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CITY 01' CAKPBBLL
DBPT. 01' PUBLIC WORD
70 Nortb First st.
Campbell, CA 15008
(408) 866-2150
88-190
Permit No.
X-Ref. file
Application Date 7/21/88
Applio.tion ezpires in , .os.
PUBLIC WORD PBRMIT
(for workinq in tbe
publio riqbt-of-w.y)
I..ued 7':J.-2. - ~&'
Permit ezpire. in 12 .os.
APPLICATION - Applio.tion i. bereby ..de for . Publio Works Permit in .ooordance witb Caapbel1
xunioip.l COde, Seotion 11.04. (Applio.tion ezpires in , .ontbs if perait not pulled)
A. Work .ddress or tr.ct f 1701 S. Bascom - 552' S. of Hami 1 Ton
utility trencb 10c.tion
B. N.ture of workl
Emeroencv Service Repair
C. Att.cb five (5) oopies of . dr.winq sbowinq tbe loc.tion, extent and di.ensions of tbe work
Tbe dr.winq sb.ll sbow tbe rel.tion of tbe proposed work to exi.tinq .urf.ce and underqround
iaprov..ents. When .pproved by tbe City Bnqineer, s.id dr.winq beco.es . p.rt of this perait.
D. The General Conditions for .11 permits are listed on tbe rever.e side. speci.l pJbvision. for
tbis permit are listed below. F.ilure to abide by these conditions and provisions ..y result
in job shut-down and/or forfeiture of F.ithful Performance Bond. and c.sh deposit.. (See
General Conditions 1 and 2).
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B. AD applioation fee .ust .ocoapany this .pplic.tion. This is non-refundable.
Name of Applicant San Jose Water Company
Address 1221 S. Bascom Avenue San Jose 95128
Telepbone: 279-7847
Is tbis work beinq done by tbe property owner .t tbeir own re.idence? ___yes ___no
Co.plete and .ttach Workers' Compens.tion and Contr.ctor Information forms.
The Applicant/Permittee hereby aqrees by affixinq their siqDature to tbis permit to hold the City of
Campbell, its officers, aqents and employee. free, safe and harmle.. from any claim or demand for
damaqes re.ultinq from tbe work covered by this permit.
Tbe Applicant/Permittee hereby .ckDowledqe. tbat they bave read and under.tand both the front and
back of tbi. permit, and tbat tbey will inform tbeir contractor(.) of tbe information.
ACCEPTED
NOTBSa ALL WOU SIIALL COlIFORM WITH 'l'BB ATTACBBD, APPROVED PLUS AND ALL APPLICABLE CUPBBLL
STANDARD DRAWINGS AND CONDITIONS.
'l'BB CONTRACTOR MUST BAVE TBIS PBRMIT AND APPROVED PLUS AND MUST HEBT WITB 'l'BB P.W. INSPBCTOR ON
'l'BB SITB AT LBAST TWO DAYS BBFORB STARTING WOU.
BOTICB MUST BB GIVBN TO PUBLIC WORD AT LBAST 24 HOURS BBFORB RBSTARTING ANY WOU.
SPBCIAL PROVISIONS
_1.
street shall not be open cut for underqround installations. Mini.um cuts .ay be allowed
for connections or ezplor.tion boles. Sucb cuts must be specifically .pproved by the
Inspector.
p.v..ent .ay be out for un4erqround inst.ll.tions and .ust be restored in .ccordanoe witb
tbe Utility Trench Restoration Stand.rd Dr.winq.
Work to be staked by . licensed Land Surveyor or Civil Bnqineer and two (2) oopies of tbe
cut sheets sent to tbe Publio Work Deptartaent before st.rtinq Work.
Tbe hours of work .re li.ited to outside tbe bours of 7-1 .... and 3-6 p... for any work
affectin9 .,traffio lane.
X'&4o......e: f R.6f>LA(~ ~,~l;wALI.c.. AIiTiA/EEAI,s<.E:>,U: /VtA/e.~ ~v'.
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PBRMIT APPLICATION FBB
PLU CBBCE DBPOSIT
BOND FOR FAITBI'UL PBRI'ORHABCB
(R-1)
($35.00)
$50.00
$500.00
(100' 01' BNG. BST.)
(4' 01' BOND, $500 XIN)
STANDARD
UOUJl'1'
RBCBIPT NO.
~
$ ..5l). CO
$
$
$
$.3S- 0 0
CASH DBPOSIT
($200.00)
Q c ~,
<, c,? /D-(.
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Dat;'~
PBIUIIT FBB
(7' 01' F.P. BOND, $35 XIN)
<'J:Ji0-v;;L-.
for C ty Bnqineer
;'
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APPROVED FOR ISSOANCB
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fa l'WPBIUIIT