95-237
aJ'Y Of CAMPBELL
DEPT. Of PUBUC WORICS
'70 NordI fUll St.
Campbell, CA 9sc:m
(a) 866-2150
ENCROAawENI' PERMn'
(lor wortiD& witbiD tbe
public riabt4.-y)
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Pamit No.
X-let. file
95-237
AppIicatiaD n.tc 1 0 I 9 / 9 5
AppIicatiaD apini. 6 ...
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" . APPUCAllON . AppIicatiaD iI bcreby IMdc for a Public WClIb Permit iIl8llXlCll'daDcc witb r...."..J1 M~ Code, Secac. 11.G4. (ApplicatiaD apireI
.= 8 ill 6 IDClGtha if the permit iI DOt iIIued).
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~ ~ A. WorhddrellortrKt# W/S Superior, 75' N/O Ontario
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EMERGENCY MAIN REPAIR on 10 7
an x 0 e In lrt.
C. Attadl four (4) copieI of u eqiDecred cI.rniq IbowiD& tbe IocatioD, aICIlt aDd diJD#..ac- of tbe work. nc cInwiq IbaIJ IIaow tbe relatiaD of tbc
PJ'OIlClICd wort to cxiItiq IUJface aDd UDdcrpouDd iDlpftMmcDtL Wbal approved by tbe at)' PJlP_, aid cI.rniq becaIDa a put of tbiI permit
D. AU wort sba1I CODform to the aty'. Galcral CcDditioaa, StaDdud Coam1actioIl ProviIioaI aDd StaDdud CcIaItnIctiaD DetaiII for Public Worb
Cclamw:tioD; the Geaera1 Permit CcDditioaa lilted OIl tbc rcvene Iidc; aDd tbc SpcciIl ProviIioaI for daiI permit, lilted below. failUft to abide by
tbcIe coaditioaa aDd proviIioaa may raWt ill job ahut-4owD aDd/or forfeiture of faithful PcdormaDC:C Sureties aDd c:Sl depcStL (See GeDenl
PenDit Coaditioaa 1 aDd 2.)
E. A IICIIlJ'CfuDdable applicatiaD fee mull ~II)' tbiI appIiI:atiaD.
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Utility lIeDCIIlocatioa
Name of Applicant
San Jose Water Companv
TelepboDe 279-7979
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Addrell
1221 South Bascom Avenue, San Jose, CA 95128
ls.thiI wort beiDg doDe by the property owaer at tbcir on raidcDce?
Yes
No
Complete aDd attacb Workers' CompeDlltiaD aDd Coatrldor lDformatioa fOl'lDl.
The ApplicIDtjPerminec hereby qreca by aftixiq their lipature to tbiI permit to bok1 the cty of r...."...\, ita al6&:crs, IpIlll aDd empkliyllCI free, life
aDd harmIea from uy claim or demaDd for damapI reaultiq holD tbe wort CCMred by tbiI permit
The AppIicaDtjPermittee hereby actDc:Jwled&cs that tbcy have read IDd IlllderstaDd both the front IDd bIct of this permit, IDd tbcy wiD worm their
coatrac10r(1) of tbe inCormatioa.
~~ Jane Leinberger (EMERGENCY VERBAL)
(ApplicaDt (permittee) priDt/1ip
10/9/95
o.te
Nares: AU. WORK SHALL CONFORM wrIH nIB ATrAOIED, APPROVED PLANS AND AU. APPUCABLE CAMPBEll. SfANDARD
DRAWINGS AND CONDmON5.
nIB CONI'RACI'OR MUSf HA VB nus PERMrI' AND APPROVED PlANS AT 1HE srre AND MUSf NOTIPY 1HE PUBUC WORKS
DEPARThIENI' AT lEAST lWO DAYS BEfORE srAR11NG WORK.
NonCE MUSf BE GIVEN TO PUBUC WORKS AT LEAST 24 HOURS BEfORE RPSrAR11NG ANY WORK.
SPECIAL PROVISIONS
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_1. Street Iha1I DOt be opeD cut for uderpouDd iDItaIlftiolll Minimum cull may be allowed for COIIIIedioaa or apioratioa boles. SudI CUll.!!!!!!!
be soedficaUv IUDJ'O'<'ed bv the lDsDector,mor to cuttiDE.
hYemeDt may be cut for IlllderpouDd iDaalIatiollllDd mull be restored ill accordaDce with tbc Utility TradI RatoratiaD SIaDdard I>rawiIIg.
Wort to be stak~ by a 1iccDled Lud Swwyor or 0Yil EqiDecr aDd two (2) copies of the cut Uaeell _t to tbc Public Worb DepanmeDt
before IWtiDC wort.
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11~~ ~4- /6:;"/6e. 1 MWl.L 1.1"r~ ~Jt,{jW'b ruMr. AT ~m~ t::H~. CUT 1N1'IfA,(IJJNI.. ~~1'.J.
INtTN 4- 1Aw. Nci'tFf p.W lA/rflf.C:-~ 1..1 r. ~-11~ t1JA4e ~.4C. IS 7'JJ de tUlIICilf!/J.
SfANDARD AMOUNI' REC"P1V1" NO.
PERMIT APPUCAllON FEE sno.OO S.lJ.. '5"; 0 (.) 11
PIAN OIECK DEPOSIT SSOO.oo S
SURElY POR PAIIHF'UL PERPORMANCE (1~ Of ENG. FSI'.) S
CASH DEPOSIT (4* Of SURETY, SSOO MIN) S -
PIAN CHECK a. INSPECllON FEE (PIRSI' $0-$30,000 14*; S /20 . CI ~
Next $30,000.$80,000 10%; AmouD~t r thaD ~ " S200 miD)
APPROVFl) POR ISSUANCE ~.!L I' /I~/95
for City . r Date
b:PW PERMlT/Rev.4/94 (ICe other side)
USA phone (800) 642-2444 TICKET NO.
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CITY OF CAMPBELL
Public Works Department
FAX MEMO
DATE: July 2, 1996
TO: San Jose Water Co. -- Sandra Luczkowiak
FAX #: (408) 292-5812
FROM: Randy Westfall / Public Works Inspector
SUBJECT: Utility Cut Deficiency Report
PERMIT # DEFICIENCY
95-237 The sidewalk was replaced on the west side of Superior, 75' north of Ontario,
and has a lot of graffiti in the new concrete. This job was done in Oct. of last
year, but the concrete work was done without notice to the City, so I didn't find
the graffiti until Nov. sometime. I don't know which contractor did the concrete
work. Please correct the problem. Thanks.
K:dl~ Ot~~i^" ~
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W.
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Deficiency must be corrected within 10 days. Work must be performed under a current
encroachment permit. Notify Public Works prior to any work being done and for inspections,
by 8:30 a.m. on the day before work is to be done.
Telephone (408) 866-2165 Fax (408) 376-0958
70 North First Street. Campbell, California 95008.1423 . TEL 408.866.2150 . FAX 408.379.2572 . TOD 408.866.2790
NEW PW FAX #
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CITY OF CAMPBELL
FIELD ENGINEER'S DAILY REPORT
ITEM
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CONTRACTOR:
PROJECT NO. r s- 2 ? 7
REPORT NO:
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DATE :
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