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ENC2013-00200of ' C9'~i ~~ A~ ~ ~ ~; r r y~ ~~ UkCHaR0 CITY of CAMPBELL Public Works Department November 12, 2014 Tracy Horton 871 W. Latimer Ave. Campbell, CA 95008 SUBJECT: PERMIT NO. ENC 2013-00200 871 Latimer Ave. ONE YEAR MAINTENNACE INSPECTION AND ACCEPTANCE Dear Tracy: 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 2013-00200 70 North First Street • Campbell, California 95008-1436 • TEL 408.866.2150 • FnX 408.376.0958 • TDD 408.866.2790 Print Form CITY OF CAMPBELL DEPT. OF PUBLIC WORKS 70 North First Street Campbell, CA 95008 Ph. (408)866-2150 Fx. (408) 376-0958 R-1 ENCROACHMENT PERMIT (Non-engineered work within the public right-of-way) ($10,000.00 maximum value of work) ISSUED: ~ ©/ ` ~ / ( Permit Expiration Date: I V ~ ~~ Permit No. L--~N c ~` 13 ~UU2c c7 X-Ref File Application Date G Application Expiration Date APN ~~ ~~ IuUC:x3 j APPLICATION -Application is hereby made for a Public Works Permit in accordance with Campbell Municipal Code, Section 11.04. (Application expires in 6 months if the permit is not issued.) A. Work Address: ~ ~ fa yV ~ ~~ ~ ~'~ ~~ _ ~U B. Nature of Work: I RewtovC paY 14 S~4-~r! h C4v~Ct'C "~'C ~ ~jr.C ~c~'I I tr,Ti-rn ~~,~) C. Attach three (3) copies of a drawing showing the location, extent and dimensions of the work. The drawing shall show the relation of the proposed work to existing 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: Tele hone: ~ '- , - Address: ~ 7 I 1/~( L~~' (Vt ~~ - ~ti ~_ ( C ~ ~~ f~~2L C,-~ ~.~ ~ ~ ~ _ _ E-Mail Address: 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 information. _ _ ACCEPTED: (Appli(~rjt/~i'~rnittee) (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 recorded. 2. 3. STANDARD AMOUNT RECEIPT N0. SECURITY FOR FAITHFUL PERFORMANCE (100% Of Engr's Est.) $ S y~~ ~`jU Lf 7 D R-1 PERMIT FEE $ APPROVED FOR ISSUANCE: ~- ~ ~ ~ f ~ I for City ngineer Date Permit Expires 6 Months after Date of Issuance. GENERAL PERMIT CONDITIONS 1. Payment of a security to insure faithful performance and completion of the work is required. This security is refundable upon completion of the work and written acceptance by the City. 2. A one-year maintenance period for all work is required. Such period will begin on date of acceptance by the City. It is the applicant's responsibility to remove and replace unacceptable improvements within the one-year maintenance period. 3. Refund or cancellation of the Faithful Performance Surety will be initiated by the written acceptance of the work by the City. 4. Submit project schedule 10 days prior to proposed start of work. Special provisions maybe required for work within City facilities and downtown Campbell. S. The Permittee must request in writing a final inspection and acceptance of the work upon completion. Acceptance by the City will be made in writing to the Permittee. 6. Maintain safe pedestrian and vehicular crossings and free access to private driveways, fire hydrants and water valves. 7. Replace as directed by the City Engineer any damaged or removed improvements in accordance with City Standards and Specifications at the sole expense of the Permittee. 8. Sawcut for all PCC and AC removals. All PCC removals shall be to nearest scoremark and shall be doweled to existing improvements. 9. Adequate signing and barricading is required on the job site. Failure to provide such signing and barricading as specified by the City Engineer may result in the City's providing such signing and barricades and charging the cost to the Permittee. 10. The Contractor or Permittee will have a supervisory respresentative available for contact on the project at all times during construction. 11. This permit shall be kept at the site of work and must be shown to any authorized representatives of the City of Campbell or any law enforcement officer upon demand. 12. No storage of materials or equipment will be allowed near the edge of pavement, within the traveled way, or within the shoulderline, which would create a hazardous condition to the public. 13. This permit shall not be construed as authorization for excavation and grading on private property adjacent to the work or any other work for which a separate permit may be required, nor does it relieve the Permittee of any obligation to obtain any other permit required bylaw. 14. This permit does not release the Permittee from any liabilities contained in other agreements or contracts with the City and any other public agency. 15. This permit is not transferable. Work must be performed by the Permittee or his designated agent or contractor as specified thereon. 16. Prior approval of inspector is required for any work done after normal working hours, on weekends or holidays and may require reimbursement of inspection costs at the current overtime rate. 17. Call back (call out) due to emergencies regarding this permit shall be at the current overtime rate with a three (3) hour minimum charge per occurrence. 18. If the public interest requires a modification of, or a departure from, the plans and specifications, the City shall have the authority to require or approve any modification or departure and to specify the manner in which the same is to be made for City-owned or maintained facilities. 19. Pursuant to Chapter 14.02 of the Campbell Municipal Code, applicant shall not cause to be discharged any material into the municipal storm drain system other than storm water. Applicant shall adhere to the BEST MANAGEMENT PRACTICES established by the Santa Clara Valley Urban Runoff Pollution Prevention Program. Applicant shall be responsible for ensuring that all those providing services under the applicant are aware of and understand all of the above conditions. Date J:\FO~iA4b'~Templates\Encroachment Permits\R-1 Encroachment Permit STATIC form2.pdf Rev. 03/13 PUBLIC WORKS DEPARTMENT LAND DEVELOPMENT Effective July 1, 2013 TO: City Clerk PUBLIC WORKS FILE NO. ~t~ ~ Zc~ ('~ "' U ~' ? oC~ PROPERTY ADDRESS ~ ~ w ~~ tNl t~ Please collect & recei t for the followin monies: ACCT. ITEM AMOUNT LAND DEVELOPMENT ncroac ment ermlt pp Icatlon ee Non-Utilit Encroachment Permit Ma'or ?$10,000 $377.00 Minor Encroachment Permit <$10,000 $215.00 Initial R-1 Permit N/C Subsequent R-1 Permits within Two Year Period $209.00 Street Tree Plantin /Removal N/C 2203 ($500 per Tree Plantin Deposit Re uired) $500.00/tree 2203 Plan Check Deposit 2% of En ineer's Estimate $500.00 min Utility and R-1 Permits no deposit required 4722 Gradin & Draina a Plan Review Sin le Famil Lot $265.00 Site < 10,000 s.f. $795.00 Site ? 10,000 s.f. < 0.5 Acre $1,060.00 Site ? 0.5 Acre $1,590.00 4722 NPDES Review (C3 Requirements For projects not required to submit numeric sizing $153.00 For projects required to submit numeric sizing Im envious Area 10,000 Sq. Ft to 1 Acre $663.00 Impervious Area 1 Acre or more $867.00 Plan Check & Ins ection Fee Non-Utility) 4722 En r. Est. up to $250,000 14% of En ineer's Estimate "2203 Engr. Est. ?$250,000 Actual cost +20% Admin Overhead Min $35,000 Deposit) 2203 Emer enc Cash Deposit 4% of En r. Est." ($500 min/$10,000 Max) 2203 Faithful Performance Security (FPS 100% of ENGR. EST.' 2203 Labor and Materials Security 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 Ma (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 4722 LOt Line Ad~UStment (Includes Certificate of Com Hance) $1,785.00 4722 Vacation of Public Streets & Easements $2,386.00 4722 Certificate of Com Hance $1,764.00 4722 Certificate of Correction $530.00 4722 A eal Filin Fee $200.00 4722 Nota Fee ( er si nature) $10.00 4722 Assessment Segregation or Reapportionment First Split $846.00 Each Additional Lot $265.00 511.7424 Postage MI ELL U Other (Please S ecif ) 'Engineer's Estimate shall be as approved by the City Engineer and shall include all items of work. ~ C' ~ '"Actual Cost Plus 20% Overhead (Non-Interest bearing deposit) TOTAL $ C NAME OF APPLICANT ' ~ NAME OF PAYOR ~C PHONE - ~~G- V ADDRESS ~ W ZIP ~ '- ~- ----- FOR RECEIVED Y CITY CLERK ONLY Date ~d Recei t # ~ : . Date/ Initials J \FORMS\TemdelasWdminlstrehw\Receipl Form LaM Dewloprtient 13-14 DECLARATIONS We will provide the insurance described in this policy in return for the premium and compliance with all applicable provisions of this policy. 05-QT-5285-2 Policy Number Coverage afforded by this policy is provided by State Farm General Insurance Company 900 Old River Road Bakersfield, CA 93311-9501 A Stock Company with Home Offices in Bloomington, Illinois. Named Insured and Mailing Address ' Horton, Tracy 871 W Latimer Ave Campbell, CA 95008-0907 The Policy Period begins and ends at 12:01 a.m. Standard Time at the residence premises. 08/06/2013 Effective Date 12 months -Policy Period 08/06/2014 Expiration of Policy Period Limit of Liability -Section 1 $434,200 Dwelling $325,650 Personal Property (Minimum 75% of Dwelling) Limit of Liability -Section 2 $300,000 Personal Liability $1,000 Medical Payments to Others Policy Type Homeowners f~1 -Replacement Cost -Similar Construction Increased Dwelling Up to $86,840 -Option ID Automatic Renewal - If the Policy Period is shown as 12 months, this policy will be renewed automatically subject to the premiums, rules and forms in effect each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee/Lienholder written notice in compliance with the policy provisions or as required by law. Deductibles -Section 1 $500 ALL LOSSES In case of loss under this policy, the deductible will be applied per occurrence and will be deducted from the amount of the loss. Other deductibles may apply - refer to your policy. Policy Premium $809 Location of Premises 871 W Latimer Ave Campbell, CA 95008-0907 Forms, Options, & Endorsements FP-7955.CA Homeowners Policy Form 438bfu Ns Lndr Loss Pay Ordinance/Law 10% $43,420 Homeowners Policy Endorsement Mortgagee & Addl. Interests Mortgagee 3 OCWEN LOAN SERVICING LLC ITS SUCCESSORS AND/OR ASSIGNS PO Box 4025 Coraopolis, PA 15108-6942 Loan Number: 0687861816 Prepared: 10-16-2013 559-916.5 Agent Name 8~ Address Patricia Money 164 Los Gatos Sartga Rd Los Gatos, CA 95030-5307 (408) 399-6669 Agent's Code:2941 APPLICANT COPY ;'.iii?=; ~''~ lh.S C~7 s,'4~fl J L~• :l'i : Wi`t'+>~ . t_~•~ ~~'~L v, ~- .: ~~' . _ ,. ~, ~';; CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT CLEARANCE FOR FINAL INSPECTION AND ACCEPTANCE LETTER Encroachment Permit#: ENC 2013-0200 Name: Tracy Horton Property Address: 871 W. Latimer Ave. Date of Final Inspection: 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: - ~~ ~ ~_ Administra r Reviewed by: -- Inspector ~ , Reviewed by: Land Development Engineer J:UoAnnaT~Deposit refunds\CHECKLISTS\Latimer.871.doc (Rev. l0/11) Refundable Deposit Check Request To: Finance Director Check Payable To: Address -Line 1: Line 2: City: Description: Account Number: Account Number: Account Number. (Finance Dept only) ~~~~ Tracy Horton 871 W. Latimer Ave. Campbell State: CA Zip: 95008 Faithful Security Deposit Refund 101.2203 Amount: Amount: 101.540.7448 Amount: Interest Earned $500.00 (Finance Dept only) Total Payable: texact Amount) Purpose: Refund of Faithful Security Deposit Voucher #: Permit #: ENC 2013-00200 Receipt #: 250470 Date: 10/17/2013 Re nested b - Title: PW Inspector Date: q Y~ Syed Wah~ii Approved by: /~J Title: Sr. Civil Engineer Date: ~~ Lisa P ersen Finance Dept Only: ~/ Verified by: 'F Title: Accounting Clerk II Date: Approved by: _`~ Title: Accountant Date: S~eci~al Instructions For Hand/ ing CN Mail Is: ~' i I Retur To: Mail in Attached Envelope: JoAnna Thomason (Name) Interim Check: Needed By: Public Works (Department) f/n: Forms/excel/chkreq - Revised O5/00 •1ti•Cq~ f '. ~ U r. `-' ~~' c n n Rio CITY of CAMPBELL Public Works Department November 4, 2013 Tracy Horton 871 W. Latimer Ave. Campbell, CA 95008 SUBJECT: PERMIT NO. ENC 2013-00200 871 W. Latimer Ave. Campbell, CA FINAL INSPECTION AND ACCEPTANCE Dear Tracy: 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 permit begins as of the date of this acceptance letter. The pennittee 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 ine at (408) 866-2165. Sincerely, _~ Syed Wahidi Public works Inspector Ce: Inspector file Permit #ENC 2013-00200 70 ivic~;tn i=irsi street Campoeli, California 95008-1423 rte 408.866.2150 = Fnx 408.376.0958 ~ 'rn~ 408.866.2790 CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT CLEARANCE FOR FINAL INSPECTION AND ACCEPTANCE LETTER Encroachment Permit#: ENC 2013-0200 Name: Tracy Horton Property Address: 871 W. Latimer Ave. Date of Final Inspection: 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: .~ Administra r Reviewed by: - - Inspector Reviewed by: Land Development Engineer I:UoAnna'ilDeposit refunds\CHECKLISTS\Latimer.871.doc (Rev. LO/11) CITY OF CAMPBELL vENDOR No. 10012439 CHECx No. 244198 f Ac ount Purchase Order InvoiceNamiber Arru~unt Descri lion 101 2203 CR110413 500.00 SECURITY DEPOSIT REFU 10012439 TRACY HORTON n I I • 1 ~ ~ 1 1~ 1 • ~ 1 1 oC "C`~ip CITY OF CAMPBELL WELliS FARGO BANK, N.A. 11 24 CHECK DATE CHECK NO. '~" -~ 42 0 MONTGOMERY STREET 1210 11 / 18 ~ 13 2 4 419 8 ~S ~ 70 NORTH FIRST STREET C'r SAN FRANCISCO, CA 94104 CAMPBELL, CALIFORNIA 95008 0 o AMOUNT ~ *******500.00* ~. ', : .~ ~~, ~. ~ 'o VOID AFTER 90 DAYS ~' kCHARV n D. PAY THE SUM OF FIVE HUNDRED DOLLARS & ZERO CENTS m ~: r e To THE TRACY HORTON L"Y ORDER g ~ 1 W LAT IMER AVE of CAMPBELL CA 95008 /~~~~~ u'244L9811' ~:i2L000248~: 4L2L8554L5i1' ~ ~ ~-- CITY OF CAMPBELL 70 NORTH FIRST STREET CAMPBELL, CALIFORNIA 95008 TRACY HORTON 871 W LATIMER AVE CAMPBELL CA 95008 OF CA'11 ~ • A~ ~ r U r 0 0 ti ~ `~ c~ ~~k~HARO Transmittal JoAnna Thomason Office 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 To Tracy Horton Date: November 18, 2013 Re: Deposit Retunl-Permit #2013-00200, 871 Latimer Ave., 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\Transmittal Form.ck retms.DOC (Rev. 03/08) OF LA~~ ~' ~.~, U CITY of CAMPBELL Public Works Department November 4, 2013 Tracy Horton 871 W. Latimer Ave. Campbell, CA 95008 SUBJECT: PERMIT NO. ENC 2013-00200 871 W. Latimer Ave. Campbell, CA FINAL INSPECTION AND ACCEPTANCE Dear Tracy: 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 ine at (408) 866-2165. Sincerely, Syed Wahidi Public works Inspector Cc: Inspector file Permit #ENC 2013-00200 70 ~?orth i-irsi Street Camp'oeli, California 9500£-1423 rt L 408.8Gb? 1 50 F'~~x 408.3iv.C95S ~'w 4v8.c4 .2790