95-236
CTY Of CAMPBElL
DEPr. OP PUBUC WORICS
70 Nortb Pi1'It St.
CaIpbcIl, CA 95CXB
(408) 866-2150
BNCR.OAOIMENf PBRMlI'
(for wortiq withiD the
public ri&bl-<lf-way)
IIIued I 0 J 6 Jqs !i)C
Penalt apira ill U -.
Penalt No. 95-236
X-Rd. file
Applic:atioa Date 10/4/95
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APPUCAnON - AppJu..fioa II bczeby IIIIIlk for a Public Worb Penait iD -.daDce with Campbell M~ Code, Secdoa 11.oc. (App1ilo.a- ~
iD 6 IDOIldll if the pcnDiI ill DOt iIIued).
A. Wort addreII 01' tnICt #
n/e corner WALTERS AND HARRIET
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Utility bacia Iocatioa
B. Nature ofWOJt l' Y 4' rollT in rI ~nl1;) 1 + f()r mri i n r~nrl i r
C. Attacb four (4) copieI ol_ eap.ec:red dmwiDi IbowiDa the Icx:adoa, Clteat aad dime__ ol the work. ne dnwiD& IballIIIow the ftlatioa ol the
pt'OpClICd wort 10 CIliItiDa IUIfacc _ tIDlIetJrouDd im~~tL Wbea approved by the Oty &peer, aid dnwiq becIoIDeI a put ol tbiI permit.
D. AD wort IbaII CllIIform 10 the Cty'1 GcaenI ~ SIaadant CAatructiaD PIoviIka _ Staadard CAatructiaD DetaiII for Public Wmb
CoaItructioa; the GeDeIaI Permit CoaditioaIIiIted 011 the reverse Iide; _ the Spoc:iaI ProviIioaI for tbiI permit, lilted below. Pailure 10 abide by
tbeIc coaditioal _ proviIioaI may reIUII ia job lbul4JwD _/or forfeilure ol Paitbful PerformaDcc Suretiea _ caIb dcpoIitL (See GeDenl
Permit Coeditioal1 _ 2.)
E. A DClIU'efuDdabIe appIicatioa fee mull ~ .....111 tbiI appIicatioa.
Name of AppIicaDt SAN JOSE WATER COMPANY (Jane - emergency verbal)
T~ 279-7846
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1221 S. Bascom, San Jose 95128
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Is thilwort beiag doae by the pIOpC1'ty OMICI' at their own raicIcDce?
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Complete aDd attac:b WotkaI' CompeDlatioa _ Coatractor IIlformatioa fonDL
The AppIicaDt/pcrmittee beIeby apeeI by affixiDa their Iipaturc 10 thiI permit 10 bold the Oty ol CuDpbc1l, its ofticcJs, lIpD" aad ~ fnc, ufe
IIId IwmIeII &om aD)' claim or demaDd for damapI nlIUItiag &om the wort ~red by thiI permit.
Tbe AppIicantJPcrmittee hereby ac:blowIcdJa that they baw read _ UDdcIltaDd both the front _ bact of tbiI permit, _ they will worm their
coatractor(l) of the wODDatiOD.
Aa:eptect
Jane ( emerqency verbal )
(ApplicaDt (Penaittee) priIIt/1ip
10/4/95
Date
NOTP.S: ALL WORK SHALL CONFORM Wl'IH 11IE ATIAOIBD, APPROVED PLANS AND ALL APPUCABLE CAMPBElL SfANDARD
DRAWINGS AND CONDmONS.
11IE CONTRAcroR MUSf HAVE 1HIS PERMIT AND APPROVED PLANS AT 11IE SITE AND MUSf NOTIFY 11IE PUBUC WORKS
DEPAR'I'MENI' AT LEAST NO DAYS BEFORE SfAll11NG WORK.
NonCE MUSf BE GIVEN TO PUBUC WORICS AT LEAST 24 HOURS BEFORE RESTARnNG ANY WORK.
SPECIAL PROVISIONS
SfANDARD
AMOUNI'
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RBMm"T NO.
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Sheet IbaII DOt be opeD cut for 1IIIdcrpouDd ialtallatioaL MiDimum cuts may be allowed for ~ or CIJlIoIatioa boIcs. Such CUtl.!!!!!!l
be IDCcificalIy aumuved bv the IDsDector Drior to cuttiJuL
hvcmcnt may be cut for UDdcrpouDd ialtallatioal _ mull be JatCnd iD ea:ordaDce with the Utility TRDCb Ratoratioa Studard Drawiag.
Work 10 be Itabd by a IiceIIIed Laad Sunoeyor or Civil &peer _ two (2) copieI ol the cut 1heetI1CD~ 10 the Public Wmb Department
before Itartinc work. . )
urG ,,f,U::l1-htJ \4' McK-/::;(i/ w/7J4 2. clclC. ,>1Ij1/4/QM~ 5'~.
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PERMIT APPUCAll0N PEE $210.00
PLAN CHECK DEPOSIT SSOO.oo
SURETY FOR PAmIPUL PERFORMANCE (1~ OP BNG. ESI'.)
CASH DEPOSIT (4~ OP SURETY, S500 MIN)
PLAN CHECK .t. INSPECI10N PEE (FIRSI' 1).$30,000 14~;
..... -,.,., --6rJifJ,ooo ,S200 miD)
APPROVED FOR ISSUANCE ~
forCi . r
h:PW PERMITfRcv.4J94 (ICe other lick)
USA phone (800) 642-2444 TICKET NO.
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CITY OF CAMPBELL
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PROJECT NO. q ( . ..1.3 L,
REPORT NO:
FIELD ENGINEER'S DAILY REPORT
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WEATHER: ~/
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CONTRACTOR: C1A5-t.JM11 A)
INSPECTOR: K. .v~51fALL
ITEM
DESCRIPTION
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