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DEPT. UF 5'tJiSLIC lfOlUtS
10 North rir.t st.
cppbell, CA 15008
(408) 86',-2150
rl"llft"'~ .~
(for workin9 i!l the
public ri9ht-~;-Vay)
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Perait explrd in. 12 ....
PerAit 110. f I .- I { .~l
X-Mf. flle 96 - ","" {' ~.-
ApplicaUon Date "7- 1.;- ~l. J
ApplicaUon expir.. in 1 ~..
APPLICATION _ ApplicaUon i. berebY ..de for a Publio Worb Perait in aooor4anOe with cupbell
kl\J.,,:l.cij'1Ill Co4,~, :'J.ction "1.04. (ApplicaUon expire. in 1 ~tU if paralt not pull.)
_~o :tnrk adue.. or tract .--'/L3/ HAULWtJd 7)
utility treneb location
8. lIat.ure of workl~..lt:If-f::.Er ///I1X'<~,/2-"':/) E/l/ I-'~
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c. Att.ch flve (5) copie. of . dr.wift9 uovift9 th. location, extant ancI d1aaMioM of the work
The u.win9 .b.ll uow th. rel.tion of the propo.. work to axi.tillCJ .urf.ce an4 uncler9r0un4
pprov..enta. 1ftlen .pprovecl by the city Bn9ine.r, ..id u.wln9 becoaa. · part of thla paralt.
D. The General ConlSiUon. for .11 peraita are li.ta4 on th. raven. aid.. special PrOViaioM for
thla permit .re llated belovo r.llure to abide by the.e condition. and proviaion. aay re.u1.t
in job .hut-down .nd/or forfeiture of raithful Perforunca 8On48 ancI oaU depoait.. (8"0
Gener.l condiUOM 1 and 2). ,7'_"'c{"Z-
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B. An .pplicaUon fee _.t .acoapany thi. .pplicaUon. Tbi. la ncm-refUDdable.
._ .< _11.... :ft;:llIfLL /f'I, f?art.' ...-, ..fi?g A/~
Addre.. (be, ( ~_e~' II Lo~'J ~AN :M)e" I 01- '15'/,,2. Cf _.-
I. t.hb work bein9 done by the property owner .t their own re.idenca? --3e. ~
Co.plete and .tt.ch Worker.' coapan..tion and contractor Inforaation forae.
The APplic.nt/permittee hereby .ckndWledge. th.t taay h.ve raad .nd under.t.nd both the front and
b.ck of thi. perm~;f .nd-,,~t they wll1 4.nfoo their contr.ctor(.) of the inforaation.
..-- M~ ~ I~ 7-10-'7/
Applicant (Peoittee pr'1nt/ai Data
MJff/lJrl4u- Pl Peffy
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IIOTES: ALL WOU SHALL COliFORM WI'f'II THB AftACBBD, APPROVED PIANS AND ALL APPLICABLB CAKPULL
STANDARD DRAWINGS AND CONDITIONS.
THE CONTRACTOR MOST HAVE 'f'IIIS PERMIT AND APPROVED PIAN8 A1ID 1I011T lIDT WIft TIlB P .11. DSnC'l'OR OIl
'f'IIE SITE AT LEAST '1'110 DAYS BEFORE STARTIIIG WOB.
NOTICE MOST U GIVDI TO PUBLIC WOIUtS AT LDST 24 BOUJt8 urou USTA'RTDG NY 1fOIUt.
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street aball not be open cut for underc)r0un4 luull.UOM. II1niaua auta ..y be .llowed
for connectioM or exploration bole.. such cuta rat be aD8ei.fieallv aaarcvad bv t:hL
In.Dector.
Pavement ..y be cut for underc)r0un4 luull.UoM ancI _t be rat;ored in .ocor4anOe with
the uUlity Trench Re.tor.tion stand.rd or.wift9.
Work to be .uke4 by . licen.e4 Land surveyor or Civil Bn9i....r and two (2) copi.. of the
cut .he.t. .ent to the Public Work Depurtaent before .tartift9 work.
The hour. of work .re U..itecl to ouuid. the bOUn of 1-1 .... ancI 3-1 p... for any work
.ffecting . traffic lane.
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&PECIAL PROVISIONS
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BOND lOR rA1'l'BFUL PBR!'ORIIAHCB
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(100' or aG. 1IS'1'.)
(4' or laID, $500 KIll)
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PLAJI CBBCB . DSnctIOH nz ($0-$100,000 10"
$100,000 _ $SOO,OOO ~" $500, 0 aDd abOVe '" $100 KIB)
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APPROVED FOR ISSUANCE 1 6-z "1. t-.. t-' .>.,
for city Enc;rinc.r!
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P~EMIUM CHARGED ANNUALLY
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BOND NUMBER: 0438 1129
Aluerican Bonding C011lpany
PERFORMANCE BOND
KNOW ALL MEN BY THESE PRESENTS, that we
MARSHALL M. PETTY; DAVID N. HOGUE
hereinafter called the Principal, and AMERICAN BONDING COMPANY
hereinafter called Surety, are held and firmly bound unto
CITY OF CAMPBELL
In the amount of
hereinafter called Obligee,
THIRTY-ONE THOUSAND AND NO/100*****
Dollars ($ 31 ,000.00
for the payment of which Principal and Surety bind themselves, their heirs,
executors, administrators, successors and assigns, jointly and severally,
firmly by these presents.
WHEREAS, the Principal has by written agreement dated
, 19
, entered into a contract with the Obligee for
PERMIT 902-2, 1031 HAZELWOOD, CAMPBELL, CA
in accordance with drawings and specifications prepared by
which contract is by reference
made a part hereof, and is hereinafter referred to as the Contract.
NOW, THEREFORE, The condition of this Obligation is such that, if Principal shall
promptly and faithfully perform said contract, then this obligation shall be null
and void; otherwise it shall remain in full force and effect. Whenever Principal
shall be, and declared by Obligee to be in default under the contract, the Obligee
having fully performed Obligee's obligations thereunder, the Surety may promptly
Femedy the default, or shall promptly:
1) Complete the work under the contract in accordance with the plans and
specifications, or:
2) Obtain a bid or bids for submission to Obligee for completing the work
under the contract in accordance with the plans and specifications and upon
determination of the Obligee and Surety of the lowest responsible bondable
bidder arrange for a contract between such bidder with corporate surety and Obligee,
and then pay the Obligee the bidders price less the balance of the contract price
but not exceeding, including other costs and damages for which the Surety may
be liable hereunder, the amount set forth in the first paragraph hereof. The term
"balance of the contract price" as used in this paragraph, shall mean the total
amount payable by Obligee to Principal under the original Contract and any amendment
thereto, less the amount properly paid by Obligee to Principal.
Any suit under this bond must be instituted before the expiration of one (1) year
from the date on which final payment under the Contract fall due.
No right or action shall accrue on this bond to or for the use of any person or
corporation other than the Obligee named herein or the heirs, executors,
administrators or successors of Obligee, and this instrument may not be transferred
or assigned without the written consent of the Surety.
3)rf this bond is issued in conjunction with a Payment bontl, the amount herein stated, is
part of the payment bond and not in addition to.
SIGNED AND SEALED THIS 30TH day of JULY 19 91
(8-90)
MARSHALL M. PETTY; DAVID N. HOGUE
~ ,pr~' ipal Seal
BY,tlij- ~~ M\,~~
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AM~AN BO,NI~ COMPJNY/-:J~ t' r{:..../S..)r
BY: ~-tL€C~ (.. . ?llJ ;;,:(" /", \..-c. _
E t B S .. Attorney-In-Fact / Seal
as ay urety ANNELIE I DOUGLASS
Bond insurance Services
91 Gregory Lane #5
Pleasant Hill, CA 94523
Form 106
STATE OF CALIFORNIA
COUNTY OF LOS ANGELES
On this 4 day of November, 1989 , before me a Notary Public, personally
appeared the above-named officer of AMERICAN BaIDING aJ.1PANY, a corporation, known to me
to be the person and officer who executed the above Power of Attorney on behalf of the
corporation and acknowledges the corporation and acknowledges the. corporation v,)luntarily
executed the same.
\
AMERICAN BONDING
PASADENA, CALIFORNIA
A STOCK ca1PANY
COMPANY
0438
i\]Q
1129
POOER OF ATroRNEY
AMERICAN BaIDING CCMPANY, a Nebraska Corporation, having its administration office in
the City of Pasadena, State of California, does hereby make, constitute and appoint
ANNELIE I. DOUGLASS of Pleasant Hills, California
as Attorney (s)-in-fact, with full power and authority hereby conferred to execute and
deliver and affix the seal of the corporation thereto, if a seal is required, for and
on its behalf as Surety and as its act and deed, all of the following classes of
documents, to wit: any and all bonds and undertakings, recognizances, contracts of
indemni ty and other writings obligatory in the nature thereof, which are or may be
allowed, required or permitted by law statue, rule regulation contract or otherwise,
for any single obligation, regardless of the number of instnnnents issued for the
obligation.
This power is construed to be used for any and all bonds in an
amount not to exceed Five Hundred Thousand ($500,000.00)
AMERICAN BONDING c:x:MPANY further certified that the following is a true and exact
copy of Artilce VII Section 3. of the By-Laws of AMERICAN BaIDING CCMPANY duly adopted
and now in force, to wit:
SEcrION 3. All bonds, undertakings, recognizances or other written obligations
of the corporation shall be executed in the name of the corporation by the
president, any vice-president, secretary, any assistant-secretary or the
treasurer, or by such other persons as may from time to time be properly
authorized. The president, any vice-president, the secretary, any
assistant-secretary or the trea~urer may appoint.or remove resident vice-
presidents, resident assistant-secretaries, attorneys in fact, agents or
other persons who shall have authority to issue and deliver bonds,
undertakings, recognizances or other written obligations in the name of the
corporation. The corporate seal is not necessary for the validity of any
bonds, undertakings, or other obligations of the corporation. The signature
of any authorized officer and the seal of the corporation may be affixed by
facsimile to any power of attorney or certification thereof authorizing the
execution and delivery of any bond, or undertaking of the corporation; and such
signature and seal when so used shall hove the same force and effect as though
manually affixed.
IN WI'INESS WHEREOF, AMERICAN BaIDING C'a1PANY has caused these presents to be
executed by its duly authorized officer and its corporate seal affixed, this
-L day of Novemoer, 1989.
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e OFFICIAL SEAL
- M. S. RODRIGUEZ
. N01ARY p,..UC-.(AUt-ORNIA
. PRINOPAI. OHI('[ IN
I.O!' AN(;nt:.o; ('Ol'NH'
. My Commission Expires Nov. 3. 1993
CERTIFICATION
I, the undersigned, certify that I am the Secretary of AMERICAN BONDING COMPANY, a
Nebraska corporation, and that the attached Power of Attorney remains in full force and
effect and has not been revoked; and furthennore that Article VII Section 3. of the
By-Laws of said company as set forth in said Power of Attorney, are now in full force
and effect.
IN TESTIMONY WHEREOF, I have hereunto subscribed my name and affixed the corporate
seal of the said Company this
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30TH day Of~'~91 ,
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SURETY RIDER
To be attached and form a part of American Bonding Company Bond No.
0438 1129
in the amount of $ 31,000.000
on behalf of
MARSHALL M PETTY; DAVID N HOGUE
as Principal and in favor of
CITY OF CAMPBELL
as obligee.
It is understood and agreed tbat tbe above described bond 1s hereby modified as to the
follow1ng
TYPOGRAPHICAL ERROR ON DAVID N HOGUE'S NAME
The Surety hereby amend$ the bond to read:
From:
DAVID N HOGUE
To:
DAVID N HOUGE
Nothing herein contained 81~11 be held to vary, alter, waive or extend any othor t.rms,
agreements, conditions or limitations of the above mentioned bond, other than as stated
above.
SIGNED, SEALED & DATED this
31ST
day of
JULY
199
AMERICAN BONDING
i\
i 'Surety, \
B~~l,-C .
A~to~ney-in-Fact
COMPANY
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ANNELIE I DOUGLASS
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East Bay Surety
Bond Insurance Services
91 Gregory Lane #5
Pleasant Hill, CA 94.523
TO:
CITY OF CAMPBELL
AMERICAN BONDING COMPANY
General Status Inqu~ C I IV jJ JId
SEP 0 3 1992
Date: 08/14/92 Bond #: BND4381129
Bond ~U.cnWorks/Engi~ri,Q..OO Type: SUBD
Effective Date: 07/.~/91
Principal: MARSHALL M. PETTY
Agent: EAST BAY BOND & INSURANCE
SBG#:
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70 NORTH FIRST STREET
CAMPBELL
CA 95008 0000
Job:
As Surety for the above bond, we need a status report on the progress of the
job described above. Your completion and prompt return of this brief inquiry
would be appreciated and prove helpful to us both. These inquiries will
be sent periodically until the job is satisfactorily completed.
1. Is work completed? Yes
If no, percent completed
No ~ If yes, date completed: 1 1
% and probable completion date:===I===I===
2. Is final payment made? Yes
If no, payments to date: $
No
If yes, date made: 1 1
Amount retained --- --- ---
3. Is work progressing satisfactorily? Yes No
If no, why not?
4. Are payments due to contractor assigned? Yes No
If yes, to whom?
5. Is contractor promptly paying labor, suppliers, subcontractors, etc.?
Yes No Comments
6. Any liens or withhold notices filed? Yes
If yes, by whom
No
Amount
7. Original Contract Amount $
Change Order Amount $
Final Contract Amount $
Remarks: (')fF .siT~ IIJ\Pu..DV,::-Mii"Ni'S /JOI s-rAR.:rtr-D -130J..iD lL' 12t;'-}./}AIN iN FoRGe'"-
PlEAS;; oc:.,:; C~l-ry OF CAMpBeLL. PE~MI7" "# ,?>j-J~9 IJJ Fu1'"uRF /NGI'IIf?..~<..
It is understood that the information contained herein is furnished as a
matter of courtesy for the confidential use of the surety and is merely an
expression of opinion. It is also agreed that in furnishing this
information, no guaranty or warranty of accuracy or correctness is made and no
responsibility is assumed as a result of reliance by the surety.
Date: sepJ'. +, /992-
,
By: ~~~
Title: PU8'.le... WrJJe.t<c;. /jJ ~ p6~C/O.e..
6245 E. Broadway - P.O.box 16862 - Tucson, Arizona 85732 - (602)747-5555
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CITY OF CAMPBELL
70 NORTH FIRST STREET
CAMPBELL. CALIFORNIA 95008
(408) 866-2100
FAX # (408) 379-2572
Department: Public Works
November 5, 1993
Marshall. M. Petty
1031 Hazelwood Avenue
Campbell,CA 95008
Subject: Permit No. 91-169, 1031 Hazelwood Avenue
Bond No. BND4381129
Dear Mr. Petty:
The City has performed a final inspection of the work performed under the above
encroachment permit and find it acceptable and in conformance with City standards. Your
cash deposit of $1,240 is hereby released, and will be sent to you under separate cover. As
the requirement for street improvements was replaced by a Deferred Street Improvement
Agreement, only a small amount of inspection was required for your project. Accordingly,
the City is refunding $2,325 from the plan check and inspection fee which you posted. This,
too, will be sent to you under separate cover.
Because of the limited amount of work done in the public right-of-way, a one-year warranty
period will not be required for this project. Your performance surety is hereby released.
You executed a Deferred Street Improvement agreement to replace the requirement for
installing street improvements on this project. If, as City staff expects, the San Tomas Area
Policy takes effect on December 15, the City will release your agreement. If you have any
questions, please do not hesitate to call me at 866-2158.
V~/7 ~~ur~_ //1
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Michael A Fuller
Assistant Engineer
cc: American Bonding Company, P.O. Box 16862, Tucson, Arizona, 85732
File: Permit No. 91-169
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CITY OF CAMPBELL
MEMORANDUM
From:
Joan Bollier
City Engineer
Mike Fuller fJJ- f)~
Assistant Engineer
Date:
October 21, 1993
To:
Subject:
Permit No. 91-169, 1031 Hazelwood Avenue
The permittees on the above encroachment permit executed a deferred street improvement
in-lieu of installing street improvements. They have satisfied the conditions set out to
them on June 4, 1993 for the release of their improvement bond and cash deposits. I
propose that these items be released at this time. Attached is a letter and check request
which will accomplish this.
A plan check and inspection fee of $3, 100 was collected with this permit. As very little
inspection was performed, I propose that we refund 75% of this fee. This seems
appropriate considering the cost of plan check is usually considered to be approximately
20%-25% as much as the cost of inspection. Attached is a check request in the amount
of $2,325 which would refund of the above percentage.
I also propose that no maintenance period be established for the work which was done
in the public right-of-way. The work consisted of a pot-hole patch, and this area has
already been chip-sealed by the City.
If you have any questions, or need further information, please let me know.
attachments: letter
check requests
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i SPECIAL INSTRUCTIONS i FOR i' HMrolING OIEac: ,'~ '/'t;'f it:., ,'....'.,(,..f..,.....,...'l..,;.cl... "'.i.t . 't~,},..
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CHECK REQUEST
TO: FINANCE DIRECTOR
CITY OF CAMPBELL
Please issue check payable to: Marshall Petty
(30 spaces)
(30 spaces)
Address:
Line 1:
Line 2 :
1031 Hazelwood Avenue
City:
Campbell
(20 spaces)
(30 spaces)
State: ~ Zip: 95008
(2) (10 spaces)
Description: P Ian Check & Inspec. Fee
(24 spaces)
Exact Amount Payable:
Account Number:
$2,325.00
905.4443
Refund of plan check & inspection fees in connection
PURPOSE:
with property at 1031 Hazelwood Avenue - Perrnit#91-169 _
Receipt #43001 dated 6/17/92 (See attached memo dated 10/21/93)
~
Michael A. Fuller
~ /"AJ~
fJan M. ~ol~
SPECIAL INSTRUCTIONS FOR HANDLING CHECK:
Requested by:
Title:Asst. Engineer
Date:
10/22/93 '
10/22/93
Approved by:
Title: City Engineer
Date:
Mail as is
xx
Mail in attached envelope
Return to:
(Department)
(Name)
Other:
Rev 08/22/88
City of Campbell
Dept. of Public Works
70 North First Street
Campbell, Ca. 95008
August 16, 1993
ATTN: Mike Fuller
RE: 1031 and 1033 Hazelwood Ave.
Dear Mike,
Due to our desire to maintain the rural feel of the San
Tomas area we requested a "Deferred Improvement Agreement" ,
which the City of Campbell approved. As a result the amount
of inspection originally planned for was not required.
Therefore, we are requesting that a portion of the
inspection fee be returned to us. We appreciate your
consideration in this matter.
/1
?~;;l/~
Marshall Petty
RECEIVED
AUG 271993
PUBLiC VVI.Ji{i(:.>
ADMINISTRATION
CITY OF CAMPBELL
70 NORTH FIRST STREET
C AMP BEL L. C A L I FOR N I A 9 5 0 0 8
(408) 866-2100
FAX # (408) 379-2572
Department:
Public Works
August 9, 1993
Marshall M. Petty
1031 Hazelwood Avenue
Campbell, California 95008
Subject: Permit Number 91-169, 1031 Hazelwood Avenue
Dear Mr. Petty:
Attached please find a red-lined check print of the grading and drainage plan for the above
project. Please make corrections in accordance with these comments, and return three
copies to this office for review.
A final inspection is being performed on the work done in the public right-of-way with your
project. A list of deficiencies will be sent to you shortly. Upon completion of the grading,
grading and drainage plan, and offsite work, your encroachment permit, bond, and deposits
will be released.
If you have any questions, please do not hesitate to call me at 866-2158.
~$A
Michael A Fuller
Assistant Engineer
~
Attachment: Grading and Drainage Plan
JAN 11 '93 139: 24
, . .-f>, 1~/ -j (;l
Phoneh 377~727
Fad 3.77-35'8'6
January 7, 1993
City of Campbell
70 N First Street
Campbell) CA 95008
A'ITN: Mike Fuller
RE: 1031 and 1033 Hazelwood Avenue
Dear Mike;
As we previously discussed we would like to request that we be issued
a deferred Lmprovement Agreement in lieu of previously proposed plan-
ned improvements. We would like to make this change in order to main-
tain the "country" atmosphere present in the area.
Thank you for your consideration in this matter.
Very trol~rSj .' ,_
c-71~t ~y. _~
Marshall Petty
David Houge
kk:\:"-"i/V'...
"" .~J
JAN 11 1992
Public WorksjEngir:ocring
(LITf aF CAMrR,E(L
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 4, 1993
Marshall Petty
1031 Hazelwood Avenue
Campbell, California 95008
Subject: Permit Number 91-169, 1031 Hazelwood Avenue
Dear Mr. Petty:
On April 20, 1993, the Campbell City Council executed deferred street improvement
agreements with you and David Houge for the properties at 1031 and 1033 Hazelwood
Avenue. These agreements were taken in lieu of street improvements on the frontage of
these properties. The encroachment permit deposit and bond which you previously
submitted for the installation of street improvements at this site will be released upon
completion of the following items:
1) The trenches in the public right-of-way must be repaired to the satisfaction of the
City.
2) The street shoulder in the public right-of-way must be graded to drain and restored
to the satisfaction of the City.
3) Because the onsite storm drainage system was eliminated, the grading and drainage
plan must be amended to reflect this and any other changes. The revised plan must
be signed and stamped by a licensed engineer, land surveyor, or architect. The
following statement must be made on this plan: "The design shown hereon is
necessary and reasonable and does not restrict any historic drainage flows from
adjacent properties nor increase the runoff to adjacent properties." Please submit
this plan for review by the City.
When all of the above requirements are met, your cash deposit in the amount of and
$1,240.00 will be released. Upon placement of a maintenance surety in the amount of $500,
your performance bond will also be released. The work which you did in the public right-of-
way will then enter a I-year maintenance period.
CITY OF CAMPBELL
Marshall Petty
June 4, 1993
Page 2
If you have any questions, please do not hesitate to call me at 866-2158.
~~
Michael A Fuller
Assistant Engineer
~Q
cc: Chuck Gomez
File (91-169)
h: \petty
,
Please issue check pa~able to:
I"
T"f"j:: .
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'., TO: SANDY TERPKO
ACCOUNTS RECEIVABLE
( .. )
, >,.1
: ...1; ,~~':""'(,'~,,\')"_~: :')"; ,'p. ......-J.:
1031 Hazelwood Ave
Address:
, I. Line 1:
Li ne 2:
-' .', ",~,,:..c:"~{?;:'~',l "';: ::'>,' ;.>:
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. (
City: Campbell' 'St~i~t"CA"';':iiP: 95008
, ' ",:t~;;:t~>.. ,'~ ..
Description: Ref Deposit/Permit No: 91-169:;';:~:f~I~!EREST EARNED
, Exact Amount Payable: $500 .00' i";;"'~'f'~-;~.',./ '
,
"
- ;Ii ',\ "
LOCATION: 1031 Haze~wood Ave
7
DATE AND NO. OF RECEIPT:
" ;',. ,.' ;" "."," l ,".." ,'., ,>,'
, '," . .,' ";",,/" \x~"J ) ''',',
.- ''; ,- ",~;,,':'..,::G.'i <:"(~"';;;:1J~/,),i'i!~)~r~,}i,.' :...;,",
.-,/ ..,','
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. 'Account Number:
plan check\de~osif
PURPOSE:
Requested by:
Approved by:
Verified by:
';I,'
"(J.-.'
~L ~ /,::
Mike Fuller
" Michelle Q~in~
!
,:" ;), <f~i;,~~i:~f;~h~f,j'<'>:'
,~~}3~;?~ ", . ,,(,~>~)~,;" ..
Title':AsstjEngr:'~"'.":i':. A Date: 6/2/93
'jht'J;ilr'(,,\"',:~ '.
Title: Acting "City Engr Date: 6/2/93
,( :", ?":it.7{tf
Title:
Date:
, ,
,'" -" ":. \~, ):'; .'t" ~ '<
~:~~'~:.':;'\.:;
":'JL:~;/:'t~;.~.
.i"F:'.:
in attached envelope
SPECIAL INSTRUCTIONS FOR HANDLING CHECK:
Mail as is
xxx
:!Mail
Return to:
"
(Department)
;\. (Name)
t,,'
'.
Other:
't '
.,-"\,
,~
Rev 11/21/91
Ref. No.
TELEPHONE CALL RECORD
DATE 1/13/'3
TIME I : tit)
PROJECT p~,eJflIT .:p:. C} / - / , ?
, PLACED CALL
C RECEIVED CALL
OF
Mf/ F OF C of'C SPOKE WITH
NAME
$.C,i/( W,D.
COMPANY
bENE SlJt..LI flR/V
NAME 6~ ~ ~}(7, Z2S7
;;;. v. P'f , 07:)
TELEPHONE NO.
ITEM DISCUSSED/.\CTION REQUIRED .I 77JZ.1:> t:.~N6 ~&rJr /::I()()6~ ""DJ2~/N/N'
TO 7716 f3ACe:. J ANn I:-/~ 5~ 11) 7Hnv 1/6'1) Llk~ fO
5 ~ G "q GI2Jq'lJIN'
PCI4/l1. ~ND J.lL CI!JV~]) 61 l/G A
~UICIt. ~1V5fA)~/!.. l./~ ~AI7) 1N147" J7-1~ //II~G75 @
7H6- ~I4CKS ~ 7JI"S~ f'At()fJt!T<71~S 114 /'Z~ ~t1C~y HANv7J9/w6l;"
.
flJlJl) 6.,t~~ss,v~ fvxv -ro 7}f6 ~JIICJC. MA)/ ~ ~ p~4aM,
-
DISTRIBUTION:
~/t.6.
CONTINUED:
eYES
I!J NO
JAN 11 '93 09: 24
P.2 9/-/6'1
January 7, 1993
City of Campbell
70 N First Street
Campbell, CA 95008
AnN: Mike Fuller
RE: 1031 and 1033 Hazelwood Avenue
Dear Mike;
As we discussed it will not be possible to install the off site storm
line indicated on our plans due to the high invert elevation and utility
conflicts. Therefore, it will be necessary to alter our on site draw-
ings .
Plans will be following reflecting the changes we discussed.
Very Truly Yours
c- ff~~~-
Marshall etty ;.u':.
David Houge
kC\.-'LlllV
... ~..,
JAN 111992
PUblic Work-dE .
"', ng:r.ooring
AMERICAN BONDING COMPANY
Iii:iCr.:.V..~
DEe 211992
General Status Inquiry
Public WorksjEnginoc:,ing
70 NORTH FIRST STREET
CAMPBELL
CA 95008 0000
Date: 12/16/92 Bond #: BND4381129
Bond Amount: 31,000 Type: SUBD
Effective Date: 07/30/91
Principal: MARSHALL M. PETTY
Agent: EAST BAY BOND & INSURANCE
SBG# :
TO: CITY OF CAMPBELL
Job:
CITY OF CAMPBELL PERMIT #91-169
As Surety for the above bond, we need a status report on the progress of the
job described above. Your completion and prompt return of this brief inquiry
would be appreciated and prove helpful to us both. These inquiries will
be sent periodically until the job is satisfactorily completed.
1. Is work completed? Yes
If no, percent completed
No ~ If yes, date completed:___I___I___
% and probable completion date:___/___/___
2. Is final payment made? Yes
If no, payments to date: $
No
If yes, date made: 1 1
Amount retained --- --- ---
3. Is work progressing satisfactorily? Yes No
If no, why not?
4. Are payments due to contractor assigned? Yes No
If yes, to whom?
5. Is contractor promptly paying labor, suppliers, subcontractors, etc.?
Yes No Comments
6. Any liens or withhold notices filed? Yes No
If yes, by whom
Amount
7. Original Contract Amount $
Change Order Amount $
Final Contract Amount $
Remarks: P..P:VI6kJIN.(;~ c!)rP' .S'IC PLAj.j5
It is understood that the information contained herein is furnished as a
matter of courtesy for the confidential use of the surety and is merely an
expression of opinion. It is also agreed that in furnishing this
information, no guaranty or warranty of accuracy or correctness is made and no
responsibility is assumed as a result of reliance by the surety.
By: ~ ~.~
Tltle: Pt.J6 L/(', lA/Ok' ~r, /).} <'JJEY_TLJ~
,
Date:
J rrAi 8 ' / 9 C) 3
)
6245 E. Broadway - P.O.box 16862 - Tucson, Arizona 85732 - (602)747-5555
,.ERICAN BONDING CaMP. I
General
Status Inqu~ ~ , i 'V i jl;.)
SEP 0 3 1992 n;"...~-
Date: 08/14/92 Bond #: BND4381129
Bond ~UchWorksIEngi~Jfi.w>O Type: SUBD
Effective Date: 07/"3t/91
Principal: MARSHALL M. PETTY
Agent: EAST BAY BOND & INSURANCE
SBG#:
TO:
CITY OF CAMPBELL
70 NORTH FIRST STREET
CAMPBELL
CA 95008 0000
Job:
As Surety for the above bond, we need a status report on the progress of the
job described above. Your completion and prompt return of this brief inquiry
would be appreciated and prove helpful to us both. These inquiries will
be sent periodically until the job is satisfactorily completed.
1. Is work completed? Yes
If no, percent completed
No ~ If yes, date completed: / /
% and probable completion date:==:/==:/==:
2. Is final payment made? Yes
If no, payments to date: $
No
If yes, date made:___/___/___
Amount retained
3. Is work progressing satisfactorily? Yes
If no, why not?
No
4. Are payments due to contractor assigned? Yes
If yes, to whom?
No
5. Is contractor promptly paying labor, suppliers, subcontractors, etc.?
Yes No Comments
6. Any liens or withhold notices filed? Yes
If yes, by whom
7. Original Contract Amount $
Change Order Amount $
Final Contract Amount $
No
Amount
Remarks: ('JFF oS iT~ rlJ\F>Rc)\lI~M /;N 7'~ /.JOt Sr.4R..76f:) - eOkJ D /0 Rt:.-MA-I J.J IN n.T"Jt<.Ge'" _
PLEAS;; 0<;':: C-l-ry OF CAMpBeLl., P€PM/7"' -d:. '?>I-J~c~ IIJ I=u7'"uR,J.:" JNr:r"d!..~"
It is understood that the information contained herein is furnished as a
matter of courtesy for the confidential use of the surety and is merely an
expression of opinion. It is also agreed that in furnishing this
information, no guaranty or warranty of accuracy or correctness is made and no
responsibility is assumed as a result of reliance by the surety.
Date: 5 epoi'. +) J 992.
By: ~~~
Ti tIe: PI.JI3t..Ie., W()R.J<~ /jJ ~ p6'Cr'OI!:..
6245 E. Broadway - P.O.box 16862 - Tucson, Arizona 85732 - (602)747-5555
TO:
City Clerk
q / C
PUBLIC WORKS FILE NO, / - 0' i
/
Please collect & receipt
for the following monies:
35-3396
ACCl ITEM AMOUNT RECEIPT NO.
$
3372
3521
3521
3521
Project Revenue (specify project)
Public Works Encroachment Permit Fees:
Application Fee
Plan Check Deposit
Faithful Performance (Cash) Deposit
($105)
($500)
(100% of)
(ENGR. EST)
(4%of FPS)
($500 min,)
L\.~(j0 I
Other Cash Deposit (specify)
3372
L\. ':>00 (J
3373
3373
3373
3373
3372
3372
3372
3372
3372
3370
3380
3395
3510
Plan Check & Inspection Fee ($0 - $100,000 10%;
$100,000 - $500,000 9%; $500,000 and above 7%; $100 min,)
Project Plans & Specifications
General Conditions, Standard Provisions & Details ($10 or $1/page)
"No Parking" signs ($1/ea, or $25/100)
Copies of Engineering Maps & Plans ($.50/sq.ft.)
Final Parcel Map Filing Fee ($475 + $21/ per lot)
Final Tract Map Filing Fee ($525 + $21/ per lot)
Lot Line Adjustment Fee/Certificate of Compliance ($420)
Vacation of Public Streets and Easements ($500)
Assessment Segregation or Reapportionment
First Split ($500)
Each Additional Lot ($150)
Storm Drainage Area Fee per Acre (R-1, $1,875;
Multi-Res., $2,060; all other, $2,250)
Public Works Special Projects
Park Dedication In-lieu Fee
Postage
NAME OF APPLICANT
ADDRESS I ~(""{ I
FOR
CITY CLERK
ONLY
TOTAL
$ ~S L!cJt[r(;)
111;) J,.iZS+iA U-
IV'l;./2./Ltlt Lap
/>1. u---J
. r CI I I
SAN
.J() S Q
eA-
PHONE
C(7ff-oj/'{
ZIP 9~n.<4.
RECEIVED BY
DATE
~
\.Q- \, -~::L
JLHj-16-1992 13: 11 FF'C - I B SH~,j JCiSE
CERnFICATE()J=f:SI.i~(;g,iii . ... ...C$R" "'"'DA:;~~~1'"
"il! ,...". T~ISCERTIFICATE IS ISSUED AS A MATTEA OF INFORMATION ONL V AND
!lrok6r... Ii CONFERS NO RIGHTS UPON THE CERTtflCATE HOLDER. THIS CERTIFICATE
:ii DOES NOT AMENO, EXTeNO OR AI. TER THE COVERAGE AfFORDED OY THE
;1 POLICIES 6ELOW.
I
i
~
~
ACORD~
PAOO~IC"R
.J"rdl no= I t')'.;urGr.:-:
c.in Joc.e ! nc:.
152 N. lhird St.. SUit. 800
San Jo~e tA ~S11~-SS60
4(J(j-{8SJ-OOOO
11'<~l,)r,co
Ncrn~n ~. HQWae, l~., ~tut.
200 Crl.tich Lane
\:tIl~-<ll CA 9':,OQe
.-.~--'
TCi
-:.:'''''''"<1.:'1-' .-
_I ( l...)_,ob
P.02
COMPANIES AFFORDING COVERAGE
COMP..NY A fiiE'W "arrvshire
LETrER
COMPANY B California C~'stloo
U;-mA
COMPANY C
LETTER
COMPANY 0
I.ElTEA
COMPANY E
U::ITEA
..
C!.'l'Jl:AAt;E-S . ";" "', " 1"/";":::':::'< "!.,",::,;;~", '
, HI~ 15 TOcr'm,.-~'I'HA"rHe F>()UCIE$ OF INSiJAAI'lCf l.I~"ED -i.DW HAVE BEEN IE,~U€O 10TI1e;IN~\JACO N.....MEOABO\/E FOF\TH~ POliCY PEAlOO
INCnCA n:r.. Nm\<oJrIH~; rAilDINCl ANY IlEOUH'lCtvlCtff, TH1~1 ON0lT10N OF ;INY Cr.lNTAACT OR O111f:R OOCUJ\1ENT WI rH RESft<:T 'fQ WHICH nl15
r,E~,r,Fr(:A TE ",,,y f:l~ 1<<;:;i,ltD OR M","" P!::/rtAIN, TMi I N !1lI iliA N .. Aflf"CI",OW or rr1!; PO'.ICIES OfSCRlBED H~ffElN 15 SUSJECTTOALL "O-iE'TERM5,
[/J~LU;:'IC:NS ArlO cOW). I jON~ ur r.L:'H POLICIES. UMITS ~MO ~ MA'( HAvf flEEN "EOUC~O IIY PAID CLAIMS,
CO
LTF<
TyPE OF IN:,U:l..illCf:
~UCY N ~SER
Cl[r;::AAL UAa,Urr
A )( ":lMlv.E'r'C1AL GENfP^L LIAblUTY
,ClAIM!! fJA'1! X OCr.'VR.,
O',V;jER'S t. '~NT"ACTOR"~ PI1CT,
AVTOMoai!..E u"filu I Y
AN'( AV'lv
I'.LLOWI<lEOAUT03
...')( ;,CHE:~UU:D "'-IID3
)( ..., Rc;O AUTO..
X NON-:lWNI:OAUTOS
UARAGiE. UAtllU ry
,I
CPD96"J
1
!
II
i
excrss UABIUi'(
t IMA~E'li..A FOAr.~
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Q
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W,~FH;fR'~ i:()Mf't:N~?'o 110""
Arm
EMPlOYERS' UI\8IUT'r
, OTHER
CEf-l'TrlCA Tf: HOWt:.H
[jE.sCrtIPT,I)r, 01' Di'E"~ nON~fLOC" TICN:lIYEHICl.ES~~IAI. t'tEfIII
lie: 1031 t 103J Kazt(wOQd enel 1SOO & 1~ Whilte
City of Cl<ll~ll
70 H. FirH St.
C'1ll~ll C.l 95008
FOUCY EFFECTIVE KJUCY EX?IAATlON
DATE(MM/DOfm . OATE (MMIOCjYY)
UMlr~
06/18/91
06/18/92
CSNEAAlAGQR~GA~ $
PAOOUCTS<:O/tlP/OF AGO, $
P(Ft~ONAL & ...0'0'. INJURY :I;
EACH CCCUFl~NCE ~
FlAE DAMAGE: (Anyone tire) $
11018), E/.t'EN~E (Any one per~o"
2.000,000
1,000,000,
, , 000, 000
',000,000,
50,000
S,OOO
06/18/91
Cl2/0S/9"
C~ll, Ca.
CANf'~~T,tQN,;;.;,\;> ,~..'.';'..'."'.:...
SI-tOULD ANY OF THE A80ve OeSCRJ!)eo PQUC1e~ ee CANCELLED !lEFORE THE
EXPIR..mON DATE THEReof. Th[ ISSUING COMPANY V>lLL ENOeA\iOR TO
MAIL l2..oA YS WAI'TTEN NOTlce TO TI'1!i <:eATlFICATE HOLDER NAMCO TO THE
!.EFT, 8l1T FAILURI;TO MAIL SUCH NOTICE ~,tJ\~~ IMPOSE N006IJ::>AilOI</ OR
llABIUTY OF ANY IQ~O UPON THfCOMPANY.IT:;. AGt::I'lTS OR R€PRf:SEtlTA~""ES
p.,r'::r)t".o2.'r~, \T!'XJj
-----....'......_~...-
, i'"
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(/'
~7Z4~
, ',AC0RO cooroAATloN1~~
JUI ~u It:,-'19'3:? 13: l:? F' - JIB '3AH JCJ'::,E TO 3773':::;6 P. 03
NOrmLl" B. Htge, I nc .
THIS ENOORSEMENTJ~HANGES THE: POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL NSURED - OWNERS, LESSEES OR
C NTRACTORS (FORM B)
Trtis endorsement modifies insl.lran ~ prcvjd~d under the fOllowin~:
COMMERCIAl. GENERAL Ll BILlTY COVERAGE PART.
I
SCHEDULE R E :
1031 & 1033 Hazelwood and
1800 & 1806 White Oaks Road
Carnpbe 11, Ca.
NamCi \It Purson or O~illni:tatiQn:
City of Campbell and its r spective officers, agents
-1i-iCi e(1ployel?s are namedadl i~tional insured from any
Cdildgc-, loss, l1ability, c sts or exp.:!nses ar-ising
out of or in any WdY conne ted with the construction
project.
(It no etl~ry appears abov~. informaon required to ~omplete this er'ldors~m-:nt will be shown in HIe Declarations
a$ <.1pplicable to this endorsement.
WHQ I~ AN INSURED (S6Ct;Oli II) i amended to include iJS an insured the person or organll.aticn shown in the
Schodu'e. but only with resp.c' to l.bilitY .'''ong out of "you, WO,"" fo, ",at insured by or fo, you.
I
~
I!
TnlS coverage shall be priJary and any coverage carri0d by additional insured shall
be excess only. ! .
CG 20 10 11 85
Co yright. Insurance ~ar"ices Office. Inc... 1984
o
CITY OF CAMPBELL
Perm1t No.
q/-/0?J
INFORMATION SHEET FOR ENCROACHKENT PERMITS
WORKERS' COMPENSATION INSURANCE INFORMATION
Name of contractor~~))-Iuj/'>-/)~// Ii ?E.f")-J
--
One of the following must be on file with the Public Works Department:
A Cettificate of Consent to Self-insure issued by the Director of
Industrial Relations; OR
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~o the Yorkers' ompensation Laws :f caJ1fornia.
signed~g ~~ Date S~/ &2-
,- ... - ( /
NOTICE TO CONTRACTO~PPLI~ If, after signing this
Certificate of Exempt1on;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 and sub-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
Other (specify)
Electrical
f:perminfo
10/91
.'
(
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
~1.;li'r; i] c r!~,{l-E--_n_-'--T\~[]
;,:fl;~it~Tll .'l~-'r\
I D (;'1 , ,: I;' ~T-:-.a:: :. '
L..:I.\,_:\_i\rm"~'
f~}-'~:~'~~-~- i_!.. 'Jj~
I"". /'
I . -,; ~. ,_, , __I___~ ..
CITY OF CAMPBELL
Department: Public Works
January 9, 1992
Marshall M. Petty
1691 Merrill Loop
San Jose, CA 95124
SUBJECT:
Encroachment Permit No.: 91-169
Application Expires: 1/10/92
Permit Address: 1031 Hazelwood
Dear Mr. Petty:
Our records indicate that you applied for subject Public
Works Encroachment Permit approximately six months ago.
This is to remind you that applications for these permits
expire six months from the application date. The
expiration date is shown above.
If you wish to have the permit issued prior to expiration
of the application please call this office to find out what
needs to be done.
Very truly yours,
JI2~
Don King
Engineering Tech II
DK: j d
f:91-169(JD)
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PREMIUM CHARGED ANNUALLY
,
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BOND NUMBER: 0438 1129
Aluerican Bonding COll1pany
PERFORMANCE BOND
--------------------------------------------------------------------------
KNOW ALL MEN BY THESE PRESENTS, that we
MARSHALL M. PETTY; DAVID N. HOGUE
hereinafter called the Principal, and AMERICAN BONDING COMPANY
hereinafter called Surety, are held and firmly bound unto
CITY OF CAMPBELL
in the amount of
hereinafter called Obligee,
THIRTY-ONE THOUSAND AND NO/100*****
Dollars ($31,000.00
for the payment of which Principal and Surety bind themselves, their heirs,
executors, administrators, successors and assigns, jointly and severally,
firmly by these presents.
WHEREAS, the Principal has by written agreemeqt dated
, 19
, entered into a contract with the Obligee for
~PERMIT 902-2, 1031 HAZELWOOD, CAMPBELL, CA
in accordance with drawings and specifications prepared by
which contract is by reference
made a part hereof, and is hereinafter referred to as the Contract.
NOW, THEREFORE, The condition of this Obligation is such that, if Principal shall
promptly and faithfully perform said contract, then this obligation shall be null
and void; otherwise it shall remain in full force and effect. Whenever Principal
shall be, and declared by Obligee to be in default under the contract, the Obligee
having fully performed Obligee's obligations thereunder, the Surety may promptly
Femedy the default, or shall promptly:
1) Complete the work under the contract in accordance with the plans and
specifications, or:
2) Obtain a bid or bids for submission to Obligee for completing the work
under the contract in accordance with the plans and specifications and upon
determination of the Obligee and Surety of the lowest responsible bondable
bidder arrange for a contract between such bidder with corporate surety and Obligee,
and then pay the Obligee the bidders price less the balance of the contract price
but not exceeding, including other costs and damages for which the Surety may
be liable hereunder, the amount set forth in the first paragraph hereof. The term
"balance of the contract price" as used in this paragraph, shall mean the total
amount payable by Obligee to Principal under the original Contract and any amendment
thereto, less the amount properly paid by Obligee to Principal.
Any suit under this bond must be instituted before the expiration of one (1) year
from the date on which final payment under the Contract fall due.
No right or action shall accrue on this bond to or for the use of any person or
corporation other than the Obligee named herein or the heirs, executors,
administrators or successors of Obligee, and this instrument may not be transferred
or assigned without the written consent of the Suret~.
3)If this bond is issued in conjunction with a payment bontl, the amount herein stated, is
part of the payment bond and not in addition to.
SIGNED AND :::El\!..E: THIS 30TH da'T of JULY 19 91
BY:
(8-90)
East Bay Surety
Bond Insurance Services
91 Gregory Lane #5
,."
MARSHALL M. PETTY; DAVID N. HOGUE
~ ,p~iPal Seal
BY, tlfI;' ~~ ~~\,c=-~
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AME AN BOND~ COMPANY /8 I~' r
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Attorney-In-Fact (Seal -
ANNELIE I DOUGLASS
Form 106
STATE OF CALIFORNIA
<XlUNTY OF LOS ANGELES
On this 4 day of November, 1989 , before me a Notary Public, personally
appeared the above-named officer of AMERICAN IOIDING a:MPANY, a corporation, known to me
to be the person and officer who executed the above Power of Attorney on behalf of the
coq:x:>ration and acknowledges the coq:x:>ration and acknowledges the coq:x:>ration v.:)luntarily
executed the same. ?PI. ..J. ~ 4.1' ""~
. OFHnAL SEAL Notary Public L1J?r'
- M. S. RODRIGUEZ 1/ U
. NOTARY'l'IUC.(.AUFORNIA
. ,IUNO'AI. OtFlU IN
I.OS AN(;t:US ('Ol'NTY
Uv r..nmmis~ion Expires Nov, 3. 1993
\
A 1'! E R I CAN BON DIN G C v ,i PAN Y
PASADENA, CALIFORNIA
A STOCK cn1PANY
0438
r\J~
1129
PCMER OF ATI'ORNEY
AMERICAN BCtIDING cn-tPANY, a Nebraska Corporation, having its administration office in
the City of Pasadena, State of California, does hereby make, constitute and appoint
ANNELIE I. DOUGLASS of Pleasant Hills, California
as Attorney (s)-in-fact, with full power and authority hereby conferred to execute and
deliver and affix the seal of the corporation thereto, if a seal is required, for and
on its behalf as SUrety and as its act and deed, all of the following classes of
documents, to wit: any and all bonds and undertakings, recognizances, contracts of
indemnity and other writings obligatory in the nature thereof, which are or may be
allowed, required or permitted by law statue, rule regulation contract or otherwise,
for any single obligation, regardless of the number of instruments issued for the
obligation.
This power is construed to be used for any and all bonds in an
amount not to exceed Five Hundred Thousand ($500,000.00)
AMERICAN BCMJING CU4PANY further certified that the following is a true and exact
copy of Artilce VII Section 3. of the By-Laws of AMERICAN BCl'IDING cn-tPANY duly adopted
and now in force, to wit:
SECl'ION 3. All bonds, undertakings, recognizances or other written obligations
of the coq:x:>ration shall be executed in the 'hame of the coq:x:>ration by the
president, any vice-president, secretary, any assistant-secretary or the
treasurer, or by such other persons as may from time to time be properly
authorized. The president, any vice-president, the secretary, any
assistant-secretary or the trea~urer may appoint,or remove resident vice-
presidents, resident assistant-secretaries, attorneys in fact, agents or
other persons who shall have authority to issue and deliver bonds,
undertakings, recognizances or other written obligations in the name of the
corporation. The corporate seal is not necessary for the validity of any
bonds, undertakings, or other obligations of the coq:x:>ration. The signature
of any authorized officer and the seal of the corporation may be affixed by
facsimile to any power of attorney or certification thereof authorizing the
execution and delivery of any bond, or undertaking of the corporation; and such
signature and seal when so used shall hove the same force and effect as though
manually affixed.
IN WI'INESS WHEREOF, AMERICAN BONDING C'a1PANY has caused these presents to be
executed by its duly authorized officer and its corporate seal affixed, this
~ day of Novemher, 1989.
/.~q~:~~:?~~,<;,
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CiR~iIFICA.rIG~;
I, the undersigned, certify that I am the Secretary of AMERICAN BCl'IDING CD1PANY, a
Nebraska corporation, and that the attached Power of Attorney remains in full force and
effect and has not been revoked; and furthennore that Article VII Section 3. of the
By-Laws of said company as set forth in said Power of Attorney, are now in full force
and effect.
IN TESTIMONY WHERIDF, I have hereunto subscribed my name and affixed the corporate
seal of the said Company this
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30TH day Of,. JU:: C1'~9' .
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Secretary
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SURETY RIDER
To be attached and form a part of American Bonding Company Bond No.
0438 1129
in the amount of $ 31,000.000
on behalf of
MARSHALL M PETTY; DAVID N HOGUE
as Principal and in favor of
CITY OF CAMPBELL
as obligee.
It is understood and agreed that the above described bond 18 hereby modified as to the
following
TYPOGRAPHICAL ERROR ON DAVID N HOGUE'S NAME
The Surety hereby amende the bond to read:
From:
DAVID N HOGUE
To:
DAVID N HOUGE
'l':
Nothing herein contaiued 81~11 be held to vary, alter, waive or extend any other t8rms_
agreements, conditions.or limitations of the above mentioned bond, other than as stated
above.
SIGNED, SEALED & DATED this
31ST
day of
JULY
199"
AMERICAN BONDING COMPANY
B~~
Aftorney-in-Fact
ANNELIE I DOUGLASS
~
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East Bay Surety
Bond Insurance Seruices
91 Gregory Lane #5
Pleasant Hill, CA 94523
H'I',\Tg (}J~ C,\J.IFOIlNIA
H:I.
COm'lTY Ol~ .. . . ~9~~~~. .C;:~W;L:~. .
. 31 st . July . 1 991
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OFFICIAL SEAL
C~mISTlE J. WASH
NO :^RY PUBLIC-CAliFORNiA
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"",t;oI,( """',.""l1on
TO:
City Clerk
PUBLIC WORKS FILE NO.
J
'-
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Please collect & receipt
for the following monies:
ACCT ITEM AMOUNT RECEIPT NO
3372
3521
3521
Project Revenues (specify project)
Public Works Excavation Permit Fees:
Application Fee
Plan Check Deposit
Faithful Performance (Cash) Deposit
R-1:
($50)
Other:
($100)
($500)
(100% of)
(ENGR. EST)
(4% of FPB)
($500 min.)
$
2(j 30'13 -7
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.....~
,:;"c::c c:::.. '~''J -1 3 <((
35-3396
3521
Other Cash Deposit (specify)
($200)
3372 Plan Check & Inspection Fee ($0 - $100,000 10%;
$100,000 - $500,0009%; $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 ($1/ea. 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
cC:
$ 0' CL'
PHONE 97 ~--(J/11
ZIP 9.~/;J..1
NAME OF APPLICANT
ADDRESS (
FOR
CITY CLERK
ONLY
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ENCROACHMENT PERMIT ISSUANCE (;heCK LIST
Encroachment Permit No. Cll- / i- q
,
City of Campbell
Department of Public Works
~Applicant section complete
~Applicant signature and date
~permit Application fee $100.00 paid
Receipt number .~ 0 /7 .~ '1-
~Plan check deposit, $500.00 paid
) )
Receipt number~ 0 rJ "'> ,'- L
VFive sets of improvement plans submitted
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~Bond for faithful performance, 100% of City Engineer's
estimate, supplied or paid
Amount $ .....31, () 00. <.to Form '6 C t-' 1~ 1. D. # b'l-)(5 II z q
f -/
~cash Deposit: 4% of FP bond, $500 min. paid, ,
Amount $ {2..yo _ C'Q Receipt No. t/30(.>c
~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. pa~~ I
Amount $ ;3, It:) 0, G (; Receipt No. Ct....5C("'1 I
~'
_____Workers' compensation information received for Applicant
(see Information Sheet for Encroachment Permits)
~A11 other Public Works requirements listed in the
Conditions of Approval of the development.
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~Workers' comp and Contractor's Information received for
Contractor (see Information Sheet for Encroachment Permits)
~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:pmtcklst (Misc forms)
Revised 4/91