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92-171 APPLICATION - Application i. hereby Mde tor. Public Worlta Penlit in .ccordance vitb CUpbell Kunicipal COde, Section 11.04. (Application expiru in 6 ~ntba it permi~ not PUlletll/i t: i: I ~ Iiii MJ A. Work .ddre.. or tr.ct , VA,e'/OG!-,::> c...-GCA T/{)Al5 KAIL.WAv ,/~/LL6N 1f(7/~NA~ )fil'':;" Utility trencb location LJCC A T77/C:J.(u ..[)12 Avt/"UC..5 MAY 2 9 1992 7 B. N.ture ot work: UL-OC4 Ti 7GL-E:'PHo/lJ~ F4cI(...,.1T7E:5 FOR... ...5~0 ' 't '''''''''''':''. //I1Pti20VEM NT ti--'ROJEcT: . ......,..} ..41 ..... I'" C. Attacb five (5) copi.. ot . dr.vinq .howinq tbe location, extent and diaenaiona of tbe work I TIl. dr.vinq aball .how tbe relation of tbe propo.ed work to exi.tinq .urface and underqround ~ improvement.. Wb.n approved by tbe City Enqineer, .aid dravinq becoaea a part ot tbb per1lit. 0 t::l:l t::l n ~ "'C t"" t::l ~ tlj o t::l:l to< ~ "'C "'C t"" H Q z ~ I I 1 I I 1 CITY OF CAMPBELL DEPT. OF PUBLIC WORKS 70 Nortb Fint St. ea.pbell, CA 95088 (408) 866-2150 ParJlit No. ~'/ -/71 X-Ref. tile Application Date, ~- 2 --:; _clZ . Application expire. in , ao.. BlfCROACIIIIDT PERIIrl' (tor vorkinq vitbin tb. public riqht-of-v.y) I..ued ;, -// - ~ r2 ..) Permit expirea in 12 110.. D. TIle General COnditiona for all permit. are li.ted on tbe reven. .ide. Special Proviaiona tor tb18 permit are li.ted below. Failure to abie!e by tb..e conc!itiona ani! provi81on. MY reault in job .hut-down and/or forfeiture of Faitbful Performance Sunti.. and ca.h e!epo.ita. (See General Conditions 1 ane! 2). E. An application t.. lIUIIt accompany tbi. application. TIli. t.. 18 non-retunc!able. Name of Applicant .:J..--/4C/,c:-tC hEL.<- Telephone: 4'13- 7094 Mdress.347c:;-B /lIo ,b,., \.JT. AH2LlO. ~,J~..sEJ CJA 95134 , I. tbia vork beinq done by tbe property owner at tbeir own ruie!ence? -ye. ./ ~no Complete ani! attacb Worken' COmpenaation ane! COntractor Inforlllltion foras. TIle Applicant/Permittee hereby .qree. by affixinq tbeir 819ftatun to tb18 permit to hole! tbe City of Campbell, its officers, aqents and ..ployees free, s.fe and h.naless fro. any claim or e!emane! for damaqes re.ultinq from tbe vork covered by tbi. permit. TIle Applicant/Permittee hereby .cknovledqe. tb.t tbey bave read and une!entane! botb tbe front and back of tbis permit, and tbat tbey viI nform tbeir contr.ctor(s) of tbe information. ACCEPTED . . C1 Applicant (Permittee}"" pr n i ~-- 2.. 7 -92 Date NOTES: ALL WORK SHALL CONFORM WITH STANDARD DRAWINGS AND CONDITIONS. APPROVED PLANS AND ALL APPLICABLE CAMPBELL THE CONTRACTOR MUST HAVE THIS PERMIT AND APPROVED PLANS ON-SITE AND MUST MEET WITH THE P.W. INSPEctOR ON THE SITE AT LEAST TWO DAYS BEFORE STARTING WORK. APPLICANT MUST CONTACT THE INSPECTOR TO ARRANGE FIELD MEETING. NOTICE MUST BE GIVEN TO PUBLIC WORKS AT LEAST 24 BOURS BEFORE RESTARTING ANY WORK. ~PECIAL PROVISIONS ___1. Street aball not be open cut for unc!erqrounc! installations. lliniawl cuta ..y be allowed for connections or exploration boles. Sucb cuta must be sll8cificallv aDDroved bv tlle InsDector Drior to cuttina. Pavement may be cut for underqround inatall.tions ani! lIUIIt be rutored in accordance vitb tbe utility Trench Restoration StandareS Dravinq. Wark to be staked by a licensed Lane! Surveyor or Civil Enqin..r and two (2) copies of tbe cut abeets sent to tbe Public Work Department before --.tartinq work. TIle hours of work are limited to outside tbe hours of 7-9 .... and 3-6 p... for any work aftectinq a traffic lane. Lz. _3. _4. 1-5. - WOP..i<. $'HI1L.L ("t.iI'JFCJ7!fVl To 71-IG Ft!lP5 SfECIF"IC.;:;770l1.S /1//./j) SCfitFDt/d c/'r c;/lJI1j?l.~,tLL c:..ID~30. - MI1I/J.lml/1/ ;5/1;:1:,71";0'- w/1V712/IFF/(..,' Ar /ft.,- 77/1-1E5. , , , STANDARD AMOUNT $ / [l 5' ~:Q... $ $ $ $ IOS ':.E RECEIPT NO. Q PERMIT APPLI~ON FEE PLAK CHECK DEPOSIT StIRBTY lOR FAITBFDL PBRFORIIAlfCE CASH DEPOSIT $105.00 $500.00 (loot OF ERG. EST.) (4t OF SURETlr, $500 KIN) Q {It/It} L Date PLAN CHECK , INSPECTION FEE ($0-$100,000 lOt, $100,000 - $500,000 911' $50~.I~00 ~ above 7t, $100 IIIN) APPROVED FOR ISSUANCE m1~/Iw. ~ Aft 1/1 tor City qineer t: PW PERMIT Revised 10/91 (SEE OTHER SIDE) - I I 1 1 1 I I I I I ~3 o t::l:l t::l n ~ "'C t"" t:j ~ t':l o t::l:l to< n H ~ to< I I I I I I I I - :; .., ',-\j ~ "' q - <: ~ '\ ~ o \) " <: ;) U "' :> ......... '" ~ -' -'-' -'w wa2 i 112< ~o liJ i ~~ ......... LQ <w -- ~Z ~ i C ~ - '0j '.\... B '-.j !I/ , \t Il t.i./ wtts:-- i I -II ,_~J >- " ~ -..J --... /------'-----~~- -~- -~--9f= ~~' . 5: 12 ~ l i ~. '~.-~ ~ II ~. ~ , -' :- <; i ~ l\ '-.J "'--J' ~ ........._j ~ ~ ~) '-J ~ ___J. ',,'.j '-.l 1'.,,' ~ Qj ~ :-:" \:, '--.J \\j '-' , ,'" .. ~ 1 \j ......'~Llj: -....... lJ .......LJ --.J i:V ~ C\J v") ~--Jl1.:Jh:: ,',j , ~ ~ ~LiJ~>? 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