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CIH OF CAMPBELL
DEPT. OF PUBLIC WORKS
70 North First St.
campbell! CA 95008
(408) 860-2150
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PUBLIC WORKS PERMIT
(tor wor~lng 1n ~ne
public right-of-way) X-Ref. file
Issued &~*g Application Date ~-:;i1.-ffl
Permi~ ez e ~n l~ aos. expires i Q .
a Public Works Perait in accordance with Ca~pbeli~
Per.it No.
APPLICATION - Application is hereby .ade for
Municipal Code, Section 11.04.
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A. Work address or tract' Shelley Ave.
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B.
Utility trench location ~n#111 r: 1 hRnn
Nature of work: Install utilities as indicated on the attached sketch.
Attach five (5) copies of a drawing showing the location, extent and diaensions 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 I and 2).
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E. An application fee must accompany this application. This is non-refundable.
Name of Applicant Pacific Gas and Electric Company Telephone: 725-2114
Address 10900 N. Blaney Ave. Cupertino 95014
Is this work being done by the property owner at their own residence? _yes no
Complete attached Workers' Compensation and Contractor forma.
this permit to hold the City of
from any claim or demand for
front and
ACCEP
Hav ~~~ 1988
NOTES:"'-:ALL WORK SHALL CONPORM 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 BEPORE 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.
~avemenc 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 aheets 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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(R-l)
($35.00)
STANDARD
$50.00
$500.00
(100' 0' ENC. EST.)
(4' OP BOND,$500 MIN)
(7' OP P.P. BOND
$35.00 MIN)
($200)
AMOUNT
$ ~O.OQ
$
$
$
RECEIPT NO.
PERMIT APPLICATION FEE
PLAN CHECK DEPOSIT
BOND FOR FAITHFUL PERFORMANCE
P. P. (CASH) DEPOSIT
PERMIT PEE
APPROVED POR ISSUANCE (-~)r~ I,;i / le,/
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ReVised 7/87