88-192
CXTY OF CAMPBBLL
DIP'!' . or PUBLIC WORltS
70 North First st.
campbell, CA 95008
(<<08) 866-2150
PUBLXC WORItS PERMIT
(for workinq in the
public riqht-of-way)
Xssued r .27-- '8~
permit expir.s in 12 .os.
Permit No.
<68' - , <1 ?
X-Ref. file
Application Date 7/26{88
Application expires n 6 .os.
APPLXCATXON - Applic.tion is hereby m.de for. Public Works permit in .ccordance with campbell
xunicipal Code, section 11.0<<. (Application expires in 6 .onths if permit not pulled)
A. Work address or tract t N/W Cornpr of M,..Rrl; n rlnrl Mi r1"liil~'
utility trench location
B. N.ture of work: Repair broken water IDa in
c. Att.ch five (5) copies of . dr.winq showinq the loc.tion, extent and dimensions of the work
The dr.winq shall show the rel.tion of the proposed work to existinq surface and underqround
improvements. When approved by the City Enqineer, said drawinq becomes a part of this permit.
D. The Gener.l conditions for all permits .re listed on the reverse side. special pJbvisions for
this permit are listed below. Failure to abide by these conditions and provisions may result
in job shut-down and/or forfeiture of F.ithful Perform.nce Bonds .nd c.sh deposits. (See
General conditions 1 and 2).
B. An applic.tion fee must .ccompany this .pplic.tion. This is non-refundable.
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Name o~ Applicant
San JosP. Wrlrpr rnmr~ny
Telephone:
279-7847
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Address
1221 S
R;:}~("'!()m n.~7~n"A C:~l""l .JO.Q
CA 95128
Xs this work beinq done by the property owner .t their own residence? ---yes ___no
Complete .nd .ttach Workers' compens.tion and contr.ctor xnform.tion forms.
The Applicant/Permittee hereby aqrees by .ffixinq their siqn.ture to this permit to hold the city of
campbell, its officers, .qents .nd employees free, s.fe .nd h.rmless from .ny cl.im or dem.nd for
dam.qes resultinq from the work covered by this permit.
The Applicant/permittee hereby acknowledqes th.t they have re.d .nd underst.nd both the front .nd
b.ck of this permit, and th.t they will inform their contractor(s) of the inform.tion.
ACCBPTED
HOTBS: ALL WOU SHALL CONFORM WXTH THE ATTACHED, APPROVED PLANS AND ALL APPLXCABLE CAXPBBLL
STANDARD DRAWXNGS AND CONDITIONS.
THE CONTRACTOR IlUST RAVE THIS PBRXXT AND APPROVED PLANS AND IlUST BET WXTH THE P.W. XNSPECTOR ON
THE SITE AT LEAST TWO DAYS BEFORE STARTING WOU.
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NOTXCE IlUST BB GXVEN TO PUBLIC WORltS AT LEAST 2<< HOURS BEFORE RESTARTXNG AllY WOU.
SPECIAL PROVXSIONS
_3.
Street sh.ll not be open cut for underqround inst.ll.tions. xinimum cuts m.y be .llowed
for connections or exploration holes. Such cuts must be specific.llY approved by the
xnspector.
P.vement m.y be cut for underqround inst.ll.tions and must be restored in .ccordance with
the utility Trench Restor.tion Stand.rd Dr.winq.
Work to be staked by . licensed Land surveyor or civil Enqineer and two (2) copies of the
cut sheets sent to the Public Work Dept.rtment before st.rtinq work.
The hours of work .re limited to outside the hours of 7-9 .... and 3-6 p.m. for any work
.ffectinq . tr.ffic lane.
_1.
/' 2.
CASH DEPOSZT
($200.00)
$50.00
$500.00
(100% OF ING. BST.)
(<<% OF BOND, $500 XIN)
(7% OF F.P. BOND, $35 XIN)
$ , 5"()~ 00
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PERMIT APPLXCATXON rEB
(R-l)
($35.00)
STANDARD
MOUNT
RECEIPT NO.
PERMIT FEB
$
$
$
$ .35.00
PLAN CHECK DEPOSIT
-
BOND FOR FAITHFUL PERJ'ORMANCE
----
APPROVED FOR XSSUANCB
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for C~ Enq1neer
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~: PWPERMIT