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~~~F~~~! 'VI: D ~~~
'70 North P'ust St. public ri&bt4-way)
=2~ 9S4D OCT 271995 18ue41!i:.! :r=- 9~ - J AppIic:atioll Date 10' 1(p. c:rs
Permit . . u "'/JitlO AppIic:atioll a:pira ia 6 IDOL
PUbliC Vv v"";:; ID '/
APPUCATION _ ~~~ for a Public Warb Permit ill ac:corduM:c wida C...".....u NUIIidpU Code, SectioIlIUM. (Applic:atioll c:IpiJa
ill 6 IDOIltbl if the permit iI DOt iIIued).
A. Work addrca or tnct # B 7 4lS / 11<.Ac T ')
-
Pumit No.
X-Ilef. file
95 -~LJs--
Utility treaeb Iocatioll
B. Naturufwon: 'NA.-rte. M~\N \N5Tb.LL~T\ON
ES- 251... (ET) ,U -J~ ~
I
C. Attacb four (4) copies 01 III capDccred dIawiaC IbowiD& tbe IocatioD, aICDt aad llia1--'7'" 01 tbe 1IOIt. Tbe dIawiaC 1bID__ tM RIatiaa 01 tbe
~ won: to CIiItiD& lUlfacc aad UDderp'oUDd ~ WIlla ~od bJ tbe Cty &peer. laid ~..... a put 01 daiI permit.
D. AD won: IbaIJ coaform to the Oty'1 GeDcraI CaaditiaaI, SIudud CaaItnidiae ~ _ SIudud CoaItnIdioe DeWII (or PubIie Worb
CoeItIuctioD; the GeDUll Permit CODditioallilted GO the rcwne Iidc; _ the Special Provilioal (ex daiI permit. lilted bciow. Mae to IIbide bJ
dIeIe caoditioal ucI pnMIioaI may rault iD job lib....,... _/or forfeiture 01 Paitbful PafClC'lD8DCC Sureties ucI caIb depalitL (See GeDcraI
Pumit CODditioall and 2.)
B. A lIOIU'Cfv.Ddable application fee mlllt ICXlllIDJlU1 thiI 8ppIicatioa.
Name 01 AppIicUIt SAN JcbE. \fJ A. TE..Q.. Co.
Mdrca 11...2.\ S, BA5(Q./\ A\l E. . SAt-J J?st:. .
,
TcIepboDe.11:1-7t347
a. CfS/28
Ya V-- No
Co /<..1.;;;;" Co So r II .:34/670
Complete and attach Workers' Compelllatioll and CoIItnctor lDformation form5.
(INCW9E5. ~euc. '5Tl2.EET t 'R2.1\J~E. S-fa:Er lLtlQl()
Tbe AppIicUItfPermittee hereby qrea by atfbriD& tbcir IipatuK to daiI permit to IIoId tbe Oty 01 C-.."....Jt. ill ofticeII, apll _ empIcI,- free, aafe
and barmI_ ftom any claim or demand for damap raultiD& ftom the won: covered by daiI permit.
II thiI won: beiDa doDe by the property oner at their 0WIl1'CIideDcc?
The AppIicUItfPermittee hereby actDowfed&es tbat they baYe read and 1IIIderItUId both the float ucI bact 01 thiI permit, ucI they will inform their
COIItnctOr(S) of the information.
Aalepted E.tN-I IN L. M E.LLD 'P. t:..
(ApplicUlt (perauttee)
oc..T ~ ,
Date
NOTES: AIL WORK SHAll. CONFORM wrm 1HB ATIACHED. APPROVED PLANS AND AIL APPUCABLE CAMPBElL SI'ANDARD
DRAWINGS AND CONDmONS.
1HB CONTRACTOR MUST HAVE nus PERMIT AND APPROVED PLANS AT 1HB srre AND MUSI' N011FY 1HB PUBUC WORKS
DEPARTMENT AT UAST lWO DAYS BEFORE STARTING WORK.
NonCE MUST BE GIVEN TO PUBUC WORKS AT LEASI' 24 HOURS BEFORE RESTARTING ANY WORK.
SPECIAL PROVISIONS
_1. Sbeet IbalI DOt be opeD cut for UDdefll'OUDd iIIItalIatioal. NiDimum cull may be ~ for COIIDCCtioaI or upIoratioll bola. SudI cull must
be mecificallv IOOt'OYed bv the lnmector mior to cuttill2.
_2. ~meDt may be cut for UDderpouDC! iDItalIatioal ud mlllt be restoRd iD accorcSUIcc with the Utility TmICb IlatoratioD StUIdard DrniDJ.
_3. Work to be staked by a liceued LaDeS SurYep or CM1 EqiDcer ucI two (2) copies 01 the cut lbects IeDt to the Public Worb DepartmeDt
before starting wort.
_4. uS/; 21.4e~ I~AI6/~A11IY',~J,~ MO-HLt.. foIL IUL I,ei,NC/~~ f-jJ.....es J/'J ;~uc 1..0.1,./.
STANDARD
AMOUNT
s ;1.15)0 Q
s
S
S -
S //1;/,'(0.
RP.l'F.IPT NO.
APPROVED FOR ISSUANCE
$210.00
$SOO.oo
(1~ OF ENG. ESI'.)
(4~ OF SURETY. SSOO MIN)
(FIRST SO-S30,ooo 14~;
7%, S200 min)
a
PERMIT APPUCATION FEE
PlAN amac. DEPOSIT
SURETY FOR FArI'HFUL PERFORMANCE
CASH DEPOSIT
PlAN amac. ct lNSPECI10N
Next $30,000-$80,000 10%;
()
r
'* '*
h:FW PERMIT fRev.4f94
USA phone (800) 642-2444
(see other side)
TICKET NO.