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ENC2017-00174 I OF ' O4,y UtCHAX� CITY OF FCAMPBELL Public Works Department August 22, 2019 Jeanne Moore 40 Hernandez Ave. Los Gatos, CA 95030 SUBJECT: PERMIT NO. ENC 2017-00174 96 E. Rincon, Campbell, CA FINAL INSPECTION AND ACCEPTANCE Dear Jeanne: 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 remaining 25% of your Faithful Performance Security is enclosed. If you have any questions, please call me at(408) 866-2165. Ad ly, ahidi Public Works Inspector 70 North First Street • Campbell, California 95008 TEL 408.866.2150 - FAX 408.376.0958 TDD 408.866.2790 ........... .............-....................... ...................................... . ............................... ........... ............. ........................... .................. ...................................... ......... ................... ....................................... ......... .......... ................ .......... . ............... .... > CITY OF CAMPBELL VENDOR NO. 10013876 CHECK NO. 274936 Account.... V,PurchaseQrde :�A t'.. 101 2203 CRO80519 3,000.00 96 E RINCON 10013876 JEANNE MOORE it QF'.0 ' IT .::;0 CHECK DATE CHECK NO. C IFY . ECANOBELL WikS..FARGO BANK, N.A. .11-24 42a MONTGOMERY STREET FIRST STREET 08/19/19 274936 1210 'S"*'FRANCISCO, CA 94104 CAMPBELL CALIFORNIA 95008 > 0 AMOUNT $ *****3 ; 000 . 00* 61 ORCIIAS v :....:..VOID AFTER 0 90 DAYS PAY THE SUM OF THREE THOUSAND DOLLARS &- ZERO CENTS mi TO THE JEANNE MOORE ORDER 40 HERNANDEZ AVE > F < LOS GATOS CA 9503'0 V27493610 1: 1210002484 412119SPIL5115 . ......... ..................... .................................. ................. ............................... .......... ................... .................... ... .......................................i ........................ ............ .............................. ........... *See Reverse Side For Easy Opening Instructions* -- -------- - -------------- --------------- -------------------- ......-------- CITY OF CAMPBELL 70 NORTH FIRST STREET CAMPBELL, CALIFORNIA 95008 JEANNE MOORE 40 HERNANDEZ AVE LOS GATOS CA 95030 Wr Refundable bepos t Check Requesfi a To: Finance Director.° cA, _:J e , Check Payable To: 'Jeanne'M6ore .. ` Line 1 40 Hernandei:Ave Address Line 2 , t` City: Los Gatos State:-CA Zip` 95030 f Description: `9&E.Rincon - 'Account Number: 101.2203 ': Amount: . $3,00000 f Account Number: . 1U1.2203 Amount: i _ count Numb Account er .- , 161 540 7448„: . Amount ` _''(Finaace Dept only) ••Interest:Earned (Finanee Dept'only) Total Payable: (Exact Amount) 1 Purpose:,. 25%Remaining FPS Refund:. f, Permit# ENC2017-00174 t - Receipt#`. 27.0452 Date-:'- 7/12/2017" Receipt# Date - Requested by: Title: Inspector Date: ` Syed Wahidi m. Title: Sr., t Approved by:" Engineer_ Date* Roger S o Approved by: Title: _City'Engineer Date: V .Amy Olay 5• 0 V " r Finance Dept Only a , ,Verified by:, Title: Accounting Clerk 11 Date: i Approved by "Title: Accountant Date t s Sp ecial Ins#r uc tions for Handling Check . ! Mail AS 1S Mail in Attached'Envelope:r Interim Check 7777-7. Needed By �ll Return To o'Anna Thomason Public Works .i J , (Name) •` - (Department " CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT CLEARANCE FOR FINAL INSPECTION AND ACCEPTANCE LETTER Encroachment Permit#: ENC2017-00174 Name: Jeanne Moore Property Address: 96 E. Rincon Ave. Date of Final Inspection: 7/29/19 On File: Bonds CD aithful performance: $ 3,000.00 abor and Material: $ Construction Cash Deposit to be released: $ Other overdue deposits to be released (Description): 1 Processed by: ' C Administrat r Reviewed by: Inspector Reviewed by: Land Development Engineer JAJoAnnaT\Deposit refunds\CHECKLISTS\Rincon 96 2019.doc(Rev. 10/11) R Encroachment Permit Final Sign Off Encroachment Permit# L 20 17-0O 17 L j Address: W—D-N /N✓I-- Date of Final Inspection and Acceptance: 2f"��q Inspected by: J� OK to release deposits: 100% V 75% Comments: F CY, f i ` pF Cq4� � •CkCHARO - - I, August 7, 2018 CITY of CAMPBEL L Public Works Department Jeanne Moore 40 Hernandez Ave. Los Gatos, CA 95030 1 Z SUBJECT: PERMIT NO. ENC 2/00174 96 E. Rincon Ave., Campbell, CA FINAL INSPECTION AND ACCEPTANCE Dear Jeanne 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 July 19, 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 refund in the amount of$9,000.00 and your Construction Cash Deposit refund for $500.00 are enclosed. The City will continue to hold 25% of your $12,000.00 Faithful Performance Surety($3,000.00) for the one-year maintenance period. If you have any questions, please call me at(408).$66-2165. Sincerely, e Syed Wahidi Public Works Inspector Cc: Inspector/Suspense Files Permit File ENC2017-00174 70 North First Street • Campbell, California 95008-1436 TEL 408.866.2150 FAX 408.376.0958 TDD 408,866.2790 CITY OF CAMPBELL ENCROACHMENT PERMIT Permit No.: ENC2017-174 DEPT.OF PUBLIC WORKS (for working within the X-Ref. File pu 70 North First Street b c r ay � Application Date i t oft ay CA 95008 9 Ph. 408 866-2150 Issued Application Expiration Date Fx. (408)376-0958 1 APN Permit Expiration Date APPLICATION-Application is hereby made for a Public Works Permitinaccord ncewi Campbell Municipal Code,Section 11.04.(Application expires in six (6) months if the permit is not issued. Application Fee is non-refundable.) A. WorkAddress: 96 E RINCON AVENUE B. Nature of Work/Utility NEW ADA DRIVEWAY APPROACH Trench Location: ❑ No Fee Permit for work related to City Project Project Name: C. Attach four(4)copies of an engineered plan,showing the location and extent of the work, and four(4)copies of the preliminary Engineer's Estimate of work. The plans shall show the relation of the proposed work to existing surface and underground improvements. When approved by the City Engineer,said plan becomes a part of this permit. D. All workshall conform tothe City ofCampbell Standard Specifications and Details for Public Works Construction;the General Permit Conditions listed on the reverse side;and the Special Provisions for this permit,listed below.Failure to abide by these conditions and provisions may result in job shutdown and/or forfeiture of Faithful Performance Sureties and cash deposits. E. The Contractor must have this permit and approved plans at the site and must notifythe Public Works Department at least two days before starting work. Notice must be given to Public Works at least 24 hours before restarting any work. Name of Applicant 9Va j^ee Tele Bone i7n f/ Address`=�=:a �ii.�.� ��,,�- ,Zn,/ ➢ GG(/!g/��<� ��l. E=1Vlall Address: / lJ, r� 24 HOUR EMERGENCY PH".�E NU,,:MBE_- - � /�� /��J` Is this work being done by the property owners at their own residence? ❑ Yes No &3 The Applicant/Permittee hereby agrees by affixing their signature to this permit to hold the City of Campbell,At fficers,agents,and employees free,safe and harmless from any claim or demand for damages resulting from the work covered by this permit. The Applicant/Permittee hereby acknowledges that they have read and understand both the front and back of this permit, and they will inform their contractor(s) of the information.Applicant is advised that upon issuance of this permit, property owner, or property owner's successors, shall be responsible for any and all dams es ari 'ng out of improvements completed in lic righ w Accepted: L%9 �r'L�?i/ _,�� ' �'/ fe� ' ` v �ApplicanY Rermi-,ttee)=Jf (3ign)' Date T (Contractor) (Print Name) Date SPECIAL PROVISIONS: 1. _Street shall not be open cutfor underground installations.Minimum cuts may be allowed forconnections orexploration holes.Such cuts may be Tnprifirallyannroypri hKthe Inspector nrinr to rutting. 2. Pavement may be cdt for underground installations and must be restored in accordance with the Standard Details Trench Restoration Method "A",unless otherwise approved by the Engineer. 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. Prior to any work,the property owner shall execute an Agreement for Private Improvements in the Public Right-of-Way,which shall be recorded. 6. Public Notification Requirements: 7. SEE PUBLIC WORKS FEE SCHEDULE FOR CURRENT FEES AMOUN ri RECEIPT NO. PERMIT APPLICATION FEE $240 PLAN CHECK DEPOSIT $ SECURITY FOR FAITHFUL PERFORMANCE/LABOR&MATERIALS CONSTRUCTION CASH DEPOSIT $ -� PLAN CHECK&INSPECTION FEE $ woo EMERGENCY PERMIT FEE $ nn� APPROVED FOR ISSUANCE } !l For City Engineer to Permit Expires 12 Months After Date of Issuance I ! GENERAL PERMIT CONDITIONS 1. The Permittee must provide evidence of insurance and Additional Insured Endorsements as required bythe City.Insurance shall be maintained for the duration of the permit work. 2. 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 of the construction cash deposit balance and refund or cancellation of the 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 prior to any lane closures. 9. A Construction Traffic Control Plan shall conform to the most recent version of the California Manual on Uniform Traffic Control Devices(MUTCD). 10. 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 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 by the 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. 16. No storage of materials or equipment will be allowed near the edge of the 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 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. 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 by the Permittee or his designated agent or contractor as specified thereon. 20. 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. 21. 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. 22. If the public interest requires a modification of,or a departure from the permit,plans,special provisions and/or 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. 23. Permittee must provide advance notification to all parties that may be affected by the permit activities.Notification shall be reviewed by the City prior to distribution and include dates of work and a contact name and a phone number. 24. Applicant shall remove water from utility vaults in accordance with the requirements of State Water Resources Control Board Water Quality Order WC.2014-0174- DWQ. Said vault water shall not be-discharged into the City of Campbell's storm drain system. See http://www.waterboards.ca.gov/water issues/programs/npdes/utilityvaults.shtml for more information. Applicant is her by responsible for ensuring that all those providing services under t e applic a aware of and abide by all of the above conditions. App'plli a Dater, Contractor (Print Name) Date: J:\FORMS\Templates\Encroachment Permits\Encroachment Permit STATIC form2.pdf Rev.04/18 NOTE: REMOVE EXISTING PAVEMENT FULL DEPTH TO CLEAN, REMOVE EXISTING STRAIGHTEDGE AC SECTION AND BASE(12"MIN) REPLACE AS SHOWN \ GRIND 2"DEEP PAVEMENT KEY_ TYPE A Y2"•MAX-MED AC (95%COMPACTION) NEW PCC IMPROVEMENTS ` CURB,GUTTER,DRIVEWAY IT 9ii - 12u APPROACH OR ACCESSIBILITY RAMP EXISTING PAVEMENT TO REMAIN DOWEL TO EXISTINGPCCIMPROVEM NTS WITH#4 REBAR E6"EMBEDMENT I=I I I I I I I I I I I=I I I I I 10"MIN 2 SACK SAND/CEMENT SLURRY BACKFILL,2 SACK CEMENT PER CUBIC YARD OF MATERIAL 6"CLASS 2 AGGREGATE BASE (95%RELATIVE COMPACTION) COMPACTED NATIVE NOTE: APPLY TACK OIL TO ALL (95%RELATIVE COMPACTION) SURFACES PRIOR TO PLACING NEW A,C. {gip cA�r�'Ile A.C. PAVEMENT REMOVAL & RESTORATION ;ram Qa r DRAWN BY: DETAIL CHECKED BY: AT NEW PCC IMPROVEMENTS A-3 d pkcg j¢9 6� APPROVED BY: REVISED DAIE:,MA�'201? J.\DRAWINGS\STD DETAILS\A-3 P( 4'--0" SIDEWALK ,,--MECHANICAL f� SEPARATOR CONSTRUCTION JOINT SIDEWALK WEAKENED , SEE NOTE 5 PLANE JOINT OR CUT JOINT. SIDEWALK_ 'I 1/8" WIDE, 2" DEEP WEAKENED PLANE JOINT P OR CUT JOINT .1/8" WIDE, 2" DEEP ti�0 3/4„ OAR PER FOOT 5/8„ 1"R a.,. —1/2" R R 10'-0" 4,-6„ 5'-6„ 2'-0" 6" +10% MAX CONFORM 1- SLOPE = 1/ 4" PER Fr. . ��� Q::°:';6;:a;:}`; :Q::a.:is . 'a :•: •.'.a;;; .: . 6" CLASS A CONCRETE, TYP. . 6„ 6" CLASS 2 AGGREGATE BASE, TYP. o' o NOTES SECTION A—A DOWEL-. 1. WHEN THE DRIVEWAY.IS NOT POURED AT THE SAME. TIME AS THE CURB AND GUTTER, 12" OF NO. 4 REBAR AT 4' INTERVALS SHALL BE INSTALLED AS SHOWN (REBARS TO BE BENT DOWN AND COVERED. UNTIL USED). 2. SCORE MARKS SHALL NOT EXCEED 4'-0" O.C., AND USE MECHANICAL SEPARATOR AT. EVERY OTHER SCORE MARK. . 3. DRIVEWAY APPROACHES (EXCEPT SINGLE FAMILY) .SHALL HAVE A 6"X6"X10/10 WELDED WIRE FABRIC 3" ABOVE BOTTOM OF CONCRETE. 4. DOWEL ALL NEW CONCRETE IMPROVEMENTS TO EXISTING CONCRETE IMPROVEMENTS. - 5. AT LOCATIONS WHERE NEW SIDEWALK ENDS AND MEETS AN EXISTING SIDEWALK, THE NEW SIDEWALK-SHALL TRANSITION TO MEET THE EXISTING SIDEWALK AS DETERMINED BY THE CITY ENGINEER. og c A CITY OF CAMPBELL l REV. DATE BY SCALE: .�A��t PUBLIC WORKS DEPARTMENT ' Residential N.T.S. DRAWN BY: DATE 02/04 Driveway. Detail DETAIL �•q�Oj CHECKED BY: DATE (Attached' Sidewalk ) N0. ti APPROVED BY: oRCHAR9 c�4 MCCHEHELLE Q�EY J:fDrawings/Std Details/D15 D 1 5 i OF C4 U s � •UA•CHAR�• CITY OF CAMPBELL August 7, 2018 Public Works Department Jeanne Moore 40 Hernandez Ave. Los Gatos, CA 95030 SUBJECT: PERMIT NO. ENC 201-00174 96 E. Rincon Ave., Campbell, CA FINAL INSPECTION AND ACCEPTANCE Dear Jeanne 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 July 19, 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 refund in-the amount of$9,000.00 and your Construction Cash Deposit refund for $500.00 are enclosed. The City will continue to hold 25% of your $12,000.00 Faithful Performance Surety ($3,000.00) for the one-year maintenance period. `- - If you have any questions,please call me at(408) 866-2165. Sincerely, Syed ahidi Public Works Inspector Cc: Inspector/Suspense Files Permit File ENC2017-00174 70 North First Street • Campbell; California 95008-1436 TEL 408.866.2150 FAX 408.376.0958 • TDD 408.866.2790 ......................... ....................................... ........................................ ............. .................... . ............. ........ ................................. ..................................... --- -- ----- ------ - -- ------------- CITY OF CAMPBELL VENDOR NO. 10013876 CHECK NO. 269226 Aecoirnt ....... er:::Urc ase:. 101 2203 CR073018 9,500.00 96 E RINCON 10013876 JEANNE MOORE CHECK DATE CHECK NO; or C-,.IT:Y::;;:.O]F-.-.�-CAM�PBELL, ,,.,", -BANK, N.k.Wdbl:::�iARGO 11-24, 0 8 016--/-1'8',��-, 269226;;ds:: H'FIR'ST STREET stet.i.:..:.::i.:MONTGO;4ERY STREET z. 1210 CAMPBELL ;CALIF ORNIA 95 'FRANCiSCO, 410 1 4 008 9 5 AMOUNT �q6,`:Qb AMO .............. S' mo VOID'AFTER 'DAY PAY THE SUM OF NI.N2 THOUSAND, FIVE HUNDRED DOLLARS & ZER6 tt TO THE JEANNE MOORE ORDE 40 HERNANDEZ` 'AVE xi S' GATOS� CA� F �O 9503,0 m 22.q'.2'2 1�2 icob'2, ,'A" 4 1 '2,Wh,55 1. 1 SJi lliffil:[.Ilglll$351:tli,.l=liL!ie]Rojollloj:kt�(o)67.lrTjlTor.nITIMMMM - - ----------------------------------- ............ ...... ........ ....................... .................................*..................... :......__......_....-._...........-I ................................. ...................................................... ........... .................................. ............................... *See Reverse Side For tcosy'Opening Instructions* .4 - --------------- ----- -- --- ----------- CITY OF CAMPBELL - 70 NORTH FIRST STREET CAMPBELL, CALIFORNIA 95008 JEANNE MOORE 40 HERNANDEZ AVE LOS GATOS CA 95030 PUBLIC WORKS DEPARTMENT LAND DEVELOPMENT Effective July 1,2017 TO: Finance PUBLIC WORKS FILE NO. ENC �l - l 1/ PROPERTY ADDRESS 96 E Rincon Avenue L- 1� Please collect&receipt for the following monies: ACCT. ITEM AMOUNT. LAND,DEVELOPMENT 4722 Encroachment ermll Application Fee 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 $ 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 $ 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 En r.Est.<$250,000 14%of Engineers Estimate $ 1,680.00 4722 En r.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 FEmme .. : °,&mh30- i§1* 4%of Engr.Est.*($500 min/$10,000 Max) $ Qffiff50T(3Gz 2, 2203 , aitbfrIerfgarrerSeG�Irit;,a�P_S 100%of ENGR.EST.* $ oOpTQO 2203 Labor and Materials Securit"- 100%of ENGR.EST.* 4721 Storm Drainage Area Fee Per Acre R-1 $2,120.00 $ 341.00 (Multi-Res$2,385.00) All Other$2,650.00 ---4722 Parcel a 4 Lots or Less 4,20 + 90 of Final I ract map or more ots + lot 2203 Monumentation Security 100%of Cit '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 Ap roved Plan Revision Fee $100/sheet 4722 Appeal Filing Fee $200.00 730.4924 Notice of Im roveent Ooi on Pa ment 4722 egrmgti pssessment eaon teaoonme nt First Split $940.00 Each Additional Lot $295.00 511.74241 Postage MISCELLANEOUS, Other Please Specify) *Engineer's Estimate shall be as approved by the City Engineer and shall include all items of work. TOTAL $ 15,231.00 NAME OF APPLICANT Bob and Jeanne Moore /� NAME OF PAYOR PHONE —103 ADDRESS nan Azzas 5 ZIP 3l� V FOR RECEIVED-BY CITY CLERK p ONLY Date Recei t# + 2 JALL 13e 1P nCheck Ca-11-Specific Prj -AUiw Project in P,;rwSkRnoon Am 960nd -96ERin-n p� 9 i F GJAI p!PbtU J CC Y�����ooSSfE �//���VV V©Y 8�'IJ�� p -;1 s7 a a- -- � , yy _ ry ( ;1, `��s..S"0. _ � �' ,may�,�"���.Y ems_ -._,_.__ �' c � � i i� 1 ` ("�;+ � ��� �t �������. w_� ___ __. ... ._. ., t _ __._. r ���� _ -- -- - ._ ��� �� .`° --- n . ___,_.. _ i ti"' �� u y.__.._. _.._,___ . _.._.�_ �_ _ ___. .___. ... � � 4 _ _._-_-_-. _. ._..__._ .__ __ _ __. � �, e CITY or CAMt'ItELL PAYGR> .+£ANNE MOORE TODAY'S DATE. 07,1121'17 REGISTER DATE: 07i12/17 TIiuE: 00:00 DESCRIPTION AMOUN -CUST ID.iErr,'7i};2017-00174 ENOR { FILING F ENGR & SUBDIV FILING F r;. OUST I%+rENC2O17-00174 �2�f.GG ENor R & SUBDIV V FILING COST ID:ENC2017-00174 i7J. ENOR & SUBDIV FILING F OUST Iti. f'._ rr• 3aa080.GO sE#,..0.?— c137 0 POW— i 0.1I OUST lD:ENC2017—ooj--ILI G "PtISTI - O$ OUST II;aENC2017—t�_ � L117�} STORM DRAIN FEES FN 2 �3u1.00 TENDERED CHANGE- ; TCtTAL # n __$15,231.00 15, S.GO CHECK REF NUN: C '�'+7i[1� S a�tt[[ t t t � a CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT CLEARANCE FOR FINAL INSPECTION AND ACCEPTANCE LETTER I Encroachment Permit#: ENC 2017-00174 Name: Bob and Jeanne Moore Property Address: 96 E. Rincon Ave. Date of Final Inspection: On File: Bonds CD Cash F�aeth u{i ref ancen $ `� 000 0,0 C�® � �100D Labor and Material: $ c 3 _� % �Gonst�� ct o ����r,i�slt�t'i� b�release�ti V6PQF0 Other overdue deposits to be released (Description): Processed by: dminist for Reviewed by: Inspector Reviewed by: Vv� ' t c Land Development Engineer l J:UoAnnaT\Deposit refunds\CHECKLISTS\Rincon 96.doc(Rev. 10/11) Encroachment Permit Final Sign Off Encroachment Permit## �C. ��-���7�f Address: a{ CN�ci� Date of Final Inspection and Acceptance: C`� Inspected by: f OK to release deposits: 100% 75% V Comments: ��C)� '� ' Ref Ondable Deposit Check Request To. Finance Director, - Check Oa'yable To Jeanne•-Moore Address-Lino.1:. 40:Hernandei Ave I Line I City: Los Gatos State.'CA Zip "'95030 . P. Description: 96 E.Rincon'. AccounYNumber: 101.2203 Amount u $91000:00._'. Account'Number: 101:2203: Amount: 500:00: Account Number% 101.540.7448 Amount::' (Finance Dept only) , Cy interestEarned (Finance llept only) - "Total yab Pale: I� � lExact Amount Purpose: Deposit'Ref Inds: 4 :Permit#: ENC2017-00174. Receipt#:',. .- 270452 : Date: 7M2/2017 Receipt# Date Requested byy Title 1ns'pector.,. Date- Approved by. `•` - :itle �Sr.Engineer• Date: Approved•by: .Title City Engineer Date ?." Amy Olay Rhance'Dept Only: Verified by .':Title '' Accounting Clerk II Date: Approved Title Accountant: Date; Special ::Instructons.;-For Handling Check Mail As Is: Mali'In Attached Envelope: Inferim�Clie'k:, Needed By. Return To:,, JOAn'na Thomason Public'Woeks,... (Department), l = Othe.t Please return check to JoAnna f " Jun 1218 02:47p Marcel Adame 831 -637-4910 p.2 ACC D® CERTIFICATE OF LIABILITY INSURANCE °AT�`MM,D°"YY' 6/12/201 8 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. It SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NANNrACcT Benita Hall, CISR - Landscape Contractors (Lic#0755906) PHONE (559)650-3555 AIC wr .:(559)650-3551i Insurance Services, Inc. C ApDRESS:bhall@lcisinc.com 1935 N. Fine Avenue RECEIVED INSURER(S)AFFORDING COVERAGE NAICiI Fresno CA 93727 INSURERA:Financial Pacific Ins Co 31453 INSURED )NsuRERB Great Amov:Laan. Ins Cc of NY 22136 Mike McCall Landscape Inc_ IN SUR E R 4749 Clayton Road Public Vvo tO Administrar INSURERD: INSURER E Concord CA 94521 INSURERF: COVERAGES CERTIFICATE NUMBER:19/19 Pkg rx Auto REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN: THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTRR TYPE OF INSURANCE POLICY NUMBER MMfDDYrYYY MM!POLICY P LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADEE X❑OCCUR PREMISES'Ea xalrrence $ 100,000 60505011 6/1/2018 6/1/2019 N1ECE(m(Anyone-jerson) $ 5,000 X $2,000 Pd Ded PERSONAL&ADV INJJR-1 $ 1,000,000 GENI'L AGGREGATE LIMI-APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- LOC PRODLCTS-COMPIOPAGG $ 2,000,000 OTHER: Employee Benefits $ 1,000,000 AUTOMOBILE LIABILnY U\[IT $ 1,000,000 Ea acc dert A ANY AUTO BODILY INJURY(Per person) $ ALL O%NNED SCHECULEO AUTOS X AUTOS 60505011 6/11./2018 6/1/2014 BODILY INJURY(Peraecicent; $ NON-OWNED 'RO-ERTY DAMAGE $ X H REC AUTOS X AUTOS 'Per acddent Madcal pavments $ 5,000 UMBRELLA LIAR OCCUR EACH OCCJRR-NCE $ EXCESSUAS CLAIM AGGREGATE S DED RETEN-ION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR,PAP,-NERIEXECUTIVE Y❑N!A E.L-EAC-IACCIDENT $ CPHCERIMEMEER D(CLUDED7 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ if Yes,descnbe under C-SCR IPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ S Inland Marine IMP257288200 6fxf2DI8 51112P19 DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES(ACORD 101, dr�onal Remadcs Schedule,may be ettac ed if more space Is required) RE: Moore Residence @ E Rir=. A ENC 2017-00174._._•. (See Attached CG2012 04 13) kk City of. Campbell, its Officers, employees and volunteers (Excluding Professional Liability) are named as additional insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Campbell THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 70 19 First St ACCORDANCE WITH THE POLICY PROVISIONS. Campbell, CA 95008 AUTHORIZED REPRESINiA71VE B Hall, CISR/fiGOM6E 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(20114f0i) The ACORD name and logo are registered marks of ACORD INS025(E01401) r_ n INSURANCE REQUIREMENTS CHECKLIST Permit# _ N�- a�1r CIP Project# Consultant/Contractor: `I' \� P_ :�LaC Ca c,\D' The following insurance is required of all consultants/contractors working in..the City of Campbell public right-of-way. Insurance certificates must be accepted by City staff before work can begin. These insurance requirements apply to work being performed under an Encroachment 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. ❑ $1,000,000 general aggregate limit applying separately to the project, or $2,000,000 general aggregate limit. ❑" Policy expiration date C \ Automotive Liability: / d, �pnw,-r"e ' `L<Z6� o Any Auto checked on certificate ❑ $1,000,000 per accident for bodily injury and property damage Eolicy expiration date 1 Workers' Compensation and Employ r's/Liability Waiver of Subrogation clause 1,000,000 per accident for�: bodilq jury or d'sease Policy expiration date < < 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: - 1AThe City, its officers, employees'and volunteers are named as additional insured. C j (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.. Workers' Compensation Insurance Sheet Submitted For General Contractor ❑ For Developer or Owner J:\FORMS\Templates\lnsurance-Requirements\lnsurance Requirements Cklist.doc (Rev Jan 2018) Page 1 J Acceptability of Insurers) ❑ Insurer(s) has current A.M. Best Rating of A:VII and is authorized to transact business in the State of California. Name: It`-uC` 0, 1 "`C` NAIC# Rating: i� _`Authorized in CA: Name: G� Kpc\e<vCr,-,1\ems. NAIC# zZ i Rating: AA- K\,-/ Authorized in CA: Name: NAIC# Rating: Authorized in CA: Name: NAIC# Rating: Authorized in CA: 2 ZCA —7 Campbell Business License# Jl > Expiration: ��2 61 ❑ Contractors License# 3 Class: C- 21- Expiration: Insurance Certificate Reviewed VCL itials 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 assIsi /0 io jAwt aci-I VYLJ vts� chtr Cc�tir� YYlc�2cz1 �daw� Jun 1218 02;47p Marcel Adame 831 -637-4910 p.3 POLICY NUMBER: 60505011 COMMERCIAL GENERAL LIABILITY CG 20 12 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Govemmental Agency Or Subdivision Or Political Subdivision: City of Campbell, its officers, employees and volunteers (Excluding Professional Liability) With respects to work performed Cd Moore Residence @ 916 E Rincon Ave ENC 2017-00174 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section 11 — Who Is An Insured is amended to 2. This insurance does not apply to include as ap additional insured any state or a. "Bodily injury" "property damage" or governmental aggency+ or s ibcdivrsion or political 'personal and advertising injury" arising out subdivision shown in the Schedule, subject to the of operations performed for the federal following ;provisions: government, stale or municipality;or 1. This insurance applies only with respect to b. "Bodily injury" or •'properly damage" operations performed by you or on your behalf included within the "products-completed for which the state or governmental agency or opeerations hazard". subdivision or political subdivision has issued a permit or authorization. B. With respect to the insurance afforded to these additional insureds, the following is added to However: Section III —Limits Of Insurance: a. The insurance afforded to such additional If coverage provided to the additional insured'is insured only applies to the extent permitled required by a contract or agreement the rhos; we by law: and ,will pay on behalf of the additional insured is:the b. If coverage provided to the additional amount of insurance: insured is required by a contract or 1. Required by the contract or agreement; or agreement, the insurance afforded to such additional l9sured will not be broader than 2• Available under the applicable Limits of that which you are required by the contract Insurance shown in the Declarations: or agreement to provide for such additional whichever is less. insured, This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations, CG 2012 0413 9 insurance Services Office. Inc., 2012 Page 1 of 1 Jun 1218 02:48p Marcel Adame 831 -637-4910 p.4 Ai►�R D® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDJYYYY) s/12/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Benita Hall CISR NAME; Landscape Contractors (Lic#0755906) WH,No Ext; (559)650-3555 WC No,. (559}6s0-3558 Insurance Services, Inc. ADOReSs:bhall@lcisinc.coia 1835 IT. Fine Avenue INSUREMS)AFFORDING COVERAGE NAIC0 Fresno CA 93727 INSURERA;Oak River Insurance Company 34630 INSURED FNSURERS: Mike McCall Landscape Inc. INSURERC: 4749 Clayton Road INSURERD: INSURERE; Concord CA 94521 INSURER F: COVERAGES CERTIFICATE NUMBER:17/18 WC REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS. �� TYPE OF INSURANCE S R POLICY NUMBER MMIl7oY EFF IPOL IDCp E)<P LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ :.LAIMS-MADE F OCCURA PREMISS Ee occusence $ MED EXP(.Any one person) $ PERSONAL&ADV'N URY $ GENL AGGREGATE L MIT APPLIES PER: GENERAL AGGREGATE $ POLICY1:1 RO- ,PELT LOC PRODUCTS-COMPAOP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGE LMIT $ Ea accident , ANY AJTO - BODILY INJURY(Per person) $ AL_OWNED SCHEDULED AUTOS AJ.JTOS BODILY INJURY(Per accident) $ NON-OVoNED PR0P32TY DAMAGE $ HIREDAUTCS AUTOS Pe-acddenl UMBRELLALIA13 OCCUR EACH OCCURRENCE $ EXCESSLIAB Id CLAMS4AADE AGGREGATE $ DIED RETENTION$ $ WORKERS COMPENSATION X �TRTUTE �RH AND EMPLOYERS'LIABIUTY Y f N CFRCERIMEIMBEREXCLLDED?_CUTIVE ❑ NfA E.L.EACH ACCIDENT $ 1,000,000 A (Myya22ndatoryinNH) y H1PCals"s 10/1/2017 10/1/2018 =.L.DISEASE-EAEMPLOYEE $ 1. 000 000 LESCunde RIPT-IN OF OPERA710NS below =.L.DISEASE-POLICY UPtIT $ 1 400 000 DESCRIPTION OF OPERATIONSJ LOCATIONS f VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached Ir more space Is required) RE: Moore Residence 0 916 E Rincon Ave EPIC 2017-00174 ***** WC Waiver of Subrogation attached ******* City of Campbell, its officers, employees and volunteers are named on the waive= of Subrogation CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Campbell THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 70 F F]xst St ACCORDANCE WITH THE POLICY PROVISIONS. Campbell, CA 95008 AUTHORIZED REPRESENTATIVE - B Hall, CISR/ACON-BE O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 23(2014101) The ACORD name and logo are registered marks of ACORD INS025:201401) Jun 1218 02:48p Marcel Adame 831 -637-4910 p.5 WORKERS COMPENSATION AND EMPLOYERS LIA811L1TY INSURANCE POLICY WC 99 04,10g (Ed.9.14) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALJFORNIA BLANKET BASIS We have the right to rocover our payments from anyone liable for an injury covered by this policy. Wa will not enforce our right against the person or organization named in the Schedule. (This agreement appl ies only to the extent that you perform work under a written contract that requires you to obtain this agreementfrom us.) Tile additional premium For this endorsement shall be 2%of the total manual premium otherwise due an such remuneration. The minimum premium for this endorsement is $350. This agreement shall not operate directly or indirectly to benefit anyone not named In the Schedule. SCHEDULE BLANKET WAIVER person/Organization Blanket Waiver—Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. Job Descrlpftri Waiver Premium All CA Operatlons This endorsement changes ttta policy to which it is attached and Is affective on the date'lssued unless atharwiss stated. (The information below is required only when this endorsement Is Issued subsequent to pnepirratlon of the policy.) Endorsement Effective 10/0112017 Forisy No. MIWC8153M Endorsement No. leisured Mike McCall Landscape, Inc Premium$ Insurance Company Oats River Insurance Company Countersigned by _ 61002���� WC 99 94108 (Ed.9-14) TO BE RECORDED WITHOUT FEE NOV 1 3 2019 SECTION 6103 GOVERNMENT CODE AT THE REQUEST OF CITY OF CAMPBELL 2377 0407 Clll( CLERK'S OFI-iGE Recording Requested by _ Regina n - Clerk-Recorder Santa Clara CountytY CITY OF CAMPBELL 10/06/2017 08:33 AM When Recorded Mail To: ) Titles'. 1 pages: 5 Fees: 0.00 Taxes: 0.00 City Clerk ) Total: 10-00 City of Campbell ) 1 � ■ v6"���I.'�`��� '��Ii`�'��Nl,'��.�'��� 70 North First Street ) Campbell, CA 95008 ) , APN: 412-05-077 (Space Above This Line For Recorder's Use) ADDRESS:96 E Rincon Avenue,Campbell,CA 95008 No Consideration Given GRANT DEED FOR PUBLIC SIDEWALK EASEMENT ROBERT D. MOORE AND JEANNE MOORE', HUSBAND AND WIFE AS COMMUNITY PROPERTY WITH RIGHT OF SURVIVORSHIP hereby GRANT(S)to the City of Campbell, a municipal corporation,of the County of Santa Clara, State of California;easements for public sidewalks over,through and upon that certain real property within said City more particularly described as follows: SEE EXHIBIT"A"AND EXHIBIT`B"ATTACHED HERETO AND MADE A PART HEREOF. Said property contains 94.30 square feet,more or less,and is generally shown on the attached Plat Map. ROBERT D. MOORE AND JEANNE MOORE, HUSBAND AND WIFE AS COMMUNITY PROPERTY WITH RIGHT SURVIVRS Dat ed: v� �j SIGN URE ROBERT D. MOORE, OWNER Dated: NATURE ANNE MOORE, OWNER (Notary Acknowledgement Required for Signatures) CALIFORNIA ALL- PURPOSE CERTIFICATE OF ACKNOWLEDGMENT [andnot notary public or other officer completing this certificate verifies only the identity f the individual who signed the document to which this certificate is attached, the truthfulness, accuracy, or validity of that document. State of California } County of ` _\C. a\ck�Co-_ } On X5 .al�i1l before me, .. _ (Here insert name aria ime or the a leer) _ personally appeared cl��(�-�Mt ice, a�� 'C� �.\e. \ n off er , who_proved to me on the basis of satisfactory evidence to be the person(s) whose name(s)-isfare subscribed.to.the within instrument and acknowledged to me that helix(they executed the same in his/her/their authorized capacity(ies), and that by h sAief-/their signature(s) on the instrument the.person(s), orthe entity upon behalf of Which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of'California that the foregoing paragraph is true and correct. JOANN THOMASON TN�SS my hand and official seal. _ '' commission#2110789 s':` Notary Public- California z ? '° Santa Clara County My Comm.Expires May 9,2019 j Notary'.Public Signature (Notary Public Seal) l ADDITIONAL OPTIONAL INFOR@IIRTIORI INSTRUCTIONS FOR COMPLETING THIS FORM This form complies ivith current California statides regarding notary wording and, DESCRIPTION OF THE ATTACHED DOCUMENT ifneeded,should be completed and attached to the document.Acknowledgment from other-states may be completed for•documents being sent to that slate so long as the wording does not require the California notary to violate California notany G1, ,VAS Le CA C D\_Q,I•C law. (Title or description of attached document) • State and County information must be the State.and County where the document signer(s)personally appeared before the notary public for acknowledgment. Sloe WQ��� do s``S�`�u Date of notarization must be the date that the signer(s)personally appeared which (Title or description of attached document continnueed)d) must also be the same date the acknowledgment is completed. • The notary public must print his or her name as it appears,within his or her Number of Pages Document late commission followed by a comma and then your title(notary public). • Print the name(s)of document signer(s) who personally appear at,the time of notarization. - - CAPACITY CLAIMED BY THE SIGNER indicate the correct singular or plural forms by crossing off incorrect fortes(i.e. 4/she/the}—is/are)or circling the correct forms.Failure to correctly indicate this ❑ Individual(S) information may lead to rejection of document recording. p Corporate Officer • The notary seal impression must be clear and photographically reJdate. e. Impression must not cover text ar lines. If seal impression smudges, a (Title) sufficient area permits,otherwise complete a different acknowledgment El Partner(s) Signature of the notary public must match the signature on file with thof the county clerk. ❑ Attorney-in-Fact Additional information is not required but could help-to is ❑ TfUStee(S) acknowledgment is not misused or attached to a different docu ❑ Other indicate title or type of attached document,number of pages anIndicate the capacity claimed'by the signer. If the claimed caa corporate officer,indicate the title(i.e.CEO,CFO,Secretary). 20 i 5'Vert,ior:tM1 iva.tvetaryClass s.cont.�00-S73-J88 Securely attach this document to the signed document with a staple. 1 ` APN: 412-05-077 ADDRESS:96 E Rincon Avenue,Campbell,CA 95008 GRANT DEED FOR PUBLIC SIDEWALK EASEMNT OFFERED: ROBERT D. MOORE AND JEANNE MOORE, HUSBAND AND WIFE AS COMMUNITY _ PROPERTY WITH RIGHT OF SURVIVORSHIP CITY ACCEPTANCE STAMP: ACCEPTED ON THIS 3 day of Q6... ..,soon for and on behalf of the City of Campbell,a Municipal, Corporation, of the State of California, pursuant to Resolution No. 749, recorded in Book 4509—Page 100 Santa.Clara County.Records. Wend ood, City Clerk City of Campbell, Califomia EXHIBIT "A" LEGAL DESCRIPTION SIDEWALK EASEMENT - 96 EAST RINCON AVENUE,CAMPBELL,CA 95008 LANDS OF MOORE AN EASEMENT OVER CERTAIN REAL PROPERTY SITUATE IN THE CITY OF CAMPBELL, COUNTY OF SANTA CLARA, STATE OF CALIFORNIA,DESCRIBED AS FOLLOWS: A PORTION OF LOT 20, AS SHOWN ON THAT CERTAIN MAP ENTITLED, "MAP OF THE CURTIS SUBDIVISION IN THE NORTHWEST 1/4 OF THE NORTHWEST 1/4 OF SECTION 35,TOWNSHIP 7 SOUTH,RANGE 1 WEST,NEAR CAMPBELL STATION", WHICH MAP WAS FILED FOR RECORD IN THE OFFICE OF THE RECORDER OF THE COUNTY OF SANTA CLARA, STATE OF CALIFORNIA, ON DECEMBER 20,1904 IN BOOK OF MAPS,LETTERED "K" AT PAGE 31,MORE PARTICULARLY DESCRIBED AS FOLLOWS: BEGINNING AT THE NORTHEAST CORNER OF SAID LOT 20,LYING ON THE SOUTHERLY LINE OF EAST RINCON AVENUE;THENCE SOUTH 44°30'00" WEST,6.86 .. FEET; THENCE, SOUTH 89°49'00"WEST, 14.30 FEET; THENCE,NORTH 45°52'00"WEST, 6.55 FEET; THENCE, SOUTH 89°49'00"WEST,2.30 FEET;. THENCE,NORTH 0°1 F00" WEST, 0.30 FEET TO SAID SOUTHERLY LINE OF EAST RINCON AVENUE; THENCE,ALONG SAID SOUTHERLY LINE OF EAST RINCON AVENUE,NORTH 89°49'00" EAST, 26.11 FEET TO THE POINT OF BEGINNING. THE ABOVE DESCRIBED SIDEWALK EASEMENT CONTAINS A TOTAL OF 94.30 SQUARE FEET MORE OF LESS, AND IS GRAPHICALLY SHOWN ON EXHIBIT"B" ATTACHED HERETO AND MADE A PART HEREOF. END OF DESCRIPTION THE BEARING SOUTH 89049'00"WEST OF THE CENTERLINE OF EAST RINCON AVENUE, AS SHOWN ON THAT CERTAIN MAP ENTITLED, "MAP OF THE CURTIS SUBDIVISION IN THE NORTHWEST 1/4 OF THE NORTHWEST 1/4 OF SECTION 35, TOWNSHIP 7 SOUTH,RANGE 1 WEST,NEAR CAMPBELL-STATION", WHICH MAP WAS FILED FOR RECORD IN THE OFFICE OF THE RECORDER OF THE COUNTY OF SANTA CLARA, STATE OF CALIFORNIA, ON DECEMBER 20, 1904 IN BOOK OF MAPS, LETTERED "K"AT PAGE 31,WAS TAKEN AS THE BASIS OF BEARINGS USED IN THIS DESCRIPTION. THE LEGAL DESCRIPTION WAS PREPARED BY ME OR UNDER MY DIRECTION PURSUANT TO THE REQUIREMENTS OF THE PROFESSIONAL LAND SURVEYOR'S ACT. ID ONO 9 XEVI p 9 . ,Q w PAGE 1 OF 2� F � L qz, �7 OF CA11F0 I — — — (BASIS OF BEARINGS) GRAPHIC SCALE _ _N89' 49' 00"E -344.74' _ 69.78' 3 SIDEWALK 0 15 30 60 EAST RINCON AVENUE 'IR EASEMENT �i ui 94.30f S.F. (50' WIDE) Z N POINT OF IN FM SEED AIL BEGINNING 1 inch = 30 f1" - - - - - - - - N89' 49' 00"E- 150 00' -_ T NO' 11' Q S44' 30' 00'W 0.3089' 49' CO-WI 6.86' [NO' 11' 00'W \ �y 14.30' 11 0.30' \ ; �S89' 49' 00"W I I S89' 49' 00'W 2.30' s `r2\ ,...,... 445' 52' 00'W 6.55' 1 I I----------------vl I I DETAIL 1"c5, W • o I of c �10 I in CUR TIS I SUBDIVISION BOOK I K, PG 31 I I LANDS OF MOORE I I LANDS OF MASON I DOC. NO. 23041935 I LANDS OF PRESTON DOC. NO. 22683530 LOT AREA=7,200 S.F. DOC. NO. 23075123 I I I I I I I I LOT 18 LOT 19 LOT 20 LOT 21 LOT 22 I I - - - - 50.00' _ � - - - - � - - - - - - -.� - - 9r - S89 49 00am W o ALLEY LEGEND EXH I B IT'"B" —— PROPERTY LINE PLAT TO ACCOMPANY LEGAL DESCRIP71ON ADJACENT PROPERTY LINE FOR SIDEWALK EASEMENT ACROSS THE —————— EASEMENT LINE Q(,p►N�S(, LANDS OF MOORE SIDEWALK EASEMENT = R`F 96 EAST RINCON AVENUE -� CAMPBELL, CA 95M C� ItEV M. O APN 412-05-077 BASIS OF BEARING& - SMITH THE BASIS OF BEARINGS SOUTH 89449'00' WEST OF No.8237 PAGE 2 OF 2 -THE CENTERLINE OF EAST RINCON AVENUE, AS SHOWN AP ON THAT CERTAIN MAP ENTITLED, MAP OF THE -7,1 JOB NO.K15M CUR71S SUBDIVISION IN THE NORTHWEST 114 OF THE OF CAS-CFO NORTHWEST 114 OF SEC71ON 35, TOWNSHIP 7 SOUTH, KEVIN SMITH RANGE 1 WEST, NEAR CAMPSELL STATION", WHICH M1_!, A MAP WAS BLED FOR RECORD IN THE 0MCE OF THE LAND SURVEYING RECORDER OF THE COUNTY OF SANTA CLARA, STATE OF CALIFORNIA, ON DECEMBER 20, 1904 IN BOOK OF o-2r17 MAPS, LETTERED 'K" AT PAGE 31, WAS TAKEN AS 1420 MERRILL STREET. THE BASIS OF BEARINGS USED ON.THIS PLAT. SANTA CRUZ,CA 95062 (831)588-0154 OINTERLOCKING PERVIOUS PAVERS PER 5BA OCONCRETE PAVING PER 5A/C3 S.A.D. l (j3 Q . CONCRETE WALK/PATIO,. S.L.D.; SEE 6/C3. OS.L.D. FOR EX. AND PROPOSED FENCES. 10 DRIVEWAY APRON SEE CAMPBELL PUBLIC Wi DETAIL D-15 SEE 3jC3. ENCROACHMENT PE TRENCH DRAIN AT DRIVEWAY, SEE 7/C4. VIN QA 14' MCN "P3 - j DRIVEWAY NOTE: AN ENCROACHMENT PERMIT FROM PUBLIC WORKS IS I ` REQUIREREPLLACEMENT D FOR THE DRIVEWAY F_LT99 97 f TP 200.68 , 1 n CONFORM FL 200.4 1 , I c? TP 200.6� k{" C ,J C FL ±199.93 CONFORMM� ` DS 0 z c,3 j FG LU N c ` 202.0 ?_C' olk1 �� . - �, �° Col.OD 0 ,. SZ o t TS N N c01 t�.) f G t 00.5 �4 202.33 + r� 01 ® ONFORM PORCH a, V` ALK C i- } z �s J c � m� r � �- FG �._ ._ to L� 202.3 1 " 8 c� + >> 3 DS �. FG t200.4" 1 f � CONFORM n3 4t +� Q 202.1 + - 0' 11' 001Wui jp �fn FL 200.1 4 8 I 7 CID `� I CD r Ia. J ' . - ', { � , ' " .- j � �' � � ,. `� - �` � �'� _ [..F,e `u', .fi c � t. , i +e.. ' �,g;