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CITY OF CAMPBELL
DEPT. OF PUBLIC WORKS
70 North Firat St.
Campbell, CA 95008
(408) 866-2150
8?~//~
PUBLIC WORKS PERMIT
\~or wor~~ng ~n ~ne
public right-of-way)
Pennit No.
Ref. file
App. date 2 19 88
Issue date '3'.:.l. - J- "y
APPLICATION
^pp~lCa~lon is hereb~ ..de for a Public Works Permit in accordance with Campbell
Municipal Code, Sectlon 11.04.
A. Location of work: 19 Milton Ave., Campbell
B. Nature of work: See attached sheet
Attach three (3) copies of a drawing ahowini the location, extent and dimensions
of the work. The drawin~ shall show the re ation of the proposed work to existing
surface and underground lmprovements. 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. Failure to abide by these conditions
and provisions may result in job shut-down and/or forfeiture of Faithful
Performance and Cash Bonds. (See General Conditions 1 and 2).
E. An application fee of $35 must accompany this application. This is non-refundable
C.
O.
F.
The Contractor(s) must meet the inspector on the site at least 48 hours before
starting work. Call 866-2150 for appointment.
Upon completion of the work, written request for final inspection and acceptance
must be made.
Permit applications expire in 6 months. Issued permits expire in 12 months.
Fees are not transferable or refundable.
G.
H.
Name of Applicant Pacific Gas & Electric Company
Address 10900 N. Blaney Ave.. Cupertino 95014
Is this work being done by the property owner at his own residence? ___yes no
Telephone:
725-2009
Complete attached Workers' Compensation and Contractor forms.
The Permittee hereby agrees by affixing his signature to this permit to
of Campbell, its officers, a~ents and employees free, safe and harmless
or demand for damages resultlng f om the work covered by this permit.
ACCEPTED E. Orepeza C! 2-19-88
hold the City
from any clalm
ua~e
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 Inspector.
Pavement cut for underground installations must be restored in accordance
with the Utility Trench Restoration Standard Drawing.
Work to be done in accordance with the attached, approved plans.
Work to be staked by a licensed Land Surveyor or Civil Engineer and two (2)
copies of the cut sheets sent to the Public Works Dept. before starting
work.
The hours of work are limited to outside the hours of 7-9 a.m. and 3-6 p.m.
for any work affecting a traffic lane.
../
2.
10
C\2
10
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3.
4.
5.
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Whl~
6.
NOTICE MUST BE GIVEN TO PUBLIC WORKS AT LEAST 48 HOURS BEFORE BEGINNING WORK.
Amount
PERMIT APPLICATION FEE $ c::::::2''). <=C..;
BONO FOR FAITHFUL PERFORMANCE $
CASH DEPOSIT REQUIRED $
PERMIT FEE (7~ of F.P.~~:;::~. C>C)
Approved for lssuance ~
Receipt No.
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Rev. 5/85
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GAS T&D: 'f 0 DIRT.
1. OBTAIN PERMIT D IXJ STREET
2. NOTIFY GAS M&C BEFORE STARTING WORK.
3. EXPOSE AND CORRECT CONTACT OR FAILURE. t J 0 SIDffi.lALK .31/~-I4
" (~ WALL MAP:
CP AREA: )112--3~
-
APPROVED BY
REV. DATE DESCRIPTION GM' OWN. CHKD. SUPV~ APVD.
GM CATHODIC PROTECTION EXCAVATION - 3' x 3' 81M
SUPV. DWO. UST
DSGN. ~l.JR ADDRESS: :39, m/1_'f~L Ave, SUPSDS
OWN. sUPSO BY
CHKD. CITY: ('''' n:,~l.J~/1 - . SHEET NO. 1 SH~
O.K, DRAWING NUMBER REY.
... DATE I SCALE ,PACIFIC AS AND ELECTRIC COMPANY
..
... MN "RANCISCO. CAU"ORNIA
i 1"-100'
..'...,. I". ,..,.., ""MTD Oil DI_ _. '_.'0 CL&A...."" ...._.OUT .-.. MICROFILM