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CITY of CAMPBELL
Public Works Department
June 14, 2018
Mr. Michael Pham
730 Kenneth Ave.
Campbell, CA 95124
SUBJECT: PERMIT NO. ENC 2017-00119
730 Kenneth Ave., Campbell, CA
FINAL INSPECTION AND ACCEPTANCE
Dear Michael:
The City of Campbell has made the final 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
70 North First Street • Campbell, California 95008-1436 • TEL 408.866.2150 • FAx 408.376.0958 • TDD 408.866.2790
Encroachment Permit Final Sign Off
Encroachment Permit #"���7 TOG11,J
Address: 730 k�j. Nclir1 .
Date of Final Inspection and Acceptance:
Inspected by:
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OK to release deposits: 100% 75.%
Comments:
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CITY OF CAMPBELL
Public Works Department
Tune 6, 2017
Mr. Michael Pham
730 Kenneth' Ave.
Campbell, CA 95008
SUBJECT: PERMIT NO. ENC 2017-00119
730 Kenneth Ave.
FINAL INSPECTION AND ACCEPTANCE
Dear Michael:
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 May 18, 2017. The
permittee 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 $1,000.00 is enclosed.
If you have any questions, please call me at (408) 866-2165.
Sincerely,
Syed Wahidi
Public Works Inspector
Cc: Inspector/Suspense Files
Permit File ENC2017-001 19
70 North First Street • Campbell, California 95008-1436 • TEL 408.866.2150 • Fax 408.376.0958 • TDD 408.866.2790
Print Form
CITY OF CAMPBELL R-1 ENCROACHMENT PERMIT Permit No. i= NCB 020 \—j —
DEPT. OF PUBLIC WORKS (Non -engineered work within the public right-of-way) X-Ref File 00 \\ \
70 North First Street ($10,000.00 maximum value of work) Application Date
Campbell, CA 95008 Application Expiration 1
Ph. (408) 866-2150 ISSUED: 51-66-7 Date
Fx. (408) 376-0958 Permit Expiration Date: 7_APN a r L QQIYI C�o
APPLICATION -Application is hereby made fora 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: j "7 3,n H A
B. NatureofWork: SZ v�.nt C�t�AC J)JS� UST ` �Y A. (2`I P�Ped
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: f� Telephone: (gip) RG ^0-2-U '
Address: �� C� 1�-� 1' '% iI� V E CA I-,Ip CS L( lA qS-0-0--9
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: 6, 3 / 2-0 f
(Applicant/Permittee) (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 4216 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.
STANDARD AMOUNT RECEIPT NO.
SECURITY FOR FAITHFUL PERFORMANCE 0 % Of Engr's Est.) $ VWC) 24n 4 &6
R-1 PERMIT FEE $
S
APPROVED F(1P ICCIJ G��ICE, j
for City Engineer Date j
GENERAL PERROT 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 may be 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 thejob 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 projectat 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 by law.
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
mi in �irnal ctnrm drain cvcta, ther than stor „ water nnlirant chAll arlhoro to the RFCT MANA(;EMENT PRA(TlCES octahlished 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. A %%%
x /YY-W4 0=U4 V v
Applicant_
JAFORMS\Templates\Encroachment Permits\R-1 Encroachment Permit STATIC form2.pdf
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Date
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c�65 9b0 Old River Rd.
Bakersfield, CA 93311-9501
HOMEOWNERS AVAILABLE COVERAGE NOTICE
AT2 H-02- 2331-FAD9 H W F
002274 0001
PHAM, JANETTE & MICHAEL
730 KENNETH AVE
MJ
�• CAMPBELL CA 95008-4604
I'Il'llllll"I'Illll'Illltltlltlllllll'Il'I'Illlllll'Illl"'I'III
SEE RENEWAL CERTIFICATE
IT IS IMPORTANT THAT YOU OCCASIONALLY REVIEW THE COVERAGES AND LIMITS IN YOUR HOMEOWNERS
POLICY TO BE CERTAIN YOUR NEEDS ARE BEING MET. THE FOLLOWING INFORMATION WILL ASSIST YOU IN THE
REVIEW PROCESS,
THE COVERAGE LIMITS FOR COVERAGE A - DWELLING, COVERAGE B - PERSONAL PROPERTY, COVERAGE L -
PERSONAL LIABILITY, AND COVERAGE M - MEDICAL PAYMENTS TO OTHERS ARE LISTED ON THE ACCOMPANYING
RENEWAL NOTICE, PLEASE REVIEW THESE LIMITS TO DETERMINE IF THEY ARE ADEQUATE IN THE EVENT OF A
LOSS,
THE FOLLOWING IS A PARTIAL LIST OF THE OPTIONAL COVERAGES YOU HAVE-QT ADDED TO YOUR POLICY.
THEY MAY BE AVAILABLE TO YOU FOR AN ADDITIONAL PREMIUM.
Back -Up of Sewer or Drain (for damage caused by water •from outside the plumbing system which backs up
through sewers or drains)
Building Ordinance or Law (higher limits)
Business Property (for higher limits)
Business Pursuits Liability (for teachers, school administrators, sales persons, and clerical workers)
Child Care Liability (for those providing child care in their home)
Firearms (for broadened coverage and higher limits)
Home Computers (for higher limits)
Identity Restoration
Incidental Business Liability (for those with an incidental office, studio, or school in the home)
Jewelry and Furs (for broadened coverage and higher limits)
Loss Assessment (for neighborhoods with Homeowners Associations)
Nurses Professional Liability (for those in the nursinrofession)
"*Optional Coverages continued on the reverse side
This notice contains only a general description of the coverages and is not a contract. All coverages are subject to
i the provisions in the policy itself._ Should you have a need for any of these coverages or higher limits, contact your State
Farm Agent to discuss details, cost -and eligibility.
IMPORTANT INFORMATION ABOUT DAMAGE CAUSED BY FLOODING
This policy does not cover damage to your property caused by flooding. You may be eligible for such coverage through the
National Flood Insurance Program ("NFIP"), if you live in a participating community. For more information, contact your
State Farmvagent or visit floodsmart.gov.
5664 2011 1 Agent HO QUANG NHUT INS AGENCY INC
2N,DR,NP,12,PD Telephone 408 223-6163 REB
p ( ) Prepared JUL 202016
rar111 ueiieiai ni�u�aiit;a �.vntPaiiy
900 Ol� River Rd.
-Ba:lersfield, CA 93311.9501
nCIVGWHL VCn Irll�ll l C
Homeowners Policy
SEP 15 2016 to SEP 15 2017
H-02- 2331-FAD9 H W F
002274 0001
PHAM, JANETTE & MICHAEL
730 KENNETH AVE
CAMPBELL CA 95008--4604
Location: Same as Mailing Address
Loss Settlement Provisions (See Policy)
Al Replacement Cost - Similar Construction
B1 Limited Replacement Cost - Coverage B
Forms, Options, and Endorsements
Homeowners Policy
Increase Dwlg up to $52,700
Ordinance/Law 10%/ $26,350
Jewelry and Furs $1,500/$2,500
Homeowners Policy Endorsement
Amendatory Endorsement
FP-7955.CA
OPT ID
OPT OL
OPT JF
FE-3422
FE-3247
SEP 15 2016
Coverages and Limits
Section I
A Dwelling
Dwelling Extension Up To
B Personal Property
C Loss of Use
Deductibles - Section I
All Losses
Section II
L Personal Liability
Damage to Property of Others
M Medical Payments to Others
(Each Person)
Annual Premium
Amount Due
Premium Reductions
Home/Auto Discount
Claim Record Discount
Inflation Coverage Index: 283.6
$596.00
$263,500
26,350
197,625
Actual Loss
Sustained
1,000
$500,000
500
1,000
$596.00
$596.00
130.00
66.00
CALIFORNIA LAW REQUIRES US TO PROVIDE THE FOLLOWING NOTICE: Our records indicate that you have not
purchased Earthquake Coverage.
This policy includes Building Code Upgrade Coverage of $26,360.
Please help us update the data used -to determine your premium, Contact your agent with the year each of
Your home's utilities (heating/cooling, plumbing, or electrical) and roof were last updated.
DD� oving? See your State Farm agent,
M
�iCUr/�sif�cai'S • •, See reverse for important information.
5665 2011 1 Agent HO QUANG NHUT INS AGENCY INC Prepared
2N.DR,NP,12.Po Telephone (408) 223-6163 REB JUL 20 2016
��• ... RCVGRJC JIUC r-reparea --- -- -
CITY OF CAMPBELL
Public Works Department
June 6, 2017
Mr. Michael Pham
730 Kenneth Ave.
Campbell, CA 95008
SUBJECT: PERMIT NO. ENC 2017-00119
730 Kenneth Ave.
FINAL INSPECTION AND ACCEPTANCE
Dear Michael:
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 May 18, 2017. The
permittee 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 $1,000.00 is enclosed.
If you have any questions, please call me at (408) 866-2165.
Sincerely,
Syed Wahidi
Public Works Inspector
Cc: Inspector /Suspense Files
Permit File ENC2017-00119
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
MICHAEL PHAM
730M KENNETH AVE.
CAMPBELL CA 95008
10014405
CHECK NO
...........................
J.
262835
Encroachment Permit Final Sign Off
Encroachment Permit
Address:
Date of Final Inspection and Acceptance
Inspected by: slw
OK to release deposits: 100%y 75%
Comments:
CITY OF CAMPBELL
PUBLIC WORKS DEPARTMENT
CLEARANCE FOR FINAL INSPECTION
AND ACCEPTANCE LETTER
Encroachment Permit#: ENC 2017-00119
Name: Michael Pham
Property Address: 730 Kenneth Ave.
Date of Final Inspection: 5/18/17
On File: Bonds CD Cash
Faithful Performance: $1,000.00
Labor and Material:
Construction Cash Deposit to be released:
Other overdue deposits to be released (Description):
Processed by:
Reviewed by:
Reviewed by:
51 1k-1
inistrator
g/u� f q
Inspector
Land Development Engineer
J:VoAnnaT\Deposit refunds\CHECKLISTS\Kenneth 730.doc (Rev. 10/11)
Refundable Deposit Check Request
To: Finance Director
Check Payable To: Michael Pham
Address - Line 1: 730 Kenneth Ave. 2
Line 2:
City: Campbell State: CA Zip: 96008
Description: 730 Kenneth Ave.
Account Number: 101.2203 Amount: $1,000.00
Account Number: 101.2203 Amount:
Account Number: 101.640.7448 Amount:
(Finance Dept only) Interest Earned (Finance"Deptonly)
Total Payable: (Exact Amount)
Purpose: ENC2017-00119
Receipt #:
Receipt #
269406
Permit#: ENC2017-00119
Date: 5/3/2017
Date:
Requested by: Title: Inspector Dater
Syed Wahidi
Approved by: Title: 'Sr. Engineer Date:
Roger Storz
Finance Dept Only:
Verified .by: Title: Accounting Clerk II Date:
Approved by: Title: Accountant Date:
Special Instructions Fpor Handling
Mail As Is: Mail in Attached Envelope: Interim Check:
Needed By:
Return To: JoAnna Thomason Public Works
(Name) (Department)
Other: Please return check to JoAnna