88-207
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PUBLIC WORKS PERMIT Per.it No. ~~~-- ~t:J~
IIor worK1ng 1n tne
pUblicri~~t-of~w4a ).-, X-Ref. file
Issued ./ ~ J if ('1 Application Date P:- if;; -f!Pj
Permit ~ eJl ~'" 1I0S. expires itr'T-th .
APPLICATION - Application is hereby made for a Public Works Perllit in accordance with Campbell-
MuniCipal Code, Section 11.04.
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CITY OF CAMPBELL
DEPT. OF PUBLIC WORKS
70 North First St.
Campbell! CA 95008
(40B) 86C1-2150
A.
121 S. 3rd Street
Abandon gas service as lndlcated on the an:ached bl,eLc..l...
Work address or tract ,
B.
Utility trench location
Nature of work: SDf,!41G06898, SO#88109
C.
Attach five (5) copies of a drawing showing the location, extent and di.ensions ~fYthe 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. Failure to abide by these conditions and provisions may result
in job shut-down and/or forfeiture of Paithful Performance Bonds and cash deposits. (See
General Conditions I and 2).
E. An application fee must accompany this application. This is non-refundable.
Name of Applicant Pacific Gas and Electric Company Telephone: 725-2114
Address 10900N. Blaney Ave. Cupertino
D.
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Is this work being done by the property owner at their own residence? ___y.s 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 har.less from any claim Or demand for
damages resulting fr the work covered by this permit.
The Applicant/Per that they have read and understand both the front and
back of this per their contractor(sl of the information.
Lawr August 11, 1988
ACCEPTED
uate
NOTES: ALL RK SHALL CONPORM WITH
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.
, APPROVED PLANS AND ALL APPLICABLE CAMPBELL
NOTICE MUST BE GIVEN TO PUBLIC WORKS AT LEAST 24 BOURS 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 ~ outside the hours of 7-9 a.m. and 3-6 p.m. for any work
affecting a traffic Ian..
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PERMIT APPLICATION FEE
PLAN CHECK DEPOSIT
BOND FOR FAITHFUL PERFORMANCE
F. P. (CASH) DEPOSIT
PERMIT FEE
(R-I)
($35.00)
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APPROVED FOR ISSUANCE
STANDARD
$50.00
$500.00
(100\ OF ENG. EST.)
($200) (4\ OF BOND,$500 MIN)
(7\ OP F.P. BOND
/ $35.00 MIN)
~lty' i~~.t.~4' (l(..~----'
AMOUNT
S:t.. ; 1
$
$
$
$
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$ .,.
RECEIPT NO.
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bate
[or
f: PWPERMIT
Revised 7/87
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