92-155
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CITY OF CAMPBELL
DEPT. OF PUBLIC WORKS
10 North first St.
campbell. CA 95008
(.c 08) 866-2150
C.
Attach five (5) copi.. of . c1r....ir\9 .hovir\9 the location, axtant and diaansion. of tha work
The dra...inq .h.ll .hov the ral.tion of the proposed ...ork to axi.tir\9 .urface and undarqround
i.prove.ents. Whan approved by the City Enqin..r, ..id dr.vir\9 beco... . part of thi. perait.
D.
The Cener.l conditions for all perait. ara li.tad on tha rev.rae .ida. special ProVi.ions for
this perait .r. li.tad belovo F.ilure to abida by the.e conditions and provbion. ..y r_ult
in job .hut-dovn and/or forfeiture of Faithful Parforaance Bonde and cash depoI5ita. (Saa
Gener.l Conditions 1 and 2).
E.
,i. non-refundabla.
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'relephone:
Addrass
Is this vork beir\9 dona by the property ownar at thair own ra.idenca?
~a.
co.plete .nd .ttach worker.' Coapensation .nd COntractor Inforaation foras.
The Applicant/peraittaa bareby aqraa. by affixir\9 thair .iqnatura to thi. perait to hold tha city
ot
eaapbell, its officers, avanta and ..ployaa. frea, ..fa and baral... froa .ny cl.1a or daaand for
da.aqe. resultir\9 frea the vork covarad by thi. perait.
'!'he Applicant/Paraittae bareby acltnoVladqe. that thay bava raad and undarstand both tha front and
back of this perait. .nd that thay vill in ora thair contractor(.) of the inforaation.
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NOTES: AU. WORK SHAU. CONFORM WITH TIlE ATTACHED, APPROVED PLANS AND ALL APPLICABlZ CAJlPBELL
STANDARD DRAWINCS AND CONDITIONS.
THE CONTRACTOR MUST HAVE THIS PERMIT AND APPROVED PLANS AND MUST MEET WITH TIlE P.W. INSPECTOR ON
THE SITE AT u:AST TWO DAYS BEFORE STARTING WORK.
NOTICE MUST BE CIVEN TO PUBLIC WOIUCS AT LEAST 2C HOURS BEFORE RESTARTINC ANY WORJ(.
SP~L PROVISYONS
_1. Street sh.ll not be open cut for undarqround installations. Kini.ua cut. ..y be alloved
for connections or exploration boles. Such cuta .uat be .oecificallv .DDroved bv the
InsDector.
_2. pave.ent..y be cut for unc1erqround installation. and .ust be restorec1 in accorc1ance vith
the Utility Trancb Restoration Standarel Dravinq.
_3. Work to be staked by a licensed Land survayor or Civil Enq'inaar and twO (2) copieI5 of the
cut sh.ets sent to the Public Work Oeptartaant befora .tartinq vork.
The hours of vork are li.itec1 to outaide Ula bours of 7-9 .... .nd 3-6 p... for any vork
attectinq a traffic lane.
_c.
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MI1/NmIIlJ SIlF6. -r1JJ-lUlly TJZ/iF'Flc
/4/ 11 LI
77/1A~S
fR-H
STANOARD
AMOUMT
RECEq 110.
PERKIT APPLICATION FEE
($50.00)
SloO.OO
$ 105; 00
$
$
$
$/05,00
<; /',{ t: ~-
, ta
PLAN CHECK DEPOSIT
$500.00
BOND FOR fAITHFUL PERFORMANCE
(loot OF ENG. EST.)
(C' OF BOND, $500"111)
CASH DEPOSIT
($200.00)
PU.N CHECK ,
INSPECTION ~EE..... -1:", c.." (:tl F.P.
ISSUANCE ~'J..R.,? AA. 'fA
for City Enqineer
BOND, $100 KIN)
APPROVED FOR
t: PWPERKIT
Revised 7/90
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