88-145
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RECEIVED
CITY OF CAMPD~LL PUBLIC WORKS PERMIT
DEPT. OF PUBLIC WOW Y 41988 (Ior worunq In tne
70 North First St._MA pUblic right-of-way)
Campbell CA 95008 ~ :i
(408) 866-2150 C WORKS Issued ~ I 6' Y Application Date ~:>
PUBLI Permit: e p [ Ion J..o: 1I0S. expires
APPLICATION - APPlic~G.NIJE~~~y made for a Public Works Permit in accordance with Campbell-
Municipal COde, Section 11.04.
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A. Work address or tract , Steinway Ave.
Utility trench location Install utilities as indicated on the attAched sketch.
SDI!41G06634
Permit No.
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B.
Nature of work:
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. Pailure 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 Conditionl"'-'J, and 2). ']
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E. An apPlicati~n fee ~~st acc~. y th~applic T is is non-refundable.
Name of APPlicant"-..Ea-c11 and El ctric Telephone: 973-8930
Address 10900 N. Blane
Is this work being done by the property owner at their own residence? ___yea no
Complete attached Workers' Compensation and Contractor for.s.
The Applicant/Permittee hereby agrees by affixing their signature to this permit to hold the City of
Campbell, its officers, agents and employees free, safe and harmless from any claim or demand for
damages resulting from the work covered by this permit.
Permitte.hereby acknowled that.they have read and understand both the front and
ermit, and!that they will rm their contractor(s) of the information.
"ct Crowfoo May 2, 1988
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NOTES: ALL WORK SHALL CONFORM WITB'1'HE 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 BEFORE RESTARTING ANY WORK.
SPECIAL PROVISIONS
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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: may 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 PEE
PLAN CHECK DEPOSIT
BOND POR PAITHPUL PERPORMANCE
(R-l)
($35.00)
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$50.00
$500.00
(100' OP ENG. EST.)
AMOUNT
$ ~"("~
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$
$
RECEIPT NO.
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P. P. (CASH) DEPOSIT
PERMIT FEE
($200) (4' OF BOND,$500 MIN)
(7' OP P.P. BOND
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APPROVED POR ISSUANCE
f: PWPERMIT
ReVised 7/87
\ -1100'
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