ENC2018-00062 .Of C,4`l(
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CITY OF CAMPBELL
Public Works Department
May 31, 2019
Blair Askew
417 Nottingham Way
Campbell, CA 95008
SUBJECT: PERMIT NO. ENC 2018-00062
417 Nottingham Way
FINAL INSPECTION AND ACCEPTANCE
Dear Blair:
The City of Campbell has made a final inspection of subject Public Works improvements
and finds the work to be acceptable and in conformance with City standards.
Accordingly, the City Engineer accepts the improvements.
If you have any questions, please call me at (408) 866-2165.
Sincerely,
J
Syed Wahidi
Public Works Inspector
Cc: Inspector/Suspense Files
Permit File ENC2018-00062
70 North First Street • Campbell, California 95008 TEL 408.866.2150 • FAx 408,376.0958 TDD 408.866.2790
Encroachment Permit Final Sign Off
Encroachment Permit#_ �.fC '2-eI GGc)CZ
Address: �� (- N&1k'r k1r:,,VV%
Date of Final Inspection and Acceptance:
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Inspected by:
OK to release deposits: 100% 75%
Comments:
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CITY OF CAMPBEL.1L
Public Works Department
May 29, 2018
Blair Askew
417 Nottingham Way i
Campbell, CA 95008
SUBJECT: PERMIT NO. ENC 2018-00062
417 Nottingham Way
FINAL INSPECTION AND ACCEPTANCE S
Dear Blair:
The City of Campbell has made a final inspection of subject Public Works improvements
and finds the work to be acceptable and in conformance with City standards.
Accordingly, the City Engineer accepts the improvements.
The one year maintenance period stated in the permit begins as of May 14, 2018. The
permittee is responsible for the repair and/or replacement of any defective work or
failures that occur within one year. The City will inspect the improvements within one
year and notify you, in writing, whether or not any repairs are required.
Your Faithful Security Deposit in the amount of$1,000.00 is enclosed.
If you have any questions,please call me at (408) 866-2165.
Sincerely,
Syed Wahidi
Public Works Inspector
Cc: Inspector/Suspense Files
Permit File ENC2018-00062
70 North First Street • Campbell, California 95008-1436 TEL 408.866.2150 FAX 408.376.0958 TDD 408,866.2790
pF Cgs
'OR CHARD
CITY of CAMPBELL
Public Works Department
May 29, 2018
Blair Askew
417 Nottingham Way
Campbell, CA 95008
SUBJECT: PERMIT NO. ENC 2018-00062
417 Nottingham Way
FINAL INSPECTION AND ACCEPTANCE
Dear Blair:
The City of Campbell has made a final inspection of subject Public Works improvements
and finds the work to be acceptable and in conformance with City standards.
Accordingly, the City Engineer accepts the improvements.
The one year maintenance period stated in the permit begins as of May 14, 2018. The
permittee is responsible for the repair and/or replacement of any defective work or
failures that occur within one year. The City will inspect the improvements within one
year and notify you, in writing, whether or not any repairs are required.
Your Faithful Security Deposit in the amount of$1,000.00 is enclosed.
If you have any questions,please call me at(408) 866-2165.
Sincerely,
t
Syed Wahidi
Public Works Inspector
Cc: Inspector/Suspense Files
Permit File ENC2018-00062
70 North First Street • Campbell, California 95008-1436 TEL 408.866.2150 FAX 408.376.0958 TDD 408.866.2790
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CITY OF CAMPBELL VENDOR NO. 10014914 CHECK NO. 268006
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CITY-OF CAMPBELL
70 NORTH FIRST STREET
CAMPBELL, CALIFORNIA 95008
I
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BLAIR ASKEW
417 NOTTINGHAM WAY
CAMPBELL CA 95008
Ref urdable .Deposit .Check Request
To Finance Diree'tor
Cfieck.Payable To. Blair Askew _
t
Address Line 1 417%Nottingham_Way
City: Campbell::. State;.,CA Zip-,95.008 "
Descnptiori: ' 41-7.,Notti.ngham Way.: _
Account Number: ° 101 2203, ;; Amount: . :$1`000.00
ACcount Number. 1012203 Amount.': ., .
Account Number:. 401 54Q7448 _ _ Amount.:..,'
(Finance Dept only) . Interest Earned -' (Finance Dept only)
TotaN=Fayab.le t a _ (EzactAritount)'
.Purpose FFS D.epost,Return .
Permit:#.: -.ENC2018 00062
:.Recel,pt# 274:773• Da#e: , 4/19/2018 .: , ,
Recei pt,# Date,-
•
Requested by Title. I'nspecfor Date
Syed W,ahidl
Approved by Title Sr.-Engl'neer Date.
Roger Storz
Finance Dept Only - n - - - -
Venfied by. Title.`. . .Accounting.Clerk JI ` Date
Approved by 1 Title. Accountant Date
S eci.:al ructi ons1-1:andlin ' , c{k
mall. Mail h Attached Envelope Inierlm t;neCK
Needed 2.
.By =
JpAnna:Thomason Pufil�c Works
(Name) (Department)
Other: Please retuirn check
'to.JoAnna
CITY OF CAMPBELL
PUBLIC WORKS DEPARTMENT
CLEARANCE FOR FINAL INSPECTION
AND ACCEPTANCE LETTER
Encroachment Permit#: ENC 2018-00062
Name: Blair Askew
Property Address: 417 Nottingham Way
Date of Final Inspection: 5/14/18
On File: Bonds CD Cash
Faithful Performance: $ 1,000.00
Labor and Material: $
Construction Cash Deposit to be released: $
Other overdue deposits to be released (Description):
Processed by:
Ad inist for
Reviewed by:
Inspector
Reviewed by: yy��-, G
Land Development Engineer
J:VoAnnaT\Deposit refunds\CHECKLISTS\1 Checklist-Final Acceptance.doc(Rev. 10/11)
Encroachment Permit Final Sign Off
Encroachment Permit# � � -cocG2
Address: �l.t 7 `l Tr�►yCJt�.
Date of Final Inspection and Acceptance:
Inspected by:
OK to release deposits: 100% 75%
Comments'
Print Form
CITY OF CAMPBELL R-1 ENCROACHMENT PERMIT Permit No. r 2
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
Campbell,CA 95008 Application Expiration Ci I LI it,
Ph.(408)866-2150 ISSUED: �' Date
Fx.(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. I
(Application expires in 6 months if the permit is not issued.)
A. Work Address: 417 Nottingham Way, Campbell CA 95008
B. Nature of Work: line up the driveway approach with the driveway (extend current approach)
C. Attach three(3)copies of a drawing showing the location,extent and dimensions of the work.The drawing shall show the relation of
the proposed work to existing improvements. When approved by the City Engineer,said drawing become a part of this permit.
D. All work shall conform to the City of Campbell Standard Specifications and Details for Public Works Construction;the General Permit
Conditions listed on the reverse side;and the Special Provisions for this permit,listed below. Failure to abide by these conditions and
provisions may result in job shutdown and/or forfeiture of Faithful Performance securities.
NAME OF APPLICANT: Blair Askew Telephone: 408 410 5732
Address: 417 Nottingham Way, Campbell CA 95008
E-Mail Address: blair.askew@gmail.com
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.
y
ACCEPTED:
(Applicant/Permittee) (Sign) Date
NOTES: All work shall conform with the attached approved plans and all applicable Campbell Standard Details and Conditions and applicable
insurance requirements.
The Contractor must have this permit and approved plans and must arrange to meet with the Public Works Inspector at the site at least two days
before starting work. Notice must be given to Public Works at least 24 hours before restarting any work
Per Section 4216 of the Government Code this permit is not valid for excavations until Underground Service Alert(USA)has been notified and the
inquiry identification number(Ticket No.)has been entered hereon. USA Phone: 1-800-227-2600.Ticket No.:
Applicant is advised that upon issuance of this permit,property owner,or property owner's successors,shall be responsible for any and all
damages arising out of the design,installation or condition of private improvements in the public right-of-way.
SPECIAL PROVISIONS
1. Prior to any work,the property owner shall execute an Agreement for Private Improvements in the Public Right-of-Way,which shall be
recorded.
2. Cy Nzl ra i2 SUAL.t_- PO 5S tf'1s C-L/-\SS A C,12, CIA—IS C—8 L—I tL4A<F
3.
STANDARD AMOUNT RECEIPT NO.
SECURITY FOR FAITHFUL PERFORMANCE (100%Of Engr's Est.) $ WOO 1, 7T �
R-1 PERMIT FEE $ 3
APPROVED FOR ISSUANCE:
for City Engineer Date
"` Permit Expires 6 Months after Date of Issuance.
GENERAL PERMIT CONDITIONS
1. Payment of a security to insure faithful performance and completion of the work is required.This security is refundable upon
completion of the work and written acceptance by the City.
2. A one-year maintenance period for all work is required. Such period will begin on date of acceptance by the City. It is the applicant's
responsibility to remove and replace unacceptable improvements within the one-year maintenance period.
3. Refund or cancellation of the Faithful Performance Surety will be initiated by the written acceptance of the work by the City.
4. Submit project schedule 10 days prior to proposed start of work.Special provisions may be required for work within City facilities
and downtown Campbell.
5. The Permittee must request in writing a final inspection and acceptance of the work upon completion. Acceptance by the City will be
made in writing to the Permittee.
6. Maintain safe pedestrian and vehicular crossings and free access to private driveways,fire hydrants and water valves.
7. Replace as directed by the City Engineer any damaged or removed improvements in accordance with City Standards and
Specifications at the sole expense of the Permittee.
8. Sawcut for all PCC and AC removals. All PCC removals shall be to nearest scoremark and shall be doweled to existing improvements.
9. Adequate signing and barricading is required on the job site. Failure to provide such signing and barricading as specified by the City
Engineer may result in the City's providing such signing and barricades and charging the cost to the Permittee.
10. The Contractor or Permittee will have a supervisory respresentative available for contact on the project at all times during
construction.
11. This permit shall be kept at the site of work and must be shown to any authorized representatives of the City of Campbell or any
law enforcement officer upon demand.
12. No storage of materials or equipment will be allowed near the edge of pavement,within the traveled way,or within the shoulderline,
which would create a hazardous condition to the public.
13. This permit shall not be construed as authorization for excavation and grading on private property adjacent to the work or any other
work for which a separate permit may be required,nor does it relieve the Permittee of any obligation to obtain any other permit
required by law.
14. This permit does not release the Permittee from any liabilities contained in other agreements or contracts with the City and any other
public agency.
15. This permit is not transferable. Work must be performed by the Permittee or his designated agent or contractor as specified thereon.
16. Prior approval of inspector is required for any work done after normal working hours,on weekends or holidays and may require
reimbursement of inspection costs at the current overtime rate.
17. Call back(call out)due to emergencies regarding this permit shall be at the current overtime rate with a three(3)hour minimum
charge per occurrence.
18. If the public interest requires a modification of,or a departure from,the plans and specifications,the City shall have the authority to
require or approve any modification or departure and to specify the manner in which the same is to be made for City-owned or
maintained facilities.
19. Pursuant to Chapter 14.02 of the Campbell Municipal Code,applicant shall not cause to be discharged any material into the
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 understpnd all of the above
conditions.
Applicant Date
J:\FORMS\Templates\Encroachment Permits\R-1 Encroachment Permit STATIC form2.pdf
Rev.02114
PACE 3
USAA CASUALTY INSURANCE COMPANY MAIL MACH-1
Ilk N1411W 9800 Fredericksburg Road - San Antonio, Texas 78288
USAA® AMENDED DECLARATIONS PAGE - EFFECTIVE 02/01/18
Named Insured and Residence Premises Policy Number
BLAIR ASKEW TRUST, DATED OCTOBER 17TH, 2016 CIC 00402 05 00 92A
417 NOTTINGHAM WAY
CAMPBELL, SANTA CLARA, CA 95008-0817
Policy Period From 02/01/18 To: 02/01/19
(12:01 A.M. standard time at location of the residence premises)
SECTION I - COVERAGES AND AMOUNTS OF INSURANCE
COVERAGE A - DWELLING PROTECTION $365,000
COVERAGE B - OTHER STRUCTURES PROTECTION $36,500
COVERAGE C - PERSONAL PROPERTY PROTECTION $273,750
COVERAGE D - LOSS OF USE PROTECTION (UP TO 12 MONTHS) $73,000
SECTION 11 - COVERAGES AND LIMITS OF LIABILITY
Personal Liability - Each Occurrence $500,000
Medical Payments to Others $5,000
DEDUCTIBLES (Applies to SECTION 1 Coverages ONLY)
We cover only that part of the loss over the deductible stated.
ALL PERILS $500
POLICY PREMIUM for Section I and Section 11 Coverages Above $857.90
CREDITS AND DISCOUNTS (Included in policy premium above.) $260.52 CR
Details on the following page. (If applicable)
OTHER COVERAGES AND ENDORSEMENTS
Forms and Endorsements are printed on the following page.
STATE SURCHARGES AND TAXES (Shown below if applicable)
TOTAL:POLICY:.PREMIUM
Including Credits, Discounts Optional Coverages` Endorsements State Surcharges and..Taxes
TOTAL PRORATED RETURN $15.67
PREMIUM DUE AT INCEPTION. THIS IS NOT A BILL. STATEMENT TO FOLLOW.
In witness whereof, this policy is signed on 03/05/18
Deneen Donnley,Secretary S.Wayne Peacock,President
REFER TO YOUR POLICY FOR OTHER COVERAGES, LIMITS AND EXCLUSIONS.
HO-131 (07-08) ATTACH THIS DECLARATION TO PREVIOUS POLICY 87028.0708
PUBLIC WORKS DEPARTMENT LAND DEVELOPMENT
Effective July 1,2017
TO: Finance PUBLIC WORKS FILE NO. tW 2o1 CCa62
PROPERTY ADDRESS
Please collect&receipt for the followingmonies k
� ��
i4CCT' ITEM _a
LAND -
47227Non-Utili
oachment Permit Application Fee
Encroachment Permit Ma'or>_$10000 1 $425.00
Minor Encroachment Permit<sio,000 $240.00
nitial R-1 Permit N/C
Subsequent R-1 Permits within Two Year Period $240.00
Ins ection Fee Minimum Charge per Location $420.00
Street'Tree Planting/Removal ' N/C
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
4722 Grading&Drainage Plan Review
Single Family Lot $295.00
Site< 10,000 s.f. $885.00
Site>_ 10,000 s.f. <0.5 Acre $1,185.00
Site>_0.5 Acre $1 772.00
4722 NPDES Review C3 Requirements)
For projects not required to submit numeric sizing $175.00
For projects required to submit numeric sizing
Impervious Area 10,000 S . Ft to 1 Acre $740.00
Impervious Area 1 Acre or more $965.00
4722 For ro'ects sent to Consultant for review Consultant Cost+20%
4722 Additional treatment facilities $315 ea
Plan Check& Inspection-Fee(Non-Utility)
4722 En r. Est. <$250 000 14%of Engineer's Estimate
4722 Engr. Est. >_$250,000 and:5$500,000 $35,000.00+8%of Engineers Estimate
4722 En r. Est. >$500 000 $55 000.00+7%of Engineers Estimate
2203 Emergen6V Cash Deposit 4%of En. r. Est.'($500 min/$10 000 Max
2203 Faithful Performance Securi FPS 100%of ENGR. EST.
* loon
2203 Labor and Materials Security 100%of ENGR. EST."
4721 Storm Drainage Area Fee Per Acre R-1 $2,120.00
(Multi-Res$2,385.00)
(All Other$2,650.00)
4722 Parcel Map(4 Lots or Less) $4,200.00+$90/10t
4722 Final Tract Map 5 or More Lots) $5,115.00+$124/lot
2203 Monumentation Security 100% of Ci '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
4722 Approved Plan Revision Fee $100/sheet
4722 Appeal Filing Fee $200.00
730.4924 Notice of Improvement Obligation Payment
Assessment segregation or Reapportionment
First Split $940.00
Each Additional Lot $295.00
511.74241 Postage
MISCELLANEOUS:'- '.. < .
Other(Please peci )
'Engineer's Estimate shall be as approved by the City Engineer •and shall include all items of work. TOTAL $ )Goo
NAME OF APPLICANT P— A Jl��" _
NAME OF PAYOR OS L-19 l IQ- L-1) PHONE a - t4 (O —
ADDRESS /v �T--1 iV G Gj A ft1� `t O
-I
FOR RECEIVEDZ.
y
CITY CLERK w r ty
,{( 12-
ONLY Date I
Receipt .
-.. - - -
J'.1FORM5\temp � —