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~IT& OP CAMPBELL
DEPT. OP PUBLIC WORKS
70 North First St.
Campbell! CA 95008
(408) 860-2150
Per.it No. J" ~ - 2. i 3
X-Ref. file -n'. ~I $2- ,
Application Date ~J-; >'~~<f>
expire8 n me.
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PUBLIC WORKS PERMIT
(tor wor~lng In ~ne
public righ~-~t~~2)
Issued ~~~-3 L' Kef
Permi~ exp res' 4-' m08.
APPLICATION - Application is hereby .ade for a Public Works Permit in accordance with Campbeli-
Municipal Code, Section 11.04. S
A. Work address or tract t ~(, ') Bascom Avenue
Campbell
B.
Utility trench location to
Nature of work: Tn!':1"";:lll 111""; 1; 1""; P!': R!': incH rR1""pc1 em 1""np R1""1""Rrnpc1 !':u-pj-"n "n#Fl f,qqf, ><
Attach five (5) copies of a drawing showing the location, extent and diaensions of the work i
The drawing shall show the relation of the proposed work to existing surface and underground tIJ
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 Paithful Performance Bonds and cash deposits. (See
General Conditions 1 and 2).
C.
D.
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E. An application fee must accompany this application.
Name of Applicant Pacific Gas and Electric
10900 N. Blaney, Cupertino
This is non-refundable.
Telephone: 973-8930
Address
95014
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/Per ittee hereby agrees by affixing their signature to this permit to hold the City of
Campbell, its 0 cers, agents and employees free, safe and har.less from any claim Or demand for
damages reault. from the work cove~,~ by this permit.
.;"' , "
The Applican er tee here~y'acknoWl.~s that they have read and understand both the front and
back of thl i , .a~d that they 11 orm tMir contractor(s) of the information.
ACCEPTED ~'u""............--.....---- 8/22/88
, uue
APPROVED PLANS AND ALL APPLICABLE CAMPBELL
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 BEPORE 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 cuts must be specifically approved by the
Inspector.
~avemenc may be cut for underground installations and must be restored in accordance ~1th
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. . . .'
,4)?b..t..lnd N7F-7Uo/) A 0;:- THE U17t.-/;;'fT~C/-/ /feb1l:J/l.,.:lnO/l./ .i>e;r:jl' ~.e .5~e?:T CUT
.A),4'G"/'J'U'L/'€ 1'tff{lJw:Jce riAL{. F"LAM. Dt: S/~~K.
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PERMIT APPLICATION PEl
PLAN CHECK DEPOSIT
BOND FOR PAITHFUL PERFORMANCE
(R-l)
1$35.00 )
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STANDARD
$50.00
$500.00
(100\ OF ENG. EST.)
AMOUNT
$ :57),190
$
$
$
$ 4~.oo
RECEIPT NO.
P. P. (CASH) DEPOSIT ($200) (4\ OP BOND,$500 MIN)
PERMIT PEE Z40L.t:.tE.20eQ.. ::"~448DO(1\ OP P.P. BOND
. '~~MIN) _
APPROVED POR ISSUANCE ~ ..-L--
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f: PWPERMIT
Reviaed 7/87
AUG 231988
PUBLIC WORKS
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