88-152
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PUBLIC WORKS PERMIT Permit No. Afj".- /~
(tor wor~log 10 ~ne
public right-of-way) X-Ref. file
Issued c;, ~cf' ~ a Application Date~:~:Jj/.p)
Peuli't elip lIf'li ~" .os. expires 1: ~ .
APPLICATION - Application is hereby made for a Public Works Permit in accordance with Campbell~
MuniCipal Code, Section 11.04.
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CITY OF CAMPBELL
DEPT. OF PUBLIC WORKS
70 North First St.
Campbell! CA 95008
(408) 860-2150
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Work address or tract .
1777 S. Bascom Ave.
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SD#41G06892
B.
Utility trench location
Install utilities as indicated on the attached sketch.
Nature of work:
Attach five (5) copies of a drawing showing the location, extent and di.ensions 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 conditions and provisions may result
in jOb shut-down and/or forfeiture of Faithful Performance Bonds and cash depoSits. (See
General Conditions 1 and 2).
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E. An application fee must accompany this application. This is non-refundable.
Pacific Gas and Electric Company 725-2114
Name of Applicant Telephone:
10900 N. Blaney Ave. Cupertino ~~U14
Address
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/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 deaand for
damages resulting from the work covered by this permit.
The Applicant/Permittee he y aCknOWledges t t they have read and understand both the front and
back of thi it, and they will inf of the information.
ACCEPTED avid Crowf I' I May 26, 1988
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NOTES: ALL WORK SHALL CONPORM WI~~HED, 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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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.
~avemen't 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 FOR FAITHFUL PERFORMANCE
F. P. (CASH) DEPOSIT
(R-l)
1$35.00)
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($200)
STANDARD AMOUNT RECEIPT NO.
$50.00 $ SO. DO q
$500.00 $
(100' OF !NG. EST.) $
(4' OF BOND,$500 MIN) $
PERMIT FEE
/ . I (" OF F. P. BOND
, / ,1"1 /..,.'! $35.00 MIN)
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$ "S"'".= C! 0-&":
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APPROVED POR ISSUANCE
f: PWPERMIT
Revised 7/87
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