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CI'1'Y OF CAMPBELL
DEPl'. OF PUBLIC WOlP'~
70 Harth Fi~t St.
ca.pball, CA '500l
(408) 866-2150
Permit No. q 1- I 2..::t-
ENCROACHMENT PERMIT
(for workinq in the
public rigbt-of-way)
--"] l - {
Issued 1/ -. ?- f }
Permit expiru in 2 IIOS.
X-Ret. file
Application Date 3> - '?" - 9 1
Application expir.. in , 110..
APPLICATION - Application 18 bereby ..de for a Public Wora Permit in accordance with C8JIpbell
Municipal Code, Section 11.04. (Application expire. in 6 IIOntba if peJ:1lit not pulled)
Work addru. or tract . 3:.J.. 5/ -.3 7- H S. ~ '.cC',m A\{c:> '
utility trench location
If.ture of work: (',.."n')fr'u.c+-\c,(\ ~ Y\e iJV hl~IJllll.j -!V\s+ctIINf(or\ cJ; Lct->l;fle:-,
Attach five (5) copies of a dravinq .bowinq the location, extent and dben.iona of the work
The dravinq ahall abow the relation ot the proposed work to ex18ting .urtace and underqround
iJlprov-..nts. When approved by the City Enqineer, .aid draving becoaaa a part ot th18 permit.
'!'be a.nerel COnelitiona for all permits are listed on the reveree dele. Special Providona tor
thi. permit are listed below. Failure to abide by the.e conditiona and provi.ion. ..y re.ult
in job abut-down and/or torteiture ot F.ithtul Pertormance Banda and casb depodts. (See
a.neraJ. COncli tiona 1 and 2).
E. An application tee IlU8t accoapany th18 application. Th18 is non-retundable.
- N... at Applicant ...Tr.>h (\ ~. OH-c-J :r:-V\ C' . Telephone: 91 b - <'\<t 1-t:E<10
Addru. I ~ / g. So con d S. f-;rp crt ,r (:)"Br)~ 2&1') f s: ct c r c.f\,Q V\.-t:() I C A. q.5 f 12...
Is this work being elone by the property owner at their own resiclence? ~_ _no
A.
B.
c.
D.
CoIDplete and attach Workere' Coapensation and contractor Intormation toras.
The Applicant/Permittee hereby agre_ by attixinq their .iqnatun to th18-permit to bold the City
at
ca.pbell, ita otficere, agents anel employee. tree, .ate and barmle.. f~ any claim or elemand for
claJIaq_ resulting from the work covered by this permit.
'l'be Applicant/Permittee bereby acknowledqe. that they have read and underetand both the tront and
back ot thi. permit, and that they will intOl'lll their contz:a~(s) of the intormation.
ACCEPTED DOJ'lJA-I-.O /I1A-rr/J.~t7t.Yf----'[)~M iIi.~~ ~-f<-?/
Applicant (Permitt_) print/81qn Date
NOTES: ALL WORK SBAI.L CONFORM WI'1'B THE ATTAaIED, APPROVED PLANS AND ALL APPLICABLE CAMPBELL
STANDARD DRAWIHGS AND COHDI'nONS.
THE CONTRACTOR HOST RAVE 'l'IaS PERHI'1' AND APPROVED PLANS AND HOST MEET WI'l'B THE P.W. INSPECTOR ON
THE SITE AT LEAS'1' 'tWO DAYS BU'ORE S'tAR'1'IHG WORlt.
NOTICE HOST BE GIVER '1'0 POBLIC WORD AT LEAST 24 HOORS BEFORE RU'l'ARTING AllY WORK.
SPECTAL PROVISrOHS
_1.
street aball not be open cut for underqround installation.. Hini1lwl cuts ..y be allowed
for connectiona or exploration bola. Such cuts IllUst be IIDecificallv aDDroved bv the
Intn).C'tar.
pav_ent ..y be cut for unelerqround inatallationa and maR be rutored in accordance vith
the utility 'trench Rutoration Standard Draving.
Work to be staked by a licen.ed Land surveyor or civil Enqineer and two (2) copi.. ot the
cut abeets .ent to the Public Work Deptartment betore .tartinq work.
'!'be boure of work are la1ted to outsiele the boure at 7-' .... and 3-6 p... for any work
attectinq a traffic lane.
_2.
_3.
_4.
_5.
(R-l ,
STANDARD
D~PT NO..
AHOUIft'
PERMIT APPLICATION FD ($50.00)
PLAN alECK DZPOSI't
BOND lOR FAI'l'BFtJI. PZRFORMAHCE
CASH DEPOSI't ($200.00)
PLAN alECK , INSPECTION FD
$100,000 - $500,000 ", $50
APPROVED FOR rSSOANCE
$ 1<20 e<f,
c. $ SW) !ZR"-)
$;.;';:: 1...-0.,):-
$/.-+-.:3...;.(;>
i. i' "
r.. I.' /"'
I,LJL\Oc,(~,
0~6C.{) <1.
$100.00
$500.00
(loot OF ENG. 1ST.)
(4' OF BOND, $500 KIN)
($0 - $100,000 10"
e 7t: $100 KIN)
-, .,d, U-"'"
12 1(:'!->L)7 r'
$ ~,'7';:;', ;,.;.~
3tl I 75""
~ol 7(...
~, -,:Z7-~>
Date
(SEE anIER SIIE)
(
r
,
CITY Of
C,4iM1IJ]lfl[
70 NORTH FIRST STREET
C AMP BEL L, C ALl FOR N I A 9 5 0 0 8
(408) 866-2100
FAX # (408) 379-2572
FINAL NOTICE
Department: Public Works
November 5, 1993
John F. Otto, Inc.
Attn: Mr. Mike Fuse
P.O. Box 2858
Sacramento, CA 95812
SUBJECf: ONE YEAR WARRANTY, DEFICIENCIES
PERMIT NO. 91-127
LOCATION: 3751-3777 So. Bascom Avenue
SURETY: Reliance Insurance Company
BOND NO. B2170029
Dear Mr. Fuse:
As previously reported, we have made a one (1) year warranty inspection of subject public
works improvements and there are deficiencies that must be corrected before we can release
your warranty surety and obligations in this matter. A deficiency list is attached. If these
deficiencies are not corrected within 30 days, we will call on the surety to have this work
accomplished.
Please contact me at (408)866-2158 to coordinate the correction of these deficiencies. Upon
satisfactory completion of the corrective work, we will release your surety.
;;:ti~
Michael A. Fuller
Assistant Engineer
.l~
Attachment: Deficiency list
cc: Reliance Surety, Attn: Bond Department, P.O. Box 15901; Sacramento, CA 95852
Suspense - 30 days
File: Permit No. 91-127
I
I rlTY Of CAMPBEll
70 NORTH FIRST STREET
C AMP BEL L, C A L I FOR N I A 9 5 0 0 8
(408) 866-2100
FAX # (408) 379-2572
Department:
Public Works
August 2, 1993
Mr. Brian Furlong
John F. Otto, Inc,
P.O. Box 2858
1717 Second Street
Sacramento, CA 95812-2858
SUBJECT: One Year Maintenance Deficiencies
Permit No. 91-127
Location: 3751-3777 So. Bascom Avenue
Surety: Reliance Insurance Company
Account/Surety No. B2170029
Dear Sir:
We have made a one (1) year maintenance inspection of subject public works improvements.
There are deficiencies that must be corrected before we can release your bond and
obligations in this matter. A deficiency dated July 20, 1993, list is attached.
Please contact me at (408) 866-2150 to coordinate the correction of these deficiencies.
Upon satisfactory completion of the corrective work, we will release your bond.
Sincerely,
Cruz S. mez
Assistant Engineer
1JHimw
Attachment - Deficiency List
cc: Reliance Surety, A1TN: Bond Department, P.O. Box 15901, Sacramento, CA 95852
Suspense - 30 Days
File (91-127)
h:\91-127.ltr(MW)
ONE-YEAR MAINTENANCE INSPECTION - DEFICIENCIES
PERMIT NO. 91-127
3751-3777 SOUTH BASCOM
JOHN F. OTTO, INC.
JULY 20, 1993
1. Replace northerly dead tree (existing trees wilting due to lack of water).
2. Replace cracked sidewalk square just south of bus stop bench.
3. Paint/install street light pole numbers.
(Northerly pole number is 25460, southerly pole number is 25461)
H: \91-127.L TR(MW)
CITY OF CAMPBELL
BANK OF AMERICA
CAMFBELL OFFICE
125 E, CAMPBELL AVE.
CAMPBELL, CA. 95008
11-35
1210
No.
32448
70 NORTH FIRST STREET
C AMP BEL L . CALI FOR N I A 95 008
DATE
08/18/1992
CHECK NO.
32448
AMOUNT
$1,602.00
ONE THOUSAND SIX HUNDRED TWO AND 00/100 DOLLARS
SIGNATURE
PAY TO
THE
ORDER
OF
JOHN F. OTTO, INC.
1717 SECOND STREET
P.O. BOX 2858
SACRAMENTO CA 95812-2858
{ I , i : , : jl " i \ 'I I I '"I ,v,'' \ \ J I I' I I / ( .. . .' ..'. '. '
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(/II~~~ ~....- 'Jj#."\ I' " I,
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III 0 ~ 2 L. L. B III I:. 2 . 0 0 0 ~ 5 B I: 0 g . g ~ III B 0 20 0 III
VENDOR .033 JOHN F. OTTO, INC.
DETAIL PURCHASE ORDER #
08/18/1992 Check # 32448
INVOICE # DESCRIPTION AMOUNT
001.00.905.0000.4662
001.05.540.0000.4448
REFUNDABLE DEPOSIT
INTEREST EARNED
1,484.0<
118.0<
TOTAL
1,602.00
}J
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~ [V-, \Cl
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A L. G - 1 :3 - '9 2 T H U 1 1 : 1 8 J 0 H N F. 0 T Tal N C .
P.02
June 26, 1992
Department of Public Works
City of Campbell
70 North First Street
Campbell, CA 95008
Attention: Hank Imokawa
RE: PERMIT NO. 91-127 - MAINTENANCE BOND FOR WORK
COMPLETED AT 3777 s. BASCOM AVENUE
Per your request enclosed is a maintenance bond in the
amoutn of $9,275.
It has been a pleasure working with you and the City of
Campbell on this project. If you have any other concerns
regarding this project, do not hesitate to call.
Sincerely,
JOHN F. OTrO, INC.
By:
Brian Furlong
Estimator
BF:rs
Enclosure
John F. Otto. Inc.
PO Sox 2858
SOClomElr'\IO CA Q58~2.2858
(Q10) 441.01370
~AX .(016) .l.:l1.eI38
~Ic::.,.". ."8809
~
Al ~G-l 3-92
~/~
~/
"
THU
1 1 : 20
JOHN
F.
OTTO
INC.
P.04
I~.~~.t~:i:".. ...~~..: ~' '~'_
RELIANCE INSURANCt-: COMPl\.NY
..uo CF""IClE. ~HIlJt.OE,"~Io(IA. P€NNSY,"VAHI~
"
poweR OF A TiOANEY
KNOW &1.1. MEN ev r~eSE PFlESEN fS. r";1! /Pl. FilEl.l,lNCe lNSU!VoNCl; COMPANY, . <:OIOOtallon dUly ~r<l.1n'lGd IoIn".r me la.~ 01 ''''. S.."" ')1
P.,,,,,,,I";S"'d. 110." ",,'oCy '''M~., COf''''''''. ..tlCl Jooo.rll
JOSEPH H. WEBER of SACRAMENTO, CALIFORNIA
--------~..
.l.S IN. Ind lawf\ll ,lnorney.,n.F.;lCl. 10 ",111<0, GUClIle. ,.,QI .1t'1Cl Cleli....t tor .n<S on Its beI'\;alf. .."d as .Q aC1lnCl ClOOO
ANY AND ALL BONDS AND UNDERTAKINGS OF SURETYSHIP _______
and ID CIInd Itle REU"NCE INSUF!.ANCE COMPANY trloteCy u lully and 10 trle SAme extent u If SI.IC" bonds and undel1alci"ga and oltl... wnu"gs
OCn;al~ if' 11'10 ".'l.It. ltl.tOOf .OtO sl;noo by an E.wecuh. Offlcor of trlo RELJANCE INSU~NCE COMPANY and MaleCl ."d .fto:Ued by 0". oth.r
of I..,C" ClrnC.~ and ".,eby radnes and conl'lrm. allll'lal it:s sal(~ AltOln~sHn.FaC'l may do i" pl.!l'Suanco PlOC'eof.
,",18 Pow.r of Ano",.y 18 Ot.nted un~.r ."d I)y .utnotl~ of Al1lcle VI' of ~. ety.I.,a'tltS 0' REU"NCE INSURANCE COMPANY whle" ~m.
ef'Ioc:ll... SeplOmtler '. 1978. w"te" "ro...isions .,.. "OW In lull rote. and effect. readln~ as follows:
ARTICleE VII - EXECUTION OF BONDS AND UNDERTAKINGS
,_ The Board of DlteclorS. lI'l. President. lI'le Cr\aitm.an Olll'le BoarCl, any Sonier Vie. PrCDldOt1t, Iny Vice Presldon, Oft A:r.sls~nt Vice Proside'"
or oG'lOC' offlc.r doslgnalod.t1'1 tile eo.rd.ol Oltec10rt sl'lall "....0 power .nd authority to (., a"pOlnt "llOmeya-ln.F.C!. and to IUV'lOf1:fe ~.m 10 exoc:ulo
on C>e".'f 01 tho Company. bonds a,,('J Ul'ldOl'tAkln~.. roco;"'utlc... contrlcta Of Itleem.,lt'( an<l Otl'1.r wrlUno, obllg.to,., In, the natura theroof. a",d (b)
to remcMI anyauch A~orney.'n.F.clll .n)' limo and t~Oko trle power a~d .vd'loricy \IN." 10 him. .
a. Aftomoys.I",'.ct '''.Ill'l..... power .nd au1tloticy. lubloct 10 lie terma .nd IlmilD.llona of 'tle Pow... of anolTMl)' lasuod to tnom. to execute
atld doll.... on be,.." of .... Company. bot'l(lt and undermklnga. rOC:O;"'zanc.a. contraCIII Of lndomnl~ InG 0In0I' .-rillngl obllga1OtY In I'lo naTure hroof,
The ~te MI' la not nec:oSS4ty 'or tn. ....Udlt'( of atly bOndl and ufl<ll~klng, recognizances.. con1nlc:ta of Indemtllty and 0ltl8l' ,wrltl('lga ot>llgalory
In .,... nA!l.Ire thoreof. "
3.. AftOrn<<PyS-ln.Fad ahallPlav. pOwer ancl autl'lol'l"f ID exec&M Imdavltl reQuired II:) be .ftOe!\od ID ~ rocognl;zanc:os, ~~aea of Inclem.
nlcy or Oltler Condltlonl' or obll;alory u"denaklngo and ~ Ihall also PIa.... power Ind aull'lOl'lty.to eot1lfy #'Ie IIn."cl.r .\Glomont.Of tI'le Company .nd
ID copI8I of". ey.uwa of the Company or any .r1l~le ~ aoctlon "er&Of.
,",I, pow... Of anornO)' la slgnOCl .nCS ,Iealed b)' Iac:.almue, under an<l I)y au1l'lorlty of #'Ie followl,,; RQ30I~o" .do~lod by the ,Board of Dlr~ of
REUANCE INSURANCE COMPANY .t . mooUng held on lie ~Il <Say Of ..I..,n.. 1.979. .t whlCll . quoNm was presont, .tIe I8ICS Ro$Olutlc;w; h.. not tleen
ameroCled er r.pealed: .
. . ,
-ResoNed. thaI trle alonal\.lres of auCII dlrectOta and ofIIC4n III'd the IIOaI of tho Compatly "IllY be amXed to any SUCh pew....
of .ctom.., or III'Y certlllcate r"ltlnO lI'\"~o ~ facsimile. and any sUeIl pOw... of AlIofMy' Ot ~f1e.a.. bearing auc",
lacalmn. slgN",r.. or fecal mil. :IelII ahaI'I tie .....Id and t)lncllng upen tho ComC*'Y and any aud'I power eo ..~ and
certifled by facsimile a1gna",'", and "cs'ml~ Mal 3ha1l be ....11d and binding upon lie Compuiy In ~ Ml.lre 'WIth reIlpect
to any bond or undonaklng ID wflld'lllla auachec1'"
IN Wl'T'NESS WHEREOF, the REUANCE INSURANCE COa.4PANY l'IaI cauaed "... I)reMtltlIID C>e IigI'leCf by 111 Vk:e Prealden" .,..., Ita eotpOI'atll ....
to tie '** .fIIlled. thJ. 2 3 r dsay <If J u 1 y 1 III 9 a
REl/NK:.E INSURANCe COMPANY
~~~=-
va Preeident
STATEM Washington
COUNTY OF I< i ng
,23rd
On till
}-
July,
if.~
Q),
day of
',19 9~lty.ppeartJd
Lawrence W.
Carlstrom
, .
.10 me lcnown to be tho V1ce.Ptes/dont of 11'I. REUANce INSURANCE COMPANY, and
.InSIIUment and .!fIxed ~ soar of iald corpo(.~on thore1iCl. Ifl<I "'I Mcle VII. .Soe'lI '1, 2. a
tk)n" Nt Iot1t\ thoreln. ar. dllln full fotCll. . '
May lS
,1' 94
l""1ged hI !'Ie exocl.Md af)d ItIO$ted ~ foregOing.
<If I'le By.L.a~ of ..lei Cotnpany anc:I tI'le Reao/u.
My Commlaalon expires:
NoGlI)' PublIc In .nc1 for StIlle of
RosIdlng ~ Tacoma
.. Robert o. Ri tzhaupt . AMI.,.nt $ocr.1)' of Itle REUANCE INSURANCE COMP.ANV. do I\o,eb)' certify ..... tI'le .~
anc:Ilotegolng I. . 11'\.I. and ~orrt~et copy of . Pow... of "norney exoc:L/Ied by ul<l REUANCE INSURANCE COMPANY, wnlCl\ II _1\ In till fotce and
efI-=r. '
-...-.--- ...- .----- ..
.- -. --.- ____ ___.. _._ "I"\_\....
460..,
AlJG-13-92 THU 11:19 JOHN F. OTTO INC.
~~~..~~~ '~~(FAJlt""",.:lI'~:~- . ..,..~__......__"'.......-ail~
P.03
''''_~__''''--,-
-~
/~
MAINTENANCE BOND
Bond No. B2170029
Premium: $186.00/yr
RELIANOE INSURANOE COMPANY
MEAO OFFICE, FHII.AOEL.PI-I'A. FENNSVl..VANIA
KNOW ALL MEN BY THESE PRESENTS, that we John F. Otto, Inc.
as Principal. .and RELIANCE INSURANCE COMPANY, a Pennsylvania corporation, as Surety, are held and
firmly bound unto
CITY OF CAMPBELL, CA
as Obligee, in the full and just sum of Nine Thousand !Va Hundred Seventy-Five and OO/lOOths----
------------------------------------------------------ Dollars ($ 9,275.00---------------).
for the payment of which sum, well and truly to be made, we bind ourselves, our heirs, executors, administra.
tors, successors and assigns, jointly and severally, firmly by these presents.
WHEREAS, the said Principal entered into a contract with City of Campbell, CA
dated for Permit No. 91-127, Constructions of Certain Improvements
For Recovery Inn of Campbell, 3777 South Bascom, Campbell, CA
WHEREAS, said contracT provides that the Principal will furnish a bond conditioned to guarantee
for the period of One (1) year(s) after approval of the final estimate on said job, by the owner. against
all defects in workmanship and materials which may become apparent during said period, and
;1
1;(
L'.I\
~...
~.
,
WHEREAS, the said COntract has been completed, and was approved on f..!'S/'1Z.
NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH, that ifwithinOne(l~ear(s)
from the date of approval of the said contract, the work done under the terms of said contract shall disclose
poor workmanship in the execution of said work, and the carrying out of the terms of said contract, or it shall
appear that defective materials were furnished thereunder. then thi~ ohligRtjon llhall rem~in in fL1I1 force and
virtue, otherwise this instrument shall be void.
Signed and sealed th is
19th
day of
June
. 1992 .
Witness;
PrincIpal
1
RELIANCE INSURANCE COMPANY
By: .,J4?t- (c./~_
CITY OF CAMPBELL
70 NORTH FIRST STREET
CAMPBELL, CA. 95008
RELlANC"URANCE COMPANY
PHILADE~, PENNSYLVANIA
UNITED PAt.;IFIC INSURANCE COMPANY
FEDERAL WAY, WASHINGTON
PLANET INSURANCE COMPANY
FEDERAL WAY, WASHINGTON
CANCELLATION NOTIC.f.O. BOX 15901,SACRAMENTO, CA. 95852
~ERTIft e\! flV I! f/ll9 080 209
J U L 2 4 '992
flNANCE DEPT.
1
..
Reliance.
TO: Obligee!
Address:
RE: Principal!
Address:
JOHN F. OTTO, INC.
P.O. BOX 2858
SACRAMENTO, CA. 95812
it a; \.: a: ~ V liIi i..i
JUL 2 8 1992
Public Works/Enginoering
Bond No.:
B 183 07 47
B d7i ENCROACHMENT PERMIT BOND CONSTRUCTION WORK 3751-3777 S. BASCOM AVE.
on ype..
CAMPBELL, CA. NO. 91-127
Effective Date. 6-17-91
You are hereby notified the captioned bond is cancelled in accordance with the cancellation provisions
contained therein or in applicable laws or regulations. This notice is mailed to you on
7-22-92
and is to be effected on or about
~~-1~-92 or if such effective date does not provide for a sufficient number of days
notice, as required, then upon the earliest date permitted. The issuance of this Cancellation Notice
shall not, however, extend the effective date of cancellation if such bond has been cancelled upon an
earlier date under the provisions of said bond.
RELIANCE INSURANCE COMPANY shall not be responsible thereunder for any acts
or defaults committed or loss occurring after the effective date of cancellation, nor for any losses not
discovered in accordance with the provisions of such bond.
BY.
Surety-
RELIANCE
INSURANCE COMPANY
~ /?7. -&~~-r
KY. BUENAFE
Attorney-in.Fact
D'::: ICANCELLATION ACKNOWLEDGMENT (Please sign rPlicate ot this Notice and return to Surety)
CC: JOHN F. OTTO,INC., PICKETT-ROTHHOLZ & MURPHY
CITY OF CAMPBEll
PUBLIC WORKS ENCROACHMENT PERMIT/PROJECT
INSPECTION REPORT
DATE: "-/7 -92...
PERMIT/PROJECT NO.: 9/-127 TRACT NO.
ADDRESS: 3'75/-3777 S. BASCOM PrVb~
TYPE OF WORK: STREET: V STORM: Y""
SANITARY:
,,/
SIGNALS
LIGHTING:
SIGNING: V
STRIPING: / IRRIGATION: PLANTING: V
P.C.C. :~PAR.KWAY: OTHER:
PRELIMINARY INSPECTION WITH DEFICIENCY LIST:
(Date)
v
FINAL INSPECTION AND ACCEPTANCE:
0-/7 --92-
(Date)
SIGNED PLANS? YES
COUNCIL ACTION? YES
C E ACTION? YES
FILE NOC? YES
NO~
NO V'
NO v
NO~
NO~
PER HOUR - $
CHARGES AGAINST DEPOSIT? YES
OVERTIME:
HRS. @ $
EQUIPMENT RENTAL: TYPE;.
AMOUNT: $
DATE:
REASON:
TOTAL CHARGES:$
ONE YEAR MAINTENANCE WITH DEFICIENCY LIST
ONE YEAR MAINTENANCE ACCEPTANCE
/-I. IMOkA-UlA
INSPECTOR
G-/7-92
DATE
f:pw insp
9/91
REFUNDABLE DEPOSIT
CHECK REQUEST
TO: SANDY TERPKO
ACCOUNTS RECEIVABLE
Pl ease issue check payabl e to: John F. Otto, Inc.
Address:
Line 1: 1717 Second Street
Line 2: P.O. Box 2858
City :
Sacramento
State: ~ Zip: 95812-2858
Description: Ref Deposit/Permit No: 91-127
Exact Amount Payable: $1,484.00
INTEREST EARNED
LOCATION:
DATE AND NO. OF RECEIPT:
Account Number: 001.00.905.4662
3751 - 3777 S. Bascom Avenue
001.05.540.4448
3-11-91 #26264 6-24-91 #30175
PURPOSE:
Return of Cash Deposit
Requested by: H. Imokawa 14.J._ Title: P.W. Inspector Date: 6-17-92
Approved by~JJjA )~ Title: City Engineer Date: 8 /\3/""L
Joan Bollier " ' I.
Verified by: Title: Date:
SPECIAL INSTRUCTIONS FOR HANDLING CHECK:
Ma i1 as i s
Return to: Public Works
(Department)
Mail in attached envelope
Hank Imokawa
(Name)
Other:
Rev 11/21/91
(
"'11[;1 ~ Pl it 0/2 9 V
CITY OF CAMPBELL
70 NORTH FIRST STREET
C AMP BEL L, C A L I FOR N I A 9 5 0 0 8
(408) 866-2100
FAX # (408) 379-2572
Department:
Public Works
June 17, 1992
Mr. Brian Furlong
John F. otto, Inc.
P.O. Box 2858
1717 Second st.
Sacramento, CA 95812-2858
SUBJECT: FINAL INSPECTION AND ACCEPTANCE
PERMIT NO.: 91-127
LOCATION: 3751-3777 S. BASCOM AVENUE
BOND: RELIANCE INSURANCE COMPANY, BOND #B2170029
Dear Mr. Furlong:
We have made a final inspection of subject Public Works
construction and find it acceptable and in conformance with City
standards. Accordingly, we will recommend the acceptance of the
work to the City Engineer.
You are responsible for the maintenance, repair and/or replacement
of all work done should any failures occur within one (1) year of
this date.
We will inspect the work in one (1) year and advise you whether or
not maintenance is needed.
We have received your maintenance bond in the amount of $9,275.00
and hereby release your faithful performance bond. Enclosed is
your cash deposit of $1,484.00 plus interest.
Please feel free to call me if you have any questions.
Since~ely, ~
Hen~awa <~
Public Works Inspector
~~
cc: Mike Fuller
Maintenance Division
Bond Company
Suspense - 1 year
File (91-127)
J U!~ 1 ~
June 11, 1992
Henry Imokawa
Department of Public Works
City of Campbell
70 North First Street
Campbell. CA 95008
RE: PERMIT #91-127
Dear Henry Imokawa:
We hereby request that a final inspection be completed for the
offsite work performed at 3751-3777 S. Bascom Avenue.
The punch list has been completed except for the numbering of the
Lightoliers. We are still waiting for the numbers from your
cd.fLee_ Lcd. idlLCL tJm'.' 1,\ f... Ii: t,e,> ._:lr.e o( t];l.~, mLd..C'r.
he thank vou rot' ,.our c=J()j)erat,~oL in hanci.iin2 th:~s mar.tL'r.
:~~, 11 C: (' .T" C' 1
Jot!\ F. CITe, I\C..
PI \'
BFism
John F. Otto, Inc.
PO Box 2858
Sacramento. CA 958122858
(916) 441.6870
FAA #(916) 441-6138
License #178809
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CITY OF CAMPBEll
70 NORTH FIRST STREET
C AMP BEL L, C A L I FOR N I A 9 5 0 0 8
(408) 866-2100
FAX # (408) 379-2572
'N\MBERl~
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Department: Pub 1 ic Works
April 9, 1992
Mr. Donald Mattarolo
John F. otto, Inc.
1717 Second Street
P.o. Box 2858
Sacramento, CA 95812-2858
SUBJECT: PRELIMINARY INSPECTION - DEFICIENCIES
PERMIT NO. 91-127
LOCATION: 3751-3777 SOUTH BASCOM
Dear Mr. Mattarolo:
You have requested a final inspection on subject
construction work. There are deficiencies in the work
which are indicated on the enclosed list. These
deficiencies must be corrected in accordance with City
standards before we can make a final inspection or
acceptance of the work.
Upon completion of the corrective work, please submit a
written request for a final inspection and acceptance.
Sincerely,
Henry Imokawa
Public Works Inspector
HI/bg
Enclosure
cc: Frank Robles
Charles Gallardo
f:9l-127
CITY OF CA.l,tPBEll
PRELIMINARY INSPECTION-DEFICIENCIES
PERMIT NO. 91-127
3751-3777 SOUTH BASCOM
A. General
1. Submit certificates of compliance for street
lighting electrical conduits, standards,
luminaires, paint materials.
2. Supply reproducible as-built plans.
B. Specific Items Deficient
1. Install 40 mph sign on electrolier.
2. Change pavement markers on Bascom Avenue to Type C
3. Paint curb red at bus stop.
4. Install pole numbers on electrolier standards.
5. Install hold down lugs on No. 3-1/2 pull boxes.
6. Bond service run.
7. Bond standards inside hand hole cover.
8. Remove scotch lock fasteners and replace with
pressure type waterproof connectors.
9. Install 3-1/2 service box with ground rod adjacent
to PG&E box lid to be marked "Street Light
Service." Service box must be separate from
Campbell pull boxes.
10. Prior to final inspection clean all concrete and
pavement of all dirt and debris.
f:91-127
MR.. DOt-Jt:\L D MA -r TA RDLQ
J6t\NF OllD) IN.C
1"7 q Scc..Or-.iD S,. P.O. BOX. 2..858
.sAc..~AtJ\~"'fl") CPt. 9~81 Z. -2.858
S .; B..} t-C\'
PR.Gc..-t!1I}.J.f\R-Y iN,opec....nD"-' - C>&FtC,lcNGtiS..
PER..M II NO. <)j -,2. ~
~CCATI CAj: 3"7.51 - 3> 771 Sc. bA.SCt.M .
D~~ 1J\1?-. MA-IIAROLO :
You have requested a final inspection on subject construction
work. There are deficiencies in the work which are indicated on
the enclosed list. These deficiencies must be corrected in
accordance with City standards before I can make a final
inspection or acceptance of the work.
Upon completion of the corrective work, please submit a written
request for a final inspection and acceptance.
Sincerely,
Henry Imokawa
Public Works Inspector
HI:djr
Attachment
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John r. Otlo, Inc.
GENERAL COl\"TRACTOR
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Attn:S~1 Illlr:kworth-Alanzo
Ihh 4-2-92
In' ~3?~_. ~.572
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Ttt c.ncl~ ~ bcinl' lJu......rdC-t 110::':
IN,~ 11 [
Co%I'JLt[j~. Wp t.rnlllrl likp fin:!:!l inspection of Permit #91-127 at 37~1-
3777 S Bn::;coJl) Ave, Campbell, ,Ca. 95008.
CCo Brian Furlong JFO Inc.
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DVH MaLtarolo
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April 2, 1992
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Regarding: Light inspection at 3751 and 3771 B€r.~scom Ave.
(permit #91 ______~
================================- -=---~==========================
Charles Gallardo ~ve inspecte e streetlighting
installa' on So. Bascom Ave. Project # 91-121-:-~ Below is a
R ist for discrepancies which need to be corrected.
<:...0 K.Co € C:I Fe l-LC ....,.UI-iL) PI SC RtPf:\"-lU~~
1. Service run not bonded.
To: Hank Imokawa
From:
2. Poles not bonded . need to fasten bond wire inside handhole
,
cover.
c
3. S)(otchlock fasteners are to be removed and replaced with
pressure type waterproof connectors.
4. No service box and fuses.
Service box must contain splice
between PG&E conductors and streetlighting conductors and shall
be marked service. Service box must be separate from Campbell
pull boxes.
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PlEASE TRANSMIT TH.E FOll..OW1NG MESSAGE TO:
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FAX NUMBER: ?/G, 7"4//-- G /$ P
ATTENTlON: 81U~ .Fr"~)N~ I
THIS MESSAGE CONSISTS OF -&- PHOTOCOPlES AND THIS PAGE
SUBJECT: ~1/~1lJ /I-""J c,F /.-of C'1f71'}$
COMMENTS;
(j-) lJJt'" (;J/U T~ //.J.5.flff-{...//JV ~.~ 7")"-1#1 /Ci-.-&H../,JtE;[
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FROM;t ~~ t-It"Ge- coo. ~""'Z$!:JE~ Co
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ROSENDIN ElECTRIC, IIC. . VJ ~ ~ -.
LARRY P. HOUJS p.. f
8ENIOR PROJECT MANABER ~'f./V a.x..f/./~ or-
1N00000000DNlSION I ftaAL. PftOJEC1'S vJ N ~ [
0ff1C2 NUMBER (a)-..o-
OIGrrAL PAGER NUMBER (408) 194-1848
FAX NUMBEJl (408) 29S-eC23 '
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eeo N. Ma'buryat, San Jose. CA t5,
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'tel. (408) 286-~
Ma"~ AdcSreu; ,.0. ~" S&Il 'Ott. ~ ts1 50-5061
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(Date)
Name iV\t<... .D()N/~ GD MA.-rll')f<.OJ.,O
Company ~ if) H- !\l h (;j~,* ~ N G
Adddress "1 j 7 ,S6~') ? R O. 80)( 2fJ58
City, Zip SACf<.A MI--:IJ.{\.. CA l C)t.SfJJ2.-Z-fjcJ8
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SUBJECT: PRELIMINARY INSPECTION - DEFICIENCIES
PERMIT NO. 0; - 12.. 7
LOCATION: :r75"1 -377"7 ~. BAS(:flfJt
Dear M~. MJl.1TA R OLi) /,_\.,,)(7-'>
/
You have requested a final inspection ory!subject construction
work. There are deficiencies in the W:k which are indicated
the enclosed list. These deficiencies must be corrected in
accordance with city standards before can make a final
inspection or acceptance of the work.
on
Upon completion of the corrective work, please submit a written
request for a final inspection and acceptance.
sincerely,
Henry Imokawa
Public Works Inspector
HI:djr
Attachment
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S. iJJ,S/ftLL.. HoL.C:> DOWN '-v(7S oN jJO. 3 f p~ 80X6"$
G. BOND Se:r<-v(ct:: ~ LJ;J .
7. BoAJ..t> S.LI't-N DAR.-bs IN.S lOG ;.../fl-NPtl-ot-e UVS/:...,.
8# Re-MDue 6C. 07CH LDGi<. P/tS/ENt;;'7L5 I7ND let:-PLAC&- wITH
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MEMORANDUM
SUBJECT:
CITY OF CAMPBELL
K-C--- 70 NORTH J:IR~T ~TBEU._
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DATE:
..MESSAGE CW:= .f:::L~L5_1<2 I~j.an '1"-<"< ~ f ~')_'Z;:'---
r ~hd(ld-#. ~hc'P ~ j/Zt1U! ~cGe;Jl-d /k= IIL<::Q~_~~.
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, Project: ..p~Q...(-1 ~ ':) i -/2. 7 Job NoJq%3,OO2..~~
Subject: ~IELD CONSTRUCTION INSPECTION REPORT (NUCLEAR) Date: ':-;-1-:2.1. \tfi.-
From: ...:,'J.~ () To: ! U; ') From: To: Hours:
EquipmentinUse:,-v./.'..... Or.........--n J,\; fp\.~~~ L.:>~~I~?\M,~ept.NO:
UNSATISFACTORY CONDITIONS PREVIOUSLY REPORTED
(Give report date only. Circle dates of items corrected in this report
and explain below.)
REMARKS
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A.C. & H. CIVIL ENGINEERS, INC.
ASSOCIATION OF JOHN G. R. CLEGG & ALAN HUNTZINGER
2443 ASH STREET PALO ALTO. CALIF. 94306
(415) 327-3900 (408) 294-4000
J8num-y 21, 1992
Job 1'{ o. 88--36
Vr Don Vattarolo
0/0 Otto Construotion
3751 !. Basoom Ave
Campbell, CA ~008
RECiilViilD
JAN 24 1992
eublic Worb/Engineering
Ite r Dr i veways
At the request of the City of Campbell, the driveways were widened along the curb
line to 35 feet, 25 teet at property ltne. In Qrder to miss the exi9t1n~ T.V. and
Telephoae boxes near the south property line, it was required to relooate the
driftWay northwl!l1"d.. . .
The note on Sheet 0-2 to remove the t.V. and releph.ne boxe. was an errer. These
boxes ~~ to remain, and the driveway is to miss the boxes (just). Water meter,
existing sewer lateral, and existing drive to be removed.
It you have any questions, ~lease oall.
Sinoerely,
~n L-
Alan HuntaingerJ Y
C.1 vi 1 ing! neer
ores
'11-/)...1
MlXlRE @Speediset@ MCP@ Patented 407
1556
MEMORANDUM
TO:~~.
.
CITY OF CAMPBELL
70 NORTH FIRST STREET
CAMPBELL, CA 95008
(408) 866-2100
.---------. -..-----. SUBJECT: ~c..tLe'cy.._-:;;;!!Y1 -__.._..f.1_- /2.7
FRoM:_~_h.f:...._-.a.~___________ DATE: ~:::::~2__.________._.___._........
....
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Department: Public Works (~~
Signals & lighting
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March 16, 1992
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Mr Larry Hollis
Rosendin Electric Inc.
880 N. Mabury Road
San Jose Ca. 95133
Dear Larry Hollis:
The City of Campbell has done an inspection of the two street
lights on Bascom Ave. Project # 91-127. Below is a punch list of
the discrepancies that need to be corrected.
No service box and service fuses ( per City of Campbell
Standard Construction Details )
No Ground Rod
Poles not Bonded
Splices not made
No Fuse Holders and Fuses
Need to Grout Poles and Pull Boxes
Poles need to be touch up
If. you have any questions please contact me at (408) 364-2832
Sincerely,
Charles Gallardo
Signal & Lighting Technician
CC: Tony Rucker
Lynn Snyder
Hank Imokawa
Sal Duckworth
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PUBLIC \4~KS FILE NO..i / - /? 7-
~~.
TO: City Clerk
Please collect & receipt
for the following monies:
3372
3521
3521
3521
3372
3373
3373
3373
3373
3373
3372
3372
3372
3372
3372
3395
J)i 0
3380
3510
Protect Revenue. (sDeclty Drotect)
Public Works Excavation Permit Fees:
Application Fee
Plan Check Deposit
Faithful Performance (Cash) Deposit
Other:
($100)
($500)
(100% of)
(ENGR. EST)
(4% of FPB)
($500 min.)
R.1:
($50)
Other Cash Deposit (specify)
($200)
Plan Check & Inspection Fee ($0 - $100,000 10%;
$100,000 - $500,000 9%; $500,000 and above 7%; $100 min.)
Project Plans & Specifications ($10)
General Conditions, Standard Provisions & Details ($10 or $1/page)
"No Parking" Signs ($1/ea. or $251100)
Work Area Traffic Control Handbook ($5)
Copies of Engineering Maps & Plans ($.50/sq.ft.)
Final Parcel Map Filing Fee ($450 + $20 per lot)
Final Tract Map Filing Fee ($500 + $20 per lot)
Lot Line Adjustment Fee/Certificate of Compliance ($400)
Vacation of Public Streets and Easements ($500)
Assessment Segregation or Reapportionment
First Split ($500)
Each Additional Lot ($150)
Park Dedication In-lieu Fee per Unit ($4,548)
Storr.\ Drai naqe ,;'rea ~;:e
Public Works Special Projects
Postage
TOTAL
$
~ , . c:- ,,-. \ I I i"'-'/I ) /1 /1 1 / 0. '1,."'"
NAME OF APPLICANT :'. en. '-, . (..5n.~. I --Lt,C.. PHONE,f. 'J "-\ - \ ' -V.) \ -..J '<~.'
;' "il ..... ,-.+ (0 r-.' " (:'t::::;. r:. -, J /' A q>:" S !? .
ADDRESS -r -7.f:' ... \r1 :, '- ., !. (_.1 r.::o~ 1-:-- .>. J:"( \:::'(:V. "(:} 11') <2/ \1::0,( H . -' \~Zfp'"
FOR
CITY CLERK
ONLY
RECEIVED BY
DATE
c: r c-~C ;::.
,3/ !' / C;, i
ISSUE DATE (MM/DDIYY)
,1
A.~..III."
.-
CERTIFICA Tt:. uF INSURANCE
.-.
PRODUCER
~acram~nto V~ll~y
( '-~ En 1. s /) r' 0 k ,,'r s
P J OX 1 57 ,; 2
jaCr2ffiento, C I~
J fL I..Ir"nc >~)
"I III 1
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
> ,
. .,
COMPANIES AFFORDING COVERAGE
COMPANY A
LETTER
rAi:r':l.=lf':d '.... ':..)J .lty
: INSURED
f~T~~NY B
I/: Dr y
nj ~: ;4 U .~~:11 t y
John r. C~~O, Inc.
? o. iox 21;),5
Sacram~nto LA
COMPANY C
LETTER
Maryland ualty
y'-::,: 1 ..
COMPANY D
LETTER
l:utL..c inCEITin2ty
f~T~~Y E
)COVERAGE5
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.
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION
DATE (MM/DDIYY) DATE (MMIDD/YY)
ALL LIMITS IN THOUSANDS
,\ GENERAL LIABILITY
,..
~ <, 1 1
I .'1'
.'11
I. 1;>'_'
I C I ''; 1 GENERAL AGGREGATE $
PRODUCTS.COMP/OPS AGGREGATE $
PERSONAL & ADVERTISING INJURY $
EACH OCCURRENCE $
FIRE DAMAGE (Anyone fire) $
MEDICAL EXPENSE (Anyone person) $
1 iJ C
10re
10JC
1 U()C
1
X COMMERCiAL GENERAL LIABILITY
CLAIMS MADE X OCCUR.
X OWNER'S & CONTRACTOR'S PROTo
"
AUTOMOBILE LIABILITY
X ANY AUTO
X ALL OWNED AUTOS
X SCHEDULED AUTOS
X HIRED AUTOS
X NON.OWNED AUTOS
GARAGE LIABILITY
(}~ '1
1
I'
I ,,{-I:
, I
;! I'll ~~~~~NED
LIMIT
BODILY
INJURY
(Per person)
$
1 CjC
$
BODILY
INJURY
(Per accident)
$
6~~~~~TY $
L. EXCESS LIABILITY
X UM2~~LLA rORM
OTHER THAN UMBRELLA FORM
UE 11 '+H71 i
l
I
I .~Jd q~
EACH AGGREGATE
OCCURRENCE
$1 ',J 'J $ 1f'0.1
1
,J
WORKER'S COMPENSATION
AND
EMPLOYERS' LIABILITY
? L) l; -j _~~- ..)
71 1/ /
II 1/01
$
$
$
STATUTORY
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1J fj (DISEASE-POLICY LIMIT)
1 0 C C (DISEASE-EACH EMPLOYEE!
OTHER
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AI
DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/SPECIAL ITEMS
!h~ll
3 :l 3.HI
! CERTIFICATE HOLDER
CANCELLA TION
SANTA CLAxA CDUN1Y
bUILCINu .:":PA?TMdH
7u WEST 1:-2fJ..,lNG,?TI~ "!-:..:C,
SAN JO~_, L~ 9~11L
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. I
.'-"'1
, ACORD 25-5 (11/89)
AUTHORIZED REPRESENTATIVE
1jLt \lliC N
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(C)ACORD CORPORATION 1989 J
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MAIN OFFIC"
610 McKENDRIE ST.
.
SA~ PLANT
790 ON AVE.
.
PLEASANTON PLANT
15A4 STANLEY BLVD.
PLEASANTON, CA
(.415) .4.49-.433.4
.
SA.... JOSE, CA 95110.1595
PHONE ("08) 293.6272
WEIGHMASTER'S CERTIFICATE OF WEIGHT AND MEASURE
THIS IS TO CERTIFY that the lallawing described merchandise wo.s weighed, measured
or counted by 0 private weighmaster, and his signature is 0 recognized authority 01 accuracy
os prescribed by Chapter 7.3 (commencing with Section 12740) 01 Division 501 the Calilornia
Business and Pralessions Code, administered by the Division 01 Measurement Standards
01 the Deportment 01 Food and Agriculture 01 the State 01 Calilornia.
WARNING
PROPERTY DAMAGE RELEASE
(TO BE SIGNED IF DEliVERY TO BE MADE INSIDE CURB LINE)
IRRITATING TO THE SKIN AND EYES
Wear Rubber Boots and Gloves.
Dear Customer. The driver of this truck in presenting this RElEASE to you for
your signature is of the opinion that the size and weight of his truck may
pOSSIbly c<?use damage to the premises and/or adl,?cent property If he places
the motenol In thiS load where you desIre It. It IS our wish to help you In
every way that we (on, but in order to do this the driver is requesting thot
you sign this RELEASE relieving himondCENTRAl CONCRETE SUPPl Y CO. ,INC. from
ony responsibility from any damage that may occur to the premises and/or adjacent
property. buildings. sidewalk. driveways. curbs, ete. by the delivery of this
material. and that you also agree to help him remove mud from the wheels af his
vehicle so that he will not litter the public street. Further, os additional con-
sideration. the undersigned agrees to indemnify and hold harmless the driver
of this truck and CENTRAL CONCRETE AND SUPPl YCa.. INC for any and all damage
fa the premises and/or adiacent property wh ich may be c1ai med by anyone to have
arisen out of del ivery of this order
uwu
Contains Portland Cement.
PROLONGED CONTACT MAY CAUSE BURNS.
Avoid Contact With Eyes and Prolonged Contact With Skin.
In Case of Contact With Skin or Eyes, Flush Thoroughly With
Water. If Irritation Persists, Get Medical Attention.
SIGNED X
KEEP CHILDREN AWAY
NOTICE MY SIGNATURE BELOW INDICATES THAT I HAVE READ THE
ABOVE HEALTH WARNING NOTICE CENTRAL CONCRETE WilL NOT
BE RESPON'SiiITE FOR ANY DAMAGE CAUSED WHEN DELIVERING
INS IliECUiiiiliN E
LOAD RECEIVED BY
SOLD TO: !
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If any action at law or in equity is nece~~nfor,* Of interpr~l\t terms otthis agreeme:nt the prevailing party
shall be entitled to reasonable attorn8lt:.feei and cOsts in addition to any other relief to which he may beentitled.
:" Et-o
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WATER ADDED ON JOB
AUTHORIZED BY
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GALS
X
TRUCK NO
CUBIC YARDS
MIX NUMBER
CUST NO. /PROJ. NO
SLUMP PROD CT IDENTIACATION
DATE
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PTS LAMP BLACK/YARD
CENTRAL CONCRETE SUPPLY CO INC PRIVATE WEIGHMASTER
DEPUTY
DRIVE RS NAME
~'~ 1': h.1 li!".
51 f
f':" ,;
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LOAD NO.
ACCOUNT/MIX TOTAL
DELAY EXPLANATION/CYLINDER TESTS TAKEN
FINISH UNLOADING
ARRIVE PLANT
TIME
DUE
PLANT
NUMBER
TOTAL ORDER
U IJ iJ U
ORDER
NUMBER
TICKET NUMBER
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LOAD
TAG
NO.
CC-62510/86
241478
SAN JOSE PLANT
790 Stockton Avenue
San Jose, Calif.
PLEASANTON PLANT
1544 Stanley Boulevard
Pleasanton, Calif.
COHellfTE SUHLY co., INC.
MAIN OFFICE
610 McKENDRIE STREET
SAN JOSE, CALIFORNIA 9511 0-1595
TELEPHONE (408) 293-6272
FAX (408) 294-3162
DATE: January 2, 1992
Casey Fogli
1970 National Avenue
Hayward, California 94545
ATTENTION: Jeff Otani
RE: Recovery Inn of Campbell
3751 & 3777 So. Bascom Ave.
Campbell, California
Job 17769
MIX #: 1084
MIX DESCRIPTION: 6 sack 3/4" gravel
USE: Class A Concrete
DESIGN STRENGTH: 3000 psi
SLUMP: 3"-4"
SOURCE
SSD
VOLUME
CEMENT: ASTM C-150, Type II
480
2.44
FLY ASH: pozzo1anic International,
Milpitas, California
85
.61
COARSE AGG: 1" X #4 Gravel,
Pleasanton
1750
10.46
FINE AGG: 01y "0" Sand,
Felton
1320
8.14
ADMIXTURE: Air Entrainment (Micro Air)--.3 oz./cwt.
.81
WAIl'ER:
283 (34 gals.)
4.54
TOTALS
27.00
3918
Sincerely,
CENTRAL CONCRETE SUPPLY CO., INC.
wt~
Quality Control Department
J. ,-~~,,:~!:.'T.~'~rff~.."".~:?~~~1."."Y2j ..-t:',ci~,Ce::.~1~~'~r0(r~~~~~.'!'~t~'~t:~(7~' .
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. .-- . . . .~.. )
J Project: ~Q...("-1 ~ Job No: ,<t% -;.OOz.ti~
. Subject: ~,IELD CONSTRUCTION INSPECTION REPORT (NUCLEAR) Date: '"T~~"L
From: cN~ () To: ! U, ') From: To: Hours:
Equipment in Use:'''''''''.'''' Or....wV\ J, \, (l;p'-~ ~~ L.:>~ I~? 'M,:\pc.'~ept. No:
UNSATISFACTORY CONDITIONS PREVIOUSLY REPORTED
(Give report date only. Circle dates of items corrected in this report
and explain below.)
REMARKS
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John F. Otto, Inc.
.
LETTER OF TRANSMITTAL
I
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Project~ Rec= Inn 0+ t_os Gatos .jOD~ 5194
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f-=.nange Ctrdt:::~--
Sample~ Specificatisn~
X Other~ SEE BELOW
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r.~p.C:_;-?""-"1 n T "1 :-~r~'
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~lcen~,e or permit bond certlfl.ca~2 r~
Chec~ ~or $4,~6q4=00=
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MAINTENANCE BOND
Bond No.
Premium:
B2170029
$186.00/yr.
RELIANCE INSURANCE COMPANY
HEAD OFFICE. PHILADELPHIA, PENNSYLVANIA
KNOW ALL MEN BY THESE PRESENTS, that we John F. Otto, rnc.
as Principal, .and RELIANCE INSURANCE COMPANY, a Pennsylvania corporation, as Surety, are held and
firmly bound unto
CITY OF CAMPBELL, CA
as Obligee, in the full and just sum of Nine Thousand Two Hundred Seventy-Five and 00/100ths----
---------------------------------------------------- Dollars ($ 9,275.00---------____),
for the payment of which sum, well and truly to be made, we bind ourselves, our heirs. executors, administra-
tors, successors and assigns, jointly and severally, firmly by these presents. .;
WHEREAS, the said Principal entered into a contract with City of Campbell, CA
dated
For Recovery Inn of Campbell, 3777 South Bascom, Campbell, CA
for Permit No. 91-127, Constructions of Certain Improvements
WHEREAS, said contract provides that the Principal will furnish a bond conditioned to guarantee
for the period of One (1) year(s) after approval of the final estimate on said job, by the owner, against
all defects in workmanship and materials which may become apparent during said period, and
WHEREAS, the said contract has been completed, and was approved on June 15, 1992
NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH, that if within One (1year(s)
from the date of approval of the said contract, the work done under the terms of said contract shall disclose
poor workmanship in the execution of said work, and the carrying out of the terms of said contract, or it shall
appear that defective materials were furnished thereunder, then this obligation shall remain in full force and
virtue, otherwise this instrument shall be void.
Signed and sealed this
19th
day of
June
,1992 .
Witness:
Ri:CEIViliJ
SEP 021992
Principal
RELIANCE INSURANCE COMPANY
Public Works' Engin:Joring
By:
Attorney-in-Fact
BDR.2308 ED. 7-71
I{.ELIANCE INSURAN<-~E COMPANY
Hl.. OFFICI:. PHIUOELPHIA. PENNSYLVANIA
POWER OF A. TTORNEY
KNOW A.LL MEN 8Y rHESE PRESENTS. rhat me RELIANCE INSURANCE COMPANY. a corporatIon duly organozed under !he laws 01 'he State <JI
P..nnsy'van.a. 'Joes hp.reby make. constItute .lnd .JppOlnt
JOSEPH H. WEBER of SACRAMENTO, CALIFORNIA __________
Its lrue and lawful Attorney-.n-Fact. 10 make. execute. _I and deliver for and on Its betlall. and as Its act and deed
ANY AND ALL BONDS AND UNDERTAKINGS OF SURETYSHIP _______
and to bind the REUANCE INSURANCE COMPANY thereby as fully and to the same extent as if such bonds and undertakings and other wntings
obligatory in the nature thereof were signed by an Executive OfIicer of the REUANCE INSURANCE COMPANY and :sealed and attested by one other
of such officers. and hereby ratifies and confirms allthet its said Anorney(s)-in-Fact may do in pursuance hereof.
This Power of Attorney is granted under and by authority of AttIcle VII of the By-Laws of REUANCE INSURANCE COMPANY which became
effective September 7, 1978. which provisions are now in full force and eflect. reading as follows:
ARTICLE VII - EXECUTION OF BONOS AND UNDERTAKINGS
1. The Board of Directors. the President, the Chairman of the Board. any Senior VIce President, any Vice President or Assistant Vice President
or other officer designated. by the Board of Directors shall have power and authority to (a) appoint Attorneys-in-Fact and to authorize them to execute
on behalf of the Company. bonds and undertakings. recognizances, contlacts of lndem':'lity and other writings obligatory in the nature thereof. and (b)
to remove any such Attorney-in-Fact at any time and revoke the power and !luthority given to him.
2. Attorneys-in-Fact shall have power and authority. subject to the terms and limitations of the power of attorney issued to them. to execute
and deliver on behalf of the Company, bonds and under1akings. recognizances. contracts of indemnity and other writings obligatory in the nature thereof.
The corporate seal is not necessary for the validity of any bonds and undertakings. recognizances, contracts of indemnity and other writings obligatory
in the nature thereof.
3. Attorneys-in-Fact shall have power and authority to execute afliclavits required to be attached to bonds. recognizances. contracts of indem-
nity or other conditional or obligatory undertakings and they shall also have power and authority to certify the financial statement of the Company and
to copies of the By-laws of the Company or any article or section thereof.
this power of attorney is signed and. sealed by facsimile. uoder and by authority of the following Resolution adopted by the. Board of Directors of
REUANCE INSURANCE COMPANY at a meeting held on the 5th day of June. 1979. at which a quorum was present, and said Resolution has not been
amended or repealed:
-Resolved. that the signatures of such directors and ofIIcers and the seal of the. Company may be affixed to any such power
of attorney or any certificete relating th4treto by facsimile. and any sUch power of attorney. or cer1ificate bearing such
facsimile signatures or facsimile seal shaJI be valid and binding upon the Company and any such power 80 executed and
certified by facsimile signatures and facsimile seaJ shall be valid and binding upon the Company in the future with respect
to any bond or under1aking to which it is attached..-
IN WITNESS WHEREOF. the REUANCE INSURANCE COMPANY has cauaecJ these presents to be signed by ita VIce President. and ita corporate seaJ
to be herweo af'IIxed. this 2 3 r diay of J u 1 Y 18 9 0
RElIANCE INSURANCE COMPANY
STATEOF
COUNTY OF
On this
Washington
King
23rd
}-
July
~.~
~(~~
~y
CJ!E~A ~~
VIce President
day of
. 19 9~1Iy appeared
Lawrence W. Carlstrom
to me known to be the Vice-President of the REUANCE INSURANCE COMPANY. and
.lnstrument and affixed the seal of said corporation thereto. and that Article ~I. SectI 1, 2. a
tlon. set b1h therein. are stili In full force.
May 15
.19 94
l"'<1ged that he executed and atiested the foregoing
of the By-laws of said Company and the ResoIu-
A
Residing at
Tacoma
My Commiaalon expires:
Notary Public In and for State of
I. Robert D. Ri tzhaupt . Assistant Secretary of the REUANCE INSURANCE COMPANY. do hereby certify that the above
and foregoing Is a true and correct copy of a Power of Attorney executed by said REUANCE INSURANCE COMPANY. which Is stili In full force and
effect.
IN WITNESS WHEREOF, I have hereunto set my hand and affixed the lI8aI of said Company this
~~..~.
,~rg~
\~~)jl
19th
IIDR- to! Ed. IIN
Aaalatant
srATE OF CALIFDRNIA)
CX>UNTY OF SACRAMEN'ro)
SSe
On this 19th day of June , in the year 1992, before me a rb!:ary Public, personally
appeared Joseph H. Weber, personally known to me (or proved to me on the basis of
satisfactory evidence) to be the person whose name is subscribed to this instrument as the
Attorney-In-Fact on behalf of, the corporation therein named and acknowledged to me that
the corporation executed it.
WENDY GAGE
. NOTARY PUBLIC-CALIFORNIA
2 ~ COMMISSION #896341
II> ;I. PRINCIPAL OFFICE IN
SACRAMENTO COUNTY
I MY Commission upires Octobei 21. 19M
(Agent of Corporation)
STA'IE OF CALIFORNIA
COUNTY OF SACRAMENTO John F. Otto, Inc.
On August 27, 1992 before me, a Notary Public in and for said State,
personally appeared Carl R. Otto personally known to me to be the person who
executed the within instrument as the agent of the corporation that executed the within
instrument. and acknowledged to me that such corporation executed the within
instrument pursuant to its by-laws or a resolution of its board of directors.
and and official seal.
~\v
<~~.'.,\ mli';~If.L SEAL
SA:X>:k,.\ IQ:'IS[ som
~ \<i:f~551 ~^::~}~.~::~!f~ ~~!~g~N",
{j \ '~'~;./ . ."'.. .,,1. ......: c~ ,.,", 4. 1994
~~..,--,,--~-~~ -.".---,....-::-...,-:,
Signature
August 31, 1992
It E C f I V,
S "u
EPO 27992
~Clbl;c: ~
orb/En
t1fnsstil'/!}
Hank Imokawa
Department of Public Works
City of Campbell
70 North First Street
Campbell, CA 95008
RE: PERMIT #91-127
Dear Hank:
Per your request, enclosed is the maintenance bond for the
offsite work completed at 3751 - 3777 S. Bascom Avenue.
If there is anything else required to close out this
project, please let me know.
Sincerely,
JOHN F. OTTO, INC.
(~fi/k I
Brian K. Furlong
Estimator
By:
BKF:rs
Enclosure
John F. Otto, Inc.
PO Box 2858
Sacramento, CA 95812-2858
(916) 441-6870
FAX #(916) 441-6138
License # 178809
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TO:
City Clerk
Please collect & recejpt
for the following monies:
PUBLIC WORKS FILE NO.
'7/-/2- 7
ACCT ITEM AMOUNT r.ECEIPT NO
35-3396
Project Revenues (specify project)
Public Works excavation Permit Fees:
Application Fee
Plan Check Deposit
Faithful Performance (Cash) Deposit
R-1:
($50)
3372
3521
3521
3521
Other Cash Deposit (specify)
($200)
Other:
($100)
($500)
(100% of)
(ENGR. EST)
(4% of FPB)
($500 min.)
$
~
98y 3O/7~
..:J 71 0 ~ .:::0/7/,
3372 Plan Check & Inspection Fee ($0 - $100,000 10%;
$100,000 - $500,000 9%; $500,000 and above 7%; $100 min.)
3373 Project Plans & SpeCifications ($10)
3373 General Conditions, Standard Provisions & Details ($10 or $1/page)
3373 "No Parking" signs ($lIea. or $25/100)
3373 Work Area Traffic Control Handbook ($5)
3373 Copies of Engineering Maps & Plans ($.50/sq.ft.)
3372 Final Parcel Map Filing Fee ($450 + $20 per lot)
3372 Final Tract Map Filing Fee ($500 + $20 per lot)
3372 Lot Line Adjustment Fee/Certificate of Compliance ($400)
3372 Vacation of Public Streets and Easements ($500)
3372 Assessment Segregation or Reapportionment
First Split ($500)
Each Additional Lot ($150)
3395 Park Dedication In-lieu Fee per Unit ($4,548)
3370 storm Drainage Area Fee
3380 Public Works Special Projects
3510 Postage
TOTAL
NAME OF APPliCANT o Of-{ ,V' P c7T3 /f...../C ~
ADDRESS /7/ .5ec..ON,<-:) :5T -5~?.4/~
FOR
CITY CLERK
ONLY
PHONE
$ '161109-
&/~) ~YI- C,G7{}
ZIP 9rBJ 2-
DATE
RECEIVED BY
(;-21-
..
-
~
ACttlllt" CERTIFICA 1 ~ OF INSURANCE
ISSUE DATE (MM/DD/YY)
PRODUCER
6/18/91
SACRAMENTO VALLEY INSURANCE
AGENTS/BROKERS
P.O. BOX 13792
SACRAMENTO, CA 95853
(916) 920-3400
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
COMPANIES AFFORDING COVERAGE
COMPANY A
LETTER
Maryland Casualty Company
INSURED
COMPANY B
LETTER
Republic Indemnity
John F. Otto, Inc.
P.O. Box 2858
Sacramento, CA 95812
COMPANY C
LETTER
COMPANY D
LETTER
COMPANY E
LETTER
: COVERAGES
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.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION ALL LIMITS IN THOUSANDS
,LTR DATE (MM/DD/YY) DATE (MMIDD/YY)
GENERAL LIABILITY GENERAL AGGREGATE $ 1,000
X COMMERCIAL GENERAL LIABILITY PRODUCTS.COMP/OPS AGGREGATE $ 1,000
A CLAIMS MADE X OCCUR. EPA10135847 6/30/90 6/30/91 PERSONAL & ADVERTISING INJURY $ 1,000
X OWNER'S & CONTRACTOR'S PROTo EACH OCCURRENCE $ 1,000
FIRE DAMAGE (Anyone fire) $ 100
MEDICAL EXPENSE (Anyone person) $ 5
AUTOMOBILE LIABILITY COMBINED
SINGLE $ 1,000
A X ANY AUTO LIMIT
X ALL OWNED AUTOS BODILY
ECA10135805 6/30/90 6/30/91 INJURY $
X SCHEDULED AUTOS (Per person)
X HIRED AUTOS BODILY
INJURY $
X NON.OWNED AUTOS (Per accident)
GARAGE LIABILITY PROPERTY
DAMAGE $
EXCESS LIABILITY EACH AGGREGATE
6/30/90 6/30/91 OCCURRENCE
A X Umbrella Form UB71404710 $ $
OTHER THAN UMBRELLA FORM 10,000 10,000
STATUTORY
WORKER'S COMPENSATION
PC998530 7/1/90 7/1/91 $ 1,000 (EACH ACCIDENT)
B AND
$ 1,000 (DISEASE-POLICY LIMIT)
EMPLOYERS' LIABILITY
$ 1,000 (DISEASE-EACH EMPLOYE~
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/SPECIAL ITEMS
Re: Permit #91-127,
3777 South Bascom Avenue, Campbell, CA 95008
Endorsements Attached.
CERTIFICATE HOLDER
City of Campbell
Building Department
70 North First Street
Campbell, CA 95008
CANCELLA TION
--!
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DA-rpr Tt\;'fER.~1 THE ISSUING COMPANY WILL IKNOKMf.I!l!R:xrnl
MAIL 1.L DAYS WRITTEN WChlCE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT, SXJx~~)(l~IDcfW\1tl~IX:N~J{)NOCK ~~:xNO:XOO)(JOCMOC>N:;O:R
XlK6{IX1X:;OJ(~lllmWO'}(ec~;XI1'S~~OC~~~A:'r)vllS<:
AUTHORIZED REPRESENTATIVE
'l)avltl W. ~
__. (C)ACORD CORPO.!l~.'T.!2.~_2!89
ACORD 25-S (11/89)
POLICY NUMBER: EP A1 0 13 5 847 COMMERCIAL GENERAL LIABILITY
John F. Otto, Inc.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS (FORM B)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
Name of Person or Organization: City of Campbell, Its Officers, Agents and
Employees.
Re: Permit #91-127
3777 South Bascom Avenue, Campbell, CA 95008
(If no entry appears above. information required to complete this endorsement will be shown in the Declarations
as applicable to this endorsement.)
WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the
Schedule. but only with respect to liability arising out of .'your work" for that insured by or for you.
"The City of Campbell and its respective officers, agents and
employees are named as additional insureds from and against
any claims, loss liability, cost or expense arising out of or
in anyway connected with the construction of the project. This
coverage shall be primary and any coverage carried by additional
insured shall be excess insurance only."
CG 20 10 11 85
Copyright. Insurance ~ervices Office. Inc., 1984
o
~
Policy Number: EP'10135847
Insured: John F. eto, Inc.
Re: Permit #91-127
3777 South Bascom Avenue, Campbell, CA 95008
PRIMARY INSURANCE
Such Insurance as is afforded by this endorsement for the
additional Insureds shall apply as primary insurance. Any
other insurance maintained by the Additional Insureds or it1s
officers and employees shall be excess only and not
contributing with the insurance afforded by this endorsement,
except in the event of sole or contributory negligence on the
part of the Additional Insureds.
,.,".:,;: :--7','" ,;~~_.:t:
,-....--..-. ....
. '". .. ..
~
81 elian~.
"llsura e
'-'Umpanl ~s
I
RELIANCE INSU~ COMPANY
PHILADELPHIA, P. .SYlVANIA
UNITED PACIFIC INSURANCE COMPANY
FEDERAL WAY, WASHINGTON
PLANET INSURANCE COMPANY
FEDERAL WAY, WASHINGTON
Type of Bond:
Bond No.
executed by
and by
in favor of
and dated
From:
This rider is effective
Signed and Sealed
Principal
8D-1468 Ed. 9/86
RIDER
P. O. Box 15901, Sacramento, CA 95852
To be attached to and form a part of
Encroachment Permit Bond
B 1 83 07 47
John F. Otto, Inc.
, as Principal,
Reliance
INSURANCE COMPANY, as Surety,
City of Campbell, Department of Public Works
June 17, 1991
In consideration of the premium charged for the attached bond, it is hereby agreed to change:
The third paragraph in the bond form is changed
PROVIDED, HOWEVER, That this bond shall continue in force until:
1. June 17, 1991, or until the expiration date of any Continuation
Certificate executed by Surety, at its sole option.
To:
PROVIDED, HOWEVER, That this bond shall continue in force until:
1. June 17, 1992, or until the expiration date of any Continuation
Certificate executed by Surety, at its sole option.
The attached bond shall be subject to all its agreements, limitations and conditions except as herein
expressly modified.
June 17, 1991
June 19, 1991
By:
Reliance
INSURANCE COMPANY
ey:
~~. -/L..~
Ka M. Buenafe, Attorney-in-Fact
RIDER ACCEPTED Please si n du licate of this Rider and return to Surety)
By:
CC: John F. Otto, Inc.
Pickett-Rothholz & Murphy Ins.
Sacramento, CA
Date
RELIANt.;E INSURANCE COMPANY
HEAD OFFIC~. PHILADELPHIA. PENNSYLVANIA
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS. That the RELIANCE INSURANCE COMPANY, a corporation duly orlJlnized under the laws of the State of
Pennsylvania, does hereby meke, oonstitute and appoint
KAY M. BUENAFE of RANCHO CORDOVA, CALIFORNIA---
its true and lawful Attorney-in-Fact, to make, execute. seal and delivar for and on its behalf. and as its act and deed
ANY AND ALL BONDS AND UNDERTAKINGS OF SURETYSHIP------
and to bind the RELIANCE INSURANCE COMPANY thereby as fully and to the same extent as if such bonds and undertakings and other writings
obligatory in the nature thereof were signed by an Executive Officer of the RELIANCE INSURANCE COMPANY and sealed and attested by one other
of such officers. and hereby ratifies and confirms all that its said Attorneylsl-in-Fact mey do in pursuance hereof.
This Power of Attorney is granted under and by authority of Article VII of the By-Laws of RELIANCE INSURANCE COMPANY which became
effective September 7, 1978, which proviSions are now in full force and effect, reading as follows:
ARTICLE VII - EXECUTION OF BONDS AND UNDERTAKINGS
1. The Board of Directors. the President. the Chairman of the Board, any Senior Vice President. any Vice President or Assistant Vice President
or other officer designated by the Board of Directors shaH have power and authority to lal appoint Attorneys-in-Fact and to authorize them to execute
on behalf of the Company. bonds and undertakings, recognizances. oontracts of indemnity and other writings obligatory in the nature thereof, and (b)
to remove any such Attorney.in-Fact at any time and revoke the power and authority given to him.
2. Attorneys-in.Fact shall have power and authority, subject to the terms and limitations of the power of attorney issued to them. to execute
and deliver on behalf of the Compeny. bonds and undertakings. recognizances. contracts of indemnity and other writings obligatory in the nature thereof.
The corporate seal is not necessary for the validity of any bonds and undertakings. recognizances, oontracts of indemnity and other writings obligatory
in the nature thereof.
3. Attorneys-in-Fact shall have power and authority to execute affidavits required to be attached to bonds, recognizances. oontracts of indem-
nity or other conditional or obligatory undertakings and they shall also have power and authority to certify the financial statement of the Company and
to copies of the By-Laws of the Company or any article or section thereof.
This power of attorney is signed and sealed by. facsimile under and by authority of the following Resolution adopted by the Board of Directors of
RELIANCE INSURANCE COMPANY at a meeting held on the 5th day of June. 1979, at which a quorum wes present, and said Resolution has not been
amended or repealed:
"Resolved. that the signatures of such directors and officers and the seal of the Company may be affixed to any such power of
attorney or any certificate relating thereto by facsimile. and any such power of attorney or certificate bearing such facsimile
signatures or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by
facsimile signatures and facsimile seal shall be valid and binding upon the Company in the future with respect to any bond or
undertaking to which it is attached."
IN WITNESS WHEREOF, ,he RELIANCE INSURANCE COMPANY has caused these presents to be signed by its Vice President. and its corporate 5081 to
be hereto affi xed, this 21s t day of June 19 83
AELIAN'Z,"SUAA~CEn .
~l~& . J"uuJt-
Vice President
STATE OF
COUNTY OF
Washington
King
21st
} ss.
On this
day of
June
, 1 ~ 3 ,personally appeared
Charles B. Schmalz
to me known to be the Vice-President of the RELIANCE INSURANCE COMPANY, and acknowledged that he executed and attested the foregoing
instrument and affixed the seal of said corporation thereto, and that Article VII. Section 1, 2. and 3 of the By-Laws of said Company and the Resolu.
tion. set forth therein, are stili in full force.
July 20,19
86
Il
Residing at
My Commission ExpirllS:
I. Charles J. Falskow . Assistant Secretary of the RELIANCE INSURANCE COMPANY. do hereby certify that the above
and foregoing is a true and correct copy of a Power of Attorney executed by said RELIANCE INSURANCE COMPANY. which is still in full force and
effect.
IN WITNESS WHEREOF, I have hereunto set my hand and affixed the seal of said Company this
~
~J
19TH
day of
June
1991.
BDR.1431 Ed. 6n9
Assistant Secretary
CL L, fJ ~:LJ.
., ..-""J:" ",.' ~
"7
-
81 elian~
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RELIANCE ~ANCE COMPANY
PHILADELF-. . PENNSYLVANIA
UNITED PACIFIC INSURANCE COMPANY
FEDERAL WAY, WASHINGTON
PLANET INSURANCE COMPANY
FEDERAL WAY, WASHINGTON
I
RIDER
}!. ('. ;;""f);. . :j~,".~{Jl_, :;aclc.fi:,:::n .:..', ...,
iI'
To be attached to and form a part of
Type of Bond:
:~ncr OdC}ll{1~~n.j: l?eITu_ t Borld
Bond No.
) (,4 1_)7 ,1)
executed by
."rf)}.}]') .F. \ ;.", t_ nc.
, as Principal,
and by
!?f.;;=~.ld~ \ ':.:,:c:
INSURANCE COMPANY, as Surety,
in favor of
"..- ~- t \' '\.- (~r:l\tr'} J-::::It f I>==t;dT - .I(-:(:n; .,":f .~- ';,1(:,,1
~,{~C~"
and dated
June;
'/
, ,
:."'; ~
In consideration of the premium charged for the attached bond, it is hereby agreed to change:
t\.:-':l\.~_i:d! ,1:
, \,~'
'l\., -F ~ ~,..,.
C '':;'. '1\; ;~,;"!
From:
.~ .. .C,.'\;':'! t:::'~~
: !C,','.' '/T.:_" ! -h~,i '~.
,';~. LJlJ ~I ..,
'. ~-? if :_.. !_"
Jt:n::.;r~ ~~ 7" 1 '~!q~
~~. ',_ .;. ':":(J .i _, t' f-"': .(~,
,
.1.
.;' t. \~ '!
~. ~ )
To:
~_~ "r ~~ {
':',,- ,;'
t~ \. ,--, "-.:
I"; r ,; ~ . ,__ . ~
The attached bond shall be subject to all its agreements, limitations and conditions except as herein
expressly modified.
This rider is effective
Signed and Sealed
'?'~',",'-
Principal
By:
Title
INSURANCE COMPANY
By:
M
Attorney-in-Fact
Iicate of this Rider and return to Surety)
By:
Date
. ~ --- --"'""""nv
r
CITY OF CAKP!Ell., CITY ENGINEER'S CONSTRUCTION COST ESTIMATE
~ ') /"j c,~),., I k"/ <" / ,,// // :/',.
Address __ / ...::, --- -f/ I / / :' ,__ c... ;',,/' /' ' c-
Surf.e~ Construction
Cleering , Grubbing
Lump Swa E.tillate
/!
$ 4.00
Sewcut Concrete
LF@
Concrete lleIaoval
SF @ 3.00
LF@ 5.00
EA@ 600.00
LF@ 14.00
SF @ 4.00
SF @ 5.50
EA@ 400.00
LF@ ..50
LF@ 50.00
Curb 6 Gutter aeaoval
::. (
/ _____I '..,'1
Inlot Drain with Pipe
Curb 6 Gutter
Sidewalk
Driveway Approach
Handicap llaop
Extruded Curb
larricade
~ I /
mit No. ./ I. , .
,/ / ' .: j
by~date (-,/~.i./
- $
- $
$
- $
- $
$
- $
- $
- $
$
$
(. 1',
-'-, '\ '~~. tr"/
5 c~":
,
'j
/ I ,.; I.:'.
I /1/1.!~ j
/
Street Excavation
( -
<--. ......
_>.,>SF)x($O.lO)x~.) - $
Adju.t Manhole to erade
Adjust Handhole to Grade
SF)x($0.30)x<",:,-.) $
- $
- $
$
AC Pave.ent
Konuaent !ox w!Kcmuaent
/j
./j;J,
EA@ 375.00
EA@ 275.00
EA@ 600.00
EA@ 300.00
LF@ 0.65
EA@ 40.00
EA@ 120.00
EA@ 15.00
LF@ 10.00
r
"
,- r.'.~
..... -"
Street Tree (l5-pllon)
Paveaent Striping ($100 .in)
Paveaent LegeruU ($100 ain)
Stop, Street Haae or Other Sign
Pave..nt Kerker.
--. ~-
L:-
Paveaent Key .cut
/. r/ /
/ ."/.,; ;/ /"1' '.r~ /~ /
,.-. ..
... . '. ;
--~
.z. ,.Y
_ $ I) c " l. ,', )
$
$
2'IZ,oo
- $
$
$~,.//,r:.,'
I
I (" '~
/,/C~. ::i
$.1., ~
$-Z' ' ; 1:>:- (7.)
...,
Surface Subtotal .S' - $
Adjust for .ize: .S.<$30,000 add 20_, .S.>$100,OOO subtract 10_ (+ or -) $
$~ /-"'-,/'
EA@ 2.000.00
LF@ 10.00 - $
Ir
LF@ 2.00 $ , '
,. I ( r ,.
Ea@ 200.00 - $ (1'\
$
LF@ 60.00 $
LF@ 70.00 $
EA@ 1,600.00 $
EA@ 2,400.00 $
I EA@ 650.00 $
- $
St:reet t i .ht:in..
ElectroUer
Conduit
Conductor, pair
Pull !ox
StOnl. Draina.e
12- or 15' acp
U. or 21" acp
Street Inlet
Manhole
!reak 6 Enter KaDhole
//
./;',) .'J \
1"'- '-' '
/1" i ~\
::.- I c) ...~.- ,.
'tOTAL ESTIMATE $ , }
$ " r , ,
USE FOR BOND I. /
-; (c~ _ "
"
rev1aed 6/88
f/eon...eost:-est
Pickett-Rothholz and Murphy
~HOI F()Is()m B()ule\ard, Suite :100
Sacrament(), Calif()rtli;l
"CIIVID
JUL 2:; 1991
Pult'ic W orq/I .
"Itneer;ng
I/lSll r{{/lce Agel/Is
({wi nr{)ke/"S Sil/ce 1')1')
PO B()x 15190
Sacrament(). Calif()rnia 9'iHl:\
916':lH:\2222
'.:. J. \/ ..i. E\ '! i '~) i~) ].
;' ~ r' Ij~::I'r'! i<]. 'f'r I::
l~ :,r, y c. t C ell It p bE:' :t J.
/:.<. c~I.~l'i.'t~I"~
i Y'" ==:- '(".: ~:3 t 1 . c:: E'~ t
C,c"ii,he:l j" CE, iJ~:;~:,t:::i
;.:,UF,iJE
"l~ .
: ,.
,.I U f-j i-..: [) ..j i. (] , ] :\j [: ,
L:((~;.I',.!r> r,~Ll.. F> 1. E~2~e1-? "-:j--;
1) f:~ Ei Y" "'; 'r~- .. '-':, 1 roo; L! ~
~.fJCl ~J .L :::, ~~ i i.-:. E-? t (I ~:.:\ ~~I ~;.IJ /U'E~ ~l() u t h i:'< -:.: 1'.. r', f~' ~:':\ t)...:. \/ (0 rnc.? "('((; :i Ct;";E:C;
:-nc: r<'<::!;:"iC:'~"!l'r1r":->:'Y-lt I:'le'r--r(l~.. t 13c1Y'ld l,...J i}:_ ~:~.'i~: t'~:'l\.-' ~~ Y"I i.-?:,.:"-j-:"c:c:t U'f'17:' _;. 1. t hr.:::-
pl"C peT is C~(:fr(lpletew
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Belian~
,,![1sura e
\.AJmpanl ~s
RELIANCE RANCE COMPANY
PHILADELPh,1\, PENNSYLVANIA
UNITED PACIFIC INSURANCE COMPANY
FEDERAL WAY, WASHINGTON
PLANET INSURANCE COMPANY
FEDERAL WAY, WASHINGTON
-4
Type of Bond:
Bond No.
executed by
and by
in favor of
and dated
From:
This rider is effective
Signed and Sealed
Principal
60-1468 Ed. 9/86
RIDER
P. O. Box 15901, Sacramento, CA 95852
To be attached to and form a part of
Encroachment Permit Bond
B 1 83 07 47
John F. Otto, Inc.
, as Principal,
Reliance
INSURANCE COMPANY, as Surety,
City of Campbell, Department of Public Works
June 17, 1991
In consideration of the premium charged for the attached bond. it is hereby agreed to change:
The third paragraph in the bond form is changed
PROVIDED, HOWEVER, That this bond shall continue in force until:
1. June 17, 1991, or until the expiration date of any Continuation
Certificate executed by Surety, at its sole option.
To:
PROVIDED, HOWEVER, That this bond shall continue in force until:
1. June 17, 1992, or until the expiration date of any Continuation
Certificate executed by Surety, at its sole option.
The attached bond shall be subject to all its agreements, limitations and conditions except as herein
expressly modified.
June 17, 1991
June 19, 1991
By:
John ;;/~
~- ~
!:5ztrXl . ,~ .~ ~1-
Title
Reliance INSURANCE COMPANY
By:
~;?b. ~7
Ka M. Buenafe, Attorney-in-Fact
RIDER ACCEPTED Please si n du licate of this Rider and return to Surety)
By:
CC: John F. Otto, Inc.
Pickett-Rothho1z & Murphy Ins.
Sacramento, CA
Date
REuANC~ 'U
PHILADElPH~ ~NNCN~OMPANY
. Q,LVANIA
UNITED PACI
FEDERAl WA~~~~~=: COMPANY
~~~NSURANCECOMPANY
WAY, WASHINGTON
BOND NO.
Premium:
B1830747
$742.00
LICENSE OR PERMIT BOND
KNOW ALL BY THESE PRESENTS:
That we, John F. Otto
. Inc.
Reliance
to transact surety b . INSURANCE COMP.
_In tJ;1e State of caHforn~NY, a Pennsylvania as Principa~'l, and
70 C1ty of Ca b 1 a corporal'
Th' North First Stre t mp e 1, Department of ~ bl' as Surety, ate held and fi .on authorized
Hty Seven Thousand 0 e , Campbell, CA 95008 u 1C Works ormly bound unfO
($ 37.100.00 ne Hundred and no/lOO .
II ) DO - - · as Obhgee I tI1
we and truly fO be made' LLARS, lawful mon ' --- --- - - -' - n e penal sum of
firmly by these Presents,' we bond oorselwo, our heirs, legal ';e~~he United States of America, for th - - -
. sentatJves, Successors and assi ~ ~ayment of which,
WHEREAS, PrinctpeJ has ' gns. JOIntly and severally,
No _ Q 1 _ 1 ,.,., _ applied tn t"\"'li",.~. <-
srATE OF CALIFORNIA)
COONTY OF SACRAMENID) ss.
On this 17th day of June . in the year 1991. before me a Notary J>.:.blic, personallY
appeared Joseph H. weber . personallY known ~(or proved to me on the basis of
1\atisfactory evidence I to be the person .mose name is subsCribed to this ins""""",,,t as the
Attorney-In-Fact on behalf of the corporation therein named and acknOWledged to me that
tlb.e COrPOration executed it.
.JI....,.,:,iillil/IIIIIl1IllllOlllllnl-..- 117............
r:
r e.~ f "\l~~~~JC~~~;Pl.
t _ ..:~ PlU",CIPAL OI-FICE IN
~. . , s "C.1\AMENTO COUNTY
MY c(jmmis~ion Eltpires October 21. 19~4
,_11 -. ---IIII'V'-n "'-'IllI\IIIIIIIIIIII
John
o.
Reliance
f 11fA.L-
Jose H. Heber
I'mapJ6
INSURANCE COMPANY
By
By
AttOrney-in-fact
6D-7::<O:> l~
RELiANcE INSURANCE COMPANY
PHILADELPHIA, PENNSYLVANIA
UNITeD PACIFIC INSURANCE COMPANY
FEDERAL WAV. WASHINGTON
PLANET INSURANCE COMPANY
FEDERAL WAY, WASHINGTON
BOND NO. Bl830747
Premium: $742.00
LICENse OR PERMIT BOND
KNOW ALL BY THeSE PRESENTS:
That we.
John F. Otto, Inc.
as Principal(s), and
Reliance INSURANCE COMPANY, a Pennsylvania corporation authorized
to transact surety business in the State of California , as Surety, are held and firmly bound unto
City of Campbell, Department of ~ublic Works .
70 North First Street, Campbell, CA 95008 , as Obligee. in the penal sum of
Thirty Seven Thousand One Hundred and no/lOO --------------------------------------------_
($ 37, 100. 00 ) DOLLARS, lawful money of the United States of America, for the payment of which,
well and truly to be made, we bind ourselves, our heirs, legal representatNes, successors and assigns. jointly and severally,
firmly by these presents. .
WHEREAS, Principal has applied to Obligee for a license or permit to do business as Encroachment Permit
No. 91-127, Dated 3-8-91 for construction work at 3751-3777 S. Bascon Avenue, Campbell, CA
)W THEREFORE. THE CONDITION OF THIS OBLIGATION IS SUCH. That, it the said Principal(s) shafl comply with all
plicable Ordinances, Rules and Regulations, and any Amendments thereto, then this obligation shall be void, otherwise
remain in full force and effect.
1
OVIOEO. HOWEVER, That this bond shall continue in force until:
t. June 17 , 19 91 . or until the expiration date of any Continuation Certificate executed
.. ",.,~ by Surety. at its sole option.
.-, OR
t Cancelled by Surety giving
..1 nate its liability hereunder.
" 1 17th June
.',~ED AND SEAlED this day ot
30
days written notice to Obligee and Principal of its intention to termi-
9 91
, 1
By
~
INSURANCE COMPANY
By
'/I~
Jose H. hTeber
AttOrneyin-Fact
5lH;JO;> l2AlCl
I ":LIANCI-': INSURANC~~ COMl~ANY
'0 OFFICE. PHILADELPHIA. PENNSYLVANIA
POWER OF ATTORNEY
KNOW ALL MEN BY fHESE PRESENTS. fha! ttle RELIANCE INSURANCE COMPANY. .lI corporation dulV orqanlzed under \tie laws o' the Stat'e tJ'
P..nnsvNan,a. does herel:ly make. constltule 3nd .1ppOlnt
JOSEPH H. WEBER of SACRAMENTO, CALIFORNIA
Its true and lawful A"orney-tn-Fact. 10 make. ell8Cute. seal and deliver for and on Its behalf. and as Its act and deed
ANY AND ALL BONDS AND UNDERTAKINGS OF SURETYSHIP -------
and to bind the REUANCE INSURANCE COMPANY thereby as fully and to the same extent as if such bonds and undertaki~s and other wntings
obligatory in the nalure thereof were signed by an Exeeutive Officer of the REUANCE INSURANCE COMPANY and sealed and attested by one other
01 such officers. and hereby ratifies and confirms an that its said Attomey(sl-in-Fad may do in pursuance hereof.
This Power of Attorney is granled under and by authority of ArtIcle VII of the By-La_ of REUANCE INSURANCE COMPANY which beCame
effeetive September 7.1978. whic:h provisions are now in fun force and effect. readi~ as follows:
ARTICLE VII - exECUTION OF BONOS AND UNDERTAKINGS
1. The Board of Directors. the President, the Chairman of the Board. any Senior VIce President, any VIce President or Assistant Vic:e Presidenl
or other offICer designated. by the Board of Directors shall have power and authority to (a) appoint Attorneys-In-Fact and to authorize them to execute
on behalf of the Company. bonds and under1akings. recognizances. contracts of Indem"ity and other writings obligatory in the nature thereof. and (b)
to remove any such Attorney-in-Fact at any time and revoke the power and .uthority given to him.
2. Altorneys-in-Fact shall have power and authority. subject to the terms and limitations 01 the Power 01 attorney issued to them. to execute
and deliver on behalf of the Company, bonds and under1Bkinga. recognizances. contracts of Indemnity and other writings obligatory in the nature thereof.
The corporate seal Is not necessary for the validity of any bonds and under1aklngs. recognizances. c:ontrac:ts of Indemnity and other writings obligatory
in the nature thereoL
3. Attorneys-In-Fad shall have power and au1hority to execute aflidavlts required to be attached to bonds. recognizances. con1rac:ts of Indem-
nity or other conditional or obligatory undertakings and they shall also have power and authority. to certify the financial statement 01 the Company and
to c:opIea of the By-laWS of the Company or any article or section thereof.
this power 01 attorney Is signed and sealecl by facsimile. under and by authority of the following Resolution adopted by the. Board of DirectorS of
RELIANCE INSURANCE COMPANY at a meeting held on the 5th day 01 June. 1979. at which a quorum was present, and said Resolution has not been
amended or repealed:
. .
-Resolved. that the signatures of such directors and officers and the seal of the. Company may be affixed to any such power
of attorney or any certificate relating ttMweto by facsimile. and any sUch power 01 attorney. or cerIIlk:ate -bearing such
facsimile signatures or facsimile seal shall be valid and binding upon the Company and any such power 80 executed and
certified by facsimile signatures and facsimile seal shall be valid and binding upon the Company in the future with respect
to any bond or undertaking to which It Is attac:hed. -
IN WITNESS WHEREOF. the RELIANCE INSURANCE COMPANY has cauaed ~ ~ to be signed by Ita VIce President, and Ita corporate ....
to be hereto affixed. this 2 3 r Way 01 J u 1 Y 1Q 9 0
On tNa
}SL
July
{i}
~JI
RELIANCE INSURANCE COMPANY
ct:':.:..;.4 L4--=.
STATEOF Washington
CQUNTYOF King
. 23rd
day of
.. 19 9 A-aonanY appeared
Lawrence W. Carlstrom
.19 94
-tged that he executed and atiested the foregoing.
01 the By-La_ of said Company and the ResoIu-
. to me known to be the VIce-President of the REUANCE INSURANCE COMPANY. and
.b,strument and affixed the seal of Said corporation ttiereto. and that AttIc:Ie ~I,Sectl .1. 2-
lion. Nt tof1h therein. are still In full force. .
My Commission expires:
May 15
Notary Public: in and for State 01
Reaicllng ..
Tacoma
.. Robert D. Ri tzhaupt . AssIstant Secretary of the REUANCE INSURANCE COMPANY. do hereby cer1lfy that the above
and Ioregolng Is a true and correct copy of a Power 01 Attomeyexec:uted by said RELIANCE INSURANCE COMPANY. whlc::h Is a1IH In fOil force and
etrec:t.
IN WITNeSS WHEREOF. I have hereunto set my hand and affixed the .... 01 said Company thla
~
~.~=+!:
17th
Aaslstant
8OR- tOt Ed. al7t1
.-.,-~,--
Pickett-Rothholz and Murphy
....,.---
IJlS1UYIJlU) AgeNts
(I/I{I Hroh'rs Sillce l'J/')
~HOJ Folsolll Bouk\ard. Suill' ~1I11
Sacrallll'1110, California
,;\.",j
PO Box 1:\ 1911
Sacraml'11lo, Califor11la 9~H I ~
91('~H~~2222
July 1, 1991
"
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Mr;-:A1:t-en'-Gu uld lr.!,
John F. Otto, Inc.
P.O. Box 2858
Sacramento, CA 95812
, "-
v
, ,{
1--,,00\
Re: City of Campbell Encroachment Permit
Bond
.//
. ^
It ),I.'
r. .,.
Dear Allen:
Enclosed
June 17,
inserted
it.
you will find a rider changing expiration date of the bond from
1991 to June 17, 1992. For some reason, the wrong date was
during the final preparation of the bond and I failed to catch
Therefore, would you please have the rider acknowledged, by you, and
forwarded to the City of Campbell for their acceptance and signature. A
self addressed envelope is enclosed for the City of Campbell to return
the acceptance directly to the surety.
I am sorry for any inconvenience and I don't even know whether the City
of Campbell is aware of the minor error but we must still correct it at
this time.
Surety
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ENCROACHKENT PERMIT ISSUANCE
CK LIST
0/_ It?
City of Campbell Encroachment Permit No. 7 I ~
Department of Public Wvrks
/'
_____Applicant section complete
~APP1icant signature and date
v~rmit Application fee $lOQ ..00 ($50.00 for R-1 Homeowner),
paid. Receipt number0t0b ':':"(,,5
7' ~~n check ?eposit. $50~.OO,(JI1aived for R-l Homeowner),
~d. Rece~pt number0kL2\(..;<-j
_____Five sets of improvement plans submitted
{ .~.. Bond for faithful performance, 100% of City Engineer's
estimate, (waived~for R-1 Homeowner), supplied or paid.
~ '. / '
Amount $ '"7.':; ~ -.- Form ;..... ,..) .', I. D. # ':.' 1'--:,; ._, c,-,/<.,L
~V~~ash Deposit: 4% of FP bond, $500 min. ($200 for R-1
Homeowner), p.aid.:~<;?(/.y"t.-'.!:=..' -,__
Amount $ ...:... ... / + t r Receipt No. 'j C! "7 \~
,) /
(jL/( Plan Check & Inspection fee of 10% of F.P. Bond for
amounts of $0 - $100,000; 9% for $100,000 - $500,000;
7% for $500,000 and above; $100 min.
(waived for R-l Homeowner) paid. --, _.
Amount $ ~ '- '" ~ Receipt No. ~ f ()/ /' b
'/f-
_____Worker's compensation information received for Applicant
(see Information Sheet for Encroachment Permits)
_____All other Public Works requirements listed in the
Conditions of Approval of the development.
17P
~orkerls comp and Contractor's Information received for
Contractor (see Information Sheet for Encroachment Permits)
I ,.
(J(~certificate of Insurance with Additional Insured's
Endorsement received from Contractor (see General Summary of
Insurance Requirements for Encroachment Permits)
~Three sets of off-site plans, stamped APPROVED (Tract or
Development and Public Works Permit number and property
address on plans)
~~ Permit signed for City Engineer
WHEN ALL OF THE ABOVE ITEMS ARE COMPLETE, PERMIT MAY BE ISSUED
Issuer: Initial and date and file with permit
UPON ISSUANCE, INITIATE CHECK REQUEST FOR PLAN CHECK DEPOSIT REFUND
f:pmtck1st (Mise forms) 7/90
-,.- . ...... ..:.. ~ .
JelTY OF CAMPBEll
PRELIMINARY INSPECTION-DEFICIENCIES
PERMIT NO. 91-127
3751-3777 SOUTH BASCOM
A. General
1.1./ Submit certificates of compliance for street
lighting electrical conduits, standards,
luminaires, paint materials.
2.vI Supply reproducible as-built plans.
B.
Specjfic Items Deficient
1.vI Install 40 mph sign on electrolier.
2. ~hange pavement markers on Bascom Avenue to Type C
3 V Paint curb red at bus stop.
4. Install pole numbers on electrolier standards.
5. ~nstall hold down lugs on No. 3-1/2 pull boxes.
6. /Bond service run.
7. ~Bond standards inside hand hole cover.
8. ~Remove scotch lock fasteners and replace with
pressure type waterproof connectors.
9. ~nstall 3-1/2 service box with ground rod adjacent
to PG&E box lid to be marked "Street Light
Service." Service box must be separate from
Campbell pull boxes.
10~rior to final inspection clean all concrete and
pavement of all dirt and debris.
f:91-127
CITY OF CAMPBELL
., (--'
, fL '" '
~j/.Jii _/' -- ~.
ql-)~l f2EU>V~ ItJrJ
PROJECT NO. CJ )-)27
REPORT NO: --
FIELD ENGINEER'S DAILY REPORT
CONTRACTOR: J)jJN f. 01)6) JNC--.
DATE: /-- '5-9 ~
WEATHER: PAlC1f.Jf C/puj) (1) 5'1) · +-
INSPECTOR: If)
fC irJs ~-rrAr{,L,
ITEM
DES CRI Pl'ION
-;' v'1 f:;/tf"C m A
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of TlY-6 ~
-29-71.
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Cjl-J2.7
PlEASE TAANSMrr THE FOLl.OW1NG MESSAGE TO:
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FAX NUMBER: ?/G ~4/ I'" G / S P
ATTENllON: !? It1 ~ ,Fr., ~),...; ~ I
THIS MESSAGE CONSISTS OF ~ PHOTOCOPiES AND THIS PAGE
SUBJECT: ~1/l:1lJ II.N..,! e-F /-of C~J'
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SENIOR PROJECT MANAQER . ~vv (J2.ij/.".,41 ..-
1N00000000DNlSlON I ftaALPftOJECTB vJ N ~ [
0Ff1CE NUMBER Ca) -..m'
DIGITAL PAGER NUMBER (408) 184-1148
FAX NUMBEft (408) 29S.e423 '
~ N. Mabuty&d., San JC*. CA '51
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t Project:~Q..(---t ~ '}i -12? . JobNo: ,Q;%3.()o2..P~
, Subject: ~.IELD CONSTRUCT~ON INSPECTION REPORT (NUCLEAR) Date: ,:\"1'J.l. \~"L
From: ~-:l; () To: - U, S From: To: Hours:
Equipment in Use:1""J,"" 0 r...wvl J \ \, (.: 1>'. ~ ~~ ~~ !~i 'M~~ept. No:
UNSATISFACTORY CONDITIONS PREVIOUSLY REPORTED
(Give report date only. Circle dates of items corrected in this report
and explain below.)
REMARKS
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John F. Otto, Inc.
PO Box 2858. 1717 2nd St.
Sacramento. CA 95812
TRANSMITTAL MEMORANDUM
(916) 441-6870
To: City of Campbell
Pablic Works
7u North r1rst ~treet
Campbell, r.a.
ATTN: III:NRY "IlANK" IMOKAWA
The following is being forwarded from: JOBS ITE
Job No. 5 19 4
Date 7 FEB 92
Project Recover)' Inn of Los G
Number For Correct &. For Your
Prints Description Approval Approved Resubmit Use
1 AB Certification
1 iConcrete mix certification r. n-f r
1 I Copy of mix design.
Remarks:
John F. Otto. Inc.
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PLEASA
lN4ST .aYD.
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MAIN OFFlCJ'\ r SAN JOSE PLANT.
610 McKlNDIlI S~ .,' 790 lCTON AVE.
SAlfJOSI~CA tlI10.1591
PHONE (41.1) 2t3~6272
. , J
WEIGHMAS~R'S CERTIFICATE OF WEIGHT AND MEASURE
. THIS IS TO CERTIFY that the fallawing .described mercfia~iidise waT.weighed. measured
or counted by a private; weighmaster. and his signature is a recognized authority af accuracy
as prescribed by Chapter 7.3 (commencing with Section 12740) of Division 5 of the California
Business and Professions Code. administered by the Division of Measurement Standards
of the Department of Food and Agriculture of the state of California.
I'LIAIANTON. CA
~
(415) U'.4J4
COHeRE-TESUPPLY co. INC.
WARNING
IRRITATING TO THE SKIN AND EYES
PROPERTY DAMAGE RELEASE
(TO BE SIGNED. IF DELIVERY TO BE MADE INSIDE CURB LINE)
Contains Portland Cement.
Dear Customer - The driver of this truck in presenting this RelEASE to you for
your signature is of the opinion t~ot the size. and weight of hil truck may
possibly cause damage to thtt premises and/or adjacent property if he plac..
the mot.riol in ,this load where you desire it,. It 'i.. our wish to help you in
every way that, we can, but in order to do thiS the driver is requesting that
you sign this RELEASE relieving him ondCENTRAl CONCRETE SUPPlY CO..INC. from
any responsibility from any damage that may occur to the premises and/or adjacent
property. buildings. sidewalk, drivewoys. curbs. etc. by the delivery of this
material, and that you 0110 a~r.. to help him remove mud from the wh..I, of hi,
vehicle so thot he will not hUer the public str..t. Further. a. additional con.
sideration. the -undersigned agre.s to indemnify and hold harml... the driver
of thi,truck and CENTRAL CONCRETE ANDSUPPl YCO..INC. tor any and all damage
to the premises and/or adjacent property which may be claimed by anyone to have
arisen out at delivery otthi, order.
Wear Rubber Boots and Gloves.
PROLONGED CONTACT MAY CAUSE BURNS.
Avoid Contact With Eyes and Prolonged Contact With Skin.
In Case of Contact With Skin or Eyes. Flush Thoroughly With
Water. If Irritation Persists. Get Medical Attention.
SIGNED X
KEEP CHILDREN AWAY
Sq.~I?TO: CA~Ex.: ~nGLI,~__ ~ ~
., ) J. &- 3/7.. ,lO. 31\.:>1..011. 4...AKPBELL
RECQVERY rnN ~ CORNER OF WOODARD
JC,R ON R HiHT. SOUTH OF C'AKOEN AV.
JOB #7769 APPROACH
I~
Of '~~~.s.rm'of"'I'''''''''''''prwall6ngpMy
.nd CMtaln IIddttkHIto qotMr"""to whichMn.-ybe..utllld.
AUTHORIZED BY
X
TRUCK NO.
CUBIC YARDS
MIX NUMBER
CUST NO.lPROJ. NO.
DATE
.1~L)
I (\.. 1M"
1084
290000 769
3.0 MISC~CLASS A 3/4
'"
07-Feb-9:i
WATER TEMP. 0
% ":.;~'IJM
CENTRAL CONCRETE SUPPLY co. INC. . PRIVATE WEIGHMASTER
.,-' DE PUTY
"ARTIH l). HROBSKY
DRIVERS NAME
PTS. LAMP BLACK/YARD
EmfY l,m::~T A
LOAD NO.
ACCOUNT/MIX TOTAL
DELAY EXPLANATION/CYLINDER TESTS TAKEN
FINISH UNLOADING
ARRIVE PLANT
If)
1
10.0€i
TOTAL ORDER
LEAVE PLANT
j
'\ 'I;
) /.
/'
::,
ORDER
NUMBER
:~;:.:.
L\~.. 1!t~lJ
TIME
DUE
PLANT . 1
NUMIlfR
")
TICKET NUMIlfR
20236
\~~.. Hi~~T }USe CLASS A 'J/4
PRICE
C.O.D. AMOUNT
1~Q0 CE'RTIFICATF COJtF'
COP)" Of' )U :XES ..
::1'lil0. ';:1:lNON-CHLOJnf!E. . 5:t ___
l
..
CUSTOMER JOB COpy
TOTAL .
CC-625 10lB
LOAD
TAG
NO.
241478
. SAN JOSE PLANT
790 Stockton Avenue
.. San Jose, Calif.
PLEASANTON PLANT
1544 Stanley Boulevard
Pleasanton, Calif.
COHCUTI SUHn co.. INC.
MAIN OFFICE
610 McKENDRIE STREET
SAN JOSE, CALIFORNIA 95110-1595
TELEPHONE (408) 293-6272
FAX (408) 294-3162
Casey Fogli
1970 National Avenue
Hayward, California 94545
DATE: January 2, 1992
ATTENTION: Jeff Otani
RE: Recovery Inn of Campbell
3751 & 3777 So. Bascom Ave.
Campbell, California
Job .7769
MIX I: 1084
MIX DESCRIPTION: 6 sack 3/4" gravel
USE: Class A Concrete
DESIGN STRENGTH: 3000 psi
SLUMP: 3"-4"
SOURCE
SSD
VOLUME
CEMENT: ASTM C-150, Type II
480
2.44
FLY ASH: Pozzolanic International,
Milpitas, California
85
.61
COARSE AGG: 1" X 14 Gravel,
Pleasanton
1750
10.46
FINE AGG: 01y "0" Sand,
Felton
1320
8.14
ADMIXTURE: Air Entrainment (Micro Air)--.3 oz./cwt.
.81
WA'l'ER:
283 (34 gals.)
4.54
TOTALS
3918
27.00
Sincerely,
CENTRAL CONCRETE SUPPLY CO., INC.
~~
~wality Control Department