88-226
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CITY OP CA~PBELL
DEPT. OF PUBLIC WORKS
70 North First St.
Campbellt CA 95008
(408) 860-2150
PUBLIC WORKS PERMIT
'ror wor~lng In ~ne
public right-ozWzay X-Ref. file I
Issued 1" 1'_ c::P Y Application Dai:fi ~7~ <f'.?
Per.i~ e.pl~ l~ mos. expir~a In .
APPLICATION - Application ia hereby made for a Public Worka Permit in accordance with C.apbell-
MuniCipal Code, Section 11.04.
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A. Work addresa or tract t
65 shelly
Campbell
Utility trench location
Nature of work: Abandon service as indicated on the attached sketch.
Attach five (5) copies of a drawing ahowing the location, ezt~nt and di.enaig~. of the work
The drawing shall ahow the relation of the proposed work to e!1sting surface &nd underground
improvementa. When approved by the City Engineer, said draWing becomes a part of this per_it.
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 provi8ions ..y result
in jOb shut-down and/or forfeiture of Paithful Performance Bond. ~nd CAsh deposita. (See
General Conditions 1 and 2).
E. An application fe. muat accompany this application. This is non-refundable.
Name of Applicant Pacific Gas and Electric _Telephone:
Addreu 10900 N. Blaney Ave., Cupertino 95014
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973-8930
Ia this work being done by the property owner at their own reaidence? ~yes ___no
Complete attached Workera' Coapensation and Contractor for...
The Applicant/Permittee hereby agree. by affixing their .ignature to this per.it to hold the City of
Campbell, ita officera, agenta and emplOYee. free, safe and haral.ec fgoa any claim or de..nd for
damagea reaulti from the work covered by this permit.
The Applicant .ittee her!~ a edges that they have read and understand both the front and
back of this mit, and th~l inform their contractor(a) of the information.
wr Be 8/31/88
ual:.
NOTES: L WORK SHAtL CONPORM WITH APPROVED PLANS AND ALL APPLIC~~! CAMPBELL
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.
NOTICE MUST BE GIVEN TO PUBLIC WORKS AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK.
SPECIAL PROVISIONS
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Street ahall not be open cut for underground inatallationa. Minimum cuts ..y be allowed
for connections or exploration holea. Such cut. must be specifically approved by the
~~:~:~~~r_
y be cut for underground installationa and muat 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 aheet. sent to the Public Work Deft. before .tarting work.
The houra of work are limited ~ outa de the houra of 7-9 a.m. and 3-6 p... for any work
affe~ting oa traffic lane. .
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PE~IT APPLICATION PEl
PLAN CHECK DEPOSIT
80ND FOR PAITHPUL PERPORMANCE
P. P. (CASH) DEPOSIT
PERMIT PEE
(R-l)
($35.00 )
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STANDAJU)
$50.00
$500.00
(100\ 01 SHO. EST.)
RECEIP.T NO.
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($200)
(4\ OP 8OND,$500 MIN) .
(7',O'P.P.DOND
$35.00 MIN)
$ 35',00
APPROVED POR ISSUANCE
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f: PWPERMIT
Revised 7/87
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