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CITY OF CAMPBELL
DEPT. OF PUBLIC WORKS
70 North First St.
campbell! CA 95008
(408) 861>-2150
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Permit No.
PUBLIC WORKS PERMIT
(Ior wor~lng 1n ~ne
public right-of-way) X-Ref. file
Issued ~ ~ --t'O' Applicat 10n Date ~ / JI /8 .S?
Permi~ p s 1n J.4: mos. expires 1 III llIos.
APPLICATION - Application is hereby made for a Public Works Permit in accordance with Campbell-
Municipal Code, Section 11.04.
A. Work address or tract t
60 Shelley Ave.
B.
Utility trench location Abandon gas service
N t f k sDt/41G6 704 7, S01t6576T42
a ure 0 wor :
Attach five (5) copies of a drawing showing the location, extent and dimensions 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, 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. Pailure 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 1 and 2).
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as indicated on the attached sketch.
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E. An application fee must accompany this application. This is non-refundable.
Name of Applicant Pacfic Gas and Electric Company Telephone: 725-2114
Address 10900 N. Blaney Ave. Cupertino
Is this work being done by the property owner at their own residence? ___yes 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 officers, agents and employees free, safe and harmless from any claim or demand for
damages resulti from the work covered by this permit.
edges that they have read and understand both the front and
1 inform their contractor(s) of the information.
August 8, 1988
uate
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NOTES: ALL WORK SHALL CONFORM WITH~aE
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.
ACHED, APPROVED PLANS AND ALL APPLICABLE CAMPBELL
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. Minimum cuts may be allowed
for connections or exploration holes. Such cuts 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 Go 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 FEE
PLAN CHECK DEPOSIT
BOND FOR FAITHFUL PERFORMANCE
F. P. (CASH) DEPOSIT
PERMIT FEE
(R-l)
($35.00)
$ _~ .DD
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AMOUNT
RECEIPT NO.
STANDARD
$50.00
$500.00
(100\ OF ENG. EST.)
$
$
$
($200)
(4\ OF BOND,$500 MIN)
(7\ OF F.P. BOND
$35.00 MIN)
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APPROVED FOR ISSUANCE
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f: PWPERMIT
Revised 7/87
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