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CITY OP CAMPBELL
DEPT. OF PUBLIC WORKS
70 North First St.
Campbellt CA 95008
(408) 8611-2150
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PUBLIC WORKS PERMIT
(ror worK1nq 1n the
pUblic right-of~W y) X-Ret. file
Iuued 3J~ ~ R Application Date 3/2-./ 6~
Perlllit e~l~ n 1" mos. expire. 1n). ..).. '
APPLICATION - Application is hereby .ade for a Public Work. Per.it in accordance with Call1pbell-
Municipal Code, Section 11.04.
Per.it No.
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Work addre.. or tract t
14351 Bascom Ave
Los Gatos, California
95020
Utility trench location
B.
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Nature of work: Tn"'t-:'lll lIHlit-;ps :'lS ;ndi(';Jted on the attached sketch. SDi!41G66797 ><
Attach five (5) copies of a drawing showing the location, extent and di.ensiona of the work >1
The drawing shall show the relation of the proposed work to existing surface and underground ~
improvelllent.. When approved by the City Engineer, said drawing becomes a part of this per.it.
The General Conditions for all permits are listed on the reverse side. Special Provisions for
this permit are listed below. Pailure to abide by these conditions and provisions may result
in jOb shut-down and/or forfeiture of Faithful Performance Bonds and cash deposita. (See
General Condition. land 2).
C.
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E. An application fee must accompany this application. This is non-refundable.
Nallle of Applicant PACIFIC GAS & ELECTRIC
Address 10900 N. Blaney Ave, Cupertino 95014
1. thi. work being done by the property owner at their own residence? ___yes
Complete attached Workers' Compensation and Contractor tor.s.
The Applicant/Permittee hereby agrees by affixing their signature to this per.it to hold the City of
Campbell, ita offtce~ agents and employees free, .afe and har~ess fro. any clai. or de..nd for
damages resultinjVfrom~he work covered by this permit.
The APplicant/P~r.i~ee"herebY acknowledges that they ~ave read and understand both the front and
back of this pei'lri"f, ani2"'ttiat, they will inform, tl:leir qontractor(a) of the information.
ACCEPTED DAVE CROWFOOT / February 19, 1988
App~lCant (rerIll1ttee, uate
Telephone:
973-8930
no
NOTES: ALL WORK SHALL CONPORM WITH THE ATTACHED, APPROVED PLANS AND ALL APPLICABLB 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 BEFORE RESTARTING ANY WORK.
SPECIAL PROVISIONS
~. Street shall
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2.
not be open cut for underground installations. Minimum cuts may be allowed
for connections or exploration holes. Such cuts must be specifically approved by the
Inspector.
ravelllent ..y 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 hour. of work are limited ~ outside the hours of 7-9 a... and 3-~ p.m. for any work
affecting a traffic lane.
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PERMIT APPLICATION PEl
PLAN CHECK DEPOSIT
BOND FOR FAITHPUL PERPORMANCE
(R-I)
($35.00 )
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STANDARD
$50.00
$500.00
(100\ OP ING. 1ST.)
MOUNT
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$
$
RECEIPT NO.
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P. P. (CASH) DEPOSIT
PERMIT PEE
f: PWPERMIT
aevised 7/87
($200) (4' OF BOND,$500 "IN)
(7' OP F.P. BOND
~:':MIN)
~EIVlb
FEB 221988
$ ~~. c.:;>O ~
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APPROVED POR ISSUANCE
Public Work_ AcIrnlnlstrltion
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