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ENC2017-00279 ®e C4,t14 K c L� •U�tCH AAA (CITY o>F (C A4PB ;LL Public Works Department July 16, 2019 Elizabeth Hawkins Hawkins Enterprises, LLC. 1715 Manitou Ct. San Jose, CA 95120 SUBJECT: PERMIT NO. ENC 2017-00279 256 Beverly Court, Campbell, CA FINAL INSPECTION AND ACCEPTANCE Dear Elizabeth The City of Campbell has made the final inspection of the subject Public Works improvements and finds that no remedial work is required. Your warranty requirements and any surety, therefore, are hereby released. Your remaining 25% deposit refund in the amount of$1,250 is enclosed. SinLrely, 'Syed Wahidi Public works Inspector 7o North First Street • Campbell, California 95008 • TEL 408.866.2150 • rAx 408.376.0958 • TDD 408.866.2790 V .......................... ................................... ................. .................. ....................... .............. ............................ ...................... ............... .......... .......... .................. ......... ............................... CITY OF CAMPBELL VENDOR NO. 10014996 CHECK NO. 274350 Account'. Purchase..Order: invoice kutn6er Athount Deki ion 101 2203 CR070219 1,250.00 ENC2017-00279 RFND 1X)14996 ELIZABETH HAWK,, IJ 'CA CHECK DATE CHECK NO 4 CITVV*:�:.Of CAMPBELL "LLS FARGO BANK, N.A. 11-24 1210 jzq:MONTGOMERY STREET07/15/19 274350 76�6�� FIRST"STREET :;,SAN FRANCISCO, CA 94104 CAMPBELL"CALIFORNIA 95008 0 AMOUNT $ *****1, 250 . 00* ORCIII.V00, 0. ...:VOID AFTER 90 DAYS -n PAY THE SUM OF ONE THOUSAND, TWO HUNDRED FIFTY DOLLARS & ZER6- m CENTS • TO THE ELIZABETH HAWKINS ORDER 1715 MANITOU CT F; SAN JOSE CA , 95120 L ............................. ................... ............... ................ ..................... ............................. ..........................- ........................................ .......................... ..................... ......................... ...................................... ................................ Z- *See Reverse Side For Easy Opening Instructions* CITY OF CAMPBELL 70 NORTH FIRST STREET CAMPBELL, CALIFORNIA 95008 ' ELIZABETH HAWKINS 1715 MANITOU CT SAN JOSE CA 95120 i Refundable Deposit Check Request To: Finance Director Check Payable To: Elizabeth Hawkins Address- Line 1: 1715 Manito.0 Ct. Line 2: City: San Jose State: CA Zip: 96120 I ' Description: ENC2017-00279 (; Account Number: 101.2203 Amount: $1,250.00 j Account Number: 101.2203 Amount: j Account Number: 101.540.7448 Amount: (Finance Dept only) Interest Earned (Finance Dept only) Total Payable: (Exact Amount) Purpose: 25% FPS Deposit refund, Permit#: ENC2017-00279 ` I Receipt#: 272836 Date: 12/13/2017 � I Receipt#: Date:- Requested by: �`" � Title: Inspector Date: 7 Syed Wahidi Approved by: ' Title: Sr. Engineer Date:_4 2AYA ' Roger Storz Finance Dept Only: Verified by: Title: Accounting Clerk II Date: i Approved by: Title: Accountant. Date: i I Special Instructions . For Handling Check Mall As Is:. Mail in Attached Envelope: Interim (:heck: i Needed By: . i Return To: JoAnna Thomason Public Works 1 (Name) (Department) CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT CLEARANCE FOR FINAL INSPECTION AND ACCEPTANCE LETTER Encroachment Permit#: ENC 2017-00279 Name: Elizabeth Hawkins Property Address: 256 Beverly Court Date of Final Inspection: 6/20/18 On File: Bonds CD Cash Faithful Performance: 25% $1,250.00 Plan Check Deposit: Construction Cash Deposit to be released: Other overdue deposits to be released (Description): Processed by: C4�, [ 1 A 'nistrator Reviewed by: � 7`Z f I Inspector Reviewed by: Land Development Engineer J:VoAnnaT\Deposit refunds\CHECKLISTS\Beverly 256.doe(Rev. 10/11) oV ' C% r U r, 0 0 A a G •()kCHARID• CITY of CAMPBELL Public Works Department, Elizabeth Hawkins Hawkins Enterprises, LLC. 1715 Manitou Ct. San Jose, CA 95120 SUBJECT: PERMIT NO. ENC 2017-00279 256 Beverly Court, Campbell, CA FINAL INSPECTION AND ACCEPTANCE Dear Elizabeth The City of Campbell has made the final inspection of the subject Public Works improvements and finds that no remedial work is required. Your warranty requirements and any surety, therefore, are hereby released. Your remaining 25% deposit refund in the amount of$1,250 is enclosed. Sincerely, Syed Wahidi Public works Inspector 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#_ 617-00 2-7 c� Address:_ Z Date of Final Inspection and Acceptance: Inspected by: OK to release deposits: 100% 75% Comments: jl of C4 �A, L 4 VC UkcH ARC• - CI'TY OF CAMPBELL Public Works Department July 10, 2018 Elizabeth Hawkins Hawkins Enterprises, LLC. 1715 Manitou Ct. San Jose, CA 95120 f,,.s`''� SUBJECT: PERMIT NO. ENC 2017-00279 256 Beverly Court, Campbell, CA FINAL INSPECTION AND ACCEPTANCE Dear Elizabeth The City of Campbell has made a final inspection of subject Public Works iLrl�rovements and finds the work to be acceptable and in conformance with City-Min�rds. Accordingly,the City Engineer accepts the improvements,---- The one year maintenance period stated in the permit begins as of June 20, 2018. The,- permittee is responsible for the repair and/or replacement of an 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. 75% of your Faithful Security Performance Deposit in the amount of$3,700.00 is enclosed. The City will continue to hold 25% of your $5,000.00 Faithful Performance Surety for the one-year maintenance period. If you have any questions,please call me at(408) 866-2165. Sincerely, Syed Wahidi Public Works Inspector Cc: Inspector/Suspense Files Permit File ENC2017-00279 70 North First Street • Campbell, California 95008-1436 TEL 408,866.2150 FAX 408.376.0958 TDD 408.866.2790 OV C� •GkCHARID• CITY of CAMPBELL Public Works Department July 10, 2018 Elizabeth Hawkins Hawkins Enterprises, LLC. 1715 Manitou Ct. San Jose, CA 95120 SUBJECT: PERMIT NO. ENC 2017-00279 256 Beverly Court, Campbell, CA FINAL INSPECTION AND ACCEPTANCE Dear Elizabeth 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 June 20, 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. 75% of your Faithful Security Performance Deposit in the amount of$3,700.00 is enclosed. The City will continue to hold 25% of your $5,000.00 Faithful Performance Surety for the one-year maintenance period. If you have any questions,please call me at(408) 866-2165. Sincerely, Syed Wahidi Public Works Inspector Cc` Inspector/Suspense Files Permit File ENC2017-00279 70 North First Street • Campbell, California 95008-1436 TEL 408.866.2150 FAX 408.376.0958 TDD 408.866.2790 ............................. ......................... ....................... ............... .........................................2 ..........................................i ...................................... ............ ................... .......... ........................ II CITY OF CAMPBELL VENDOR NO. 10014996 CHECK NO. 268774 Un Account- 101 2203 CR070218 3,750.00 ENC2017-00279 RFND P < 10014996 ELIZABETH HAWKINS W 1171.1 M 1:1-plffll I ffif I I I RA kl Ll 4:01 10TAd 0,1171:n 9 31111-111 Lmmiimlln!R I CHECK CHECK NO. P EILL -24 B' �Alii.:FARGO BANK, N.A. 42:a'�ONTGOMERY STREET -1-21 7 0 9 18 26 0-74 FIRST STREET CO, CA 94104 0-- CAVPBELL�,- ,- CALIFORNIA 95008 5 0 AMOUNT, . O �.,o 0!* 6 ptt 0 VOID AFTER 0 :jo�-DAYS: rNnR 0 DOLLARS PAY THE "SUM OF THR' EE .,THOUSAND, SEVEN HUNDRED FIFTY DO CENTS TO THE ELIZABETH HAW ORDER 1715. MANITOU CT' AN JOSE CA 9 512 0 A> [in 2.6 B ? TI.11 1: 1.2 ibd"O 2 S R W.M., MOM. Ron!1:11"l. ......... -------- ........... ................ .........................*-*,-*, ............ ................... ........... ........... ................................. ........................................ ....................................... ................................. z— *Sep Reverse Side For Easy Openin Instructions* CITY OF CAMPBELL 70 NORTH FIRST STREET CAMPBELL, CALIFORNIA 95008 ELIZABETH HAWKINS 1715 MANITOU CT SAN JOSE CA 95120 Encroachment Permit Final Sign Off Encroachment Permit# C 2d 7 7 Address: Z 13-r r Date of Final Inspection and Acceptance: Inspected by: OK to release deposits: 100% 75% ^ Comments: r7 S o/a = 3 1 Sc�a° r CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT CLEARANCE FOR FINAL INSPECTION AND ACCEPTANCE LETTER Encroachment Permit*: ENC 2017-00279 Name: Elizabeth Hawkins Property Address: 256 Beverly Court Date of Final Inspection: 6/20/18 On File: Bonds CD Cash Faithful Performance: $5,000.00, 75% $3,750.00 Plan Check Deposit: Construction Cash Deposit to be released: Other overdue deposits to be released (Description): Processed by: qZ0[ I g Ali inistrator Reviewed by: Inspector Reviewed by: ' i Land Development engineer J:VoAnnaT\Deposit refunds\CHECKLISTS\Beverly 256.doc(Rev. 10/11) � ---- — 1. - - ,-�:-1-.1�"'- - f� u-�,-. "---, W-, o��, -Deposit �-�:,- , --.1t"C h � -. :L.:. e,S- , _ "- 4 � - T0 Firbh662Di�§ct6� .".-.--.-,.'-t-, --1-, .l-- � -�.., .,.; ". l . ,-.,',4�� -;;,f'-_lt "', ,, ,---, �'L�--, --, �� , - " -L''I ",� �,�_'�;,: �"",,z ,. �, . , , ,�, -�- ,,- . , - - , _ I I, -111.��,;-, �', ��,-- -.-�,-,�,��,�?t,,:,',,--.-�-�,-;�- -,"- -1��"�,*----,-,'.�,-�-� ,',-tti-, -, -��"f'," ,-,f-�,�_. .-� i- c 1� -' --b"'T '."'," 'Elikdbet",Hawkins! ,,:-�Il-i�'-i t "I -- j,� ,l ,k,I- '. -,.�t,�_--,-,,;� ,",�1'.�0,,,-,� ,."'I'll-I - -��,,C,he'k P' �� :�& , .; . Va. , M 'r`�" ' ,',,,�:,-o�,"�,�, ,,, -, -�1� -Xi, I - —1 h 11 , �� - -,t`� � . I., " . , -9'� , . '"'j.f. ;f," ,"j, � .-', P . �", - �l -,,.-;.,L',>-_.,�, 'a . I , , ,,v-,-,--!` `-.,; ,,-, - 1. .�Payable . - � - , - - Address: a�--t--i,,6§'-i,,.-�1'.f,I-"-, U h�,6,.,�,_%--!,'- 1,f.-'f-7,,;' 16 I-'W h,-,,otq--�':u�..If k!, .,, Line 2 .-.�. j. j Cii,-�y� 8,- eI.h"Jose S O t,.6 -C -�I95120 -,--, 9 1�6,. -1 2- 0 , .t e-�--,. II , De�sc�,;r.�-;i-p'--t-i.O,,,-T- 01,I 1,---z1 4�-�--6,�--�. 9, �--.,�j'�, - ,l-c",-O U, n ,Nu n--I-.,-b� e-P,,f ,-1""-"-7_;,-,"-.- "-,�O-I . ;---,II-V'.V' 2203 -2 - --,--�, � A�%_ h-� �u-�--,t nt $-,�--,-%,,-3-,,�-��1-l--�7., ---,---6.'"�'-16: 6--�"` . , --I , 7:3 -: �I1 -- ,-, "�l i Account Number - Qj 20& Amount t ., A-c-,"�b� ou,,,"nt�,,,--',.--N, ,u�.,,..m'�-.-,`- e;-,-�--f lO-1.A,'.,4--�.-, --��7f-,4,'-4 P Amount -qn('I � "(P diDe� only) Interest 4qed (Finance��"',-,.* Dek,� -o.�n-i-y)-'- I. ..1� .`--:�-:1Lj TO�--t-,�al--'',,,--A,ay�0 - , (�w,N. n,o U-P - .:��.- - 0u-r,p1.,,.I-.�o- e P---0� 5,� '1114`gb� O,4' s� i jf,refund - ---- I- -1 �,- I� ,- ,-- '-- T;"�-� d,--�- rm i't-.-- ; 8 N C�"� 2�,� 4�",-P� 1 7 ?"-' 0.-,-. _l0,I�,; -2 !l,' , -- ,- - , -,--,- � ,! . -I �.l -�-- '-i-�:--� -, - , X -",-. ---- -' , � .,- - - -" .. ..' -, .-. � ,. -" ,:- � - � ,- i , - , , 1666[0,* 2Z A& � Date � 2 12Q.T7,r , , , i v F - " - - - � w Receipt# f i�� b I7�1 ? j1 J , , l t Title fiPsPPPbo. b6ib -eqq@�fpd UV : , -i-, -1 - ` A� Syed W4 ! i1 , , -t-*Io ,~ " 4'; � A,t ," I — ' � V,y , ) � "roved�ly, Title ,,{Sr.t%th ihebf natp � Roger ttqa,'I 5 �, , r Finance epA 0nly - -� r - Verified ddb s Title Ccq nq ng,Q!errAV Date AP roved ;b I Title ccountanj Date -- �_ SO mL0 Instructionso - �F`or'.." d1l n Check } Mai`A6 is Mai 6K-Att'ac - EIyplpp@ nteh m, neCW ,,�, � -i I- r e00 :0y 1 r 1 : R6fUrh Id JOAnnlIThPnapT Public Wo s I (Name) (Department) , athLr Pidige,retO-^Ch - " . i, "I I - " 1'f � " ,,. j.I t � � ' ,,i,"A' - �,., - , � - ,�, , � - -,, 1 - �- -".� r ; ",,-,, � .-'.- - .:f t,�'-�,::, � r - . -I � , , ----��r, ` -" , , "- ,- i-' �,- �,-'�z ��.!�_. � ' -1-,--�, f::- �,-�'-.-Z-.,,,,�,-�,� -;,-l-'.`-11`l - , " �'j � '.,. , , � -'�- � ,,-* , ! , - - . - - 11 � - r' ,,��" '11, � - , I I . , - � : . - - - - .- , � - --7!- I I - - , � , .-,�- -�: I - -: , PUBLIC WORKS DEPARTMENT LAND DEVELOPMENT Effective July 1,2017 TO: Finance PUBLIC WORKS FILE NO. ENC2017- [_ PROPERTY ADDRESS 256 Beverly Court Please collect&receipt for the following monies: ACCT. ITEM AMOUNT LAND DEVELOPMENT 4122 Encroachment ermit Application F ee Non-Utility Encroachment Permit Major�!$10,000 $425.00 Minor Encroachment Permit<$10,000 $240.00 $ 240.00 Initial R-1 Permit N/C Subsequent R-1 Permits within Two Year Period $240.00 Inspection 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 z 10,000 s.f. <0.6 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 projects sent to Consultant for review Consultant Cost+20% 4722 Additional treatment facilities $315 ea Plan Check&Inspection Fee (Non-Utility) 4722 Engr. Est.<$250,000 14%of Engineer's Estimate $ 700.00 4722 Engr. Est.>_$250,000 and<_$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 Engr. Est.*($500 min/$10,000 Max) r a•:f7. I. V. '1f '.e �_ .� - .r ray,^.8. 2203 Labor and Materials Security 100%of ENGR.EST.* 4721 Storm Drainage Area Fee Per Acre RA $2,120.00 $ 297.00 (Multi-Res$2,385.00) (All Other$2,650.00 4722 Parcel Ma 4 Lots or Less $4,200.00+$90/lot 4722 Final Tract Ma 5 or More Lots $5,115.00+$124/lot 2203 Monumentation Security 100%of 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 4722 Assessment Segregation or Reapportionment First Split $940.00 Each Additional Lot $295.00 511.7424 Postage MISCELLANEO08-- Other(Please Specify) *Engineer's Estimate shall be as approved by the City Engineer and shall include all items of work. TOTAL $ 6,237.00 NAME OF APPLICANT Elizabeth Hawkins �+ NAME OF PAYOR S PHONE ADDRESS 17/Sy r G ZIP A" 00-f I 6A Z 6 0 FOR RECEI ED BY DEC II ITY CLERK ONLY Date Receilw# �+ sa �� Am wr m—A J:\IandDMPlar Crea Canmentsll-Spe fic Prgec -A MProject in Pmgr—\Ba.e 1W Mrrvace !?rint Form A- t Permit No ENC2017- ,2 71 CITY OF.,cAmPBELL ENCROACHMENT PERMIT DEPT.OF PUBLICWORKS (forwo rking within the public X-Ref. File 70 North First Street right- =w ) Application Date 10/19/17 ':ampbell,CA 95008 fp /{j�sr10 Application Expiration Date 04/19/18 "h.(408)866-2150 Issued APN �tal t 17 C) x. (408)376-0998 ` Permit Expiration Date APPLICATION-Application is hereby made fora 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 orTract No.: 256 Beverly Court ' UtilityTrench Location: Replace (E) driveway with new curb gutter and 6-ft sidewalk B. NatureofWork: (N) drivew_ay Detail D-15 no wider than the 14-ft garage opening C. Attach four(4)copies ofan engineered plan showingthe location and extent ofthework,andfour(4)copies ofthe preliminary Engineer's mm 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 workshall conform to the City ofCampbell Standard Specifications and Details for PublicWorks 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. 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 startingwork.Noticemust begivento PublicWorks atleast24 hours before restarting a nywork. E Name of Applicant: Elizabeth Hawkins t—LL-C L/0 9 Sa S' Is- E-MailAddress: lizhawkins5@hotmail.com owl= Lf D 8 kZ 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 resultingfrom the work covered bythis 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. 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 improvements com 1 e public right-of-way. Accepted: Elizabeth Hawkins ) SPECIAL PROVISIONS: 1. Street shall not beopencut o undergroundinstallations. rinimumula,Da y be allowed for connections or exploration holes.Suchcutsmaybe 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 the Engineer. Q✓ 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 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 has been entered hereon. USA Phone: 1-800-227-2600. USA TICKET NO, 5. Priorto 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 $ 200 'wag 54t- -ILAN CHECK DEPOSIT $ SECURITY FOR FAITHFUL PERFORMANCE/LABOR&MATERIALS 'CONSTRUCTION CASH DEPOSIT $ PLAN CHECK&INSPECTION FEE $ 2:72 EME G0VV, M�E $ APPROVED FOR ISSUANCE C® For City Engineer Date Permit Expires 12 Months After Date of Issuance GENERAL PERMIT CONDITIONS 1. The Permittee must provide evidence of insurance and Additional Insured Endorsements as required by the City.Insurance shall be maintained for the duration of the permit work. A Construction Cash Deposit is required.Changes 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. 3. Refund ofthe construction cash deposit balance and refund or cancellation ofthe Faithful Performance Surety will be initiated by the written acceptance ofthe work by the City. 4. A one-year maintenance period and surety are required.Such period will begin on date of written acceptance by the City.Surety posted shall be equal to 25%of the original Faithful Performance Security. 5. Submit project schedule 10(ten)days prior to proposed start of work.Additional lead time may be required for work within City facilities and downtown Campbell. 6. 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. 7. Maintain safe pedestrian and vehicular crossings and free access to private driveways,bus stops,fire hydrants,and water valves. 8. 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 priorto any lane closures. 9. A Construction Traffic Control Plan shall conform to the 2006 California Manual on Uniform Traffic Control Devices(MUTCD). 10. Replace,as directed bythe City Engineer,any damaged or removed improvements in accordance with City Standards and Specifications atthe sole expense ofthe Permittee as expeditiously as possible. 11. Sawcut for all PCC or AC removals.All PCC removals shall be to the nearest scoremark and new PCC shall be doweled to existing improvements. 12. Prior approval of inspector is required for any work proposed after normal working hours,on weekends or holidays and may require reimbursement of inspection costs at the current overtime rate. 13. Work on arterials and collectors may require the use of changeable message boards.Adequate signing and barricading is required on the job site.Failure to provide such signing and barricading may result in the City's providing signing and barricades and charging the cost(including all labor and materials)against the construction cash deposit. 14. Compaction testing of subgrade,base rock,and asphalt concrete by Permittee is required unless otherwise stated bythe City Engineer. 15. 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.and on weekends. No storage of materials or equipment will be allowed nearthe edge ofthe pavement,the traveled way,or within the shoulderline which would create a hazardous condition to the public. 17. This permit shall not be construed as authorization for excavation and grading on private property adjacent to the work or any otherwork forwhich a separate permit may be required,nor does it relieve the Permittee of any obligation to obtain any other permit required by law. 18. This permit does not release the Permittee from any liabilities contained in other agreements or contracts with the City and any other public agency. 19. This permit is not transferable.Work must be performed bythe Permittee or his designated agent or contractor as specified thereon. 20. Call back(call out)due to emergencies regarding this permit shall he at the current overtime rate with a three(3)hour minimum charge per occurrence. 21. Pursuant to Chapter 14.02 ofthe Campbell Municipal Code,applicant shall not cause to be discharged any material into the municipal storm drain system otherthan storm water.Applicant shall adhere to the BEST MANAGEMENT PRACTICES established by the Santa Clara Valley Urban Runoff Pollution Prevention Program. 22. Ifthe public interest requires a modification of,or departurefrom the permit,plans,special provisions and/or specifications,the City shall have the authorityto require or approve any modification or departure and to specify the manner in which the same is to be made. 23. Permittee must provide advance notification to all parties that may be affected by the permit activities.Notification shall be reviewed bythe City priorto distribution and include dates of work and a contact name and a phone number. 24. Applicant shall remove waterfrom utility vaults in accordance with the requirements of State Water Resources Control Board Water Quality Order WQ2014-0174- DWQ. Said vault watershall not be discharged into the City of Campbell's storm drain system. See http://www.waterboards.ca.goy/water issues/programs/npdes/utilityvaults.shtml for more information. Applicant is hereb nsiblefor ensuring that all those providing services underthe applicant are aware of and abide by all ofthe o/ditions. ozssoi � � irCs �li Grp ,r�i.�f i i� i' J:\FORMS\Templates\Encroachment Permits\Encroachment Permit STATIC form2.pdf Rev.03/17 i CITY OF CA�iPIRELL .I. ii ;'S =ire i, DESCRIPTION AMOUNT i r r CUST 10 1.000 REF DEPOSIT — 101 TOTAL ]DUE. $6.237.00 TENDERED: -, 16.237.00 17 yL4 %Its'...• _.._. - .. a...__.v}1'r a.r, F & v`Jui'i. r .a.—wN- CUST _ 237„ ',_i t is aiii`yl.; r 06-04-18;08; 10AM;Don Williams & Associates ;408-379-7554 # 1/ 1 POLICY NUMBER: WWC3293461 WORKER'S COMPENSATION LIABILITY Bearden Construction Co,Inc. CG 24 0410 93 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: WORKER'S COMPENSATION LIABILITY SCHEDULE Name of Person or Organization: The City of Campbell Attn. Dept of Public Works 70 North First Street Campbell, Ca 95008 The City of Campbell, its officers, directors, agents, representatives, servants, employees, divisions, subsidiaries and all related entities or individuals whether specifically scheduled herein and the Project Owners. (If no entry appears above, information required to complete this.endorsement will be shown in the Declarations as applicable to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV- COMMERCIAL GENERAL LIABILITY CONDITIONS)is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or"your work" done under a contract with that person or organization and included in the"products-completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. Project: 256 Beverly Ct, Campbell, CA 95008 ENC 2017-279 CG 24 0410 93 Copyright, Insurance Services Office, Inc„ 1992 INSURANCE REQUIREMENTS CHECKLIST Permit# CIP Project# Consultant/Contractor: 1)eacACV\ Cn✓lSi- - ��,�,—CE�,}ef The followinginsurance is required of all consultants/contractors working in the City df Campbell q 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 Permit and work being performed under contract for Capital Improvement Projects. Limits Commercial General Liability for bodily, personal injury and property damage: $1,000,000 per occurrence, and --- - --a- $3;060;000 geneta�aggregate litrji ap}�lying-separ-ately to tlie.project;or- ---- ---- -- - - $2,000,000 general aggregate limit. Policy expiration date �-1 �T Automotive Liability: t "Any Auto" checked on certificate $1,000,000 per accident for bodily injury and property damage olicy expiration date aLk Workers' Compensation and Employer's Liability ❑ Waiver of Subrogation clause $1,000,000 per accident for bodily injury or disease Policy expiration date -7 Course of Construction (if required in Special Provisions) ❑ Completed value of the project ❑ Policy expiration date Required Endorsements to General Liability and Automobile Liability Policies Additional Insured Endorsement: The City, its officers, employees and volunteers are named as additional insured. (Reference Project Location/Permit Number) . The insurance coverage afforded to the Additional Insured is primary insurance. Cancellation area should say: Should any of the above described policies be cancelled before the expiration date thereof,notice will be delivered in accordance with the policy provisions. orkers' Compensation Insurance Sheet Submitted ,For General Contractor ❑ For Developer or Owner J:\FORMS\Templates\Insurance Requirements\Insurance Requirements Cklist.doc (Rev Jan 2018) Page 1 Acceptability of Insurer(s) ❑ Insurer(s) has current A.M. Best Rating of A:VII and is authorized to transact business in the State of California. 3 Name: WCEk vvl i NAIC# Rating: xY Authorized in CA: Name: '\ N gjej cSA1%IC# ,?400PRating: XV Authorized in CA: � Name: C o NAIC#LS-W Rating: l- V Authorized in CA: ✓ Name: NAIC# Rating:, Y Authorized in CA: f� Campbell Business License # Expiration: Contractors License# ��. ` 1 Class: Q5 1 Expiration: _. C\ Insurance Certificate Reviewed U (b U Initia s Date ❑ Copy of Insurance Certificate placed in tickler file one month prior to expiration. J:\FORMS\Templates\Insurance Requirements\Insurance Requirements Cklist.doc (Rev 08 14) Page 2 Jun 01 18, 10:15a CB Concrete Construction 4083543486 P.1 ACC MEW CERTIFICATE OF LIABILITY INSURANCE DA7EQ6M1001YYtY) 0610112018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE IIOLDER.TI(IS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGEAFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S).AUTHORIZED REPRESENTATNE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the Certificate holder Is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisiarts or be endorsed. N SUBROGATION IS WAIVED,subject to the terns and conditloas of the pogey,certaln polMos may require an endorsement. A statement on this certificate dow.not confer rights to thSMMVM 1rt Ileu of such endomemant(s). PRODUCER UONNAMTACT BrendanWiliams l%n191IIIIamS&AssociateS,Inc, PUN (408)402-3646 Ne; (408)884-8871 17510 Ferley Road.Wei J U N 1 2018 E4AEL s; brondanbondw0lamsdI9ma1c:m ADDRE I NSURERC%AFFORDING COVERAGE NAIC Los Gatos Public Works Admi@ 6499 INSURERA; west American lnsoD 44393 INSURED INSURER B: Amerman Fire&Casually Co 24066 Bearden Construction Co Inc INSURER c; WESCO INSURANCE COMPANY 25011 641 UniveisityAve INSW ER 13 t INSUtiEit E; losGalos CA 95032 INSURMF- COVERAGES CERTIFICATENUMIBER: CI-I86103619 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEHJ ISSUED TOTHE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. MOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER 0OCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY T8E POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IFEW LTR TYPEOFINSURANCE rNBD YIID POLICY NUMBER P D UHTS X COMMERCtAL-GENERAILLIABILITY EACHOCCURRENCE S 1,000,000 CdAIlS•Aa4DE QOCCUR PR9ALS aoxnrres I DAMAGE TO RENTED ce S 500,000 MED DIP Pw am neap) S 15.000 A BLW56424311 08R212D17 0812112018 PERIIAL&ADVNJURY S 1.000,000 GEnAGGREGATE1VXr APPLES PER: GENERAL AGGREGATE S 20m,000 X POLICY r LOG PRODUCTS-CDMPAGPAGG S $OW,000 i}7�EIi: S AUTOMOBILE LIAB¢RY GOMBNE4 SINGLE IJMf1• S 1.OW.00O Ea aLrJdent X ANYAUFO BODLYINJURY(Perperapa) S B X X M"ED SC �ULED EAA56424811 OW24018 03724d2019 amLymliniuFartPrxx ddentN S ANLY A� HIRED NON-WONED POPERTY DAMAGE AUTOS ONLY AUTOS ONLY eradm $ Medical payments 8 SAW LIMB All IA IJR'Aa OCCURL EACH OCCURRENCE S EXCESS L CLAIMS-MADE AGGREGATE S DED RETENTION S S WGRXHNS COMPENSATION PER OTH- AND EMPLOYE RS'LiABILITY STIN ATUTE ER C ANY PROPMErrORIPARTHERIEXECUTIVF Y[7 NrA WWC32939$1 07M112017 07101/2018 E.L.VACHACdDENT S 1,oW.000 touFdi4r HRFJfRODED7 1__f 1.00D.000 J EL DISEASE-FAEMPLOYEE S U yoa,describe under DESCRIPTION OF OPERATrONS balmy EL.msmE-FOLICYLUAr" S 1,00D.000 DESCriWi[OH t>P DPFJTATIONSf LOCATIONS r4EHICLE6(ACORD iet,AddYlonal RemsrksSehMub,mayifeottachadtftaarospaceh required) The City of Campbalk 7s offfcers,employeesarad volunteers as additional insured.The Insurance coverage afforded to the additional Insured is the primary insurance. Job:25S Eevedy COurt.Campbell,Ca 05008. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF.NOTICE WI LL BE DELIVERED I N City of Campbell ACCORDANCE Wrr'rl THE POLICY PROVISIONS. 70 N First Street AUTHORIZED REPRESENTAMVE Campbell CA 95008 0 198 8-20 1 5 ACORD CORPORATION. Al rights reserved. ACORO 25(2M 6103) TheACORD name and logo are registered marks ofACORD Jun 01 18,04:30p CB Concrete Construction 4083543486 p.1 PLEASE POST IN A CONSPICUOUS PLACE NOT TRANSFERABLE BUSINESS LICENSE CITY OF CAMPBELL (408)866-2174 ESTABLISHED: 0 311 81201 5 EXP DATE: .0212812019 LICENSE NO. 029186 LOCATION: 641 UNIVERSITY AVE LOS GATOS,CA 95032 BUSINESS: CB CONCRETE CONSTRUCTION INC TYPE OF BUSINESS OWNER: CHRISTOPHER BEARDEN CONTRACTOR-CONCRETE-OUT OF TOWN The person,firm,or corporation named above is granted this business license.pursuant to the provisions of the City Business License Ordinances to engage in,carry on,or conduct the business,trade,calling,profession,exhibition,or occupation described above. Issuance of the license is not an endorsement, nor certification of compliance with other ordinances or laws,nor an assurance that the proposed use is in conformance with the city zoning regulations. This license is issued without verification that the licensee is subject to or exempt from the licensing by the State of California. Valid only within the City of Campbell city limits. CITY MUST BE NOTIFIED ON ANY CHANGE IN OWNERSHIP,LOCATION,OR CLOSURE.. . ANNUAL TAX PAYMENT DUE ON OR BEFORE THE EXPIRATION DATE.RENEWAL NOTICE NOT REQUIRED. • I { ROOF EAVE PROJECTIONS LOCATED WITHIN S _ /� / j I ■ OF THE PROPERTY LINE SHALL BE PROTECTED / � 'I BY L ONE-HOUR FIRE RATEVENTILATION ASSEMBLY Y PER _ ADDITION_ TABLE GSA E N T PE VENTILATION / • '" , OPENINGS ARE NOT PERMITTED AT THE RATED EAVE PROJECTIONS. OC co o ISSUE 1 Gei., '- a Teems t OR 6 GAL 9, TeBLSf3 Permit Submittal 16 GAL, 6 TAMERS o I / ` i / / / Permit ReSubi m aMw ADDITION to ROOF EAVE PROJECTIONS LOCATED WITHIN 5 OF THE PROPERTY LINE SHALL BE PROTECTED BY AN ONE-HOUR FIRE RATED ASSEMBLY PER NEW un PORCH I I TABLE R3021(1).EAVE VENTILATION I OPENINGS ARE NOT PERMITTED AT THE RATED PI ��r� I EAVE PROJECTIONS. TIES PLACED 6" wx !N FORK OR BRANCH I � I GL POLE' pw STAm i srEF CMONM OR I I EXISTING GAS METER SQUeL. IIOTBAILU�T�S EL 3TeKLn PJ1d13 3rAI�.9%R w tGER) - .- .... .. . ... . _. . . ..—:.. . —.— . — ._:—. — : STAMP I REDROOD�IIITH ((a) W SACR CONNEC N g MWAMG.WIND SIDE) I t�•�, n HOW ONCRETE DRIVEWAY AND SITE AT STORM WATER WILL NOT BE V '- DT CROIIN. 1�a�—S/�L� .I FLOW ONTO ADJACENTGRs1DgSLOPE ALL WALKS TOWARDSSCAPEARFAS. � Ur N 1 IS 3CRE'6NED I STOONES AT PAVING MATCH (n� OR FIR BARS IIQIaCH LL. FRONT YARD LANDSCAPING FINISH TO DRIVEWAY. Z USM. GROZ _ SLOPE SO THAT STORM WATER , Y I WILL NOT BE DIRECTED TO FLOW s , OU ONTO ADJACENT PROPERTIES. CV Z I - _ LANDSCAPING AT BIDE OF DRIVEWAY. 1 I PROVIDE PERMANENrIRRIGATION rII.IZER TeBIL�f3 LO y NEW CONCRETE DRIVEWAY N cm I 1 3FOR10- _ - (may - ��T 1 0.\J �y Pk()u � '—� R CONS -=' I REMOVE EXISTING DRIVEWAY AND ENTRY OWNERSHIPAN !—S LANDSCAPICIO WALKS AS NG AS REQUIREDTP LA OR NEW PAVING 7 KDewings,Spegdagons and co{ z l L-are and shall remain Its proper Campbell 'LA NOT EXCEEDAS SITE COVERAGE.ALL aa df�dal regulatory requirements or I and are not to be used n '�� OF ROOT. HAW. ♦�/ .Of ��' LANDSCAPE AREAS TO HAVE PERMANENT .Q � heconsWed as publication In derc f I]'(, IRRIGATION. i ieNn'HO'1TOY OF I is copyright or other reserved dgt Did UK. Iic Works Permit No JOB NO. NEW SEWER CLEANOUT ` must have •these plans on the lob site during corrsirudion. DRAWN- BY RAIIri ROCS --- --- --- --- --- --- --- --- --- - - 60'0" \. ��-OMIC,) SCALE IT.T� - NEW SIDEWALK.CURB N OGUTTERACROSS NEW PUBLIC SIDEWALK rL'/11saa++ FRONT OFPROPERTY IN COMPLUWCEWmi �. ADA DRIVEWAY APPROACH CITY OF CAMPBELL DETAILS. SITE PLAT DETAIL 12 CC• -- EXISTING WATER METER I (N). 14' DRIVEWAY APPROACH GENERAL CONTRACTOR TO OBTAIN AN, ' - i ENCROACHMENT PERMIT FOR ALL WORK TAKING PLACE IN THE PUBLIC RIGHTOFWAY. w 3 MAX 50% FRONT YARD PAVING SITE COVERAGE SITE. PLAN 1 ,767 SQ. FT. TOTAL FRONT YARD AREA _ SCALE: 1/8" = 1'—On bev e . r c o 973 SQ. FT: LANDSCAPING: 55% COVERAGE 794 SQ.. FTS PAVED: 45% COVERAGE