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cry OP CAMPBELL
DEPT. OF PUBLIC WORKS
70 North First St.
Campbelll CA 95008
(408) 860-2150
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PUBLIC WORKS PERMIT
Permit No.
APPLICATION - Application is hereby
Municipal Code, Section 11.04.
';)-ge:,
A. Work address or tract I HACIENDA
AVE.
CAMPBELL
SAKTA CLARA
SD#41G16633
B.
Utility trench location
Nature of work: INSTALL UTILITIES AS INDICATED ON THE ATTACHED SKETCH
Attach five (5) copies of a drawing showing the location, extent and di.ensions of the work
The draWing shall show the relation of the proposed work to existing surface and underground
improvements. When approved by the City Engineer, said drawing becomes a part of this permit.
The General Conditions for all permits are listed on the reverse side. Special Provisions for
this permit are listed below. 'ailure to abide by these conditions and provisions may result
in job shut-down and/or forfeiture of Paithful Performance Bonds and cash deposits. (See
General Conditions 1 and 2).
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E. An application fee must accompany this application.
Name of Applicant "PMTFTC GAS & ELECTRIC
Address 10900 N. Blaney Ave. Cupertino 95014
Is this work being done by the property owner at their own residence? ____yes no
Complete attached Workers' Compensation and Contractor for.s.
The Applicant/Permittee hereby agrees by affixing their signature to this per.it to hold the City of
Campbell, its officers, agents and employees free, aafe and harmleaa from any claim or deaand for
damages reSUlting from the overed by this permit.
The Applicant/Permittee he and underatand both the front and
back of thia permit, and s) of the information.
This is non-refundable.
Telephone:
973-8930
ACCEPTED...D
NOTES: ALL WORK SHALL CONPORM WITH THE ATTACHED,
STANDARD DRAWINGS AND CONDITIONS.
THE CONTRACTOR MUST HAVE THIS PERMIT AND APPROVED PLANS AND MUST MEET WITH THE P.W. INSPECTOR ON
THE SITE AT LEAST TWO.DAYS BEPORE STARTING WORK.
NOTICE MUST BE GIVEN TO PUBLIC WORKS AT LEAST 24 HOURS BEPORE RESTARTING ANY WORK.
SPECIAL PROVISIONS
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Street shall not be open cut for underground installations. Minimum cuts may be allowed
for connections or exploration holes. Such cuta must be specifically approved by the
Inspector.
~avemen~ may be cut for underground installations and must be restored in accordance with
the Utility Trench Restoration Standard Drawing.
Work to be staked by a licensed Land Surveyor or Civil Engineer and two (2) copies of the
cut sheets sent to the Public Work Dept. before starting work.
The hours of work are limited ~ outside the hours of 7-9 a.m. and 3-6 p.m. for any work
affecting a traffic lane.
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3.
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5.
PERMIT APPLICATION PEE
PLAN CHECK DEPOSIT
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($35.00)
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RECEIPT NO.
STANDARD
$50.00
$500.00
AMOUNT
$QJ.(~
$
$
$
PERMIT PEE
(100\ OP ENG. EST.)
($200) (4\ OP BOND,$500 MIN)
(7\ OF P.P. BOND
~~J\~ .IN'
[or 1,;1.~rr
al liVID
JAN l:i 1988
$ ~ 'So . c:c:..:> Ci?
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JAN 13198'8 1rt
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PUBLlC-iVORKS
~N6rNEERrNG.
BOND FOR PAITHFUL PERPORMANCE
P. P. (CASH) DEPOSIT
APPROVED FOR ISSUANCE
f: PWPERMIT
Revised 7/87
Public Werle. .~,tf..1eft