ENC2017-00190of �a y
r
U
•UkCHAR��
CITY of CAMPBELL
Public Works Department
September 18, 2018
Ed Oreb
1764 Lotman Dr.
Santa Cruz, CA 95062
SUBJECT: PERMIT NO. ENC 2017-00182
1471 Patio Dr., Campbell, CA
FINAL INSPECTION AND ACCEPTANCE
Dear Ed:
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
Cc: Wil Renczes
7o North First Street • Campbell, California 95008-1436 • TEL 408.866.2150 • FAX 408.376.0958 • TDD 408.866.2790
l
.r - _ - -_._ __
-
, a
'
• 'in
fi 1 romp 1 r1 1 1 1
1 1•
,Yr.
r
e �S PMrn •
G 3, ,,AMPI3ELL wEc�cs eARco nxtc x:n
CHECKS DATE' CHECK 'NO.
L.
" ,
:Y
p.-.,•t (, p rt } MOMTGOMERX STREET::
°, s 3 7D NOk `i F(RST STREET
11_za
., 121{t -O � Qcg � �•? . ` � 6. 4:f 92
3 <
v
MPBE. L Cd1Ll ANIA 95008
0 0
AMOUNT * * * * * 2 ;ooa.00*
1
�kcttAa9
}OID AFTER 90: DAYS to 0V�
}
�,°�'k�3�:
.�,
• :' .' - -
} '$�� �
r,
PAY THEr SUM OF TWO THOUSAND DOLLARS CENTS
` m
<
,&'ZERO
F
TO THE ED OREB t/
>4
$ ,
>� 7
ORDER 1.7 64" 'LOTMAN -DR
SANTA CRUZ-CA 95062
JY'#
-
i"
w
II■ 2 6 4 6 9 2 F►�' 1: i` It0 0 c�`4'88l' `4 1 2 18.5 S
• F
C. A.
JoAnna Thomason
From: Carolina Vargas
Sent: Monday, November 20, 2017 10:33 AM
To: JoAnna Thomason
Subject: RE: check request
Check was paid on 10/13/17.
Carolina Vargas
Accounts Payable
City of Campbell Finance Department
70 N. First Street Campbell, CA 95008
www.citvofcampbell.com 1408.866.2170
-----Original Message -----
From: JoAnna Thomason
Sent: Monday, November 20, 2017 10:21 AM
To: Carolina Vargas
Subject: RE: check request
Thanks,
Can you see if it was ever cashed. I might have sent it out without noting it in his file.
JoAnna Thomason
Office Specialist
City of Campbell Public Works Department
70 N. First Street Campbell, CA 95008
www.citvofcampbell.com 1408.866.2150
-----Original Message -----
From: Carolina Vargas
Sent: Monday, November 20, 2017 9:56 AM
To: JoAnna Thomason
Subject: RE: check request
Good morning JoAnna,
Yes, I did issue a check on 10/09/17 please see attached. Let me know if you have any questions.
Thank you,
Carolina Vargas
Accounts Payable
City of Campbell Finance Department
70 N. First Street Campbell, CA 95008
1
t • ' r
www.citVofcampbell.com 1408.866.2170
-----Original Message -----
From: JoAnna Thomason
Sent: Monday, November 20, 2017 9:46 AM
To: Carolina Vargas
Subject: check request
Hi Carolina, I was reviewing my file, and it doesn't look like I ever received this check. Do you show ever issuing a
check?
Thanks
JoAnna
JoAnna Thomason
Office Specialist
City of Campbell Public Works Department
70 N. First Street Campbell, CA 95008
www.citVofcampbell.com 1408.866.2150
z
°F ' C4,
�Aa
n"Asir
U r
0 0
F' G�
'k CHARO
CITY of CAMPBELL
Public Works Department
Ed Oreb
1764 Lotman Dr.
Santa Cruz, CA 95062
SUBJECT: PERMIT. NO. ENC 2017-00190
1471 Patio Dr.
FINAL INSPECTION AND ACCEPTANCE
Dear Ed:
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 21, 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 $2,000.00 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 ENC2017-00190
Wil Renczes
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 # ` -2-e i7-aC, 6
Address:
Date of. Final Inspection and Acceptance: 9 j7 /I&
Inspected by: S�
OK to release deposits: 100% ✓ 75%
CnmmPntc�
CITY of CAMPBELL
Public Works Department
November 20, 2017
Ed Oreb
1764 Lotman Dr.
Santa Cruz, CA 95062
!r
SUBJECT: PERMIT NO. ENC 20 0-00190
1471 Patio Dr., Campbell, CA_��''"
FINAL INSPECTION AID't�CCEPTANCE
Dear Ed:
The City of Campbell has made a final inspection of subject Public Works improvements
on September 21, 2017 and finds the work to be acceptable and in confo ce_with City
standards. Accordingly, the City Engineer accepts the improvetr�enTn
The one year maintenance period stated in the permit be,�a (on September 21, 2017.
permittee is responsible for the repair and/or replaceme� t o y defective wore
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 $2,000.00 was previously mailed out to
you in October.
If you have any questions, please call me at (408) 866-2165.
Sincerely,
"e Waliid
Pu is Works Inspector
Cc: Inspector /Suspense Files
Permit File ENC2017-00190
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. 7 —CC) 19 G
DEPT. OF PUBLIC WORKS X-Ref File
(Non -engineered worl<within the public right-of-way)
70 North First Street ($10,000.00 maximum value of work) Application Date •
Campbell, CA 95008 //(�, Application Expiration
ISSUED:
Ph. (408) 866-2150 l v�� Date
Fx. (408) 376-0958 Permit Expiration Date: APN �\ 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: ,11 II
B. Nature of Work:�� S C��
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: r Telephone:
Address:
111011
e
t\ E-Mail.Address: J
.... ... .... ......_._...-.._.. _.....__ .......
The Applicant hereby confirms that this work is being done by the operty 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 u derstand b h the front and back of this permit, and that they will inform their
contractor(s) of the information.
ACCEPTED: _-- Off' ( U,7 a-
.(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.
1\
3
SECURITY FOR FAITHFUL PERFORMANCE
STANDARD AMOUNT�y
RECEIPT NO.
r
!
(100% Of Engr's Est.) $ ICJ
R-1 PERMIT FEE
^ $ 7�%C�rT—
270 S
J
i
APPROVED FOR ISSUANCE:
City Engineer
Date
j
L�
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 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 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 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
munlCirnal stnrm drain system other than storm Water. Annlir� nt shall adhere to the RFCT MANAGEMENT PRACTICES ostabli�hod by
.r.,....__..- �...... adhere ... .
the Santa Clara Valley Urban Runoff Pollution Prevention Program.
Applicant shall be responsible for ensuring that
conditions.
Applicant
providing services under the applicant are aware of and understand all of the above
6, /C,7
Date
JAFORMS\Templates\Encroachment Permits\R-1 Encroachment Permit STATIC form2.pdf
R o n-) n a
1
-.P0"_I.U "Ie'':_
.-
,-- e D.:. O s
iL-':t' .��4-h_�C..I
C*.;:`R'e1�'4_'�-`d0
'
�
..'
"
-II.-�-�-
,4 '
-
,
3
!
t
4',, 'l_.jC
-", -To-FinanceDirectorF j1i
.t�'")'
Check Payable 6_dJQreb 1
M1 � ?Address in6f1i 64-L�ikiA.6r��" `
1� 'P;,': 2 ,t'1P
-_
�''
6.1.
:
..
i
City
I ,h y"_Santa
---, ia..-. h'4lt.,' ju��. t11,-
State ........ C
"A' Z--j" I - ,,.
95062
�-b,,e"'�1:si-,"d,rptt ip:-�n-.-'EN'C2017*d':..p.1-,. .7.9
e- ''
,r--
� -
-
.-
'''"
.- _ ..
,'
Account.,NWn�6r-i61.910 Amount 2jOQO QQ
I.,'`
,
�
,."
Account: .Num6r- -1220&,`Amount s
1
_ I i .-
, t,
.A--�" m-O"-�--..un ,-I' -- u.m _.d.,'n
,1
4df.6�'.4',- 1,4%-.. 4'-' I.,
.6
A.�- R-y.p
O
�
,II ...7
,
-
.
I-
(FinanceDeptonly) hteresiXiifed ' (YIW6ngtLonly) —
" '�
-
'I, "
,TotW;PayabI,M-i1&66,�A�6!-'
L '
-".jA_',d
p,-,4s
. 4
�-'_'N Q'..�70
0''
'-1--.'''
.4?..0',"',;
e-p R_'"-�_e-
n
�
Y. Permit gN 2QT7rQ,
Q
j..'�
c';'
-"
.
�
�.._
'
,
�.
-
.
-.
:
i.
-
-, -
1
..
,
'
:
'
,
.-.I.�.
.. .., .';.
....I
_'--
.
�.
'
.,'
;L.',
"
t
-I
_f -1 .
.''
:
.�
....I."
:-
. AO
,-
1I
I
.,
I
I�
.i
1:,
Receipt:#1,C270807Date _t 627I'
Rb6b1pt-#F Date
eMpd,bvq_- Title 1- ft60�t�FDate
qVed"Wafiidf"I
r " - '%v
Aoprved byTitle -,Srr,,Engineer,-POte _
RogerStKpr-
f I ; , - "
I
I4I
l
i.'
i
.nanda-Dept -0pI '.�
!I
i
'
�
1:I
Verified ,bY1 " Title 4Ad666Oiing"C,erkL1Date '.,
rovedbTitle-' AccQuntantDate -�--p "
' ' Z- �
5; ec - ;I1 oant F_ ,-'tn.4-
maii As is 6C16P"Ime fi-Gnd6k
�'r
,1 "
�Il1
i
-
"
.Z1
' A '"- -1�'
, , Needed By
1'-
Re nToJwAn0&'Thomason
Om 1k:W rki'
�(Name) )F I(Department)F-a
;'_ ' , ,�I-
1
r, dik6r�OIgpq, return 'ChqqOfipJ0I ,,
t 'I--k
!
j
�
1
-
..
Y
.y f' r.-,li
�
:
t
,
"_ - r - - "-" .
'
..
, '-
.".. - ,. - - -
,.'
CITY OF CAMPBELL
PUBLIC WORKS DEPARTMENT
CLEARANCE FOR FINAL INSPECTION
AND ACCEPTANCE LETTER
Encroachment Permit#: ENC 2017-0.0190
Name: Ed Oreb/Wil Renczes
Property Address: 1471 Patio Dr.
Date of Final Inspection:
On File: Bonds CD Cash
Labor and Material: $
Construction Cash Deposit_to-be-..r..eleased: $
Faithful Security Depo�: $2,000.00
Other overdue deposits.to be released (Description):
Processed by:
N
Administrator
Reviewed by:
\�I. pector
Reviewed by: V/V) 9 I'
Land Development
J:VoAnnaT\Deposit refunds\CHECKLISTS\Patio 1471.doc (Rev. 10/11)
Encroachment Permit #
Address: `Lt-
Encroachment Permit Final Sign Off
i-- 1\1 .r 9-0 1-1- oG 1 el v
Date of Final Inspection and Acceptance:
Inspected by:
OK to release deposits: 100% 75%
Comments:
PUBLIC WORKS DEPARTMENT UTILITY ENCROACHMENT, TRAFFIC & MISCELLANEOUS RECEIPT
Effective July 1, 2017
TO: Finance 1� G
PUBLIC WORKS FILE NO.
PROPERTY ADDRESS OAT lb
Df—
Pie collect & receipt for the following monies:
47221 Utility Encroachment Permit Application Fee $455.00
Emergency Permits
$130.00
Plan Check & Inspection Fee
Minimum Charge Per Location
$420.00
Conduits/Pipelines up to 500 Feet
$2.95/ft
Above 500 Linear Feet
$1.75/ft
Manholes/Vaults/Etc.
$190.00/ea
Pole Set/Removal
$190.00/ea
4760
Storage Container Permit (valid up to 60 days only)
$170.00
4760
Project Plans & Specifications
Project No.
4760
Standard Specifications & Details $1/Pg $15.50/13k
4760
Engineering Maps & Plans
Aerial Plot 24" x 36"
$65.00
Aerial Print 8 1/2" x 11" -
$32.00
Map Research (includes max of two 24"x36" copies)
$32.00
Maps and Plans 24" x 36"
$15.00
4722
Penalties: Failure to restore public improvements
$100/Calendar Day (Muni Code Sec. 11.34.010)
4722
Penalties: Failure to correct unsafe conditions
$100/Calendar Day
4722
Work Without Permits
4 Times Applicable Fee/Min$500
r
AFFIC
,+ +
r � fr x + �
r
4728
Traffic Flow Map (Daily Traffic Volumes)
$35.00
4728
Signal Timing Information
$73 per hour
4271
Truck Permits
$16.00 per trip
4728
No Parking Signs
$1 each or $25/100
SCELL WEOUS
511.7424
Posta e
?rl�I
Other (Please Specify) FA i7r 7 L SL)coy-f
TOTAL
NAME OF APPLICANT" C (n t-Q�b 2
NAME OF PAYOR -� a irG� PHONE
ADDRESS a (o I�C►ncx\ `� �� ZIP 9 5�
9
r J E A 4 }
^. .. ..
FOR iRECEIVED Y
CITY CLERK
p -
ONLY �Date,� i4 :> �.fteceipt# , � � � Y I
.A P V ()
J:TORMS1Templatesl dministrativetReceipt Form UbIny Encroachment & Misc 17-18.als
Home
Authoril
Residential
Property Pc
Agent:
Named
Insured(s):
The residential �
offer earthquake
not accepted the
(CEA) Basic Eart
Earthquake polio,
urance Offer of California Earthquake FAR M E R S
Policy INSURANCE
Arl-AN-wiv,".0 Itt;ViE-R 0= riK
4-I W11,414i A.'i f Ii71IAn=111l1np1 r, iSAI
92675-53-03 Property 1471 Patio Dr
Location: Campbell, CA95008-2417
Gary E Stribling Print Date: 1/4/2017
(408)371-2000
gstribling@farmersagent.com
Kellisa Sandoval and Wil Renczes
roperty insurance policy referenced above does not provide earthquake coverage. California law requires that insurers
coverage to policyholders when a new policy is purchased and every other year upon renewal if the policyholder has
offer of earthquake coverage. Farmers ® satisfies this requirement by offering the California Earthquake Authority
iquake Policy, which is available to homeowners, renters and owners in a common interest development (the Basic
Below is an offer ofthe CEA's Basic Earthquake policy. This is not bill orinvoice. We are sending this offer because one of the following
applies to you:
a) You recently purchased property coverage under the property insurance policy referenced above;
b) We are oI fering to renew the property policy referenced above and you have not accepted a previous offer of earthquake
coverag�; or
c) We are offering to renew the property policy referenced above and you purchased the CEA's Basic Earthquake Policy - Common
Interest Development. This policy allows you to choose from among three coverage options, and we are sending this offer so you
can review, and if desired, change your coverage options
Offerof California Earthquake Authority Basic Earthquake Policy
(The bolded information in the offer below is mandated by California law.)
Your residential property insurance policy does not cover earthquake damage to your home or its contents.
To cover earthquake damage to your home and its contents you need to purchase a separate earthquake insurance policy. The
coverage provrfled by an earthquake insurance policy is different from, and typically more limited than, the coverage provided
by your residential property insurance policy.
California law requires insurance companies to offer earthquake insurance in conjunction with a residential property insurance
policy. If you do not acceptthe offer of earthquake insurance below within 30 days of the mailing of this notice, your insurance
company shall presume that you have not accepted this offer of earthquake insurance.
fa
25-3489 2-15 1 Pagel of3
Offer of California Earthquake Authority Policy (continued)
You may purchlase earthquake insurance coverage on the following terms:
(A) Amount of Dwelling/Building Coverage Limit: $402,000
(Referred toias "Building Property" coverage in the Common Interest Development Policy.)
(B) Deductible: 15% $60,300
(C) Contents C I verage Limit: $5,000
(Referred tolas "Personal Property" coverage in the policy.)
For a Homeowners Policy, the dwelling deductible applies to Contents Coverage. Nothing will be paid
until the dwelling deductible is met by damage to Coverage A and Coverage B property. For Renters
Policies and Common Interest Development Policies, a selected percent deductible applies to
Contents Coverage.
(D)Additional Living Expense Coverage Limit: $1,500
(Referred to 6s "Loss of Use" coverage in the policy.) No deductible applies to this coverage.
(E) Loss Assessment Coverage: No Coverage
EstimatedAnnpal Premium: $988.00
The Basic Earth' uake Policy Common Interest Development offers three coverage options: (1) Building Property; (2) Personal
Property and Loss of Use; and (3) Loss Assessment. You may choose any combination of one or more of these options.
The deductible) represents the amount of damage your covered property must incur before the earthquake insurance coverage
begins. If your covered loss is less than the applicable deductible, you may not receive any payment.
If you choose not to accept this offer within the 30-day period, you may apply for earthquake coverage at a later date.
Your insura
customers.
Living Expe
coverages
Contact your
other coveral
.insurance poli
farmers
company contracts with the California Earthquake Authority (CEA) to offer earthquake insurance to its
an additional premium, you can choose CEA coverage options such as higher limits for Contents or Additional
increased building code upgrade limits, or a lower deductible. You can also choose to buy certain CEA
surance agent or your insurance company to obtain details regarding this offer of earthquake insurance and
options. Please note we will not consider the offer received until the effective date of your residential property
even if your acceptance is received by us before that effective date, and only if the premium quoted above is paid.
25-3489 2-15 1 Page 2 of 3
California Earthquake Authority -Availability
of Hazard -Reduction Premium Discount
CALIFORN/A
�E
AAR7HQt/AKE
[fiHOR17Y^
L-THE STRENGTH
'TO RtBUILW
A participating Insurer of the California Earthquake Authority (CEA)
The California Earthquake Authority (CEA) offers a Hazard -Reduction Premium Discount to policyholders who have followed qualifying
procedures to reIIrofit their houses to make them more resistant to earthquake damage. The following describes requirements and
available discounts:
1. If your home is a single-family dwelling (house)
You maybe eligible for a 5 to 20 percent Hazard Reduction Premium Discount if the insured dwelling meets all of the following requirements:
1.1 Basic req I irements (all must be met)
a. the dwelli g is of wood -frame construction, built before 1979; and
b. the dwellinq is built on a raised foundation; and
c. the dwelling is anchored to the raised foundation in accordance with California Building Code (CBC) standards using approved
anchor bolts, or foundation anchors; and
d. the water heater is secured to the building frame in accordance with Guidelines for Earthquake Bracing of Residential Water
Heaters (California Department of General Services, Division of the State Architect). Tankless water heaters shall be installed in
accordance with the manufacturer's requirements.
1.2 Additiona) mandatory requirements (based on home construction)
a. If the dw0ing has cripple walls, they all must be braced in accordance with CBC standards, using plywood or its equivalent that
is installe according to CBC standards.
b. If the dwelling has a post -and -pier or post -and -beam foundation, the dwelling must, in compliance with CBC standards, have
foundatio is that are placed continuously under all exterior bearing walls, be anchored to the perimeter foundation, and have all
cripple walls braced.
Discount procedure: In order to obtain a basic, 5% discount, policyholders must verify that all the requirements above have been met.
To obtain higher discounts, policyholders are required to submit a CEA Earthquake Insurance Dwelling Retrofit Verification form
(CEADRV (01/2016)) -please contact your agent, broker, or residential insurer for details or to obtain the necessary form.
Note: Dwellings1built on a "slab" or "other" foundations types do not qualify for the discount.
2. I f your home is a manufactured home (mobilehome)
You maybe eligible for up to a 23 percent Hazard Reduction Premium Discount if the insured manufactured home (Mobilehome) meets
either of the following requirementsandusesthediscountproceduredescribedbelow:
2.1 The manufactured home (mobilehome) is reinforced by an Earthquake Resistant Bracing System (ERBS) of type certified by the
State of California, Department of Housing and Community Development; or
2.2 The manufactured home (mobilehome) has been positioned on an approved foundation system in accordance with subdivisions
(a) or (b) of section 18551 of the California Health and Safety Code.
Discount procedure: In order to obtain the discount, policyholders who have installed an ERBS or an approved foundation system will
be required to provide to the participating insurer a copy of final inspection report that verifies prior issuance of building permit and
that the system acid installation meet California Department of Housing and Community Development certification or county building -
Inspection requirements.
fa
Policy No. 92675-53-03
25-4494 2-15 1 CEA 02S (01 /2016) Page 3 of 3
Next Ge eration Homeowners Declaration
Page
PolicyNumber: 1 92675-53-03
Effective:
2/25/2017 12:01 AM
Expiration:
2/25/2018 12:01 AM
Namedlnsured(s)
Kellisa Sandoval and Wil Renczes
1471 Patio Dr
Campbell, CA95008-2417
e-mail
kellisa@gmail.com
Address(es):
Property Insured:
1471 Patio Dr
Campbell, CA95008-2417
Underwritten By:
Fire Insurance Exchange
6301 Owensmouth Ave.
Woodland Hills, CA91367
Descriptior
Year of Constru
1956
Property Co,
Coverage
Coverage A - Dwi
Extended Repl
................................
Coverage B - Sep
............... _...... _..-_-
Coverage C - Per:
Contents Repli
................................
Wild Fire Smoke,
Damage
Liability
If Property
on Construction Type
Frame W/ 0%-33% Mason ry Veneer
Limit
I ling
$402,000
icement Cost
$100,500
................. ..---- ------ ................ ..
irate Structures
- .. .. .. .
$40,200
.......... .................... -- - - -- --
onal Property
$301,500
cement Cost
Covered
.....................................................................
Soot, Char, Ash or Odor
......... I—........
$5,000
Limit
Coverage E - Persnal Liability $300,000
Personal Injury Covered
_..........................................................._...................._..............._......_...........
Association Loss Assessment Not Covered
Deductible
Applicable to each, covered loss
farmers.con5 Policy No. 92675-53-03
FA,R ME RS
Premiums
Policy Premium $941.39
Your policy premium includes a Total Discount Savings of $580.95
*also see Information on Additional Fees below
This is not bill.
Your bill with the amountdue will be mailed separately.
Roof Type
Number of Units Occupancy
Tile - Concrete 1
Owner
Occupied
(Primary Res.)
Coverage
Limit
Coverage D - Loss of Use
$196,800
Additional Living Expense Term
24Months
.........._................................._..........._ ... -....._......................-_._..........
Identity Fraud Coverage
........._.............._..........
$30,000
- - ._-.................... ..........
Building Ordinance or Law
------ - - - ............. ..
10%
Coverage Limit
Coverage F - Medical Payments To Others $1,000
Deductible
$1,000
Questions? Manage your account:
Call your agent Gary E Stribling at (408) Go to www.farmers.com to access
371-2000 or email your account anytime!
gstribling@farmersagent.com
56-6177 lstEdit$n 4-15 1/4/2017
Page 1 of 3
Decia
Page (continued)
DiscountsAbplied to Policy
DiscountType
Auto/Home
...........................
Non Smoker
11110- Total Discount Savings
Mortgagee Other Interest
1st Mortgagee Loan Number
Specialized Loa Servicing LLC 1012071921
ISAOA
PO Box 620188
Doraville, GA30362-2188
DiscountType
Experience Rating Plan
....... .... .... ....... .... .... ........................ I......... .
Home/Life
$580.95
2nd Mortgagee Loan Number
Pnc Bank National Assc ISAOA 0003853731
ATI MA
PO Box 7433
Springfield, OH 45501-7433
Mortgagee eductible Clause
The following pr'is
ion applies only if mortgagee is named in the policy:
For any loss in w ich only the mortgagee's interest is adjusted and settled, not including any interest you may have in the property or
loss, the applicable deductible will be the smallest of the following amounts:
1. The deductible stated in the declarations or renewal notice, or
2. $1,000.
The policy deductible stated in the declarations or renewal notice will apply to settlement of any interest you may have in the property or
loss.
Policy and
This section lists the policy form number and any applicable endorsements that makeup your insurance contract. Any endorsements
that you have PL rchased to extend coverage on your policy are also listed in the coverages section of this declarations document:
56-5532 3rd ed. J6235 2nd ed.; J6965A 1 st ed.; 25-8531 10-12; 438BFUNS 5-42
Other lnfor
• Your policy
• Please cont
Youragent
available to
• Farmers SrT
you qualify
Homeowne
• The attorne
paid out ofI
your policy.
• This policy i
• The limit of
cost for lab(
as a Actual Cash Value Loss Settlement Endorsement For Roof Coverings; see endorsementJ6235.
ct your Farmers® agent for a free Farmers Friendly Review® so that you can ensure that your family is properly protected.
an explain all of the policy discounts/credits, coverage options and our various other product offerings that maybe
ou.
in Plan Home® Policy offers less coverage than is available in the Farmers Next Generation o Homeowners product. If
nder Farmers underwriting guidelines, you maybe eligible to purchase reduced coverage in the Farmers Smart Plan
so product for a reduced premium. You may contact your Farmers o agent for additional details.
-in-fact (AIF) or management fee for your renewed policy will never exceed 25% of the policy's premiums and will be
1e premiums. You may wish to consider this information in deciding whether to acceptor decline this offer to renew
:ludes 10% Building Ordinance coverage (calculated as a percentage of coverage A or B) as applied perthe policy.
bility for this structure (Coverage A) is based on an estimate of the cost to rebuild your home, including an approximate
and materials in your area, and specific information that you have provided about your home.
farmers.cdm
Policy No. 92675-53-03 Questions?
Call your agent Gary E Stribling at (408)
371-2000 or email
gstribling@farmersagent.com
Manage your account:
Go to www.farmers.com to access
your account anytime!
56-6177 1st Edition 4-15
1 Page 2 of 3
Declarati
The "Fees" state
also apply:
1. Service Chz
agreement 1
For Recur
and fully,
(applied I
For other
For all otF
If this account is
are not effective
each policy.
Authorized
fa
Page (continued)
on Additional Fees
in the "Premium/Fees" section on the front apply on a per -policy, not an account basis. The following additional fees
ae per installment (In consideration of our
allow you to pay in installments):
ig Electronic Funds Transfer (EFT)
rolled online billing (paperless): $0.00
r account)
Dcurring EFT plans: $2.00 (applied per account)
r payment plans: $5.00 (applied per account)
)r more than one policy, changes in these fees
ntil the revised fee information is provided for
2. Late Fee: $10.00 (applied per account)
3. Returned Payment Charge: $25.00 (applied per check,
electronic transaction, or other remittance which is not
honored by your financial institution for any reason including
but not limited to insufficient funds or a closed account)
4. Reinstatement Fee: $25.00 (applied per policy)
One or more of the fees or charges described above may be
deemed a part of premium under applicable state law.
Policy No. 92675-53-03 Questions?
Call your agent Gary E Stribling at (408)
371-2000 or email
gstribling@farmersagent.com
Manage your account:
Go to www.farmers.com to access
your account anytime!
56-6177 1st Edition 4-15
1 Page 3 of 3
�f
NWT
AN 41
r.
11
GARY � STRIBLING
280 E HAMILTON AVE #C
CAMPBELL, CA95008
Horne Insurance Renewal Offer
KSANC
1471 Pi
CAMP
1/4/2017
Dear Kellisa
Thank you for(
opportunity to
DVAL, W RENCZES
TIO DR
-LL CA 95008-2417
and Wil Renczes,
1 Farmers for your homeowners insurance needs. We appreciate the
continued coverage for you and your family.
Please review the renewal documents that have been enclosed:
• Declaration page — a summary of your insurance coverages, limits, and deductibles
• Detailed reconstructioncostestimateof your home
Asummary ofyor premium and policy change information is shown below. With this
renewal, you'll see an increase in your home coverage limits. This change reflects the rising
cost to replace h�mes in your area, including labor and construction materials.
Premium at-a-glance
........................................................................
Policy Premium $941.39
Summary of changes
Coverage: Dwelli g
Coverage: Loss of Use
Coverage: Perso al Property
Coverage: Separate Structures
Previous
Renewal
$392,000
$402,000
$192,800
$196,800
$294,000
$301,500
$39,200
$40,200
This is not bill. Your bill with the amount due will be mailed separately.
If you prefer, you :an log into farmers.com today to review your balance and make a
payment. You can also contact us at 1-877-327-6392 or visit your agent's office with your
payment.
Sincerely,
Farmers Insuranc Group®
fa
FARMERS
NSU,RANC:E.
Your Farmers Policy
Policy Number: 92675-53-03
Effective: 2/25/2017 12:01 AM
Expiration: 2/25/2018 12:01 AM
Property Insured
1471 Patio Dr
Campbell, CA 95008-2417
Your FarmersAgent
Gary E Stribling
280 E Hamilton Ave #C
Campbell, CA95008
(408)371-2000
gstribling@farmersagent.com
To file a claim call
1-800-435-7764
Did you know?
rim
it
Farmers Friendly Review
Contact your agent to learn more
about the policy discounts, coverage
options, and other product offerings
that may be available to you.
�1 Farmers' RewardsVisa•Card
Apply today for the Farmers
Rewards Visa card, offered by
Comenity Bank! This program gives
you flexible rewards for your
everyday activities. Learn more at
farmers.com/frv.
Terms and Conditions Apply
25-8164 1-14
70,
SN
O��• P� 4'-0"
G�
OIL �� SIDEWALK
R I�� MECHANICAL SEPARATOR
CONSTRUCTION
JOINT
SIDEWALK
SEE NOTE 5 WEAKENED
PLANE JOINT
OR CUT JOINT
SIDEWALK �p'I 1 /8" WIDE,
2' DEEP
25
WEAKENED PLA E' JOINT P
OR CUT JOINT /8" WIDE,
2" DEEP
D
L - �3/�4-
�s 5/8'.
FOOT PER • OR\
... o., 1 „R
�— 1 /2" R
R 10'-0"
4'-6" 5'-6" '2'-0"
+10% MAX 6"
CONFORM\_ SLOPE 1/ 4" PER FT.
—6% MAX :, ..: • : •. •..: ..:a.::. :o-;: - a:Q:: • ....o.,.
6" CLASS A CONCRETE, TYP. ` °;' ` ° ' °. ' °•
6"
6" CLASS 2 AGGREGATE BASE, TYP.
NOTES
SECTION A —A DOWEL
1. WHEN THE DR VEWAY IS NOT POURED AT THE SAME TIME AS THE CURB AND GUTTER, 12" OF NO. 4 REBAR AT 4'
INTERVALS SHALL E 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.
5. AT LOCATIONS IWHERE NEW SIDEWALK ENDS AND MEETS AN EXISTING SIDEWALK, THE NEW SIDEWALK SHALL
TRANSITION TO MEr THE EXISTING SIDEWALK AS DETERMINED BY THE CITY ENGINEER.
F OC e jjA I CITY OF CAMPBELL REV. DATE BY SCALE:
PTrBLIC WORKS DEPARTMENT Residential N.T.S.
DRAWP BY: DATE 02/04 Driveway Detail DETAIL
• O CHEC HY: DATE
's� tics CHE VED BY: (Attached Sidewalk ) NO'
°RcgeBo McCHEUcUINN J:/Drawings/Std Details/D15 D — 1* 5