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CITY OF CAHPBELL
DEPT. OF PUBLIC WORKS
70 North First St.
campbell! CA 95008
(40B) 86b-2l50
i-:J
Permit No. e.:.)t;:':ll>'" \"\~
X-Ref. file
Application Date lJI~2 ~crd(
expires 1n 5./
PUBLIC WORKS PERMIT
IIor worK1ng 1n ~ne
public right-ot-way)
I~:~:~t ~~~!~ mos.
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APPLICATION - Application is hereby ~ade for a Public Works Permit in accordance with Campbell-
Municipal Code, Section 11.04.
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Work address or tract f
//- ~~
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Utility trench location
B. Nature of work: ,.:::'51-, tP---? ~ /,.:..'./ P /.~;: L'e> __ /,7.2' = r.!' -/ 7':> /.c:? ,.,;." ;;
/ ,.
C. Attach five (S) copies of a drawing showing the location, extent and dimensions of the work
The drawing shall show the relation of the proposed work to existing surface and underground
improvements. When approved by the City Engineer, said drawing becomes a part of this permit.
D. The General Conditions for all permits are listed on the reverse side. Special Provisions for
this permit are listed below. Pailure to abide by these conditions and provisions may result
in job shut-down and/or forfeiture of Paithful Performance Bonds And cash deposits. (See
General Conditions land 2).
E. An application fee must accompany this application. This is non-refundable.
Name of Applicant 1::/......-~~..../-.. C;' ,Af/#<:--E -', ...../ Telephone:...../~.....t: .;j5~~"C$
Address /?C7. ~~ k?J.-~~ L"/--; C 4 -/...---,,~ C::::4'/ "T'::>~ 3/
Is this work being done by the property owner at their own residence? ___yes J<: no
Complete attached Workers' Compensation and Contractor fora..
The Applicant/Permittee hereby agrees by affixing their signature to this permit to hold the City of
Campbell, its of ers, agents and employees free, safe and harmless from any claim or demand for
damages result' 9 f om the work covered by this permit.
The Applican /Pe ittee5f!e y nowled~es that they have read and understand both the front and
back of thi pe mit, an t '11 lnform their contractor(s) of the information.
ACCEPTED ~ . --; - J 't.. - ~ ~
uate
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NOTES: ALL WORK SHALL CONFORM WITH THE ATTACHED, APPROVED PLANS AND ALL APPLICABLE CAMPBELL
STANDARD DRAWINGS AND CONDITIONS.
THE CONTRACTOR HUST HAVE THIS PERMIT AND APPROVED PLANS AND MUST MEET WITH THE P.W. INSPECTOR ON
THE SITE AT LEAST TWO DAYS BEFORE STARTING WORK.
NOTICE HUST BE GIVEN TO PUBLIC WORKS AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK.
SPECIAL PROVISIONS
...:
o
tt
[T.
1.
Street shall not be open cut for underground installations. Hinimum cuts may be allowed
for connections or exploration holes. Such cuts must be specifically approved by the
Inspector.
yavement may be cut for underground installations and must be restored in accordance with
the Utility Trench Restoration Standard Drawing.
Work to be staked by a licensed Land Surveyor or Civil Engineer and two (2) copies of the
cut sheets sent to the Public Work De~t. before starting work.
The hours of work are limited to outs1de the hours of 7-9 a.m. and 3-6 p.m. for any work
affecting a traffic lane.
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3.
4.
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PERMIT APPLICATION PEE
PLAN CHECK DEPOSIT
BOND FOR PAITHFUL PERFORMANCE
P. P. (CASH) DEPOSIT
(R-l)
($35.00)
(
l-
e-:
..
STANDARD
$SO.OO
$500.00
(100' OF ENG. EST.)
(4' OF BOND,$500 MIN)
(7' OP F.P. BOND
$35.00 MIN)
AMOUNT
$ .f b P.f:!..
$ ~G I ~
$.).'1. ,i'tJ () ':3-
$ '992 bE
<:)'"
$ ~736 ~
{
($200)
RECEIPT NO.
/ fd' /; ?
I ? d't 7
I ~4-... -l;;' 0\ \b"-,.:;;.
, 7'1 {,
PERHIT FEE
/ /;," ,
ISSUANCE L../~ L'~
r -';l~ r
'7 V ~.
Iu~fr
APPROVED FOR
f: PWPERHIT
Revised 7/87
ASSIGNMENT AND RECEIPT OF INVESTMENT CERTIFICATE
TO CITY OF CAMPBELL, 70 N. FIRST STREET
CA"I.:pnELL, CALIFORNIA 95008 (408) 866-2150
P.W. Permit No. 2f-/7,J
TR or DEV
Loc.
I am/We are the owner(s) of a savings account at '<<--1{ /..-,1--20 ~.--?t_~
at its branch office at 'if! f!..-?...t 4d'r~ ,Ca}.,i ornia, Investm.~,.t Certificate
No.//~- 9-0-9'o-b7t-'in the namesl()f ~ ;(-t~zt'~ J,t-c.-( V{(/."77- ~K~^--t.4z;;..,a,<-Z:>!
and having a present balance of $ tP".;< 5'?', voo .
I hereby grant, transfer and assign said account, said Investment Certificate, said
balance (includinR interest which accrues thereon), and all other rights in connection
therewith to the CITY OF CAMPBELL, assignee, for a good and valuable consideration.
receipt of which is hereby acknowledged, for the purpose of insuring construction
described as follows:
Investment Certificate and du licate of this Assi nment
I understand that assignee can withdraw from said account any time on his signature alone
upon presentation of the Investment Certificate to the issuer. I also understand that I
may not withdraw from said account unless I present said Investment Certificate and the
si~nature of assiRnee approvinR said withdrawal. The issuer of the certificate assumes
no responsibility for the conduct of the assignee and may act on the signature of the
assignee without further inquiry.
Executed on
, 19
at said office of the issuer.
Assignor
Assignor
ACKNO\.'LEDGEHENT BY ISSUER
Issuer affirms that there are no other holds on subject account, that subject monies are
available, and that the above described assignment has been noted on the Records of said
issuer.
Date
7
By
Authorized Signature
Title:
INSTRUCTIONS TO ASSIGNEE
Please sign below for signature identification and as acknowledgement of your notice of
Assi~nment and as receipt of said Investment Certiticate. Return this Assignment and
Receipt to the issuer at its address above. Retain one copy of this Assignment and
Rece ipt for your files. /)
D.t. jh/Jt' ;;'Y /
RELEASE BY ASSIGNEE
Said assignee hereby releases and relinquishes all his right, title and interest in and
to said account, said Investment Certificate, said balance and all other rights in
connection therewith.
Da t e '7 J ~? let I
/4
City of Campbell
Bv
rt~~{e~
PAYMENT BOND-CERTIFICATE OF DEPOSIT
MULTIPLE MATURITY - NON-NEGOTIABLE
Member FDIC
CERTIFICATE OF DEPOSIT ACCOUNT NO.: 114-9-045690
THIS CERTIFICATE OF DEPOSIT ISSUED BY OUR
[ $ 6,200.00************1
CERTIFIES THAT .
w"ESTGATE
OFFICE
" ~ 45 2 9-9 dors Q-8-ets
DOLLARS
HAS BEEN DEPOSITED ON NnvPTTlhPr ?R , 19~BY:
FORrY 'JW) WEST INVESTMENTS
(DEPOSITOR)
AND WilL BE PAYABLE TO:
CITY OF CAMPBELL (PAYEE)
UPON DELIVERY OF THIS CERTIFICATE, PROPERLY ENDORSED, AT THE ISSUING OFFICE WITHIN THE FIRST TEN CALENDAR DAYS FOllOWING MATURI-
TY, WHICH IS 12 IDNTHS FROM THE DATE OF DEPOSIT. IF .NOT SO DELIVERED DURING THIS WITHDRAWAL PERIOD, WE WILL
AUTOMATICALLY REINVEST THIS DEPOSIT FOR A LIKE PERIOD, IF AVAILABLE, AND AT THE INTEREST RATE THEN IN EFFECT ON THE DAY OF REINVEST-
MENT. WE RESERVE THE RIGHT, HOWEVER, NOT TO REINVEST THE DEPOSIT WHEN IT MATURES. A DEPOSIT THAT IS NOT REINVESTED DOES NOT
EARN INTEREST AFTER IT MATURES. THIS DEPOSIT WILL EARN INTEREST AT A RATE OF 7.90 PERCENT PER ANNUM, COMPUTED
ON A COMPOUND INTEREST BASIS USING A 365 -DAY YEAR. INTEREST WILL BE PAID TO THE
DEPOSITOR. THIS CERTIFICATE IS ********TRANSFERABLE. IF ANY OR ALL OF THIS DEPOSIT IS WITHDRAWN BEFORE MATURITY, THE AMOUNT
WITHDRAWN WILL BE SUBJECT TO A SUBSTANTIAL INTEREST PENALTY AS DISCLOSED IN OUR PUBLICATION.
DOCUMENT SERIAL NUMBER. N 0 0 5 6 6 2
FORM 3117 (REV 11/88)
~~,~
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CITY OF CAMPBEll
70 NORTH FIRST STREET
C AMP BEL L, C A L I FOR N I A 9 5 0 0 8
(408) 866-2100
FAX # (408) 379-2572
Department:
Public Works
July 11, 1991
Forty-Two West Investments
106 W. Campbell Avenue
Campbell, CA 95008
SUBJECT: ONE YEAR MAINTENANCE ACCEPl'ANCE
PERMIT NO.: 88-178
LOCATION: 42 W. CAMPBELL AVENUE
Dear Gentlemen:
We have made a one year maintenance inspection of subject
public works improvements and find that no maintenance is
required.
By copy of this letter, we hereby release your maintenance
bond. You will need to come into the office for release of
your time deposit.
:J;~~
Sal Duckworth-Lanzo
Senior civil Engineer
SDL/AS:djr
F:88-178
CITY OF CAMPBELL
PUBLIC WORKS INSPECTION REPORT
DATE: 1 / ///1 /
I ,
ADDRESS: 4 () w. COt m {)b~ / (
,
PERMIT/PROJECT NO.: g<6~ / Ie
TRACT NO.
Ii1/(
TYPE OF WORK:
STREET:~ STORM:
SANITARY:
ELEC:
P.C.C.:
PARKWAY:
OTHER:
[] PRELIMINARY INSPECTION WITH DEFICIENCY LIST
[J FINAL INSPECTION WITH DEFICIENCY LIST
[J FINAL INSPECTION ACCEPTANCE
SIGNED PLANS ? YES
NO
COUNCIL ACTION? YES
NO
CHARGES AGAINST DEPOSIT? YES
NO
OVERTIME:
HRS. @ $
PER HOUR = S
EQUIPMENT RENTAL: TYPE:
AMOUNT: $
DATE:
/
/
REASON:
TOTAL CHARGES:$
[J ONE YEAR MAINTENANCE WITH DEFICIENCY LIST
~ ONE YEAR MAINTENANCE ACCEPTANCE
ASSIGNMENT AND RECEIPT OF INVESTMENT CERTIFICATE
TO CITY OF CAMPBELL, 70 N. FIRST STREET
CAMPBELL, CALIFORNIA 95008 (408) 866-2150
P.W. Permit No. /(p -/ 7?
TR or DEV
Loc.
I am/We are the owner(s) of a
at its branch office at 1494
E~fyi~tce~rnp~gTl
savings account at California First Bank
Saratoga Ave. San Jose 95lpCalifornia, investment
in the names of Forty-Two West Investments, G.P.
having a present balance of $ 24, 800. 00
and
I hereby grant, transfer and assign said account, said investment certificate, said
balance (inClUding interest which accrues thereon), and all other rights in connection
therewith to the CITY OF CAMPBELL, assignee, for a good and valuable consideration,
receipt of which is hereby acknowledged, for the purpose of insuring construction
described as follows:
I have physically delivered verification of said investment certificate and duplicate of
this Assignment and Receipt to said assignee.
I understand that assignee can withdraw from said account any time on his signature alone
upon presentation of a written order to the issuer. I also understand that I may not
withdraw from said account unless I present a signed release from the assignee. The
issuer of the certificate assumes no responsibility for the conduct of the assignee and
may act on the signature of the assignee without further inquiry.
:> --_/
Executed on ' ,,/ 2-? 19t\""-at said ce Of~ i~
sign - ~~ Assignor
print Bruce E. Hodgin G. P.
sign
print
Assignor
ACKNOWLEDGEMENT BY ISSUER
Issuer affirms that there are no other holds on subject account, that subject monies are
available, and that the above described assignment has been noted on the Records of said
issuer.
Date~. -R ~ /f"~
~~
Authorize Signature
Title: J(;P,~.
INSTRUCTIONS TO ASSIGNEE
ATTACH
NOTARY
ACKNOWLEDGEMENT
Please sign below for signature identification and as acknowledgement of your notice of
Assignment. Return this Assignment and Receipt to the issuer at its address above.
Retain one copy of this Assignment and Receipt for your files.
City of Campbell
By
Date:
RELEASE BY ASSIGNEE
Said assignee hereby releases and relinquishes all his right, title and interest in and
to said account, said investment certificate, said balance and all other rights in
connection therewith.
Ci ty of Campbell
By
Date:
/
'"'\
C I T Y II F C 1\ [wi>> iil it L I.
WIMBfRl r/j HANDLING
HELMS ~ ~ RETURN TO
JOCSON r DISCARD
I(RU~ER
PENOYER
70 NORTH FIRST STREET
C AMP BEL L, C A L I FOR N I A 9 5 0 0 8
(408) 866-2100
FAX # (408) 379-2572
Department:
Public Works
July 18, 1990
Forty-Two West Investments
106 W. Campbell Ave.
Campbell, CA 95008
SUBJECT: FINAL INSPECTION AND ACCEPTANCE
Permit No.: 88-178
Location: 42 W. Campbell Ave.
Dear Gentlemen:
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.
We have received your maintenance bond in the amount of $6,200. Your
Faithful Performance Bond will be released by a separate action.
We will inspect the work in one year and advise you whether or not
maintenance is needed.
Please feel free to call me if you have any questions.
Sincerely,
Gregg Eaton
Public Works Inspector
GE:sd
cc: Suspense - 1 year
'-
f:88-178 (permits)
'~ ; /.
; ,l''!''
,.... ti'
Pcrmit or Project No.
(! OAnvIJDeI/
tI
REPORT
xg~ l7'~
f(rfP,
-- ,../".
----
DAte ~7.; 7/90-
Addre:i$ 4~. (J.) ~
Ty,p4: of work z Stn:eX Storm
Other (dcscribe)
PUBLIC WORKS INSPECTION
SAnitAry
Electrical
[JPRELIMINARY INSPECTION WITH DEFICIENCY LIST (attAched)
[JFINAL INSPECTION WITH DEFICIENCY LIST (attAched)
~INAL INSPE~TION - ACCEPTANCE
~igned plAn~? Y dOC) (If uigned. Council AcceptAnce.)
ChArges AgAinst deposit? y
Overtimcl hrs. @ ~
DAte {, re.,lOonz
Q)
/hr.
-
$
BArricAde rentAl (AttAch invoice)?
DAte {, reAsonz
y
N
~
Other?
~
~
TotAl chArgea deducted from depositJ
(CAsh Deposit $ lcas chArges $
$
- Refund S
[JaNE YEAR MAINTENANCE WITH DEFICIENCY LIST (AttAChed)
ck. req.)
[JaNE YEAR MAINTENANCE - ACCEPTANCE
(RelcAae'mAintenAnce bond. Check Request if CASh.)
Engineer
REFUNDABLE DEPOSIT
CHECK REQUEST
TO: FINANCE DIRECTOR
CITY OF CAMPBELL
Please issue check payable to:
Forty Two \.vest Investments
(30 spaces)
Address:
Line 1:
106 W. Campbell Ave.
(30 spaces)
(30 spaces)
State: CA Zip: 95008
(2) (10 spaces)
Line 2:
City:
Camobell
(20 spaces)
Description:
Cash Deposit Refund
(24 spaces)
Exact Amount Payable:
$992.00
Account Number:
905.4662
Release of cash deposit for excavation permit 88-178.
PURPOSE:
See receiot #746 dated 10/18/88.
Requested by:
G. Eaton
Ti tIe :
P.W. Insoector
Date:
7/18/90
Approved by:
D.C. Wimberly
Ti tIe :
P.W. Director
Date:
Verified by:
Accounts Receivable
Date:
SPECIAL INSTRUCTIONS FOR HANDLING CHECK:
Mail as is
xx
Mail in attached envelope
Return to:
(Department)
(Name)
Other:
08/24/88
TO: City Clerk
PUBLIC WORKS FILE NO. 3 S -/7!
Please collect & receipt
for the following monies:
ACCT.
35-3396
ITEM
Project Revenues (specify project)
Pu.bUc. (~O,'l.lu Exc.a.va.:uon peJtr.I,{;t Fe..M:
Appl icat ion Fee
Plan Check Deposit
Faithful Performance Deposit
R-1 :
($'35)
OthelL:
($ 50)
'( $500)
( % of FPB)
($500 min.)
(]'7u of FPB)
($35min.)
@ji)
3521
Plan Check & Inspection Fee
Other Cash Deposit (specify)
3373
3373 &
3372 Tentative Parcel Map Fil ing Fee ($350)
3372 Final Parcel Map Fil ing Fee ($300)
3372 Tentative Tract Map Fil ing Fee ($400)
}372 Final Tract Ma Fil in Fee ($350)
3372 Lot Line Ad'ustment Fee/Certificate of Comp1 iance
3372 Vacation of Pub1 ic Streets and Easements
3372 Assessment Segregation or Reapportionment
First Split ($500)
Each Additional Lot ($150)
3372 Environmental Assessment:'
Categorical Exemption
Ne at i ve Dec 1 a ra t ion
3370 Storm Drainage Area Fee per Acre Multi-Res.,
$2,060; all other, $2,250)
3395 Park Dedication In-1 ieu Fee per Unit ($1,132)
3380 Public Works Special Projects
3510 Postage
AMOUrJT
$
fJ9.;f, CJ 0
'/1 7~b. ~O
"72. UO
$ /,( o~
3 70 .- y Y Y t
9'.:;,-- C) () rF"
TOTAL
NAMElu~ T WV !U~
. ~ _. $;; ~"!I' - ," ~
ADDRESS ./ -" /
/'U6 u.J. C!~ ~
7sLb
,;,27;). ~. 00
~
I CJ -/ X'- Y Y
PHONE
ZIP
FOR
C I TV CLERK
a-lLY
RECEIPT NO.
AMOUIlT PAID
RECE I VED BY
DATE'
July, 1987
(
CITY OF CAMI)IlELL
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
Department:
Public Works
May 24, 1990
Forty-Two West Investments
106 W. Campbell Ave.
Campbell, CA 95008
SUBJECT: PERMIT NO.: 88-178
LOCATION 42 W. Campbell
There appears to have been no repair work completed regarding the
deficiencies outlined in the letter dated Januarv 9, 1990.
These deficiencies must be corrected before the work can be accepted by
the City and bonds and/or deposits released. The .City is requesting that
you complete the repair work within 30 days so that you can begin your one
year maintenance period.
Upon completion of all work and correction of all deficiencies, a written
request for final inspection and acceptance of the work must be
submitted. This then sets in motion the actions necessary to release your
bond and refund your deposits. Should you have any questions or require
additional information please contact me as soon as possible.
Thank you for your cooperation.
Sincerely,
aton
Public Works Inspector
encl:
cc:A. Scimeca, Engineering Assistant
CITY OF CAMPBEll
70 NORTH FIRST STREET
CAMPBELL. CALIFORNIA 95008
(408) 866-2100
FAX # (408) 379-2572
Public Works
WIMBERLY
HELMS
JOCSON
KRUGER
PENOYER
Er-:mN TO
\SCAfiO
Department:
January 9, 1990
Forty-Two West Investments
106 W. Campbell Ave.
Campbell, CA 95008
SUBJECT: PERMIT NO.: 88-178
LOCATION 42 W. Campbell Ave.
We have made a preliminary inspection of the work covered under the
referenced permit. Deficiencies in the work have been found and are
shown on the attached list.
These deficiencies must be corrected before the work can be accepted
by the City and bonds or deposits released. Please contact Public
Works Inspector Gregg Eaton to schedule corrective work or clarify
any questions.
Upon completion of all work and correction of all deficiencies, we
will need a written request for final inspection and acceptance of
the work. This then sets in motion the actions necessary to release
your bond and refund your deposits.
Thank you for your cooperation.
Sincerely,
Carlos M. Jocson
Associate Civil Engineer
CMJ/sd
enc1:
cc: G. Eaton, P. W. Inspector
B. Long, Sr. Lighting & Traffic Technician
f:keyproDEFLTR
January 8, 1990
PERMIT NO. 88-178
LOCATION: 42 W. CAMPBELL
DEFICIENCY LIST
1. Remove forms at back of sidewalk at westerly end.
2. Sidewalk crack repair is not acceptable. Either repair it so
that it is acceptable or remove and replace same.
3. Crack seal along lip of gutter (total lenght of project).
~
DAte f4~o
Address 4-2
PUBLIC WORKS INSPECTION REPORT
Permit or Project No.
'-87 ...6~' ~ 8 -- I 7<3
~. ~~~ ~.
Type of work: Street"..- Storm
Other (describe)
SAnitAry
Electrical
[JPRELIMINARY INSPECTION WITH DEFICIENCY LIST (attAched)
~ INSPECTION WITH DEFICIENCY LIST (attAched)
o FINAL INSPECTION - ACCEPTANCE
Signed plAm;'? Y N (If signed. Council AcceptAnce.)
Charges against deposit? Y
Overtime; hrs. @ $
DAte" reAson:
N
/hr.
-
$
BArricade rentAl (Attach invoice)? Y N
DAte " reAson: $
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.)
!n~
~or
January 8, 1990
PERMIT NO. 88-178
LOCATION: 42 W. CAMPBELL
DEFICIENCY LIST
1. Remove forms at back of sidewalk at westerly end.
2. Sidewalk crack repair is not acceptable. Either repair
that it is acceptable or remove and replace same.
3. Crack seal along lip of gutter (total lenght of proje
-a>
VYl{) Jf7kr;+... ~ . (
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~-- ~ ~
C/lMIUY ~'
SEP 06 '89 16:23 KIER and WRIGHT 408 727 5641 269 P02
KIER & WRIGHT Lt L. W_ CAf-4P'e:rtJ-'-
CIVIL ENGINEERS & SURVEYORS, INC.
3350 Scott Boulevard, Building 22
Santa Clara, California 95054 . (408) 727-6665
STAKING FOR: tJff'7lr, ,"-6- OFFSET: ~ 31
BENCH MARK: f f~ If 8 ~ COLOR OF NOS.:
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CUT SHE
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DA~: ~-l. 3-og-<\
JOB NO.: &633
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STATION STAKE
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FORTY-TWO WEST INVESTMENTS
106 WEST CAMPBELL AVENUE
CAMPBELL, CALIFORNIA 95008
November 28, 1989
city of Campbell
70 North First Street
Campbell, California 95008
Attention: Public Works
Reference: 42 West Campbell Ave., Off Site Bond/Clearance
Dear Sir:
At this time I am pleased to report that we have com-
pleted the "off-site" improvements required at 42 West
Campbell Avenue. At your earliest we request that you
confirm same and release the certificate of deposit that you
hold in the amount of $24,800.00.
Enclosed find a new certificate of deposit in the
amount of $6,200.00 to be used as the maintenance bond.
Please call if you have any questions.
t/~Y1~
Bruce E. Hodgin
REFUNDABLE DEPOSIT
CHECK REQUEST
TO: FINANCE DIRECTOR
CITY OF CAMPBELL
Please issue check payable to:
Forty Two West Investments (30 spaces)
Address:
Line 1:
106 W. Campbell Ave.
(30 spaces)
Line 2:
City:
Campbell
(20 spaces)
(30 spaces)
State: CA Zip: 95008
(2) (10 spaces)
Description:
Cash Deposit Refund
(24 spaces)
Exact Amount Payable:
$500.00
Account Number:
905.4662
PURPOSE:
Release of cash deposit for excavation permit #88-178.
See receipt #19867 dated 7/13/88.
Requested by:
Don King ; 0
Ti tle: En g. Tee h I I
Date: 7/26/89
Approved by:
Donald C. Wimberly
Ti tle: P. W. D ire c tor
Date:
Verified by:
Accounts Receivable
Date:
SPECIAL INSTRUCTIONS FOR HANDLING CHECK:
Mail as is
xx
Mail in attached envelope
Return to:
(Departmen t)
(Name)
Other:
08/24/88
10: City C I e rk
PUBLIC WORKS FILE NO. ~ ~- 117~
Please collect & receipt
for the following monies:
ACCT.
35-3396
3372
3521
3521
ITEM
Project Revenues (specify project)
PubUc. (~O:I.IM Exc.a.va.:uon PeJl.r.1-U FeM:
A I i ca t i on Fee
Plan Check Deposit
Faithful Performance (Cash) Deposit
R-l :
($35)
($200)
OthVt :
($ 50)
'( 500
(4% of FPB)
($500 min.)
(7'1u of FPB)
($ 35 min.)
3372
Plan Check & Inspection Fee
3521 Other Cash Deposit (specify)
2373
3373
Project
Gene ra I
&
3372 Tentative Parcel Map Fil ing Fee ($350)
3372 Final Parcel Map Filing Fee ($300)
3372 Tentative Tract Map Fil ing Fee ($400)
3372 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 Split ($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-lieu Fee per Unit ($1,132)
3380 Publ ic Works Special Projects
3510 Postage
TOTAL
NAME
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$
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ADDRESS
ZIP
FOR
C I TV CLERK
ClNLY
\q ~ Gi1
_~ CI()
AMOUNT PAID ~
RECE I VED BY L \J
f1JI3j8~
-,
RECEIPT NO.
DATE
July, 1987
CALI'-::CIII<I\UA I ....
FIRST BANK ~.,
Member FDIC
.-_, twIL.... _V'..U-\"_., I ..-.",1-\. _ _.- "-'-. --..
MULTIPLE MATURITY - NON-NEGOTIABLE
CERTIFICATE OF DEPOSIT ACCOUNT NO,: 114-9-041863
THIS CERTIFICATE OF DEPOSIT ISSUED BY OUR
CERTIFIES THAT I $ 24,800. OOi,**,'<*,b',,'<*i.'k I
\'JESTCATE
OFFICE
C';::'4l1.i'F!)},"'~1i~~;2 ~ 8-0 Q ,'i'. "~Q-G '
,-,-,,' .- ...... - " . .... 'j;~' ....... '" ',j . .
l"";'.~:.t .l~<I3~k. . Cd}l ~ Gts
DOLLARS
HAS BEEN DEPOSITED ON
October 26
. 19~BY:
****FORTY - TtJO UEST I flVESTi HiTS, G. P . *......,...:**,..*,',.;...:***i;-/.***..;-/<** (DEPOSITOR)
AND WILL BE PAYABLE TO:
***C I TV OF C/\[:P BE L L .,<*';;;'.**':.*1ddr*-:.-:.**"l"-;"-i.."o:*...,'<**,'<*iddd<*.'n'<*****,"i.*id. (PAYEE)
UPON DELIVERY OF THIS CERTIFICATE, PROPERLY ENDORSED. AT THE ISSUING OFFICE WITHIN THE FIRST TEN CALENDAR DAYS FOLLOWING MATURI-
TY. WHICH IS 1 80 [)a~/s FROM THE DATE OF DEPOSIT. IF NOT SO DELIVERED DURING THIS WITHDRAWAL PERIOD, WE WILL
AUTOMATICALLY REINVEST THIS DEPOSIT FOR A LIKE PERIOD, IF AVAILABLE, AND AT THE INTEREST RATE THEN IN EFFECT ON THE DAY, OF REINVEST-
MENT. WE RESERVE THE RIGHT, HOWEVER, NOT TO REINVEST THE DEPOSIT WHEN IT MATURES. A DEPOSIT THAT IS NOT REINVESTED DOES NOT
EARN INTEREST AFTER IT MATURES, THIS DEPOSIT WILL EARN INTEREST AT A RATE OF 7 . 1 S PERCENT PER ANNUM, COMPUTED
ON A s irlp 1 e INTEREST BASIS USING A :JC:; .DA Y YEAR, INTEREST WILL BE PAID TO THE
DEPOSITOR, THIS CERTIFICATE IS ******,,< TRANSFERABLE, IF ANY OR ALL OF THIS DEPOSIT IS WITHDRAWAN BEFORE MATURITY, THE AMOUNT
WITHDRAWN WILL BE SUBJECT TO A SUBSTANTIAL INTEREST PENALTY AS DISCLOSED IN OUR PUBLICATION,
DOCUMENT SERIAL NUMBER N 0 0 0 1 6 6
FORM 3117 9/83
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,
PUBLIC YORKS PERMIT ISSUANCE CHECK LIST
City of Campbell
Public Yorks Permit No. ~~ t"b
4~ ~ ~lt--\,\,~
~Applicant section complete
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~---------------------------------------------------------------------
Applicant signature and date
~ Permit Application fee, $35.00 for R-l, $50.00 for
standard, paid. Receipt number It( 1"67
V Plan check deposit,!..... $500.00 for standard only, paid.
Receipt number I?~ 7
~ Five sets of improvement plans sub~itted
~Bond for faithful performance, 100% of City Engineer's
estimate for standard only, posted and appropriately noted
Amount $'~Stie>~ Form ~Lr, O'w::- I.D. #\.\l\--~-<j4\~G:S.
\~,,;.\.""'{' .
~Cash Deposit: $200.00 for R-l; 4% of FP bond, $500 min.
for standard, posted.
Amount $ Cf::t.~. ~ Receipt No. ~ 4-f::,.
~ermit fee of 7% of FP bond, $35.00 min., paid.
Amount $ l"t ~ci:>. (;~CJ Receipt No. I 4-~
~ Yorker's compensation information received for Applicant
(see Information Sheet for Public Yorks Permits)
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All other Public Yorks requirements listed in the Con-
ditions of Approval of the development.
---------------------------------------------------------------------------
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~Yorker's comp and Contractor's Information received for
Contractor (see Information Sheet for Public Yorks Permits)
~ Certificate of Insurance with Additional Insured's
Endorsment received from Contractor (see General Summary of
Insurance Requirements for Public Yorks Permits)
vi 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
WHEN ALL OF THE ABOVE ITEMS ARE COMPLETE, PERMIT MAY BE ISSUED
Issuer: Initial _____ and date and file with permit
1/ UPON ISSUANCE, INITIATE PLAN CHECK DEPOSIT REFUND CHECK REQUEST.
1/;2 /'/ /Y ~1
6/88
f/permchklst
,0___.._---- _._______.._ -_
This is to certify that
CERTIFICATE OF INSURANCE
KJ STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois
o STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois
I
has in force for
Address of Policyholder
'A
Name of Policyholder
106 W. CAMPBELL AVENUE
location of operations
CAMPBELL, CA 95008
42 W. CAMPBELL AVENUE
INIUUN'
Phillip "Cab" Driver, Agent
120 West Campbell Avenue
Suite A - P,O, Box 326
Campbell, California 95008
Phone: Off. (408) 378-3403
the following coverages for the periods and limits indicated below,
POLICY NUMBER TYPE OF INSURANCE POLICY PERIOD LIMITS OF LIABILITY
(elf/exp.)
49-8 Q Comprehensive 1/8/88 - 11/8/8 o Dual Limits for: BODIL Y INJURY
97-55 28 General Liability
Each Occurrence $
0 Manufacturers' and Aggregate $
Contractors' Liabi I ity
0 Owners', Landlords' and PROPERTY DAMAGE
Tenants' Liability
Each Occurrence $
The above msurance includes o PRODUCTS-COMPLETED OPERATIONS Aggregate' $
(applicable If indicated by ~ )
o OWNERS' OR CONTRACTORS' PROTECTIVE LIABILITY [iJ Combmed Single Limit for:
o CONTRACTUAL LIABILITY BODIL Y INJURY AND
o BROAD FORM PROPERTY DAMAGE PROPERTY DAMAGE
o BROAD FORM COMPREHENSIVE GENERAL LIABILITY Each Occurrence $ 1,000,000
POLICY NUMBER TYPE OF INSURANCE POLICY PERIOD Aggregate $ 2,000,000
(eff/exp,) CONTRACTUAL LIABILITY LIMITS
o Watercraft (If different than above) BODILY INJURY
Liability Each Occurrence $
PROPERTY DAMAGE
0 Each Occurrence $
0 Aggregate $
o Combined Single Limit for: BODILY INJURY AND
EXCESS LIABILITY PROPERTY DAMAGE
o UMBRELLA
o OTHER Each Occurrence $
Aggregate $
Workmen's/Workers' Com- Coverage A STATUTORY
o pensatlon-Coverage A
Employer's Liability Coverage B $
-Coverage B
'Aggregate not applicable if Owners', Landlords' and Tenants' Liability Insurance excludes structural alterations, new construction or demolition,
THE CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR NEGATIVElY AMENDS,
EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN.
CITY OF CAMPBELL AND ITS RESPECTIVE OFFICERS AGENTS AND EMPLOYEES ARE NAMED AS
ADDITIONAL INSUREDS FROM AND AGAINST ANY CLAIMS, LOSS LIABILITY, COST OR EXPENSE
ARISING OUT OF OR IN ANY WAY CONNECTED WITH THE CONSTRUCTION OF THE PROJECT. THIS
COVERAGE SHALL BE PRIMARY AND ANY COVERAGE CARRIED BY ADDITIONAL INSURED SHALL BE
EXCESS INSURANCE ONLY, AS PER FORM GL 2010.
-,
NAME AND ADDRESS OF PARTY TO WHOM CERTIFICATE IS ISSUED
I
CITY OF CAMPBELL
70 NORTH FIRST STREET
CAMPBELL, CA 95008
ATTENTION: DON KING
I
~MR.
L
~
Title AGENT
(558) F6,994,8 Printed in U,S,A, Rev, 11/84
WEST CON g~;p
Cf~(: '
, ,,,,c.?
/ /, / vf
C f.../
WESTERN CONSTRUCTION DEVELOPMENT CORPORA TlON
January 26. i989
Don KIng
PublIC Works Dept.
70 N. 1st Street
Campbe] ]. CA 95008
Dear Mr. King:
Enclosed IS a copy of our Workmens Comp and LiabIlity Ins.
that your hac requested from Bruce HodkIn. If you need more
InformatIon or have any questions. please do not heSItate to
ca.! J .
SIncerely.
~~
D. Fred Altmann
West Con Dev Corp
DFA/p1
106 W, Campbell Avenue · Campbell, CA 95008 . (408) 866-7092
,/~
" Ie
-,\
j
D FREMONT
INDEMNITY COMPANY
HEW
1. THE INSURED AND MAILING ADDRESS:
WESTfRH COHSTRUCTION DEVElOP"E~T
CORPORATIOli
1445 lOLL CIRCLE _114
SAN .lOSE
WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY
INfORMATION PAGE FORM NUMBER WC 00 00 01
r.;-, FREMONT COMPENSATION D COMSTOCK
L!..J INSURANCE COMPANY INSURANCE COMPANY
POLICY ~O: WN88-41501o-01
NON PARTICIPATING
EHTITY: CORPOR~TION
CA 95112
OTHER WORKPLACES NOT SHOWN ABOVE:
.,ONE
BUREAU:
OFFICE: SAN ~ATEO
PRODUCER: WILLOW GLEN INSURANCE AGENCY
PRODUCER CODE: 3433/100
DIRECT BILL
2. POLICY PERIOD: fRO" 11/01/88 TO 11/01/89
12:01 A.". STANDARD TIME AT THE INSURED'S MAILING ADDRESS.
3. COVERAGE:
A. WORKERS' COMPENSATION INSURANCE: PART ONE OF THE POLICY APPLIES TO THE
WORKERS' COMPENSATION LAWS OF THE STATES LISTED HERE: CALIfORNIA
B. EMPLOVERS' LIABILITY INSURANCE: PART TWO DF THE POLICY APPLIES TO WCRk
IN EACH STATE LISTED IN ITEM 3.A. THE LIMITS Of OUR lIABILITY UNDER
PART TWO ARE:
BODILY INJURY BY ACCIDENT: $l,GCu,CCO EACH ACCIDENT
BODILY INJURY BY DISEASE: $l,GCU,OOO EACH EMPLOYEE
BODILY INJURY BY DISEASE: $1,OCO,000 POLICY LI~IT
C. OTHER STATES INSURANCE: PART THREE Of THE POLICY APPLIES TC ALL THE
STATES, If ANY, LISTED HERE: HONE
D. THIS POLICY INCLUDES THESE ENDORSEMENTS ANt SCHEDULES:
ENDORSE"ENlS: 01.WC990601, 02.WCC4C301, C3.~C04036C, C4.WC99C3Gl,
05.WC99C302
4. THE PREMIUM fOR THIS POLICY WIll BE DETER~I~ED BY OUR MANUALS OF RULES.
CLASSIFICATIONS, RATES AND RATING PLANS. ALL INFOR~ATION REQUIRED BElO~ IS
SUBJECT TO VERIFICATION AND CHANGE BY AUDIl.
PREMIUM BASIS: PREMIUM BASIS = TOTAL ESIIftATED ANNUAL REMUNERATION.
RATE = RATE PfR $100 Of REMUNERATION. EAP = ESTIMATED ANNUAL PREMIU~.
ST CODE CLASSIFICATION fRE'HUPI RATE: EIlP
BASIS
----- --_._-------------------------- -------- ----- ----------
CA 5606 CONTRACTORS--CONSTRUCTIO~ OR 30,cee 4.96 1.488
ERECTION--EXECUTIVE SUPERVISORS--
EXERCISING SUPERVISION THROUGH
SUP fRItH ENDEfHS AND FOREP\EN--I\O
DIRECT SUPERVISION.
CA 881GClI CLERICAL OFfICE EMPLOYEES--N.O.C. lC,CCC .70 18
THE CIGA ASSESSMENT SHO.N BELO. IS It Of THE TOTAL ESTI~~TED A~I\UAl PREMIU~.
flINIMU~ [EPOSIT DEPOSIT TI<ANSfER ADDITIONAL TCTAl EST If',ATED
PRE"IUP1 fiCffUUfi, FRO~ DEFOSII DUt A~NUAl PREfUUPfo
----- ------- -------------- ------- ---------------
$1.,50G $1, Sf C $C $Ci $1.566
$16 - CIGA ASSESSfr.Et\T DUE ill HI DEPOSIl.
z
PAYROLL REP[~lIhG A~D PRE~IU~ ADJUSTMENT PERIOD:
INSTAlL"E~T BILLING:
PAYROLL R=PORlING FRE~UE~CY: QUARTERLY
'"
~ COUIITERSIGHED ATL()S 'UUiELE S, CALIF DRtiIAO" 11-22-88
u;
z
~
BY:
E~ d- 4~
EDWAADJl.1EBER SEU'cTA.R'
c
z
WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY
. ' FORM NUMBER: we 99 03 02
D FREMONT
INDEMNITY COMPANY
r:;, FREMONT COMPENSATION
~ INSURANCE COMPANY
D COMSTOCK
INSURANCE COMPANY
POLICY NUMBER:
WN-88-475070-01
11/01/88 TO 11/01/89
WESTERN CONSTRUCTION
DEVELOPMENT CORPOR~TION
OFFICERS AND DIRECTORS COVERAGE/EXCLUSION ENDORSEMENT-CALIFORNIA
ENDORSEMENT NUMBER:
6
POLICY PERIOD:
ISSUE DATE:
11/22/88
11/01/88
INSURED:
EFFECTIVE DATE:
If the employer named in Item 1 of the I nformation Page is a private corporation whose officers and directors are
the sole shareholders, this policy applies to all such officers and directors, as employees, except those excluded below or
named as excluded in Item 4 of the Information Page.
Officers and Directors Excluded Title
JERRY FOURNIER
FRED ALTMANN
BRUCE HODGINS
VICE PRESIDENT
PRESIDENT
SECRETARY/TREASURER
The premium basis for this policy includes the entire remuneration of each covered officer or director. subject to
the minimum and maximum remunerations as established by the California Workers' Compensation Insurance Rating
Bureau, Each officer or director covered by this policy shall be subject to an annual minimum premium charge of
$250,00,
THE FOllOWING SPACES ARE TO BE COMPLETED ONLY IF THIS ENDORSEMENT IS NOT ATTACHED TO
THE POLICY WHEN ISSUED,
ACCEPTED AND AGREED TO at
(Name of Corporate Insured)
this
day of
19_ by
(Name and T,lle of Officer)
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated,
PRODUCER:
WILLOW GLENN INSURANCE AGENCY
COUNTERSIGNED BY:
CODE:
3433/100/2
SM:att
we 119 03 02 Edward J. Ueber, Secretary
(Ed,l-87)
CITY OF CAMPBELL
70 NORTH FIRST STREET
CAMPBELL, CALIFORNIA 95008
(408) 866-2100
WIMBERLY
HELMS
JOCSON
KRUGER
PENOYER
Department:
Public Works
January 19, 1989
Mr. Kjartan O. Armann
P.O. Box 1080
Los Gatos, CA 95031
SUBJ ECT
Public Works Permit No.: 88-178
Application expires: 1/12/89
Permit Address:42 West Campbell Ave.
Our records indicate that you applied for subject Public Works Permit
approximately six months ago. This is to remind you that applications for
permits expire six months from the application date. The expiration is
shown above.
If you still wish to have the permit issued we will extend the expiration
of the application sixty days. Please call this office to find out what
needs to be done.
Very truly yours,
<-PI:'
Don King
Engineering Tech II
DK:sd
FIELD CHECK LIST
FOR
DEVELOPMENT OR TRACT
IMPROVEMENT PLANS
~~K~\ ~-tl~
A "-0 _
c..>r -:L - ~- C!:::>
G.-b~F~''-^-
\. - l~, - ~,~,
1. Are existing PCC improvements accurately shown?
~ no
2. Do existing PCC improvements meet current standards?
~ no
<:"c:..~' I ,.~'
3. Width of sidewalk? (Do ~ include curb)
4. List non-standard improvements to be replaced.
5. Are existing standard improvements in acceptable condition? ~ no
Indicate on plans location(s) and dimensions of areas to be removed
and replaced.
6.
../
Indicate required sawcut locations on plans.
7.
Indicate any obvious storm drainage facilities not already shown on
the plans.
8. Is there an existing street lighting system?
Gno
Type pole?
Type luminaire?
Location of nearest electrolier?
9. Are all existing surface utility facilities accurately shown?~ no
If not, indicate on plans. ~
10. Pavement condition: Description
A.-.C- .
Acceptable as is
~.
Needs overlay
Needs remove & replace
If overlay or remove and replace is partial, indicate location and
dimensions on plan.
CONDITIONS OF APPROVJ ~-..... FILE . ZC 86-05
SITE ADDRESS: 42' 60 w. CAMPBELL AVE.
APPLICANT: ARMANN, K.
PC MTG DATE: 6-24-86/8-11-87
PAGE 3.
----.
~~r
PUBLIC WORKS DEPARTMENT
19. Submit 3 copies of on-site grading and drainage plan.
20. Obtain an excavation permit, pay fee, and post surety for all work in
the public right-of-way.
21. Dedicate additional right-of-way to realign curb, gutter, and
sidewalk.
Additional Conditions from Public Works Department as of 8-11-87:
22. File and process a parcel map to combine the two lots.
23. Execute an agreement to realign the curb, gutter, and sidewalk and
post surety to guarantee the work.
24. Dedicate a PUblic Utilities Easement along the easterly property line
of approximately 10 feet.
CHECKt:D:
V 1)
v""/ 2)
V 3)
V 4)
v
v
v
/'
v
;! ~
..:t~
Tract No.
~ ~erc\~'~t? ~ ,'f-
or Address
I~PROVE!':Et;T PLAN CHECK LI ST
DEVELOPtlENTS
ITEI-1:
CO:-"lE!~TS :
Permit number and prop-
erty address on plan?
Site review completed?
Applicable standard notes
Engineer's Stamp, Signa-
ture and Expiration Date
S) Conformance with City
standard specifications
and details
6) Street geometries
7) Street grading plan con-
fornity with overall
street grades and/or
official grading plAn
8) Approved roadway
structural section
9) Street lighting
requirements
~. 10) Storm sewer design
V 11) All relevant conditions
of approval have been
met
v' 12) Traffic review
~ 13) Service Center review
Plan check CO::lpleted by tSlf::-. 9- R'- ~6
'.
Recommeded for approval
~l>r-- C, -8- ~~
nill !-1. Helms~Dv,-, Date
Engineering r~nager
Send originals for signing
Donald C. ~imberly Date
Birector of Public Works
- $
- $
- $
- $
- $
Surface Subtotal 'S" - $ /q 1~9.-3t:)
Adjust for size: "S"<$30,OOO add 20', "S">$lOO,OOO subtract 10' (+ or -) $1 ~.137, eb
(
CITY OF
Address
Surface Construction
Clearing & Grubbing
Lump Sum Estimate
;'I() U'@ $ 4.00
// ~ if- L( SF @ 3.00
/qz., U'@ 5.00
;J... EA@ 600,00
ICjz.. U'@ 14.00
IIL/~ SF @ 4.00
'37/ SF @ 5.50
---
EA@ 400.00
U'@ 8.50
Sawcut Concrete
Concrete Removal
Curb & Gutter Removal
Inlot Drain with Pipe
Curb & Gutter
Sidewalk
Driveway Approach
Handicap RDp
Extruded Curb
Barricade
U' @ 50.00
( ;z.. ~ f' SF)x($O .10)xc:L,")
U y SF)x($0.30)xc.1_")
Street Excavation
AC Pavement
Adjust Kanhole to Grade
EA@ 375.00
.---. EA@ 275.00
EA@ 600.00
) EA@ 300.00
U'@ 0.65
EA@ 40.00
EA@ 120.00
EA@ 15.00
U'@ 10.00
Adjust Handhole to Grade
Konument Box w/Honument
Street Tree (lS-gallon)
Pavement Striping ($100 min)
Pavement Legends ($100 min)
Stop, Street Name or Other Sign
Pavement Karkers
Pavement Key Cut
Street Lhhtin!!:
Electrolier
EA@ 2,000.00
U'@ 10.00
U'@ 2.00
Ea@ 200.00
li:. <(.. ;,0 19m
U'@ 60.00
U'@ 70.00
EA@ 1,600.00
EA@ 2,400.00
EA@ 650.00
Conduit
9
9
I
I
Conductor, pair
Pull Box
121=- LoCAT62 .bL<.:;<:rRo,
Storm Draina!!:e
12- or 15" RCP
18" or 21" llCP
Street lnlet
Manhole
Break & Enter Kanhole
TOTAL ESTIKATE
$
$
USE FOIl BOND
reviaed 6/88
.f'1t":nn_e.os~_.st
Permit NO.~~ - \ 1 ~
by 7)1:::.. date q -"'l... -tr. r
_ $ ..5p:J.. (YO
_ $ yl/o,OV
- $1tJ3z.,o?J
_ $ Qc'06/'J
_ $ ',2--00&. 6"0
_ $ )..."~?:rr1J
,
_ $ ~59z,oJ
$ 1-.040. 50
.
-
- $
- $
- $
- $
- $
- $
- $
- $
_ $ / Ja~~a-o
- $
- $
:2 59. 20
7'77. ~o
- $
- $
- $
- $
- $
1:J' t:J.. 0/;
/6.0'0
LOa. C' ()
I SOo.. a::.)
$
- $
$
- $
- $
- $
21t 83 r: 1&
..J r.; , .;?t))o .. cTr)
,
j-cf'- I 7 ~
CITY OF CAMPBELL
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.
WORKERS' COMPENSATION INSURANCE INFORMATION
/' -- - . \~.---- ~ ..--.,
Name of Contractor/Applicant r 0,.... I ~ - 100:; WA> I '/"/'10-'.,-/.1 ~ / /2r'~ /_'$
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
Signed
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 Contractor
Address
Telephone
State Contractor License No.
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
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MEMO
To: Bill Helms
From: Jim Penoyer
Subject" UNDERGROUND UTILITY DISTRICT
~
Karti Armann called late yesterday afternoon, Aug. 10 about the
property at 42-60 Campbell Avenue. As a condition of aeproval of
thelr request for extension we are requiring them to grant an
easement along tne easterly property line for puelic utilities.
The easement will be necessary to provide underground servIce to
units currently being served overhead that are located south of
Karti's proJect. We anticipate that the pole provideing the existlng
overnead service will be removed in the underground district.
Karti is concerned about what condition the property will be in if
PG&E installs the service after the project has been built. In
order to avoid the problem he is offering to install the conduit
as part of his proJect. To do that he needs to know what our
requirements are. Maybe you could have Dave find out what will be
needed when he talks to Jim Lauth.
If you agree let me know and I'll tell Karti we'll get back to him.
,
(
CITY OF C1\MPHEll
70 NORTH FIRST
CAMPBELL, CALIFORNIA
(408) 866-2100
STREET
95008
Department:
Planning
November 12, 1986
Mr. Warren Jacobsen
Warren Jacobsen Associates
274 E. Campbell Ave.
Campbell, CA 95008
RE: ZC 86-05
42 and 60 W. Campbell Ave.
Dear Mr. Jacobsen:
Please find enclosed copies of the adopted ordinance and
approved plans for the above referenced office project.
The City Council's action on August 5, 1986, included the
development schedule indicated in Exhibit "B". This pro-
ject approval is valid for that period of time and is
subject to the conditions of approval.
If you should have any questions regarding this approval,
please do not hesitate to contact the Planning Office.
Sincerely,
ARTHUR A. KEE
PLANNING DIRECTOR
'A :/ ) ~ ,J" v,'. (,', ,:
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TIM J. HALEY
PLANNER II
TJH:lj
cc: Bruce Hodgin, Forty-Two West Investments, 106 W. Campbell
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ORDINANCE NO. 1605
BEING AN ORDINANCE AMENDING THE ZONING MAP OF THE
CITY OF CAMPBELL. CALIFORNIA (ZC 86-05 ).
The City of Campbell does ordain as follows:
SECTION ONE: That the Zoning Map of the City of Campbell. together with
amendments thereto. is hereby changed and amended. Said amendments being
outlined on the map attached hereto entitled Exhibit A.
SECTION TWO: This Ordinance shall become effective 30 days following its
passage and adoption and shall be published once within 15 days upon passage
and adoption in the San Jose Mercury News. a newspaper of general circulation
in the City of Campbell. County of Santa Clara.
PASSED AND ADOPTED this 5th day of Aug~
vote:
1986. by the following roll call
AYES:
Councilmen: Ash\rorth, fuetsch, Watson, Podgorsek, Koto.vski
NOES:
Councilmen: None
ABSENT: Councilmen: None
::~
ICHAEL F. KOTOWSKI. MAYOR
AITEST:~~~p, ~,""A--iA
Louise B. Pena,'Deputy City Clerk
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ORDINANCE NO. 1606
BEING AN ORDINANCE OF THE CITY COUNCIL OF THE CITY OF
CAMPBELL APPROVING PLANS, ELEVATIONS, DEVELOPMENT
SCHEDULE AND CONDITIONS OF APPROVAL FOR CONSTRUCTION OF AN OFFICE
BUILDING TO BE LOCATED ON PROPERTY KNOWN AS 42 & 60 W. CAMPBELL AVE.
IN A PD (PLANNED DEVELOPMENT) ZONING DISTRICT.
(APPLICATION OF WARREN JACOBSEN, ZC 86-05).
The City Council of the City of Campbell does ordain as follows:
SECTION ONE: That the Zoning Map of the City of Campbell is hereby changed
and amended by adopting the attached Exhibit A entitled Plans and Elevations;
Exhibit B entitled Development Schedule; Exhibit C entitled Map of Said
Property; and Exhibit D entitled Conditions of Approval, as per the application
of Mr. Warren Jacobsen for approval of plans, elevations and development
schedule on property known as 42 & 60 W. Campbell Ave. in a PD (Planned
Development) Zoning District. Copies of said exhibits are on file in the
Planning Department.
SECTION TWO: This Ordinance shall become effective 30 days following its
passage and adoption and shall be published once within 15 days upon passage
and adoption in the San Jose Mercury News, a newspaper of general circulation
in the City of Campbell, County of Santa Clara.
PASSED AND ADOPTED this 5th day of August
roll call vote:
, 1986' by the following
AYES:
Councilmen: AshWJrth, Ibetsch, Watson, Pcx:lgorsek, Kotowski
NOES:
Councilmen: None
ABSENT: Councilmen: None
ATTEST:
~~~-~~
Louise B. Pena, Deputy City Clerk
./6M- '
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MICHAEL 'F. KOTOWSKI, MAYOR
RECOHtfErWED FINDI~u...
FILE NO: ZC 86-05
APPLICA~~T: JACODSO~:t ~..'.
SIT'::: A:)DRESS: 42 & 60 t.'. CA'rr>DSLL A','S.
P.C. r~G.: 6-24-36
Ii)
1. The proposed parkin'j facilities indicate a parking ratio of 1: 229 is
considered adequate.
2. The huilding design \lith modifications as reco;"'L';1ended by the
Architectural Advisor are acceptable.
3. The proposed office use is consistent with the Professional Office use
s'1o:,m Orl the Larld Use Ele:1ent of the General Plan.
4. The proposed buildin~ setbacks are those typically required of a
residential use.
co:mITIa::s or- APP~OVA!..: ZCS6-05
ArI'LI CA:~T: JACOnSO::, 1:.
SI7[ A~Dr.~SS: 42 & 60 W. CN~PBZLL AVE.
P.C. ::TG. 6-24-36
The a?~licant is notified as part of this application that he/she is requirec
to neet the follo\ling conditions in accordance with the Ordinances of the City
of Camp~ell and the Laws of the State of California.
1. P.evised site plan indicating improved buildin~ entry to be subnitted to
the Planning Depart~ent and approved by the Planning Director upon
recommendation of the Architectural Advisor prior to application for a
buildinz per;,it.
2. Property to be fenced and landscaped as indicated and/or added in red on
the plans. Landscapin~ and fencing shall be r.laintained in accordance with
the approved plans.
3. Landscaping plan indicating type and size of plant material. and location
of irrigation systen to be submitted to the Planning Department and
approved by the Site and Architectural Revie~1 COioL.,ittee and/or Planning
COioL.,ission prior to issuance of a building permit.
4. Fencin~ plan indicating location and design details of fencing to be
sU~mitted to the Plannin~ Department and approved by the Planning Director
prior to issuance of a building permit.
5. Applicant to either (1) post a faithful performance bond in the amount of
$10.000.00 to insure landsca~in~. fencin~. and stripin~ of parking areas
within 3 nonths of co~pletion of construction; or (2) file written
a~ree8ent to conplete landscaping, fencing. and stripin8 of parking areas.
Bond or agreement to be filed with the Planning Department prior to
application for a building permit.
6. Applicant to subnit a plan to the Planning Department. prior to
installation of PG&~ utility (transformer) boxes. indicating the location
of the boxes and screening (if boxes are above ground) for approval of the
Planning Director.
7. All mechanical equipnent on roofs and all utility meters to be screened as
approved by the Planning Director.
8. Building occupancy will not be allowed until public improvements are
installed.
9. All parking and driveway areas to be developed in compliance with Chapter
21.50 of the Campbell Municipal Code. All parl~ing spaces to be provided
with appropriate concrete curbs or bumper guards.
10. Underground utilities to be provided as required by Section 20.16.070 of
the Ca::lpbell !!unicipal Code.
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CO:mITIO::S OF APP~OVAL: ZC86-05
APPLIC^~:T: JACOESOi:. t.'.
SIr;: A!)n!l~SS: 42 & 60 t.'. CA'pnr:L!.. AVe.
r. C. IITG. 6-24-36
PACI:: 2
11. Plans suhmitted to the Buildin~ Department for plan check shall indicate
clearly the location of all connections for underground utilities including
water. sewer. electric. telephone and television cables. etc.
12. Sign application to be subnitted in accordance with provisions of the Sign
Ordinance for all signs. No sign to be installed until application is
ap?roved anc permit issued by Planning and Building Departments (Section
21.68.030 of the Ca1lpbell :tunicipal Code).
13. Ordinance Ho. 782 of the Campbell Nunicipal Code stipulates that any
contract for the collection and disposal of refuse. garbage. wet garbage
and rubbish produced within the limits of the City of Campbell shall be
made with Green Valley Disposal Company. This requirenent applies to all
single-family dwellings. multiple apartment units. to all cOmMercial.
business. industrial. manufacturing. and construction establishments.
14. Trash container(s) of a size and quantity necessary to serve the
development shall be located in area(s) approved by the Fire Department.
Unless otherwise noted. enclosure(s) shall consist of a concrete floor
surrounded by a solid wall or fence and have self-Closing doors of a size
specified by the Fire Department. All enclosures to be constructed at grade
level and have a level area adjacent to the trash enclosure area to service
these containers.
15. Applicant shall comply with all appropriate State and City requirements for
the handicapped.
16. The applicant is hereby notified that the property is to be maintained free
of any combustible trash. debris and \leeds. until the time that actual
construction co~~ences. All existing structures shall be secured by having
windows boarded up and doors sealed shut. or be demolished or removed from
the property. Sect. 11.201 & 11.414. 1979 Ed. Uniform Fire Code.
FIRE DEI' A..1 r..rr:NT
17. Provide automatic sprinkler system for all areas of the structure.
including parking areas beneath the building.
punLIC tm!lr~S m:PARTHEr~T
10. Submit three copies of on-site grading and drainage plan.
19. Obtain an excavation permit. pay fees, and post surety for all work in the
public right-of-way.
20. Dedicate additional right-of-way to realign curb, gutter, and sidewalk.
BUILDING DEPA:"tTHENT
No comments at this time.
* * *
E}JII!3IT n
STAIIDARD DEVI:LOP'tE::T SC!!I::>UL!::
FILE NO: C 86-05
APPLICANT: JACOBSO;:. l!.
SITE ADDrrCSS: 42 Ex 60 t.'. CAllPBELL AVE.
1. Construction to be~in within one year of final approval.
2. Construction to be co~pleted within one year of starting date.
NOTE: Above Development Schedule is a standard used by the Planning Departnent
when applicant has not submitted a schedule for his project.