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CITY OF CAMPBELL
DEPT. OF PUBLIC WORKS
70 North First St.
Campbell! CA 95008
(408) 8h-2l SO
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PUBLIC WORKS PERMIT
(tor wor~ln9 In tne
pUblic right-o~-w y) X-Ref. file
Iuued 3'~~ cr cY Applicat ion Date 3/?-(.'.? tf"
Permit ex lr n l~ 1I0S. expires In me.
APPLICATION - Application is hereby made for a Public Works Permit in accordance with Campbell~
Municipal Code, Section 11.04.
Penli t No.
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A.
Work address or tract I
14371 Bascom Ave
Utility trench location Los Gatos Ca. 95032
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Nature of work: Install utilities as indicated on the attached sketch. Sn!f41Gflfl 798 ><
Attach five (5) copies of a drawing showing the location, extent and dimensions 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 FaithfUl Performance Bonds and cash deposits. (See
General Conditions land 2).
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E. An application fee must accompany this application.
Name of Applicant. PACIFIC GAS & ELECTRIC
Address 10900 N. Blaney Ave, Cupertino
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/Permi~e hereby agrees by affixing their signature to this permit to hold the City of
Campbell, its Offi:~rs;-'~gents a~ emplo~ees free, ufe and harmlus from any claim or demand for
:::a:::I::::~;::~~~::e~~~;::;k.c::::::d9:st:~:t~::~t~ave read and understand both the front and
back of this per~ andtnat~hey will inform,tlleJr,contractor(s) of the information.
This is non-refundable.
Telephone:
973-8930
ACCEPTED
DAVE CROWFOOT
ApplICant \~ermlttee,
February 19, 1988
uate
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NOTES: ALL WORK SHALL CONFORM 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 BEFORE STARTING WORK.
NOTICE MUST BE GIVEN TO PUBLIC WORKS AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK.
SPECIAL PROVISIONS
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VI.
Street shall 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.
~avement say 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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PERMIT APPLICATION FEI
PLAN CHECK DEPOSIT
BOND FOR FAITHFUL PERFORMANCE
(R-l)
($35.00)
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STANDARD
$50.00
$500.00
(100' OF ENG. EST.)
AMOUNT
$ ~""':> . (-X::)
$
$
$
RECEIPT NO.
F. P. (CASH) DEPOSIT
PERMIT FEE
f: PWPERHIT
Revised 7/87
($200) (4\ OF BOND,$500 MIN)
(7\ OP F.P. BONO
~ $35.00 MIN)
ror ~l~qBceer R~fTV1! D
FEB 22 1988
APPROVED POR ISSUANCE
$ ~~.~ 9
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Public Works Administration
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