ENC2017-00281 of o14 y�
' r
•�RCHO.0
CITY of CAMPBELL
Public Works Department
December 14, 2018
Mr. Spencer Peterson
1361 El Moro Dr.
Campbell, CA 95008
SUBJECT: PERMIT NO. ENC 2017-00281
1361 El Moro Dr., Campbell, CA 95008
MAINTENNACE INSPECTION AND ACCEPTANCE
Dear Mr. Peterson: -
The City of Campbell has made the final 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,
4
U-"
Syed Wahidi
Public works Inspector
ce:
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# U 2--o,te -�e2.�%�
Address:
Date of Final Inspection and Acceptance:
Inspected by:
OK to release deposits: 100% 75%
Comments:
of 7 CAA
•�R CH ARO.
CITY OF CAMPBELL
Public Works Department
January 16, 2018
Spencer Peterson
1361 El Moro Dr.
Campbell, CA 95008
SUBJECT: PERMIT NO. ENC 2017-00281
1361 El Moro Dr., Campbell CA
FINAL INSPECTION AND ACCEPTANCE
Dear Spencer:
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 December 12, 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 arid notify you, in writing,whether or not any repairs are required.
Your Faithful Security Deposit in the amount of$5,000.00 is enclosed.
If you have any questions, please call me at (408) 866-2165.
Sincerely,
Syed Wahidi
Public Works Inspector
Cc: Permit File ENC 2017-00281
70 North First Street • Campbell, California 95008-1436 TEL 408.866.2150 FAX 408.376.0958 TDD 408.866.2790
of C411
�< cry.•._ �;
.. •EACH A�i0_ .
CITY of CAMPBELL
Public Works Department
January 16, 2018
Spencer Peterson
1361 El Moro Dr.
-Campbell, CA 95008
SUBJECT: PERMIT NO. -ENC 2017-00281
1361 El Moro Dr., Campbell CA
FINAL INSPECTION AND ACCEPTANCE
Dear Spencer:
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 December 12, 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$5,000.00 is enclosed.
If you have any questions,please call me at (408) 866-2165.
Sincerely,
Syed Wahidi
Public Works Inspector"
Cc: Permit File ENC 2017-00281
7o North First Street Campbell, California 95008-1436 TEL 408.866.2.150 •FAX 408.376.0958 TDD 408.8.66.2790
........................................
...................
.................... .............................. ...................... ............... ............ ....... .........
........... .....................
------------------------------------I-----------------------
CITY OF CAMPBELL VENDOR NO. 10014711 CHECK NO. 266043
101 2203 CRO10418 -2,500.00
1361 EL MORO DR.'.RPND
V
10014711 SPENCER PETERSON
'CHEM'DATE
EL' ""CHECK NO.C.-.,lT-.Y---:-0!Fl�-'AMPB' L v�`-
11-24
70'NORTH FIRST STREET V�:Q.:��-NONTGOMERY STREET 72-1-0 266043
.-.1.:W-FRANCl$CO3, CA 94104 01 8
CAIVIPBEL�-'--',��CALIFORNIA 95008
0
0
AMOUNT *2,;-500 0
E�i:::I:i:i:�::VOID i�PTER,,90,.DA-kS",
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NY THE SUM- OF ZERO-CENTS
RO,
TWO, THOUSAND, FIVE HUNDRED DOLLARS & E CENT8,".-I, co
SPENCER:
PENC R: PETERSON
DE
J�-LWOOD
R
13.61
. .. .........
CAMPBELL "CA 95 008
-8 S 51 Ai:�-l.'l,21 .15
fln 26604� -
----------------------------------------------------------- ---------------------I--------- --------------I-------- -------------------------------------------m-------------------------
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*See Reverse Side For Easy Opening Instructions*
---------------------------------------------------------------------------- ------ ------------- -- -----
CITY OF CAMPBELL
70 NORTH FIRST STREET
CAMPBELL, CALIFORNIA 95008
SPENCER PETERSON
1361 ELWOOD DR
CAMPBELL CA 95008
` Ref undable: Deposit.Check. Request
To: Finance Director _
Check Payable To Spencer Peterson
Address':- Line"I 9361 Elwood`Dr..:_
Line.2:
City: Campbell State: CA• Zip::95008 - :-
Descriptiob: _ I 361 EI.Moro•Dr.
Account Nurhber: 10T.2203' Amount: $2,500 00.
Accd'unt.Number...` 101:2203 - ' Amount:
Account Number: 101-.- 40.7448. Amouht:
(Finance Dep►only) I Inferesf Earned , Dept only)=
Total Payable:... - (Exact.Amount)
Purpose: 1-361•.EI Moro:Dr..:FPS Refurid_.
_ Pe if*'
ENC2017 00291
Recei pf#: 272586 Date:. .11/29%2017
Receipt_#: Date:
Requested py;. : �.'. Title Inspector Date77 .
Syed Wahidl
Approved py Title: . Sr:`Engineer' Date:
Roger Stoci
Finance'Dept Only.:. ,
Verified•by: Title: Accounting.Clerk 11' Date:
'Approved by: Title: Accountant Date:-
5 ecidl -, r - Handling. C. heck
mall P1 ;' Mail ln,AttBched Envelope: -lmermuneCK: _
. Needed By:
ReturrrTo JoAnna.Tfiomason ' Public Works.
" (Name)` (Department)
_,' Dt'her:, Please:retuM check to idAnna'
JoAnna Thomason
From: nosretep22 <nosretep22@gmail.com>
Sent: Thursday,January 04, 2018 8:48 AM
To: JoAnna Thomason
Subject: RE: 1361 El Moro (ENC 2017-00281)
Please mail the check to my home.
1361 El Moro Drive
Campbell 95008
Thank you,
Mr. Spencer Peterson
Sent via the SainSLIng Galaxy S8+.an AT&T 4G L.TE smartphone
-------- Original message --------
From: JoAnna Thomason<joannata�cityofcampbell.com>
Date: 1/3/18 2:00 PM (GMT-08:00)
To: Syed Wahidi <SyedW(akityofcampbell.com>, 'Spencer Peterson' <nosretep22acgmail.com>
Subject: RE: 1361 El Moro (ENC 2017-00281)
The refund paperwork was sent to our Finance Dept.the day before the holiday shutdown, and the check will be ready
on January 15th. 1 can mail it or you can pick it up at that time.
JoAnna
JoAnna Thomason
Office Specialist
City of Campbell PLibIiC WOH(S Department
70 N. First Street Campbell;CA 95008
b1 4V4V.CIlVOICalllpbl l l.CCHl1 408.866.2 150
1
CITY OF CAMPBELL
PUBLIC WORKS DEPARTMENT
CLEARANCE FOR FINAL INSPECTION
AND ACCEPTANCE LETTER
Encroachment Permit#: ENC 2017-00281
Name: Spencer Peterson
Property Address: 1361 El Moro Dr., Campbell CA
Date of Final Inspection:
On File: Bonds CD Cash
Labor and Material:
Construction Cash Deposit to be released:
Faithful Security Deposit: $2,500.00
Other overdue deposits to be released (Description):
Processed by:
Administrator
Reviewed by: ..
Inspector
Reviewed by: r6
Land'Development Engineer
J:VoAnnaT\Deposit refunds\CHECKLISTS\Campbe11400..doe(Rev. 10/1 I)
Encroachment Permit Final Sign Off
Encroachment Permit.# 2S 1
Address:
Date of Final Inspection and Acceptance:
Inspected by: w
OK to release deposits: 100% 75%
Comments:
V/
• Print Form a
CITY OF CAMPBELL R-1 ENCROACHMENT PERMIT Permit No. (= O 1 _
DEPT.OF PUBLIC WORKS (Non-engineered work within the public right-of-way) X-Ref File
7UNorth-FirstStreet ($10,000.00-rrraximun vatue-ufwark)- -Appheation-Date- \\I-,r.i Campbell,CA 95008 Application Expiration G
Ph.(408)866-2150 ISSUED: it
// O I 1 Date = ,1 _
Fx.(408)376-0958 Permit Expiration Date: t 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:
. .�ep li'kC ..... LL i7..:`..._..!�..M:....W i7I-1.......AD,-\..���.PLt.�N r.....'�W�f:.....�"10\Ci.+
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: Telephone: o��
_........... .1 ?,1 'ice._...._...._.......__._.._.._. .._... _ ...._.J _.
Address:
..tiLo ............EJf....................... 4� � _ .._ _.._.___M.......................................
E-Mail Address: 2Zk—p-
........._.__...... a.... ................. ............. . . ..... ... ................_............__._..................._............ ..
The Applicant here by confirms that this work is being done bythe 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:
(App N nt/Permittee) •(Sign) Date
NOTES:- -All-work shall conform withtheattachedapproved-plans and at?applicable Campbefl-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.:
AppUcantisadvised_thatupon issuanceof.this.permit,properry_owner,or property_owner'successors,shai[be-responsihlefor_any-andall.
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. r_
3• \
u
- M
s.
STANDARD AMOUNT CD c' RECEIPT N0.
SECURITY FOR FAITHFUL PERFORMANCE (. 0%Of Engr's Est) $ S`Gd
R-1 PERMIT FEE $
APPROVED FOR ISSUANCE:
for City Engineer Date —
Permit Expires 6 Months after Date of Issuance.
V(x Con*-+rw•L4 J�,% ✓1il- U-) prj r 2—J cl<,
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.
A.- Submit-pruject*schedule10-layspriartoproposedsta,tofwork.-Special-provisions-may be required,foF-workwithinCityfacilities-
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 shaft 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 shouiderline,
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. t
is. 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
municipa!storm drain system other than storm water. Appiicant shall adhere to-the BEST MANAGEMENT PRACTICES established by
the Santa Clara Valley Urban Runoff Pollution Prevention Program.
Applicant shall be pon'�sib foe ensuring that all those providing services under the applicant are aware of and understand all-of the above
conditions. �re
k�t—
Applicant a Date
J:\FORMS\Templates\Encroachment PermitAR-1 Encroachment Permit STATIC form2.pdf
Rev.02/14
� S\
P� 4'-0"
SGO� g6 GF-
Qiy1 SIDEWALK
MECHANICAL
SEPARATOR
CONSTRUCTION
JOINT
SIDEWALK
SEE NOTE 5 WEAKENED
PLANE JOINT
OR CUT JOINT
SIDEWALK 1/8" WIDE,
2��p
2" DEEP
WEAKENED .PLANE JOINT
OR CUT JOINT 1_/8" WIDE, \\�• P
2" DEEP
�O -
3/4" .
PER FOOT 5/8"
I"R
1/2„ R
10'-0"
4'-6" 5'-6" 2'-0'
+10% MAX 611
CONFORM SLOPE = 2.0%
—6% MAX a:: :d::• a;: e...
6" CLASS A CONCRETE, TYP. °'o: ' ° '•°:': + '°:: 6"
6" CLASS 2 AGGREGATE BASE, TYP.
NOTES SECTION A—A DOWEL t
1. -WHEN THE DRIVEWAY IS NOT POURED AT THE SAME TIME AS THE CURB AND GUTTER, 12" OF NO. 4 REBAR AT 4'
INTERVALS SHALL BE INSTALLED AS SHOWN (REBARS TO BE BENT DOWN AND COVERED UNTIL USED).
2.. SCORE MARKS SHALL NOT EXCEED 4'-0" D.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 WHERE NEW SIDEWALK ENDS AND MEETS AN EXISTING SIDEWALK, THE NEW SIDEWALK SHALL
TRANSITION TO MEET THE EXISTING SIDEWALK AS DETERMINED BY THE CITY.ENGINEER.
og CAAfA CITY OF CAMPBELL REV. DATE BY SCALE:
PUBLIC WORKS DEPARTMENT 1 02/17 12 Residential N.T.S.
DRAWN BY: DATE 02/04 Driveway Detail DETAIL
•a °'°'qa°j �• CBECIM BY: DATE (Attached Sidewalk ) NO.
♦d, G`� APPROVED BY:
ANY OLAY
�RCgsa9 CreY ENGINEER J:/1)rawings/Std_Details/D15 D — 1 5
�.��• vv cm,i�Yweb W% r),r L4.) rj'rO1 K—� eiG
GENERAL PERMIT CONDITION
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 applicants
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 projectschedule 10-dayspriorto-proposed-start-of work.-Special provisions-may be requiredfor-workwithirrl♦tyfaci}ities-
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
5peclficatiorts 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 C1ty 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 maybe 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 nat 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
munidnal storm drain system other than storm water. Applicant shall adhere to-the REST MANAGEMENT PRACTICES established by
the Santa Clara Valley Urban Runoff Pollution Prevention Program,
Applicant shall be fs onsibl jfoe ensuring that all those providing services under the applicant are aware of and understand all ofthe above
conditions. -
Applicant` > : ( Doi j �—�JAFORMS\Templates\Encroachment Permits\R-1 Encroachment Permit STA-Kformlpdf
Rev,02114
v
Renewals and Inquiries
Your AAA Homeowners Policy renews automatically on each anniversary of your inception date.The Homeowners policy
renewal Declarations (both front and back pages), the Billing Wan Explanation, the most recent version of the
Homeowners Policy booklet and anything else we provide to you that states that it is a part of our renewal offer, .
together constitute the terms under which we have renewed your AAA Homeowners policy.
As a AAA Member Organization, we take pride in putting members first. Should you have inquiries or complaints
regarding your policy,please contact our Insurance Service Center at(800)922-8228.
If you have contacted us to discuss your policy and remain unsatisfied by our response, you may have the matter
reviewed by the Department of Insurance.Their telephone number is(800)927-4357.
Please allow us the opportunity to answer your questions before contacting the Department of Insurance.
Notice of Non-Renewal
We are required to notify you at least 45 days before policy expiration if we do not offer a renewal of your policy. If we
do not notify you 45 days in advance,your policy continues in effect unchanged for 45 days until we provide a notice of
non-renewal.
Allowing Someone Else To Receive Your Non-Payment Notices
You can select another person,in addition to yourself,to receive the following notices about your insurance policy:
notices of lapse,termination,expiration,nonrenewal,or cancellation of your policy for non-payment of premium.You
can remove or replace this person at anytime.This person will not be covered under your insurance policy and cannot
make any changes to your policy.If you would like to select another person to receive these notices about your insurance
policy,call an Insurance Customer Service Specialist at(800)922-8228,Monday—Friday between 7 AM and 9 PM,or
Saturday and Sunday between 7 AM and 7 PM,Pacific Time.
AAA Northern California,
Nevada Exchange Utah
Insurance Homeowners Policy Declarations
PO Box 22221,Oakland CA 94623-2221 See Important Notices on Reverse
For questions or changes call: 1-800-922-8228
Page 01 of 01
Membership Number Homeowners Policy Number
474-96-05-4 HO-GU-62-91 7
Named Insured and Mailing Address From a 12:01 A.M.Pacfic Standard
I��l'�II'II.1.�I■1.■��■1■■1�111�1�11�1�11"'1'�1111"II'1111I11' : Time,but not prior to the
PETERSON SPENCER/MELISSA CLARK time applied for or,if this is
1361 EL MORO DR ' a replacement Declarations,
CAMPBELL CA 95008-3305 Your 4 Z3 2017 not prior to the time coverage
Policy a change was requested.
Period To
4-23-2018 12:01 A.M_ Pacific Standard Time.
Alt: Premium to be paid by: Primary Secondary
r
Location 1361 EL MORO DR Home: 650 269-1835 Insured X
Of CAMPBELL CA 95008-3305
Insured
Property rarotno 045 045 769 000 ANI 13,2017
use only
Coverages and Limits of Insurance: insurance is provided for the following coverages only when a limit is shown. The limit
of liability for this structure (Coverage A-Dwelling) is based on an estimate of the cost to rebuild your home,including an
approximate cost for labor and materials in your area, and specific Information that you have provided about your home.
Section) Section11
A B C D E F
Other Personal Personal Liability Medical Payments to Others
Dwelling Structures Property Loss of Use (Personal Injury&Properly Damage)
Each Occurrence Each Person I Each Accident
$ 285,000 $ 28,500 $ 142,500 $ 114.000 $ 300,000 $ 1,000 $ 25,000
Section 1 Only:
POOCOO
Section 11: Additional Residence Premises if any located:(Number,Street,City;State) 1st Mortgage Loan No.
2nd Mortgage Loan No.
This policy does not provide Earthquake Insurance.
This policy does not provide Flood Insurance. Premiums
Basic Policy Premium
Forms and Endorsements made part of this policy at time of issue.
Homeowners Policy - special form - $1000 Deductible (HO-3).
Name change Endorsement (60 1000 12 13)
Limited Home Replacement Cost endorsement - 150% Of Cov A (HO-28). Ind.
$1000 Deductible (NO-60). 253.00
workers' Compensation & Employers' Liability - CA (Ho-90).
Private Residence Employees - Class 0910. ind.
Building Code Upgrade Limit - $71,250.00
Discounts/Benefits Applied: AAA Membership,Multi-Policy Total Policy Premium
$
First Automatic Renewal This policy will be renewed
rst Mortg
agee Name if other:than Mtg_ Svc_ Co. automatically,however,if our rules prohibit renewal,
we will give you advance written notice.
Total Balance $
1075 0815 (Over)
PUBLIC WORKS DEPARTMENT LAND DEVELOPMENT
Effective July 1,2017
TO: Finance PUBLIC WORKS FILE NO.
PROPERTY ADDRESS
Please collect&receipt for the following monies:
ACCT. ITEM AMOUNT
LAND DEVELOPMENT
4722 1 Encroachment Permit Application Fee
Non-Utility Encroachment Permit Major>_$10 000 $425.00
Minor Encroachment Permit<$to,000 $240.00
Initial R-1 Permit N/C
Subse uent R-1 Permits within Two Year Period $240.00
Inspect on Fee Minimum Charge per Location $420.00
Street Tree Planting/Removal N/C
2203 ($500 per Tree Planting Deposit Required) $500.00/tree
22031 Plan Check Deposit 2%of Engineer's Estimate $500.00 min
Utility and R-1 Permits no deposit required
4722 Grading&Drainage Plan Review
Single Family Lot $295.00
Site< 10,000 s.f. $885.00
Site>_ 10,000 s.f. <0.5 Acre $1,185.00
Site?0.5 Acre $1 772.00
4722 NPDES Review C3 Requirements)
For projects not required to submit numeric sizing $175 00
For projects required to submit numeric sizing
Impervious Area 10,000 S . Ft to 1 Acre $740.00
Impervious Area 1 Acre or more $965.00
4722 For ro'ects sent to Consultant for review Consultant Cost+20%
4722 Additional treatment facilities $315 ea
Plan Check& Inspection Fee(Non-Utility)
4722 En r. Est. <$250 000 14%of Engineer's Estimate
4722 Enqr. Est. >_$250,000 and<_$500,000 $35,000.00+8%of Engineers Estimate
4722 En r. Est. >$500 000 $55 000.00+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.' i
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 $4,200.00+$90/lot
4722 Final Tract Ma 5 or More Lots) $5,115.00+$124/lot
2203 Monumentation Security 100%of City'- Monumentation Estimate
4920 Parkland Dedication Fee(75%/25%Due Upon Cert. of Occupancy)
4722 Lot Line Adjustment(Includes Certificate of Compliance) $1,990.00
4722 Vacation of Public Streets& Easements $2,700.00
4722 Certificate of Compliance $1,970.00
4722 Certificate of Correction $590.00
4722 Document Recording Fees $15.00/first page$3 ea.Additional
4722 Private Improvement in Public ROW $100.00
4722 Approved Plan Revision Fee $100/sheet
4722 Appeal Filing Fee $200.00
730.4924 Notice of Improvement Obligation Payment
4722 Assessment Segregation or Reapportionment
First Split $940.60
Each Additional Lot $295.00
511.7424 Postage
MISCELLANEOUS~ -
Other(Please peci )
*Engineer's Estimate shall be as a y yEngineer 9� approved b the City and shall include all items of work. TOTAL $
NAME OF APPLICANT ~
NAME OF PAYORAl 0 PHONE ,2_6
ADDRESS ` ZIP
FOR RECEIVE BY, ;+ �Y OF Q,,,A P8EL[
CITY CLERK
ONLY Date Reeei t# -5�'
J'IFORMS\T.mpla _
FIE
f'.,~: S _,.ICI; , ._.ER.4.ON
+i"...+�.`.i C,I, ('11 :.;i•};its"; -
REF DEPOSIT 101 $2,500.00
Snub
CHECK S2,500.00
REF NUN: '
'heck A License - License Detail Page 1 of
Contractor's License Detail for License # 943783
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.
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Arbitrations are not listed unless the contractor fails to comply with the terms of the arbitration.
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Business Information
GONZALEZ CONCRETE
13801 WESTBORO DRIVE
SAN JOSE, CA 95127
Business Phone Number:(408)687-8379
Entity Sole Ownership
Issue Date 02/24/2010
Expire Date 02/28/2018
License Status
This license is current and active.
II information below should be reviewed.
Classifications
-8-CONCRETE
Bonding Information
Contractor's Bond
his license filed a Contractor's Bond with AMERICAN CONTRACTORS INDEMNITY COMPANY.
Bond Number: 100112550
Bond Amount: $15,000
Effective Date: 01/01/2016
Contractor's Bond History
Workers' Compensation
This license has workers compensation insurance with the SOUTHERN INSURANCE COMPANY
Policy Number:OWC1005466
Effective Date: 02/04/2017
�Expire Date: 02/04/2018
Workers'Compensation History
ttps://www2.cslb.ca.gov/OnlineServices/CheckLicenseII/LicenseDetail.aspx?LieNum=943783 11/30/201
aE^nY IKlxsn coNCItErE SAN JOSE PLANT GILROY PLANT -'
1'404 SOUTH 7TH STREET t't ,25 BUENA VISTA WARNING
SAN JOSE, CA 95112 GILROY, CA IRRITATION TO THE SKIN AND EYES
ACCOUNTING OFFICE: (408) 947-0669 (408) .848 1560 Contains Portland Cement.Wear Rubber Boots and Gloves.PROLONGED CONTACT MAY
QUAI Il Y CONCRE FAX: 408 947-Q434 CAUSE BURNS.Avoid Contact with Eyes-and Prolonged Contact With Skin.In Case of
( ) t contact With Skin or Eyes.Flush Thoroughly With Water..If Irritation Persists.Get
DISPATCH: (408)N947-0159 Medical Attention,KEEP CHILDREN AWAY.
FAX: (408"),94{''=0,1�93.`. �•
SOLD TO i1 ___ SHIP TO:
t't+.hi_�if f}'.: F.• I- � r 1 I _ . E-s f'`I i !..
' ' Y.,�•�,., .Y �..:.1." 4 .Alt
31 i
TIME FORMULA LOAD SIZE YARDS ORDERED USE DRIVER/TRUCK MAPCOORDINATE PLANT TRANSACTION#
g'A".
DATE CHARGE C.O.D LOAD# YARDS DEL. BATCH# WATERTRIM SLUMP TICKET NUMBER
IF PROPERTYTOBEMADE IN WEEIGHMASTER CERTIFICATE Excessive Water is Detrimental to Concrete Performance
(T0 BE;SIGNED IF DELIVERY TO DAMAGE MALE INSIDE CURB LINE) 4
Dear Customer-The driver of this truck is presenting this RELEASERgyau for your signature is of the opinion THIS IS TO CERTIFY that the following described com- H2O Addedlly Request/Authorized By
that the size and weight of his truck may possibly cause damage loathe premises and/or adjacent property
It he places the material in this load where you tlesue it It is our wl to help you in every way that we can, modify was Weighed,measu ed,or counted by a
but in order to do this the driver is requesting that you sign this REL ASE relieving hls and his supplier from,
any responsibility from anytlamage that may occur te.the pr tim s and/br adjacent property,buildings, weignmaster,whose SlgOafU�e IS On this certificate,Who GAL
sidewalks,drive-ways,curbs,etc.,by the callvery of this materlal�and that you also agree to help him is a reco nized authorit of accurac ,as rescribed b
remove mud from the wheels di his vehicle so that he will not litfeeth'e public•street.Further,as additional 9 Y y p y CONCRETE is a PERISHABLE COMMODITY and BECOMES the PROPERTY of the PUR-
consideration,the undersigned agrees to indemnity and hold harmles the driverot this truck and this supplier Chapter 7(commencing wilf�section 12700)of Division CHASER WHEN TRUCK IS LOAQED.ANY CHANGES or CANCELLATIONS of ORIGINAL
for eny out
all damage t the premises and/orand enf property n u may ee claimed si anyone to have t INSTRUCTIONS MUST be TELEPHONED to the OFFICE BEFORE LOADING STARTS.
arisen out oYtlelivery of This order.Jurisdiction andVenue.Sellgran.Buyer agreeihatexdusivejudsdictionand 5 of California Business andl,professions Code,adminis- -
venuearisingoutofandrelated to the subject matter of this credit applir4ion and any sale of goods from Seller to The undersigned promises to pay all costs,including reasonable attorneys'fees,
tered by the Division of Measurement Standards of the
Buyer shall lie in the Superior Court or the State of California,County of Santa Clara.. incurred in collecting any Sums owed. ,
SIGNED California Department Of Fo`pd and Agriculture. All COD-s not paid at time of delivery will be charged a$50.00 Service Charge and bear
X I' Interest at the rate of 10%per annum,
r r •r ,, WEIGHMASTER• ,„ Not responsible for Reactive.Aggregate or Color Quality.No Claims For Such Allowed
.f Unless Made at Time Material is Delivered.
r ' , r r r r t••`P—� ��`"-)-r I A$50.0 Service Charge and Loss of Cash Discount will be Collected on all Returned
Checks.
LOAD RECEIVED BY: 1l•}.)
XExcess Delay Time Charged®$1.50/per minute
QUANTITY CODE DESCRIPTION UNIT PRICE EXTENDED PRICE'
y
� :I-..'ri ;,.'(.r'i!.:.'Irl!•Y1.'•- ( �ri1'1
''i.�t }.i. '_'t,.1,) i't.:q)�•f1�=ir:.i'rr•F')I:y " r.:r-..
'THERE WAS NO CONCRETE OR CEMENTITIOUS MATERIAL LEFT IN STREET OR STORM DRAIN BY STAR CONCRETE X
RETURNED TO PLANT LEFT JOB FINISH UNLOADING DELAY EXPLANATION/CYLINDERTEST TIMEALLOWED
r .r •
1.JOB NOT READY 6.TRUCK BROKE DOWN
2.•SLOW POUR OR PUMP 7.ACCIDENT
3.TRUCK AHEAD ON JOB 8.CITATION
LEFT PLANT A(RIVED JOB STARTUNLOADING 4.CONTRACTOR BROKE DOWN 9.OTHER TIME DUE
5.ADDED WATER
_• y-� f ADDITIONAL CHARGE 1
o
ERROR IN PRICE,EXTENSION AND ADDITION SUBJECT TO CORRECTION.
TOTALROUNDTRIP . TOTALATJOB UNLOADTIME DELAY TIME ADDITIONAL CHARGE 2
CUSTOMER,COPY
SUGGESTIONS FOR PLACING CONCRETE SLAB
TO MINIMIZE RANDOM CRACKING '
WHAT YOU DO WHY YOU DO IT
Level and compact sub grade, place 4" of STEP 1. The sand provides a cushion for the concrete
damp sand and -grade so concrete and good drainage.
I
poured is a consistent depth.
.;7EP2. Separate your new concrete from all STEP 2. The felt separates your new concrete from
existing concrete with 1/2" felt. Felt in-List existing, so it may shrink, expand, move up
I
match tlie depth of your new slab. or down. without a detrimental affect.
STEP 3. Screen off your concrete. STEP 3. Make sure there are no low spots.
STEP 4. Roller bug Your concrete. STEP 4. Once over the surface, it helps vibrate, con-
solidate and give You a better finish.
STEP 5. Float concrete with wood bull float only. STEP 5. Wood keeps the surface open and allows the
concrete to bleed preventing water entrapment
and discoloration and/or plastic cracking.
STEIP0. Cut control joints perpendicular from edge STEP 6. These joints should allow the concrete to crack
114 the depth of the slab, using appropriate in the joint taking the path of least resistance.
spacing,. 4" slab would be 8.'x8'.
STEP 7. Allow all.bleed water to evaporate from the STEP7. If you do not wait for all bleed water
ater to
surface, then you can finish the concrete evaporate,you end up troweling your bleed
L"�
with metal trowels. water back into the surface, dramatically
changing your water/cement ratio, on the
surface, causing a weaker surface.
VEP 8. When surface is finished,spray with aconcrete STEPS. This protects the concrete from wind., beat
cure, if the concrete is colored you must use a and allows your slab to cure on. its own.
cure formulated for colored concrete. giving you a in-Lich better finished product.
S1 Elp 9. Never add water or dry cement to the STEP9. These two things also change water/cement
surface of your slab. ratio on the surface and can ruin your slab.