88-244
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fi:le-
WEST VALLEY SANITATION DISTRICT
OF SANTA CLARA COUNTY
SERVING RESIDENTS OF
CITY OF CAMPBELL
TOWN OF LOS GA TOS
CITY OF MONTE SERENO
CITY OF SARA TOGA
UNINCORPORA TED AREA
100 East Sunnyoaks Avenue
Campbell, California 95008
Telephone (408) 378-2407
r.o. I::! C f~ . ~i f:J J~,
Ii~ [; Mi II Y ~ .'!.'I'
May 17, 1991
MAY :~ u 1~31
Ted Theony
City of Campbell
70 N. First Street
Campbell, California
Public WcrksJEnqinoorin$l
95008
RE: Open jobs - Nadcon Development
Dear Mr. Theony:
As a follow-up to our conversation this morning, the only jobs
currently under construction by Nadcon are Tract 8292 (Hacienda @
Capri) and Tract 8328 (West Sunnyoaks). Tract 8292 has not yet
been balled or mandrelled by the contractor. After this is done,
the sewers will be television inspected by our crews. A final
inspection will be performed after TVing, and a punch list will
be made. The balling, mandrelling, and TVing should have been
done before paving.
The manholes in Tract 8328 are currently buried. When the
manholes are exposed, the sewer will be TV inspected by our
crews. Once again, this inspection should be made before the
pavement work is done. After paving, a final inspection will be
done, and a punch list made.
The district has also not yet accepted Tract 7972 on Redding
Road. The plumber installed 3" cleanouts rather than 4"
cleanouts. The district has offered to accept the main sewers
only and transfer maintenance responsibility of the lateral
sewers to the homeowners. The district will not accept
maintenance of the lateral sewers with 3" cleanouts.
f !W'''':' + "*
Cl~" "Llftf
Nadcon also owes the district inspection costs for Tract 8179-
Sunnyoaks Avenu~ Tract 8212-San Tomas Aquino Road, Tract 8225-
Vot Avenue, tlIld-Latimer Villas.
If you have any questions, please call me.
Very truly yours,
William A. Gissler
District Ma~er and Engineer
)~1 ~ ~.
.--- //7 -, / , 7
, /V / /?'
by: Mike Ful<<r
Junior Civil Engineer
\FORMERL Y COUNTY SANITATION DISTRICT NO.4)
T !~r~n~~~~!~~a
Transamerica Premier Insurance Company
AGIl...M"'...... ""0<:<1 ."'_. c..~luln...
3 -?JO -'C[O
TRANSAMERICA PREMIER INSURANCE COMPANY
C/o Commercial Surety Bonding Agency Q)iJC~
o Southern California
630 The City Dr.. Suite 120.
Orange, CA 92668
17141 S71-CS8A 12722)
o Northern California
1265 S. Bascom Ave., Suite 108,
San Jose. CA 95128
(408) 29B-CSBA (27221
r
SUBDIVISION STATUS INQUIRY
-,
RECIIVED
JAN 09 1991
City of Campbell
70 North First
L Campbell, CA 95008
...J
P-ublic W oral Engineering
J/"l:. /J A
BOND NUMBER
TPI 780068
TRACT NUMBER
Permit No. 88-244
<<
SUBDIVIDER
Chateau Chambord
TRACT NAME
490-496 Sunnvoaks Avenue
IMPROVEMENTS
Street Improvements
PLEASE ANSWER THE QUESTIONS BELOW AND RETURN THIS FORM.
1. Has this work been fully completed and accepted? Jtfyes 0 No
2. II accepted, on what date? f2:/2.1g.TJ
3. II not accepted, is work p~oJressln9 satislacto,rily?
If no, explain !::!.J-.4
4. Percentage completed? ---L1 J/I A
DYes
D No
REMARKS
{Jrv
fntJJN- a
~ ~. D"OrJd'
~f1 /c/c
.....
Title
(
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 Yorks
December 7, 1990
Chateau Chambord
150 E. Campbell Avenue, #101
Campbell, CA 95008
SUBJECT: ONE YEAR MAINTENANCE ACCEPTANCE
PERMIT NO. : 88-244
LOCATION: 490, 494, 496 Sunnyoaks Avenue
Gentlemen:
WIMBERLY
HELMS
We have made a one year maintenance inspection of subject public
works improvements and find that no maintenance is required.
Sincerely,
By copy of this letter, we hereby release your maintenance bond.
Gregg Eaton
Public Yorks Inspector
GE:sd
cc: Bond Company
f:88-244
LING
i 8::~.,l~?J
-.\
CITY OF CAMPBELL
PUBLIC WORKS INSPECTION REPORT
DATE: /J- / 1- /qo
PERMIT/PROJECT NO.: 68 r;J4f
TRACT NO.
ADDRESS: 190-4Q& ~hnlfaUc~
Au-e ~.
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:
/
/
REASON:
TOTAL CHARGES:$
[] ONE YEAR MAINTENANCE WITH DEFICIENCY LIST
~. ONE YEAR MAINTENANCE ACCEPTANCE
/
{//
(
[..,1 k,' 1,4,' rl' 'V iH.'1 Ie, 'iii /Iii M".1 ~.M '1 )I)~' H
_ j I UJ[' Ln" 11 U'LL.....
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
WIMBERLY
HELMS
JOCSON
KRU6ER
PENOYER
d"~' r-~
Department:
Public Works
July 25, 1990
Chateau Chambord
150 E. Campbell Avenue, #101
Campbell, CA 95008
SUBJECT: FINAL INSPECTION - DEFICIENCIES
PERMIT NO.: 88-?44
LOCATION: 490, 494, 496 SUIlllyoaks Ave.
Dear Gentlemen:
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
Encl.
Permit 88-244 - Chateau II
Deficiency List
1. Install reflective strip on guy line.
2. Replace $13,600 Faithful Performamce Bond with $3,400
One Year Maintenance Bond.
- T !~~~~~~!!~a
Transamerica Premier Insurance Company
AI.I"UlllSI141.~tr OIIIC~ 1I'\I11't:. C""lurnld
-) -
(--.J . ~ (_I L C)
TRANSAMERICA PREMIER INSURANCE COMPANY
c/o Commercial Surety Bonding Agency
o Southern California
630 The City Dr., Suite 120,
Orange, CA 92668
(714) 971-CSBA (2722)
o Northern California
1265 S. Bascom Ave.. Suite 108.
San Jose, CA 95128
1408) 298-CSBA (2722)
r
SUBDIVISION STATUS INQUIRY
-, f.?~CE~VEa
City of Campbell
70 North First
L Campbell, CA 95008
..J
{\U G 1:) 1990
~TY OF CAMPBELL
SJ",,,", ~INr, ,",1"'~'nN
BOND NUMBER
TPI 780068
TRACT NUMBER
Permit No. 88-244
Street Improvements
SUBDIVIDER
"Cha teau Chambord
"""---fFfACT NAME' .
490-496 Sunnvoaks Avenue
IMPROVEMENTS
PLEASE ANSWER THE QUESTIONS BELOW AND RETURN THIS FORM.
1. Has this work been fully completed and accepted? XYes ~
2. If accepted, on what date?
3. If not accepted, is work progressing satisfactorily?
If no, explain
4. Percentage completed? ~
DYes
DNo
REMARKS
.o-m~, , ,,/ /0/1-/
~ ~r~'-Y \
~~
PUBLIC WORKS INSPECTION REPORT , //
DAte 17~/i6- Permit or Project No. ~:yly- ...C/iifff,t<,0 ~
::e:: :ork' :~~t~~ :~2 49~n1t~~r~~
Otht:r (dt:scribt:)
(JPRELIMINARY INSPECTION WITH DEFICIENCY LIST (attAched)
)(fFINAL INSPECTION WITH DEFICIENCY LIST (attAched)
o FINAL INSPECTION - ACCEPTANCE
Signed pIAnG'? Y N (If u1gned, Council AcceptAnce.)
ChArges AgAinst deposit? y
Ovt:rtimel hrs. @ $
DAte {, reAson:
N
/hr.
-
$
BArricAde rentAl (Attach invoiCt:)? y N
DAte {, reAson: $
Other? $
$
TotAl chArges deducted from deposit I $
(CAsh Depo&it $ It:as chArges $ - Refund $
ck. req.)
[JONE YEAR MAINTENANCE WITH DEFICIENCY LIST (AttAChed)
o ONE YEAR MAINTENANCE - ACCEPTANCE
(Rel~Aae'mA1ntt:nAnce bond. Check Request if CAsh.)
Eng1nca:r
REFUNDABLE DEPOSIT
CHECK REQUEST
TO: FINANCE DIRECTOR
CITY OF CAMPBELL
Please issue check payable to:
Chateau Chambord
Address:
Line 1:
150 E. Campbell Ave., #101
(30 spaces)
(30 spaces)
(30 spaces)
State: CA Zip: 95008
(2) (10 spaces)
Line 2:
City:
Campbell
(20 spaces)
Cash Deposit Refund
(24 spaces)
Description:
Exact Amount Payable:
$1,042.00
.
Account Number:
905.4662
PURPOSE:
Release of cash deDOsit for e~cavation permit #88-244.
See receints #: 1013 dated 1/13/88 for $500,00 and
#1444 dated 11/22/88 for $542,00.
Requested by:
Date: 7/26/90
G. Eaton
Ti tle : P . W . Insoector
Approved by:
Verified by:
D.C. Nimberly
Ti tle : P . W . Director
Date:
Accounts Receivable
Date:
SPECIAL INSTRUCTIONS FOR HANDLING CHECK:
Mail as is
x
Mail in attached envelope
Return to:
(Department)
(Name)
Other:
08/24/88
TO: Cty Clerk
PUBL I C WORKS FILE NO. Y f- ;) t/-t./
Please collect & receipt
for the following monies:
ACCT.
35 -.) 96
~l~~':
~~
3372
(Cash) Depos i t
($200)
Plan Check & Inspection Fee
3521 Other Cash Deposit (specify)
3373
3373
Project
General
&
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 Ma Fil in Fee (S350)
3372 Lot Line Ad'ustment Fee/Certificate of Compl iance
3372 Vacation of Publ ic Streets and Easements
3372 Assessment Segregation or Reapportionment
First Split ($500)
Each Additional Lot ($150)
3372 Envi ronmental Assessment:'
Categorical Exemption
Ne ative Declaration
3370 Storm Drainage Area Fee per Acre Multi-Res.,
$2,060; all other, $2,250)
3395 Park Dedication In-l ieu Fee per Unit ($1,132)
3380 Public Works Special Projects
3510 Postage
TOTAL
NAME
/) /'-7 Ii . ,
L / { tl C { {l ( ( C I ~(2 )I ( f) If. l c("
/";;-Z. t, /"12 J h I)~ it.' (
ZIP ,/^:j[(,/
AMOUNT
$
:5(- , r!' C
,,5'zc. cC
$
'56? ,C'C
PHONE
Y ,;- 1-.. '2f '/ '/ ,J<.:r'
ADDRESS
/
FOR
C I TV CLERK
OoILY
RECEIPT NO.
/0/3
-,___ f!J <'
~) ,,~ { /'
~
AMOlI'lT PAID
RECE I VED BY
DATE /0 - / .?:" ~'.> 8'
July, 1987
TO: C:ty Clerk
PUBLIC WORKS FILE NO. S~-"2 Y V
Please collect & receipt
for the following monies:
ACCT.
J~-J. -6
3372
3521
3521
R-l :
(S'35)
( $2,00)
t; eII.:
($ 50)
'( $500)
(4% of FPB)
($500 min.)
(n of FPB)
($35min.)
(Cash) Depos i t
3372
Plan Check & Inspection Fee
3521 Other Cash Deposit (specify)
3373
3373 &
3372
3372
3372
3372
3372
3372
3372
3372
3370 Multi-Res.,
1395 Unit ($1,132)
3380 Public Works Special Projects
3510 Postage
TOTAL
NAME
PHONE
AMOUNT
$
51( Z. 6-G
9-12.(;(
$ (f-- 9~C.~
,
ADDRESS
ZIP
Fat
C I TV CLERK
CIN1. y
/L/f../-'-I
/~9~/
RECEIPT NO.
~ PAID
00
RECE tVED BY a nJ
DAn / /' ,~:;J- - :? Y
July, 1987
t _ ]'}I (J F C A I\/l iP' .u f II
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
Public Works
Department:
November 28, 1989
Nadcon Development
150 E. Campbell Ave., #101
Campbell, CA 95008
RE: Final Inspection and Acceptance
Permit No.: 88-244
Location: 490, 494, 496 Sunnyoaks Ave.
Maintenance Bond Amount: $3,400.00
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,
~~
Associate Civil Enginneer
CMJ : sd
cc: G. Eaton, P.W. Inspector
Suspense - 1 year
~ 3, 'Iv~. "
. --- - .-.- -.- .. . __ ..0._
PUBLIC WORKS INSPECTION REPORT
Date 11/2(/~j Permit or Project No. ,ee -244-
Address <!-C} () - 4'1 L ~NNJ04K.5. Auc.
2'ype of work. Stre.t ~ Storm Sanitary Electrical
Other (describe)
o PRELIMINARY INSPECTION WITH DEFICIENCY LIST (attached)
o FINAL INSPECTION WITH DEFICIENCY LIST (attached)
[31f.iNAL INSPECTION - ACCEPTANCE
Signed plans? y ~ (If signed, Council acceptance.)
Charge. again.t deposit? y
Overtime. hr.. . $
Dote 5.reo.on,
~
-
$
Barricade rental (attach invoice)? y
Date , reaaon.
@
$
Other?
~
$
$
$
· Refund $
~otal charge. deducted from deposit.
(eash Deposit $ lea. charge. $
DONE YEAR MAINTENANCE WITH DEFICIENCY LIST (attached)
o ONE YEAR MAINTENANCE - ACCEPTANCE
(Rel.a..'..intenance bond. Check Request if cash.)
ck. req.,
ineer 'I/; vA
t't'U/~
c~
In or
CHATEAU CHAMBORD, INC.
150 . Campbell1 AVE., Suite 1101
Campbel I, CA 95008
R E C . I V ~ i)
NOV 16 1989
Public Worb/Engineering
November 16,1989
Mr. Greg Eaton, Public Work Dept.
City of Campbell
70 North First Street
Campbell, CA 95008
RE: Project:
Tract:
Address:
Chateau Chambord
#8179
494 Sunnyoaks Ave.
To whom this may concern:
This letter is regarding the request for the final on the
above mentioned project.
If you should have any question, please call (408) 866-7788.
Since:vy, .~ ~~
~~~~C4~-~/
Ross Naderzad
President
CHATEAU CHAMBORD, INC.
T I~~n~~~~!!~a
Transamerica Premier Insurance Company
A~nhnISIl..llw~ o'ht:e l,-..,.nc C..liluHlloi
TRANSAMERICA PREMIER INSURANCE COMPANY
c/o Commercial Surety Bonding Agency
o Southern California
630 The City Dr.. Suite 120.
Orange. CA 92668
17141 971-CS8A 127221
o Northern California
1265 S. Bascom Ave., Suite 108.
San Jose. CA 95128
14081 298-CS8A 127221
r
SUBDIVISION STATUS IN.QUIRY
-,
RIC~iVci.~
SEP 05 1989
City of Campbell
70 North First
L Campbell, CA 95008
...J
;
Public Worka/Enginoerins
BOND NUMBER
TPI 780068
TRACT NUMBER
Permit No. 88-244
Street Improvements
SUBDIVIDER
Chateau Chambord
TRACT NAME
490-496 Sunnvoaks Avenue
IMPROVEMENTS
PLEASE ANSWER THE QUESTIONS BELOW AND RETURN THIS FORM.
1. Has this work been fully completed and accepted? DYes 0'N' 0
2. If accepted. on what date?
I ~
3. If not accepted. is work progressing satisfactorily? lZIY es DNo
If no, explain ,
4. Percentage completed? IS"
REMARKS
~ .. v--1o.c...K.. (;Wa-J,Lj. - &r--l-.D TO
Of\.) SIIe' ~MA;\~ IN
E::::FFE<- ~
Above information furnished by: (signature) Title
b-~ ~A-r?::;J ~63t..I'<... ~,z;CS .-:--
/- A_7l!>A:.-
DATE
o/".s;/85
Sanlo CIoro Ik>IIe!J Waler Distrid 6
{k.m1T-- ~g-2#
PERMIT
5750 ALMADEN EXPRESSWAY. SAN JOSE, CALIFORNIA 95118 . (4081265-2600
Facility Page Percolation System Date Issued June 1, 1989 Permit No. 89922
Permittee
Pacific Gas & Electric Company
10900 North Blaney Avenue
Cupertino, CA 95014
Attention: Mr. Glen Ritchie
Telephone (408) 725-2042 File Permits , Water Utilities
Page Perc. System
Sly of W. Sunnyoaks Avenue;
Ely of Kenneth Avenue
Re: Est. 41G17164
Tract 8179
89A203A, 89P203A
Purpose of Permit
a Encroachment
ia Construction
o Temporary
Installation of gas, electrical, cable TV and telephone utility
conduits within and adjacent to District easement.
Construction Expiration Date June I, 1990
Encroachment Expiration Date
PERMITTEE MUST NOTIFY AND FURNISH SCHEDULE OF WORK TO:
IDDISTRICT'S CONSTRUCTION DIVISION, TELEPHONE 265,2600 EXT 324
o
AT LEAST TWO NORMAL WORKING DAYS BEFORE STARTING ANY WORK UNDER THIS PERMIT. FAILURE
TO NOTIFY IS CAUSE FOR REVOCATION OF PERMIT AND REMOVAL OF WORK. EXERCISE OF THIS PERMIT SHALL
INDICATE ACCEPTANCE OF AND AGREEMENT TO COMPLY WITH ALL PROVISIONS INCLUDED HEREIN. THIS PERMIT IS
SUBJECT TO THE PROVISIONS LISTED ON THE REVERSE SIDE HEREOF EXCEPT AS EXPRESSLY MODIFIED IN THE
ADDITIONAL PROVISIONS LISTED BELOW. VIOLATION OF ANY PROVISION SHALL BE CAUSE FOR IMMEDIATE
REVOCATION OF PERMIT.
1. PERM ITTEE MUST MAl NT AIN A COPY OF THIS PERMIT AND APPROVED PLANS ON JOB SITE FOR DURATION OF
CONSTRUCTION PERIOD.
2. All work shall be constructed in accordance with approved plans and to the satisfaction of the District's Inspector. The
work area must be restored to the satisfaction of the District's Inspector.
3. The quality of water passing through or below the site shall be maintained at all times and the addition of silt or other
deleterious material to the water will not be permitted.
4. All backfill within District right of way shall be compacted to at least 90% relative compaction in accordance with
California Test Method 216 or 231 or ASTM designations 01556 or 02922. '
5. Obstructions to the existing waterway between October 15 and April15 will not be allowed except by special permit to
be applied for at least 15 days in advance and requiring District approval of detailed plans and proviSions for
emergency flows.
6. The electrical crossing of the District 24-inch waterline adjacent to Sunnyoaks Avenue
is to be placed with a minimum 24 inches of cover.
7. The gas, TV and telephone lines located approximately 70 feet from W. Sunnyoaks will
be installed below our 24-inch pipe. The electrical line at this location will cross
over the pipe.
8. All utility line crossings of our pipe shall have a minimum of 12 inches clearance
from the 24-inch pipe.
cc: Ross Naderzad
Nadcon Development Company
150 East Campbell Avenue, Suite 101
Campbell, CA 95008
Mr. Ed Murphy
Building Inspector
City of Campbell
70 North First Street
Campbell, CA 95008
~~ Don Wimberly
Department of Public Works
City of Campbell
Approval:
ORiGiNAL SiG;"~ED BY
FC60 (71.75)
DIVISION ENGINEER
DESIGN COORDINATION DIVISION
\,
STANDARD
. WORKERS' COMPENSATION AND
EMPLOYERS' LIABILITY POLICY
Declarations
I
,
.. EM 1.
r-
Name of
Insured
Add ress
L
Producer
Name and
Address
NAOCON DEVELOPMENT, INC.
153 E. CAMPBELL AVENUE, #101
CAMPBELL, CA 95008
FRANK R. OLMO & SON
P.O. BOX 58152
SANTA CLARA, CA 95052-8152
P.O. Box 40X2
Woodland Hills, CA 91365-40R2
5900 Canoga Avenue, Suite 200
Woodland Hills, C A 91367
~:::SERIO/)
.~-~
/lTIO\'\~
INSURANCE ('()~W\ "y
CnnUUCf\ IlII '~Id.~ \1"" 1,,/1'1<
POLICY I
NUMBER:
02-W2G-21152-B ___.-I
RENEWAL OF 02-W2G-21152-A__
[~~~t~~;~~t~~j0~ ,.. ;.L:- ~~ ~'~j
o Individual
[Xl Corporation
o Parfner'lihip
o
Locations: All usual workplaces of the insured at or from which operations covered by this policy are conducted are located at the above address unle's
otherwise stated herein:
ITEM 2. Policy Period: From
07-01-88
To
07-01-89
12:01 A.M., standard time at thc addrcss
of the insurcd as stated hcrein.
ITEM 3. Coverage A of this policy applies to the workers' compensation law and any occupationat disease law of each of the following states:
California
-.-
ITEM 4. Classification of Operations
Entries in this item, except as specifically provided elsewhere in this policy.
do not modify any of the other provisions of this policy.
Clerical Office Employees - N.O.C.
Salesmen, Collectors ur Messengers-- Outside
Governing Class:
EFFECTIVE 07-01-88 TO 07-30-88
CARPENTRY-CONSTRucrION OR REMODELING OF DETACHED
PRIVATE RESIDENCE FOR OCCUPANCY BY ONE OR TWO
FAMILIES AND THE CONSTRUCTION OF PRIVATE GARAGES
IN CONNECTION WITH SUCH STRUCTURES-INCLUDING
INSTALLATION OF INTERIOR TRIM, BUILDERS FINISH AND
CABINET WORK-EMPLOYEES WHOSE REGULAR HOURLY WAGE
DOES NOT EQUAL OR EXCEED $17.33 PER HOUR.
Normal Anniversary Date
Experience Modification
07-30-88
Minimum Premium $ 1,030
If indicated herein, interim adjustments D S . A II 0 Q t I
of premium shall be made: em I' nnua Y lXJ uar er y
Numbers of endorsements forming a part of this policy /In its effective date:
~-U/W-102, W2-U/W-104, W2-U/W-106, ~-U/W-110,
W2-U/W-114, W:-U/W-118, W2-U/W-119, W2-U/W-142
ITEM 5. Limit of Liability for Coverage B - Employers' Liability $ 1,000,000
o Monthly
BURLINGAME, CALIFORNIA
37-28-88an
WC-U/W-l01 1/86
Countersigned By
WHITE.INSURED BLUE.AGENT COpy GREENUiWRITING CANARY CLAIMS PINK.BUREAU GOLD ACCT'G WHITE.HOME OFF ICE
(Authorilcd ARent)
Code
--
Tot,lls
Rates
Premium Basis
Esfimated T ot..11
RefnunerUion
Per $100 of
Remuner.uion
E\tinuted
PremiuOl'\,
5645(1)
VARIES
18.82
%
Total Estimated Policy Premium $ 3,000
Deposit Premium $ 1,000
C. loG.A. 1%
. subject to all the terms of this policy having referencc thcr rt.,.
,~
I KU\..I\ 1I\f:>UKI\I\f\...l: l:^\...nl-\l\f\.71:
INIERIM CERTIFICAIE AS IU IVIDtNCE UI INSURANCE
IIII~ IS NOT AN INSURANCE POLICY. II liS IS ONl Y A VERlrlC ^ rlON or IN~\ Ip MIr r "n(1l~ tlO I IN ANY WA Y AMIND. I X I END OR ALlER Itll
COVERAGE PROVIDED BY TIlE POliCIES IISlED RHOW.
Nam"d
Inlur..d
Add,...
KIYOUMAR NADERZAD, SAIED SARAYDARrOUR, KOOROS NADERa~D
150 E. CAMPBELL AVENUE
CAMPBELL, CA. 95008 96-90-39A
-558.L3522
Pnlir:y" n"n 11;11,
A9""I
pnlic:y" Aulo ll:lh
rolicy' CArinO
This is to certify ,hot policies for the obove nomed insured or" in force <1S follows:
rolir:y" Work ('(HllP
This Interim Certificate As To Evidenc!) of InSlIl;lncc sl1;l1l pvpirf' sixty dClYS IrolTl___l;?:.9L__A__ M"
11-11 ,19 88, unless concellp<1 rrior to such dale by written notice to the named inslll('d.
ug .... Please issue CI Permanent Certificole
COVERAGE COMBINED LIMITS OF LIABIlITY
AUTO
LIABILITY
Nor
COVERED
[] [-J Owned
[J [J Hired
[] [] NE on IOwn,edN _ I
[J [ ] rnp oyer s on Owners lip
____________Cont~~Slent Lial~il_ifL __ _
Single Limit Liability fo, Coveroges checked IXI "bove
COVERED
Roddy Injury
P"'rpr Iy [)nrllo(j('
$ ____ ,000 each person
$ _____ ,000 each occurrencp
$ _____ ,000 each occurrencp
$
,000 eoch occurrence
GENERAL LIABILITY
. M&C - OL T
J Owners & Contructors
[] ) Contrmlual.
~ Elevalors
Prod,)( Is and / or
Cornpl~ted OperoliclI"
_ m____"_ ,,_
Single limit liabilily lor Covernqps cI,eckrd IXI nho.,r
[1
[]
I'r "prr ty Un Il\lIqe
$
$
$
$
$
,000 each person. .
,000 each occurrpnce
000 ontluol nQ(lr0!I,tlf"
prnduf ,... . . .
,000 each occurr el1(e
000 Ollflunl oqq''''''l 11....
prOdlH ,";...
Bodily Injury
Lxl
$ __1.,000_____
$ _J..JlD~-
,000 eoch occurr r' H,P
onnunloqqrr>'l"I,.
,000 prpdl}cto; .. .
[]
[]
CARGO
$
$
,000 each vehicle
,000 each occurrence
[J
WORKERS'
COMPENSATION
· Includes Goods or Products Warranty, Wrillel1 I.PClse of Prernises, fospment Aqrpernent, Municipal OrdirH111(('
Agreement, Sidetrock Agreement, Elewllor or !'scnln!"r Maintenonce Agreement only, unless accompclIlicd h)
specific endorsement providing add~~~r~~<;'0!1~~<::.lua_I_S--:'2~_~~~19? _________________________
r-J n." "h.d ['J n." "c''''''
L~ h("lo.N . /I,<t'H'd
YEAR, MAKE, TYPE OF BODY, lOAD CAPACITY
[J
Statutory
OWt'IFD (
Auro r
~~OBILES, )
(OVERED ~
IDENTlFICA TlON NUMBER
PROJECT
490 W. SUNNYOAKS
CAMPBELL CA. 95008
lAST 1
DIGlI';
SHOWN
,000 retained limit
each occurrence
aggregate
Umbrello Liobility
$
$
$
POliCY NUMflFR
If this Interim Certificate As To Evidence Of Insuronce is 10 he cancelled prior to Ihe expirotion dale, we shall
provide 30
days odvance notice in writin9 to wlwrn this certificate is issued.
IT IS HEREBY AGREED THAT THE CITY OF CAMPBELL AND ITS RESPECTIVE OFFICERS,
Cp',Iificole issu..d 10 AGENTS AND EMPLOYEES ARE NN1ED AS ADDITIONAL INSURED FROM AND AGAINST ANY
CLAIMS, LOSS LIABILITY COST or EXPENSE ARISING OUT OF OR IN ANY WAY CONNECTED
WITH THE CONSTRUCTION OF THE PROJECT. T.IIS COVERAGE SHALL BE PRIMARY AND ANY
COVERAGE CARRIED BY ADDITIONAL INSURED SHALL BE EXCESS1f1.ABILITY ONLY
C ITV OF CM~PBELL . ,.- . j)(
70 N. FIRST STREET C''''',I'''';q""d _lJlilllJ f c1iLI 1l'~JJli~
. . NoI Appli(~~P.~~~ , CA. 95008 ~"'hn'''.d Pnl'"".p,,',,IIve
... In Texas the oggreq,.,'p nlc;o npplipo:; '0 ownprs (1r\d (nn1rnclor<; prnl('l( livf"', fClnlro(!lJl,1 (III/L-or (ornplf'len orprnlinnc;
Nome
And
Addr.."
~@1c/
llf)O~1..,~R71'?f'1W!?OOC!1?nornJN'ff1"JtI~^ (~)M
,r Transamenca
111111 Insurance Services
Transamerica Premier Insurance Company
Administrative office: Irvine. California
TRANSAMERICA PREMIER INSURANCE COMPANY
Bond #TPI 780068
ENCROACHMENT PERMIT BOND
(Faithful Performance)
WHEREAS, that we Chateau Chambord ,
as Principal and the TRANSAMERICA PREMIER INSURANCE COMPANY, a Corporation
organized and existing under the laws of the State of California, and
authorized to transact a general surety business in the State of California
as Surety, are held and firmly bound unto City of Campbell
as Obligee, in the just and full sum of Thirteen Thousand Six Hundred---
($13,600.00 ), for the payment whereof well and truly to be made, the
said Principal and Surety bind themselves, their heirs, executors,
administrators, successors and assigns, jointly and severally. firmly by
these presents.
THE condition of this obligation is such that if the said Principal shall
comply with the requirements of the City of Camobell
and shall indemnify and
save harmless the above Obligee from any damage brought for or on account
of any damage to real or personal property, occasioned by or arising out
of any failure of the Principal to comply with any of his or its obligations
under any such permit, and shall properly safeguard said work thereon, then
this obligation to be void; otherwise, to be in full force and effect.
This bond is effective from the date hereof and shall cover any act or
omission of the Principal. Unless otherwise stated herein, this bond may
be cancelled upon thirty (30) days written notice received by the
rity nf r~mrhP~l
from the Surety, provi ed the above bounden Principal has not commenced
performance of the work prior to said 30 days.
IN WITNESS WHEREOF, we have hereby set our hand and seals this 8
day of November , 1988.
, rr Transamenoa
I Insurance Services
Transamerica Premierlnsurance Company
Administrative Office Irvine, CalifornIa
N~i 2848
GPA n__nn~_~~___~
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 ~_____ __~____n
CHARLES GRISWOLD
~fn San Jose -- d S f- r~' 'f~-----;-------:----
o _______ an tate o___.~l orn]~__n___ 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
~n_ COf.lTRACT-BONDSTS.B.A. Guarantee Agreement - MAXIMUM PENALTY T5(f(r:Q00-:-OQ~--==~~~-_~=-_~n
OTHER CONTRACT BONDS - MAXIMUM PENALTY 100,000.00
n_-~~__t\ICQtHE1CBON~~-=-MAX)MUM PENALTY $25,000.00
"THIS POWER OF ATTORNEY SHALL TERMINATE AND BE-----------------.---- ---- ---------
-- ---- --- - ----- - - - ------------- -----
OF NO FURTHER EFFECT AFTER DECEMBER 31, 1989"_______~~__~n~_n___
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 ___ Pre s i den t____~
and its corporate seal to be hereto affixed thiL 16th day of
On this__ 16th
CALtFORl\\t.
day of
Joan M. l~ynn
Jack M. Trapp
executed the within instrument as Pres i dent
acknowl~~ 1QaI; tQa.~ar~~~ it.
ij ~""~. 6-I=F!CIALSEAL--I~
~I ,{-./'" \' i"~~':""'" lr, r," J (' ~ '," .,.':\! N .'
! ;~:j:;;,-",.".;I,.:',,;~,y; J,--j~l' I'h. \,,\. ~ l"li.
J.: 1-,.",.".. 'c' W'H-'" ~,.,..,.. '.." .".-."", ,f..
Jl {",'~~-'~f :,<',"_/j .' ~~~: ~~" ;, I :,:~.(~"'~' ';.:r~~"j,:~ ~~', i\ :,\,;;' I~
i,1 ~"11,,:_,<}..\.~/ f ru. 1 .,1.. .... ), , ;\-_ 11\j t1
~' ".~;:'.::-. or,l',i"'3L c,~rJ.;TY !iI-
M.'(-SS~\4~0Slg!,g~i::.i~~i (:Chl7,,_15'11 It
,. ~. .~"'l .,,"' ......... ~-v-r''''''''-''
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.
} ss
~_ October _, A.D., 19
State of California
County of Orange
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
('
-:J. A~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
8
day of ___Novem~r______u_~____
19__~_88 __..
THIS POWER OF ATTORNEY EFFECTIVE ONLY IF
ATTACHED TO BOND NO._~U80068
Ou/J~
Secretary
30024A
10-85
ENCROACHMENT PERMIT ISSUANCE CHECK LIST
City of Campbell
Department of Public Works
/ Applicant section complete
V Applicant signature and date
Encroachment Permit No.
Eo<
H
L'Ei1
Ztil
HP<
~~
.....0
~~
OZ
~O
H
08
~16 .c
~_i_______~__~~~:_::~:_~~_~~:~~~~~_~~~_:~~~~~:~___________________
~ Permit Application fee $50.00 ($35.00 for R-I Homeowner),
paid. Receipt number
v'
Plan check deposit, $500.00 (waived for R-I Homeowner),
paid. Receipt number
~ Bond for faithful performance, 100% of City Engineer's
estimate, (waived for R-I Homeowner), supplied or pai~.
Amount $ (~fboO Form I.D. # 7;>1 7E2()t)~8
.
~. Cash Deposit: 4% of FP bond, $500 min. ($200 for R-l
Homeowner), paid.
Amount $ Receipt No.
~
Plan Check & Inspection fee of 7% of FP bond, $35.00 min.,
(waived for R-I Homeowner) paid.
Amount $ Receipt No.
~. Worker's compensation information received for Applicant
(see Information Sheet for Encroachment Permits)
All other Public Works requirements listed in the
Conditions of Approval of the development.
8
tilH
u~
~til
::>P<
tJ)
tJ)tJ)
H~
~o
O~
~
U
OH
~Ci5
H::>
::>P<
01
t1~
/Worker1s comp and Contractor's Information received for
Contractor (see Information Sheet for Encroachment Permits)
~ Certificate of Insurance with Additional Insured's
Endorsment received from Contractor (see General Summary of
Insurance Requirements for Encroachment Permits)
vi Three sets of off-site plans, stamped APPROVED (Tract or
Development and Public Works Permit number and property
address on plans)
..,/
Permit signed for City Engineer
WHEN ALL OF THE ABOVE ITEMS ARE COMPLETE, PERMIT MAY BE ISSUED
Issuer: Initial and date and file with permit
UPON ISSUANCE, INITIATE CHECK REQUEST FOR PLAN CHECK DEPOSIT REFUND
8/88
permchklst
CITY OF CAMPBELL, CITY ENGINEER'S CONSTRUCTION COST ESTIMATE
Address t/?q q"1~ q'fj6 5C/,.u~:/6AK-.5 rl? $/179
Permit No. f j - 2J.!C!
bY~date 1~/3(/-?J
Surface Construction
Clearing & Grubbing
Sawcut Concrete
Concrete Removal
Curb & Gutter Removal
Inlot Drain with Pipe
Curb & Gutter
Sidewalk
Driveway Approach
Handicap Rarp
Extruded Curb
Barricade
Street Excavation
AC Pavement
Adjust Manhole to Grade
Adjust Handhole to Grade
Monument Box w!Konument
Street Tree (15-gallon)
Pavement Striping ($100 min)
Pavement Legenda ($100 min)
Stop, Street Name or Other Sign
Pavement Markers
Pavement Key Cut
Lump Sum Estimate
18 LF@ $ 4.00
~S"2 SF @ 3.00
(
/3& LF@ 5.00
/ EA@ 600.00
/3() LF@ 14.00
7rZ SF @ 4.00
,27"'0 SF @ 5.50
EA@ 400.00
LF@ S.50
LF@ 50.00
SF)x($O.lO)x(~")
SF)x($0.30)x(-==-')
EA@ 375.00
EA@ 275.00
EA@ 600.00
If EA@ 300.00
LF@ 0.65
EA@ 40.00
EA@ 120.00
EA@ 15.00
LF@ 10.00
Surface Subtotal
OS.
Street Lisrhtinlf
Adjust for size: "5"<$30,000 add 20\, "S.>$lOO,OOO subtract 10\ (+ or -) $
Electrolier
Conduit
Conductor, pair
Pull Box
Storm Draina2e
12- or 15" RCP
IS" or 21" RCP
Street Inlet
Manhole
Break & Enter Hanhole
EA @ 2,000.00
LF@
LF@
10.00
2.00
Ea @
200.00
-..--' LF@ 60.00
LF@ 70.00
-- EA@ 1,600.00
EA@ 2,400.00
EA@ 650.00
- $
- $
- $
- $
- $
- $
- $
- $
$
$
- $
- $
- $
- $
- $
- $
- $
- $
- $
- $
- $
- $
- $
- $
- $
/aoa, (TO
71,.0 I)
2..~~.oo
,
(PFJo.c.")
(P O()..OD
II q() 'I. w
.
J., Cf b 'I. ,jO
r
-
, 200.0'1)
I
I', ;%0. ;;'D
2,1... (Z.,O-V
,
- $
- $
- $
- $
- $
- $
- $
- $
- $
- $
- $
TOTAL ESTIMATE
$
/3 5~G.o-o
.
$ ,:s ;;Odl ~c)
1
revhed 6/88
USE FOR BOND
j) -if" "P S ; r- (t{;'\ 6't.p(/ eJ'V
F ~ (7t{J C/J' 2. eye)
f/con-cost-est