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ENC2007-00144 i Roger Storz From: Roger Storz Sent: Monday, March 13, 2017 2:14 PM To: 'mike Paydar'; 'sarkiss@polarissurveyors.com' Cc: JoAnna Thomason; S.yed Wahidi . Subject: Parcel Map - 661 El Patio Drive Attachments: Monument Bond Release.pdf, B0837P0041.TIF; B0837P0042.TIF Importance: High Gentlemen, We are cleaning up some old files and came across the Parcel Map at 661 El Patio Drive (see attached). We still have $4,000 in cash on file for the Monument Bond. It appears that you were supposed to set four(4) iron pipes as part of this map. Have the pipes been set? If so, please provide documentation so we can close this out and return the monument bond to you. Thank you, Roger Storz, PE City of Campbell (408) 866-2190 (direct) rogers(a)cityofcam Abel I.com Land Development Website Nc ,r\ \A e C� i DOCUMENT : �`61078 Pages: I Fees . . . . No Fees Taxes. . . Recording Requested by: ) Cop i es. . AMT PAID City of Campbell ) REGINA ALCOMENDRAS RDE # 012 When recorded mail to: ) SANTA CLARA COUNTY RECORDER 7/01/2010 Recorded at the request of 11 44 AM City City Clerk ) City of Campbell ) 70 North First Street ) Campbell, CA 95008 ) APN: 279-45-055 (Space above this line for Recorder's use only.) ADDRESS: 661 El Patio Drive, Campbell,CA 95008 STREET IMPROVEMENT AGREEMENT RECITALS THIS AGREEMENT, identified by File No(s). PLN 2006-188, is entered into this L! day of P\,0 , 2010, by and between MOHAMMAD MASSOUMI AND FAPJMAH MASSOUMI, husband and wife, hereunder referred to as "Owner," and the CITY OF CAMPBELL, a municipal corporation of the County of Santa Clara, State of California, hereinafter referred to as "City." On April 16, 2007 the Director of Community Development granted,conditional approval of a Tentative Parcel Map for that certain real property described as Lot 16 as delineated and so designated upon map entitled Tract No. 2, Rancho Del Patio, in the County of Santa Clara, part of south one-half of section 26, township 7 south, range 1 west, M.D.M., which map was recorded on February 17, 1931 in the Office of the Recorder of the County of Santa Clara, State of California, in Vol. "Y" of Maps, page 26, and commonly known as 661 El Patio Drive, which property is hereinafter referred to as "said real property." TERMS AND CONDITIONS Now, therefore, in consideration of the above referenced approvals, and in satisfaction thereof, the parties to this Agreement shall comply with the following terms and conditions: (1) The Owner shall provide, construct and install at his/her own proper cost and expense, street improvements as described in Section 11.24.040 of the City Code within 12 months from the date first mentioned hereinabove; provided, however, that in the computation of said 12 month period, delays due to, or-caused by acts of God, viz., unusually inclement weather, major strikes, and other delays beyond the control of the Owner or his/her successors shall be excluded. (2) If the Owner fails to complete the work required by this Agreement within the said 12 month period, the City, after giving ten (10) days written notice to the Owner, or his/her successors, may construct and/or install said improvements and recover the full cost and expense from the Owner, or his/her successors. THE FOREGOING INSTRt T 19 A TRUE AND CORRECT COPY OF yFLO OpGAAg, ON FILE IN TMS OFFIC_. AT rMT:ANNE BYBEE,CRY Ci ;AMPML CA IIIATED STREET IMPROVEMENT PLANS (3) The Owner, shall cause to be prepared at his/her cost and expense street improvement plans for the construction and installation of said improvements prior to such construction or installation. Said plans shall be prepared by a civil engineer registered by the State of California and submitted to the City Engineer for examination and approval. (4) All of said improvements embraced in this Agreement shall be constructed and installed in accordance with the plans approved by the City Engineer and shall be made under the inspection and to the satisfaction of the City Engineer. Said construction and/or installation shall be in accordance with the existing ordinances and resolutions of the City of Campbell and all applicable plans, specifications, standards, sizes, lines and grades approved by the City Engineer, and all State and County statutes. Upon completion and acceptance of the improvements by the City, the Owner, shall provide reproducible as- built plans to the City Engineer. PLAN CHECK AND INSPECTION FEE (5) Prior to approval of the plans by the City Engineer pursuant to Section (3) of this Agreement, Owner, or his/her successors, shall pay the City for plan checking of improvement plans, field inspection of construction of improvements and all necessary expenses incurred by City in connection with said improvements, a sum calculated in accordance with Resolution No. 10494 as adopted by the City Council on May 3, 2005, or as may subsequently be adopted by the City Council. FAITHFUL PERFORMANCE SECURITY (6) The Owner, or his/her successors, shall file with City, prior to beginning construction, security acceptable to the City in amount equal to the City Engineer's estimated cost of the street improvements to ensure full and faithful performance of the construction of all the aforementioned improvement work. Said security shall guarantee that Owner, and his/her successors, will correct any defects which may appear, in said improvement work within one (1) year from the date of acceptance of the work by City and pay for any damage to other work resulting from the construction thereof, as well as pay the cost of all labor and materials involved. This security shall remain in effect until one (1) year after date of final acceptance of said improvements by City. Said security amount may be reduced by the City Engineer in his/her sole discretion after the date of final acceptance to not less than twenty-five (25)percent of its full value. (7) Upon final release of said security by City, the obligations of Owner, and his/her successors, contained in this Agreement shall be considered null and void, except as otherwise provided by applicable law, or Sections 12 or 13 of this Agreement. FORMATION OF A SPECIAL ASSESSMENT (8) The Owner. when called upon by City to do so, shall execute a petition for the formation of any special assessment district created pursuant to any special assessment act as provided in the Streets and Highways Code of the State of California created for the purpose of constructing and/or installing any or all of said improvements. Owner, or his/her successors, shall participate in and become a part of any special assessment district as described in Section(8) of this Agreement. (9) The Owner's, or his/her successors' obligations contained in this Agreement that are accomplished to the satisfaction of said City Engineer by said special assessment district shall be considered to satisfy those obligations. RIGHT-OF-WAY ACQUISITION (10) Owner at his/her own cost and expense, shall acquire any easement and right-of-way within or without said real property necessary for the completion of the improvements shown upon aforesaid improvement plans. It is provided, however, that in the event eminent domain proceedings are required for the purpose of securing said easement and right-of-way, Owner, shall deposit or cause to be deposited with City a sum covering the reasonable market value of the land proposed to be taken and to be included in said sum shall be a reasonable allowance for severance damages, if any. It is further provided that in addition thereto such sums as may be required for legal fees and costs, engineering and other incidental costs shall be deposited with the City. (11) The Owner, shall carry out any and all negotiations with all interested parties and shall perform or cause to be performed at his/her own cost and expense and to the satisfaction of the City Engineer any and all work required to abandon, remove, raise, lower, relocate and otherwise modify irrigation lines within or without the boundary of said real property. INDEMNITY AND INSURANCE (12) The Owner, and his/her successors, to the fullest extent permitted by law, shall indemnify, defend and hold the City of Campbell, the City of Campbell Redevelopment Agency, and its agents, employees, attorneys, officers, officials and assignees harmless from any and all claims, actions, causes of action, liabilities, damages, losses and expenses, including, but not limited to, attorneys' fees, arising out of, or resulting from, or alleged to arise out of or result from any negligent or intentional act or omission (including misconduct) of said Owner, or his/her successors, or any subcontractor, or anyone directly or indirectly employed by him, or anyone for whose acts any of them may be liable in the course of performance of the Agreement, except for any claims, actions, causes of action, liabilities, damages, losses and expenses proximately caused by the sole negligence or willful misconduct of the City. (13) The Owner, and his/her successors, shall also indemnify, defend and hold the City of Campbell, the City of Campbell Redevelopment Agency, and its agents, attorneys, employees, officers, officials, and assignees harmless against and from any and all claims, actions, causes of action, liabilities, demands, losses, lawsuits,judgments, damages, costs and expenses (including, but not limited to, attorneys' fees and court costs, whether incurred at trial, appellate or administrative levels) which the City of Campbell may incur- or suffer, or to which the City of Campbell may be subjected resulting frorn, or alleged to result from the failure of Owner, or his/her heirs, assignees, successors, grantees, agents, employees, subcontractors, or anyone performing services under him, to fulfill any of the obligations imposed under this Agreement, except for any claims, actions, causes of action, liabilities,judgments, damages, costs and expenses proximately caused by the sole negligence or willful misconduct of the City. (14) The Owner and his/her successors shall also indemnify, defend and hold harmless the City, the City of Campbell Redevelopment Agency, and its agents, officers and employees from any claim, action, or proceeding against the City or its agents, officers or employees to attach, set aside, void or annul an approval of the City, its City Council, Planning Commission, Community Development Director, Public Works Director, Building Official, City Engineer, or other such City official concerning a subdivision, which action is brought within the time period provided for in California Government Code Section 66499.37. (15) In the event that this contract is subject to California Civil Code section 2782(b), the foregoing indemnity provisions shall not apply to any liability for the active negligence of the City or the Campbell Redevelopment Agency. The foregoing indemnity provisions are intended to fully allocate all risk of liability to third-parties. No other rights of indemnity or contribution shall exist between the parties in law or in equity. The provisions set forth in this section shall survive the termination of this Agreement. (16) The City will promptly notify the Owner of any claim, action or proceeding to attack, set aside, void or annul any approval concerning a subdivision of said real property, and will cooperate fully in the defense. (17) Owner and his/her/its successors shall maintain insurance for injuries to persons or damage to property conforming to the following specifications: A. Minimum Scope of Insurance Coverage shall be at least as broad as: 1. Insurance Services Office (ISO) CGL form CG 00 01 11 85; and 2. ISO form G0009 11 88 Owners and Contractors Protective Liability Coverage Form—Coverage for Operations of Designated Contractor; and 3. Course of Construction Insurance covering all risks of loss; and 4. ISO CA 00 01 06 92 including symbol 1 (Any Auto); and 5. Workers' Compensation insurance as required by the Labor Code of the State of California and Employer's Liability insurance. B. Minimum Limits of Insurance Owner shall maintain limits no less than: 4 1. General Liability: $1,000,000 combined single limit per occurrence for bodily, personal injury and property damage. If Commercial General Liability Insurance or other form with a general aggregate limit is used, either the general aggregate limit shall apply separately to this project/location or the general aggregate limit shall be twice the required occurrence limit. 2. Automobile Liability: $1,000,000 combined single limit per accident for bodily injury and property damage. 3. Workers' Compensation and Employer's Liability: Workers' Compensation limits as required by the Labor Code of the State of California and Employer's Liability limits of$1,000,000 per accident. C. Deductible and Self-Insured Retention Any deductibles or self-insured retention must be declared to and approved by the City. At the option of the City, either: the insurer shall reduce or eliminate such deductibles or self-insured retention as respects the City, the City of Campbell Redevelopment Agency, its agents, officers, attorneys, employees, officials and volunteers; or the Owner shall procure a bond guaranteeing payment of losses related to investigations, claim administration, and defense expenses. D. Other Insurance Provisions The policies are to contain, or be endorsed to contain, the following provisions: 1. General Liability and Automobile Liability Coverage: a. The City, City of Campbell Redevelopment Agency, its agents, officers, attorneys, employees, officials and volunteers are to be covered as insureds as respects: liability arising out of activities related to this Agreement performed by or on behalf of the Owner, products and completed operations of the Owner, premises owned, occupied or used by the Owner, or automobiles owned, leased, hired or borrowed by the Owner. b. The Owner's insurance coverage shall be primary insurance as respects the City, City of Campbell Redevelopment Agency, its agents, officers, attorneys, employees, officials and volunteers. Any insurance or self-insurance maintained by the City, City of Campbell Redevelopment Agency, its agents, officers, attorneys, employees, officials and volunteers shall be excess of the Owner's insurance and shall not contribute with it. C. Any failure to comply with reporting provisions of the policies shall not affect coverage provided to the City, City of Campbell Redevelopment Agency, its agents, officers, attorneys, employees, officials, and volunteers. d. The Owner's insurance shall apply separately to each insured 5 against whom claim is made or suit is brought except with respect to the limits of the insurer's liability. C. Coverage shall not extend to any indemnity coverage for the active negligence of the City in any case where an agreement to indemnify the City would be invalid under Subdivision (b) of Section 2782 of the California Civil Code. 2. Workers' Compensation and Employer's Liability Coverage: The insurer shall agree to waive all rights of subrogation against the City, City of Campbell Redevelopment Agency, its agents, officers, attorneys, employees, officials, and volunteers for losses arising from work performed by the Owner for the City. 3. Course of Construction Coverage: Course of Construction policies shall contain the following provisions: (a) the City shall be named as loss payee; and (b) the insurer shall waive all rights of subrogation against the City. 4. All Coverages: Each insurance policy required by this clause shall be endorsed to state that coverage shall not be suspended, voided, canceled by either party, reduced in coverage or in limits except after thirty (30) days prior written notice by certified mail, return receipt requested, has been given to the City. E. Acceptability of Insurers Without limiting Owner's indemnification provided hereunder, Owner shall take out and maintain at all times during the life of this contract, up to the date of acceptance of the work by the City, the policies of insurance listed in Paragraphs 12 through 16 of this Agreement. Insurance is to be issued by an issuer with a current A.M. Best Rating of ANE and be authorized to transact business in the State of California, unless otherwise approved by the City. F. Verification of Coverage Owner shall furnish the City with certificates of insurance evidencing coverage required by this clause. The certificates for each insurance policy are to be signed by a person authorized by that insurer to bind coverage on its behalf. The certificates are to bd on forms provided by the City. Where by statue, the' City Workers' Compensation related forms cannot be used, equivalent forms approved by the Insurance Commissioner are to be substituted. All certificates are to be received and approved by the City before work commences. G. Subcontractors Owner shall include all subcontractors as insured under its policies or shall furnish separate certificates by each subcontractor. All coverage shall be subject to all of the requirements stated herein. 6 MUTUAL BENEFIT COVENANTS BINDING ON HEIRS, ASSIGNEES, SUCCESSORS, AND GRANTEES OF OWNER (18) It is acknowledged that the provisions of this Agreement constitute covenants for the improvement of the subject real property for the mutual benefit of Owner's property, commonly known as 661 El Patio Drive, and the City's property, commonly described as El Patio Drive where it adjoins Owner's property. These covenants shall be considered to affect rights in the above-described real properties, and shall be binding on the heirs, assignees, successors, grantees and agents of the Owner to said real property. UNVESTED INTERESTS (19) Nothing contained herein shall be construed to transfer any unvested interests in real or personal property for purposes of the rule against perpetuities. BREACH OF CONTRACT (20) The City, upon breach any of the terms, conditions, or covenants of this Agreement by the Owners, shall be entitled to recover from the Owner, in addition to any other relief available in law or equity, all costs and compensation incurred in attempting to obtain enforcement of the Agreement, including reasonable attorneys' fees and court costs. ENTIRE AGREEMENT BINDING (21) This is the entire Agreement between the parties, and there are no representations, agreements, arrangements or understandings that are not frilly expressed herein. This Agreement can be executed in counterparts by the parties hereto, and as so executed shall consist of one agreement, binding on all parties. PRELIMINARY PLANS (22) Owner shall provide and construct public street improvements per preliminary plans titled "STREET IMPROVEMENT PLANS — OFFSITE — 661 El Patio Drive," which are subject to approval by the City Engineer,prepared by SMP Engineers.. 7 IN WITNESS WHEREOF, said City has caused its name to be affixed by its City Engineer and City Clerk, who are duly authorized by Ordinance 2059 adopted September 20, 2005, and said Owner has caused his/her name to be affixed the day and year first above written. OWNER Mohammad Massoumi Farimah Massoumi CITY OF CAMPBELL Michelle Quinney, City Engin (Notary Acknowledgment for above signator(ies) MUST be attached.) Attest: . ANNE BY BEE -'' Commission # 1794690 z , s: Notary Public -California Santa Clara counter MVCorrm MW30,2012 Anne Bybee, City Clerk s CALIFORNIA ALL-PURPOSE ACKNOWLEDGMEK17 State of California County of ���- CAI � On before me-,,,, ✓� '''�{'"/ ' v`' _ l Here Insert Name and Title�of the Officer personally appeared ° �� '�" z"1 '� N me(s)of Signer(s) who proved to me on the basis f satisfactory evidence to be the person whose name is/�.e subscribed to the within instrument and ack owledged to me that he+e/t y executed the same in his/r�r/tf�ir authorized capacity(i ), and that b his/h�/tnr signatures') on the instrument the person, or the entity upon'behalf of JOANNE M. VAMBROSIA which the person acted, executed the instrument. Commission# 1735773 Notary Public-California a > I certify under PENALTY OF PERJURY under the laws Santa Clara County MY Comm.Ex Tres Mar 31,2019 of the State of California that the foregoing paragraph is true and correct. WITNESS hand and o7ffinci I se . gnatur �I� Place Notary Seal Above Si�/ Signature of Notary Public Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Document Title or Type of Document: Document Date: Number of Pales: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: ner's Name: ❑ Individual ❑ I vidual Corporate Officer—Title(s): ❑ Corpo to Officer—Title(s): ❑ Partner—El Limited ❑ General ❑ Partner— Limited ❑ General ❑ Attorney in FactiwgWR ❑Attorney in Fac Trustee op of thumb here ❑Trustee Top of thumb here Ell Guardian or Conservator ❑ Guardian or Conservator\ ❑- Other: ❑ Other: \ Signer Is Representing: Signer Is Representing: ©2007 National Notary Association-9350De Soto Ave..P.O.Box2402-Chatsworth,CA91313-2402-www.NationalNotary.org Item45907 Reorder:Call Toll-Free 1-800-876-6827 CALIFORNIA ALA.-PURPOSE ACKNOWLEDGMENT State of California County of On before me, Dale Here Insert Name and Title of the Officer personally appeared I_ir"2A Af-\ y k YV> 4:, 4S<)�)Q \M� Name(s)of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the �- - —� instrument the person(s), or the entity upon behalf of SARAH WHITMAN which the person(s) acted, executed the instrument. �! �� Commission # 1823836 Notary Public -California D I certify under PENALTY OF PERJURY under the laws 7- "'y': Santa Clara County Y M t�--a-�" t Comm:Expires Dec 19:2012 of the State of California that the foregoing paragraph is true and correct. WITNESS�1�and and official s.al. Signature Place Notary Seal Above p�/g EAL Signature of Notary Public Op�TiO V Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Document Title or Type of Document: Document Date: Number of Pages: Signer(s) Other Than Named Above: _I`�'1 Q V1 M yn t li . 5-5 yi- Capacity(ies) Claimed by Signer(s) Signer's Name:-' kl"Vn�LOf\ lN, �A!�L-,�k)Y, L., Signer's Name: t _❑-*'`Individual ❑ Individual ❑ Corporate Officer—Title(s): ❑Corporate Officer—Title(s): ❑ Partner—❑ Limited ❑ General ❑ Partner—❑ Limited ❑ General ❑ Attorney in Fact ❑Attorney in Fact • El Trustee ❑Trustee Top of thumb here Top of thumb here ❑ Guardian or Conservator ❑Guardian or Conservator ❑ Other: ❑ Other: Signer Is Representing: Signer Is Representing: 02007 National Notary Association-9350 De Soto Ave..P.O.Box 2402-Chatsworth,CA 91313-2402-www.NationalNotary.org Item ft5907 Reorder:Call Toll-Free 1-800-676-6827 ` ' ' . . . .. - . . ~ CALIFORNIA JLLL-PURPOSE ACKNOWLEDGMENT State of California County of N On Ci: before me, Date Here insert�ame and Title of the Officer personally appeared Name(s)bf Signer(s) who proved tnmeon the basis of satisfactory evidence to be the person(*whose name(s) ia/ar*-eubsnrbed to the within instrument and acknowledged to me that he/sha/th«y executed the same inhis/heotn& authorized oapaoity(ie,3)' and that byhis./hunYheirsignatupe(a)-onthe instrument the pemun(s)� or the entity upon behalf of � '''-'- - BEE � which the person��oo��d executed the inotnumont � Commission # l794690 � ` ' ' � � Notary Public 'CoUtw,n|o s Z Santa Clara County | certify under PENALTY OF PERJURY under the |mwo of the State of California that the foregoing paragraph is true and correct. WITNESS my hand-and official Signature Place Notary Seal Above Signature*wot"rgPublic OPTIONAL Though the information below is not required uy law, x may prove valuable m persons relying on the document and could prevent fraudulent removal and reattachment o/this form to another document. Description of Attached Document Title or Type of Document: Document Date: Number ofPages: Signor(s) Otha,Than Named Above: Cmpocity(ima) Cio|nmod by Signer(s) Signer's Name: Signer's Name: O Individual El Individual O Corporate Officer--TNo(a): [] Corporate Officer--Titlo(s): O Partner—O Limited O Gmeng O Partnmr—O Limited O General U Attorney in Fact [I Attorney in Fact U Trustee Top of thumb here El Trustee Top of thumb here O Guardian orConservator [] Guardian orConservator O Other: O [ther: Signer |o Representing:------___ Signer |u Representing: ___________ JoAnna Thomason From: Roger Storz Sent: Wednesday, March 15, 2017 4:56 PM To: 'massoumim@yahoo.com'; 'sarkiss@polarissurveyors.com'; 'mike Paydar' Cc: JoAnna Thomason; Syed Wahidi Subject: RE: Parcel Map - 661 El Patio Drive Attachments: SKMBT_50117031516510.pdf Gentlemen,just one extra issue, it seems that Mike Paydar was the one who posted the$4,000 deposit and our finance department will only return the funds to the person who paid the deposit to the City. Thank you, Roger Storz, PE City of Campbell (408) 866-2190 (direct) rogersC@cityofcam Abell.corn Land Development Website From: Roger Storz Sent: Wednesday, March 15, 2017 3:37 PM To: 'massoumim@yahoo.com'; 'sarkiss@polarissurveyors.com' Cc: JoAnna Thomason; Syed Wahidi Subject: Parcel Map - 661 El Patio Drive Importance: High Gentlemen, We are cleaning up some old files and came across the Parcel Map at 661 El Patio Drive (see attached). We still have $4,000 in cash on file for the Monument Bond. It appears that you were supposed to set four(4) iron pipes as part of this map. Have the pipes been set? If so, please provide documentation so we can close this out and return the$4,000 to you. Thank you, Roger Storz, PE City of Campbell (408) 866-2190 (direct) rogersacitvofcampbell.com Land Development Website i CITY OF CAMPBELL CROACHMENT PERMIT !No d- OV �`Id DEPT.OF PUBLIC WORKS (for working within the public X-Ref.File 70 North First St. right-of-way) Campbell,CA 95008 i r Application Date (408)866-2150 Issued Application Expiration Date Fax(408)376-0958 Permit 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 six(6) months if the permit is not issued. Application Fee is non-refundable.) A.Work address or tract# V '+ (o(o J Utility trench location (� B.Nature of work '�� �Y1 �aYcd N&D g3-? i M -4 k `T z C.Attach four(4)copies of an engineered plan showing the location and extent of the work,and four(4)copies of the preliminary Engineer's Estimate of work. The plans shall show the relation of the proposed work to existing surface and underground improvements. When approved by the City Engineer,said plan becomes 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 Sureties and cash deposits. (See General Permit Conditions I and 2.) E.The Contractor must have this permit and approved plans at the site and must notify the Public Works Department at least two days before starting work. Notice must be given to Public 1W^orrksL at least 24 hours before restaartingnany �work. c� Name of Applicant b-f "�(�®V YAM(- t ��,1_V 1 I� SS(El, M l Telephone Address �7 l � 1�.3Q.5 � � A (print name) t�-`j`19 24-HOUR EMERGENCY TELEPHONE NO. E-Mail Address cG:50 LAM i VY\ Is this work being done by the property owners at their own residence? Yes No The Applicant/Permittee hereby agrees by affixing their signature to this permit to hold the City of Campbell,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/Permittee hereby acknowledges that they have read and understand both the front and back of this permit,and they will inform their contractor(s)of the information. Appl' it is advised/tupn issuance of this permit, property owner, or propert�owner's successors, shall be responsible fora and all damages arising out of th ndi ' of any vemen in a pub' right-of-way. Accepted 7 (i f (A Wca rmittee sign) tDate (� 7 jC&Q&T1 Contractor (Print Name) Date SPECIAL PROVISIONS _1. Street shall not be open cut for underground installations. Minimum cuts may be allowed for connections or exploration holes. Such cuts may be specifically approved by the Inspector prior to cutting. _2. Pavement may be cut for underground installations and must be restored in accordance with the Standard Details Trench Restoration Method "A",unless otherwise approved by Inspector. _3. Work to be staked by a licensed Land Surveyor or Civil Engineer and two(2)copies of the cut sheets sent to the Public Works Department before starting work. _4. Per Section 4215 of the Government Code this permit is not valid for excavations until Underground Service Alert(USA)has been notified and the inquiry identification number has been entered hereon. USA Phone 1-800-227-2600. USA TICKET NO. _5. Prior to any work,the property owner shall execute an Agreement for Private Improvements in the Public Right-of-Way,which shall be recorded. _6. Public Notification Requirements: 7. SEE PUBLIC WORKS FEE SCHEDULE FOR CURRENT FEES AMOUNT RECEIPT NO. PERMIT APPLICATION FEE $-;?>0a= PLAN CHECK DEPOSIT $ ' SECURITY FOR FAITHFUL PERFORMANCE/LABOR&MATERIALS $�2 2taU 7 CONSTRUCTION CASH DEPOSIT $_ c fir- —,ODD PLAN CHECK&INSPECTION FEE z $ 4 APPROVED,OR ISSUANCE ✓-2-') --Zo I ` For City Engineer };;•, Date Permit Expires 12 Months After Date of Issuance i i GENERAL PERMIT CONDITIONS 1. A Construction Cash Deposit is required. Charges will be made against this deposit if there is an emergency call-out,overtime inspection or when City ordered barricading is required. Any such costs in excess of the deposit will be billed to the Permittee. 2. A one-year maintenance period and surety are required. Such period will begin on date of written acceptance by the City. 3. Refund of the cash deposit balance and refund or cancellation of the Faithful Performance Surety will be initiated by the written acceptance of the work by the City. 4. 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. 5. Maintain safe pedestrian and vehicular crossings and free access to private driveways,bus stops,fire hydrants and water valves. 6. A Construction Traffic Control Plan and a Construction Schedule are required for all lane closures, detours and street closures. This plan must be reviewed and approved prior to any lane closures. 7. The Construction Traffic Control Plan shall conform to the Caltrans Manual of Traffic Controls for Construction and Maintenance Work Zones,dated 1990,available at Caltrans. Traffic control equipment shall include Type I1 flashing arrow signs if required. 8. 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. 9. Sawcut for all PCC or AC removals. All PCC removals shall be to nearest scoremark and shall be doweled to existing improvements. 10. 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. 11. Adequate signing and barricading is required on the job site. Failure to provide such signing and barricading may result in the City's providing sighing and barricades and charging the cost(including all labor and materials)against the cash deposit. 12. Compaction testing of subgrade,base rock,and asphalt concrete by Permittee is required unless otherwise stated by the City Engineer. 13. The Contractor or Permittee will have a supervisory representative available for contact on the project at all times during construction. Contractor or Permittee shall provide a phone number at which they can be contacted outside the hours of 8:00 a.m.to 4:00 p.m. 14. No storage of materials or equipment will be allowed near the edge of pavement, the traveled way, or within the shoulderline which would create a hazardous condition to the public. 15. 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. 16. This permit does not release the Permittee from any liabilities contained in other agreements or contracts with the City and any other public agency. 17. This permit is not transferable. Work must be performed by the Permittee or his designated agent or contractor as specified thereon. 18. 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. 19. Pursuant to Chapter 14.02 of the Campbell Municipal Code,applicant shall not cause to be discharged any material into the municipal storm drain system other than storm water. Applicant shall adhere to the BEST MANAGEMENT PRACTICES established by the Santa Clara Valley Urban Runoff Pollution Prevention Program. 20. 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. 21. Permittee must provide advance notification to all parties that may be affected by the permit activities. Notification shall be reviewed by City prior to distribution and include dates of work and a contact name and phone number. Applicant shall be responsible for ensuring that all those providing services under the applicant are aware of and understand all of the above conditions. p ant II D tee Contractor (Print Name) ate 4 J\forms\pwperm Rev. 11/9/05 INSURANCE REQUIREMENTS CHECKLIST kEKJG2CO-7 _ QC-)( `J Permit# t 63 El °Fa Rio Dr, S-�"e_ n'iasa,,u Cor�ere Cc���s ku✓�� , I n�. The following insurance is required of all contractors working in the City of-Campbell public right-of-way. Insurance certificates must be accepted by City staff before work can begin. These insurance requirements apply to work being performed under an Encroachment Pen-nit and work beinb performed udder contract for Capital Improvement Projects. Limits Commercial General Liability for bodily, personal injury and property damage: �N.�Ic��q�l X S1,000,000-per occurrence; and ❑ S1,000,000 general aggregate limit applying separately to the project, or ,A- : IX $2,000,000 general aggregate limit. 9 Policy expiration date 12_2/1 1I Automotive Liability: A IGf "Any Auto,. checked on certificate Ex� e i S1,000,000 per accident for bodily injury and property damage ;io Policy expiration date y /21 1I I Workers' Compensation and Employer's Liability z Waiver of Subrogation clause S1,000,000 per accident for bodily injury or disease 25 Policy expiration date Co se of Construction required rn ecial Provisions) ❑ mpleted value the project ❑ Poll ion date Required Endorsements to Gener�aL ability and Automobile Liability Policies Additional Insured Endorsement , lA The City, the City of Campbell Redevelopment Agency, its officers, employees and volunteers are named as additional insured. 0 The insurance coverage afforded to the Additional Insured is primary insurance. Cancellation area of certificate edited to delete "endeavor to" and "but failure to mail such notice shall impose no obligation or liability of any kind upon the com any its agents or representatives". ❑ . Workers' Comp�ens rance Sheet Submitted❑ F neralactor ❑ For Developer or Owner _ 5 Acceptability of Insurers) Insurer(s) has current A.M. Best Rating of A:VII and is author S business in the State of California. ❑ Campbell Business License# Insurance Certificate Reviewed 3/2—Z 1 I Initials Date Copy of Insurance Certificate placed in tickler file one month prior to expiration. J:\ ORMS\Templates\Insurance Requirements\Insurance Requirements Cklist.doc(Rev 05.10) - a C hif U-S-S Please- 3 b , 1, A CORD DATE(MMIDDNMj TM. CERTIFICATE QF LIA61LITY INSURANCE 0312212011 PRODUCER: Phone:408Y9768BB:Fax:-0OB,2802170 THIS CERTIFICATE IS ISSUED AS A MATTER OF,INFORMATION SENIGAGLIA.INSURANCE AGENCY ONLY AND,CONFERS NO RIGHTS UPON THE CERTIFICATE 460 S.BASCOM AVE.,SUITE 2113 HOLDER. THIS CERTIFICATE DOES"NOT.AMEND; EXTEND OR . SAN JOSE`CA 95128 ALTER THE COVERAGE.AFFORDED BY THE POLICIES BELOW, 114SURERS AFFORDING COVERAGE NAIC# A9enLy'Licp:0669522 .. _ INSURED. INSURERA: Truck Insurance Exchange STEVEMASON.CONCRETE CONSTRUCTION,INC. INSURERS: 1116 ELKQ.DR.IVE .............. _ _.- --Y--•. SUNNYVALE,CA 94089 �NSURERC INSURER D: INSURER E: ..COVERAGES . THE POLICIES OF INSURANCE LISTED BELOW,HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR.THF ROLICY.PERIOD INDICATED. NOTWITHSTANDING ANY'REOUIREMENI'.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TOwHIQH THIS CERTIFICATE MAY.BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT'TO ALL THE TERMS; EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.-AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRAlm I TYPE OF INSURANCE POLICY NUMBER POUCYEFFECTAM POLK EXPIRATION LIMITS LTR IN5 PATE(UNIUMM DATE NNIOOIYY GENERAL'LIABILITY S _-_ EACH OCCURRENCE COMMERCIAL GENERAL UABILrrY S . DMIAOE 70 RENTED .— . PREWSES{EA ECwgnes). _.. .....:.....:: 'CLAIMS MADEE'OCCUR MED.EXP(Anyone person) S PERSONAL&AOV INJURY S GENERAL AGGREGATE L - - GEN'LAGGREGATELIMITAPPLIES'PER: PRODUCTS-COMPIOPAGG S PRO- POLICY. JECT LOC AUTOMOBILE LIABILITY 60434 54 04. I 04121110 04/21/11 I COMBINED SINGLE LIMIT I, X ANYAUTO (Ea accident) s 11000,000 ALL OWNED AUTOS BODILY INJURY (Per person) $ SCHEDULED AUTOS. A ES X HIRED AUTOS BODILY INJURY S X NON.OWNED#UTOS (Persccldent) — --- PROPERTY DAMAGE S Per accdent I GARAGE LIABILITY_ � AUTO ONLY•EA ACCIDENT I s R1ANY AUTO OTHER THAN EA ACC S I AUTO ONLY: AGG_S EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ :OCCUR CLAIMS MADE AGGREGATE S 3 _..._..... ..... DEDUCTIBLE S RETENTION 80928 71 90 04117/10 04/17/11 X WORKERSCOMPENSATIDNAND WOSTA71L t OTHER EMPLOYERS'-LIABILITY ANY PROPRIETORIPARTNEWEXECUTIVE - E.L.EACH ACCIDENT S 1.000,000 A OFFICERIMEMB ER EXCLUDED? E.L;:DISEASE-EA EMPLOYEE 1a 1,000,000 rye*,descilb.under VECtAL PROMIONI b.ldw E.L.DISEASE-POLICY LIMIT I3 11000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSr4EHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Certificate>of Inaurance:for The City of Campbell,City of:Campbeil Redevelopment Agency,its officers,employees,volunteers.&Mohammad Massouml;with respect to work done by Steve Mason Concrete Construction,Inc.. Protect 661:&463 El.Patlo Dr.,Campbell,CA 95008 CERTIFICATE HOLDER CANCELLATION CITY'UF CAMPBELL' ... SHOULD,ANY OF THE ABOVE.DESCRIBED POLICIES BE CANCELLED BEFORE THE ATTN DEPT.-OF PUBLIC WORKS EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL QQE4ueR*8 M41L 10 DAYS WRITTEN NOTICE.TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUX-ELn unc 70 NORTH FIRST$TREET CAMPBELL,:CA 95008 .....: FAX:408.744-1658 AUTHORIZED REPRESENTATIVE Attention:' .!:eff 5enigaglia ACORD 25'(2001108) Certificate# 21885 ©AC.ORD CORPORATION 1988 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy.We will not enforce our right against.the person or organization named in the Schedule,but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule where you are required by a written contract to obtain this waiver from us. This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule. The premium for this endorsement is shown in the Schedule. Schedule 1. (X) Specific Waiver Name of person or organization The City of Campbell, City of Campbell Redevelopment Agency,its officers,employees,volunteers$.Mohammad Massoumi ( ) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: 3. Premium The prenuum charge for this endorsement shall be percent of the premium developed on payroll in connection with work performed for the above person(s) or organizatiou(s) arising out of the operations described. 4. Minimum premium 5. Advance Premium All other terms and condition of the policy remain unchanged. (The information below is required to be completed only when this endorsement is issued subsequent to the policy effective date.) Effective March 22,2011,this endorsement forms part of Policy No. B0928 7190 Of Issued to:Steve Mason Concrete Construction, Inc. Endorsement No.21885 AUTHORTZBD REP�ENTATIVE iN� � " ootLiy POLICY NUMBER- 60434 54 04 COMMERCIAL AUTO COVERAGE THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ THIS CAREFULLY ADDITIONAL INSURED PRIMARY COVERAGE This endorsement modifies insurance provided under the following: COMPAERCIAt AUTO:COVERAGE PART; This insurance ls'pnmary for the person or organization shown in the schedule,but only with respect to liability arising out of your wbrfc br that insured by or you.Other insurance afforded to that Insured will apply as excess and not contribute as primary to the:insurance afforded by this endorsement. All other endorsement provisions,conditions and exclusions:of this Insurance shall remain unchanged and apply to the additional insured and described below. SCHEDULE ADDITIONAL INSURED CONTRACT/PROJECT The Cityof Campbell, p 661 &663 El Patio Dr., Campbell,'CA 95008 ' City of Campbell Redevelopment Agency, its officers, employees, volunteers Mohammad Massoumi NAMED:INSUREq STEVE MASON CONCRETE CONSTRUCTION, INC. 1116.ELKO DRIVE SUNNYVALE,-CA 94089 . E(MWDONYYY ACORDTM: CERTIFICATE OF LIABILITY INSURANCE I' DAT0311612011; } PRODUCER xPtlDna:40aI 900e2100:FeX:"404-28o-2iiD THIS CERTIFICATEAS1SSUED"AS A MATTER OF:INFORMATION ONEPOINT.;BUSINESS&INSURANCE SERVICES ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 950 S.BASCOM AVE.,SUITE 2118, HOLDER. THIS'CERTIFICATE DOES NOT AMEND, EXTEND OR SAN JOSE CA 95128 ALTER THE COVERAGE AFFORDED.BY THE POLICIES BELOW. J.; INSURERSAFFORDING COVERAGE NAIL# Agency UO;OB93663 — INSURED INSURER A: CenturySur®tyrCompany ; STEVE MASON CONCRETE':CONSTRUCTIONINC. INSURER B: 1i18 ELKQ.DRIVE;." INSURER C. SUNNYVALE1 CA 94089. . INSURER D: INSURER E: COVERAGES THE"POLICIES OF'°INSURANCE LISTED BELOW HAVE BEEN i55UE0 TO THE INSURED NAMED ABOVE FOR-THE POLICY PERIOD INDICATED.'NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION.OF ANY"CONTRACT.OR OTHER.DOCUMENT WITH RESPECT ToWHICH.THIS CERTIFICATE MAY.BE ISSUED'OR MAY PERTAIN. THE INSURANCE AFFORDED,BY THE'POLICIES:DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS:AND CONDITIONS OF SUCH , POLICIES.AGGREGATE LIMITS'SHOWN'MAY HAVE BEEN,REDUCED BY PAID CLAIMS. IMR ADD _.. POLICYEFFECTNE, POLICY:EXPIRATION LIMITS' . TYPE OF INSURANCE . POLICY NUMBER .':.L7R INS ... ., -:DATE YID -DAT YMID .. - . GENERAL LIABILITY CCP650910 04129110 W29111 EACH CC !a 1,000000 'X; COMMERCIAL GENERAL LIABILITY OAMAGETO RENTED S 100;000 :. PREMISES(Ea ocagr )' . X CLAIMS MADE OCCUR MEO:EXP(Any ona person) S Excluded: A 1,000,000 PERSONAL !S GENERAL AGGREGATE $ 2,000,001) GSWL AGGREGATE LIMIYAPPLIESIPER: PRODUCTS-COMPIOP AGG. 5 1,000,006 " :PE PRO... _ POLICY JEC lOC AUT.OMOSILE'LIABILITY' COMBINED'SINGLE LIMIT ..' ANY AUTO (Ea accldenq S. ALL OWNED BODILYiNJURY' SCHEDULEDAUTOS (Per:pedsanl. 3 HIREDAUTOS - BODILY INJURY S NON-OWNED AUTOS (Per acrrdenl) -- ------�—•--- PROPERTY DAMAGE $ (Pereccideni) GARAGE W4BILITY -: S . AUTO'ONLY=EA ACCIDENT ANYAUTO OTHERTHAN FA ACC 5 AUTO ONLY: AGGIS FXCESSY.UMBRELLA LIABILITY _. - EACH OCCURRENCE. . $, OCCUR CLAIMS I VIDE" AGGREGATE S r: DEDUCTIBLE.'' S RETENTIONS S _. _. WC STATU - WORKERS COMPENSATION AND. TORYLIMITS OTHER EMPLOYERS'LIABILITY, E.L.EACH ACCIDENT S ANY:PROPnIRORIPARTNaR/[XEDVr1YH .... -- OFFK*"EMDEREXCLUDED7:_' .. - a. <' E.L.DISEASE-EA EMPLOYEE 'S' ' ny.tia.Wwuaa.. ::.: LI smcm OwnsloNs wiow, E.L.DISEASE-POLICY LIMIT S OTHER: DESCRIPTION.OF OPERATIONSILOCATIONS/VEHICLESIEXCLUSIONS ADDED BY,.ENDORSEMENT!SPECIAL PROVISIONS Certificate of,lnsurance'naming The City of Campbell;Clty of Campbell Redevelopment Agency,'lts'officers,employees,'volunteers& MoMamrnad Maesouml es additional Insured vrlth respect to work done by Steve Mason Concrete Construction,Ind. - Project:661 El Patio Dr Campbell,CA 95008 .. "CERTIFICATE.HOLDER' CANCELLATION CITY OF CAMPSEILL, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF.THE ISSUING INSURER WILL 6G 'MAIL 10 DAYS ATTN DEFT:OF PUBLIC WORKS WRITTEN NOTICE TO THE.CERTIFICATE HOLDER NAMED TO'THE LEFT, 7D::NORTH fj RSTSTREET';. CAMP13ELL,C. .1 8 - FAX:4OB-74I-1858 AUTHORIZED REPRESENTATIVE i Attention:' Jeff'Tatro.':. ACORD 25(2601/05) Certificate#': 21859 0ACORD.CORPORATION 1986 Page 1 of 1 Jeanine Grundman From: Jeanine Grundman Sent: Monday, March 21, 2011 4:23 PM To: 'eva.mandujano@onepointbusinessinsurance.com' Subject: Steve Mason Concrete Policy Attachments: Sample Certificate of Insurance.pdf; Insurance Requirements.pdf; Insurance Transmittal Steve Mason Concrete Const..doc Hi Eva, We recently received the certificate of insurance for Steve Mason Concrete Construction, Inc. Their Century Surety Company Policy# is CCP650910 and their Truck Insurance Exchange Policy#is 604345404. They intend to apply for an Encroachment Permit for the curb and gutter at 661 &663 El Patio Dr. in Campbell. Please review the attached documents. I have included the the necessary Insurance Requirements for the City of Campbell Department of Public Works as well as some additional information,that may be helpful to you. Please reference the project address on the updated certificates. Thank you very much, Jeanine Jeanine Grundman City of Campbell Public Works Department 70 North First Street Campbell, CA 95008 408-866-2150 3/21/2011 EF N CZco+1 —w Lf LQ CITY OF CAMPBELL DE-PARTMENT OF PUBLIC WORKS 70 NORTH FIRST STREET CAMPBELL , CA 95008 FACSIMILE/EMAIL TRANSMITTAL SHEET TO: FROM: Eva Mandujano Jeanine Gr uidman EMAIL DATE: eva.mandujano@onepointbusinessinsurance.com 3/21/11 FAX NUMBER: TOTAL PAGES INCLUDING COVER: (408)280-2110 PHONE NUMBER: SENDER'S EMAIL: 1 (800)297-6686 jeanineg@cityofcampbell.com RE: PUBLIC WORKS FAX #: Insurance Certificate Requirements (408)376-0958 ❑URGENT❑FOR REVIEW❑PLEASE COMMENT X PLEASE REPLY ❑PLEASE RECYCLE Notes/Comments: ***Please note permit number and work site on certificate of insurance*** Re: Insured: Steve Mason Concrete Construction,Inc. Work Site: 661&663 El Patio Dr.,Campbell,CA 95008 We have received the certificate of insurance for the work your insured will be doing in the City of Campbell. In order to meet our minimum insurance requirements,we still must ask that the following changes or additions be made to the certificate or information provided to the City. 1. Automotive Liability policies are to show"Any Auto"checked on certificate and the Insurance provided to the Additional Insured is Primary. 2.The cancellation area of the certificate is to be edited to delete"endeavor to"and"but failure to mail such notice shall impose no obligation or liability of any kind upon the company, its agents,or representatives". 3. In the Workers' Compensation and Employer's Liability area of the certificate the requirements are as follows: A waiver of subrogation clause is required in connection with the workers' compensation coverage. 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TYPE OF INSURANCE I ' " hollCY N111USEk.'.'.' t7 cicr.SrvEerNB.'. .roLfcr Fxastatta4.l oRrn W .ate. LfaffT§.. . ::0 1AAtAl¢). . . . . . . ...'. . .'. ... ... CAMl7ERCUL GENERAL.L±,b cm.y. �KMo : 5 C1�111AS MADE. .;.00CUR . btED E�IAnY one'Darsw} ,;::.-tc .:'::: :: ...P. . . . . . . . . . .' .. . ... ... ... ... ... ... ... ... .. :. .:.. �a . �'• 'fgN�RAL AGGRSGAT$;.:.:;:;'. . .. '.GefLAGGREMTELIMrrAPFL1ESPER:'. . : ' :.'..f•'fiC3JUCTS:COMPIOP:,4GG: . .. .POLICY:.:.:�.,?ECy!:';'.' ?t'.G•C;.'.:.'.:.'.:.•.:.'.:.'.:.',:.'.:.'.:.'.:.'.:.�.:.'.:.. .'.�.'.. ----- ------•- -• -........-- :#AU70MOH14E lfABiLRK•, . @qq .S$a9.'.:.'. '.'.:.oi4.If10::'.:'.'.:.041a6f11:.'. CQPd61NSDSINGL£LIAgT.:...: . : . . . . . . . . . . . . •.'.'.'.'. :'�:. : . . . . . . . . . . . . . . .. lEescddeM} . . . . . . . :3.• . 9,00D,ODO,... ... . -- #:..#nLLOwNEDAuraS .'.'. .'. - . . . . j'.'.'... .' '.'.•.'.:.. ... BOD,LY.IN.IURY. . #.SCHEDlLF1SAtiTbB. ... ... ... ... ... ... ... .....(. ... ... IPerPest111.:.'.:.'.:. .:.'.:S':.:.'.:.'.:.'.:.'.:.' :.'.:.'. ......:XNON4WNEOAV1'OS. . .... e4DSLY INJURY.'. 1Per ncdtlonq'-'.:. #..:.#...:.:-.::.:-.::.:...................:::..: ;...:.:.:..:. ...;. .:... ... ....;....:... .... ...:..:. ... ..,..' P.'.'.'.......'.'. $. .'.'....E GARAGR LMAUTY.'.'...... (: RQPERiY pAM4tiE - :.. . . . . . . . . . : : . . . .. ..... .'.:gLtT0.t3lJE.Y.?.FArACgOENT::....................... '•. OTHER TFL1F1 . . . . ... . . . . . ....................... ... . . .... EMCESSJUWIaRELLALL1Bftm..'.'. .' . fAG}7OCCURR'.. :: .. ... .. ., ...:DEDUCTIBLE ... ... ... ,. RtiEttrlON'S . PovtiRfiE3i?3coeQsFiJsa�wwpno •.: : B0928T1:90. Dey4Tfi0':'::':`:::'Od/i7f1'1:.'..X' orre ars:i . . . . S . > LQVER9:'iElllil', ,..'.'.'.'.•'.': . . . . . . . . . . . ai}+i�_ -� ---- — ' A(' in°HQARHiFOR1P/AfYJ2Wk>G4C(r71Y�.:.'.:. . .:..::.:.: :: E,L:EACHACC(5Em, .' ' 'S 1;¢pOp040;:::•::: ... . . . . . . . . . . . . . . . . . . ... . . . l . i.:•.:avHc(lL#ptriLiEi75'e.lar.' .; ...'.'.'.'.'.'.'.'.VE:L'DISEASE-PbIiEYLWIY.'.g:.•: 1.0 . . . . .. .. .. ................................... :.'.: :... ...'.'. . .'. . . . . DESCRIPTI¢N OF OPERA7)OA1SILaC:A�FG41J51VE11iCL�57H?C4`LElS1OAl9:iQiG:WE6 Oy-EPIIIGRSEMENTI SPE;CIAL�.PROYiSIOHq Ceirtlff:ca¢eof:tnsurairce:for.Tiee.Cilpof'.CampheEf,.CI(y.vf:CampEae¢I.Reduvelopm®ntAgerecy,:itsbfRcer. . . . . .. . * . . . . . . S:Pl. . . . .a. .. .:: ... . maasoumfM(h' pecttvwoek:dopeby3feveA'1�sonCGn:orefe.G:ons#rucf(on lria .'. . . . . . .S;eu l s,volunteers •.. . . . .. :.: :.PriiJ.. .681.. .lx. ...r. ....E. . ;CA'�JS008... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .: . . ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .:. G #3FiFfGIkT :Kf lti3lGEt-----:.:- :. :CI7YOF..CMPSELL.. .:.'.:. .:. .:.'.:. .:. .:.'.:.'.:. .:.'.:. .:. .:.'.'�.]LD H� .THE�89YETDIESCRIBED'POLICIESMh At %Lgp:PEF0P2ETHE ATTR 09PT.:OV IOVOU�WORKS: : : ;'. : .�cR IiY eN T10 7E TH OF: E-1.%`Uel{G'-IhtUR Y17LL ENCEA R T6 nI,vG lO•DAAY3 ... ... .. lO;NORTH FIEESTSTREET. : . : NOTICE TO THE rti:fr LATE HOLDE0-AM D TO THE LEFT;BUTFAILI1k7E.:. .: . tO.0050SFlALIIA1Q65ENOdBLIGAToNOpLIIii3lLlTl CPl1NYIQH3ltPbNTHEIN$URER,.'. . .•; CAMPSELL;CA1 MOOS '.:. : :::'::: ::: ::: Hsa xrsoRi+Er sFxiArrvEs:.... .' .'.'. . . . .' . . . . •.•. .•. :FAX::4i78-Z441958: : :�: : :•: ;•: ;�: :•.�.•. .�.•:-.�: . .•:• �: :�:.:. .A�T .. ... ... . ::: ::: .. ... ... ... ... . �fIORIZED.REV?AESEMTAT.^JE.'.:.'.:.'.: -.'.: .�. -�. . . :A!lerldlob�c: ::: ::: :::'::: ::: ::: ::: ::: .... ':::'::: :::: : ::: :. ':::.:..:':: .:.•. .•. . ...' efEiJ Seri . . . . . . . . . . . . . . . . ACORD 25(2001108)...:..:. ......:. .:: .:. .:.'.'CeNflc�#�fl•. .29866..:.:. .:. .:. 4C08D GoRPoRAtlQfd 1e6 . . . . ..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 �1cy,IL� Joy F -- is CF'CA.k Exect assistant A� City of kampbell 1 Department of Public Works U r 70 North First Street 0 o Campbell,CA 95008 Phone:(408)866-2150 CH A ° ( )Fax: 408 376-0958 RRn• Transmittal To: Mohammad&Farimah Massoumi Date: 8/2/10 Address: 3395 S. Bascom Ave., Campbell CA 95008 Re: 661 El Patio Drive, Campbell CA ❑ Urgent- ❑ For Review ❑ Please Comment ❑ Please Reply x For Information &Use Enclosed please find a copy of the recorded Street Improvement Agreement for 661 El Patio Dr. Joy Francois cc: Land Dev File M:�077O:0104_4---ww 9/17/2007 11:18AM Payment History For k6CE Case #: ENC2007-00144 rr^ x, 3 P ,.. wet k##•,. ... R J Q . . ,., �,., ,_�- a n_ s,,. Pa► D to FMPM 200706251548544180 Parcel Map Fees-4 Lots or 3,550.00 3,550.00 6/13/2007 4611 197550 JD 0.00 Less 3DB 200706251549121520 Storm Drain Fee- 387.00 387.00 6/13/2007 4611 197550 JD 0.00 Multi-Far FPSD 200709171113209210 Faithful Perf. Security/Dep 12,458.00 12,458.00 9/17/2007 3178 200076 JD 0.00 V6, " 200709171113349990 Monument Security 4,000.00 -4,000.00 9/17/2007 3178 200077 JD 0.00 �A'i. 200709171114267330 Construction Cash Deposit 500.00 500.00 9/17/2007 3178 200078 JD 0.00 PCI1 200709171114541240 Non-Util Plan Ck/Insp to 1,619.54 1,619.54 9/17/2007 3178 200079 JD 0.00 $250K APP 200709171115535150 Encroachment Application 300.00 300.00 9/17/2007 3178 200079 JD 0.00 Fee Total Fees:$22,814.54 Paid: $22,814.54 TOTAL REMAINING DUE: $0.00 Page 1 of 1 CasePaymentHistory-rpt -i PUBLIC WI - 3 DEPARTMENT�_L_AND-DEVELOPMENT"&T FIC RECEIPT Effective July 1,2007 -7 �1 L� TO: City Clerk PUBLIC WORKS FILE NO. � a f —vot � \ PROPERTY ADDRESS 1 IF-ADib-0 - Please collect&receipt for the following monies: ACCT. ITEM AMOUNT LAND DEVELOPMENT 2203 Plan Check Deposit 2%of Engineer's Estimate $500.00 min 2203 Faithful Performance Security FPS 100%of ENGR. EST. * 12 1 j519,- 2203 Labor and Materials Security 100%of ENGR. EST. 2203 Monumentation Security $1000/Monument 2203 Emergency Construction Cash Deposit 4%of En r. Est $500 min/$10,000 max * 1 Plan Check&Inspection Fee Non-Utili **2203 En r. Est.>$250,000 Actual Cost+20%min.$30,000 Deposit 4722 En r. Est.<$250,000 13%of ENGR. EST. 4722 JAW7-Application Fee AeA Non-Utility Encroachment Permit $300.00 Minor Encroachment Permit<$io,000 $135.00 R-1 First Permit No Fee Subsequent<o,000 $135.00 4722 Utility Encroachment Permits: Arterial/Collector Street $560.00 Residential Streets/Other Areas $310.00 4722 Appeal Filing Fee $100.00 4722 Lot Line Adjustment $900.00 4722 Parcel Ma 4 Lots or Less $3,400.00+$75/lot 4722 Final Tract Ma 5 or More Lots $4 200.00+$100/lot 4722 Certificate of Compliance $650.00 4722 Certificate of Correction $400.00 4722 Grading&Drainage Plan Review Single Family Lot $200.00 Site< 10,000 s.f. $600.00 Site> 10,000 s.f. <Acre $800.00 Site> 1 Acre $1,200.00 4722 Notary Fee(per signature) $10.00 4722 Vacation of Public Streets&Easements $2 200.00 4722 Assessment Segregation or Reapportionment First Split $725.00 Each Additional Lot $200.00 4721 Storm Drainage Area Fee Per Acre R-1 $2,120.00 Multi-Res$2 385.00 All Other$2 650.00 4920 Parkland Dedication Fee 75%/25% Due Upon Cert.of Occupancy) 511.7424 Postage TRAFFIC..__. _...----.____ 47281 Intersection Turn Counts Two-Hour Count $76.50 4728 Intersection Turn Counts a.m.or p.m. peaks) $150.00 4728 Traffic Flow Map(Daily Traffic Volumes $32.00 4728 Signal Timing Information $62/Hr 4271 Truck Permits $16.00/ er trip) 4728— No Parking Signs _ _ ($1/each or$25/100) MISCELLANEOUS —.._.--- --- -----._-__ _----- - ------ --•-----_- Other(Please Specify) 47221 Street Tree Planting/Removal Permit ($145.00+$500 deposit) *Engineer's Estimate shall be as approved by the City Engineer. I/-' PC �^ ,� TOTAL $ NAME OF APPLICANT mt t CJt.WY NAME OF PAYOR 1 ' ll &4_ 1 PHONE 1-2-2)c) ADDRESS 14 ( ZIP **Actual Cost Plus 20%Overhead Non-Interest bearing deposit) FOR RECEIVED BY IRC ITY CLERK 7� Q�� ONLY Date Receipt# SEP 17 ,Q O I sen over copy to Finance, oo LVr. Date7 Initials i a 7 i CITY OF CAMPBELL, GA RECVD BY: JANH 01000200077 PAYOR: MIKE PAYDAR CITY OF CAMPBELL, CA TODAY'S DATE: 07/17/07 REGISTER DATE: 09/17/07 TIME: 10:03:06 RECVD BY: JANN PAYOR: PIKE PAYDAR Q#00O2QQ076 DESCRIPTION AMOUNT TODAY'S HATE: 09/#7/Q7 REF DEPOSITS -101.2203 ------- 4,00Q.O0 REGISTER DATE: 09/17/07 TIME: 10:02:40 TOTAL DUE: $4,000.00 DESCRIPTION AMOUNT REF DEPOSITS -101.2203 $12,458.00 CHECK PAID: $4,000.00 CHECK NO: 3178 ---------------- TOTAL DUE: $1�o 5 TENDERED: $4,000.00 � g4J3.0Q GNANGE: .00 CHECK PAID: $12,458.00 CHECK NO: 3178 1 TENDERED: $12,458.00 CHANGE: $.OQ CITY OF CAMPBELL, CA j a RECVD BY: JANH 01000200079 CITY OF CAMPBELL, CA PAYOR: MIKE PAYDAR I TODAY'S DATE: 09/17/07 RECVD BY: JANH 01000200078 I REGISTER DATE: 09/17/07 TIME: 10:04:16 PAYOR: MIKE PAYDAR I TODAY'S DATE: 09/17/07 DESCRIPTION AMOUNT REGISTER DATE: 09/17/07 TIME: 10:03:26 I ENOR & SUBDIV FILING F $1,619.54 ENGR & SUBDIV FILING F 30O.0Q DESCRIPTION AMOUNT TOTAL DUE: ' -------$1 --}919.54 _________REF DEPOSITS -101.2203 I 500.Q0 I TOTAL DUE: 50Q,00 CHECK PAID: $1,919.54 CHECK NO: 3178 CHECK PAID: $500.Q0 i TENDERED: s1,919.54 CHECK NO: 3178 CHANGE: $.00 TENDERED. $500.00 I CHANGE: I I PUBLIC WORKS DEPARTMENT RECEIPT Efleelive July,16,20D6 � (j�P>/ TO:City Clerk PUBLIC WORKS FILE NO. �d� PROPERTY ADDRESS --A`O 1 Please collect&receipt for the following monies: ACCT-, rrEM +AMOUNT '. ENCROACHME14T PERMIT 4722 Application Fee Non-Utility Encroachment Permit ($275.D0) Minor Encroachment Permit<55,000 ($125.00) R-1 First Permit No Fee Subsequent $125.00 UtilitL Encroachment Permit ArterleVllector StreetCo $550.00 Residential Street/Other Areas 5300.OD 2203 Plan Cheek Deposit 2%of Engineer's Estimate $500 min 2203 Faithful Performance SecurityFPS 100%of ENOR.EST. 2203 Labor and Materiels Security 100%of ENOR.EST. 2203 Monumentation Security100%of ENOR.EST. 2203 Cash De osit 4%of En r.Est 5500 min/$10,000 max Plan Cheek&Inspection Fee(Non-Utility) - - - 4722 Engr.Est.<5250,000 (13%of ENOR.EST.) 2203 Engr.E.L >5250,000 (Deposit 8%of En r.EstJS30,000 min)** 4722 utility<$100,000 Minimum Charge Per Location ($250.00) Conduits/Pipelines up to 500 Feet ($2.25/R) Above 500 Linear Feet ($1.35/ft) ManholesNaults/Etc. ($125.00/ea) Pole SeVRemoval ($125.00lea) Street Tree Planting/Removal 5145.00 2203 Utility10>$ 0,000 Acluel Cost+20%" 4760 Storage Container Permit $125.00 4760 Pro'eof Plans&S ecifications Project No. 4760 Standord 5 ecifications&Details ($1,Pg$15.50/Bk 4760 Cie of Engin!orin Ma s&Plans - Aarial Plot 24"x 36" $54.OD Aerial Print 8 1/2'x 11" 525.00 Aerial Search Fee 525.00 Ma s and Plans 24'x 36" $12.00 4722 Penolties:Failure to restore u61ic Im rovements $1001Calendar Da Muni Code Sac.11.34.010 4722 penalties Failure to correct unsale conditions $100/Cehmdar Da 4722 Work Without Permits 4 Times Applicable Fee) LAND DEVELOPMENT - - 4722 Lot Line Adjustment 5900.00 - 4722 Parcel Ma 4 Lots or Less) $3,400.00+57511ot - - 4722 Final Tract M. IS or More Lots $4,200.00+S10011ot 4722 Certificate of Comp om lionce 5650.00 4722 Certificate of Correction $400.00 4722 Grading&Drainage Plan Review Single Family Lot $200.00 Sit.<1D,00D a.f. $sOD.DD sit.>10,000 s.f.<Acre ($800.00 Site>1 Acre $1,200.00 4722 Note Fee(par sl nature Sl0 4722 Vacation of Public Streets&Easements $2,200.00 4722 Assessment Segregation or Reapportionment First Split ($725,00) Each Additional Lot ($20a.00 4721 Storm Drainage Area Fee Per Acre (R•1 (Multi-Res 52,3115.OD) OD All Othcr$2,650.00 4920 Parkland Dedication Fee 759=5%Due Upon Cert.of Occupancy) 511.7424 Postage TRAFFIC 4728 Intersection Turn Counts Two-Hour Count 576.60 4728 Intersection Turn Counts a.m.or p.m. eaks (3160.00 -- 4728 Traffic Flow Map(Daily Traffic Volumes S32.00 4728 Campbell Traffic Model Full Sco o Assessment Actual 4728 Cam ball Traffic Model Reduced Sco a Assessment Aetual 4728 Signal Timing Information (562Mr 4271 Truck Permits $16.00/er trip) ' OTHER 4728 No Parking Signs ($1/each or$251100)- TOTAL - $ 3 • 00 "IkNAME OF APPLICANT - E+ NAME OF PAYOR PHONE ADDRESS ZIP -Actual Cost Plus 20%Overhead(Non•In g deposit) FOR ,. CITY CLERK RECEIVE BY ONLY Dote cal p ' 'For Plon'Check and Cash Deposits,send yellow copy to'Finance. t j.\formsVeceipt form 06-07.xls - ^ ; w SD OF mekw, G RCVS BY: A SmGe«+ Pam= M #mm« qm«S DATE: Gd G REGISTER DAM +dyq TIME= GEeQ DESCRIPTION AMOUNT \ 9makam RSmr q,30.00 \ STORM DRAIN FEES FM $asm ---------------- I#k me $3,037 m CHECK GG; . CHECK NO, 462 ` \ T@gq; $&GIGS r CHANCE: $.m < MOHAMMAD MASSOUfVII t ti ' 11 42664a65 4 6r�'i> FARIMAH H MASSOUMI 1210 ! PH 406 74 t 1 676 r , 3622697134E -.F r 142i5 SQUIRREL HOLLOW LN t w ' ��SzSj 3f ,, c t F,c.-rh,n MUM '� SARATOGA CA 95070541 �` l� „:r r of .'-; ' -�� 1 :�j fame, "o '.,� ., r Pm O��ar5 t�f� a I nLRM wf `f+i' xR �' t sr p k r f F Weds Fargo Bank N Al PI1YI�i' a yrME zj y� AMR a4vWx r gg t � • �wellsfargo com����� ����IC �:k„� ` � r �5' ?��� '� , t � ,] 47i' �� ��� d � t — WNW �-` 2113 6z269 ��L3�;ii� A. �.`»G �.#, � ��a' *t�t ' ' j CITY OF CAMPBELL VENDOR NO. 00007006 CHECK NO. 238072 Acei,inlf I'rirchasc Order Tm orce Nilmher rlinolin Description I 101. 2203 CROB1712 3,1.14.50 DEPOSIT RI-:FUND ,,• 101..5.10 7448 CRO81712 20.36 CNP];RE; T 'c ,1n v 0 A ;T 0 V 00007006 MIKE PAYDAR �s o o e � � o e • o e • �. t c^� CITY QF CAMPBELL wE; :EARGO BANK, N.A. CHECK llATli CHECK NO. �..: rr 11-24 .� 42; MONT>OMERY STREET 1210 0 8/2 7/12 238072 70 NORTH FIRST STREET CA 54104 , L r CAMPBELL; I CALIFORNIA 95008 0 0 AMOUNT $ *****3 , 134 . 86* of VW.D AFTER 90 DAYS 'o '�rtr.n nav fo .PAY THE SUM OF, THREE' THOUSAND; ONE HUNDRED THIRTY FOUR DOLLARS & m 86 CENTS - FI TO THE MIKE: PAYDAR ORDER oF`\ 1420' CAPRI DR ' CAMPBELL CA 95008 0'2 380 7 2no 1: L 2 1000 248l:. 4 12 L8 5 54 15 I e• o a • e e• e • o o e• o• • e as e ....__....... _.__ ... *See Reverse Side CITY OF CAMPBELL 2 70 NORTH FIRST STREET CAMPBELL, CALIFORNIA 95008 7) MIKE PAYDAR 1420 CAPRI DR CAMPBELL CA 95008 -3 i I Refundable bewsit Check Request To: Finance Director Check Payable To: Mike Paydar Address-Line 1: 1420 Capri Dr. Line 2: City: Campbell State: CA Zip: 95008 Description: Refund of remaininq 25% Faithful Security Deposit �sAo SD Account Number: 101.2203 Amount: $3,114.50 Account Number: Amount: Account Number: 101.540.7448 Amount: (Finance Dept only) Interest Earned (Finance Dept only) Total Payable: (Exact Amount) Purpose: Refund of remaining 25%of Faithful Performance Deposit for 661 &663 El Patio I Voucher#: Permit M ENC2007-00144 i Receipt#: 200076 Date: 9/17/2007 Requested by: - Title: PW Inspector Dater 8/15/2012 Syed Wahidi �Approved by: Title: NSS te Ed Arango Finance Dept Only: Verified by: Title: Accounting Clerk 11 Date: Approved by: Title: Accountant Date: Special Instructions. For Handling Check Mail As Is: Mail in Attached Envelope: Interim Check: Needed By: I Return To: JoAnna Thomason Public Works (Name) (Department) Other: fin:Forms/excel/chkreq - Revised 05/00 o� CArJ46 H AKO' CITY OF CAMPBELL Public Works Department August 15, 2012 Mohamed Massounii 3395 S. Bascom Ave, Campbell, CA 95008 Re: 661 El Patio Drive _EP 2007-00144, Parcel Map 837 41/42 Monuinentation Cash Security Dear Developer: According to the City's records, a$4000 cash security bond is still being retained for setting the survey monuments for the above-referenced Parcel Map 837 41/42. Please provide us with a letter from your land surveyor that states: (a) All monumentation has been completed in accordance with the Subdivision Map Act Section 66495, and the prepared Parcel Map 837 41/42, (b) That he has been paid for his services, and (c) That he has set easily identifiable markers at the monumentation locations (i.e. construction stakes and/or flags). Upon written request for refund of the security by the party who posted it, the staff will check the site to verify that the monuments have been set. When the monumentation has been completed, the staff will arrange to have your security released. According to recorded Parcel Map 837 41/42, monuments should have been set on or before May 2011. Please respond within two (2) weeks of receiving this letter. Contact me at (408) 866-2166 if you have any questions. Sincerely, Ed Arango, RE, Associate Civil Engineer cc: LD File/ 661 El Patio Drive Sarkiss Parvin, SMP Engineers, 1534 Carob Lane, Los Altos, CA 94604 70 North First Street • Campbell, California 95008-1423 • TFL 408.866.2150 • FAx 408.376.0958 Tnn 408.866.2790 oS."CA'Vn�� V Y5 n = r G� •GlCH ARO• CITY OF CAMPBELL Public Works Department August 15, 2012 Mr. Mike Paydar 1420 Capri Dr. Campbell, CA 95008 SUBJECT: PERMIT NO. ENC 2007-00144 661 & 663 El Patio ONE YEAR MAINTENNACE INSPECTION AND ACCEPTANCE Dear Mr. Paydar: The City of Campbell has made the final'one year maintenance inspection of the subject Public Works improvements and finds that no remedial work is required. Your warranty requirements and any surety, therefore, are hereby released. We will notify you when the check for your warranty deposit in the amount of$3,114.50, plus any interest due, is ready to be picked up. Sincerely, Syed Wahidi Public works Inspector Cc: Permit#ENC 2007-00144 Public Works Maintenance Division 70 North First Street e Campbell, California 95008-1423 o TEL 408.866.2150 • FAx 408.376.0958 • Tnn 408.866.2790 CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT CLEARANCE FOR ONE YEAR MAINTENANCE ACCEPTANCE LETTER Encroachment Permit # 2007-000144 Property Address: 661 & 663 El Patio Dr. Campbell, CA On File: ❑ Bonds ❑ CD kCash Ur Faithful Performance $ 3,114.50 Z �.�,�r� as O ❑ Labor and Material $ ❑ Construction Cash Deposit to be released: $ ❑ Other overdue deposits to be released (Description): Processed by: Administrator Reviewed by: ector Ins Reviewed by: J3-(U-2-o(7% Land Development Engineer JAJoAnna'nDeposit refunds\Checklist-El Patio.doc(Rev. 10/11) CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT CLEARANCE FOR FINAL INSPECTION AND ACCEPTANCE LETTER Encroachment Permit # EN 2007- C-C 14 4 Property Address I G(0 3 Date of Final Inspection: 201 � On File: ❑ Bonds ❑ CD Cash Faithful Performance $ 12,; 4 5B, 00 p ❑ Labor and Material $ IX Construction Cash Deposit to be released: $ 500 , 00 ❑ Other overdue deposits to be released (Description-) __ Processed by: �,(,L6ZL6'L.e, X/i�.cyYLc�n2C.t�"U Administrator Reviewed by: � Inspector Reviewed by: Lan Development Engineer Reviewed by: 1/9- '0 —( ( City Engineer J:\FORMS\Templates\Administrative\Checklist-Clearance for Final Insp and Acceptance.doc(Rev.03 10) 0f CA4 •URCH A`t) CITY OF CAMPBELL Public Works Department May 12, 2011 Mike Paydar 1420 Capri Dr. Campbell, CA 95008 SUBJECT: PERMIT NO: ENC2007-00144 LOCATION: 661 & 663 El Patio FINAL INSPECTION AND ACCEPTANCE Dear Mr. Paydar, The City of Campbell has made a final inspection of subject Public Works improvements and finds the work to be acceptable and in confonrriance with City standards. Accordingly, the City Engineer accepts the improvements. The one year maintenance period stated in the permit begins as of the date of this letter. 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 Construction Cash Deposit of$500.00 and 75% of your Faithful Performance Security(FPS) deposit of$12,458.00, plus any interest due, is now being processed and will be sent to you under separate cover. We will continue to hold 25% of your FPS deposit as a maintenance surety. If you have any questions, please call me at (408) 866-2165. Sincerely, Syed Wahidi Senior Public Works Inspector MQ cc: Suspense— 11 months Pen-nit# ENC2007-00144 Inspector File J:\JeanineG\ENC2007-00144, Final Inspection.doc 70 North First Street • Campbell, California 95008-1423 ^ TEL 408.866.2150 FAx 408.376.0958 TDD 408.866.2790 Refundable Deposit Check Request To: Finance Director Check Payable To: Mike Paydar Address- Line 1: Line 2: 1420 Capri Dr. City: Campbell State:.CA Zip: 95008 Description: Refund Deposit for ENC2007-00144 Account Number: 101.2203 Amount: $9,343.50 Account Number: 101.2203 Amount: $500.00 Account Number: 101.540.7448 Amount: (Finance Dept only) Interest Earned (Finance Dept only) Total Payable: $9,843.50 (Exact Amount) Purpose: Refund 75% Faithful Performance Security Deposit($9,343.50) Refund Construction Cash Deposit($500.00) Voucher#: Permit#: ENC2007-00144 Receipt M 200076 &200078 Date: 9/17/2007 r - Requested by: Syed Wahidi 1 Title: PW Inspector Date: 5/12/2011 Approved by: MichelleQuinney " " Title: City Engineer Date: 6/12/2011 Finance Dept Only: Verified by: Title: Date: Approved by: Title: Date: Special Instructions For Handling Check Mail As Is: Mail in Attached Envelope: Interim Check: Needed By: Return To: Jeanine Grundman PW .(Name) (Department) Other: f/n:Forms/excel/chkreq Revised 05/00 CITY OF CAMPBELL VENDOR NO. 00007006 CHECK NO. 232032 Account Purchase Order Ln,dice Number Amount Descri Linn 101 2203 CROS1211 9,843.50 CONT DEPOSIT 101.540 7448 CRO51211 57.52 INTEREST 00007006 MIKE PAYDAR �o 0lag, o e e o o e e a 'a GS C j, CITY O'F CAMPBELL 11-24 CHECK DATE CHECK NO. I WELLS FARGO BANK, N.A. 420:MONTGOMERY STREET 1210 0 6/0 6/11 232032 4 >70 NORTH FIRST STREET SAN FRANCISCO, CA 94104 CAMPBELL, CALIFORNIA 95008 �0 AMOUNT *****9, 901 . 02* i 1, + VOID AFTER 90 DAYS nl f � PAY THE SUM OF NINE THOUSAND, NINE HUNDRED ONE DOLLARS & 02 CENTS'- co r EI TO THE MIKE PAYDAR ORDER 1420 CAPRI 'DR6� IA 1 CAMPBELL CA 95008 i u■ 23203211® i: 1210002Lai: La1, 2185541511° a• - o 0 o a a• o r e o a• �a o e oo e "See Reverse Side For ll:asy Opening InstFuctions" CITY OF CAMPBELL 70 NORTH FIRST STREET ' CAMPBELL, CALIFORNIA 95008 MIKE PAYDAR 1420 CAPRI DR CAMPBELL CA 95008 Page 1 of 1 Jeanine Grundman From: Jeanine Grundman Sent: Friday, May 27, 2011 10:37 AM To: Edward Arango Cc: ' Joy Francois Subject: Check for 661 El Patio Hi Ed, Mark Massoumi came by this morning to ask that I submit the check request for Mike Paydar and to call Mark when it was ready. Evidently, they have reached an understanding and Mark plans to come in with Mike to pick it up. Mark had hoped to get the check this morning and that we would divide up the check so he could could pay Planning. I let him know that they would be notified when the check was complete, but asked that he call you before he came into the office to ensure that they brought the appropriate ID/documentation to release the check. I spoke with Mike Paydar and notified him that Mark had come in this morning to request that the check be processed and that we would call Mike when it was ready. Hope you had a good weekend. Thanks, Jeanine Mike- P&� r .307- Z897 Mark Massvu m i 31 q -7gg3 5/27/2011 nT CL rr fA ... Ggigfobcam_._:_. o.. .......... -'- A a �'! tJ4 �'.. � '� .:. 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PA'I ' v. . --'? i t WA� CA A � Civil Engi�ieers —Land Surveports Drawn By: V.G. °�ctti cti •--•----•- - 1534 CAROB LANE WS ,ALTOS, CA PAR ELITERACT MAP NOu )0C BUILDING PERMIT NON 201 � M- (am) %I- 5 PAX t ) 941-�►55 CAMPBELL, CALIFORNIA : Designed By: S.R. m e c CA W m 0 �rri■ n 0 1 > > Z FR Z0 ffr M - l . tta i .f i t i i l f �f .pp.,ppf Obi f - tc jf ! 1 f f ! f i 1 ! f ! ! Q C71 ! ........._wit PA __...... w rm fla ! BciIi.ciINci tip f I cn i f w - f i i ! i N E � -� —A p�pp tip � � w /�. �ww .w w y i awes PA w aF wow s w C�7 f . � Ito N ff � !Es � V,CA [/�� SECTIONS GRADING Smp ENGINEERS _ Date: MAY 2Q �01 A . No. Revision Date. By Ghkd _� �, �-+ aA►ND- DRAINAGE PLANS _'�' ;-;-i rn [?1 !„ PR . I { � I Civil Engineers - Land Surveyors Drawn Bar: V.G. **CR. PARCS FWA►h NOm XX BUILDING PERMIT NON 2010S88 1534 CAROB LM LOS ALWS CA 4 (050) 941--eons FAX ()941—s�s5 CAMP -BELL, CALIFORNIA Designed By: S.R. 9 _ _ f _ SD SD . _�_ SD 0 0o SD NJ _ Co 0) cn~-' GEC) r-- [50 WIDE) ` x 1 000U10) (0 S90*00*01D&E 000 -BASIS OF BEARINGS ANl ARYSEXER LINE .760•34♦ MEIN. 1 13 MON. .. _ .�. ,... 5— — — .- ... — _ Ste= cox. (E) SANITARY SF#ER LANE <I °s- -- — ------ W .... .. (£,3 WA T£R LAVE — W `_ Ea - . --- - _ . W --- .._ . W J Q TER LINE °O°cnt► — W �,,/ (Ei - — _. W--.�` W �_...� — v--�, 4, G G ---------- - _ _ _ W (E1 GAS UAAN CD Q7 . ---- --- _ �... E UTILITY LINE (E) SIDE? ALK .........M...,.. ,..,.,... ,,,.,.,_ .,, E _ .- ._..... ........ ._...... .._..... 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Li ,, R mzlq o � {[`jam � C '� pq •� � a - m o o a Q o o c a' z o o 1�.t iii111 a rr . o.:, Or C13 �• Q e o ,� ,.Cq ZO 44 S �1419. ., U - - .. - t . 11 Lj Pay o o o d I x alei �c CD 04 0.1 drWIRN,o z I" I ��� ��c z off• a� a �. .�� ,��.� of sil 9 APIll �1 . T T Rkll��Nu. lud"13471 417 M—ju, y 45 1 1 -13 12 11 10. 9 8 7 6 42.00 FND ____ N 90000**00# E 75.00/ (3) 3/40 I.P., RCE 13318 PER -Q) 0) v pj� __4 f7 FND 3/4' I.P., RCE 13318 1 PER (2) SEARCHED FOR 3/40 0 co I.P. PER (4) NOT FOUND OS rF Q) LOT 2 P, \j Q) ND I Q) 5 ? � �j 3/4I.P., RCE 13318 X Z- PER (1) S90'000"000E 60.00" POT 490 Q) cu 4 0._ 14 \.e OD -i cl c4i C> LOT 1 co C) -i C> Q (u z 0 0 rl C> C) 5 5 3 1 Ld Ld Uj P_C> V4 C> 619 4 c> 0 C) Ls- C:> .c> C) OD 25.00" 25.004' r1l, C) C:> z CD z m FND 10.0 0/ P,S,E. AND S.E. 314,v I.P., OPEN FND O.U. 314,w I.P.,, RCE 13318 PER (1) 60.001, 5 1.00' ito lw-.\ s 90*00100'w W 75,00' (3) C> C> c> cd (u S 900001100'v W231.28,1 (3) FND MANHOLE WITH STRADDLES GRAPHIC SCALE 20 0 10 20 40 I- NU C> MANHOLE WITH q to STRADDLES cv A C.- 80 � � � Q) IA w PARCEL'o MArwwo"' TM LOT SUBDIVISION 661 EL PATIO DRIVE, CAMPBELL, CALIFORNIA CONSISTING OF TWO (2) SHEETS A RESUBDIVISION OF LOT 16, AS SHOWN ON THAT CERTAIN MAP OF TRACT NO. 2 RANCHO DEL PATIO, WHICH MAP WAS FILED FOR RECORD IN THE OFFICE OF THE RECORDER OF THE COUNTY OF SANTA CLARA,'STATE OF CALIFORNIA ON FEBRUARY 17, 1931, IN - BOOK OF,MAPS LETTERED "Y" AT PAGE 26. LYING ENTIRELY WITHIN CITY OF CAMPBELL, SANTA CLARA COUNTY, STATE OF CALIFORNIA. MAY 2010 .SMP ENGINEERS 1534 CAROB LANE LOS ALTOS, CA 94024 —STREET CENTER LINE I I I 111 11 RON DISTINCTIVE BORDER LINE LOT LINE — — — — — — — — — — — — — TIES AND DIMENSION LINE —EXISTING LOT LINES EASEMENT LINE El 1#1 FND I.P. (XXX) O.U. P.S.E. S.E. REFERENCES. - FOUND 3/4"- I-P�. AS NOTED INDICATES SET 3/4" IRON PIPE WITH CAP LS 8261 FOUND IRON PIPE RECORDED DATA WITH REFERENC&!� ORIGIN UNKNOWN PUBLIC SERVICE EASEMENT SIDEWALK EASEMENT (1) PARCEL MAP 553—M— 28 (2) PARCEL MAP 577—M— 21 (3) TRACTNO. 2, RANCHO DEL PATIO "Y" —M— 26 (4) PARCEL MAP 694—M— 14 & 15 NOTES: - 1. ALL DISTANCES AND DIMENSIONS ARE SHOWN IN FEET AND DECIMALS THEREOF. 2. THE AREA OF LAND WITHIN THE DISTINCTIVE BORDER LINE IS 15,088.8 SQ.FT. MORE OR LESS. a w w loll lNeRm4lam kiffolia LOT AREA SQ.FT. AREA ACRES LOT 1 6,420.0 0.147 LOT 2 8,668.5 0.199 TOTAL 15,088.5 0.346 SHEET 2 OF 2 , .. 0.Y f LL of +,. �'�",'4 G .%z" f'r,�,t, r;�.. :fir �tA,E.�i.'s-0. ' � O f CLE OWNER'S STATEMENT SOME RIGHT, TITLE, OR INTEREST IN WE HEREBY STATE THAT WE ARE THE OWNERS OF OR HAVE AND TO THE REAL PROPERTY INCLUDED WITHIN THE SUBDIVISION SHOWN ON THE MAP; THAT WE -E THE ONLY PERSONS WHOSE CONSENT TITLE TO i PROPERTY; THAT WE HEREBY CONSENT TO THE MAKING OF SAID MAP AND REALVISION AS SHOWN WITHIN THE DISTINCTIVE BORDER WE * HEREBY DEDICATE TO PUBLIC FOR PUBLIC FACIU11ES INCLUDING POLES, WIRES, CONDUITS, GAS, WATER, HEAT MAINS AND ALL APPURTENANCES (SIDEWALKTO THE ABOVE, UNDER, UPON, OR OVER THOSE CERTAIN STRIPS OF LAND LYING BETWEEN THE FRONT AND/OR SIDE LINES OF LOTS AND THE DASHED LINES AND/OR,THOSE CERTAIN AREAS LYING BETWEEN DASHED LINES EACH DESIGNATED- AS "PSEl", -(PUBU-C -SERVICE EASE MEN -TT). THE ABOVE - MENTIONED PUBLIC SERVICE EASEMENTS TO BE KEPT, OPEN AND FREE FROM BUILDINGS AND STRUCTURES OF ANY KIND EXCEPT PUBLIC SERVICE STRUCTURES, IRRIGATION SYSTEMS AND APPURTENANCES 'THERETO, LAWFUL FENCES AND LAWFUL UNSUPPORTED ROOF OVERHANGS. WE ALSO HEREBY DEDICATE TO PUBLIC EASEMENT FOR SIDEWALK PURPOSES AND APPURTENANCES THERETO AND THE RIGHT TO CONSTRUCTo INSTALL, USE,. REPAIR, REPLACE AND MAINTAIN A PUBLIC SIDEWALK ON OR OVER THOSE CERTAIN STRIPS OF LAND DESIGNATED AND DELINEATED AS "S.E." AS OWNERS: MOHAMMAD MASSOUMI AND FARIMAH MASSOUMI, HUSBAND AND WIFE. �/� I e PRINTED NAME: a ! s - c STATE S y! � 1 F.. < ,+ COUNTY OF r # r BEFORE .. NOTARY. t PUBLIC s s (HERE r INSERT AND TITLE OF THE OFFI PERSONALLY #, APPEARED ME ON THE BASIS OF SATISFACTORY EVIDENCE TO BE THE PERSON(S) WHOSE AME(S)" R UBSCRIBED TO THE WITHIN INSTRUMENT AND ACKNOWLEDGED :. HE/SHE/ EXECUTED THE SAME IN HIS/HER)CAiWAUTHORIZED CAPACITY(IES), AND THAT BY HIS/HER/ IGNATURE(S) N THE INSTRUMENT THE PERSON(S), OR THE ENTITY UPON BEHALF ! * INSTRUMENT. FOREGOINGOF WHICH THE EXECUTED THE I CERTIFY UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF CALIFORNIA THAT THE , R. WITNESS MY HAND - OFFICIALSIGNATURE l r 3 - wf d o DA 4 CAROB LANE LOS ALTOS, 94024 i HEREBY STATE THAT I AM SATISFIED THAT THE WITHIN PARCEL. MAP IS TECHNICALLY CORRECT. s 4: am EXP. 12-31—1 STATE STATERECORDER'S CC I TY CF COUNTY �� �y BEFORE ME, ON BEFORE CIE, FILED THIS DAY OF , 2010, AT _._.._ M. PERSONALLY APPEARED NOTARY PUBLIC (HERE INSERT NAME AND TITLE OF THE OFFICER) PERSONALLY APPEARED NOTARY PUBLIC (HERE INSERT NAME AND TITLE OF THE OFFICER) IN BOOK OF MAPS AT PAGE(S) Y 1 AND _4t�, SANTA CLARA COUNTY RECORDS, AT THE REQUEST OF MOHAMMAD MASSOUMI AND FARIMA MASSOUMI . FILE NO.: �*7(0 2-4 1­& R�cin�e e�rnurninc�ec rniin�ry or�nonco j` 61 it]' w vp