88-186
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. CITY OF CAMPBELL
DEPT. OF PUBLIC WORKS
70 North First St.
Campbellt CA 95008
(40B) 860-2150
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PUBLIC WORKS PERMIT
(Ior worK1ng 1n ~ne
p~blic right-of-way) X-Ref. file
IU~ed -~s-Ig~ Application Date ?'~r;('~
Perml~ ere. 10 l~ .oa. expires 1W .
APPLICATION - Application is hereby .ade for a Public Works Per.it in accordance with Ca.pbeli-
M~nicipal Code, Section 11.04.
Per.it No.
B8-(S'=>
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A. Work address or tract . 140 S. Peter Drive
Utility trench lOCAtion SD1I41G86976. SOIJ88071
B. NAture of work: "Install utilities as indicated on the attached sketch.
c.
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 undergro~nd
improvements. When Approved by the City Engineer, .aid drawing become. a part of this permit.
The General Conditions for all permits Are listed on the reverse side. Special Proviaions for
thia permit are listed below. 'ailure to abide by these conditions and prOVisions may result
in jOb shut-down and/or forfeiture of Faithful Performance Bonds and cA.h depoaits. (See
General Conditions I and 2).
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
D.
Is this work being done by the property owner at their own residence? ___yes ___no
Complete attaChed Workers' CompenSAtion and Contractor for...
The Applicant/Per.ittee hereby Agrees by affixing their .ignature to this per.it to hold the City of
Campbell, it. officers, Agents and employe.. free, safe and harale.s fro. any clai. or de..nd for
damage. re.ult' ~ from the work covered by thi. permit.
The Applican ~ r.ittee hereby ack edge. that they have read and under.tand both the front and
back of thi ermit, and t . ~ ~ 11 inform their contractor(s) of the information.
ACCEPTED wr e t1,. Be ' July 14, 1988
ua~.
ALL WORK SHALL CONPORM WITH APPROVED PLANS AND ALL APPLICABLE CAMPBELL
STAND D 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 WOaK.
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. Mini.um cut. say be allowed
for connections or exploration hole.. Such cuts must be specifically approved by the
Inspector.
~.vemeo~ ..y 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 .heets .ent to the PUblic Work Dept. before .tarting work.
The hours of work are limited ~ outside the hour. of 7-9 a... And 3-6 p.m. for any work
affecting a traffic lane.
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PERMIT APPLICATION FEI
PLAN CHECK DEPOSIT
BOND FOR FAITHFUL PERFORMANCE
F. P. (CASH) DBPOSIT
PBRMIT FEE
(11.-1)
($35.00)
~
STANDARD
AMOUNT
$ 50.00
$
$ -
$
RECEIPT NO.
$50.00
$500.00
(100\ OF ENG. EST.)
(4\ OF BOND,$500 MIN)
(7\ OF F.P. BOND
$35.00 MIN)
($200)
APPROVED FOR ISSUANCE
r(il?:niet .
$ .3 S.Oo
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7p5/86
---
f: PWPERMIT
ReVised 7/87
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