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VI rt =' In n CD ..... rt :r - 0 1lI'tl (I) ::l 0 (I) 0 ~.IIl~~~ ...~ rt '" v .... .... N CITY O~ CA~PBELL DEPT. OF PUBLIC WORKS 70 North First St. Campbell! CA 95008 (408) 86b-21S0 Permit No. c;; :? ~ ,;1 /S '7 >-3 o OJ trl PUBLIC WORKS PERMIT (tor worKIng 1n tne public right-of-way) / I r:.f~ Issued 11/ .3/ / cl Permit exp1res In II X-Ref. file Application Date Ii (;-/fff! expires 1n 05. () o ~ 'U L' trl >-3 trl o mos. APPLICATION - Application is hereby made for a Public Works Permit in accordance with Campbell~ Municipal Code, Section 11.04. A. Work address or tract' P/Zv/vG"Y.4~ //'v'"A../ Utility trench location 8ASC6;Y? Av&, .,. /-2/D6:.e.t.-GV D/2.... OJ Nature of work: //V'5TAL-L-A-7/t::>A./ c5F cA'7V -;;r-O .:;;:-e.et//ce; ~A2{/A/GY~i:2..P >< ~&'I'~ Attach five (5) copies of a drawing showing the location, extent and dimensions of the work >-3 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. trl B. C. D. :P 'U 'U L' H () This is non-refundable. :p Z TelePhon~) 998-?:3~?ex~ C,el. 7""5"/ I'&. 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 Faithful Performance Bonds and cash deposits. (See General Conditions 1 and 2). E. An application fee must accompany this application. Name of Applicant 6/L-L-c=..AC!fe::.-e'" Address ~~4 ~/S'~ ~D. >A~-=/OS"C... Is this work being done by the property owner at their own residence? ___yes ~no Complete attached Workers' Compensation and Contractor forms. The Applicant/Permittee hereby agrees by affixing their signature to Campbell, its officers, agents and employees free, safe and harmless damages resulting from the work covered by this permit. The Applicant/Permittee her back of this permit, And that ACCEPTED ~L~ App~a this permit to hold the City of from any claim or demand for acknowledges that they have read and understand both the hey will inform their contractor(s) of the information. /p-~8~ J&!!l JJate front and NOTES: ALL WORK SHALL CONFORM WITH THE ATTACHED, APPROVED PLANS AND ALL APPLICABLE CAMPBELL 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. NOTICE MUST BE GIVEN TO PUBLIC WORKS AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK. SPECIAL PROVISIONS 0-3 o 1. 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 De~t. before starting work. The hours of work are limited to outs1de the hours of 7-9 a.m. and 3-6 p.m. for any work affecting a traffic lane. m-ovE' . C . C. . ~ SCDA:./E N'7.4A:..K. 8) ..IF F~T71t.lAT7'o~ 1".5 a9-l-/~ ,"'/4~ V~.lF4" P. d.~. o...e Gc..~€ /' 1 / W-e-,'rnF;<../ ~~;~':'I'CA1 LO..e r;~.A4o/\./T /~ ~,,",,/"/~Qt.C )AAJZ> J9U1-c.G" , , '-:oA.lI:>v.-:-r AS /':LQSe TO ~K. .=.rC (~4?K:.. /1-5 /.)0,.>:" .~(..e. r STANDARD OJ tTJ () o :s: ''0 L' trl >-3 trl o OJ >< >-3 ::c trl 2. 3. .....-- 4. ~ 5. PERMIT APPLICATION FEE PLAN CHECK DEPOSIT (R-l) ($35.00) $ $ $ $ AMOUNT RECEIPT 1..;0. .50.00 Q n H >-3 >< $50.00 $500.00 BOND FOR FAITHFUL PERFORMANCE F. P. (CASH) DEPOSIT PERMIT FEE /95' LJ, X 0.2.0 (100\ OF ENG. EST.) ($200) (4\ OF BOND,$500 MIN) - Q'3Q.oo (7\ OF F.P. BOND 4~' $35.00.?N) _~?1~frT{_ ~1 JJ4te ~ APPROVED FOR ISSUANCE $ .3CJ. PO -- l:::::ATOAJ ror f: PWPERMIT Revised 7/87 70 NORTH FIRST CAMPBELL, CALIFORNIA (408) 866-2100 STREET 95008 WfMBE.:L Y' M'iDUr-iC I.~~L~~;~~~~"~;,~:~~]~=~!... 1__V:~_r-F~~~A~t~~! [;'~~~'~~-_L_ ~_~"--'L i J ~ - ---------r------..,... - _ ~ ~ >, ~ 'I ~-,. I! - ,---'-- ., ,,-'1/"1"'1.-7' I) I i -~~--~ --~~::_-_.---i-.___,' 1--------1-_ i P',"C' ',1 i 'I ' U1 LE:~:~~__.~-=_.. -:=_=~- i.-. CITY OF CAMPBELL Department: Public Works November 3, 1988 Gillcab1e 234 Gish Rd. San Jose, Ca. 95112 Attn: Jerry Martinez Re: Permit No. 88-257/Pruneyard Inn (Bascom & Ridgley) Special Provisions Dear Jerry: There are a number of special conditions that need to be addressed regarding the proposed installation and they are as follows: 1) Bascom Avenue shall not be open cut (laterally). A longitudinal cut on the west side of Bascom as well as the south side of Ridgley will be permitted at the lip of gutter only. 2) All open cuts must be restored per the City's trench restoration detail. (Including benching and fabric at the top.) 3) Per your detail all open cuts will be backfilled with the pozzo1an mix. 4) Restricted working hours apply when a lane is affected on Basom Avenue. Work will only be permitted between 9a.m. and 3p.m. and per your spec full traffic control must be provided. 5) Asphalt patching should be completed within 48 hours after backfilling trench. (Chip seal where applicable.) The trench restoration requirement differs from what we agreed to regarding the previous multi-street undergrounding project. However, it is the City's position that all new construction adhere to the current trench restoration detail. If you have any questions or require additional information please feel free to contact me. Sincerely, Gregg Eaton, Public Works Inspector . 3N1 ~OJS\18 oS j " ------ +1 f\! 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