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Penli t NO. 2g -.2 0 (0
X-Ref. fUe
Applicat ion Date S /, I 'tJ>:; g
expires ~n a s.
APPLICATION - Application is hereby made for a Public Works Permit in accordance with Campbell-
Municipal Code, Section 11.04.
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CITY OP CAMPBELL
DEPT. OF PUBLIC WORKS
70 North First St.
campbell! CA 95008
(408) 8h-2150
PUBLIC WORKS PERMIT
(tor wor~lng 1n tne
public ri9ht-of-way)
Iuued ,f~/ p ~o {
Permi~ e~ res n ~
mos.
A.
Work address or tract' 1381 Harriet Ave.
Utility trench location Install utilities
SD#41G16909, W5~4LU41V
Tract 8132
as indicated on the attached sketch.
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B.
Nature of work:
Attach five (5) copies of a drawing showing the location, extent and di.ensions 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 drawin9 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 1 and 2).
E. An application fee must accompany this application. This is non-refundable.
Name of Applicant Pacific Gas and Electric Company Telephone:
Address 10900 N. Blaney ave. Cupertino 95014
c.
D.
725-2114
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, aafe and haral.ss from any claim or demand for
damages resulting 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 infor.ation.
August tj, 1 ':I~b
ACCEPTED
uate
NOTES: LL WORK SHALL CONPORM WITH
STANDAR 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 BEPORE STARTING WORK.
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 allo~ed
for connections or exploration holes. Such cuta 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 ~ outside the hours of 7-9 a.m. and 3-6 p.m. for any ~ork
affecting a traffic lane.
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PERMIT APPLICATION FEE
PLAN CHECK DEPOSIT
BOND FOR FAITHPUL PERFORMANCE
(R-l)
($35.00)
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STANDARD
$50.00
$500.00
(100' OF !NG. EST.)
AMOUNT
$ 50.00
$
$
$
RECEIPT NO.
F. P. (CASH) DEPOSIT ($200) (4' OF BOND,$500 MIN)
PERMIT FEE (,55 L.r./SOC ~.F, (i? .20' -'ICO.cO (7' OP F.P. BOND
ISSI...p.e'/~'" 23.25 $35.00MIN)
APPROVED POR ISSUANCE ' ) 'ls~/a, ---
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$ J 23. 2. 5
f: PWPERMIT
Reviaed 7/87