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PUBLIC WORKS PERMIT Permit No. 8S" - .20'/
'tor worK1ng 1n ~ne
public right-ot-way) X-Ref. file
Issued cP -/~- ~ J' Application Date S - (6-- g'l?
Perml~ e~p1reB 1n l~ mos. expires 1n Q m B.
APPLICATION - Application is hereby made for a Public Works Permit in accordance with Campbell-
Municipal Code, Section 11.04.
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CITY OF CAMPBELL
DEPT. OF PUBLIC WORKS
'0 North First St.
Campbellf CA 95008
(408) 860-2150
A.
251 LLewellyn Ave.
SD#41G46962, SO#73437,88105
Work address or tract .
B.
Utility trench location
Nature of work: Install utilities as indicated on the attached sketch.
C.
Attach five (5) copies of a drawing showing the location, extent and dimensions of the work
The drawing shall ahow the relation of the proposed work to existing surface and underground
improvementa. 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. 'ailure to abide by these conditions and provisions may result
in job shut-down and/or forfeiture of Faithful Performance Bonds and cash deposits. (See
General Conditions I and 2).
D.
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E. An application fee must accompany this application.
Name of Applicant PACIFIC GAS & ELECTRIC CO.
Address 10900 BLANEY CO. CUPERTINO 95014
Is this work being done by the property owner at their own residence?
Complete attached Workers' Compensation and Contractor torms.
The Applicant/Permittee hereby agrees by affixing their signature to
Campbell, its officers, agents and employees free, safe and har.less
damages resulting from the work covered by this permit.
This is non-refundable.
Telephone: 725-2114
_yea no
this per.it to hold the City of
from any clai. or demand for
The Applicant/Pe m ttee hereby acknowle
back of thia p t, and that ~~Y/W,
ACCEPTED L t nee M. Berg .~.: /
HED, APPROVED PLANS AND ALL APPLICABLE CAMPBELL
es that they have read and understand both the front and
nform their contractor(s) of the information.
August 8, 1988
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NOTES: A WORK SHALL CONPORM WITH
STANDARD WINGS 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 cuts may be allowed
for connections or exploration holes. Such cuts must be specifically approved by the
Inspector.
~.vement ..y 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.
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PERMIT APPLICATION PEE
PLAN CHECK DEPOSIT
BOND FOR FAITHFUL PERFORMANCE
F. P. (CASH) DEPOSIT
PERMIT PEE
(R-l)
($35.00)
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STANDARD
$50.00
$500.00
(100' OF !NG. EST.)
AMOUNT
$ ,Sl).00
$
$
$
RECEIPT NO.
($200)
(4' OP BOND,$500 MIN)
(" OP F.P. BOND
$35.00 MIN)
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$ .3.5'.00
APPROVED POR ISSUANCE
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Reviaed 7/87
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