88-174
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CITY OP CAMPBELL
DEPT. OF PUBLIC WORKS
70 North First St.
Campbellt CA 95008
(408) 860-2150
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PUBLIC WORKS PERMIT
(ror wor~lng 1n ~ne ro
public right-ot-way) X-Rete tile ~
Issued 7L 7 ~Y' Y Applicat ion Date 6' -;L '7- cP' Y n
PerlD1~ el: re 1n.l.4: 1I0S. el:pires 1n II DIOS. 0
3:
APPLICATION - Application is hereby aade for a Public Works Permit in accordance with Campbe11- ~
Municipal Code, Section 11.04. ~
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Per.it No.
A.
Work address or tract' 1156 Peggy Ave.
Utility trench location SD1f41G86920. BWOIf452/1228/0050
Nature of work: Install utilities as indicated on the attached
sketch.
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B.
C.
Attach five (5) copies of a drawing showing the location, extent and diaenslons 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 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.
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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 foras.
The Applicant/Permittee hereby agree. by affixing their .ignature to this perait to hold the City of
Campbell, its officers, agents and employees free, safe and harml... from any claim or demand tor
damages resultin rom the work covered by this permit.
The Applicant/ e ittee hereby ackn ges that they have read and understand both the front and
back of this mit, and tha~~~ . inform their contractor(s) of the information.
ACCEPTED ren -. B~rg l/; June 28, 1988
;"; , __.~ - J _ ' ,i ,
uate
CHED, APPROVED PLANS AND ALL APPLICABLE CAMPBELL
NOTES: L WORK SHALL CONFORM WITH T
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 BEPORE STARTING WORK.
NOTICE MUST BE GIVEN TO PUBLIC WORKS AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK.
SPECIAL PROVISIONS
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1.
Street shall not be open cut for underground installations. Minimum cut. may be allowed
for connections or exploration holes. Such cuts must be specifically approved by the
Inspector.
~avement 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.
/2.
3.
4.
5.
PERMIT APPLICATION PEE
PLAN CHECK DEPOSIT
BOND FOR FAITHFUL PERFORMANCE
P. P. (CASH) DEPOSIT
PERMIT PEE
(R-l)
($35.00)
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($200)
STANDARD AMOUNT
$50.00 $ 5'8.00
$500.00 $
(100' OF ENG. EST.) $
(4\ OP 8OND,$500 MIN) $
(7' OF F.P. BOND 3;).00
$35.00 MIN) $
Q
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RECEIPT NO.
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APPROVED POR ISSUANCE'
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Revised 7/87
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