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CITY OF CAMPBELL
DEPT. OF PUBLIC WORKS
70 ~orth First St.
Campbell! CA 95008
(408) 8611-2150
Permit No.M-JBI
PUBLIC WORKS PERMIT
IIor worK1ng 1n ~ne
public right-of-way)
Issued 7/1<((8'8
Permi~ e~p1r s 1n l~ mos.
X-Ref. file
Application Date l~J~~/~~
expires r
APPLICATION - Application is hereby made for a Public Works Permit in accordance with Campbell~
Municipal Code, Section 11.04.
A.
Work address or tract .
Utility trench location
Nature of work: Abandon
qil H;:J7:f>l Ave.
SDf!41G67014,
gas service as
SOfl6835LN'49
indicated on the attached SKeLch.
B.
C.
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, Baid drawing becomes a part of this permit.
The General Conditions for all permits are listed on the reverse Bide. 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 Electrj c Coml)any Telephone:
Address 10900 N. Blaney Ave. Cupertino 95014
D.
q7i-Rqin
Is this work being done by the property owner at their own residence? ____yea 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 office , agents and employees free, safe and harmless from any clai. or demand for
damages resulting f the work covered by this permit.
The Applicant/Pe that they have read and understand both the front and
back of this per orm their contractor(s) of the information.
ACCEPTED Law c q..., "._h July 12, 1988
Llate
NOTES: ALL RK SHALL CONFORM WITH THE ~ D, 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
1.
Street shall not be open cut for underground installations. Mini~um cuts may be allowed
for connections or exploration holes. Such cut. 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. ,.
A). 5EE A1TAc..HC=~ ~^"c..I-I i?esro~lr'T1cJ Dem,t-
.
~ CH ,'p ..:5eJJL A .c.. "TO WlATCU c..JliST1''''<='
~2.
3.
4.
.r 5.
PERMIT APPLICATION PEE
PLAN CHECK DEPOSIT
BOND POR PAITHPUL PERPORMANCE
P. P. (CASH) DEPOSIT
PERMIT PEE
(R-l)
($35.00)
Q
STANDARD
$50.00
$500.00
(100' OP ENG. EST.)
AMOUNT
$ 50,00
$
$
$
$ 35.00
RECEIPT NO.
($200)
(4' OF BOND,$SOO MIN)
(7' OF P.P. BOND
$35.00 MIN)
-7 />~.r
,/ :; --
APPROVED FOR ISSUANCE
___;. /1 /"\. / ,7../
\/ ~f I/"~
J,f, I; ~y jiJs 4
-----
f: PWPERMIT
Revised 7/87
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/\PPROVED FO~CONSTRUCoTI
~~20[':GamPbell :l
?ublic Works Pe~t No. g- 3
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