88-274
. .
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CUpbell, _ .100.
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-
TO: City Clerk
PUBLIC WORKS FILE NO,
,yY- J 7;/
Please collect & receipt
for the following monies:
Depos i t
R-l :
($'35)
pro j e c t )
Pe/w1-U: eM:
Plan Check & Inspection Fee
Other Cash Deposit
~C) d -
3373 Project
3373 General
3372 Tentative Parcel Map Filing Fee ($350)
3372 Final Parcel Map Fil in Fee ($300)
3372 Tentative Tract Map Fil ing Fee $ 00
3372 Final Tract Ma Fil in Fee ($350)
3372 Lot Line Ad.ustment Fee/Certificate of Compl iance
3372 Vacation of Publ ic Streets and Easements
3372 Assessment Segregation or Reapportionment
First Spl it ($500)
Each Additional Lot ($150)
3372 Env i ronmenta I Assessment:'
Categorical Exemption
Ne ative Declaration
3370 Storm Drainage Area Fee per Acre Multi-Res"
$2,060; all other, $2,250)
3395 Park Dedication In-lieu Fee per Unit ($1,132)
3380 Public Works Special Projects
3510 Postage
TOTAL
2) <;; S-S. era
L ;
$ 3'7-=,,;-?
NAME
/' /) /i
/^\ ~L L/\/; /.-.; / r?., ,(. /v
.
PHONE
) .-7 :..:>
) / Y _ ;; /--', .~
ADDRESS
')c( 2. L r/",;,c-;iDt
/) r2. /} ? A
.
':,,,.1/0"/\/1/.-(, ZIP
'/ '-/ G ,f' C
DATE
July, 1987
FOR
C I TV CLERK
QliL. Y
RECE I PT
~ PAID
RECE J VED BY
~:tttttJt
. ttttttt****tt***t*****t*********tt***t
CITY OF CAMP8ELL
ttt******t****************t******tt*t*
c.'1ilC"1~
'::.3
0(10(1
1212
12-0?-8::
11: 5:::: 57
Et.K;F :~.: SUBD It..! F I L I t.K
~CCT: 001.307.3372 RECEIpT# 001819
AM~ 50.00
8:::-2'7.~~
,.
REFUNDABLE DEPOSIT~
~CCT' 001,308.3521 RECEIPT# 001820
AMT 50000
1-11-' '-1~.1
':":-,::" '!
REFUNDABLE OEPOSITE
ACCT: 001.3083521 RECEIPT# 001821
AMT 1,500.00
88-27i
SALE MAPS/PU8LICATN~
ACCT: 001.307 3373 R~CEIPT# 001822
AMi 105.00
8::;-27~1
REFUNDABLE DEPOSIT~
~CCT: 001308.3521 RECEIPT# 001823
AMT 500.00
!-I':' _ .:. '7 ,01
1~1_. .:...1 I..!
'~
2,655.013
TOTAL
At'1CIUiH TEt-lDEPED
CHECK: 11-24/572
~2 .' 655 . (10
::HA~'~GE :
.00
;:::'A'lOp:
SAPPY t-1 I RK I r.'
--- THANK YOU VERY MUCH ---
WE APPRECIATE YOUP 8USlt-lESS
KEEP THIS RECEIPTi
tt***:t:*t:u::u::t:tttt:u:ttt:;::t:*t**t:t:t*****t:t
REFUNDABLE DEPOSIT
CHECK REQUEST
.TO ..... FINA~CE ,DIRECTOR
, '. I . CITY OF CAMPBELL
,,!;,:: r:"",:,'~~"~ J
542 Lakeside Dr., #2A
(30 spac~s)
(3Q spaces)'
".,Y,,-;
r~~As~is~ue chec~ pay~ble to:
?-;'t~~l":~i'T ~' 'i) ",,",;".:>:< "", " , :'," -', ;,' \
J\~?:ress :' Line 1:
Line 2:
Barry Mirkin
City :
Sunnyvale
(20 spaces)
(30. spac~~)
, ,.:,," ,~~
State; CA Zip: 94086
(2). '.. (10 ~P~9e,~,~
~24 spaces)
~ I
Cash Deposit Refund
E~actAmount Payable:
.,:......#'.;;.'.: ,:' "', ,,';
,...., .
$2,125.00
~CCOl.lnt Number:
001.00.905.0000.4662
,rU~~9~~: Relea~e of $500.00 Plan Check Deposit, receipt #;1.820 dated 12/12/88;
$500.00 Cash Deposit, receipt #1822 dated 12/12/88; and $1,125 (75%) of. i'
",
Faithful Performance Bond, receipt #1821 dated 12/12/88 (25% retained fOlj: ~.:j ,
!
} ,
,
the 1 ye9-rMaintenance Bond). Excavation Permit #88-274.
I .
,Request~(1 ~regg Eato
. '~~~ro;e4~lU ~n Wimberly
Verifieq br:
. ct. I',. .,:
P.W. Director
. . .
Date: 12/~2i8e"
Date: 12~:88
" "'.ii "'"
Title: P. W. Inspector
ccounts lieceiv~bl~
Dat~:
as is
xx
Mail ip attached envelope
,SPECIAL INSTRUCTIONS FOR HANDLING CHECK:
,- '\ .\ /
Return to:
(Department)
(Name)
~, ','"
;. ,
(
08/24/88
PUBLIC WORKS INSPECTION REPORT
Date '~~Zfi8 Permit or Project No. 88 -Z74-
Address /IA:':J N'- ~/(., n:;,..;J
~pe of work: Street Storm SanitAry Electrical
Other (describe) ~C'~,,?./7 ~~
[JPRELIMINARY INSPECTION WITH DEFICIENCY LIST (attached)
[) FINAL INSPECTION
~ INSPECTION
Signed plans'? .
WITH DEFICIENCY LIST (attached)
- ACCEPT~
Y ~ (If signed, Council acceptance.)
ChArges against deposit? Y
Overtime I hrs. @ $
Date 5 reAson:
(i)
/hr.
-
$
Barricade rental (attach invoice)?
DAte 5 reason:
Y
cD
$
Other?
$
$
Total chArges deducted from deposit:
(Cash Deposit $ less charges $
$
- Refund $
ck. req.)
[JONE YEAR MAINTENANCE WITH DEFICIENCY LIST (attached)
o ONE YEAR MAINTENANCE - ACCEPTANCE
(ReleAse'maintenance bond. Check Request if CAsh.)
Engineer
~
Inspector
r
CITY OF CAMPBELL
70 NORTH FIRST STREET
CAMPBELL, CALIFORNIA 95008
(408) 866-2100
Department:
Public Works
December 22, 1988
Mr. Barry Mirkin
542 Lakeside Dr., #2A
Sunnyvale, CA 94086
RE: Final Inspection and Acceptance
Permit No.: 88-274
Location: 100 W_ Hamilton
Maintenance Bond Amount: $375.00
We have made a final inspection of subject Public Works construction and
find it acceptable and in conformance with City standards. Accordingly,
the work is hereby accepted subject to the one-year maintenance
requirement indicated below.
You are responsible for the maintenance, repair and/or replacement of all
work done should any failures occur within one year of this date. To
guarantee this, you must either post a maintenance bond in the amount
indicated above, or maintain your existing faithful performance bond. If
you post a separate maintenance bond, your current bond will be released
by separate action.
We will inspect the work in one year and advise you whether or not
maintenance is needed.
Please feel free to call me if you have any questions.
Sincerely,
Gregg Eaton
Public Works Inspector
GE/sd
cc: Suspense - 1 year
P.S. Your cash deposit refund will follow under separate cover.
CITY OF CAlCPItu., CITY INCll1EEl'S COMSnUCTllltl COST ISTIKAn
Addr... 10 0 w. H ct ......, I +-0 "'\.
Sur~.e. Ca~.tTU~~tDn
IClu.r111& . Grub))ill&
laveut Cemereta
Cemereta a..oval
Cuz'b . Qu~~er ".oval
111lo~ Draill rith 'ip.
CUr)) . Qu~ur
.idewalk
Dri_,. Appl'Oach
llaD4icap aa.p
latnllle. Cuz'b
"nicade
'UNt "caYaUOtl
At '_t
AIIJun 1Ialh01e t;o OI'.de
Adj\l8t IIaNIhola CO Gl'ade
-'-lIt loll .~nt
'UHt %1'.. (1S...11on)
.~ 'ul,lll& (1100 aiD)
'_nt J.a.m4a (1100 alII)
'top, .ueat __ or Other 111T'
'__"t Raritan
'_t ICe,. CUt
I.-p S_ Inia8ta
'1...4-
\~~
\L.
-
\ L-
-
-
-
I
IJ"
IF'
Ut
. ".00
3.00
S.OO
lA' 600.00
U,
IF'
SF'
14.00
..00
S.SO
'and t No.
))y_deU i).. - '-8.9
- ,
- I
q", -
~. C\.q -
~-
14 , 400.00
u, '.50
- .
- .
- .
- .
- 1
I ,,~ -
- 1
_ 14 ~u -
- .
U 'SO.OO _ ,
IF)aCIO.I0)a'---) - .
11).CIO.30).,---) - .
14' 37S.OO - .
14' 271.00
lA' 600.00
lA' JOG.OO
U , 0.65
IA , 40.00
IA, 120.00
IA , 15.00
U,
10.00
- 1
- .
.
-I\~-
- .
- ,
- .
- ,
- .
- .
Ilarfac. '.total -I. _ ,\-""2 -c...~-
"'l..o.~-
Adj_t f_ .1&.: -'-<$30,000 .... 20\, .'.>1100,000 _uact lOt (+ or .) I .....
.n-..t: u."'~t".
Docaollar
c-dult
Conductor, 11&11'
Nl loll
.~8~ I)r.affta..
12- _ 15. &CP
11. or 21- &CP
.enot 1II1.t
1IIIIIbo1e
kNIt . lataI' .....1.
nn..' 6/11
~/_-_.t-_.t
.., 2,000.00
u , 10.00
u. 2.00
.. , 200.00
u,
u,
60.00
70.00
14' 1,600.00
.., 2,400.00
14 , 6SO.00
- .
- .
- .
- .
- .
- .
- .
- .
- .
- .
- .
t'O'W. ImMft . l 4-G:, ~ -
wn DIGID I \ ~OO
CITY OF CAMPBEll
Permit No.
Applicant
.
INFORMATION SHEET FOR ENCROACHMENT PERMITS
A separate form must be completed for the applicant and each contractor
that will work under this permit.
WORKERS' COMPENSATION INSURANCE INFORMATION
Name of contractor/Applicant~ a. "...... y U'-1 t ...k t ~
One of the following must be on file with the Public Works Department:
A Certificate of Consent to Self-insure issued by
the Director of Industrial Relations; QR
A Certificate of Workers' Compensation Insurance
Insurance Co.
Policy No. Expiration date
. OR
,-
)< This Certificate of Exemption from the Workers' Compensation
laws printed below (certificate must be signed).
CERTIFICATE OF EXEMPTION
I certify that in the performance of the work for this permit, I
shall not employ any person in any manner so as to become subject
to the Workers' Compen ion Laws of California.
Date I,).. - 9 -8B
If, after signing this Certificate
of Exemption, you should become subject to the Workers' Compensation
provision of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
. .
........................ ............ .......................................
CONTRACTORS INFORMATION
Note that all contractors must have current City of Campbell Business
License, State Contractor's License and Workers' Compensation Insurance.
Name of Contractor
Address
Telephone
State Contractor License No.
City Business License No.
Expiration Date
Will do the following types of work:
underground
P.C. concrete _____A.C. paving
electrical
other (specify)
f:PERKINFO
REV. 8/88
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND,
EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Teifeld & Company
255 W. Julian
San Jose, Ca.95110 c;
COMPANIES AFFORDING COVERAGE
COMPANY A
LETTER
Unigard
INSURED
COMPANY B
LETTER
Abron & Barbara Bogomilsky and
Bernard & Rosemarie Mirkin
COMPANY C
LETTER
COMPANY D
LETTER
THIS IS TO CERTIFY THAT 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 CONDI.
TIONS OF SUCH POLICIES.
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
O^TE (MMiDONYi
POLICY EXPIRATION
OA TE (MMiOOIYY\
GL804861
2/8/88
2/8/89
:;E~IERAL AGGREGATE
?'100UCTS-COMPiOPS AGGREGATE
?ERSONAL & AOVERTISING INJURY
EACH OCCURRENCE
'iRE DAMAGE (ANY ONE fiRE)
(.\EDiCAL EXPENSE (ANY ONE PERSON)
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE 0 OCCURRENCE
OWNERS & CONTRACTORS PROTECTIVE
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON.OWNED AUTOS
GARAGE LIABILITY
CSL
$
BODILY
INJURY
(PER PERSON) $
BODILY
INJURY
tcEC~DENT) $
EACH
OCCURRENCE
OTHER THAN UMBRELLA FORM
WORKERS' COMPENSATION
AND
EMPLOYERS' LIABILITY
$
$
$
(DISEASE-POLICY LIMIT)
(DISEASE-EACH EMPLOYEE)
OTHER
*as respents:
100 W. Hamilton
Cam bell Ca
DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/RESTRICTIONS/SPECIAL ITEMS Additional Insured :
Cit:y of Caml?bell & its respective officers, agents & eml?loyees are named as
addltional lnsureds from & against any claims,loss liabllity,coet or ex~ense
arising our of/or in,any way connected with t~e construc~ion_o~ the pro]ect.T
City of Campbell
Campbell, Ca.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EX-
PIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL 3 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LI ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
A ,HORIZE R RESENTAT