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CITY OF CAMPBELL
DEPT. OF PUBLIC WORKS
70 North First St.
Campbell! CA 95008
(408) 8h-2l50
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PUBLIC WORKS PERMIT Per.it No. ' ???S ,- I;) 3
(tor worK1ng 1n ~ne
pUblic right-ot-way) X-Ret. tile
Issued '1'1..Cf~.P7 Application Date ,'A-I \-Qo-
Permi~ e p1te In ~~ mos. expires ~
APPLICATION - Application is hereby .ade for a Public Works Permit in accordance with Campbell-
MuniCipal Code, Section 11.04.
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A. Work address or tract t
235 N. 3rd St.
Utility trench location OJ
B. Nature of work: Install utilitiesa as indicated on the attached sketch. SDII41G66857 >-<
C. 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.
D. 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 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 and Electric
This is non-refundable.
973-8930
Telephone:
Address
Is this
Cupertino
owner at their own residence? ___yes
Compensation and Contractor form..
affixing their signature to this permit to hold the City of
es free, safe and harmless from any claim or de..nd for
this permit.
no
at they have read and understand both the front and
-their contractor(s) of the information.
3-9-88
uate
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
~ 1. 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.
2. ~.vemen~..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 sheet8 Bent to the Public Wock Dept. before starting work.
4. The hours of wock are limited ~ outside the hours of 7-9 a.m. and 3-6 p.m. for any work
----- affecting a traffic lane.
S.
-----
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PERMIT APPLICATION FEE
PLAN CHECK DEPOSIT
BOND POR FAITHPUL PERPORMANCE
F. P. (CASH) DEPOSIT
(R-l)
($35.00)
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STANDARD
$50.00
$500.00
(100' OP !NG. EST.)
AMOUNT
RECEIPT NO.
$ --:; b. C::c.;;>
$
$
$
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PERMIT FEE
($200) (4' OF BOND,$SOO "IN)
(7. OF P.P. BOND
~ MIN) $"!;,~-.
ik-fr,y (f..n~1 E eEl V E II
MAR 11 1988
PUBLIC WORKS
ENGINEERING
Q
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APPROVED FOR ISSUANCE
f: PWPERMIT
Revised 7/87
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