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ENC2018-00050 F� MPtlntForrn CITY OF CAMPBELL R-1 ENCROACHMENT PERMIT Permit No. C ��' 'G M DEPT.OF PUBLIC WORKS (Non-engineered work within the public right-of-way) X-Ref File 70 North First Street ($10,000.00 maximum value of work) Application Date /� 1 Campbell,CA 95008 / Application Expiration g Ph.(408)866-2150 ISSUED: 3 /7/I s Date Fx.(408)376-0958 Permit Expiration.Date: 3ei APN i.. o 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 AddressF V le ^ ( N� B. Nature of Work: ��'lC. 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 ofthis 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: C �/12� c— c�o L Le Telephone: / f C �,, /�,� � n Cl l -L Address: �Z� V ( '�C"�1 !J 11.1 iz`v j .0 ..� ?.�'._� - C 1) �_.._)O�- E-Mail Address: F L��_ ._..... .._. _. _... .. ..... .. ..... .... --..._._..------ .._._ .. _ The Applicant hereby confirms that this work is being done by the property owner/applicant at their own residence. The Applicant hereby agrees by affixing their signature to this permit to hold the City of Campbell,City of Campbell Redevelopment Agency,its officers,agents,and employees free,safe and harmless from any claim or demand for damages resulting from the work covered by this permit. The Applicant hereby acknowledges that they have read and understand both the front and back of this permit,and that they will inform their contractor(s)of the information. ACCEPTED: (Applicant/Pe tee Sign D to NOTES: All work shall conform with the attached approved plans and all applicable Campbell Standard Details and Conditions and applicable insurance requirements. The Contractor must have this permit and approved plans and must arrange to meet with the Public Works Inspector at the site at least two days before starting work. Notice must be given to Public Works at least 24 hours before restarting any work. Per Section 4216 of the Government Code this permit is not valid for excavations until Underground Service Alert(USA)has been notified and the inquiry identification number(Ticket No.)has been entered hereon. USA Phone: 1-800-227-2600. Ticket No.: Applicant is advised that upon issuance of this permit,property owner,or property owner's successors,shall be responsible for any and all damages arising out of the design,installation or condition of private improvements in the public right-of-way. SPECIAL PROVISIONS 1. Prior to any Work,the property owner shall execute an Agreement for Private Improvements in the Public Right-of-Way,which shall be recorded. 2. New `c2�i 'SW ALL- 13E IUX 5APUM FU-2lum (04W,55r -CALLeW 3. CA LL - f—IZ N i;_=1v T i2t9L- (Z `Ti- (N $Z A-LL/<-[t G►J STANDARD AMOUNT RECEIPT NO. SECURITY FOR FAITHFUL PERFORMANCE (100%Of Engr's Est.) $ 56 n '1 Lf O R-1 PERMIT FEE $ -- l APPROVED FOR ISSUANCE: 3/ 7 for City Engineer Date Permit Expires 6 Months after Date of Issuance. �1 . n GENERAL PERMIT CONDITIONS 1. Payment of a security to insure faithful performance and completion of the work is required. This security is refundable upon completion of the work and written acceptance by the City. 2. A one-year maintenance period for all work is required. Such period will begin on date of acceptance by the City. It is the applicant's responsibility to remove and replace unacceptable improvements within the one-year maintenance period. 3. Refund or cancellation of the Faithful Performance Surety will be initiated by the written acceptance of the work by the City. 4. Submit project schedule 10 days prior to proposed start of work.Special provisions may be required for work within City facilities and downtown Campbell. 5. The Permittee must request in writing a final inspection and acceptance of the work upon completion. Acceptance by the City will be made in writing to the Permittee. 6. Maintain safe pedestrian and vehicular crossings and free access to private driveways,fire hydrants and-water valves. 7. Replace as directed by the City Engineer any damaged or removed improvements in accordance with City Standards and Specifications at the sole expense of the Permittee. 8. Sawcut for all PCC and AC removals. All PCC removals shall be to nearest scoremark and shall be doweled to existing improvements. 9. Adequate signing and barricading is required on the job site. Failure to provide such signing and barricading as specified by the City Engineer may result in the City's providing such signing and barricades and charging the cost to the Permittee. 16. The Contractor or Permittee will have a supervisory respresentative available for contact on the project at all times during construction. 11. This permit shall be kept at the site of work and must be shown to any authorized representatives of the City of Campbell or any law enforcement officer upon demand. - 12. No storage of materials or equipment will be allowed near the edge of pavement,within the traveled way,or within the shoulderline, which would create a hazardous condition to the public. 13. . . This permit shall not be construed as authorization for excavation and grading on private property adjacent to the work or any other work for which a separate permit may be required,nor does it relieve the Permittee of!any obligation to obtain any other permit required by law. 14.. This permit does not release the Permittee from any liabilities contained in other agreements or contracts with the City and any other public agency. 15. This permit is not transferable. Work must be performed by the Permittee or his designated agent or contractor as specified thereon. 16. Prior approval of inspector is required for any work done after normal working hours,on weekends or holidays and may require reimbursement of inspection costs at the current overtime rate. 17. Call back(call out)due to emergencies regarding this permit shall be at the current overtime rate with a three(3)hour minimum charge per occurrence. 18. 1f the public interest requires a modification of,or a departure from,the plans and specifications,the City shall have the authority to require or approve any modification or departure and to specify the manner in which the same is to be made for City-owned or maintained facilities. 19. Pursuant to Chapter 14.02 of the Campbell Municipal Code,applicant shall not cause to be discharged any material into the municipal storm drain system other than storm water. Applicant shall adhere to the BEST MANAGEMENT PRACTICES established by the Santa Clara Valley Urban Runoff Pollution Prevention Program. Applicant shall be responsible for ensuring that all those providing services under the applicant are aware of and understand all of the above conditions. g Applicant Date J:\FORMS\Templates\Encroachment Permits\R-1 Encroachment Permit STATIC form2.pdf Rev.02/14 CITY OF CAMPBELL DEPARTMENT OF PUBLIC WORKS APPLICATION FOR PLANT REMOVAL Date Submitted Application No. Pursuant to the terms of Chapter 11.08 of the Campbell Municipal Code,an application is hereby made fora permit to remove hN htJ gEg, ':f2Et 1. The location of the job in the public right of way is as follows: ' �tRTtI , , c P&E LL- Cry- q s,069 2. The reasons-for the removal-are as follows: _ .r e -qM,-'� 0,2 (use other side of sheet if necessary) 3. The applicant hereby•agrees; by affixing his signature to this application,to hold the City of Campbell, its officers, agents-and-employees"free, safe and harmless from any claim or demand for damages to third persons relating from the work herein proposed. - Name of Applicant L 1, (si ature) (print your name) Address of Applicant 124 V.A nILCL Check One: Residence K or Business() Telephone Number 14 0,0 ' r. ir :k �eiri: is fe :'ciexie �eic * ?: ic 'rde �: :kdc4; Eiek4tdcis �c � * �: x :kf�` � doakdc 's �c :kie �eE FOR OFFICE USE Date Recom endation % !�r<< �2 0 J '� /�� r✓�/ �.f`, D'" /1/La vim" (use other side of sheet if necessary) Applicant.contacted iris? By ��/��f/��° Date 2 PUBLIC WORKS DEPARTMENT LAND DEVELOPMENT Effective July 1,2017 TO- Finance PUBLIC WORKS FILE NO. E-V\J C 2-6 PROPERTY ADDRESS q VG12A Please collect&receipt for the following monies: LANW D-Pr- VEL "M 4722 1 Encroachment Permit Application Fee Non-Utility Encroachment Permit Major�:$10,000 $425.00 Minor Encroachment Permit<sio,000 $240.00 lnjtjal R-1 Permit N/C Subseqvent R-1 Permits within Two Year Period $240.00 Inspection Fee Minimum Charge per Location $420.00 Street'Tree Planting/Removal - NIC 2203 ($500 per Tree Planting Deposit Required) $500.00/tree 2203 Plan Check Deposit 2%of Engineer's Estimate $500.00 min Utility and R-1 Permits no deposit required 47221 Gradinq&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_>0.5Acre $1,772.00 4722 NPDES Review(C3 Requirements) For protects not required to submit numeric sizing $175.00 For projects required to submit numeric sizing Impervious Area 10,000 Sq. Ft to 1 Acre $740.00 Impervious Area 1 Acre or more $965.00 4722 For proiects sent to Consultant for review Consultant Cost+20% 4722 Additional treatment facilities - $315 ea Plan Check& Inspection-Fee(Non-Utility) 4722 Enpr.Est. <$250,000 14%of Engineer's Estimate 4722 Enqr. Est. �t$250,000 and 5$500,000 $35,000.00+8%of Engineers Estimate 4722 Engr. 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.* Cjc, 2203 Labor and Materials SecuritV 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 Map(5 or More Lots) $5,115.00+$124/lot 2203 Monumentation Security 100%of City's Monumentation Estimate 4920 Parkland Dedication Fee(75%/25%Due Upon Cert. of Occupancy) 4722 Lot Line Adjustment(Includes certificate of Compliance) $1,990.00 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 47221 Approved Plan Revision Fee $1001sheet 4722 1 Appeal Filing Fee $200.00 730.49241 Notice of Improvement Obligation Payment 47221 Assessment egrega ion or Reapportionment First Split $940.00 Each Additional Lot $295.00 511,74241 Postage Other(Please Specify) *Engineer's Estimate shall be as approved by the City Engineer and shall include all items of work. TOTAL $ AME OF APPLICANT RA AME OF PAYOR L— C,,-- PHONE CK Z Ot V,9 DDRESS 2J4 6 1'r = 1 Loo FOR RECEIVED CITY CLERK A iT OR C L ONLY Date AT JTORMSITmola! :z; --------- l (Q)Allstate, You're in good hands. Information as of August 4,2017 Joan o Policyholder(s) Page 1 of 2 San Joe CA 5148Rd Cyril&Aurelia De Colle San Jose CA 95148 y , Policv number 904173 530 Your Allstate agency is Joan Ho olr1111olr1li Jill 11lr111111111l'II Jill lllllll'11Ilnln1lnllllll (408)238-4833 CYRIL&AURELIA DE COLLE JOANHO@ALLSTATE.COM 1249 VIRGINIA AVE CAMPBELL CA 95008-6808 Your Paper Policy Declarations Thank you for being an ePolicy customer. Although you've requested that we send your policy documents electronically,California regulations require us to send you the enclosed paper copies of your renewal Policy Declarations. Remember that you can view your entire package of policy documents online by logging into your account at allstate.com. Thank you again for being an Allstate customer.We appreciate the opportunity to help you protect what you have today and help prepare you for the future. Sincerely, Thomas J.Wilson President,Allstate Insurance Company RP641 .r F Policy number; 954 773 53® Page 2 of 2 Policy effective date; September 25,2017 Your Insurance Coverage Checklist _ We're happy to have you as an Allstate customer!This checklist outlines what's in this package and provides answers to some basic questions,as well as any"next steps"you may need to take. ❑ What's in this package? ❑ What about my bill? See the guide below for the documents that are included. Unless you've already paid your premium in full,we'll send Next steps:review your Policy Declarations to confirm you your bill separately.Nextsteps:please pay the minimum have the coverages,coverage limits,premiums and amount by the due date listed on it. savings that you requested and expected.Read any You can also pay your bill online at allstate.com or by Endorsements or Important Notices to learn about new calling 1-800-ALLSTATE(1-800-255-7828).Para policy changes,topics of special interest,as well as espanol,Ilamar al 1-800-979-4285.If you're enrolled in required communications.Keep all of these documents the Allstate®Easy Pay Plan,we'll send you a statement with your other important insurance papers. detailing your payment withdrawal schedule. ❑ Am I getting all the discounts I should? ❑ What if I have questions? Confirm with your Allstate Agent that you're benefiting You can either contact your Allstate Agent or call us 24/7 from all the discounts you're eligible to receive. at 1-800-ALLSTATE(1-800-255-7828)-para espanol, Ilamar al 1-800-979-4285-with questions about your coverage,or to update your coverages,limits,or deductibles.Or visit us online at allstate.com. wide to your renewal package _ made simple Policy Insurance(Made Declarations* Simple N The Policy Insurance seem o Declarations complicated? o lists policy Our online R co details,such as guides explain o your property coverage terms R details and and features; coverages. www.allstate.com/ S madesimole o Espanol allstate.com o /facildeentend_er 8 0 *To make it easier to see where you may have gaps in your protection,we've highlighted any coverages you do not have in the o Q (Coverage Detail section in the enclosed Policy Declarations. o 0 r 000 ao8 o� � Page 2 of 2 Policy number; 904173-5-3-0- Policy effective date: September 25,2017 experience.Additionally,our business partners use tracking you previously opted to limit some sharing of your personal services,analytics and other technologies to monitor visits to information.Please keep in mind that regardless of your allstate.com.The website may also use Web beacons(also choices,Allstate may share your personal information with its called"clear GIFs"or"pixel tags")in conjunction with cookies. affiliates,outside companies and other entities to comply with If you prefer,you can choose to not accept cookies by changing the law,provide you with the best service on your Allstate the settings on your web browser.Also,if you would like to accounts,or as otherwise permitted by law. learn about how we gather and protect your information over the Internet,please see our online privacy statement located at ��Appreciate Your Business the bottom of the allstate.com homepage. Thank you for choosing Allstate.We understand your concerns about privacy and confidentiality,and we hope this notice has To learn more,the allstate.com Privacy Statement provides been helpful to you.We value our relationship with you and information relating to your use of the web site. look forward to keeping you in Good HandsO. This includes,for example,information regarding: If you have questions or would like more information,please 1) how we collect information such as IP address(the don't hesitate to contact your Allstate agent or call the Allstate number assigned to your computer when you use the Customer Information Center at 1-800-ALLSTATE. Internet),browser and platform types,domain names, access times,referral data,and your activity while using We reserve the right to change our Privacy practices, our site; procedures,and terms. 2) who should use our web site; 3) the security of information over the Internet;and Allstate Insurance Company 4) links and co-branded sites. 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Privacy Choices for Insurance Company,Castle Key Insurance Company and California Customers Castle Key Indemnity Company participate in information N Unless you request otherwise,we may share your personal sharing with the affiliates listed above,but have a separate N information with one or more Allstate affiliates.We may do privacy notice for their customers. o this for a number of reasons,including making you aware of the (ed.2/11/2014) o different products,services and offers they can provide. X73497-I CO Similarly,unless you request otherwise,we may share your o personal information with outside companies with which we have a written agreement to jointly offer you products and services that we believe may be of interest to you. o 00 0 You have the right to limit some sharing of your personal o information by reviewing and completing an"Important Privacy Choices for Consumers"form.We've enclosed this form unless 0 Q O 00 N r O D p O 0 O Ln 0 N 0 O O O O O O�7-- Policy number; 904 173 530 Policy effective date; September 25,2017 ` I Is Q Page7of2 � You're in good hands. Privacy Policy Statement In addition,Allstate and its business partners gather information through Internet activity,which may include,for . Thank you for choosing Allstate.We value you,respect your example,your operating system,links you used to visit privacy and work hard to protect your personal information. allstate.com,web pages you viewed while visiting our site or applications,Internet Protocol (IP)addresses,and cookies,We This statement is provided on behalf of Allstate Insurance use cookies,analytics and other technologies to help; Company and the affiliates("Allstate")listed at the end of this notice.We would like to explain how we collect,use and share ® Evaluate our marketing campaigns the information we obtain about you in the course of doing ® Analyze how customers use our website and applications business. ® Develop new services ® Know how many visitors have seen or clicked on our ads Our Privacy AssuranceO We do n_QJ sell your personal or medical information to Also,our business partners assist us with monitoring anyone. information including,but not limited to,IP addresses,domain ® We do not share your information with non-affiliate names and browser data,which can help us to better companies that would use it to contact you about their understand how visitors use allstate.com. own products and services,unless permitted pursuant to a How We Use and Share Your Personal Information joint marketing agreement. In the course of normal business activities,we use and share • We require persons or organizations that represent or your personal information.We may provide your information assist us in servicing your policy and claims to keep your to persons or organizations within and outside of Allstate.This information confidential, would be done as required or permitted by law.For example, 0 We require our employees to protect your personal we may do this to; information and keep it confidential. ® Fulfill a transaction you requested or service your policy As you can see,protecting your personal information is " Market our products important to us.In addition to the practices described above, • Handle your claim we use a variety of physical,technical and administrative • Prevent fraud security measures that help to safeguard your information.For • Comply with requests from regulatory and law Social Security Numbers(SSN),this includes restricting access enforcement authorities to our employees,agents and others who use your SSN only as ' Participate in insurance support organizations permitted by law,to comply with the law,to provide you with The persons or organizations with whom we may share your products and'services,and to handle your claims.Also,our personal information may include,among others; employees'and agents'access to and use of your SSN are ® Your agent,broker or Allstate-affiliated companies limited by the law,our policies and standards,and our written a Companies that perform services,such as marketing, agreements. credit card processing,and performing communication Our privacy practices continue to apply to your information services on our behalf even if you cease to be an Allstate customer. ® Business partners that assist us with tracking how visitors use allstate.com. What Personal Information Do.We Have and Where • Other financial institutions with whom we have a joint Do We Get It marketing agreement We gather personal information from you and from outside • Other insurance companies that play a role in an insurance sources for business purposes,Some examples of the transaction with you information we collect from you may include your name,phone • Independent claims adjusters number,home and e-mail addresses,driver's license number, o A business or businesses that conduct actuarial or social security number,marital status,family member research studies information and healthcare information.Also,we maintain • Those who request information pursuant to a subpoena or records that include,but are not limited to,policy coverages, court order premiums,and payment history.We also collect information ! Repair shops and recommended claims vendors from outside sources that may include,but is not limited to, The Internet and Your Information Security your driving record,claims history,medical information and credit information. We use cookies,analytics and other technologies to help us provide users with better service and a more customized web Renewal Deluxe Plus Homeowners Policy Declarations WAllstate.,* You're in good hands. Your policy effective date is September 25,2017 Page 1 of 4 Total Premium for the Premium Period(Your bill will be mailed separately) Information as of August 4,2017 Premium for property insured $854.00 Summary Total $8S4.00 Named Insureds) -- --- _ - _-.______ ._,--- Cyril&Aurelia De Colle Your bill will be mailed separately.Before making a payment,please refer to your Mailing address latest bill,which includes payment options and installment fee information.If you do 1249 Virginia Avenue not pay in full,you will be charged an installment fee(s). Campbell CA 95008.6808 Policy number Discounts (included in your total premium) 904173 530 Home and Auto 15% Claim Free 15% Your policy provided by Allstate Insurance Company Location Of property insured Policy period 1249 Virginia Avenue,Campbell,.CA 95008-6808 Begins on September 25,2017 throughSeptember 25,2018 at 12:01 a.m.Pacific Time,and continues until cancelled Rating Information* Premium period Please review and verify the information regarding your insured property.Please Beginning September 25,2017 through refer to the Important Notice(X72025-1)for additional coverage information. September 25,2018 at 12;01 a.m.Pacific Contact us if you have�any.changes. Time The dwelling is of frame construction and is occupied by 1 family • - Your Allstate agency is Joan Ho Dwelling Style: : 3241 S White Rd#3 Built in 1959;1 family;1750 sq.ft.;1 story San Jose CA 95148 Foundation: (408)238-4833 Unexcavated crawl space,100% JOANHO@ALLSTATE.COM Degree of slope: Some or all of the information on your 0-15 Degrees* Policy Declarations is used in the rating *Assumption based onyour foundation type, of your policy or it could affect your Attached structure:• eligibility for certain coverages.Please One 2-car attached garage. notify us immediately,if you believe Interior details: that any information on your Policy One basic kitchen Three single fireplaces , Declarations is incorrect.We will make corrections once you have notified us, Two basic full baths and any resulting rate adjustments,will Interior-floorings be made only for the current policy 20%Hardwood flooring 25%wall to wall carpet flooring period or for future policy periods. 15%carpet over hardwood flooring (acrylic/nylon) Please also notify us immediately if you (acrylic/nylon) 15%vinyl flooring believe any coverages are not listed or 25%ceramic tile flooring are inaccurately listed. *Assumptions are based on the age,style,and location of your home unless' specified by the customer. Exterior wall type: 100%stucco on frame 0 (continued) Renewal Deluxe Plus Homeowners Polic Declarations Page 2 of 4 Policy number; 1904173530 Policy effective date: September 25,2017 Rating Information*(continued) Interior wall partition: 100%drywall Heating and cooling: Gas heating,100%' Additional details: Three atrium doors Interior wall height-8 ft,100% Fire protection details: 1 mile to fire department 500 ft.to fire hydrant Roof surface material type: Composition ■100%asphalt/fiberglass shingle Other ■Two large skylights *This is a partial list of property details.If the interior of your property includes custom construction,finishes,buildup,specialties or systems,please contact your Allstate representative for a complete description of additional property details. Mortgagee CENTRAL LOAN ADMIN&REPORTING ITS SUCCESSORS&OR ASSIGNS P 0 Box 202028,Florence,SC 29502-2028 Loan number:3353952624 Additional Interested Party None C®vera9e detail for the property insured Coverage Limits of Liability Applicable Deductible(s) _ o Dwelling Protection-with Building $460,546 ■$1,000 Wildfire U Structure Reimbursement Extended ■$1,000 All other perils Limits m Other Structures Protection $46,055 ■$1,000 Wildfire ■$1,000 All other perils $ a Personal Property Protection- $345,410 ■$1,000 Wildfire R Reimbursement Provision ■$1,000 All other perils ' Additional Living Expense Refer to Policy R Family Liability Protection _ $300,000 each occurrence Guest Medical Protection $5,000 each person o Building Codes $46,055 0 Extended Coverage on Jewelry, $4,000 per occurrence ■$1,000 All peril Watches and Furs $2,000 per item s Na O N N O D n O ^O 00 O O 00 O Renewal Deluxe Plus Homeowners Policv Declarations Policy number; 1904173530 WAllstatic. Policy effective date: September 25,2017 Page 3 of 4 You're in good hands. Workers'Compensation and Statutory/See Form Employers'Liability Coverage for Residence Employees ® Other Coverages Not Purchased: •Business Property Protection* •Extended Coverage on Sports •Increased Coverage on Money* •Business Pursuits* Equipment* -Increased Coverage on Securities* •Cellular Communication System* •Fire Department Charges* -Increased Silverware Theft Limit* •Electronic Data Processing •Golf Cart* -Loss Assessments* Equipment* •Home Day Care* •Satellite Dish Antennas* •Extended Coverage on Cameras* •Incidental Office,Private •Extended Coverage on Musical School Or Studio* Instruments* *This coverage can provide you with valuable protection.To help you stay current with your insurance needs,contact your agent to discuss available coverage options and other products and services that can help protect you. The limit of liability for this structure(Coverage A-Dwelling Protection)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, This policy does not cover earth movement including earthquake. You have elected not to purchase a CEA earthquake policy. Scheduled Personal Property Coverage Your policy does not include Scheduled Personal Property Coverage.This coverage can provide you with valuable protection.To help you stay current with your insurance needs,contact your agent to discuss available coverage options and other products and services that can help protect you. Your p®Ivey documents Your Homeowners policy consists of the Policy Declarations and the following documents.Please keep them together. • Deluxe Plus Homeowners Policy-AP337 • California Deluxe Plus And Deluxe Homeowners Policy Amendatory Endorsement-AP29-4 • Lender's Loss.Payable Endorsement-AU319 - California Deluxe Plus Homeowners Amendatory Endorsement-AP4486-1 - Amendment of Policy Provisions-AP425 • Building Structure Reimbursement Extended Limits Endorsement-AP445 * California Standard Fire Policy Provisions-AP1862-1 • Wildfire Deductible Endorsement-AP4886 California Deluxe Plus Homeowners Amendatory • California Workers'Compensation And Employers'Liability Endorsement-AP2236 Coverage For Residence Employees Coverage Form-AP1127 0 m N 0 n o u Renewal Deluxe Plus Homeowners Polic Declarations Page 4 of 4 Policy number; 19m4173 53® Policy effective date; September 25,2017 Important payment and coverage information Here is some additional,helpful information related to your coverage and paying your bill; ► Coverage A-Dwelling Protection includes an approximate increase of$7,541 due to the Property Insurance Adjustment provision using the Marshall Swift Boeckh Publications Building Cost Index.Coverage C-Personal Property Protection adjusted accordingly. ® Please note;This is not a request for payment. Your bill will be mailed separately. Allstate Insurance Company's Secretary and President have signed this policy with legal authority at Northbrook,Illinois. Thomas J.Wilson Susan L.Lees President Secretary ca Ix 0 0 0 0 Q V 10 m m Ln N O O O Ln CO CO CO CO 0 N O 0 O h O O O UQ O O Ln O O O ry N C,O O 0� 0 O O 0 O O CO o O O Policy number: 904173 530 Policy effective date: September 25,2017 Page1ofi WAN11sta- te. You're in good hands. Important Privacy Choices For Consumers You have the right to control whether we share some of your personal information. Please read the following information carefully before you mare your choices below. Your Rights You have the following rights to restrict the sharing of personal and financial information with our affiliates(companies we own or control)and outside companies that we do business with. Nothing in this form prohibits the sharing of information necessary for us to follow the law,as permitted by law,or to give you the best service on your accounts with us.This includes sending you information about some other products or services. Your Choices Restrict Information Sharing With Companies We Own or Control(Affiliates): Unless you say"No,"we may share personal and financial information about you with our affiliated companies. ❑ NO,please do not share personal and financial information with your affiliated companies. Restrict Information Sharing With Other Companies We Do Business With To Provide(Financial Products And Services: Unless you say"No,"we may share personal and financial information about you with outside companies we contract with to provide financial products and services to you. ❑ NO,please do not share personal and financial information with outside companies you contract with to provide financial products and services. Time Sensitive RVIv You may make your privacy choice(s)at any time,Your choices)marked here will remain unless you state otherwise. However,if we do not hear from you we may share some of your information with affiliated companies and other companies with whom we have contracts to provide products and services. Name:Cyril&Aurelia De Colle ACCOUNT OR POLICY NUMBER(S): 904173 530 Signature: To exercise your choices do one of the following: (1) Call our toll-free number 1-800-856-2518; (2) Fax our toll-free number 1-855-219-7425;or (3) Fill out,sign and send back this form to us using the envelope provided (you may want to make a copy for your records). X73499 Syed Wahidi From: Syed Wahidi Sent: Wednesday,January 03, 2018 12:29 PM To: 'Cyril De Colle; Bob Siudzinski Subject: RE:A lae T:ee Rrncrval! ,p bicatran HI Cyril, Encroachment permit is quite simple for this type of work. There is no permit fee but we require$500 security deposit for each new tree which is refundable once work is done. To obtain a permit,you need to bring: -copy of homeowner's insurance -$500 security deposit Please let me know in when you are ready to obtain the permit. Thanks. Bob will approve the type of new tree to be installed. Syed Wahidi Public Works Inspector City of Campbell I Public Works Department 70 N. First Street I Campbell, CA 95008 www.citvofcampbell.com 1408.866.2165 -----Original Message----- From: Cyril De Colle [mailto:cyril.decolle@neurogastrx.com] Sent:Tuesday,January 02, 2018 3:20 PM To:Bob Siudzinski Cc: Syed Wahidi Subject: Re: Amber Tree Removal Application Hi Bob, The encroachment permit is news to me. Please let me know about next steps to secure it. Many thanks, Cyril Cell:408 429 9100 >On Jan 2, 2018, at 17:02, Bob Siudzinski <BobS@citvofcampbell.com>wrote: > Hi Mr. De Colle, > I will approve your application with the understanding that you will need to secure an encroachment permit from the City Inspector,Syed Wahidi. He has worked through many removal applications and makes the process as easy as possible. As stated earlier,you will need to fund the removal, stump grind, and plant a 24 inch box tree of City's choosing. We can discuss tree types at your convenience. 1 >Thank you, > Bob >-----Original Message----- > From: Cyril De Colle [mailto:cyril.decolle@neuroeastrx.com] >Sent:Saturday, December 23, 2017 4:48 PM >To: Bob Siudzinski >Subject:Amber Tree Removal Application > Dear Bob, >According to our last discussion, please find attached a tree removal for your review. > Please let us know if you have any question or if you'd like us to mail the original application to you. >Otherwise, we look forward to your authorization to remove the tree. > Many thanks in advance, >Cyril &Aurelia De Colle > 1249 Virginia Avenue >Campbell, CA 95008 >Cell: 408 429 9100 2 r Syed Wahidi From: Bob Siudzinski Sent: Tuesday,January 02, 2018 2:02 PM To: 'Cyril De Colle' Cc: . Syed Wahidi Subject: RE:emberree ieal 1pn licaa'.o--,n Hi Mr. be Colle, I will approve your application with the understanding that you will need to secure an encroachment permit from the City Inspector,Syed Wahidi. He has worked through many removal applications and makes the process as easy as possible. As stated earlier,you will need to fund the removal, stump grind, and plant a 24 inch box tree of City's choosing. We can discuss tree types at your convenience. Thank you, Bob -----Original Message----- From: Cyril De Colle [mailto:cvril.decolle@neurogastrx.com] Sent: Saturday, December 23, 2017 4:48 PM To: Bob Siudzinski Subject:Amber Tree Removal Application Dear Bob, According to our last discussion, please find attached a tree removal for your review. Please let us know if you have any question or if you'd like us to mail the original application to you. Otherwise,we look forward to your authorization to remove the tree. Many thanks in advance, Cyril &Aurelia De Collie 249 0lirglimia Avenu: Campbell, CA 95008 Cell:408 429 9100 1 0 o •U1CH A=� CITY OF iCAMPBE L Public Works Department May 7, 2019 Mr. Cyril De Colle 1249 Virginia Ave. Campbell, CA 95008 SUBJECT: PERMIT NO. ENC 2018-00050 1249 Virginia Ave.. Campbell, CA FINAL INSPECTION AND ACCEPTANCE Dear Cyril: i The City of'Campbell has made a final inspection ofsubject Public Works improvements { and finds the work to be acceptable and in conformance with City standards. Accordingly; the City Engineer accepts the improvements. Your Faithful Performance Security refund in the amount of$500.00 is enclosed. If you have any questions, please call me at (408) 866-2165. Sincere�y, Syed Wahidi Public Works Inspector 7o North First Street Campbell, California 95008 TEL 408.866.2150 . FAX 408.376.0958 TDD 408.866.2790 ..................... ................................. ........... ............................. .......... .......................... . . ............... ....................................... . ............ .......... ............ ....................... .............................. CITY OF CAMPBELL VENDOR NO. 10015443 CHECK NO. 273123 Acgolint ; ::,;Purchase—Qr:: er. Invorce7Vtrmber j, 101 2203 CR042319 500.00 FPS REFUND 10015443 CYRIL DECOLLE CHECK DATE CHECK NO. ot`4104% C—ITY,OF CAMPBELL WELLS FARGO BANK, N.A. 11-24 'l 9-3, 70 NORTH FIRST STREET 0 MONTGOMERY STREET 1210 05/06/19 2 7'3 SAN FRANCISCO,'CA 94104 CAMPBELL, CALIFORNIA 95008 > 0 0 AMOUNT *******500 . 00* "?CIZAILO V 0 VOID AFTER 90 DAYS -nl PAY THE SUM OF FIVE HUNDRED DOLLARS & ZERO CENTS mil IE TO THE CYRIL DECOLLE ORDER pq� 1249 VIRGINIA AVE. CAMPBELL CA 95008 d: 2 3 12 DO 1:;1 2 1000 2 It 8 1: 412 L 8 S S 15 0.I .............. .............................. ................... .. ............................. ............... ............ ................. .................................. ..................................... ......................................... ......................... ....................................: .......................... *See Reverse Side For Easy Opening Instructions* CITY OF CAMPBELL 70 NORTH FIRST STREET CAMPBELL, CALIFORNIA 95008 CYRIL DECOLLE 1249 VIRGINIA AVE. CAMPBELL CA 95008 Refundable Deposit Check Request. I. To: finance Director j Check Payable To: Cyril DeColle Address- Line 1: 1249 Virginia Ave. _.. Line 2: I City: Campbell State: CA Zip: 95008 i Description: 1249 Virginia Ave. } I Account Number: 101.2203 Amount: $500.00 i Account Number: 101.2203 Amount: Account Number: 101.540.7448 Amount: { (Finance Dept only) Interest Earned (Finance Dept only) jTotal Payable: (Exact Amount) i f Purpose: FPS Refund I - Permit#: ENC2018-00050 Receipt#: 274097 Date: 3/7/2018 + Receipt#: Date: Requested by: �— Title: Inspector Date: Syed Wahidi f Approved by: Title: Sr. Engineer Date: I'sn t Roger Storz l f Finance Dept Only: r Verified by: Title: Accounting Clerk II Date: i I Approved by: Title: Accountant Date: j j Special Instructions For Handling Check Mall AS IS: Mail in Attached Envelope: Interim(:neCK: j I Needed By: i Return To: JoAnna Thomason Public Works ! (Name) (Department) Other: Please return check.-to JoAnna + t ' i CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT CLEARANCE FOR FINAL INSPECTION AND ACCEPTANCE LETTER Encroachment Permit#: ENC 2018-00050 Name: Cyril De Colle Property Address: 1249 Virginia Ave. Date of Final Inspection: On File: Bonds CD Faithful Perform e: $ 500.00 Labor and Material: $ Construction Cash Deposit to be released: $ Other overdue deposits to be released (Description): Processed by: vc ZZ A inistrator Reviewed by: r f �3 Insp or �T Reviewed by: qN/- Land D velopment Engineer J:VoAnnaT\Deposit refunds\CHECKLISTSWirginial249 3.7.18.doe(Rev. 10/11) Encroachment Permit Final Sign Off Encroachment Permit# t � �� _0C, 0 Address: 12�`-tl yll �Nll /N Date of Final Inspection and Acceptance: Wit hC1 Inspected by: / OK to release deposits: 100% " 75% Comments: