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II ....:!. n r} ~ o III 0 14 III ,., ::I III 0 .. .... ,., 0' . 0 Ilt ~ .. ~ n .. n ~. ~ ~ r:- "'c;lo ,., .., , '" , I PUBLIC WORKS PERMIT p~"f,mit No. J--~- 2 2. / Trnrtlornng-rn-c-nll' public ri9ht-of-woy) ,:"X-~~.c. file Issued c;/~ 71ft : "AP~,lication Date i~/::>~.F-? Permi tlJIptl'll1l.s.rrrn-llIoa. ,I" ',.: I ellpi rea ~ade for a Public Works pe~~it 'i~,accordance with campbeli~ (.I l- e CITY OF CAMPBELL l.. ' .!-i DEPT. OF PUD[.IC WOnKS : ",' 70 North First StJ!!: cambbellt CA 95008 (40 ) 86 -2150 (:: )'1" App['ICATION - ApplicatiQh is hereby Municipl1l Code, Sectionl~p.04. : ; j ~ j A. Work address or trAct I S;O 3858 CAMPBELL AVE. ";; .![' Utility trenc~: ~oc~~ion SEE ATTACHED : Ii,' B. Nature of wor~:' PL~CE PEDESTAL IN PARK STRIP AiREA;" i':, ," Ii, " C. Attach five (5)' copi'es of adrowlng sho....ing the location, t'xtent: and dimensions of the work The dra....ing ahall spow the relation of the proposed work t'exlsting surface ond underground improvements. '!. Whe~d~pproved by the City Engineer, sdd drl ~ing i,b~comes a part of this permit. I!. '..' , . I" ; D. The General 'C~nditiQns for all permits are listed on the r~v~r~I,'side. Special Provisions for this permit Arelis~ed below. Failure to Abide by thoso condit ono and provioiono may result in job shut-down IIn'd,lor forfeiture or l'aithLul Performllnce, Uonl,! 11111.1 caoh depooits. (Soo General COndi\iOn\fiand 21. ! ;';' : ': E. ,An applicatio~if~e :~!~st accompony this opplication. This ~~, n~~:refundable. Name of Applicant .'PAtrIFIC B~LL (WALT BIEL) 1:'Telephone: (408) 491-8849 . MrJrODII 1531 PARKM .0!R AVE, SAN JOSE, CA. 9512" i' Is this ....ork being don~:~y the property owner at their own residende7 _yea r:. . ' 1- i : ~ I Complete attached ~orke~~' Compensation and Contractor forms. i', i:' ,',: ::;:' " I:':' The Applicant/Permitte~"ereby agrees by affixin9 their signatu~e t~:thia permit to hold the City of Campbell, its offi,cers ~ i llgents ~nd employees free, safe and ha~lllles6, :from any clailll or demand for damages resulting Jromi~~!! work ,covered by this permit. I:;, ;]:" . The APelicant/permi~tee! hereby acknowledges that they have rea~:i'and ::Ullderstand both the front and back of this permi,~~ A~f,!that they will inform their contractor,(,~) :o~, the information. " """ 11,1 7\: ,I t 2 1988 ACCEPTED '!', i: , j'l ri 1;1,g us, ^ppuca~:t (l'ermatee) :'; :;~ uate NOTES: ALL WORK SHALl. 'COHFORH WITH THE ATTACHED, APPROVED PLANS' AND. ALL APPLICABLE CAMPBELL' STANDARD DRAWINGS AND CO,NDITIONS. I':: ; " THE CONTRACTOR MUST;IIAV~;THIS PERMIT AND APPROVED PLANS AND MU~~ ME~;.WITH THE P.W. INSPECTOR ON THE SITE AT LEAST TWO DAYS BEFORE STARTING WORK. ,': , NO'J.'J.Ct: I1US'I' IlE cav~~ '1'11!ir:UDLJ.C WOIlKS A'I' LEAS'!' H 1I0UHS ilEt'OHE If~S'J.'AI~~l':J.NG ANY WOHK. SPECIAL pnOVISIONS '; :,,' ' !:! : \' I"': , ' , 1. Street shall no~:be open cut for underground installat~on~~ 'Minimum cuts may be allowed for connectio~f:Rr exploration holes. Such cuts must :tie s~~cifically approved by the _2. .f'~~~~~~~I;'~Y bl/~ut tor undorground instalJ.atloll8 AnrJ'lIIuat ,i~:e rutored in accordance with the Ut il1ty Tren.Ch Restoration Standard Drawing. : 'J,' 3. Work to be staked by a licensed [.and Surveyor or CivU':'Engineer and two (2) copies of the cut sheets,sent ,to the PUblic Work Dept. before starting wotk. 4. The hoursLof wotk are limited to outside the hours of :~-9 .~m. And 3-6 p.m. for any work affecting';.a tr,af'(1c lane. \ I ,: ~, 5. "'" ; , I ;, r . 't., (I : l , ;," I' I r: ";1' ;.',,1 I I" ; I,',i;,', 1"'1. ' ! ii" " ", ',:11, :' ii,':': (R-l) STANDARD L:. i~1 AMOUNT PERMIT ApPLICATION,FEE f!J'!~ '($35.00) $50.00 ii'"~ ::$1 50.00 ,PLAN CllECK DEPOSIT, I': $500.00 '$,: : I',' .! iI, I BOND FOR I'AITIII'UL PERF,OR;KANCE : ,$ , F. P. (CASU) DEPOSIT 1;1' :,i< lJ t' ( ( , : j' I_j'. I' ,','., '(ON VIA DE eSTE) t t i ~ t t ., no RECEIPT NO. q PERMIT FEE 1 (l00\ 01' ENG. EST.) ! ($200) (4\ 01' BOND,$500 HIN. I" (7\ OF 1'.1'. BOND i,: !:., , $35.00 HIN) : i: ::i;.~n.~ j ~: . : j <II !l.;.: I I, , , ~, : ~ It ; ,I "i I' ' " j i.!: ' ':: T', , .. ~..~J f .._.-.......9...___ ---..o:-"":"I'-:-~l'''''' ~. . ! , '~; (! I '~: i 35: 00 ~ I ! i R C(j Zk /S<ll.. lJa~ APPROVED 1'0R ISSUANCE f: PWpERI1IT nevised 7/87 i .;< ~ I .'!, .:: ;; :', i: 'UO!pn1ISUO:> /; ;:! ' U!I'lF1 91'" qQI;) . SUOjd ;)5,3'11 ~ " ' .!' " ,/1 UO ~.'~I~ ~~r.W IcJr' ".~ I I; ,"..'~"J, . C r' -,Jd ~. 0 f\.! ] I' it; ':"'\ '.~,., . II~n~: "TJr~Cj ~;! J :~\ :)!lqnd ~'d ., ..-: ,,~ u Y 1{, '~~ "....., 'f'. 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