
i.O~..
\~~1
By
JL ~ ~~. "'~
- J. S. Kemper, III, Senior Vice President
C~.~~
My commission expires: August 12, 1991
Rose K" Rayner, Notary Public
FM 836-5 7-88 1 M
Power of Attorney-Term
PRINTED IN U.S"A.
fE7l./YlI,r- B~ -/'J 0
RECEIVED
FEB 271989
PUBLlC WORKS
P. O. Box 1327 · San MatEiNalNEImlNG1
(415) 340-0397
7 l-4\~) "\4Pl- q~\<;.
SUBDIVISION STATUS INQUIRY
\.
RECEIVED
FE B ~(:. .bd~
, -FINANCE DEPT.
r , Lou Jones
& Associates
The City of Campbell P. 0, BOX 1327
70 N. First St. SAN MATEO, CALIFORNIA 94401
Campbell, CA 95008 ENVELOPE ENCLOSED
-
l.. ..I
BOND NUMBER SUBDIVIDER
3SM 713 578 00 William S. ClIff, Cynthia Denise Cliff & Alfred G. D'Amico
TRACT NUMBER TRACT NAME
PM 88-07 65 Shelley Avenue
IMP ROVEHENTS
Subdivision Improvements
ASE A.~S\"'ER
STIONS BELOW AND RET
1. Has this work been fully completed, accepted
~Yes
DNo
2. If accepted. on what date?
Z/Z8/8CJ
.
3. If not accepted, is work.progressing satisfactorily
D~s ""-- 0 h._
4. Percentage .-completed
REMARKS
.,-;rIe FA-/~~UL-L /e-;eF~/0n'/.q;JCG" 8e~j) ~S7 tS~
?6f~~ ~ 4 rn~/A.J~,.q-~~ ~O^,D {Z5 %' o,c ~
;::#'1 ~m.c~'-'L ,P~~"~;??rf/V(,dj r::oi< A ;Jf:;7(,d'o D 0 v=-
I yEA'/L . (Z/Z-B /~oj -pI-G 130M/:) H,r)€)u-"JT 3H71GL
.8cz 4f8/ZS-.00.
FORMATION FURNISHED BY (61gnatur~)
TITLE
56:-
~ C:-~
'i4'8t-/c- ~4~..5 ~
DATE
BOl\D DEPARTMENT
Daniel Jones
'.0_2
CITY OF CAMllBELl
Department:
Public Works
'. ';~~~ERl-;T'!-' --~J-J
'?j rx/. l I
HEU~S ..~\'r5"'Q .' .':.,..' __.j
~f\i'{'O.'N. \\rf'. .'J,..,:: t j
E~~;--~- i:------1f'
I f(;~u~.!":" ....; .'
Ill.';f~Q"(E~- "1" - r--- .
_..._.,__,....."~_ .......--...t..~~""',f'"':'O. . _I.
70 NORTH FIRST STREET
C AMP 8 ELL, C A L I FOR N I A 9 5 0 0 8
(408) 866-2100
FAX # (408) 379-2572
March 9, 1990
D'Amico Development
2599 Westgate Ave.
San Jose, CA 95155
RE: One Year Maintenance, Deficiencies
Permit No.: 88-170
Location: 65 Shelley Avenue
Gentlemen:
We have made a one-year maintenance inspection of subject public
works improvements, There are deficiencies that must be corrected
before we can release your bond and obligations in this matter. A
deficiency list is attached.
Please coordinate the corrections of these deficiencies with Public
Works Inspector Gregg Eaton,
Upon the satisfactory completion of the corrective work, we will
release your bond.
Sincerely,
Carlos M, Jocson
Associate Civil Engineer
CMJ : s d
Ene.
cc: G, Eaton
Bond Co.
Suspense - 60 days
CITY OF CAMIJBEIl
DEFICIENCY LIST
Permit No. 88-170
65 Shelley Avenue
March 8, 1990
1. Install crack sealant longitudinally along centerline and at
lateral joints at the property lines,
d'o//,,~ .
... I'.
PUBLIC WORKS INSPECTION REPORT
Date ~~~o Permit or Project No.
/
Address tR5 S~'1".~E.
Type of work: Street"--- Storm
Other (describe)
~e-/70
Semi tary
Electrical
[JPRELIMINARY INSPECTION WITH DEFICIENCY LIST (attached)
[JFINAL INSPECTION WITH DEFICIENCY LIST (attached)
o FINAL INSPECTION - ACCEPTANCE
Signed plans? Y N (If signed, Council Acceptance.)
ChArges Against deposit? Y
Overtime: hrs. @ $
DAte" rea&on:
N
/hr.
-
$
BArricAde rental (attach invoice)?
Date " reason:
Y
N
$
Other?
$
$
$
- Refund $
TotAl charges deducted from deposit:
(CAsh Deposit $ less charges $
~YEAR MAINTENANCE WITH DEFICIENCY
ck. req.)
LIST (AttAched)
[JaNE YEAR MAINTENANCE - ACCEPTANCE
(Release'maintenAnce bond. Check Reque&t if cAsh.)
(/n rz-:J.-1,~
Enpneer
~
Inspector
CITY OF CAMPBELL
70 NORTH FIRST
CAMPBELL, CALIFORNIA
(408) 866-2100
STREET
95008
~~/
f
~ 7~'-'
(#J r~
~ ~1~C/lle /
Department:
Public Works
March 9, 1989
D'Amico Development
2599 Westgate Ave.
San Jose, CA 95155
RE: Final Inspection and Acceptance
Permit No.: 88-170
Location: 65 Shelley Ave,
Maintenance Bond Amount: $8,125.00
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,
~~
Carl M. Jocson
Asso iate Civil Engineer
CMJ : sd
cc: G. Eaton, P.W. Inspector
Suspense - 1 year
Date ~~9. _ Permit or Project No.
Address Ls- ~y
PUBLIC WORKS INSPECTION REPORT
88 '/70
Type of work: Street Storm
Other (describe)
Sanitary
Electrical
[JPRELIMINARY INSPECTION WITH DEFICIENCY LIST (attached)
[JFINAL INSPECTION WITH DEFICIENCY LIST (attached)
.EtFINAL INSPE~TION - ~EPTANCE
Signed plans? '~ N (If signed, Council acceptance.)
Charges against deposit? y
Overtime: hrs. @ $
Date 5 reason:
c;f2
-
$
BArricade rental (attach invoice)?
Date 5 reason:
Y
f!)
$
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.)
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2599 Westgate Avenue · San Jose. California 95125 . (408) 265 1299 · License #490987
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CITY OF CAMPBELL
70 NORTH FIRST STREET
CAMPBELL, CALIFORNIA 95008
(408) 866-2100
Public Works
Department:
February 28, 1989
D'Amico Development
2599 Westgate Ave.
San Jose, CA 95155
RE: Final Inspection and Acceptance
Permit No.: 88-170
Location: 65 Shelley Ave.
Maintenance Bond Amount: $8,125.00
Gentlemen:
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
Council. We will send a copy of their resolution accepting the work
upon their approval of same.
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 (1) year and advise you whether or
not maintenance is needed,
Please feel free to call me if you have any questions.
Sincerely,
.
CC;;:;M~
Associate Civil Engineer
CMJ : sd
cc: G. Eaton, Public Works Inspector
Council Agenda
C. Case, Administrative Aide
Bond ~ompany:
Suspense - 1 year
f/acc-ltr
Department:
Public Works
HAi:'?,!"INQ1
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,JOCSON ..' r;:.:;':-.';-D: '~--r-j
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I WIMBERLY
HELMS
CITY OF CAMPBEll
70 NORTH FIRST STREET
CAMPBELL. CALIFORNIA 95008
(408) 866-2100
FAX # (408) 379.2572
April 12, 1989
American Motorists Insurance Company
Long Grove, IL 60049
SUBJECT: BOND NO. 3SM 713578
Public Works construction at 65 Shelley Avenue, Campbell, California
under Permit No. 88-170 has been satisfactorily completed and
accepted. Accordingly, subject bond is hereby released.
Please call the undersigned if you have any questions.
Very Truly Yours,
Car1osM, Jocson
Associate Civil Engineer
CMJ : tb
cc: G. Eaton, Public Works Inspector
fjb3sm713578
CITY OF CAMPBELL
Permit No.
Applicant
KJ' -j 7c)
INFORMATION SHEET FOR ENCROACHMENT PERMITS
A separate form must be completed for the applicant and each contractor
that will work under this permit.
WORKERS' COMPENSATION INSURANCE INFORMATION
Name of Contractor/Applicant C,} (:::\.1'0,\ 'c () ~Q~ "'~ \u ~ 6'\\\l.. '{',:+-- ,.
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.
Policy No. Expiration date
; OR
.............'.................................. ....... ........ . ............
This 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 work for this permit, I
shall not employ any person in any manner so as to become subject
to the Workers' Compensation Laws of California.
Signed
Date
NOTICE TO CONTRACTOR/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.
. ,
......................................................... .......... .. . .....
~ONTRACTORS INFORMATION
Note that all contractors must have current City of Campbell Business
License, State Contractor's License and Workers' Compensation Insurance.
" ".. C' I' . ..
Name of ,Co'}tractor, ' ~~ :' \*~ \, {:u;''' ,~ Telephone '\ Co"-\ - 1 4. \ S
Address /2 ~:/\ q \. l.s~_ _,:,--,t: ...:....0..-'
State Contractor License No.hi. '-).."'~ClO',~'-\9ity Business License No.
Expiration Date
Will do the following types of work:
_____underground _____P.C. concrete _____A.C. paving _____electrical
-
_____other (specify)
f:PERMINFO
REV. 8/88
.
,
~;'~ B8~/70
IiEC'"'IV ED
~ ~ .
a 4/' ~ ~u c G 1 ~ 19~8
P. O. Box 1327 · San Mateo, CA 944(}1, <<'~ -I llJiANct lJ.ff.L
(415) 340-0397 4rt~ ~{Q. ~ (J
, ~~ ~- .~&._--, ... ---. - --
SUBDIVISION STATUS INQUIRY ~~~~
~
r , Lou Jones
& Associates
The City of Campbell P. 0, BOX 1327
70 N. First St. SAN MATEO, CALIFORNIA 94401
Campbell, CA 95008 ENVELOPE ENCLOSED
L oJ
BOND NUMBER SUBDIVIDER
3SM 713 578 00 William S. ClIff, Cynthia Denise Cliff & Alfred G. D'Amico
TRACT NUMBER. TRACT NAME
PM 88-07 65 Shelley Avenue
IMPROVEMENTS
Subdivision Improvements
1. Bas this work been fully completed, accepted
DYes
t8J No
2. If accepted, on what date?
3. If not accepted, is. work progressing satisfactorily
? ~ er/
4. "Percent~e .::completed-. ~ ~
.
WY.es - - 0 ~~-
REMARKS
...
&~ TV ~ 1,(/ e-T~r:
FURNISHED BY (s1gnatur~)
TITLE
DATE
7D"-
'.o.a
BOND DEPARTMENT
Daniel Jones
REFUNDABLE DEPOSIT
CHECK REQUEST
TO: FINANCE DIRECTOR
CITY OF CAMPBELL
Please issue check payable to:
Cliff Dakan
(20 spaces)
(30 spaces)
(30 spaces)
(30 spaces)
State: CA Zip: 95155
(2) (10 spaces)
Address:
Line 1:
c/o D'Amico Development
Line 2:
2599 Westgate Ave.
City :
San Jose,
Description:
Cash Deposit Refund
(24 spaces)
Exact Amount Payable:
Account Number:
$500.00
001.00.905.0000.4662
PURPOSE: Release of cash deposit for excavation permit #88-170.
See receipt #19545 dated 6/23/88.
Requested by: Carlos Jocson
Title: Assoc. Civil Engr. Date: 2/28/89
Approved by: Don Wimberl y
Title: p. W. Director
Date:
Verified by:
Accounts Receivable
Date:
xx
Mail in
:II- 9135Iw1.~)'
cJ:td -4.v /81
attached envelope ~
~ #.LM
SPECIAL INSTRUCTIONS FOR HANDLING CHECK:
Mail as is
.
Return to:
(Departmen t)
(Name)
Other:
08/24/88
TO: City Clerk
PUBLIC WORKS FILE NO.
Please collect & receipt
for the following monies:
pro 'ect)
PelLm.{;t eM:
Depos i t
R-l :
($'35)
3372 Plan Check & Inspection Fee
3521 Other Cash Deposit (specify)
3373
3373
3372 Tentative Parcel Map Fil ing Fee ($350)
~372 Final Parcel Map Filing Fee ($300)
72 Tentative Tract Map Fil ing Fee ($400)
J372 Final Tract Map 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 Publ ic Works Special Projects
3510 Postage
J"cf- / 70
AMOUNT
$
~-
50c; -
NAME
~
?oJ,t l~:-
/9~() 9~t~
,
$ SEo-
3 7 /- ~ b 7 /
ZIP C;'J-/ 2- Y
TOTAL
PHONE
ADDRESS
~-..r-
FOR
CITY CLERK
QN1. y
RECEIPT NO.
I 99-,L~
SsG). dO
CL /?j
tb . ;). 3-? ~
AMOI..R'lT PAID
RECE I VED BY
DATE'
July, 1987
REFUNDABLE DEPOSIT
CHECK REQUEST
TO: FINANCE DIRECTOR
CITY OF CAMPBELL
Please issue check payable to:
Towne & Country Financial Ser.
(30 spaces)
Address:
Line 1:
c/o D'Amico Development
Line 2:
2599 Westgate Ave.
(30 spaces)
(30 spaces)
State: CA Zip: 95155
(2) (10 spaces)
(24 spaces)
City :
San Jose
(20 spaces)
Description:
Cash Deposit Refund
Exact Amount Payable:
$1300.00
Account Number:
001.00.905.0000.4662
PURPOSE:
Release of cash deposit for excavation permit #88-170.
See receipt #0020 dated 9/22/88.
Requested by: Carlos Jocson
Title: Assoc. Civil Engr. Date: 2/28/89
Approved by: Don Wimberly
Title: P.W. Director Date:
Verified by:
Accounts Receivable
Date:
SPECIAL INSTRUCTIONS FOR HANDLING CHECK:
#-9017/ ~ J~4-~
~tl3J.1,- rf/!JYf:~'f
Mail as is xx
Mail in attached envelope
Return to:
(Department)
(Name)
Other:
08/24/88
TO: City C I e rk
PUBLIC WORKS FILE NO. ~- V, 0
Please collect & receipt
for the following monies:
",..CT.
35-3396
3372
3521
3521
ITEM
Project Revenues (specify project)
PubUc. ('lOlL/v.. Exc.ava;Uon PVtm,u reM:
App 1 i ca t i on Fee
Plan Check Deposit
Faithful Performance (Cash) Deposit
R-l :
($'35)
($200)
OtheA :
($ 50)
'( $500)
(4% of FPB)
($500 min.)
(7'7.. of FPB)
($ 35 min.)
3372
Plan Check & Inspection Fee
3521 Other Cash Deposit (specify)
J373
3373
Project
General
&
3372 Tentative Parcel Map Fil ing Fee ($350)
<<72 Final Parcel Map Filing Fee ($300)
2 Tentative Tract Map Fil ing Fee ($400)
)372 Final Tract Ma Fil in Fee ($350)
3372 Lot Line Adjustment Fee/Certificate of Compl iance
3372 Vacation of Publ ic Streets and Easements ($500)
3372 Assessment Segregation or Reapportionment
First Spl it ($500)
Each Additional Lot ($150)
3372 Environmental 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-l ieu Fee per Unit ($1,132)
3380 Public Works Special Projects
3510 Postage
TOTAL
NAME
PHONE
AMOU tH
$
~ \~~. 00
$ (~e;<...:::;. ~
ADDRESS
ZIP
FOR
C I TV CLERK
QIlLY
RECEIPT NO.
t!J () ).. t!)
J 36~. ~o
0--0"
9 - :1- '2.- - 8" sr
AMOI.I'n' PAID
RECE I VED BY
DATE'
July, 1987
TO: City Clerk
PUBLI C WORKS FI LE NO. f' 1'-/7 CJ
Please collect & receipt
for the following monies:
k...CT.
35-3 96
3372
3521
3521
(specify pro.ect)
PVU"f/,(;t FeM:
R-1 :
($35)
($200)
t elL:
($ 50)
'( $500)
(4% of FPB)
($500 min.)
(7% of FPB)
($ 35 min.)
(Cash) Depos it
Qiij)
3521
Plan Check & Inspection Fee
Other Cash Deposit (specify)
2373
3373 &
3372 Tentative Parcel Map Fil ing Fee ($350)
'~72 Final Parcel Map Fil ing Fee ($300)
2 Tentative Tract Map Fil ing Fee ($400)
)372 Final Tract Ma Fil in Fee (S350)
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
Ne ative Declaration
3370 Storm Drainage Area Fee per Acre Multi-Res.,
$2,060; all 0 the r, $2,250)
2395 Park Dedication In-lieu Fee per Unit ($1,132)
3380 Public Works Special Projects
3510 Postage
AMourn
$
.:)1 ~ 75: 00
NAME
TOTAL
D I~ 1t!-tJ DCVELoPME1JT
/d() ..5~7V~ Av~
$ ~.;J. 75:"0
.
'7J'L/-- 7J/.5
ZIP 9~S"1
PHONE
ADDRESS
$. L!.
FOR
C J TY CLERK
CflLY
RECEIPT NO.
o
~ PAID
RECE J VED BY
DATE'
July, 1987
AMERICAN MOTORISTS INSURANCE COMPANY
Long Grove, IL 60049
l~empeR
inSURanCe
cmnpames
Subdivision Bond - California
Faithful Performance - Public Work
SUBDIVISION BOND
BOND NO. 3SM 713578
PREMIUM OF $650.00
KNOW ALL MEN BY THESE PRESENTS:
ThaL-
WILLIAM S. CLIFF, CYNTHIA DENISE CLIFF & ALFRED G.D'AMICO
as Principal, and the AMERICAN MOTORISTS INSURANCE COMPANY,
a corporation organized and existing under the laws of the State of IlIlinois and authorized to transact surety business
in the State of California, as Surety, are held and firmly bound unto
THE CITY OF CAMPBELL
in the sum of
THIRTY TWO THOUSAND FIVE HUNDRED AND NO/100
Dollars ($ 32,500.00 ), for the payment whereof, well and truly to be made, said Principal and Surety
bind themselves, their heirs, administrators, successors, and assigns, jointly and severally, firmly by these presents.
The condition of the foregoing obligation is such that, whereas the above-bounded Principal has entered into a con-
tract, dated
, 19_, with the
CITY OF CAMPBELL
to do and perform the following work, to-wit:
SUBDIVISION IMPROVEMENTS ON PM 88-07 KNOWN AS 65 SHELLEY AVENUE .
NOW, THEREFORE, if the above-bounded Principal shall well and truly perform the work contracted to be performed
under said contract, then this obligation shall be void; otherwise to remain in full force and effect.
SIGNED and SEALED this
3rd
day of
OCTOBER
19~.
"M..<:'"....~\I\~NCE 10:
DlR(Cl r" r':'\l\t.,n:"uw
.\ f~'\,~"'!a~es
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MM~i\G~~{G GE,:t\;AL t\u'"i7
181 2nd ?Ive P.O. Box 13
SAN M~Tc.O, CA, 94401
(415) 340-0397
Principal
Attorney-in-Fact
F,\\ 6J2 2-79 2M
Printed in U.S.A.
AMERICAN MOTORISTS INSURANCE COMPANY
BOND NO. 3SM 713 578
PREMIUM INCLUDED WITH
PERFORMANCE BOND.
SUBDIVISION / LABOR & MATERIAL BOND
KNOW All MEN BY THESE PRESENTS:
That we, WILLAIM S. CLIFF, CYNTHIA DENISE CLIFF & ALFRED G. D'AMICO ,as Principal and
AMERICAN MOTORISTS INSURANCE COMPANY, as Surety are held and firmly bound unto
THE CITY OF CAMPBELL , as Obliqee. in the sum of
THRITY TWO THOUSAND, FIVE HUNDRED AND NO/IUUs ( 32,500.00 ), lawful money
of the United States, for payment of which sum, well and truly to be made, we
bind ourselves, jointly and severally, firmly by these presents.
THE CONDITIONS or THE ABOVE OBLIGATION IS SUCH THAT,
WHEREAS, the above said Principal has agreed to provide certain tract improvements
for the subdivision known as PM 88-07 LOCATED AT 65 SHELLEY AVE. CAMPBELL CA.
pursuant to an agreement with the THE CITY OF CAMPBELL
dated 19____, wherein it agreed to comply with the requirements of
~UF r.TTY OF CAMPBELL , and is required
by the said _ r.TTY OF CAMPBELL to give a bond to
guarantee payment to the contractor, his sub-contractors and to persons renting
equipment or furnishing labor or materials to them for the improvements.
WHEREAS, under the terms of said agreement, principal is required before entering
upon the performance of the work, to file a good and sufficient payment bond with
the Obligee to secure the claims to which reference i~ made in Title 15 (commencing
with Section 3082) of Part of Division 3 of the Civil Code of the State of California.
Now, therefore, said Principal and Surety are held and firmly bound unto
TME CITY OF CAMPRFTT and all contractors, subcontractors,
laborers, ma~erialmen and other persons employed in the performance of the aforesaid
agreement and referred to in the aforesaid Code of Civil Procedure, for materials
furnished or labor thereon of any kind, or for amounts due under the Unemployment
Insurance Act with respect to such work or labor, that sai~ Surety will pay the same
in an amount not exceeding the amount hereinabove set forth, and also in case suit
is brought upon this bond, will pay, in addition to the face amount thereof, costs
and reasonable expenses and fees, including reasonahle attorney's fees, incurred by
the Obligee in successfully enforcing such obligation, to be awarded and fixed
by the court, and to be taxed as costs and to be in~IIJded in the judgement therein
rendered.
It is hereby expressly stipulated and agreed that this bond shall inure to the
benefit of ary and all persons, companies and corporation entitled to file claim
under Title 15 (commencing with Section 3082) of Part 4 of Oivision 3 of the Civil
Code, so as to give a right of action to them or their assigns in any suit brought upon
this bond.
Should the condition of this bond be fully performed, then this obligation shall
become null and void, otherwise it shall be and remain in full force and effect.
IN WITNESS WHEREOF, this instrument has been duly executed by the Principal and
Surety above on 10/3/88
..~
LOU JONES & ASSOCIATES
MANAGING GENERAL AGENTS
AMERICAN MOTORISTS INSU~MPANY
S. CLIFF, CYNTHIA DENISE CLIFF &
D'AMICO
PLEASE DIRECT ALL CORRESPONDENCE TO:
--~--
fI),#. ~..E ETO:
LO ~~1
181 .. .,' ;;V~
SAN MATEO, CA. 94401
(415) 340-0397
WILL);
A RED
BY:
BY:
BY:
AMERICAN MOTORISTS INSURANCE COMPANY
Home Office: Long Grove, IL 60049
POWER OF ATTORNEY
Know All Men By These Presents:
That the American Motorists Insurance Company, a corporation organized and existing under the laws of the State of Illinois, and
having its principal office in Long Grove, Illinois, does hereby appoint * U U U U * U U U U U U U uu * U uu ** *u u u
Daniel Jones of San Mateo, California ...................................**
.. I
naTiOnal
. . PiC
. fompame~
its true and lawful agent(s) and attorney(s)-in-fact, to make, execute, seal, and deliver during the period beginning with the date of
issuance of this power and ending December 31, 1990, unless sooner revoked for and on its behalf as surety, and as its act and
deed: Any and all bonds and undertakings provided the amount of no one bond
or undertaking exceeds FIVE HUNDRED THOUSAND DOLLARS ($500,000.00).........
EXCEPTION: NO AUTHORITY is granted to make, execute, seal and deliver any bond or undertaking which guarantees the
payment or collection of any promissory note, check, draft or letter of credit.
This authority does not permit the same obligation to be split into two or more bonds in order to bring each such bond within the
d.ollar limit of authority as set forth herein.
This appointment may be revoked at any time by the American Motorists Insurance Company.
The execution of such bonds and undertakings in pursuance of these presents shall be as binding upon the said American Motorists
Insurance Company as fully and amply to all intents and purposes, as if the same had been duly executed and acknowledged by its
regularly elected officers at its principal office in Long Grove, Illinois.
THIS APPOINTMENT SHALL CEASE AND TERMINATE WITHOUT NOTICE AS OF DECEMBER 31, 1990,
This Power of Attorney is executed by authority of a resolution adopted by the Executive Committee of the Board of Directors of
said American Motorists Insurance Company on February 23, 1988 at Long Grove, Illinois, a true and accurate copy of which is
hereinafter set forth and is hereby certified to by the undersigned Secretary as being in full force and effect:
"VOTED, That the Chairman of the Board, the President, or any Vice President, or their appointees designated in writing and filed with the
Secretary, or the Secretary shall have the power and authority to appoint agents and attorneys-in-fact, and to authorize them to execute on behalf
of the Company, and attach the seal of the Company thereto, bonds and undertakings, recognizances, contracts of indemnity and other writings,
obligatory in the nature thereof, and any such officers of the Company may appoint agents for acceptance of process:'
This Power of Attorney is signed, sealed and certified by facsimile under and by authority of the following resolution adopted by
the Executive Committee of the Board of Directors of the Company at a meeting duly called and held on the 23rd day of February,
1988:
"VOTED, That the signature of the Chairman of the Board, the President, any Vice President, or their appointees designated in writing and filed
with the Secretary, and the signature of the Secretary, the seal of the Company and certifications by the Secretary, may be affixed by facsimile on
any power of attorney or bond executed pursuant to resolution adopted by the Executive Committee of the Board of Directors on February 23,
1988 and any such power so executed, sealed and certified with respect to any bond or undertaking to which it is attached, shall continue to be
valid and binding upon the Company:'
In Testimony Whereof, the American Motorists Insurance Company has caused this instrument to be signed and its corporate seal
to be affixed by its authorized officers, this 13th day of , 19 88 '
Attested and Certified: {f?5;;"} AMERICAN MOTORISTS INSURANCE COMPANY
7c- #~ ., .... · By S2-- ~ ~~'^-~
- J. S. Kemper, III, Senior Vice President
F. C. McCullough, Secretary
STATE OF ILLINOIS 5S
COUNTY OF LAKE
I, Rose K. Rayner, a Notary Public, do hereby certify that J. S. Kemper, III and F. C. McCullough personally known to me to be the
same persons whose names are respectively as Senior Vice President and Secretary of the American Motorists Insurance Company,
a Corporation of the State of Illinois, subscribed to the foregoing instrument, appeared before me this day in person and severally
acknowledged that they being thereunto duly authorized signed, sealed with the corporate seal and delivered the said instrument
as the free and voluntary act of said corporation and as their own free and voluntary act for the uses and purposes therein set forth.
~...,~~.
(..~~:)
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My commission expires: August 12, 1991
Rose K. Rayner, Notary Public
FM 836-5 7-88 1 M
Power of Attorney-Term
PRINTED IN U.S.A.
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I' ";.'t~~'0i';'flEED& GRAHAM, INC.
<~:-, '7:"'~';,.,-:.,..-, ~':," ,":,
" ",e"" CONTRACTORS L1C. C 12. 158410
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FtE!J"Tf.!?ft::/rLm,-T #88- ~ / 70
86- 142754
ROAPOILS,A~D ASPHALTS
HOT AND COLD PLANT MIXES
WEIGHED AT:
690 SUNOL STREET
SAN JOSE CA 95126
408
690 SUNOL ST~EET - P.O. BOX 5940 r-. SAN JOSE, S<~ORNIA 95150
,TELEPHONE (408) 287-1400
FAX (408) 294-3696
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CUS!O!IJIEfl;.,!"JlE"7NEWS8ALERS ....' "
:;{X;';lt'".SPHALT M,A INTENANC(;. COMP AN Y
"'!}?8Q AMES A VE. .
:'MILP IT AS, CA 95035
' , ~j", . " ,
!j.ii WEIGHMASTER CERTlFICATI:
. ,;,~,; , ". "
rhil> "' to ;'Certify that till' following d!1,cril1ed uJllvno(jit., was
weighed. measured, or counted by a wuighmasler. ~h(;se S1(Jndture
is on thIS pertifJGatQ, who 'is a recognized. authority of ~lCCUri.h'::Y,as
prescribE;ld by ChaPter 7 (commencing with SeeliG" 127(0) d DiviSion
(, ot thE! C(~lifornia Business and Profession~ Codn, ;ichrldW;lIjr(1(j try' the
Division of Me<l5lJrOmenl Sl:1l1dards of tho Calilo"lIa Oepartrroelll of
Food and Agricultw(l,
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J090ESCRIRTIQN:rC A MPliE L L. CITY MIX
~> /'," !''',;'.'!',~:'~,!,i' SHELLY
4' ", ";"'"
-----_.~_._------------ .-.,.-~--_.__.._.._.,._-_.__._---~ --_..
JOB LOAD JOB TOr\IS
TOTAL: 1 TOTAL: <S . 2 f,
DAilY: 1 ' DAllY:,e ':' I:,
~~.; ZO {88 91 ~~= ~t3 ION .1' U" 4 I 01m03
. UO.M. OUANTITY - PRla'I--lPTAI. GR~SS -- -1-T"rJiEr;
rON 0.25 0.00 _-.!AR~-=w}tf~
NET -_LJ-_J_ffiL~~
:_~1+: .
nMElf\J/,1,
;> ':,', \"/;-";.~;fl>-r\1,
1 0: 5 8 A." '{?"
02114is9 .
T1jV1l; OUT
01:!52PM
02/.~41e ~;
DESC.~U)TlbN'
REED & GRAHAf<II. INC.
WEIGHMASTER
,. THR.rAl30>.$,flI:CEIVEQ BY;
\ . DRIVERS
: NAME IN FULL X
12 /A;J,
, 'il .
,~~tL( ~_.,...
CUSTOMER COpy
X KA Tl-L~~_c:H__I:_l,~tU:1~________._
DEPUTY
..... ,......'
- -- ---""-'-' -..
,.
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IECE'VED
FEe 2.1 1989
PUBLIC WORKS
EN.GINEERING
\i:~!.:.~;,;-,;'
RE~D & GRAHAM, INC.
CONTRACTORS L1C, C 12 . 158410
, ',.:,
R<;lAOOII.$ AND ,ASPHALTS HOT AND COLD PLANT MIXES
408
690 SUNOLSTfl,EET - P.O. BOX 5940 :- SAN JOSf' 9,~ORNIA 95150
,TELePHONE (408) 287.1400
.~::~,,.'~i;;.\:: ',,;:' " ,
FAX (408) ,294-3696
, NEWSt::ALER~ '
, HAL 1 iliA UHf,NANCf; COMPAN Y
'~o AMES AVE.
,ILP 11 AS, C'A 95035
CAMPBELL C:I T YM IX SHELLY
TIME OUT
02:49PM
02: 114/89
~'f-L PfS~mp110N
" MED IUM'
rHE:'f,\,tJ9~,~jCJ:IVEO BY:
;'::"':[)RJ~~S
~~EIN FULL X
~-
PURCHASE ORPER
JOB NO
H6 - 00 {:;;:::-... ,}
J27 'i
QUANTITY PRICE
rON
14.91
1)..00
..
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"
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,86- 142761
WEIGHED AT:
690 SUNOL STREET
SAN JOSE CA 95126
I
,
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':;";,,, :;jt;~,,: ".',
h",~il"q\:~'r .':, ..... .... ,.1-.-:1'
!:'iI4>~:i~kWf;IGHMASTER Cf;RTlFICATE
'f:~,':"~ J,f',<'f'
Thil> is. ~o..~tify that the following describHd comrnudity was
Wej\jhed.;~red.or counted byaW<lighrnast"r. whose signature
is on this 'cllrtifi(;ate, who IS a recognized authority of 'accurac'y, as
pmscribEjd i;>y Cl:)aptEjf 7 (commencing With SectKJIl 12700) oj DiVision
5 of theCallforni~ Business and Profession~ Code, <ldml/llstered by the
Division <If MeaSuroment Standards of the Cali/orni" Department of
Food andAQ':jcultur~.
JOB J"OAD
:' ~:,;;
TOTAL: 2:
DAILY: 2
;.T.... RU.,CK
'f~! i...
~:(~~~~i~~i
;. ','.l'I'.:
T
JOB TONS ,
TOTAL: 2 1 . 1 t.
DAILY: 2 1 . 1 6
DRIVER -r TAG NO-~ &G NC}'-
l) N 14 ~~ ( (;. 1 I I) 1E: :;: 0:::
GROSS
'i-i' ,- --j--"
: ,'; 4 7 "
i ., r'';'
. j' ' -- .,-,-
+t, 9 ~~I~,
__L~ 4 ',' r1
TARE
NET
,:f-'
" ',,, f~EED & GRAHAM, INC.
'.' WEIGHMASTER
X KATHLEEN BLUME
DEPUTY
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I 690 SUNOL STREET - P.O. BOX 5940 - SAN JOSE. 9,~t}aRNIA 95150
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REED & GRAHAM, INC. '
CONTRACTORS L1C; C12-158410
86- 142752
ROAD OILS AND ASPHALTS
HOT AND COLD PLANT MIXES
WEIGHED AT:
690 SUNOL STREET
SAN JOSE CA 95126
,\,
"
,
TELEPHONE (408) 287.1400
FAX (408) 294.3696
WEIGHMASTER CERTIFICATE
! CUSTOMER:
HE-NEW SEALERS
ASPHAL l MA IN"fENANCE
960 At~ES AVE.
MILPI1AS, CA 95035
COMPANY
This is, to certify that tll" tollowmg de;;crtl'ud lU1il11l0(11lV w;"
\tveightld. rneasumd. or counted by a wel(jhlflc.blu, WhO~f} ~';iuruHur(:
j;) on this' certifrcatfi, who is a rt:co{Jnilud dUlhu/lty of uccur.Jcy, as
pre~,cribed by CI'!<Jptor 7 (curnnI011cill{j with S(;ctlun 1 ~ J()(j) vI Divi;.;iljfl
::; of thl~ Calitornia BosinesCi ~nd Professions Cod", adllJlnis'lerurl Ly the
Division of Measuremont Standards of H,,, Calilc)lllIil DepJIlIlIt"ll of
h)()d and AgricultllfO.
-------..-.-...------
f
--~ --- -.---------.-.-- - ---~-----~-----~------- -----
JOB LOAD JOB TONS
TOTAL: :::: TmAL: ~::.;, . 1 :::
DAILY: 3' DAILY -:-;t'. . 1 3
I~G-OOr;3:::'J h:i-60'3 uN 14.:r.:,2 018'::1."3
- J210 TR- 1
-- , ----r----,-'-r--.--,-.. ~-,
U.O.M./ QUANTITY PfiICE, i TOTAL GROSS i \ I 2: t!> I 1 li 0
rnN 14 ':;7 n nol '--t- . ~__ '__
- . . .. . , I
- TARE ---1-' _ 1 1 I l+~.
-~~-_.- -,-~_._~.~~. L:.L~
JOB DESC~I~T10N:
CAMPBELL CITV MIX
SHELLY
)'~p~~E,.'~" TIME OUT
lO:58A~~~ O~:61PM
02/14/8'1: OZ/14/t:'i
,!,. '~TE,RIAL DESCRI.PTION
, " < :,,<,,';:,;;~'15';,._ .- .'
ASPHALT" 4 MEDIUM
' -, .' -- ,(;,f,
!~
;,'
REED 8 Gn,l\HAM, INC
WEIGHr.,tlASTEH
THE'AAQVsae't:EIVED BY;
, ,,' DRIVERS I
NAME1N FULL ~..::.:..--'"
/J./ A.;;/
i I ~/.1Z:;;;~ ~
..,
X~~T H L t:'I: r\I..J:.~~!J.~.f~____
DEPUfY
<
...
~:~""';"/:!"""
~~~~_._-~_.
CUSTOMER COpy
--'~---.
--------
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~./ ftOAD DlI,s AND ASPHALTS HOT ANO CDto PLANT MIXES
) /690 SUNOl STREET - P.O. BOX 5940 - SAN JOSE, ~3~FORNIA 95150
/ TElEPHONE (408) 287 .1400 FAX (408) 294-3696
) I
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, I JOijOESGRIPTION:
REEP & GRAHAM, INC.
CONTRACTORS L1C, C 12 -15841 0
86- 142820
WEIGHED AT:
690 SUNOL STREET
SAN JOSE CA 95126
;."0:.:.: '
CUSTOMEiji 'RE-NEW SEAL ERS
':,"ASPHAlT trfA r trt E::NANCE
""i>(:980AMES AVE.'
trfILPI.TAS, CA 95035
-----.........-------------~
This is to certify Thill tll" fOllowing (jt:scl,b,,'(j cornmOuily W,'S
weighed, Ol"i1Hured, Or COUnted by a vVeighl1l"~I"1 Who"" signiltur"
is on This cnrtiflcare, vvho i, a recognllt;d iJUlhollty of dCClIfiJcy, i"
pn~Scnbed by Chaprer 7 (commencIng Wilh Sbction 12JOO) of D,VISI,",
5 of the California BusinbsS and Proftissions Code, admlfllsto'Jrecl bl' Ii ,,'
Division of Measuremtmt Srandards of the Culltornla Dbpartmnnl IA
r'Ood ilnd Agnculruro,
WEIGHMASTER CERTIFICATE
CONPANY
CA MP BEll ~;:;;ll;--- - --.--JOBLOAO--j------__ -JoBlo7,i's.-------
AReooO TOTA~ 4 TOTAL-50. ~O
DAILY: 1 DAILY: 14 . .::.7
PURCHASf;:"CiR~E]ii-- --JOB NO.--- -------mUCii-] DkIV~AI--:fAl;--NO~-,--R&- G-r"
llG-O<){U89 R6'G~"3 ON 14.',J.'0 0183,)
J 2 '( ';I ?
DOM_ QUANTITY 'PillCE - ~--- GftOSS -r- ;r,:~~t7'~-
raN 14.67 0.00 ,__
TARE I ' .
--------.r-----
NET --------J_ __ ~,_ ~,1~
REED El GHAHAM, INc
WEIGHMASTER
TIME OUT
I TIrvtF.JN
.'. r .,
09:B6AM lO:26AM
02/t5/S9 02/15/89
"1, .'. i,.,;,'i,>l)I1ATERIAl DESCRIPTION
I AS~~;~ht', ~ 14 M ED I UM
, " , "',
THE AaOVE RECEIVED 8Y:~"..(
DRIVERS ,
NAME IN FULL X:--.
.' ~........",,/
--- ~--/
/lLKh.I!!U.06EiiM;.l1L__
-------------:---
~-~.".
CUSTOMER COpy
-'-'-'-'--,,---,,~-
- -- -------.,-------.,----
?
..
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I ROAD OILS AND ASPHAlTS HOT AND COLD PLANT MIXES
I 40;;;:
690 SUNQL STREET - P.O. BOX 5940 - SAN JOSE, %HfOANIA 95150
I TELEPHONE (408) 287-1400 FAX (408) 294-3696
If cu.~iiip~f~I's~A~~#NANC~ COMP AN V
I'.;. .,,;:,,>,1"',1,9.80 AMES..". A V E.' "
I ' "'i;<':flfILP IT AS, CA 950315
. "'''':''',''',''~~f~iJ,'.
REED & GRAHAM, INC.
CONTRACTORS LIC. C 12. 158410
86~ 142352
, WEIGHED AT:
690 SUNOL STREET
SAN JOSE CA 95126
WEIGHMASTER CERTifiCATE
Thi~ !.s to certify that the following descnbed commodity \(Vas
weighed; measured, or countQd by ,a 'weigrunoster, whose signa turd
is on thi.'i cElftificate, who is a recognized authority of accuracy, as
fm;:scribecj by Chapter 7 (comnlOllcing with S<.ction '12700) (;1 DiVision
5 of the California Buslfless ancl Professions Code. adnllnistelod Ly the
DiVision qf Measuren},mt Standards of the California DUIJ.)rtment of
Food and Agriculture.
;:';::"<:-.:,:";;:< :.ij::' :t::':i ~ :::',::. '..,
I ' JOB ()ES~~i\PON:
I
1
. TlM~,W}
09 :56A.M
02/H5/89
TIME OLlT
PURCHASE ORDER
JOB LOAD ---r------jOO TONS
roYAL 7~TOTAl 8~ .18
IlGJ~: :~8'3 9 R G _ :::~CK .[Dn:~: R 1 :~'8Nti02 : ~8 ~,~(;
J279 ?
U~OM QU~:n.T;9 PR~C~O L-- TOTAL .- - ~;OSS -11"~rip .1=
TARE I I ,'i'.. -rl '.
-= NET _ -=]J]1~:;t
CAMr,;l1El,..L. 'CITY M1XSHELLY
AR8000
12:0tiPM
02/15/89
DESCRIPTION
MEDIUM
--
I
I
----- -,------__,_,J______.______
REED h GllNli\rv'l. INC.
WEIGHMASTER
THE ABOVE RECEIVED BY:
, DRIVERS
NAME IN FULL X
-.------.-------
L KA l Hl. ::L [\1 B LU I-IE
DEPUTY
USTOMER COpy
'~.
T
..
, ,
1
I ROAD OILS ANO ASPHALTS HOT AND COLD PLANT MIXES
408
1690 SUNOL STREET - P.o. BOX 5940 - SAN JOSE, X~l;.!FORNJA 95150
1 TELEPHONE (408) 287.1400 FAX (408) 294-3696
I
1
I
>"'id~~*'~'!frI..'W"',.;'~" ._.'
REED & GRAHAM, INC.
CONTRAcTORS lIC. C 12 ~ 158410
86- 142321
WEIGHED Ai":
690 SUNOL STnEET
SAN JOSE CA 95126
COMPANY.
WEIGHMASTER C~RTIFICA1"E
This i~to certify that the following des';lllJ"d cOi1if,l(Jdlty was
. weigh~."m(ja$ured. or counted by is weigiHl1i::-.:sttJr, WhUSH siilnalUr8
is on. thj~l certificate., who is a r",cognized authority uf c"'CU:.dCY. as
prescribe(lby Chapter 7 (wllIolerlcingwlth Section 12700) or DiVision
5 of thQ Gau(ornia Busineso and Profesoions Cude, dclll';i lIi.WIEld by tho
Divls;Pll ofMoasurernent Standards of the Colif'jll1li1 Depurtllwnt of
Food and Agriculture,
;':. ,
',~ f:':.,~
JOB OESCRIPTlON:
TIME OUT
JOB LOAD
TOTAL: e.
DAilY: 2:
t PURCHASE ORDER JOB NO:---- I .. ...... TRUCK
I<G- 00 t~, I RG-'i09
J2-'9 )..s
.'~'----"'--._.-.
U.O.M. QUANTITY PHlCE . TOTAL
=r JOB TONS' -
TOTAL: t) ;, . 2 !5
f)AILY. 2.:::: . 1 2:
-r:R- 1 ~~:-~~J 0 ~ ::,~:
GROSS -~J_ 1 5 4 0
I
NET I 8 . 4 '5
-----__J,__,_, ___ ,_L L_
CAMPBELL CITY MIX SHELLY
AR8000
lO:28AM
02/15/E:'1
, . .'! ' ';."Jy1ATERIAL DESCR.IPTION.
lA$~HAhTJ'~/4' MED rUM
I '
I
I
I
I
fON
8.45
0.00
TARE
.:, ';; '5
THE ASOVE RECEIVED BY:
, ,j DRIVERS
NAME IN FUll
-J_~
REED & GHAHAM, INC.
WEIGHMASTER
x
t1~ (1) /
--' .i\ -H'tJ
-_.~--_._-
X f< A T HL (c rLJ~JU.~_____
DEPUTY
- ---.-'---,-.- ~'''--.",-,- -.- - -- -.- - -'---- --.-,-.- - ---
CUSTOMER COpy
T
..
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I ROAD OILS AND ASPHALTS HOT AND COLD P'-ANT MIXES
/690 SUNOL STREET - ~,O, BOX 5940 - SAN JOSE, iWj}ORNIA 95'50
I TELEPHONE (408) 287"400 FAX (408)'~9~"3696
~
I
I
1
11' JOBDESr;AIPTION: CAMPaELL CITY MIX ::;HELLY
AR8000
REED & GRAHAM, INC.
CONTRACTORS L1C. C 12 - 158410
86- 1.~.23S3
WEIGHED AT
690 SUNOL STREET
SAN JOSE CA 95 126
CU~TOMER:RE...NEW SEALERS
' " ;"o'ASPHAL T filA 1 Nlt:NANCE
'.980 AMES AVE.
MILPI1AS, CA 95035
~--
This is !Q ,Certify tbi~t rbu following d",,,;r/)';d CO"'illOd,ty was
wHighed)measured, or counted by a W8IghIH.<iwr. \':V~H):it; si~JI1;:'lllJrtl
1$ orl thi>) certificdtu, who is a recognlzHd out. turn ~t Of ,:K'CLJracy. as
fJ''';;ctibed by Ch"ptHr 7 (Gommn'lcing with Sec!lo,; '!:>lOCi) 0f DIVISilill
b of the California Busindss and PlOfessions COdn. iJdll,,,,i.,lt:r801 by the
Division ()f Mepsurernent Standards of the CaidtJlllia Oup':'lnmf.:nt of
fooo <lilCj AgricLJltuf<J,
WEIGhMASTER CERTIFICATE
- "':,l~'<'
COMF'ANY
,'"
---:YQ'B LOAD ,-- ---'~"JO~f3:rONS -~-~~~
, ,
TOTAL:S TOTAL: ;.::4 . 1 ';1
DAILY: 5 DAILY: 48.0,) ,
1<6-0'), 0'" ,,,11<(," 909 ON 1 L '-'0" 0 1" "'OJ
QU!'<:T1T~ Z , Y PRICE, f 8 TOTAL GROSS Fl e 9 6
~.Ol O.UU I
TARE 6 9 t'~
H~
__LJ
J . 10: lOA~h;. l~::::
02/15/~9 02/15/89
I'. ..,'~TERlAl DE$CRI~TION
AS,PHALr:'t~ii41. MED L UM
I . i:' "
1
I
I
NET
<~ l) 1
REED h GHAHAM, INC.
wr iGfiMt,STER
THE A/30VEjSCEIVED BY:
DRIVERS J.-t{
NAME IN FULL X _.::.::-._ ..
"'''''').~' ;
'KJ~_
I . "-_~~~~;y__~__
.J~~~__ ...~.
~~_.._-.._-.._- --_....--~-----
- '~-
~~.'::: ~J~~:.t~ 1'1E
DEPUTY
----... 'I... ....
- -----..... ~
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)-
\
REED & GRAHAM, INC.
CONTRACTORS UC.C12-158410
86 - 1,12323
WEIGHED Ar
690 SUI\1CJL SOl HEET
SAN JOSE CA ~Jb 12G
J
';,
\,
,,' ," , ',1
....-----;;r---y ..---__________,..--___ __.,.,..
C I r Y M I X ::, H ELL Y \. ;,JOB J,..OAD j J\ lB ro~?,
ARB. '000' . . TOTAL: (. V I TOlI\L: /:.,8. 19
It' DAllY:,3 \ DAilY' '.....;.. (. j'
),..., fl. ~ .. , ......_ . . oJ
. · TI'\:1I\PUY--:,. !i~RCHASE ORDER- ,iO~ NO'- - TlI~K -~RlVER --1:;; "". I R " G "
f/ ~~;l'k <i' ;~~m~:9.' ;'. .i' .~*<) (;,;3) ~G'30} ON 14Cm-~~:;(,
". :.!y,~t;.~TER~.e~!ifRIPT10N U.OM QUANTITY PIIIC, lUTAl .. GROSS I - - r-
~':'I~tl;1'ji~/4 Mf9~~, rON ~. ~'4 O. ')0; --- INAERrE ~=--..-1!,.~_~1_- _1 ~i~
J I, ai.i
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ROAD OJL$ AND ASPHALTS HOT AND COLD PLANT MIXES
I 408
) 690 ~UN91~STRt:ET - P,O, BOX 5940., - SAN JOSE, X~LXFORNIA 95150
I . . TE:;~HO~E 1406) 267.1400. FAX (408) 294.3696
>- I '", ", '
"'1~~~~~:! R~l~~. ~E'A4~~/'''' .' C:U"""""AN:Y
.). I (, -:,.'t!>.~tt\.,..,....':..r.,ASP~A....L. [,.JtA;., ~, .,'~,nENANCE "Ir
to !"~~i,\; 9.80 \AME.~ AVE.
)'tl~ l'~;~'\ ;;'~;'/~l L P IT ^R:' 'I~\~ 95035
." ",'.'1 ,"'"W""" \. '!.l r~j
>, ,~;-:: :....t'~~x:,':::, Ii. ~'~'i:~l ,.: .-,:"'1,
"f . ):'~"?:'J;Dt'l'''"' / ~~. )!~/
~~
',:\;'"
WEIGHMASTERCEIHIFlCATE.
--....7~~
This i:;;to' certify thai the fOlk.lWHll; deC(;IIUed(;u/llI),fXlily Wi.IS
weigh~3(t nlOasllrod, 01 cOU~lt.o(1-by it \\JUiUtllJl.:Jstur, 1"",,Ih0S~ signiHufH
is on this certificate, wllQoo.~~;, a {ocognized ~Jut!lnrily 01 3.C~U,-ucY. d~
pr~scrl~~ by ,Chapter 7 (COlflll)Hnclng Wili1 Sd~.'(h)ll l:~iOO; pf DjvJ~,i0jl
f:, of th.1I California l3i.lsil'''''$ ~nd P'ot"sliions Codl), d,'], I 11l1bll)rud by tl,,,
Dwi,ion of Measomme/lt Standards of the C;llifu'ni~ Dep"rtmellt I >I
Food and f',gnculture,
",/.'..
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REED EJ CriAH/,M, INC.
VVEIGHf'.1ASTER
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Tl1E'AI30VE RECEIVEOI;IY;
ORIVERS
NAME IN FULL
x
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DEPtH Y
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.
TRUCK INSURANCE' EXCHANGE'"
INTERIM CERTIFICATE AS TO EVIDENCE OF INSURANCE
~,~
THIS IS NOT AN INSURANCE POLICY. THIS IS ONLY A VERIFICATION OF INSURANCE, IT DOES NOT IN ANY WAY AMEND, EXTEND OR ALTER THE
COVERAGE PROVIDED BY THE POLICIES LISTED BelOW.
Named
Insured .
Address .
Al D'AMICO
D'AMICO DEVELOPMENT
2599 WESTGATE AVENUE
SAN JOSE, CA 95155
60016 10 89
Policy # Gen. liab,
Policy # Auto liab,
Policy # CARGO
This is to certify that policies for the above named insured are in force as follows:
c..,
OWNED
AUTO-
MOBILES,
IF
COVERED
POlicy # Work Comp,
This Interim Certificate As To Evidence of Insurance shall expire sixty days from 12 :01 A M"
~ 26 ' 19$-, unless cancelled prior to such date by written notice to the named insured.
Please issue a Permanent Certificate
COVERAGE COMBINED LIMITS OF LIABIlITY
COVERED NOT AUTO
COVERED LIABILITY
D ~ Owned Bodily Injury $ ,000 each person
D Hired $ ,000 each occurrence
D Non-Owned Property Damage $ ,000 each occurrence
[XJ Employer's Non-Ownership
Contingent liability
Single Limit Liability for Coverages checked IXI above $ 1.000 ,000 each occurrence
GENERAL LIABILITY $
M&C - OLT Bodily Injury ,000 each person . .
{ Owne" & Conlcodo" $ ,000 each occurrence
liJ D Contractual. $ 000 annual aggregate
Elevators $ , products...
Property Damage ,000 each occurrence
liJ D Products and / or $ 000 annual aggregate
Completed Operations ' products...
Single Limit Liability for Coverages checked IXI above $ 1,000 ,000 each occurrence
$ 1,000 o annual aggregate
,00 praducts...
D ~ CARGO $ ,000 each vehicle
$ ,000 each occurrence
D ~ WORKERS' Statutory
COMPENSATION
"'Includes Goods or Products Warranty, Written Lease of Premises, Easement Agreement, Municipal Ordinance
Agreement, Sidetrack Agreement, Elevator or Escalator Maintenance Agreement only, unless accompanied by
specific endorsement providing additional Contractual Coverage.
D Described D Description
below waived
YEAR, MAKE, TYPE OF BODY, LOAD CAPACITY
IDENTIFICATION NUMBER
THE AFOREMENTIONED POLICY SHAlL CONTAIN A PROVI ION THAT THE INSURANCE AFFORDED
THEREBY TO SAID CITY, ITS OFFICERS, AGENTS AND E PLOYEES, SHAlL BE PRIMARY IN- ~~~~~
SURANCE TO THE FULL LIMITS OF LIABILITY OF THE P LICY, AND THAT IF SAID CITY, SHOWN
,
BY SUCH POLICY, THATuOTHER TNSU~ANCE SHALL BE
morerra llao,fiTi"
POLICY NUMBER
XCESS I N?URANCE
$
$
otIL,~OO retained limit
each occurrence
aggregate
If this Interim Certificate As To Evidence Of Insurance is to be cancelled prior to the expiration date, we shall
provide 10 days advance notice in writing to whom this certificate is issued.
Certificate issued 'to:
Name
And
Address
.
ADDIIONAL INSURED:
THE CITY OF CAMPBELL
70 N. 1ST STREET
CAMPBELL, CA 95008
~
s.
s.
Countersigned
.. Not Applicable In Texas
. '" * In Texas the aggregate also applies to owners and contractors protective, contractual and/or completed operations,
Authorized Representative
56.05143-8811201 WI200 C11200 PRINTED IN USA (") M
INSURED'S COpy
--
......
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND,
EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW.
LOS GATOS-CAMPBELL INSURANCE CENTER
1935 DRY CREEK RD. #202
CAMPBELL, CA 95008
TOM SORCI
COMPANIES AFFORDING COVERAGE
INSURED
D'AMICO DEVELOPMENT
2599 WESTGATE AVENUE
SAN JOSE, CA 95155
COMPANY A
LETTER
COMPANY B
LETTER
COMPANY C
LETTER
COMPANY D
LETTER
FREMONT COMPENSATION
TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE
DATE (MMIllDIYY)
GENERAL LIABILITY
COMPREHENSIVE FORM
PREMISESIOPERATIONS PROPEAn' $ $
UNOERGROUND DAMAGE
EXPlOSION & COlLAPSE HAZARD
PROOUCTSICOMPLmD OPERATIONS
CONTRACTUAL BI & PO $ $
COMBINED
INDEPENDENT CONTRACTORS
BROAD FORM PROPERTY DAMAGE
PERSONAl INJURY PERSONAL INJURY $
AUTOMOBILE LIABILITY ImLY $
ItWlY
ANY AUTO (PER P9lSON)
ALL OWNED AUTOS (PRIV. PASS,) IlOOl.Y
ALl OWNED AUTOS (OTHER THAN) ItWlY $
PRIV. PASS, (PER ACCIOO{J)
HIRED AUTOS ~~~~TY $
NON-owNED AUTOS
GARAGE lIABILITY BI & PO $
COMBINED
EXCESS UABIUTY
UMBRELLA FORM BI & PO $
COMBINED
OTHER THAN UMBRELLA FORM
A WORKERS' COMPENSATION WN-87-459883-01 10-2-88
AND
EMPLOYERS'LIABILlTY
OTHER THE AFOREMENTIO ED POLICY SHALL CONTAIN A P
THEREBY TO SAID CIT , ITS OFFICERS, AGENTS AND
ADDITIONAL INSURED:
THE CITY OF CAMPBELL
70 N. 1ST STREET
CAMPBELL, CA 95008
~
CITY OF CAMPBELL
Permit No,
Applicant
INFORMATION SHEET FOR PUBLIC YORKS PERMITS
A separate form must be completed for the applicant and each contractor
that will work under this permit.
YORKERS' COMPENSATION INSURANCE INFORMATION
Name of Contractor/Applicant_(\AKA){- L.-llFf LCJl1st. 0(0,
One of the following must be on file with the Public Yorks Department:
A Certificate of Consent to Self-insure issued by
the Director of Industrial Relations; OR
~ A Certificate of Workers' Compensation Insurance
Insurance Co.
Policy No. Expiration date
; OR
This Certificate of Exemption from the Yorkers' Compensation
laws printed below (certificate must be signed).
CERTIFICATE OF EXEMPTION
I certify that in the performance of the work for this permit, I
shall not employ any person in any manner so as to become subject
, to the Yorkers' Compensation Laws of California.
Signed
Date
NOTICE TO CONTRACTOR/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.
. .
.......................................................................... .
CONTRACTORS INFORMATION
Note that all contractors must have current City of Campbell Business
License, State Contractor's License and Workers' Compensation Insurance,
Name of
Address
Telephone {twfh 311- iob lL
C', s /24-
State Contractor License No. :-jOb'7lo0
City Business License No.
Expiration Date
Will do the following types of work:
_____underground _____P.C. concrete _____A.C. paving _____electrical
_____other (specify)
f:PERMINFO
REV, 6/88
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PUBLIC YORKS PERMIT ISSUANCE CHECK LIST
City of Campbell
Public Yorks Permit No. ~8 - \ '1-0
~ Applicant section complete
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V Applicant signature and date
.y/ Permit Application fee, $35.00 for R-l, $50.00 for
standard, paid. Receipt number \q "'; ~~
v
Plan check deposit, $500.00 for standard only, paid.
Receipt number \q 00:;; 4~
~ Five sets of improvement plans submitted.
~/ Bond for faithful performance, 100% of City Engineer's
estimate for standard only, posted and appropriately noted
Amount $:t..1..~~(.-.e'l9 Form I.D. # '!JSH7/~~7J!l
V/
Cash Deposit: $200.00 for R-l; 4% of FP bond, $500 min.
for standard, posted.
Amount $ \'~ ('C;l, C"l> Receipt No. c)('::.>"'L-,C.:-
~Permit fee of 7% of FP bond, $35.00 min., paid.
Amount $ ,-Z-\s::;. '!!: Receipt No. 000...1.....
~ Yorker's compensation information received for Applicant
(see Information Sheet for Public Yorks Permits)
All other Public Yorks requirements listed in the Con-
ditions of Approval of the development. .
---------------------------------------------------------------------------
/
Yorker's comp and Contractor's Information received for
Contractor (see Information Sheet for Public Yorks Permits)
t/ .
Certificate of Insurance with Additional
Endorsment received from Contractor (see
Insurance Requirements for Public Yorks
4,.../' ,
Three sets of off-site plans, stamped APPROVED (Tract or
Development and Public Yorks Permit number and property
address on plans)
~permit signed for City Engineer
Insured's
General Summary of
Permits)
WEN ALL OF THE ABOVE ITEMS ARE COMPLETE, PERMIT MAY BE ISSUED
Issuer: Initial~ and date 16- --uh"~ and file with permit
UPON ISSU~CE, I~ITIATE PLAN CHECK DEPOSIT REFUND CHECK REQUEST.
6/88
f/permchklst
WEST VALLEY SANITATION DISTRICT
OF SANTA CLARA COUNTY
SERVING RESIDENTS OF
CITY OF CAMPBELL
TOWN OF LOS GA TOS
CITY OF MONTE SERENO
CITY OF SARA TOGA
UNINCORPORA TED MirA
100 East Sunnyoaks Avenue
Campbell, California 95008
Telephone (408) 378-2407
October 4, 1988
City of Campbell
70 N. First Street
Campbell, CA 95008
RE: Shelley Avenue Sewer Extension
(Damico)
This is the District's "clearance letter" for the recordation of
subject development.
This District has reviewed and approved the plans for the sewer
system servicing this development. Fees due this District have
been paid. Bond, adequate to insure subject sewer system
installation, has been posted with this District. In short,
all of the District's requirements for tract recordation have
been met.
Very truly yours,
OJ~.W
Preston R. Nichols
Assistant District Engineer
PRN:mk
E-20
Rev. 2-20-86
(FORMERL Y COUNTY SANITATION DISTRICT NO, 4)
"" " """=c!'.'" ..,,~ "''' "Tn'<T'
Address ~ ~ ~
Surface Construction
Permit No. '8~ -110
bY~clate :1' - 'Z 7 'o"fj)
Clearing & Grubbing
Sawcut Concrete
Concrete Removal
Curb & Gutter Removal
Inlot Drain with Pipe
Curb & Gutter
Sidewalk
Driveway Approach
Handicap Rluop
Extruded Curb
Ilarricade
Street Excavation
AC Pavement
Adjust Manhole to Grade
Adjust Handhole to Grade
Monument Ilox w!Konument
Street Tree (IS-gallon)
Pavement Striping ($100 min)
Pavement Legencla ($100 min)
Stop, Street Name or Other Sign
Pavement Markers
Pavement Key Cut , "
h CA (/, f?t7 7.'/. 8( t
n ~ fJ, tJ.c, 8 Y7 2- f.. 5"
Lump Sum Estimate
LF@ $ 4.00
--- SF @ 3.00
- LF@ 5.00
EA@ 600.00
7?- LF@ 14.00
~~q SF @ 4.00
31r SF @ 5.50
EA@ 400.00
LF@ 8.50
/0 LF@ 50.00
( (,?J c;, SF)X($O.lO)xL~.)
(I/"V:?/~SF)X($0.30)X( Ce ")
I EA@ 375.00
EA@ 275.00
EA@ 600.00
/ EA@ 300.00
LF@ 0.65
EA@ 40.00
EA@ 120.00
EA@ 15.00
LF@ 10.00
dC
, ,; ..:)
- $
- $
- $
- $
- $
- $
- $
- $
- $
- $
- $
- $
- $
- $
$
- $
_ $ ?: OQ,)
-
/, O() tJ, rr()
,
I. L/3ti>. 0 Q
,
1.727,c>0
,
5{)OrO()
',10 ( . (00
2.3~2.8o
37.S-;OD
- $
- $
- $
- $
- $
_ $ ,/5'90<J
:~~1oo
Adjust for size: "5.<$30",000 add 20', "5.>$100,000 subtract 10' (+ or -) $+;2tJ;z.C.,~()
Street Lh:htimr:
Electrolier
Conduit
Conductor, pair
Pull Ilox
Storm Draina2e
12- or 15. RCP
18. or 21" RCP
Street Inlet
Manhole
Ilreak & Enter Manhole
/'LEAN O~r
') c.( t( R ( f"'
revised 6/88
fjcon-cost-est
I EA @ 650.00 - $
I 6q. @ /IP/"I{I ,!C. rJ _ $
;213tJr? 77, 7.j I c., SG 0, 7J
TOTAL ESTIMATE $.:52/ s?7/. 5.J
$ 3.2; ..J"CJ{), o-D
Surface Subtotal
.5.
EA @ 2,000.00
LF@
LF@
10.00
2.00
Ea @
200.00
3;;- LF@
60.00
LF@
70.00
EA @ 1,600.00
EA @ 2,400.00
USE FOR 1l0ND
- $
$
- $
$
- $
- $
- $
- $
- $
2100.0'0
,
t:so, r {.1
1t);)(J.60
CITY OF CAMPBEll
FIRE DEPARTMENT
123 SOUTH UNION AVENUE
C AMP BEL L, C A'll FOR N I A 9 5 00 8
(408) 866-2189
5eD~ember 2. 1958
Sa~ Jose Wa~er ComDa~y
1221 S. Bascc'IA Ave'/''I\.le
Sa~ Jose. CA 95128
ATTENTION: JIM BARITEAU
RE: &0 SHELLEY AVENUE
Ge'rrt i erne'/"J :
This le~ter will serve as au~hc.riza~icc'/"l tc. i'/"lstall Ccl",e fire hydra'/"It
(4" by 2 1/2" by 2 1/2") at the lc<catic<'/",(s) listed belc.w:
1. West bou'/",dry e,f p'("c.pc.sed subdivisic..,., c.,/", Shelley Avel",ue.
.=-
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4.
5.
Si '/",ce'("el y,
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Fire l'o1a'("shal
cc: Chuck Gomez
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I
PUBLIC WORKS INSPECTION REPORT
')ate
Permit or Project No.
BB -;/7'0
Address
L5"-~y
7ype of work; Street Storm
Other (describe)
Sanitary
Electrical
[JPRELIMINARY INSPECTION WITH DEFICIENCY LIST (attached)
[J FINAL INSPECTION WITH DEFICIENCY LIST (attached)
~FINAL INSPE~TION - ~EPTANCE
Signed plans? ~ N (If signed, Council acceptance.)
Charges against deposit? y
Overtime. hra. @ $
Date ~ reason.
~
.
$
Barricade rental (attach invoice)? y
Date ~ reasona
f!)
$
Other?
$
$
$
· Refund $
~otal charges deducted from deposita
(Cash Deposit $ less charges $
ck. req.)
[JONE YEAR MAINTENANCE WITH DEFICIENCY LIST (attached)
o ONE YEAR MAINTENANCE - ACCEPTANCE
(Release'maintenance bond. Check Request if cash.)
Engineer
I~r
KIER & WRIGHT
CIVIL ENGINEERS & SURVEYORS, INC.
3350 Scott Boulevard. Building 22
Santa Clara, California 95054 . (408) 727-6665
STAKING FOR:
F. (;.
z. '1-8 ll8 6,.
OFFSET:
V
TL COLOR OF NOS.: O~,qN~
PAGE NO.: I
(
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CUT SHEE!-- m~
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BY: Gt"
1- 18-6'9
DATE:
BENCH MARK'
()
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ELEVATIONS -CUT
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JOB NO.:
ELEVATIONS
STATION STAKE GRADE CUT