88-173
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crTi uF CAMPBELL
DEPT. OF PUBLIC WORKS
70 North First St.
campbell, CA 95008
(408) 860-2150
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PUBLIC WORKS PERMIT
(tor worKIng In ~ne
public right-of~.W y) X-Ref. file
Issued 7 ~( r:P Y Application Date '-,- Z '1- ,-y'.,p
Permi~ e~ r~ n ~~ mos. expires ~n Q mos.
APPLICATION - Application is hereby .adefor a Public Works Permit in accordance with CalRpbell~
Municipal Code, Section 11.04.
per.it No.
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Work address or tract' 1724 W. Hacienda
Utility trench location SD1f41G26849, m-mIl442/1228/0050
Install utilities as indicated on the attached sketch.
Nature of work:
Attach five (5) copies of a drawing showing the location, extent and dimensions of the work
The drawing shall ahow the relation of the proposed work to eXisting surface and underground
improvementa. 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).
B.
C.
D.
E. An application fee must
Name of Applicant Pacific
Address 10900 N. Blaney
accompany this application.
Gas and Electric Company
Ave. Cupertino 95014
This is non-refundable.
Telephone: 973-8930
Is this work being done by the property owner at their own residence? _yea no
Complete attached Workers' Compensation and Contractor forma.
The Applicant/Permittee hereby agrees by affiXing their signature to this permit to hold the City of
Campbell, ita officers, agents and employees free, safe and harmless from any claim or demand for
damages result' from the work covered by this permit.
The Applican edges that they have read and understand both the front and
back of thi 11 inform their contractor(s) of the information.
June 28, 1988
uare
NOTES: ALL WORK SHALL CONFORM WITH
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.
APPROVED PLANS AND ALL APPLICABLE CAMPBELL
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.
yavemenr aay be cut for underground instAllAtions and must be restored in accordance with
the Utility Trench Restoration Standard DraWing.
Work to be staked by . 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 FEE
PLAN CHECK DEPOSIT
(R-I)
($35.00)
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STANDARD
$50.00
$500.00
AMOUNT
$ 5'6. e D
$
$
$
$ 3 S"~ 00
RECEIPT NO.
BOND FOR FAITHFUL PERFORMANCE
F. P. (CASH) DEPOSIT
PERMIT FEE
(100' OF ENG. EST.)
($200) (4\ OF BOND,$SOO MIN)
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APPROVED FOR ISSUANCE
f: PWPERMIT
Revised 7/87
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