88-107
RECEIVED
JAN- 2 81988
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PUBLlCI,w~~~MP8EI.I. '
ENGlrdQlf PUbl.lC WORII:5
"0-" 'lilt St.
c.mPb~IIL CA .~ooa
(4011) h -2!~0
per.1 t
tAo. 88 -Ie 7
.
PUBI.IC WORKS PERMIT
Itor worlln9 In ~n~
public ri\!lIt.oC~aYI
I..u~d ~ ~ (. 4c::f' ~
PeraAc-.~ r.. n A~ ~..
APPLICATION - Application ia hereby ..de for a Public Mork. Per.it
RunAcipal Code, Section 11.0t.
A. Mock .""'.-- or..UAa' # /~ .J-IA/11)L MAl Au
UUlit)' "ueR le8ul_ .h/.2.->
.. Mat ure oe work: 12. lit' PA J f.2-
I-Ref. t 11e
Application D.te 1-.:2. 7-J"K'
..pLr.. In , ao..
in accordance with ea.pbell
/LJ 'e.../e .lJAQ 12 Y L
L €n76. J
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Att.ch liv~ l!ll cop1.. ot a dr.wing .lIowin9 the location, euent .nd di_n.1on. ot the woCk
The draWing ah.ll ahow th~ ulation oe th~ propoaed work to euat1nq .ure.ce and und~qlround
laprove..ntl. When .pproved by the City En~in.er, .11d drawing beco.e. a plrt of th1a peralt.
Th~ ~eneral Condltiona toe all peralta are li.ted on the rev~rae .id~. 5peclal Prowl.ion. for
thl. per.At Ire 11.ted belovo 'allur. to ablde by the,. condltlon, and provlalon. "r reault
In job ahur-downand/or foreeiture of ralthful Pertor..nc~ 80nd. .nd ~a.h d~po.lta. Se.
Cen.,al Condltlon~ 1 .nd 21.
E. An applicatIon eee auat .ccoapany this application. Thia ia non-reeundable.
tAa.. ot AppUCant .5:J/':u..! ~5E LJJ.4~J12 L2::v.nIJAAiY 'hlephone:.2 79- 72.::>6,-
Addr.., /tl~J :Sa. ~ASLA....:n AtJ :SAN ..::u:.SE' L:!.A q51:L.~
_".a Lno
I. thla work beIng done by the property owner at their own re.ldencel
Coaplete .tt.clled ~orkec.' Coapenaatlon and Contractor tor...
The ApplAclnt/Per.ltt~e h~rebY .gre~a by .feillng thelr 'lgnature to thia per.it to hold the City ot
Ca.pb~ll. ita off1cera, agenr. and employee. tcee. a.e. .nd har.lea, tree any cl.la or de..nd for
da"9.' ceaultln\! froa the work coveted by thAi peC.lt.
ge. th.t they ha.e r..d end underatand both.the front
1ntor. their contractorlal of the infor~n.
/-~~~O
and
MOTES: ALL WORK SHALL CONrOR" WITH THE ATTACHED, APPROVED tLANS AND ALL APPLICABLE CAKP8El.l.
5TANOARO DRAWINGS ANb CONDITIONS.
THE CONTRACTOR "UST HAVE THIS PERMIT AND APPROVED PLANS AMD RUST KfET WITH THE P.W. IKSPECTOR ON
Tilt: SITE AT LUST TWO OAYS BEFORE: STARTING I<<)Rk.
ItOTICE IIOS'!' BE CIVtN 1'0 PU8l.IC NOllXS AT LV.sT H lloo1lS .[PORE RtSTAJlTING UY WORl.
'PECIAI. PROVISIONS
_1.
6rre~r ah.ll not be open cut Cor underground inatell.tion_. M1niaua cut. ..y be allow~d
tor connectlona or elplor.tion holea. Such CUt. aua' be apeclflcally approved by the
In.peClor.
~Ivfmfnr ..y be Cut tor underground tn.t.ll.tiona and auar be reatored in .ccordance WIth
th~ Utility TrenCh R.aLOratlon Standard DraWing.
Work to be .tek~d by . llc~n.ed Lend Surveyor or CiVIl Enqin..c and two 12) Copl.a ot the
cut an.et. a.nt to the PUD1IC WOrk D<<pt. before .t.rttnq ~ork.
Th. houri of vora .rc l.a.,ed to outa.d. the hour, ot 7-' .... and J-' p... tor any vork
attecLln9 . trafelC lan..
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PERAIT APPLICATION rEE
rLAM CHECII: DEPOSIT
aOND rOK FAITHfUl. PEll'ORMAHCt
'.-1)
1$J!>.001
$
$
$
$
aTAMOAllD
UO.OO
'~OO.OO
(100' or he. EST.)
AIIOONT
IU:CEIPT 1010.
"";6. CJ:::) ~
,. ~. ICASH) DEPOSIT
PERIU TrEE
to NPERMIT
.e.ue" "/11
1/'"
1$2001 (U 0' aOND,$!lOO "IN)
n, 0' r.p. aotlO
~:-('
'2.-l-~'~
.,.'C.
$
APP1IOVED 'OR I55UANCE
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