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CITY OF CAMPBELL
DEPT. OF PUBLIC WORKS
70 North First St.
campbellt CA 95008
(408) 860-2150
Permit No. cr:>cP -/y 9'
X-Ref. file
Application Date ~n5(::/ <::PcP
expires
PUBLIC WORKS PERMIT
(for YCIKlng In ~
public rig~Of-WaY)
Issued ~ 11.<< .J
Per.i~ex re n rZ-aos.
APPLICATION - Application is hereby made for a Public Works Permit in accordance with Campbell.
Municipal Code, Section 11.04.
A. Work addre88 or tract . 251 LLewllyn Ave.
Utility trench location sDtf41E26644
B. Nature of work: Install utilities as indicated on the attached sketch.
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.
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 condition~ and provisions mar result
in job shut-down and/or forfeiture of Paithful PUfCil"manCe Bonds l\ndcuh deposits. ,See
General Conditions land 2).
E. An application fee. must accompany this applici!tion. This is non-refundable.
Name of Applicant Pacific Gas and Electric Company Telephone: 973-8930
Address 10900 N. Blaney Ave. Cupertino 95014
D.
Is this work being done by the property owner at their own residence? ___yez no
Complete attached Workers' Compensation and Contractor form..
The Applicant/Permittee hereby agrees by affiXing their signature to this permit to hold the City of
Campbell, its officers, agents and employees free, s~fe and harmle.. from any claim or d~mand for
damages resulting from the work covered by this permit.
The Appli permittfih reby .~knOWled~thati they have read and undeut:and both the front and
back of is rmit, d hat 7"ey will ~~~m 'neir contractor(s) of the information.
ACCEPTE Da' Crow (X)t 5-4-88
' -_.-lIli'ri"-
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 specifical!l-!f~~oved by the
Inspector.
~avemenc may be cut for underground installations and must b~ 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.
~L~( p S"'~ t
~2.
3.
-k::::4 .
....k::::5 .
PERMIT APPLICATION PEE
PLAN CHECK DEPOSIT
BOND FOR FAITHFUL PERFORMANCE
(R-l)
($35.00)
$ ~~{,~ cp
$
$
$
STANDARD
$50.00
$500.00
(100' OF ENG. EST.)
AMOUNT
RECEIPT NO.
F. P. (CASH) DEPOSIT
PERMIT FEE
($200) (4\ OP BOND,$SOO MIN)
(7t OF.F.P. BOND
~i1~::~)
$ .>~ 'S . <'::'C...:> 9
~ - t-2..-~
ua
APPROVED FOR ISSUANCE
f: PWPERMIT
Reviaed 7/87
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