ENC2018-00127 "'?CHAO)
CITY OF CAMPBELL
Public Works Department
August 22, 2019
Ronald Wheelan
1534 Vale Ave.
Campbell, CA 95009
SUBJECT: PERMIT NO. ENC 2018-00127
1534 Vale Ave. Campbell, CA
FINAL INSPECTION AND ACCEPTANCE
Dear Ronald:
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,
Syed Wahidi
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
PUBLIC WORKS DEPARTMENT
CLEARANCE FOR FINAL INSPECTION
AND ACCEPTANCE LETTER
Encroachment Permit#: ENC2018-00127
Name: Ronald Wheelehan
Property Address: 1534 Vale Ave.
Date.of Final Inspection: 8/14/19
On File: Bonds CD Cash
Faithful Performance: $
Labor and Material: $
Construction Cash Deposit to be released: $
Ot overdue deposits to b ,released (Description):
All deposits returned
Processed by:
Adm nistra r f
Reviewed by: ri I I
Inspector l
Reviewed by:
Land Development Engineer
JA1JoAnna'RDeposit reftmds\CHECKLISTS\Vale 1534 final.doc(Rev. 10/11)
Y
Encroachment Permit Final Sign Off
Encroachment Permit# 10C
Address:
Date of Final Inspection and Acceptance: J��19
Inspected by: S�
OK to release deposits: 100% 75%
Comments:
v
r ,
•U�ICHARO
CITY of CAMPBELL
Public Works Department
August 29, 2018
Ronald Wheelehan
1534 Vale Ave.
Campbell, CA 95008
SUBJECT: PERMIT NO. ENC 2018-00127
1534 Vale Ave., Campbell, CA
FINAL INSPECTION AND ACCEPTANCE
Dear Ronald:
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 August-9, 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 Performance Deposit in the.amount of$500.00 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 ENC2018-00127
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. 10015096 CHECK NO. 269512 '�__
AtC0llnt Pi�rchase<Order . ::.:Invoice Number: .. . Amount...::: Descr non....
101 2203 CR082018 ^500.00 1534 VALE AVE FPS RFN
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10015096 RONALD WHEELEHAN
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I '� 42d MONTGOMERY STREET 1210 - 0 8/2 7 18 2 6 9,512
4 70 NOEtTH.FIRST STREET
FRANCISCO CA 94104
L t" GAMPBEL� ,CALIFORNIA 95008
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*See Reverse Side For Easy Opening instructions*
CITY OF CAMPBELL
J70 NORTH .FIRST-
_STREET
CAMPBELL, CALIFORNIA 95008
i
RONALD WHEELEHAN
1534 VALE AVE
CAMPBELL CA 95008
OF • C,
A,
i; r .
Ok CHAX�•
CITY OF CAMPS EL L
Public Works Department
August 29, 2018
Ronald Wheelehan
1534 Vale Ave. .
Campbell, CA 95008
SUBJECT: PERMIT NO. ENC 2018-00127
1534 Vale Ave., Campbell, CA
FINAL INSPECTION AND ACCEPTANCE
Dear Ronald:
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 August 9, 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 Performance Deposit in the amount of$500.00 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 ENC2018-00127
70 North First Street • Campbell, California 95008-1436 TEL 408.866.2150 FAX 408.376.0958 •TDD 408.866.2790
Refundable Deposit 'Check Request
To:, Finance Director - �•
Check Payable To:' Ronald Wheelehan
Address-Line'1: 104 Vale Ave. _
Line 2:
City: Campbell State: CA Zip: 95008
_
Description: 1534 Vale Ave.
Account Number: 101.2203 Amount: $500.00 _
Account Number: 101.2203 Amount:
Account Number: 1.01.540.7448 -Amount:-
i
(Finance-Dept only) Interest Earned (Finance Dept only)
Total Payable: (Exact Amount)
Purpose:
FPS Deposit Refund
Permit#': ENC2018-00127
Receipt#: 275403 Date: - 5/2W2018
Receipt#; Date:
Reque"sted by: Title: Inspector Date: 71s�
Syed Wa'hidi
Approved,by: �G Title': Sr. Engineer _ date:
Roger Storz
Finance Dept Only:
Verified by: Title: Accounting Clerk 11 Date:
Approved by: Title: Accountant Date:
S ecial Instructions For. Handti�n Check
I _ -interim lneCK7M811AS m
Needed By:
Return To: I JoAnna Thomason Public Works .
(Name) (Department) =
Other: Please-return check to JoAnna
v ,
CITY OF CAMPBELL
PUBLIC WORKS DEPARTMENT
CLEARANCE FOR FINAL INSPECTION
AND ACCEPTANCE LETTER
Encroachment Permit#: ENC2018-00127
Name: Ronald Wheelehan
Property Address: 1534 Vale Ave.
Date of Final Inspection:
On File: Bonds CD Cash
Faithful Performance: $ 500.00
Labor and Material: $
Construction Cash Deposit to be released: $
Other overdue deposits to be released (Description):
Processed by: f u
Administra or
Reviewed by: 5�
Inspector / 1
Reviewed by: &-5. � `S
Land Development Engineer
JAJoAnnaT\Depositrefunds\CHECKLISTS\Vale 1534.doc(Rev. 10/11)
Encroachment Permit Final Sign Off
Encroachment Permit# L-N( 22 1 , GU 12t�-
Address:
Date of Final Inspection and Acceptance: 8�� r L
Inspected by: Jw
OK to release deposits: 100% 75%
Comments:
_ ,Pr=mtForm
CITY OF CAMPBELL R-1 ENCROACHMENT PERMIT Permit No. L-Nc �2-1P,-oG i2-7
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 2 l
Campbell,CA 95008 Z q Application
Expiration)1
Ph.(408)866-2150 ISSUED: I UDate
Fx.(408)376-0958 Permit Expiration Date: Z APN 5040
APPLICATION-Application is hereby made for a Public Works Permit in accordance with Campbell Municipal.Code,Section 11.04.
(Application expires in 6 months if the permit is not issued.)
A. Work Address:
B. Nature of Work: N i._(J
C. Attach three(3)copies of a drawing showing the location,extent and d ensions 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.
j NAME OF APPLICANT: 0���.(� � • Telephone: l�y (�� ?.(_ 2 Z
Address: �j Y
r E-Mail Address: "G 14141\) & O-M/ -f L : L 0 1.�1
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 infor
CCEPTED:
(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. 4-" ovr
3.
STANDARD AMOUNT REC IPTb"0
SECURITY FOR FAITHFUL PERFORMANCE (100%Of Engr's Est.) $ 5oG [[75
R-1 PERMIT FEE $ r� -
APPROVED FOR ISSUANCE: 512 �}
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 ofiany 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 understand all of the above
conditions.
Eu 6 0�,J� 4Z
4 Applicant Date
J:\FORMS\Templates\Encroachment Permits\R-1 Encroachment Permit STATIC form2.pdf
Rev.02/14
PUBLIC WORKS DEPARTMENT LAND DEVELOPMENT
Effective July 1,2017
TO: Finance PUBLIC WORKS FILE NO.
PROPERTY ADDRESS Vlkl�- A V9-
Please collect&receipt for the following monies:
AMOUNTS.
DE-VEL--OP 4722 1 Encroachment Permit Application Fee
I Non-Utility,Encroachment Permit Mamor�:$10,000 $425.00
Minor Encroachment Permit<sio,000 $240.00
Initial R-1 Permit NIC
Subsequent R-1 Permits within Two Year Period $240.00
Inspection Fee Minimum Charge per Location $420.00
Street'Tree Planting/Removal - NIC
2203 ($500 per Tree Planting Deposit Required) $500.00/tree
22031 Plan Check Deposit 2%of Engineer's Estimate $500.00 min
Utility and R-1 Permits no deposit required
47221 Grading&Drainage Plan Review
Single Family Lot $295.00
Site<10,000 s.f. $885.00
Site a 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 Sq. Ft to I 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 Enqr. Est. <$250,000 .14%of Engineer's Estimate
4722 Enpr. Est. >_$250,000 and 5$500,000 $35,000.00+8%of Engineers Estimate
4722 Enqr. Est. >$500,000 $55,000.00+7%of Engineers Estimate
2203 Emergency Cash Deposit 4%of Enqr. Est.*($500 min/$1 0,000 Max)
2203 Faithful Performance Security(FPS) 100%of ENGR.EST.*
2203 Labor and Materials SecuritV 100%of ENGR. EST.*
4721 Storm Drainage Area Fee Per Acre R-1 $2,120.00
(Multi-Res$2,385.00)
1 (All Other$2,650.00)
47221 Parcel Map(4 Lots or Less) $4,200.00+$90/lot
47221 Final Tract Map(5 or More Lots) $5,115.00+$1241lot
22031 Monumentation Securitv 100%of City's Monumentation Estimate
e.
49201 Parkland Dedication F e,(75%/25%Due Upon Cert. of Occupancy)
-47221 Lot Line Adjustment(includes Certificate of Compliance) $1,990.00
472*4722 Vacation of Public Streets& Easements $2,700.00
4722 Certificate of Compliance $1,970.00
4722 Certificate,of Correction $590.00
47�2 Document Recording Fees $15.00/first page$3 ea.Additional
2 Private Improvement in Public ROW $100.00
4722 Approved Plan Revision Fee $1 00/sheet
4722 Appeal Filing Fee $200.00
730.4924 Notice of Improvement Obligation Payment
. 4722----As-sessment Segregation or Reapportionment
First Split $940.00
Each Additional Lot $295.00
511.7424 Postage
Other(Please bpecity)
I ngineer's Estimate shall be as approved by the City Engineer and shall include all items of work. TOTAL $
1AMEOFAPPLICANT 1-diakc-0 DAME
OF PAYOR w4t�-:6i-e f4AW
PH YOB{ 12- Z--
DDRESS 04pneeeLL ZIP.VA 11)
'EIVED
FOR EC
CITY CLERK
4
ONLY DAW,
AAA insurance Homeowners Policy Declarations
underwritten by CSAA Insurance Exchange
Orinsurance PO Box 22221 Oakland, CA 94623-2221 (800)922-8228
Renewal
For questions or changes call: (800) 922-8228
Named Insured and Mailing Address Policy Number: CAH3-105029123
{IIIIIIIIIII"I'II{IIII'111'111i11111'11'fll'I'llllllllllll'lllll Membership Number: 429005-74449299-14
` RONALD WHEELEHAN i 12:01 A.M. Standard Time,
DONNA M WHEELEHAN i but not prior to the time
1534 VALE AVE Your From: 'applied for or, if this is a
CAMPBELL,CA 95008-6413 Policy; 11/20/2017 ;replacement Declarations,
not prior to the time coverage
Period
chan a was requested.
To: ? 12:01 A.M. Standard Time.
11/20/2018
Agency Information
HOUSE AGENT LOS GATOS Notice Date: 10/03/2017
15450 LOS GATOS BLVD Home Phone#: (408)374-1221
STE-300--_
LOS GATOS, CA 95032 Businessl'hone#: (831)-207=9499 "-
Named Insured(s)
Insured Location RONALD WHEELEHAN
1534 VALE AVE DONNA M WHEELEHAN
CAMPBELL, CA 96008
PROVIDENT CREDIT
Description of Property Premium to be paid by: UNION, ISAOA
' YR Built : Construction Type :Occupancy #of Fairiily_Units-
1954 Frame Owner Occupied 1-Single Family
Coverages and Limits of Insurance: Insurance is provided for the following coverages only when a limit is shown. The limit of
liability,for this structure (Coverage A—Dwelling) is based on an estimate of the cost to rebuild your home, including an
approximate cost for labor and materials in your area, and specific Information that you have provided about your home.
Section t Section II .
. .A B C D E. F. ,
-Dwelling Other Personal Loss of Use Personal Liability Medical Payments to Others
Structures Property Each Occurrence Each Person Each Accident
$459,000 $45,900 $344,300 $183,700 $300,000 $1,000 $25,000
Section I Only:Your Section I Coverage Limits have been changed to reflect changes in Construction costs and other matters
affecting replacement costs.
rDedUefible=Secfion,l
$1,000 (In case of loss under Section I,we cover only that part of the loss over the deductible)
This policy does not provide Earthquake Insurance.
This policy does not provide Flood Insurance.
Forms and Endorsements
.'Form Number Forms-and Endorsements Made,Part of this Policy Premium:
612000 CA 10012010 (CA 7/2015) Homeowners Policy Special Form Included
438BFUNS Lenders Loss Payable Included
HO-28 01 05 Limited Home Replacement Cost Included
HO-60 10 86 $1,000 Deductible -$238.00
HO-90 10 86 Workers' Compensation and Employers' Liability Insurance Included
HO-29 08 05 Replacement Value-Personal Property $238.00
HO-48 04 84 Other Structures (Section 1) $60.00
Basic Policy Premium: $802.00
Endorsements Premium: $64.00
Seismic Safety Fee: $0.15
Total Policy Premium: $866.16
1075 09012015 Page 1 of 2
Discounts information
Discount,Applied° Saving
AAA Membership Discount $41.00
Multi-policy Discount $101.00
Protective Devices Discount $79.00
Discounts applied to your account may be removed if you become ineligible for the discount. Total Discount Savings
Removal of the discount may occur at renewal or at midterm. $221.00
Other interests
Name and Address Loan Number
1. Mortgagee/Lender
PROVIDENT CREDIT UNION, ISAOA 1608007089
303 TWIN DOLPHIN DRIVEREDWOOD CITY, CA 94065
1075 09012015 Page 2 of 2