92-165
ern or CAIIPIIBLL
DZP1". or IlU8LtC WOltD
70 NoRb r~ st.
c:upDe1l, C& '110'-
(401) a66-Z~0 .
92-165
1'eaU.t No.
_~tmII!!II'P ---
(for worJt1.DlJ w1t:1l1.D tba
public riPt-Gfj"lVa.Y) Z~. fUe
~/ c 5/11/92
I..aed -] 2-- r L-' Appl1caUon Data
Penit apiru iD 12 _. . Application apina iD 6 _.
APPLICATXON - Appl1cat10D ia benby _de tor . Pab11c WOZ'JaI PeJ:m.t iD ac:conIaDca with t!a~h.u
IIWllclpu COde, Sect:ion 11.04. (Application apiru iD 15 IIDIlt:ba if pem1t not pulled)
A. Work acIdraaa or tract t n n 1 f) P- 1 R () Y c: () 1] r t
ut1l1~ t.ranch location
Remove one flag of concrete to repair phone
[u,,":"litics.
C. Attach five (5) capi.. of . dravi.nq abovinq tile location, extant and cU.aena1ona of tile work
'l'ha dravinq aIla11 abow tha nl.Uon of tIla propoaed work to aiati.nq 81IZ'face and ~
illprovaaanta. Wban approved by tile City EnlJinaar, ..1d draviDcJ ~.a . part of tb1a panit.
D. 'l'ha Genaral ComUtiona tor all parllna ara liated on tba nvana dd.. Spaclal Pravialona tor
thia p.rmit are liatad below. P.ilura t:o abide by th... concliUona and provl81ona _I' ruult
in job abat-dovn and/or tortaitura ot Paithtul ~oraance suraU.. and CUb dapoai1:8. (Saa
GaIlaral COndltiona 1 and 2).
B. An applicatlon t.. IlU8t accompany thia application. '1'h1a t.. 18 nan-ratUDdable.
N..a ot Applicant Pac if i c Bell Telaphonal 4 91 _ 2 0 51
M~aa 145 South Montgomery, San Jose CA 95110
B. Natur. ot workl
Ia thl. work bei.nq don. by tha property own.r .t their DVD na1dancel --yu -"0
coaplat. and attach Workan' COIIpana.tlon and COntractor natoraaUon foZllll.
'l'h. AppUcant/Parmlt:t:.a h.reby .qnaa by aft1x1nq tbair dqnat:ura t:o thia parait t:o hold the Ci~ of
campball, 11:8 offie&r8, aqant. anel employa.. tn., _fa and barJal... from any cla1ll or cl&IIAncl for
cl&llaq.a naultinq trom tha work covarad by thia parait.
'l'h. AppUcant/Parmltt.. h.reby ac:Jtnovladq.. that they hava n.el and und.ratUlel both tha tront and
back of thia parmit, and that th.y will inform th.ir contraotor(a) of the iDforaation.
ACCEP'1'ZD ,Tack Sturqeon (Emerqency Verbal) 5/11/92
AppUcant (P.raitta.) print/aiqn Data
NOTES: ALL WORK SHAL". CONFORM WI'1'H THE A'1"1'ACHED, APPROVED PIMS AND ALL APPLICABLE CAMPBELL
STANDARD DRAWINGS AND CONDITIONS.
THE CONTRACTOR MUST HAVE THIS PERMIT AND APPROVED PLANS ON-SITE AND MUST JID'1' WI'1'H '!'BE P.W.
INSPEctoR ON 'l'BE sm: A'Z I.ElST TWO DAYS BUORE S'l'AR'l'IHG WORK. APPLICAHT MUST COH'l'AC'l' 'l'BE DlSPEC'1'OR
'1'0 ARRANGE l'IEI.D JlUTING.
IfO'l'ICZ MUST D GIVEN TO PDBLIc WORKS AT LEAST 24 IIOORS DFORB RBSTARnHG AllY WORK.
SPECIAL PROVTSYOHa
_1.
8traat aba11 not: b. op.n cut tor undarqround 1natall.tiona. lI1nillwl cuta ..y be allowacl
tor cann.atlona or exploration bol... SUch cuta mua~ ba saeeitleallv a~qrnv.d bv ~he
rn.~.~or ~rior ~o eu~~ift~.
Pay_ant -y b. cut tor unelarqrounel iDat:allatlona and muat be nat:ored iD ACCOrdance with
the tJtlli~ TranCb "at:or.tlon standard arawi.nq.
Work t:o ba at:aJtad by a licanaad Land Survayor or Civil Bnqinaer and t:vo (2) copi.. of tile
cut abaata aant t:o the Public Work Dapartllant bafora "ttarti.nq work.
'l'h. haura of work ar. l1llit:acl t:o outaida tIla houra of 7-1 .... and 3-6 p.II. tor any work
aft.atinq a trattic lan..
~
_3.
_4.
_5.
S'l'AHDARD
AMOtJN'1'
RECEYP'I' NO.
PZRKl'1' APPLtCl!rIOR ra
PI.uI CllECK DBllOSl'1'
SIJIlftr rem PAI'l'BPUL PERPORlWfCE
CUB DDOSl'1'
PI.AH CllECK . INSPECTION FEE
$100,000 - $500,000
APPROVED FOR ISSUANCE
t: PW PERHIT
Reviseel 10/91
. \Dh- ~
.
.
.
$ \~- ot:~
<t~
$105.00
$500.00
(loot or Ella. BB'1'.)
(n or SURftr, $500 1IDf)
ce
<;:;- h--9-L
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