88-194
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CITY O~ caHPBELL
DBPT. O~ PUBLIC WOR1t8
70 North ~irst st.
C_pall, CA '500B
(40B) .66-2150
PUBLIC WOR1t8 PERMIT
(for workinq in the
public riqht-of-way)
I..ue4 / ~/ 3~ n
perait exp res n 12 aos.
perait No.
??~-[9t.{
X-Ref. file
Application Date
Applioation exp
~ /,
APPLICATION - Applioation is hereby aa4e for a Publio Works Permit in aooor4ance with Caapbell
xunioipal C04e, seotion 11.04. (Applioation expires in 6 aonths if perait not pulle4)
A.
Work a44re.. or tract t Y / 7
1-
utili ty trenoh looation 5> (J ,._
Nature of work: ) - ,T {; }-~V, I
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B.
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Attaoh five (5) oopies of a 4rawinq showinq the looation, eztent an4 4iaensions of the work
The 4rawinq shall show the relation of the propose4 work to ezistinq surfaoe an4 un4erqroun4
iaprov..ents. When approve4 by the City Enqineer, sai4 4rawinq beooaes a part of this perait. -l
o
The General Con4itions for all peraits are liste4 on the reverse si4e. special pJbvisions for CD
~hi. perait are liate4 below. ~.ilur. to abide by th... conditions and provialona ..y r..ult ~
in job shut-40wn an4/or forfeiture of ~aithful Perforaanoe Bon4s an4 oash 4eposit8. (See ~
General Con4i tions 1 an4 2). ~ U)...
An applioation this application. This is non-refun4able.374~"5'q c..:o ~
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D.
B.
A44ress
Is this work beinq 40ne by the property owner at their own resi4ence? ---yes ~no
Complete an4 attach Workers' Co.pensation an4 Contractor Information foras.
The Applicant/peraittee hereby aqrees by affizinq their siqnature to this permit to ho14 the City of
c_pbell, its officers, aqents an4 ..ployees free, safe an4 harmless froa any claia or 4..an4 for
4_aqes resultinq froa the work covere4 by this permit.
n
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an4
ACCEPTED
7...!{,. /y.~
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NOTBSI ALL WORlt S
STANDARD DRAWINGS
COIl'l'ORM WI'1'B '1'BB A'l'TACBBD, APPROVED PLANS AND ALL APPLICABLE caHPBBLL
CONDITIONS.
'1'BB CONTRACTOR KUST RAVE '1'BIS PBRMIT AND APPROVED PLANS AND KUST KBBT WI'1'B '1'BB P.W. INSPBCTOR ON
'1'BB SITB AT LBAST TWO DAYS BE~ORB STARTING WOU.
NOTICB OST BB GIVEN 'fO PUBLIC WORD AT LBAST 24 BOURS BB~RB RBSTARTING ANY WORlt.
SPECIAL PROVISIONS
_1.
Street shall not be open out for un4erqroun4 installations. xiniaua cuts aay be allowe4
for connections or exploration holes. Such cuts aust be specificallY approve4 by the
Inspeotor.
pave.ent aay be cut for un4erqroun4 installations an4 aust be restore4 in accor4ance with
the utility Trench Restoration Stan4ar4 Drawinq.
Work to be stake4 by a license4 Lan4 surveyor or Civil Bnqineer an4 two (2) copies of the
cut sheets sent to the Public Work Deptartaent before startinq work.
The hours of work are liaite4 to outsi4e the hours of 7-' a.a. an4 3-6 p.a. for any work
affectinq a traffic lane.
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_4.
_5.
PBRMIT APPLICATION ~BE
(R-l)
($35.00)
DOUBT
$~V,~
RBCBIPT NO.
';'<0 { 53
2..0 I 5..3
~ 7~~;Jw3
1()/3
lei:?
1/ - ::3-r-~
Date
STANDARD
$50.00
$500.00
(100' O~ ENG. BST.)
(4' O~ BOND, $500 HIN)
O~ F.P. BOND, $35 XIN)
$ ~f';>l (1)
$ 73. 5oo.t ~
,
$1 9sz.o;~
$ ~/.31,.O
PLAN CBBCIt DEPOSIT
BOND I'OR ~AI'rBJ'OL PBUORHANCB
CASB DEPOSIT
PEUIT ~EE
APPROVED ~OR ISSUANCE
fl nPERMIT
(
f- 1 -, -
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L'.OCSON \ j ,iO:';""::"'! --,I
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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
December 7, 1990
Mr. Russell Johnson
1159 Fremont St.
San Jose, CA 95126
SUBJECT: ONE YEAR MAINTENANCE ACCEPTANCE
PERMIT NO.: 88-194
LOCATION: 915 S. San Tomas Aquino Road
Dear Mr. Johnson:
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.
Sincerely,
Gregg Eaton
Public Works Inspector
GE:sd
cc: Bond Company
f:88-194
CITY OF CAMPBELL
PUBLIC WORKS INSPECTION REPORT
DATE: /2. I 4 I 90
PERMIT jPROJECT NO.: 8S - /94-
TRACT NO.
ADDRESS:
9/s.- S.TA.IC..
TYPE OF WORK: STREET: ~ STORM:
SANITARY:
ELEC:
P.C.C.:
PARKWAY:
OTHER:
PRELIMINARY INSPECTION WITH DEFICIENCY LIST
FINAL INSPECTION WITH DEFICIENCY LIST
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:
I
I
REASON:
TOTAL CHARGES:$
ONE YEAR MAINTENANCE WITH DEFICIENCY LIST
----------------~~
ONE YEAR MAINTENANCE ACCEPTANCE---. ~
----- ~
@
INSPECTOR
/
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
WIMBERLY /J !~ANOLlNG
HELMS It. ~ RETURN TO
lllv -
JOCSON \, IDISC,lIF\J
KRUGER
PENOYER
Department:
Public Works
October 12, 1990
...
Mr. Russell Johnson
1159 Fremont St.
San Jose, CA 95126
SUBJECT: FINAL INSPECTION - DEFICIENCIES
PERMIT NO.: 88-194
LOCATION: 915 S. San Tomas Aquino Rd.
Dear Mr. Johnson:
You have requested a final inspection on subject construction work.
There are deficiencies in the work which are indicated on the
enclosed list. These deficiencies must be corrected in accordance
with City standards before I can make a final inspection or
acceptance of the work,
Upon completion of the corrective work, please submit a written
request for a final inspection and acceptance.
Sincerely,
Gregg Eaton
Public Works Inspector
GE:sd
Enc 1.
f:88-l94-2 (permits)
\..
./
One Year Maintenance Deficiency List
Pennit 88-194
915 San Tomas Aquino Rd.
1. Repair graffiti in sidewalk to the satisfaction of the Engineer or
remove and replace it.
2. Repair crack in sidewalk at utility pole to the satisfaction of the
Engineer or remove and replace it.
t4.j'-{;" f'L{
PUBLIC WORKS INSPECTION REPORT
DAU (Q~r;qc- Pe=1t or Project No. '. g~~f
Address _ J._ ~/h. T~f;, ~Q----,
Type of work; Street ><: Storm SAnitAry Electrical
Other (de$cribe)
[JPRELIMINARY INSPECTION WITH DEFICIENCY LIST (attAched)
[JFINAL INSPECTION WITH DEFICIENCY LIST (attAched)
o FINAL INSPECTION - ACCEPTANCE
Signed plAn~.? Y N (If uigned. Council acCeptAnce.)
ChArges AgAinst deposit? y
Overtime I hr$. @ $
DAte" reAlOonl
N
/hr.
-
$
BArriCAde rentAl (AttaCh invoice)?
DAte " reAsonl
y
N
$
Other?
$
$
TotAl chArges deducted from deposit:
(Cash Deposit $ leas chArges $
$
- Refund $
~NE YEAR MAINTENANCE WITH DEFICIENCY LIST (AttAChed)
o ONE YEAR MAINTENANCE - ACCEPTANCE
(ReleASe'mAintenAnce bond. Check Request if cAsh.)
cx. req.)
~neer
Inspector
~
./
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C IT l'
ur:
L~'l.l j\-' [till"" '," ;", h '-,"1 "',:, ", ij' ;
. ',i:; .,~ j,J l.\ I,.; L ,~r,
II .bL iL L ilL
70 NORTH FIRST
CAMPBELL, CALIFORNIA
(408) 866-2100
STREET
95008
Department:
Public Works
August 28, 1989
Mr. Russell Johnson
1159 Fremont St.
San Jose, CA 95126
RE: Final Inspection and Acceptance
Permit No,: 88-194
Location: 915 San Tomas Aquino Road
Maintenance Bond Amount: $18,325.00
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 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 the undersigned if you have any questions.
Sincerely,
Carlos M. Jocson
Associate Civil Enginneer
CMJ : sd
WIMBERLY LING
HELMS
JOCSON
KRU8ER
PENOYER J...-.
cc: G. Eaton, P.W. Inspector
Suspense - 1 year
,"
PUBLIC WORKS INSPECTION REPORT
Date ~.i~9-' -, Pendt or Project No. . ~8 -/7'4'-
AeSdreas 0'r- :S.-j-:A; R ,
Type of work I Str.,t ,.../" Storm
Other (describe)
Sanitary
Electrical
[J PJU:LIMINARY INSPECTION WITH DEFICIENCY LIST (attached)
o FINAL INSPECTION WITH DEFICIENCY LIST (attached)
canF.iNAL INSPECTION - ACCEP~E
Signed Plans?, Y ~ (If signed,
Charges against deposit? y ~
Overtime I hrs. @ $ ~.
Date 5 reasonl
. ~
Council acceptance.)
-
$
Barricade rental (attach invoice)? Y
Date 5 reasonl
Q)
$
Other?
~
[JONE YEAR MAINTENANCE WITH DEFICIENCY LIST (attached)
o ONE YEAR MAINTENANCE - ACCEPTANCE
(Release'aaintenance bond. Check Request if cash.)
$
$
$
· RefuneS $
~otal charges deeSucteeS from depositl
(Cash Deposit $ leas charges $
ek. req.)
~
-~ineer
" 1>'1/~
~
In r
CITY OF CAMPBEll
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
WIMBERLY
HELMS
JOCSON
KRUGEP:
PENOYER
HANDLING
RETURN TO
DISCARD
July 7, 1989
Mr. Russell Johnson
1159 Fremont St.
San Jose, CA 95126
SUBJECT: PERMIT NO.: 88-194
LOCATION 915 San Tomas Aquino Rd.
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 nec~ssary to release your bond and
refund your deposits.
Thank you for your cooperation.
Sincerely,
Carlos M. Jocson
Associate Civil Engineer
CMJ/sd
encl:
cc: G. Eaton, P. W. Inspector
B. Long, Sr. Lighting & Traffic Technician
f:keyproDEFLTR
CITY OF CAMPBELL
Permit No. :
Location:
88-194
915 San Tomas Aquino Rd.
ELECTRICAL INSPECTION
Inspection done on 7/6/89, #1
E1am Street light standard
After inspecting the above street light location it is my opinion that
this permit is not ready for a full electrical inspection. The following
items need to be corrected (and re-inspected by the electrical contractor
at all other locations) before another electrical inspection will take
place:
1. Repaint street light pole surface not smooth. (Review section 86
SSS, 86-2.16 Painting.
2. Wrong field wiring used.
A. Wiring from fuse holder in pull box to street light fixture
shall be #10 black THW.
B. Wiring from fuse holder at service splice box shall be #8.
Color shall be two black or one black and one red (not pink)
THW.
C. All splices sahll be in pull box not in hand hole cover.
3. No insulated bushing on conduit.end inside pole.
4. Pole not bounded to ground.
5. Pull Boxes - all.
A. No drainage (see attached drawing and spec).
B. Conduit shall come up no higher than 2 inches from bottom of
box (see attached drawing).
C. All pull box lids shall have hold down bolts.
D. No fuse holders in pull boxes.
Service point fuse 30 AMP 240V
Street lights fuse 3AMP 240V
6. All conduit ends shall be threaded with threaded insulated
bushing installed (see attached spec).
7. All conduit ends shall be bounded with #8 sold copper.
8. Conduit run from pole base to pull box not deep enough - shall be
18" minimum (see attached drawing).
f:88-194(Permits)
- ._--~-_.. - .- . --.- -
PUBLIC WORKS INSPECTION REPORT
Date ~/?~ Permit or Project No. '88 - /7'4-
AeSeSres& '9/S~, 7": /1,/l.
Type of work: Stre,t Storm Sani tary
Other (describe)
~NARY INSPECTION WITH DEFICIENCY LIST
Electrical
(attacheeS)
o FINAL XNSPECTION WITH DEFICIENCY LIST (attacheeS)
o FINAL INSPECTION - ACCEPTANCE
Signed plans? Y N (If signeeS, Council acceptance.)
Charges against eSeposit? y
Overtime: hrs. @ $
Date 5 reason:
N
/hr.
-
$
BarricaeSe rental (attach Lnvoice)? y
Date 5 reason:
N
$
Other?
$
$
$
- RefuneS $
Total charges deeSucted from deposit:
(Cash Deposit $ leas charges $
DONE YEAR MAINTENANCE WITH DEFICIENCY LIST (attached)
ek. req.)
o ONE YEAR MAINTENANCE - ACCEPTANCE
(Release'maintenance bond. Check Request if cash.)
~
~gineer
~
Inspector
T !~~~~~~~!~~a
Transamerica Premier Insurance Company
AOffilrllstrallve olhce If'Yloe. CahtOfnaa
,
TRANSAMERICA PREMIER INSURANCE COMPANY
c/o Commercial Surety Bonding Agency
o Southern California 0 Northern California
630 The City Dr.. Suite 120, 1265 S. .Bascom Ave.. Suite 1 DB.
Orange. CA 92668 . San Jose. CA 95128
1714l971.CS:;tk. ~~~~~I~~i:/;;:r[~~I~~~;Q=BAI27221
r t ~
City of Campbell
70 North First
L Campbell, CA 95008.
-'
BOND NUMBER
TPI 780023
TRACT NUMBER
Permit No. 88-194
SUBDIVIDER
TRACT NAME
1 s
IMPROVEMENTS
Storm and offisite improvements
PLEASE ANSWER THE QUESTIONS BELOW AND RETURN THIS FORM.
1. Has thisworkbee-n-fully completed and accepted? 0 Yes -!JIlt 0 No
2. If accepted, on what date? tJ / If
3. If not accepted, is work progressing satisfactorily?
If no, explain J / It
4. Perce~tage completed? f..-J / J~
o YesAl/ If- 0 No
REMARKS
. q3~ 411 (){Ab/.0 vU/nWtV7l' V11'~.
---
'-
.
Above Information furnished by: (signature) Title
,.,
I
DATE
,_ nsamenca
I" urance Services
Transamerica Premier Insurance Company
Admlmsttatlve ofl:ce Irv'"e. CalIfornia ..-'"
J I ,( _ _ _~
'::/-/CI/(O .
1-- TRANSAMERICA PREMIER INSURANCE COMPANY
c/o Commercial Surety Bonding Agency
o Southern California
630 Tbe City Dr.. Suite -1 20.
Orange. C.!\ 92668
17141 971-CSBA 127221
o Northern California
1265 S. 8ascom Ave,. Suite 108.
San Jose. CA 95128
1408J 298- CSBA 127221
r-
SUBDIVISION STATUS INQUIRY
--,
RECEIVED
AUG 27 1990
City of Campbell
70 North First
L Campbell> CA 95008
..J
Public W orbl Engineering
BOND NUMBER
_____ITI 78Q02,1
TRACT NUMBER
Permit No. 88-194
R
SUBDIVIDER
1 M'
TRACT NAME
15 San Toma A uino R ad
IMPROVEMENTS
Storm and offisite improvements
1---
PLEASE ANSWER THE QUESTIONS BELOW AND RETURN THIS FORM,
~Yes 0 No
1. Has this work been fully co~~I~~dl.and accepted?
2. If accepted, on what date? ~~q
3. If not accepted, is work progressing sati3factorily?
DYes
o No
If no, explain
4. Percentage completed?
ON
--/0
....
l
REMARKS
..
, ~
A/Y7
REFUNDABLE DEPOSIT
CHECK REQUEST
TO: FINANCE DIRECTOR
CITY OF CAMPBELL
Please issue check payable to:
Russell Johnson
(30 spaces)
Address:
Line 1:
1159 Fremont St.
(30 spaces)
Line 2:
(30 spaces)
San Jose State: CA Zip: 95126
(20 spaces) (2) (10 spaces)
City:
Description:
Exact Amount Payable:
Cash Deposit Refund (24 spaces)
$3,432.00
Account Number:
905.4662 .
PURPOSE:
Release of cash deposit for excavation permit No. 88-194.
See receipt #20153 dated 7/28/89 in the amount of $500.00 and
receipt #1013 dated 10/13/88 in the amount of $2,932.00
Date: 8/28/89
Date: '/ j?<; k"/
I 1 (
Requested by: Gregg Eaton
Approved by: D.C. Wimberly
Title: P.W. Inspector
Verified by:
-~rle: P . W. Director
rcounts Receivable
Date:
SPECIAL INSTRUCTIONS FOR HANDLING CHECK:
Mail as is
xx
Mail in attached envelope
Return to:
(Department)
(Name)
Other:
08/24/88
TO: Ci ty Clerk
PUBLI C WORKS FI LE NO. ~ ~- (crt(
Please collect & receipt
for the following monies:
. ~':T.
35- J396
ITEM
Project Revenues (specify project)
PubUc. (')0,'1.12.6 Exc.ava..ti.on PvuYJ.a FeM:
A I i ca t i on Fee
Plan Check Deposit
Faithful Performance Deposit
R-l :
($-35)
3372 Plan Check & Inspection Fee
3521 Other Cash Deposit (specify)
3373
3373
3520
3373
3373 &
3373
3373
3372 Tentative Parcel Map Fil ing Fee ($350)
3372 Final Parcel Hap Filing Fee ($300)
'2 Tentative Tract Map Filing Fee ($400)
}j72 Final Tract Map Fil ing Fee ($350)
3372 Lot Line Adjustment Fee/Certificate of Compl iance ($350)
3372 Vacation of Public 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)
J395 Park Dedication In-lieu Fee per Unit ($1,132)
3380 Public Works Special Projects
3510 Postage
TOTAL
NAME R LJ 5 S <L fI .::J Z) h. ~s OY'\..
ADDRESS 11:)<=7 Fr-~ CSV\T "Cfffi st.
SJ-
RECEIPT NO.
FOR
C I TV CLERK
Q{LY
(;2 () / oS.3
,:'') 57J. ~
~.m
7-~g-~~
AMOUNT PAID
RECE J VED BY
DATE'
AMOUtn
$
5..,. DO
-5 DO OD
July, 1987
TO: City Clerk
PUBLIC WORKS FILE NO. g g -/9,-/
Please collect & receipt
for the following monies:
,.,,,CT.
:35- 3396
3372
3521
~j)
project)
PeJLr.1.{;t e.M :
R-] :
(S-3S)
($200)
.t Vl.:
($ SO)
'( SOO)
(4% of FPB)
($SOO min.)
(n, of FPB)
($ 3S min.)
(Cash) Depos it
~79
3521
Plan Check & Inspection Fee
Other Cash Deposit (specify)
,2373
3373
3372
77.72
. .'2
)372
3372
3372
3372
3372
Tentative Parcel Map Fil ing Fee ($3S0)
Final Parcel Hap Fil ing Fee ($300)
Tentative Tract Map Fil ing Fee ($400)
Final Tract Ma Fil in Fee ($350)
Lot Line Ad'ustment Fee/Certificate of Compl iance
Vacation of Publ ic Streets and Easements
Assessment Segregation or Reapportionment
First Split ($500)
Each Additional Lot ($ISO)
Environmental Assessment:
Categorical Exemption
Ne ative Declaration
Storm Drainage Area Fee per Acre Multi-Res.,
$2,060; a II 0 the r, $2,250)
Park Dedication In-lieu Fee per Unit ($1,132)
3395
3380 Public Works Special Projects
3SI0 Postage
TOTAL
NAME
(! U6SELL- Jt ~)"so ttJ
PHONE
c2 7 y -~ d-~ ~
$
7 3e2.s-, 66
,
AMOUNT
$
~, 7-3~,ClO
~-.I8/ ,t) ()
,
/e:2~~.CJo
ADDRESS / I S 9 02 t:::/?-? o/C"fj
,S'T-
ZIP 7S-/ ~L~
S.:T.
FOR
CITY CLERK
ClNLY
RECEIPT NO.
/0/:3
9 3 d- ~_ <!:l ~
~
/ 0 - I "?:,. ~ y
~ PAID
RECE I VED BY
DATE
July, 1987
. 'FC'/J~
,I .' of V
JIL-
-
CITY OF CAMPBELL
-
I
Department of Public Works
CONTRACT IDENTIFICATION
Project or
Permit No.
Name or
Location
, -
(
/ (;-: ,/
PROJECT INSPECTOR'S
DAILY REPORT
...., /'
,I ;'; '/'
Page
of
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Date
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CITY ENGINEER
PROJECT ENGINEER
.,t C:- :-:::=.--
PROJECT INSPECTOR
-.
CITY OF CAMPBELL
-.
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Department of Public Works
CONTRACT IDENTIFICATION
{/ :/
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PROJECT INSPECTOR'S
DAILY REPORT
Project or
Permit No.
Name or
Location
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CITY ENGINEER
PROJECT ENGINEER
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/<'" ----'r;.-/ ~~-
PROJECT INSPECTOR
12/06/88
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMA TION ONLY AND
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
POUCIES BELOW.
COMPANIES AFFORDING COVERAGE
COMPANY
LETTER A
COMPANY
LETTER B
COMPANY
LETTER C
COMPANY
LETTER 0
FIREMEN'S INSURANCE COMPANY OF WASHINGTON
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' COMP~~TION INSURANCE INFORMATION
Name of contractor/APPlicant~f/ Sf r /:/ 1"---;(, {--t,,_(C7,--
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; QR
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 /' tt4*~ / Date 7/7yE,f-
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 E. M. 60'DLEY PA;PJJ6 ~~ Telephone .377-j:;LK b
Address 73ft:, JJ6R.rJ.t-R-Up .sT. .~. qs-I '2t:.
State Contractor License No. .::2 fRt/6:J.-1 e'2{:ity Business License No.tJ-/tJ/I.J9- L
Expiration Date 5~r'- d/
Will do the following types of work:
_____underground
P.C. concrete
/
_____A.C. paving _____electrical
other (specify)
f:PERMINFO
,-"'tI "Ii
SENT BY: BLI S8 &
40B77B6096~408267507EOOOOOOOOOO;# 1
;-SSL;E DA: 1:'_ (~;~MiDD,yy)
11-2~88
PRODUCER
'I,LOW GLEN INSURANCE AGENCY
1631 WILLOW STREET SUITE 105
SAN JOSE, CA 951225
THIS CI!F1TIFiCATE /S ISSUED AS A MATTER OF INFORMATION ONLY AND CON,eR$
NO MIGHTS UPON TH! CERTIFICATE HOLDliR. THIS CERTIFICATE DOES NOT AMeND,
EXTEND OR ALTER THE cOvl!RAGE AFFOftDED BY TH~ POLICIES a!LOW, .
COMPANIES AFFORDING COVERAGE
INSURED
APACHE PIPELINE CORPORATION
1087 CURTNER AVE.
SAN JOSE, CA 95125
-------
COMPANY A
LffiER
COMPANY II
LETrER
COMPANY C
LE'TiER
COMPANY D
LETTER
COMF'A/I;Y
LETTEFI
PENN AMERICA
.
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE t.IST!D BELOW HAVE BEEN 1$5UI!D TO THE INSURED NAMED A80VE FOR THe POLICY PiR100 INDICATED,
NOTWITHSTANDING ANY REQUIR!M!NT. TERM OR CONDITION or: ANY CONTRACT OR OTHER DOCUMENT WITH RESP~CT TO WHICH THIS oeRTIFICATE MAY
p~ I$$U!D OR MAY PERTAIN, THE INSURANt! AFFORDED BY THE POLICII!S DESCRIBI!D HEREIN IS 5USJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDI-
TIONS OF SUCH POLICIES,
CO
lT~
TYPE OF INSURANCE
. POLICY NUMBER
PC..IC1' EF?:CTNE
-t-"''' ~''''^ffl
PO~;CY EX?iAATION
O.l.TE if-,\MIOOIYYl
A
GENI'.RAL LIAI!I1LlTY
COMPREHENSIVE FORM
, PREMISES/OPERATIONS
'UNDEAGROUN{]
~PlOSION & COLLAPSE HIDRD
X PRODUCTS/COMPLETEO OPERATIONS
CONTRACTUAL
INDEPENDENT CONTRACTORS
BROAD FORM Pf1QPERlY OAMAGE
PERSONAL INJURY
GL40159
6-7-88
6-7-89
BOOll"
INJURY $ $
PROPERTY
DAMAGE $
il ~ PO $;, , 000
COMBINED
PERSONAL INJURY
AUTOMOBILE LIAISILlTV
ANY AUTO
ALL OWNED AuTOS (Piil\'_ PASS.)
ALL OWNED AUTOS \/OTH~tl THAN)
PAI~, PASS_
HIRED AUTOS
NON-OWNED AUTOS
GARAGE LIAS I LIlY
IIiIOilV
IflJuR'l
(~R ffRSOif, $
II()OILY
IN..\J~V '
(PE" Mt.Ji~'f, $
pROPERTY
DAMAGE $
EXCI!&S LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA Fu'RM
i.
I
I
---r----
61li PO
COMBINED $
g6t~~ED $
1
STATE
COMPENSATION
INSURANCE
I=UNO
P.O. BOX 807, SAN FRANCISCO, CA 94101-0807
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
1'10 V em b e r 3, 1 9 8 8
POLICY NUMBER 1069681-88
CERTIFICATE EXPIRES: 06-01-89
r-
City of Campbell
Attn Public Works Dept
75 N Central Ave
Campbell, Ca 95008
L
This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California
I nsurance Commissioner to the employer named below for the poli3YOPeriod indicated,
This policy is not subject to cancellation by the Fund except upon~ days' advance written notice to the employer.
30
We will also give you 'nE1IJ days' advance notice should this policy be cancelled prior to its normal expiration.
This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the
policies listed herein, Notwithstanding any requirement, term, or condition of any contract or other document with
respect to which this certificate of insurance may be issued or may pertain, the insurance afforded by the policies
described herein is subject to all the terms, exclusions and conditions of such policies.
,/f~
PRESIDENT
E~DORSEMENT #1005 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE
7-5-88 IS ATTACHED TO AND FORMS A PART OF THIS POLICY.
NAME OF ADDITIONAL INSURED:CITY OF CAMPBELL
ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE
6-20-88 IS ATTACHED TO AND FORMS A PART OF THIS POLICY.
EMPLOYER
I
Apache Pipeline Corp
1087 Curtner
San Jose, Ca 95125
L
selF 10262 (REV. 10-86)
OLD 262A
h.Q.R.~Etl~H!
. THI~ AGRE~T (identif~ed aStNo. LvI 39) ~~e and entered
J.nto thJ.s Jff day of iiiC ~ ~/-- , 19KJ., by and
between JAMES LANTIS and EBRA LYNN LANTIS, husband and wife,
and RUSSEL L. JOHNSON and MARIAN A. JOHNSON, husband and wife,
hereinafter referred to as "Owner," a'nd the CITY OF CAMPBELL, a
municipal corporation of the County of Santa Clara, State of
Califor~ia, hereinafter referred to as "City."
WHEREAS, City granted conditional approval to construct a
commercial building upon that certain real property described
in Exhibit 'A' attached and incorporated as though fully set
forth herein and commonly known as 915 San Tomas Aquino Road ,
which property is hereinafter referred to as "said real
property" ;
WHEREAS, compliance with the terms and conditions of this
agreement are conditions to the final approval of above
described application to construct a warehouse/office ;
NOW, THEREFORE, IN CONSIDERATION OF THE ABOVE-MENTIONED
APPROVAL, and satis(action of the conditions to that approval,
(1) Owner shall provide, construct and/or install at
his own proper cost and expense, public street improvements
across the entire frontage of said real property within 12
months from the date first mentioned hereinabove; provided,
however, that in the computation of said 12 months period,
delays due to, or caused by acts of God, viz., unusally
inclement weather, major strikes, and other delay beyond the
control of Owner or his successors shall be excluded.
I
I
(2) It is expressly understood and agreed to that if ~
Owner shall fail to complete the work required by this
Agreement within the said 12 month period, the City, after
after giving ten (10) days' written notice thereof to Owner, or
his successors, may construct and/or install said improvements
and recover the full cost and expense thereof from owner, or
his successors.
(3) Owner, or his successors, shall cause to be prepared
at his cost and expense improvement plans for the construc-
.'tion and/or installation of said improvements prior to such
construction or installation. Said plans shall be prepared by
a civil engineer registered by the State of California and
submitted to the City Engineer for examination and approval.
All qf said improvements shall be constructed and/or
.\
/
,
....."
.'
installed in accordance with those plans approved by the City
Engineer and shall be made under the supervision and inspection
and to the satisfaction of the City Engineer. Said
construction and/or installation shall be in accordance with
the existing ordinances and resolutions of the City of Campbell
and to all plans, specifications, standards, sizes, lines and
grades approved by the City Engineer, and all State and County
statutes applicable thereto. Upon cOmpletion and acceptance of
the imp~ovements by City, Owner, or his successors, shall
provide reproducible as-built plans to the City Engineer.
(4) The construction work of the improvements embraced by
this agreement shall be done in accordance with the specifica-
tions of the- City of Campbell and Sanitation District No. 4 of
Santa Clara County, where indicated.
(5) Prior to approval of the plans by the City Engineer
pursuant to Section (3) of this Agreement, Owner, or his
successors, shall pay to the City for examination of
improvement plans, field inspection of construction of
improvements and all necessary expenses incurred by City in
connection with said improvements, a sum in the amount of seven
percent (7%) of the estimated cost of the improvements at the
time of construction.
(6) Owner, or his successors, shall file with City, upon
execution of this Agreement, surety acceptable t~ the City in
the amount of SEVENTY THREE THOUSAND THREE HUNDRED DOLLARS
($73,300.00) to insure full and faithful performance of the
construction of all the aforementioned improvement work,
excluding sanitary sewers and water distribution system. Said
surety shall guarantee that Owner, and his successors, will
correct any defects which may appear in said improvement work
within one (1) year from the date of acceptance of the work by
City and pay for any damage to other work resulting from the
construction thereof, as well as pay the cost of all labor and
materials involved. This surety shall remain in effect until
one (1) year after date of final acceptance of said
improvements by City. Said surety amount may be reduced by the
City Engineer after the date of final acceptance to not less
than twenty-five (25) percent of its full value.
(7) Upon final release of said surety by City, the
obligations of Owner, and his successors, contained in this
i'Agreement shall be' considered null and void.
(8) When called upon by City to do so, Owner, or his
successors, will execute a petition for the formation of any
special assessment district created pursuant to any special
assessmen~ act as provided in the Streets and Highways Code of
~
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.-
\
the State of California created for the purpose of constructing
and/or installing any or all of said improvements.
(9) Owner, or his successors, shall participate in and
become a part of any special assessment district as described
in paragraph (8) of this Agreement.
It is expressly understood that ~y obligations of Owner,
or his successors, contained in this Agreement that are
accomplished to the satisfaction of said City Engineer by said
special, assessment district shall be considered null and void.
(10) Owner, or his successors, shall make such deposits
or file such bonds and enter into such agreement as required by
Sanitation District No. 4 of Santa Clara County to insure the
installation of a sanitary sewage system to serve said real
property, and Owner, or his successors, shall file with City,
upon execution of this Agreement, a letter from said Sanitation
District No.4 stating that Owner, or his successors, have made
such deposits or filed such bonds and entered into such
agreements.
~ .
(11) Owner, or his his successors, shall pay to Pacific Gas
and Electric Company any and all fees required for installation
of underground wiring circuit to all electroliers within said
real property when Owner, or his successors, is notified by
either the City Engineer or the Pacific Gas and Electric
Company that said fees are due and payable. Owner's, and his
successors', obligations under this section shall not be
relieved by delay or the passage of time, but shall remain
binding indefinitely and forever.
(12) Owner, or his successors, shall make such deposits
or file such bonds and enter into such agreement as required by
San Jose Water Company when called upon to do so to insure the
installation of a water distribution system to serve said real
property, including fire hydrant. Owner's, and his
successors', obligations under this section shall not be
relieved by delay or the passage of time, but shall bind Owner
and successors indefinitely and forever.
(13) Any easement and right of way within or without said
real property necessary for the completion of the improvements
. shown upon aforesaid improvement plans shall be acquired by
"Owner, or his successors, at his own cost and expense. It is
provided, however, that in the event eminent domain proceedings
are required for the purpose of securing said easement and
right of way, Owner, or his successors, shall deposit or cause
to be deposited with City a sum covering the reasonable market
value of ,the land proposed to be taken and to be included in
,
-,
.
"..
" ~"
'said sum shall be a reasonable allowance for severance damages,
if any. It is further provided that in addition thereto such
~sums as may be required for legal fees and costs, engineering
.and other incid~ntal costs shall be deposited with the City.
(14) Owner, or his successors, shall carry out any and
,'all negotiations with all interested parties and shall perform
or cause to be performed at his own cost and expense and to the
,satisfaction of the City Engineer any and all work required to
abandon, remove, raise, lower, relocate and otherwise modify
irrigation line or lines within the boundary of said real
property.
(15) . To the fullest extent permitted by law, Owner, and
his successors, shall indemnify, defend and hold the City of
Campbell, and its agents, employees, attorneys, officers,
'officials and assignees harmless from any and all claims,
damages, losses and expenses, including, but not limited to,
attorneys' fees, arising out of, or resulting from any
negligent or intentional act or omission (including misconduct)
of said Owner, or his successors, or any subcontractor, or
anyone directly or indirectly employed by him, or anyone for
whose acts any of them may be liable in the course of
performance of the Agreement.
The Owner, and his successors, shall also 'indemnify, defend
and hold the City of Campbell, and its agents, attorneys,
employees, officers, officials,and assignees harmless against
and from any and all claims, demands, liabilities, losses,
lawsuits, jUdgments, damages, costs and expenses (including,
,but not limited to, attorneys' fees and court costs, whether
'incurred at trial, appellate or administrative levels) which
the City of Campbell may incur or suffer, or to which the City
of Campbell may be subjected resulting from the failure of
~Owner, or his successors, or his agents, employees,
sUbcontractors, or anyone performing services under him, to
~fulfill any of the obligations imposed under this Agreement.
(16) It is acknowledged that the provisions of this
Agreement constitute covenants for the improvement of the
subject real property for the mutual benefit of Owner's
. '" property, commonly known as 915 San Tomas Aquino Road and the
.City's property, commonly described as San Tomas Aquino Road
~here it adjoins Owner's property. These covenants shall be
',. considered to affect rights in the above-described real
. 'properties, and shall be binding on the heirs, assigns,
'successors, and grantees of Owner to said real property.
(17) Nothing contained herein shall be construed to transfer
'anyunve~ted interests in real or personal property for
. .
~
-"1.
-,
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"
purposes of the rule against perpetuities.
(18) In the event that Owner, or his successors, should
breach any of the terms, conditions, or covenants of this
Agreement, the City shall be entitled to recover, in addition
to any other relief available in law or equity, all costs
incurred in attempting to obtain enfo~cement of the Agreement,
or compensation for such breach. These costs shall include
reasonable attorneys' fees and court costs.
(19) 'This is the entire Agreement between the parties, and
there are no representations, agreements, arrangements or
understandings that are not fUlly expressed herein.
(20) This Agreement can be executed in counterparts by the
parties hereto, and as so executed shall consist of one
agreement, binding on all the parties.
IN WITNESS WHEREOF, said City has caused its name to be
affixed by its Mayor and City Clerk, who are duly authorized by
resolution of the City Council, and said Owner has caused his
name to be affixed the,day and year first above written.
CITY OF CAMPBELL
Jeanette Watson, Mayor Pro Tern
Barbara Olsasky, City Clerk
APPROVED AS TO FORM:
William R. Seligmann,
City Attorney
OWNER:
~~
J rua.ntis .
, ~cf ~~~
D bra Lynn La is
,
SUBSCRIBED 'AND SWORN TO BEFORE ME
~IIS"1. 1. .DAy",9f.O{!J]~c.e.19.~
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..........................................................
5 ' '. 0 F FIe I A L SEA L a
:: """ . "" CATH5RINE A. GIANCOLA::
:: :. NOTARY PUBLIC - CALIFORNIA 5
- 0 _
:: . COUNTY OF SANTA CLARA =
- .
:: - Comm, Exp. Ma,ch 2'. '989 =
= .
..........................................................
5
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CITY OF CAMPBELL
-12c~
ry!
1) V\ L9~~
~ cv~
J('Y b /
~ August 26, 1988
f1~
70 NORTH FIRST STREET
CAMPBELL, CALIFORNIA 95008
(408) 866-2100
Department:
Public Works
Mr. Russel Johnson
1159 Fremont Street
San Jose, Ca. 95126
Re: 915 San Tomas Aquino Road
Dear Mr. Johnson;
Enclosed is the agreement to install street improvements as
required by the conditions of approval of your commercial
development at the corner of Elam Avenue and San Tomas
Aquino Road. Please return one copy of the agreement signed
and notarized. The additional copies are for you and Mr.
and Mrs. Lantis.
"
According to our records the Public Works conditions of
approval that remain to be addressed, besides this
agreement, are the storm drain area fee and the excavation
permit. The storm drain fee is $1,262.00 and the
requirements for the excavation permit, including fees,
wili be explained by Dave Valkenaar or Don Kin~i:.AnY. of us
may be reacbed at 866-2150 if you bave any queC:ons.
Sin c ere 1 y ; (j7 v- Cru Z---- ~ h-v(~j7..-----
C;:y::~y
Engineering Technician
,r I~~r~ln~~:~!~~a
Transamerica Premier Insurance Company
Administrative office: Irvine. California
TRANSAMERICA PREMIER INSURANCE COMPANY
PERFORMANCE BOND - SUBDIVISION
Bond t/TPI 780023
KNOW ALL MEN BY THESE PRESENTS:
That, Russell Johnson. Marian Johnson, James Lantis and Debra Lantis
as principal, and TRANSAMERICA PREMIER INSURANCE COMPANY (hereinafter called
Surety), as Surety. are jointly and severally bound unto the City of
Camphell (hereinafter called owner), in the penal sum of
Seventy-Three Thousand Three Hundred and no/100--------------($ 73.300.00--1
to the payment of which sum, well and truly to be made, the Principal and
Surety bind themselves, their and each of their heirs, severally, firmly by
these presents.
WHEREAS, the Principal has entered into .a certain written agreement dated
the J f) day of (/Jr7,; IC)~L-r 19~ith the Owner to do and perform the
following work, to wit:
Construction of storm and off-site improvements
under Permit No. 88-194 at 915 San Tomas Aquino Road
NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH, that if the
principal shall well and truly perform and carry out the covenants, terms
and conditions of said agreement, then this obligation shall be void,
otherwise shall remain in full force and effect.
SIGNED with our seals and dated this
5th day of October
, 19~
and
"t;'"
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Au,( 6--, tl cla~1'
Attorney-in-Fact
T I~r~~~~~!~~a
Transamerica Premier Insurance Company
Administrative office: Irvine, California
TRANSAMERICA PREMIER INSURANCE COMPANY
17671 Cowan Avenue. Irvine, CA 92714
LABOR AND MATERIAL BOND - SUBDIVISION
Bond IITPI 780023
KNOW ALL MEN BY THESE PRESENTS:
THAT, Russell Johnson, Marian Johnson, James Lantis and Debra Lantis
as Principal, and TRANSAMERICA PREMIER INSURANCE COMPANY, (Hereinafter
called Surety), as Surety, are jointly and severally bound unto the
City of Campbell , (hereinafter called Owner), in
the penal sum of Seventy-Three Thousand Three Hundred and no/100------------
($ 73,300.00--) for the payment of which sum we'll and truly to be made, the
Principal and Surety bind themselves, their and each of their heirs, executors,
administrators, successors and assigns, jointly and severally, firmly by these
presents.
WHEREAS, the Principal has entered into a certain written agreement dated the
/ rJ day of {Vela Off- , 19~ith the Owner to do and perform the
following work, to wit:
Construction of storm and off-site improvements
under Permit No. 88-194 at 915 San Tomas Aquino Road
NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH, that if the
Principal shall promptly make payment to all claimants as hereinafter
defined, for all labor and material used or reasonably required for use in
the performance of the contract, then this obligation shall be void;
otherwise it shall remain in full force and effect.
Signed with our seals and dated this 5th day of October ,19~
Principal
RANCE COMPANY
Attorney-in-Fact
,r I~~r~n~~~~!!~a
Transamerica Premier Insurance Company
Administrative Office Irvine. California
-
N~I 2818
G PA______ __________
Power of Attorney valid only if numbered in red,
General Power of Attorney
Know All Men by These Presents, That Transamerica Premier Insurance Company, a corporation duly organized and existing under the laws of the
State of California. and having its administrative office in Irvine, Orange County, California, does by these presents make, constitute and
appoint ______________________
CHARLES GRISWOLD
._~--~---~--,_._-_._-------
oL__ San Jose and State oL__.GalifQrn~____ its true
and lawful Attorney(s)-in-Fact. with full power and authority hereby conferred in its name, place and stead. to execute, acknowledge and deliver
~ CONTRACT BONDSl$.B.A-:-Guarantee Agreement - MAXIMUM ~_~NALTY 'f5Q(r,QQO.-OQ__==~=-~~_'
OTHER CONTRACT BONDS - MAXIMUM PENALTY 100,000.00
_______Ab.~_9JHEB BONDS - MAXIMUM PENALTY $25,000.00
"THIS POWER OF ATTORNEY SHALL TERMINATE ANDBE---------- ----------
OF NO FURTHER EFFECT AFTER DECEMBER 31, 19891~='~~~_-=--=~=-=---=~_=_=_-===,
and to bind the Company thereby as fully and to the same extent as if such bonds were signed by the President. sealed with the corporate seal of the
Company and duly attested by its Secretary, hereby ratifying and confirming all that the said Attorney(s)-in-Fact may do in the premises. Said
appointment is made under and by authority of the following resolution adopted by the Board of Directors of the Transamerica Premier Insurance
Company, at a meeting held on the 12th day of June, 1984.
"Be It Resolved, that the President, any Vice-President, any Secretary or any Assistant Secretary shall be and is hereby vested with full power and
authority to appoint anyone or more suitable persons as Attorney(s)-in-Fact to represent and act for and on behalf of the Company subject to the
following provisions:
"Section 1. Attorney-in-Fact Attorney-in-Fact may be given full power and authority for and in the name of and on behalf of the Company, to execute.
acknowledge and deliver, any and all bonds, recognizances, contracts, agreements of indemnity, consents of surety and other conditional or
obligatory undertakings and any and all notices and documents canceling or terminating the Company's liability thereunder, and any such instruments
so executed by any such Attorney-in-Fact shall be binding upon the Company as if signed by the President and sealed and attested by the Corporate
Secretary, "
In Witness Whereof. Transamerica Premier Insurance Company has caused these presents to be signed by its ~_ Pres i dent_____
and its corporate seal to be hereto affixed thiL 16th day of
County of Orange
} ss
____ October __, A.D.. 19
By
State of California
CALtFOR~'t.
day of --- ----
Joan M. l~ynn
Jack M. Trapp
executed the within instrument as _ Pres i dent
acknowl~<ma.thal tQa..I'Qrp,<1Hltwn.P'l(P'~ it
~j 1-rf5Ff;~:- O-F-FiC:AL SEAL --rt
i' ,j'/' , ':1~/.:,"\ Jrit\\j r'l~ ""''''N'NJ I~
I ;::17;.;.-:.;.'(",-".-'\: '-.-.. oJ I'll. ,'t.': i .
~: [,,- C'", ,',' I,'n-rr,'''' HYi ,- "., "."'-'"'' 'f..
11 \:~_,::"__,~}f;R; ;-;;~ i:'/\__.~);:f~i:~i\;~~' ,
~' ,_.",-.,-,Y' o,-.,^"If'l' '''''I'T)' I
~....." ;"!i.'\l, .1~~ \..\_........ !
M.,Y cc;-!!,~~~~11!H~'2~::::' ('(:1. 17,' 1?.'11 I~
~.~~....~ ~.....~~~
I. the undersigned Secretary of Transamerica Premier Insurance Company hereby certify that the above and foregoing is a full. true and correct copy of
the Original Power of Attorney issued by said Company, and do hereby further certify that the said Power of Attorney is still in force and effect.
16th
October
. in the year 1987 , before me
, a notary public. personally appeared
, personally known to me to be the person who
, on behalf of the corporation therein named and
On this
(
~ l1~__lL)~
Notary Public
And I do hereby further certify that the Certification of this Power of Attorney is signed and sealed by facsimile under and by the authority of the
following resolution adopted by the Board of Directors of the Transamerica Premier Insurance Company at a meeting duly called and held on the 12th
of June. 1984, and that said resolution has not been amended or repealed:
"Resolved, that the signature of the Secretary or any Assistant Secretary of this Corporation, and the seal of Corporation. may be affixed or printed by
facsimile to any certificate to a Power of Attorney of this Corporation, and that such printed facsimile signature and seal shall be valid and binding
upon this Corporation,"
GIVEN under my hand and the seal of said Company, this_~~
5th
-day of ___Q~J~_ober ~______~________,
19_8.8______
THIS POWER OF ATTORNEY EFFECTIVE ONLY IF
(A/Jcf-
ATTACHED TO BOND NO._--'D'.l, 780023
Secretary
30024A
10-85
~
PLUMBLINE ENGINEERING
'9 - - . -,. - . ..-. .. 'Ii ("u 6'
CAMPBELL, CALIFORNIA 95008
/31 .DOT A INri "'<"
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CITY OF CAMPBEll
70 NORTH FIRST STREET
CAMPBELL, CALIFORNIA 95008
(408) 866-2100
Department:
Public Works
~-
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TRANSMITTAL FROM THE OFFICE OF THE CITY ENGINEER
Date:
August 31, 1988
To:
McMurtry & B'el1 Ins.
p. Q. Box 309
Los- Gatos t CA 95031
Attention:
Dave Chappe 11
SUBJECT:
EXCAVATION PERMIT NO. 88-194
915 S. SAN TOMAS AQUINO ROAD
Reference:
We are forwarding via: mail-1L- messenger____ separate cover_____
enclosed~ attached____ other____
The following:
One copy each of subject permit and construction
cost estimatet per your request.
Remarks:
:: ~~~~
Project Engineer
OK/Ie
CHtCKt:D:
v
v
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Permi t No. ?->'l-.- \ ~ ~
~\ s Wtl. T Qy)o...S I\!.bU l 0iU
Tract No. or Address
IMPROVt!.~tl;T PLAN CHECK LIST
DEVtLOPrltNTS
ITtH:
1) Permit number and prop-
erty address on plan?
2) Site review completed?
3) Applicable standard notes
4) Engineer's Stamp, Signa-
ture and Expiration Date
5) Conformance with City
standard specifications
and details
6) Street geometries
7) Street grading plan con-
forr.ity with overall
street grades and/or
official grading plan
B) Approved roadway
structural section
9) Street lighting
requirements
10) Storm sewer design
11) All relevant conditions
of approval have been
met
12) Traffic review
13) Service Center review
Plan check co~pleted by
Recommeded for approval
Send originals for signing
CO:-~ltnTS :
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elL., iC ~t' '.
~~H ClK. evJf ~t ~fl'-'?~/f'r()L."
I
Dill M. Helms Date
Engineering ;.1anager
Donald C. ~i~erly Date
Birector of Public Works
.tJ/L.
'"
PUBLIC WORKS PERMIT ISSUANCE CHECK LIST
City of Campbell Public Works Permit No. cl: -(~ii
V Applicant section complete
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V Applicant signature and date
t/. Permit Application fee, $35.00 for R-l, $50.00 for
standard, paid. Receipt number
~ Plan check deposit, $500.00 for standard only, paid.
Receipt number
-
v Five sets of improvement plans submitted
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;/ Bond for
estimate
Amount $
faithful performance, 100% of City Engineer's
for stan~ard only, posted and appropriately noted
73 s(V'""'" Form l.D. # .,..,-, ?2cOZ'3
.
l/ Cash Deposit: $200.00 for R-l; 4% of FP bond, $500 min.
for standardd posted.
Amount $ .:?, 7 3 .;L, <!l 0 Receipt No. /0 I :3
~. Permit fee of 7% of FP bond, $35.00 min., paid.
Amount $ .5; /3/, Co Receipt No. I D I ~
V' Worker's compensation information received for Applicant
(see Information Sheet for Public Works Permits)
~All other Public Works requirements listed in the Con-
ditions of Approval of the development.
---------------------------------------------------------------------------
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t;- Worker's comp and Contractor's Information received for
Contractor (see Information Sheet for Public Works Permits)
~- Certificate of Insurance with Additional Insured's
Endorsment received from Contractor (see General Summary of
Insurance Requirements for Public Works Permits)
V . .
Three sets of off-site plans, stamped APPROVED (Tract or
Development and Public Works Permit number and property
address on plans)
v
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
UPON ISSUANCE, INITIATE PLAN CHECK DEPOSIT REFUND CHECK REQUEST.
6/88
flpermchklst
--.--..--
___._.____..__u._.___
1105 L'AVENIDA MT. VIEW. CALIFORNIA 94043
MAILING ADDRESS. p, O. BOX 729 94042
PHONE (415) 967-2125
December 19, 1988
RECEIVED
net 22 1988
PUBLIC WORKS
~Rma
S}fHOM OIlSnd
B861 (; 6 3a(J
GIIAIII:)II.
Mr. Millard Bunnell
GODLEY PAVING COMPANY
736 Northrup Avenue
San Jose, California 95126
Reference: San Tomas Aquino Project
Elam Avenue
Campbell, California
Dear Mr. Bunnell:
Following is the typical gradation of our Class 2 (Modified) Aggregate
Base material from our Azevedo Quarry:
Sieve Size Percent Passing Specs
1" 100 100
3/4" 98 90-100
114 48 35-55
1130 18 10-30
11200 5 2-9
SE: 31 25 Min.
R-Value: 80 78 Min.
If we may be of further service in this matter, please call us.
Very truly yours,
RAISCH PRODU.CTS . t. \
~ ~< . ~--
4-7 ,.
Robert E. Beatty -~"---,
REB : j g
"AN EQUAL OPPORTUNITY EMPLOYER"
''''lScA~
-.
0"" " _",,", 0"" """,,"'S "",,,,,,erI"" e<'ST S"'~" · "~,, ,.. ~g -\ g~
Address~ \ ~ ~n ~OY"'l\1A~ l~tymbY~dater;Z:Z-6tf'
Surface Construction
_ $ ~60.00
Clearing & Grubbing
Lump Sum Estimate
Sswcut Concrete LF@ $ 4,00 - $
Concrete Removal SF @ 3,00 - $
Curb & Gutter Removal LF@ 5,00 - $
Inlot Drain with Pipe -- EA@ 600,00 - $
Curb & Gutter 3~<fLF@ 14.00 - $ ~ Cd7~.(]a
Sidewalk "2.."L'-IB SF @ 4,00 - .=0
Driveway Approach 71./1 SF @ 5,50 $ t? ~ 5'0
Handicap RMIp I EA@ 400,00 $ 400.00
Extruded Curb LF@ 8,50 - $
Barricade /0 LF @ 50,00. - $ 500,. O..J
660 I qt,':' 'f..2. 7(.).95
Street Excavation (~oaO SF)x($O,lO)x(? YZ!') - $ ~,~d. " ..,
AC Pavement ~l?7.-g ~f I " 7 ..:6'? cJ
(7'1 C" SF)X($O,30)X~) - $ 5- t/2-Ce..z,JO
("
Adjust Kanhole to Grade 2-- EA@ 375,00 - $ 7S'tJ. l>O
Adjust Handhole to Grade "2,..- EA@ 275,00 - $ ~5o.,' 0
Konument Box w/Konument I EA@ 600,00 - $ hDo.OO
Street Tree (15-gallon) -3 EA@ 300,00 - $ 1C)O. triJ
Pavement Striping ($100 min) .;qo LF @ 0.65 - $ 18-?, S-o
Pavement Legends ($100 min) I EA@ 40,00 - $ / CM, 00
Stop, Street Name or Other Sign / EA@ 120.00 - $ /20.00
Pavement Karkers 2Y EA@ 15.00 - $ 360. ~ 0
Pavement Key Cut LF@ 10.00 - $
- $
- $
Surface Subtotal "S" - $ 59} /971 5(..)
Adjust for size: .5.<$30,000 add 20t. "S">$lOO.OOO subtract lOt (+ or -) $ ---C)--
Street Lhht1n2
::2- EA@ 2.000,00
/~S-LF@ 10,00
I~ LF@ 2,00
;- Ea@ 200,00
ElectroUer
Conduit
Conductor, pair
Pull Box
Storm Draina2e
s~ LF@ 60,00
LF@ 70.00
I EA@ 1,600,00
EA@ 2,400,00
I EA@ 650.00
~tj Lf 30,lTU
12- or 15" RCP
18" or 21" RCP
Street Inlet
Kanhole
_ $ fODO.OU
_ $ I. ~.rO.OO
.
_ $-33(>'\.<:10
_ $~.OO
- $
_ $ -=;. j V';J. c..J ..)
- $
_ $ ,6 OD.O 0
- $
TOTAL ESTIKATE $ 7. i2d' 7. so
USE FOR BOND $ 73,,500,00
r
revised 6/88
f/con-cost-est
..
.. .
REED & GRAHAM INC.
~.aB-J94
')\"J 5:1. A u!~_,
TELEPHONE
(408) 287-1400
P. O. BOX 5940 . 690 SUNOL ST,
SAN JOSE, CALIFORNIA 95150
TO: GODLEY PAVING CO.
736 NORTHRUP ST.
SAN JOSE CA. 95126
DATE: 4/14/89
REQUESTED BY: CITY OF CAMPBELL
3/4 COURSE TYPE "B"
...
SIEVE
SIZE
COMBINE
MIX/86
.
COMBINE
MIX/87
LIMITS
------_._--------------------------------~-----------------------------
1 t:
-I.
-----------------------------------------------~---------------------
3/4"
98
97
90--100
--------------------------.-------------------------------------------
1/2"
---------------------------------------------------------------------
3/8"
75
73
60--75
---------------------------------------------------------------------
#4
51
51
45--50 X 5
---------------------------------------------------------------------
#"3
36
37
32--36 X 5
---------------------------------------------------------------------
#16
---------------------------------~-----------------------------------
#30
20
19
15--18 X 5
---------------------------------------------------------------------
#50
---------------------------------------------------------------------
#100
---------------------------------------------------------------------
#200
3
3
3--7
---------------------------------------_._----~-----------------------
----------------------------------------------.------------------~----
S.E.
52
54
45 MIN
---------------------------------------------------------------------
PLANT 8600
BIN # 1. 35%
BIN # 2. 20%
BIN"# 3. 25% BIN # 4. 20%
DUST 00% OIL AR-8000 4.4%
*NOTE 15% R.A.P. IS ADDED TO COLD FEED IN THIS MIX
~~-----------------------------------------------------------
PLANT 8700
3/4 X 1/2
20%
3/8 X 0
37%
1/2 X 1/4 '
.20%
1/4 X # 10
00%
.
SAND
8%
R.A.P.
15%
OIL: 4. 4% -A'lfl-~ ~ TO THE ROAD CONSTRUCTION INDUSTRY -
----------------------------------------------------------------
l> ~
~
1
THIS IS TO CERTIFY THAT THE MIX SUPPLIED TO YOU WILL MEET ALL
SPECIFICATION. FOR YOUR RECORDS AND INFORMATION, WE RESPECT-
FULLY SUBMIT THE ABOVE TEST REPORT OF MATERIAL THAT WE PROPOSE
TO FURNISH AT YOUR PROJECT CITY OF CAMPBELL.
UNLESS OTHERWISE NOTED, ALL TESTS WERE PERFORMED IN ACCOR-
DANCE WITH THE STATE OF CALIFORNIA TEST METHODS. PLEASE FEEL
FREE TO CALL ME FOR ANY ASSISTANCE YOU MAY REQUIRE CONCERNING
YOUR ASPHALT REQUIREMENTS.
YOURS TRULY,
(~
KEN MONLUX
PLANT MANAGER
SAN JOSE (8600)
SANTA CLARA (8700)