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ENC2013-00187~j ~ Print Form cQ CITY OF CAMPBELL R-1 ENCROACHMENT PERMIT Permit No. ~.~~~~'/ DEPT.OF PUBLIC WORKS (Non-engineered work within the public right-of-way) X-Ref File 70 North First Street ($10,000.00 aximum value of work) Application Date ~ z ~ Campbell, CA 95008 / ~ ~ ~J Applicati Datep~ration ;1' Zi ( Ph. (408) 866-2150 ISSUED: t~. Fx. (408) 376-0958 Permit Expiration Date: APN .~-`'~~ (f1f? ~' APPLICATION -Application is hereby made for a Public Works Permit in accord nce with Campbell Municipal Code, Section 11.04. (Application expires in 6 months if the permit is not issued.) A. Work Address: I'~~S -~,-~ B. Nature of Work: ~' ~ ~ ~ ~~,! ~~ (~'~~ ~~,~,~ ~w ~ ~iP-~.~AZ~~ C.~ ~',1,.~~i C. Attach three (3) copies of a d wings owing the location, extent and dimensions of the work. The drawing shall show the rel ion of the proposed work to existing improvements. When approved by the City Engineer, said drawing become a part of this permit. D. All work shall conform to the City of Campbell Standard Specifications and Details for Public Works Construction; the General Permit Conditions listed on the reverse side; and the Special Provisions for this permit, listed below. Failure to abide by these conditions and provisions may result in job shutdown and/or forfeiture of Faithful Performance securities. NAME OF APPLICANT: ~(,~:n~ __ ~~ ~ ~ 'Telephone: ~Z~/a Address: ~ ~ tD J . _ _ ` ~ _ Cf~J~ __ _ _ _ _ E-Mail Address: (r 1 ~ \T~ //'-'+ ^ ~~--AA r/T~ _ ~ _~~~~lGi~~C. • ~i~ ~ _ 4.~ L~ f% L / The Applicant hereby confirms that this work is being done by the property owner/applicant at their own residence. The Applicant hereby agrees by affixing their signature to this permit to hold the City of Campbell, City of Campbell Redevelopment Agency, its officers, agents, and employees free, safe and harmless from any claim or demand for damages resulting from the work covered by this permit. The Applicant hereby acknowledges that they have read and understand both the front and back of this permit, and that they will inform their contractor(s) of the inf~tion. ? ACCEPTED: (Sign) Date NOTES: All work shall conform with the attached approved plans and all applicable Campbell Standard Details and Conditions and applicable insurance requirements. The Contractor must have this permit and approved plans and must arrange to meet with the Public Works Inspector at the site at least two days before starting work. Notice must be given to Public Works at least 24 hours before restarting any work. Per Section 4215 of the Government Code this permit is not valid for excavations until Underground Service Alert (USA) has been notified and the inquiry identification number (Ticket No.) has been entered hereon. USA Phone: 1-800-227-2600. Ticket No.: Applicant is advised that upon issuance of this permit, property owner, or property owner's successors, shall be responsible for any and all damages arising out of the design, installation or condition of private improvements in the public right-of-way. SPECIAL PROVISIONS 1. Prior to any work, the property owner shall execute an Agreement for Private Improvements in the Public Right-of-Way, which shall be . _ ~ ~ J2. 3. SECURITY FOR FAITHFUL PERFORMANCE R-1 PERMIT FEE APPROVED FOR ISSUANCE: STANDARD (100%Of Engr's Est.) for City Permit Expires 6 Months after Date of Issuance. WEAKENED PLANE JOINT- OR CUT JOINT 1 /8" WIDE, 2"; DEEP i ~) ~1~~ ~~ 10._~,.. VEAKENEu 'LANE JOINT CUT JOINT 1 /8' WIDE, 2" DEEP r~ ~~~' ~'~~ ~- ~~- ~-- + 10%`MAX SLOPE _ ~ / 4" PER FT. CONFORM 1 ,- ~ ~d o - 0 c 0 i ~ c ~ e., o - ~: ~ o e.. ~ .. e. Q. ,. -6% MAX $ e. e. R o ~ 6„ o o.a. ,~ 6" CLASS A ~'ONCRE?E. TYP. - ~ d ~ .: e 6" CLASS 2 .AGGREGATE BASE, TYP --'~ DOWEL SECTION A-A NOTES 1. WHEN THE DRIVEWAY IS NOT POURED AT THE SAME TIME AS THE CURB AND GUTTER, 12" OF N0. 4 REBAR AT 4 INTERVALS SHALL BE INSTALLED AS SHOWN (REBARS TO BE BENT DOWN AND COVERED UNTIL USED). 2. SCORE MARKS SHALL NOT EXCEED 4'-0" O.C., AND USE MECHANICAL SEPARATOR AT EVERY OTHER SCORE MARK. 3. DRIVEWAY APPROACHES (EXCEPT SINGLE FAMILY) SHALL HAVE A 6"X6"X10/10 WELDED WIRE FABRIC 3" ABOVE BOTTOM OF CONCRETE. 4. DOWEL ALL NEW CONCRETE IMPROVEMENTS TO EXISTING CONCRETE IMPROVEMENTS. SRANSITIONCTO MEET HERE EXISTINGDESIDEWALKDASADEDTERMNED BY THEI CITY IDNGANEER HE NEW SIDE'NALK SHALL T - BY CITY OF CAMPBELL REV. DATE F CA,~ ° '°~ PUBLIC ~YORKS DEPARTMENT ~ .~ ~, ~. ~ ;~°~eo ~° r DRAYFN HY: DATE 02/04 - .~..eo~~..~. • ~ "O'Qd°' • • CHECKED HY: DATE ~ ,;~ ~~ CRCH AR9 cl APPROVED BY: MICELLE 4UINNEY CITY ENGINEER residential Driveway Detail (Attached Sidewalk ) J:/Drawings/Std_Details/D 15 SCALE: N.T.S. DETAIL N 01. ~.-1~ w~~~ ~~~ Effective July 1, 2013 PUBLIC WORKS FILE NO. I~Q+'LIi:ATE RECEII:°T monies: PROPERTY ADDRESS ~iECi1Ti RY: s'ASkIE~t Q1ii;:iC,'2~tt;25w ~~t NT •AY4~:. hA(?r, $IlfrFkll`" Ma'or?$10,000 $377.00 fOLAY'5 I?ATE: iF ~I~Tt=R CtAT~: iQ; Qwii3 ,ooo 3Q,'t#~~%I3 TIr~: ? i l~ $215.00 N/C r`~ ~ : ~ -wo Year Period $209.00 iESCk'IF N/C TIQ~i "~'O~T )e osit Required) $500.00/tree 'EF I~Ei/QSIT - 1G1 ~:{?1C~.Q peer's Estimate $500.00 min •tJST I~t: 1155 6;II+t~ELEY Fii? I`s-18; no deposit required _ ---------------- v Ti TAL $265.00 ! I~tiE: ~°~QQ.Ci:) $795.00 ;re $1,060.00 E~iIfERE}:i: ~~~QL•, OJ $1,590.00 NAivfE: y~, t;Q ~ rit numeric sizing $153.00 wmeric sizing Sq. Ft to 1 Acre $663.00 x more $867.00 Utilit ) ~ 14% of Engineer's Estimate ~~u, _ ___ _ --- -- Actual cost +20% Admin Overhead (Min $35,000 Deposit) 2203 Emergenc Cash De osit 4% of En r. Est.* ($500 min/$10,000 Max) 2203 Faithful Performance Securit (FPS) 100% of ENGR. EST.* 2203 Labor and Materials Securit 100% of ENGR. EST.* 4721 Storm Drainage Area Fee Per Acre R-1 $2 120.00 (Multi-Res $2 385.00) All Other $2,650.00 4722 Parcel Map (4 Lots or Less $3,775.00 + $82/lot 4722 Final Tract Map (5 or More Lots) $4,590.00 + $112/lot 2203 Monumentation Securit 100% of ENGR. EST. 4920 Parkland Dedication Fee 75%/25% Due U on Cert. of Occu anc te of Com Rance) rtifi l C t Ad~ t Ll 00 $1 785 4722 ca e udes men (Inc US LOt ne eets & Easements St bli f P V i , . 00 $2 386 4722 4722 r c on o u acat Certificate of Com liance , . $1,764.00 4722 Certificate of Correction $530.00 4722 A eal Filin Fee $200.00 4722 Nota Fee (per signature) $10.00 4722 Assessment Segregation or Reapportionment First Split $846.00 Each Additional Lot $265.00 511.7424 Postage 'MI ELLA U Other (Please S ecify) *Engineer's Estimate shall be as approved by the City Engineer and shall include all items of work. **Actual Cost Plus 20% Overhead (Non-Interest bearing deposit) ~ TOTAL $ NAME OF APPLICANT ~~ ~~~ NAME OF PAYOR PHONE ADDRESS ~ rv ~ ~~ ~ 'i ~- ~-.~ ZIP J FOR CITY CLERK ONLY RECEIVE Y "` ~' '~ ( ^'~~~'Z~Q - Date 6 Receipt # !~ /L> ~'~ ` '~ ~~ Date/ tlitials4' ~t~a1=..~~.,. t,.. OF C9,yA ~~• dr U i-• y ~~ ~~kCHAR0 CITY of CAMPBELL Public Works Department November 12, 2014 Mark Giuffrida 1165 Ridgeley Dr. Campbell, CA 95008 SUBJECT: PERMIT NO. ENC 2013-00187 1165 Ridgeley Dr., Campbell, CA ONE YEAR MAINTENNACE INSPECTION AND ACCEPTANCE Dear Mark: The City of Campbell has made the final one year maintenance inspection of the subject Public Works improvements and finds that no remedial work is required. Your warranty requirements and any surety, therefore, are hereby released. Sincerely, Syed Wahidi Public Works Inspector Cc: Permit #ENC 2013-00187 70 North First Street • Campbell, California 95008-1436 • TEL 408.866.2150 • Fax 408.376.0958 • TDD 408.866.2790 CITY OF CAMPBELL VENDOR No. 10012438 CHECx No. 244194 Account Purchase Order Invoice Number Amount. Descri tion 101 2203 CR110613 500.00 SECURITY DEPOSIT REFU 10012438 MARL GIUFFRIDA O~ ~CA'ttp CITY OF CAMPBELL wELis FARCO eANx, N.A. 11 24 CHECK DATE CHECK NO. ~• ~ 420 MONTGOMERY STREET ~ 1210 11 / 18 / 13 2 4 4194 F. t~ 70 NORTH FIRST STREET .fir SAN FRANCISCO, CA 94104 " CAMPBELL, CALIFORNIA 95008 'o c AMOUNT ~ *******500.00* ~. '- .: ~' ~~ ' o~+~~mnp •~ VOID AFTER 90 DAYS ~' c~ n: ~' PAY THE SUM OF FIVE HUNDRED DOLLARS & ZERO CENTS m' r e To Txs MARL GIUFFRIDA L"Y '~~t~--~- OF ... ... ~/ ' ounsu 1165 RIDGELEY DR /~j~,,.~y~ CAMPBELL CA 95008 II'244~94n^ ~:~21000248~: 4L2L8554L5i1' CITY OF CAMPBELL 70 NORTH FIRST STREET CAMPBELL, CALIFORNIA 95008 c~ MARC GIUFFRIDA 1165 RIDGELEY DR CAMPBELL CA 95008 ~~p•CA~j ~~ ~~~ CITY of CAMPBELL Public Works Department November 4, 2013 Marc Giuffrida 1165 Ridgeley Dr. Campbell, CA 95008 SUBJECT: PERMIT NO. ENC 2013-00187 1165 Ridgeley Dr. Campbell, CA FINAL INSPECTION AND ACCEPTANCE Dear Marc: The City of Campbell has made a final inspection of subject Public Works improvements and finds the work to be acceptable and in conformance with City standards. Accordingly, the City Engineer accepts the improvements. The one year maintenance period stated in the pernit begins as of the date of this acceptance letter. The pernittee is responsible for the repair and/or replacement of any defective work or failures that occur within one year. The City will inspect the improvements within one year and notify you, in writing, whether or not any repairs are required. Your Faithful Security Deposit in the amount of $500.00, plus any interest due, is now being processed and will be sent to you under separate cover. If you have any questions, please call me at (408) 866-2165. Sincerely, ~_ Syed Wahidi Public works Inspector Cc: Inspector file Permit #ENC 2013-00187 70 i`dorzh Hest Srreet Campbell, California 95008-7423 TEL 408.866.2150 aAx 408.376.0958 Tw 408.866.2790 OF CA.tf ~ ~ r U r 0 0 ~, y y~ G ~ ~kCHARO Transmittal To Marc Giuffrida JoAnna Thomason Oftice Assistant City of Campbell Department of Public Works 70 North First Street Campbell, CA 95008 Phone: (408) 866-2701 Fax: (408)376-0958 E-Mail: Joannat@cityofcampbell.com Date: November 18, 2013 Re: Deposit Return -Permit #2013-00187, 1165 Ridgeley Dr.., Campbell CA ^ Urgent ^ For Review ^ Please Comment ^ Please Reply ^ For Information & Use We are returning your deposit in the amount of $500.00 for the Permit referenced above. Thank you cc: Project File No. 2009-00102 J:\JoAnnaT\Deposit refunds\Transmittals\Ridgeley1165.Giuffrida.DOC (Rev. 03/08) •~\l~ ~ ~~ ~ ~ G e.~~ y .-~f l A Ac=~'-~v CEi~TIF1GATE aF LIABILITY INSURANCE DATG (MM~DDh'YYY') 9/4/2013 THIS CERTIFICATE IS IBBUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE pOE5 NOT AFFIRMATtVEI„Y OR NERATIVElY AMENp, ExTENp OR ALT1;R THE COVERAQE AFFOR4EI? pY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTWORIZED REPRESENTATIVE pR PRQDUCER, AND THE CERTIFICATE HOLDER. IMPpRTANT: tf the CArtiHCate holder i6 8n ADDITIONAL INSURED, the pellcy(ies) must twa endorsed- H $UBROGATIpN IS WAIVED, subJect to the terms and condltlons of the policy, certain pollclss may roqulre an endorsement. A statement on ihls csrtiflcals does not confer rights to the certificate hbld9r in lieu of such endorsement(s). PRODUCER NAME. _ MICHAEL DUNNE INSURANCH AGENCY _ uONE x.408-448-0136 EvcNo408-448-0171 2068 LYNCOLN AVE ADDRESS:z"R]UNNgZNS[IRANCEf~ApI.~. Cl?M SALT JOSS, CA 95125 ~Rwaea(al A~rbadlNi eoveleAbe wAlcr 2 2 92 0 8 INSURER A :UNITED SPECIALTY INSURANCE C INS~IRE^ ~ DBA ; AK CONSTRUCTION ENTERPRISE I I IN8UftER B : P'AR~RS xNFURANC$ _ ___ AN17Y ]KVJITOSRT wsuReR c: STATEFUND ATOR]lCER9 COMP PQ $QX 2Q43 INSURER D; MORGAN HILL, CA 95038 _ INSURER E : ---____- - --.-__-- ~ _~ INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN I$$UED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REhUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH ftESPEC7 TO WM1CH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFpROEO BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TWE TERMS, I, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SWOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ~ ___ `~iriaR - I LTR TYPE OF INSURANCE POLICY NUMBER IoMfDDM/YY MAN D Y LIMITS x, COMMERCIAL GCMCRAL LIAa1LITY EACH OCCURRENCE S 1 O O O O O O AIMS.MADE ~ OCCUR GI PREMISES Ea ocounence S SO, OOO _ , MED EXP (Any one person) $_ 5 O O O .q ~ CaD00001366 07/23/13 07/23/14 PERSONALaADVINJVaY s 1r 000, 000_ _ _ GENT AGGREGATE LIM17 APPLIES PER' A GENERAL AGGREGATE S 2 • OOO. OOO X . POLICY ~ PRO- ~` LOC JEC7 PRODUCTS - GOMPlOP AGG $ 1 f OOO f O00 - L_._J S OTWER: __ AUTOMOBILE LIAUIIITY Ea aa~do~f $ 1, O O 0 , 0 0 0 _ ~ X ANY AUTO 3 04/14 2 BODILY INJURY (Per person} $ .- - - --- - ----- ~ - ED I 18 5 04 416 8 02/04/1 0 / ~. $ ALL OWNED AUTOS SCHEDUL AUTOS BODILY INJURY (Per accident) S -___ _- i _ H!REU AUTOS NON-OWNt;;p AUTOS Per accident $ - - --~- S UMBRELLA LIAR UCCUR EACH OCCURRENCE ~ S ^_ - - EXCESS LIAB CLAIMS•MADE AGGREGATE 3 T__-.____-_ _ . DED RETENTIONS $ i WORKERS COMPENSATION X STATUTE ER _____ ANbEMPLOYERS'LIA8IUTY rrw ANV PROpR{ETORivaRTNER7E1(FCIiTiVE r"I 9055060 DS/01/13 05/01/14 E-L EA(~M ACGIDENL OQQ QQQ $ 1, • C orr~cewr,+er~seR acwnem II~JI (Y~neNory In wH) NIA E.L. DISEASE - EA EMPLOYE ~y $ .1. • V Q f3 f O O O hyyaas dasc~+baV~der DESG~RIPTION OF OPEIiAT10N5 naow E.L. DISEASE -POLICY LIMIT OOO OOO $ l f f DESCRIPTION OF OPERATIONS (LOCATIONS / VEWICLES (AGORD 101, AdditioAil ROma9rkg SCnMae, may be aaached If more apace Ia revuired) THE CITY OF CAMPBELL I3 LISTED A3 ADDITIONAL INSURED PER BLANKET J3a~DORB$MSN'T. JOB SITE: 1165 RIDGEL]3Y DR CAMPBELL, CA THS CITY OF CAMPBELL SHpULD ANY OF TWE ABOVE DESCRIBED POLICIES BE CANCELLE[7 BEFORE 70 N. First Street, THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Campbell CA 95006 ACCORDANCE WITW THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ®198$-2413 All rights reserved. ACORD25(2013104) The ACORD name and toga are rg©Istered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE 1'OL1CY Named Insured: AK CONSTRUCTION Policy Number PO BOX 2043 9USSU6U-2013 MORGAN 1-IILL,CA 95038 WAIVI/R OF OUR RIGHT TO RECOVER FROM OTI-iER5 ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organizarion named in the Schedule, (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the schedule. The additional premium for this endorsement shall be 3%0 of the California Workers' Compensation premium otherwise due on such remuneration. Minimum Charge: $25U.UU Schedule Person or Organization: THE CITY OF CAMPBELL 70 N. FIRST ST CAMPBELL,CA 9540$ Job Description:. 1165 RIDGELEY DR CAMPBELL,CA This endorsement is part of your policy. ]t supersedes and controls anything the Contrary. It is otherwise subject to all the terms ofthe poli4y. Insurance Company; STATE COMPENSA'1'IpN INS Cp Countersigned by: WC 04 U3 OG ~l~ C~~ ~~ ~~~.~~\~~ INSURANCE REQUIREMENTS CH CKLIST Permit # ~ - ;' ~ ~~~~~ CIP Project # The following insurance is required of all contractors working in the City of Campbell public right-of-way. Insurance certificates must be accepted by City staff before work can begin. These insurance requirements apply to work being performed under an Encroachment Permit and work being performed under contract for Capital Improvement Projects. Limits Commercial General Liability for bodily, personal injury and property damage: ~~ $1,000,000 per occurrence, and ^ $1,000,000 general aggregate limit applying separately to the project, or $2,000,000 general aggregate limit. ^ Policy expiration date 'Z3-_~~} Automotive Liability: ;fib "Any Auto" checked on certificate ~x $1,000,000 per accident for bodily injury and property damage ~ Policy expiration date ~-~4- Workers' Compensation and Employer's Liability Waiver of Subrogation clause $1,000,000 per accident for bodily injury or disease ,~ Policy expiration date ~ ~~-y Course of Construction (if required in Special Provisions) ^ Completed value of the project ^ Policy expiration date Required Endorsements to General Liability and Automobile Liability Policies Additional Insured Endorsement (Description of Operations Area) The City, its officers, employees and volunteers are named as additional insured. Reference Project Location & Permit Number) ^ The insurance coverage afforded to the Additional Insured is primary insurance. Cancellation Area: ^ Cancellation area of certificate edited to delete "endeavor to" and "but failure to mail such notice shall impose no obligation or liability of any kind upon the company, its agents or representatives". OR Should Read ^ Should any of the above described policies be cancelled before the expiration date hereof, notice will be delivered in accordance with the policy provisions. C:\Documents and Settings\joannat\Desktop\Insurance Requirements.doc (Rev 03/13) Page 1 of 1 CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT CLEARANCE FOR FINAL INSPECTION AND ACCEPTANCE LETTER Encroachment Permit#: ENC 2013-00187 Name: Marc Giuffrida Property Address: 1165 Ridgeley Dr. Date of Final Inspection: \L~:? \ (~ 3 On File: ~ Bonds ~ CD ~ Cash Faithful Performance: $ 500.00 -! Labor and Material: $ -~ Construction Cash Deposit to be released: $ -~~ Other overdue deposits to be released (Description): Processed by: Reviewed by: Reviewed by: ~, .~ Adm istrator, ~~ In p for L nd Development Engineer ;~i,~`~ J:VoAnna7lDeposit refunds\CHECKLISTS\Ridgeley.1165.doc (Rev. l0/I l) ^ Workers' Compensation Insurance Sheet Submitted For General Contractor ^ For Developer or Owner Acceptability of Insurer(s) ^ Insurer(s) has current A.M. Best Rating of A:VII and is authorized to transact business in the State of California. Name: ~\,~~ ~~ ~ t~~~~ NAIC # ~ Ratin Y \ZS?~ g ~ Authorized in CA: Name: _ tc~„vHe%~/ ~ NAIC # Z~Ratin ~/ ?.~_ g: "v~ Authorized in CA: Name: ~~~-~ ~~,~,~ NAIC # Ratin g~ / Authorized in CA: Name: NAIC # Ratin g~ Authorized in CA: Campbell Business License # ~ ~ ~~ ~ i) t:=k~ r/ctI ((( t Insurance Certificate Reviewed ~ ~ .~ Irlitia Date ~„ _.. ^ Copy of Insurance Certificate placed in tickler file one month prior to expiration. 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