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ENC2017-00134Of C4,y e:z ' • Ok CHARS CITY OF CAMPBELL Public Works Department September 18, 2018 - Derek Ludlow 1915 Montemar Way .San Jose, CA 95125 SUBJECT: PERMIT NO. ENC 2017-00134 1915 Montemar Way, Campbell, CA FINAL INSPECTION AND ACCEPTANCE Dear Derek: 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 Enc:2017-00134 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 # EIX <101-7 -OC) � Address: '115 M4 M WY Date of Final Inspection and Acceptance: Inspected by: OK to release deposits: 100% 75.% Comments: e;��; 1 Of c4�a 'kCHARO , CITY OF CAMPBELL Public Works Department October 24, 2017 Derek Ludlow 1915 Montemar Way San Jose, CA 95125 SUBJECT: PERMIT NO. ENC 2017-00134 1915 Montemar Way FINAL INSPECTION AND ACCEPTANCE Dear Derek: The City of Campbell has made a final inspection of subject Public Works improvements and finds the work to be acceptable and in conformance wit>-' ty Accordingly, the City Engineer accepts the improvements. Theone year maintenance period stated in the permit begins as of September 28, 2017. The permittee is responsible for the repair and/or repla eemment of any defective wQ failures that occur within one year. The City will inspect tFie ftp-ovemen�n 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 ENC2017-00134 70 North First Street • Campbell, California 95008-1436 • TEL 408.866.2150 • FAx 408.376.0958 • TDD 408.866.2790 OF Cog' c• u HRCHARO CITY OF CAMPBELL Public Works Department October 24, 2017 Derek Ludlow 1915 Montemar Way San Jose, CA 95125 SUBJECT: PERMIT NO. ENC 2017-00134 1915 Montemar Way FINAL INSPECTION AND ACCEPTANCE Dear Derek: 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 September 28, 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 ENC2017-00134 70 North First Street • Campbell, California 95008-1436 • TEL 408.866.2150 • FAX 408.376.0958 • TDD 408.866.2790 .............................. I. ........ . . ..................... . . ................ ..... . ............. ............ .............. ------------- ---------------- T - - - - - - 7 ----- CITY OF CAMPBELL VENDOR NO. .. . .......................... ........ . ............ ......... . . ........ ...... .... . ...... . . . ......... .0014.663 CHECK NO. .264885 d 101 2203 CR101617 L, Uuu uu 1(M1014603 DEREK LUDLOW IT. BW,, 1�. A. -24 CHECI TH-FIRST STREET �`.'�qrT�MExY.'STRFET,, 1210 ISCOCA ?CALIFORNIACAMP B E E'V�.� cXL 95008 FAY' THE , ,E-,.,,THOUSAND ,SUM, OF� ON-DOLLARS &,-ZER, -CENTS,: q, TO THE 'DEREY -LUDLOW" q ORDER lj A I 19 15 MONTMEMAR'�WAY. I I ­ I I I � I I I I I Al-, SAN JdSE 'C.A: .95125 NC201700134.DEP RFND -'CHECK NOI.' <. 264885 ddb664` -7 C) aai F n 4 26488 8_V5 11",S] 4��I"2 "0, ------------- r. 0fr ----------------------- ------------------ --------------------------------------------------- ------------------------------------------------------ II I/ I ----- ------------- --------------------------- ---- ----- ... ..... ........ ..... . ... . ............. .... . ........... ..... ....................... . ... . .................................. .. . ........... . .. ............. ........... . ..... *See Reverse Side For Easy Opening Insftuctions* ----- ---------- ------------------- -------------------------------- --- ------- -------------------- ---- CITY OF CAMPBELL' 70 NORTH FIRST STREET CAMPBELL, CALIFORNIA 95008 DEREK LUDLOW 1915 MONTEMAR. WAY SAN JOSE CA 95125 KeTunaaoae_ uepvsir_ cn�cRcyuG� ' To Finance Director Check Payable To Derek Ludlow Address Line,1 : 1916Montemar Way Line'2;. City: San`Jose _ -State: CA -Zip: 95125 - - Description: ENC2017=00134 - Account Number: 1012203 Amount: $1,000.00 Account Number: . 101'.2203. Amount: i - Account. Number 101.640 7449, - Arrlount: (FinanmMptonly)': 7nterestEarned - ffinance,Deptonly)' ' = -Total',Payable: - (ExactAmoUnt) Purpose:" ENC2017-0.0134.Dep-Refund Permit # . -, ENC2017=00134 ! Receipt:#__ : - 2t39744 , - Date_:' 5126/201'7 Receipt #: Elate: l Requested byY Tlfle Inspector Date l� Syed Vllahidi: ! 'Approved:byG.' '"' Title: '. Sr._Erigineer _ Date Q* Boger Storz ' Finarice bept duly: Verified:6y:.- Title: Accounting Clerk II Date' Approved. by , Titl'e,: - -" : . Accountant ,. Date. S ec al Instruc=tions FQ,r.-`Ha'nid-1`n _ Che' k,- nnaii As IS, Mail in Attached• Envelope:. Inierl rit.nec,K: Needed By:, ._ . -. JoAnna Thomason. Public Works C.Retuo: (Name). (Department) Oilier Please return -check to;JoAnna CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT CLEARANCE FOR FINAL INSPECTION AND ACCEPTANCE LETTER Encroachment Permit#: ENC 2017-00134 Name: Derek Ludlow Property Address: 1915 Montemar Way Date of Final Inspection: On File: Bonds CD Cash Labor and Material: $ Construction Cash Deposit to be released: $ Faithful Security Depo t: $1,000.00 Other overdue deposits to be released (Description): Processed by: Administrator Reviewed by: Inspector Reviewed by: Vj^ (o q Land Development Engiineel ' JAJoAnnaT\Deposit refunds\CHECKLISTS\Montemar 1915.doe (Rev. 10/11) Encroachment Permit Final Sign Off Encroachment Permit # C 2 �-7 001 Address: � � l 5 lc:c`' z�-1 �,r - WAY Date of Final Inspection and Acceptance: �z� [ ( -7 Inspected by: OK to release deposits: 100% 75% _ C ts� ommen - � C o0 Vys ,coo© PUBLIC WORKS DEPARTMENT LAND DEVELOPMENT Effective July 1, 2016 TO: Finance PUBLIC WORKS FILE NO. ENC2017-00134 PROPERTY ADDRESS 1915 Montemar Way Please collect & receipt for the following monies: ACCT, ATEM '` AMOUNT LAND.DEVELOPMENT 4722 Encroachment Permit Application Fee Non -Utility Encroachment Permit Major >_$10,000 $403.00 Minor Encroachment Permit <$io,000 $230.00 Initial R-1 Permit N/C Subsequent R-1 Permits within Two Year Period $230.00 Inspection Fee Minimum Charqe per Location $398.00 Street Tree Plantinq/Removal N/C 2203 ($500 per Tree Plantinq Deposit Required) $500.00/tree 22031 Plan Check Deposit 2% of Engineer's Estimate $500.00 min 4722 Utility and R-1 Permits no deposit required Grading & Drainage Plan Review Sinqle Family Lot $281.00 Site < 10,000 s.f. $841.00 Site >_ 10,000 s.f. < 0.5 Acre $1,127.00 Site >_ 0.5 Acre $1,688.00 4722 NPDES Review (C3 Requirements) For projects not required to submit numeric sizing $163.00 For projects required to submit numeric sizing Impervious Area 10,000 Sq. Ft to 1 Acre $704.00 Impervious Area 1 Acre or more $918.00 4722 For projects sent to Consultant for review Consultant Cost +20% 4722 Additional treatment facilities $300 ea Plan Check & Inspection Fee (Non -Utility) 4722 Enqr. Est. < $250,000 14% of Engineer's Estimate 4722 Enqr. Est. >_$250 000 and <_$500,000 $35,000 + 8% of Engineers Estimate 4722 Enqr. Est. >$500,000 $55,000 + 7% of Engineers Estimate 2203 Emergency Cash Deposit 4% of Enqr. Est.* ($500 min/$10,000 Max) 2203 Faithful Performance Security (FPS) 100% of ENGR. EST.* $1,000.00 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) $4009.00 + $87/lot 4722 Final Tract Map (5 or More Lots) $4,871.00 + $118/lot 2203 Monumentation Security 100% of City's Monumentation Estimate 4920 Parkland Dedication Fee 75%/25% Due Upon Cert. of Occupancy) 4722 Lot Line Adjustment (Includes Certificate of Compliance) $1,893.00 4722 Vacation of Public Streets & Easements $2,530.00 4722 Certificate of Compliance $1,877.00 4722 Certificate of Correction $561.00 4722 Document Recording Fees $15.00/first page $3 ea. Additional 4722 Private Improvement in Public ROW $50.00 47221 Approved Plan Revision Fee $100/sheet 4722 Appeal Filing Fee $200.00 4722 Notary Fee (per siqnature) $10.00 4722 Assessment Seqreqation or Reapportionment First Split $895.00 Each Additional Lot $281.00 511.7424 MISCELLANEOUS.___. Postage _ 101.730.4924 NO] Reimbursement for *Engineer's Estimate shall be as approved by the City Engineer and shall include all items of work. TOTAL $1,000.00 t NAME OF APPLICANT LL a 6 LL5 NAME OF PAYOR LLci f ow PHONE -L 0J -45 -71 "09 42 ADDRESS l S /✓1 nYl�rt �vylL� w q ZIP �I 2� FOR RECEIVED BY CITY CLERK, ONLY Date, n Reeei t# r. a JTY OF CiA1�APBELL C:Ws—Vogers\De MpT-s.rls MAC. e_',0VA 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 wort: within the public right-of-way) ($10,000.00 maximum value of work) ISSUED: 5I3G/ / I Permit Expiration Date: Print Form �y Permit No. X-Ref File Application Date Application Expiration Date ,.APN 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: B. Nature of Work: �l �• t , ,���` ^ , �,�.� � �, •4t-••y— Q����-}� `�. C. Attach three (3) copies ofaa/drawing showing the Iocattion, 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: Telephone: Address: �g.f.......vvv1L✓f"yY-its-�..1s���.... ...�j•�;... .. Jp]'�—.j . ... .... 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: (Applicant/Permittee) (Sign) Date NOTES: All wort: shall conform with the attached approved la 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 leasttwo 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. 3. STANDARD AMOUNT RECEIPT NO. SECURITY FOR FAITHFUL PERFORMANCE (100% Of Engr's Est.) $ 10(ge-3 — R-1 PERMIT FEE $ APPROVED FOR ISSUANCE: f�r ty Engineer Date r - ('�-h ---S 14-- �t,Sf,veu-,_� GENERAL PERMIT CONDITIONS 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 5. 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 I y 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 td provide such signing and'barricading as specified bythe 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 c6ntact 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 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 bythe 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 touter, ,Applicant -shall adhAre to the BEST MANAGEMENT PRACTICES established by Applicant the Santa Clara Valley Urban Runoff Pollution Prevention Program. Applicant shall e responsible for ensuring that all those providing services under the applicant are aware of and understand all of the above conditio s. LIO —A— —!; % Date JAFC Rev. chment Permits\R-1 Encroachment Permit STATIC form2.pdf CITY OF CAMP.BELL ENCROACHMENT PERMIT Permit No [-NC- 2—d 1-7- GQt DEPT_ OF PUBLIC WORKS !AMENDMENT No. ( X-Ref. File 70 North First St. Application Date -7/1 h-7 Campbell, CA 95008 Amendment Date 7A3 /I'7 (408) 866-2150 Fax (408) 376-0958 ISSUED �3/l r t A. Work aL 9 15 �itrecc B. Nature of Work i9'i r2cmr Arl'j1J W ITFt 74u 90K Autumn Purple Ash C. Attach three (3) copies of a drawing (or other documentation) showing the amendment, extent and dimensions of the work. The drawing shall show the relation of the proposed worked to existing improvements. Drawings or other documentation provided and attached for proposed amendment: D. When approved by the City Engineer, said drawing becomes. a part of this permit. All conditions associated with the previously issued encroachment permit shall apply to the work contained in this amendment. E. 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. The Applicant!Permittee 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 amendment to the previously issued encroachment permit. The Applicant/Permittee hereby acknowledges that they have read and understand the requirements of this amendment, and that they will inform their contractor(s) of the information. ACCEPTED �� Derek Ludlow / plicant/Permittee) (Sign) 7/13/17 Date NOTES: ALL WORK SHALL CONFORM WITH THE ATTACHED, APPROVED PLANS AND ALL APPLICABLE CAMPBELL STANDARD DETAILS AND CONDITIONS. THE CONTRACTOR MUST HAVE THE ORIGINAL PERMIT AND'ALL AMENDMENTS ON THE PROJECT SITE AT ALL TIMES. APPROVED FOR ISSUANCE 7`13 I for City Engineer Date P', •\Forms\Encroachment Permit Amendment Por..y D=bmb— (lid Copy) Pd yNotENG038471007(PayppcOaMME B) Wxuay 27, 2017 Page 1 Lmm =PWvk1cdby MCGRAW INSURANCE SERVICES P.O. BOX 40 ANAHEIM, CA 92815-0040 Namodlmuad DEREK LUDLOW LUDLOW. ESTHER 1915 MONTEMAR WAY SAN JOSE, CA 95125 CALIFORNIA HO-3 Preferred Homeowners Insurance This is your Declarations Page poliyNo.: ENG6384710A7 Porky TyP5: HW PRFFFRRM PERSONAL HOM 3OWNhn PoliyT= Match 2Q?A17toMnchX2D18at1291amSwnMTmn at dr addteav of Named Imumd as staled h=in Co-ages-0 im =d LOCOS= 1915 MONIEMAR WAY SANTOSE CA 95125 02/272017 Pacific Specialty COMPANY LbdCrW== By PACIFIC SPECIALTY INSURANCE COMPANY FINANCIAL RATING: "Aa (EXCELLENT) BY AM BEST STATUS: ADMITTED PRODUCER: A22177, (408)-265-9100 PFARRINGTON@ALLSTATE.COM PAMELA K FARRINGTON 1017 MERIDIAN AVENUE SAN JOSE, CA 95125 Wv 11ooiSwS�:eoi Vl Manage your account. Pay bills. For policy service/questions contact your producer at (406)265a%cOcr C/S at 14MO303S0M 1-800462-II72 (For claims service) Please see next page for a full list of coverages, credits and adiustRents applied to your policy, as well as other available options. Coverage limit Dedwuble * DED. UNLESS SPECIAL DED. BELOW $1.000.00 ................................................................................................................................................................ A DWELLING $669,000.00 ................................................................................................................................................................ Al 2.. EXTENDED REPLACEMENT COST A2 ORDINANCE OR LAW COVERAGE 10.00% ................................................................................................................................................................ B OTHER STRUCTLRES $66,900.00 ................................................................................................................................................................ C PERSONAL PROPERTY $334,500.00 ................................................................................................................................................................ C1 REPLACE COST PERSONAL PROPERTY ................................................................................................................................................................ D LOSS OF USE $133.800.00 ................................................................................................................................................................ E PERSONAL LIABILITY $300,000.00 ................................................................................................................................................................ E1 ANIMAL LIABILITY $50,000.00 ................................................................................................................................................................ E2 PERSONAL INJURY LIABILITY $300,000.00 ................................................................................................................................................................ F MEDICAL PAYMENTS $1,000.00 ................................................................................................................................................................. MPD MULTI POLICY DISCOUNT 2 - Tier ................................................................................................................................................................ PPG AGE OF PLUMBING SURCHARGE 17 No. of years P18 TRAMPOLINE EXCLUSION ........................ A, Pally Dxl-- (k-ftw COPY) Pull y No. ING 03Wn0-07(Pay M= OTHWCHB:K) F xuwy 27, 2017 Page 2 P19 DIVING BOARD & SLIDE EXCLUSION ................................................................................................................................................................ RFR ROOF REPLACEMENT COST ................................................................................................................................................................ U 4388FU MORTGAGEE CLAUSE ................................................................................................................................................................ Policy C—gc P-dum (—hdiag f—): 07f1 M17 Yousare3 Sl(OADbybdngaPS fxSpmktypolkyhoMm! *WM IS NQT A BBL*4= Any payment information will be requested separately faf applicable). Please rlead your policy carefully for overage details. $1,337DD Poli,DWI— (h— dCOPY) Polly No: ING 0084710-07(Pay 0'P-- OTH-CFIDCIC) R*omy 27, 2017 Page 3 o.tB— ofc—jr. Dctaa7 Coverage Limits Deductible Premium ................................................................................................................................................................ D-Hing A DWELLING $669,000.00 $1,329.00 ................................................................................................................................................................ Al 25% EXTENDED REPLACEMENT COST $66.00 ................................................................................................................................................................ B OTHER STRUCTURES $66,900.00 INC. ................................................................................................................................................................ RFR ROOF REPLACEMENT COST ................................................................................................................................................................ INC. Primalhmxtiy C PERSONAL PROPERTY $334,500.00 INC. ................................................................................................................................................................ C1 REPLACE COST PERSONAL PROPERTY ................................................................................................................................................................ INC. Liability E PERSONAL LIABILITY $300,000.00 $25.00 ................................................................................................................................................................ E1 ANIMAL LIABILITY $50,000.00 $10.00 ................................................................................................................................................................ E2 PERSONAL INJURY LIABILITY $300,000.00 $30.00 ................................................................................................................................................................ F MEDICAL PAYMENTS $19000.00 INC. ................................................................................................................................................................ P18 TRAMPOLINE EXCLUSION INC. ................................................................................................................................................................ P19 DIVING BOARD & SLIDE EXCLUSION ................................................................................................................................................................ INC. od= A2 ORDINANCE OR LAW COVERAGE 10.00% INC. ................................................................................................................................................................ D LOSS OF USE $333,800.00 INC. ................................................................................................................................................................ U 438BFU MORTGAGEE CLAUSE ................................................................................................................................................................ $10.00 AddifltnalCiedhs MPO MULTI POLICY DISCOUNT ................................................................................................................................................................ 2 - Tier $160.00- Addi6ondCh&zM PPG AGE OF PLUMBING SURCHARGE ................................................................................................................................................................ 17 No. of years $27.00 Ikdanh'h1c * BED, UNLESS SPECIAL DED. BELON ................................................................................................................................................................ $19000.00 INC. Policy coverage premium: $1,337.00 ................................................................................................................................................................ POLICY FEE (Fully earned) $30.00 ................................................................................................................................................................ INSPECTION FEE (Fully earned) $40.00 ................................................................................................................................................................ Total 12 Month Polity Charge Yousaud$16DADbybftaPacifcSpooblypoBrAolderI Policy aid impMdon fees, if dwgcl, are fully eametl (=Mird). * Pleaw-be aware tbac the folloMng fees may apply: -Atev taa==feeof$10will apply ifyoapolsyiscal=lledmid d=mimtated. -A carwc0ationfw of $25 will apply if the policy, is can ollcd at your—i csL 0227,2017 $1,407.00 WA C:rtd CONTRACTORS STATE --- — — s. r OARD - tiW Contractor's License Detail for License # 609181 DISCLAIMER: A license status check provides information taken from the CSLB license database. Before relying on this information, you should be aware of the following limitations. CSLB complaint disclosure is restricted by law (B&P 7124.6) If this entity is subject to public complaint disclosure, a link for complaint disclosure will appear below. Click on the link or button to obtain complaint and/or legal action information. Per B&P 7071.17 , only construction related civil judgments reported to the CSLB are disclosed. Arbitrations are not listed unless the contractor fails to comply with the terms of the arbitration. Due to workload, there may be relevant information that has not yet been entered onto the Board's license database. Data current as of 5/26/2017 2:33:30 PM Business Information BEARDEN CONSTRUCTION CO INC dba C B CONCRETE CONSTRUCTION INC 641 UNIVERSITY AVE LOS GATOS, CA 95032 Business Phone Number:(408) 354-3484 Entity Corporation Issue Date 01/11/1991 Reissue Date 02/23/2009 Expire Date 02/2812019 License Status This license is current and active. All information below should be reviewed. B - GENERAL BUILDING CONTRACTOR C-8 - CONCRETE Classifications Bonding Information Contractor's Bond This license filed a Contractor's Bond with AMERICAN CONTRACTORS INDEMNITY COMPANY. Bond Number: SC6083940 Bond Amount: $15,000 Effective Date: 01/01/2016 Contractor's Bond History Bond of Qualifying Individual The qualifying individual CHRISTOPHER BANE BEARDEN certified that he/she owns 10 percent or more of the voting stock/membership interest of this company; therefore, the Bond of Qualifying Individual is not required. Effective Date: 02/23/2009 Workers' Compensation This license has workers compensation insurance with the INSURANCE COMPANY OF THE WEST Policy Number:WLV5027024 Effective Date: 07/01 /2015 Expire Date: 07/01/2017 Workers' Compensation History Miscellaneous Information 02/23/2009 - LICENSE REISSUED TO ANOTHER ENTITY