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Per.it No.
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CITY OP CAMPOE1-L R E C E_KS PERMIT
~EPT. OF PUBLIC WORKS
70 North First St. public righ.t-ofzay) X-Ref. file
Campbell t CA 95008 4 /:> r' ~
(40B 1 860-21 SO FE B &~QIa 'Z .J-- -Z (' q Applicat ion Date 2./d' <f' d--'
~twd~ e ~re ~n ~~ aos. expires ~Q ..
APPLICATION - Application p'oj8tfeb~~Sfor a Public Works Permit in accordance with Ca.pbell~
Municipal Cod., Section ll'rffGINEFRING
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A. Work address or tract' 77 Dot Ave. Camnbell. California
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B.
Utility trench location
Nature of work: Install utilities as indicated on the attached sketch. SDi!41G16473
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 beco.es 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 21.
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E. An application fea must accompany this application.
Name of Applicant PACIFIC GAS & ELECTRIC
This is non-refundable.
Telephone: 973-8930
Address 10900 N. Blanev Ave. Cupertino, California 95014
Is this work being done by the property owner at their own r.sidence? ___yes no
Complete attached Workers' Compen.ation and Contractor for...
The Applicant/Permittee hereby agre.s by affixing their .ignature to this per.it to hold the City of
Campbell, icers, a 8 and e.ployees free, s.fe and har~ess fro. any claim or de..nd for
damages res tin from t w rk covered by t permit.
The Appli nowled ey have read and understand both the front and
back of t y will contractor(s) of the information.
ACCEPTED
Ff>hl1r~ S. 1988
. .
NOTES: ALL WORK SHALL CONPORM WITH THE ATTACHED, APPROVED PLANS AND ALL APPLICABLE CAMPBELL
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
~ 1. Street shall not be open cut for underground installations. Minimum cuts ..y be allowed
for connections or exploration holes. Such cuts must be specifically approved by the
InSGector. '
2. ~av men~ ..y be cut for underground installations and must be restored in accordance with
the Utility Trench Restoration Standard Drawing.
3. 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.
4. 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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PERMIT APPLICATION PEl
(R-l)
($35.00)
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STANDARD
$50.00
$500.00
AMOUNT RECEIPT NO.
$ ~C:>. (~:;> <p
$
$
$
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PLAN CHECK DEPOSIT
BOND FOR PAITHFUL PERFORMANCE
P. P. (CASH) DEPOSIT
PERMIT PEE
(100' OF ING. BST.)
($200) (4' or BOND,$500 MIN)
(7' OP P.P. BOND
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APPROVED FOR ISSUANCE
f: PWPERMIT
Revised 7/87
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