88-166
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CITY OP CAMPBELL
DEPT. OF PUBLIC WORKS
70 North First St.
Campbell, CA 95008
(408) 860-2150
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PUBLIC WORKS PERMIT
Itor wor~ln9 In ~ne
public right-ot-way) X-Rete tile
Issued c.~ 7ffcP Application Date (- /::,-- ,y,y
Permi~ e~p ea l~ mos. expires In Q moa.
APPLICATION - Application is hereby made for a Public Works Permit in accordance with Campbell~
Municipal Code, Section 11.04.
Permit No.
A.
Work address or tract' ]11111 York Ave.
Utility trench location Install utilities
SDI!41G26925
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as indicated on the attached sketch.
B.
Nature of work:
C.
Attach five (5) copies of a drawing showing the location, extent and dimensions of the work
The drawin9 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. 'ailure 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 Conditions 1 and 2).
E. An application fee must accompany this application. This is non-refundable.
Name of Applicant Pacific Gas and Electric Company Telephone: 973-8930
D.
Address 10900 N. Blanev Ave. Cupertino
Is this work being done by the property owner at their own residence? ___yea no
Complete attached Workers' Compensation and Contractor for...
The Applicant/Permittee hereby agrees by affixing their signature to this permit to hold the City of
Campbell, its officers, agents and employees free, .afe and harmlea. from any Claim or deaand for
damages resulting from the work covered by this permit.
The Appli t~rmittee at they have read and understand both the front and
back of tape mit, an contractor(s) of the information.
ACCEPTEDDa,' Crowf June 10, 1988
Uat:e
NOTES: ALL WORK SHALL CONPORM WITH
STANDAR~~WINGS 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.
AND ALL APPLICABLE CAMPBELL
NOTICE MUST BE GIVEN TO PUBLIC WORKS AT LEAST 24 HOURS BEPORE RESTARTING ANY WORK.
SPECIAL PROVISIONS
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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.
ravement: may be cut for underground installation~ 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
affect~ng a traffic lane.
~dJ S~4L TO /V147C1-I EXI'.sT1.AJ&' /)1ql/rcM.&v-r
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A'1TAc..t-11Zt:> "'TR &oJ (,14
(R-I)
($35.00)
;eE.sTD~-ri a to..l
STANDARD
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AMOUNT
$ 50. 00
$
$
$
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RECEIPT NO.
PERMIT APPLICATION PEE
PLAN CHECK DEPOSIT
BOND FOR FAITHFUL PERPORMANCE
$SO.OO
$500.00
(100' OP ENG. EST.)
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P. P. (CASH) DEPOSIT
PERMIT PEE
($200)
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tot l!t:y il!:ng eer
(4\ OP BOND,$500 MIN)
(7\ OF F.P. BOND
$35.00 MIN)
$ .3 5". OD
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APPROVED POR ISSUANCE
f: PWPERMIT
Revised 7/87
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