95-257
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BNClWAaINBNI' PBRMlI'
(for worIdq witbiD tile
public riabtoCf-way)
IIIued 'I .1, b J <; s: /~ AppIieatioG D.te 11 / 8 / 95
Pcnait a:pireI iD 12 ....~ Appticatiall a:pireI iD 6 ....
APPUCADON . AppIic:atiae II bereby .... for . Public Won. Pcnait ill aIXlCII'lIaDce witb CaIpbcII MuaicipaJ Code, Secdaa lL04. (Aw!wtv- apircI
iD 6 IIIClIItbI if tile penDit II DOt iIIued).
ary OP CAMP8EU.
pEPT. OP PVBUC WORKS
70 Nortb PiIIt St.
CaIpbcD, CA 950lB
(408) 866-2150
ermit No.
X.Ref. file
_95-257
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A. wort Ildcbea or trId #
420 Union Avenue @ West Valley Drive
3x3 cut in concrete
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Utility bacia Iocaaiaa
B. Nature ol__
C. Anacb roar (4) copieI ol_ ......... dnlwiai IIIowiDi tile Ioc:lItiaIl, c:dCDt aad ~ of tile... ne dnlwiai IlIaD .. tile rcJatioa ol tile
pmpcllIed wort 10 ClliItiDa ..m.ce aad .......0uDCI ~o.-.eutL WbeIl appm.ed by tile Oty p...,......... laid cSrawiJII becc8a . put ol tbia permit.
D. AD WOItIllaD caIform 10 tile Cty'1 GeacraI ~ SIaadud ~ ProviIiaDI aad Staadud ec.tructioIl DetaiII for Public WOIb
CoaItructiaa; tile Geaen1 Pcnait Coaditiolllliltecl OD tile revene aide; ad tile Spec:iaI ProviIiaDI for tbiI pcnait, lilted below. Failure to abide by
tbac CDDdu. ad ~ may.-.lt ill job lbut-4oMl ad/or forfeiture ol PaitbfuI PaformaDce Suleties ad eaIh depoIitL (See Geaen1
Penait CoaditioaII ad 2.)
E. A aoarefuadabIc appIic:atiaIl fee mUll ~ ro" tbiI...,.;..Doa
San Jose Water Company
Name of AppIil:aIIt
279-7825
T~
1221 So. Bascom Avenue, San Jose, CA 95128
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Is tbia WOIt beiDa dODe by tile pmperty OWDCJ' at tbeir 0WIl raideace?
Complete aDd attIcb WorkerI' CompeautioD ad CODtractor IDfoJmatioa forma.
ne AppIicaDt/PenDittee beIeby apeeI by aIIixiq tbeir lipature to tbiI permit to bold tile Oty of r~u, ita aIficcD, ....lI aDd empIoyeca free, ufc
aDd banDIeII fmm UI)' claim or demaDd for duDapI relUltiDg fmm tile WOIt ~red by tbiI pcnait.
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Addrea
The AppIicaDt/PenDittee bereby ac:bowIedpI dlat tbcy baYc read ad UDdCJItaad both tile froDt ad bact of this pcnait, ad tbcy will inform tIleir
COIltrldor(l) ol tile informatiaa.
~
Jane (emerqency verbal)
(ApplicaDt (Permittee) priDt/1ip
11/8/95
n.te
NOTES: ALL WORK SHAlL CONPORM wrI'H 1HB A1TAOIED. APPROVED PLANS AND ALL APPUCABLB CAMPBElL SI'ANDARD
DRAWINGS AND CONDmoNS.
1HB CONrRACI'OR NUSI' HAVB nus PBR.MIT AND APPROVPJ> PLANS AT 1HB srm AND NUSI' N011FY 1HB PUBUC WORKS
DBPAR.'I'MENI' AT LBASI' lWO DAYS BEFORE SI'AR.11NG WOlUC.
NanCE MUSI' BE GIVEN TO PUBUC WORKS AT LBASI' 24 HOURS BEFORE R.ESI'ARnNG ANY WORK.
SPECIAL PROVISIONS
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Street IlIaD DOt be 0fICII cut for 1IDde1pouacI ~ MiDimIllll cull may be aDowed for ~ or cxpIoratioa boICI. Such cuts.!!!!!!!
be IIleCificaDv aomoved bv tile IDIDec:tor Drior to c:uttill2.
PavemcIlt may be cut for UDdcrpouDd ...I"ta- aDd mull be ftItored iD aa:ordaDce with tile Utility TJeDCb Ilatoratiall StaacIud DmriJI&.
Work to be Itakcd by . IiceDIed LIDd ~ or CMI EqiDecr ad two (2) copieI ol tile cut 1beetl1eII~ to tile Public WOIb Department
before ItartiJII wort.
~IAX~~ ~ ~}~a:. CO""e,Pi::)~ -to ^'~&tr. -1e..ae~L.. d;w'lC/L )~-rQ ~/"'''/6 r;fl/Vc. i/rT..J
SI'ANDARD
AMOUNr
RPL"P.J1IT NO.
PERMIT APPUCADON PEE $210.00
PLAN CHECK DEPOSIT SSOO.oo
SUREIY FOR PAI'IHPUL PER.PORMANCE (I~ OP BNG. ESI'.)
CASH DEPOSIT (4~ OP SUREIY, S500 NIN)
PLAN CHECK a INSPECI10N PEE (FIRST ~ooo I"~;
.... _''''''~~7fll' S2ilIO miD)
APPROVPJ> POI. JSSUANCE1C..l:J.~__
for Ci EqiDcer
b:PW PER.MlTjRevAj94 (tee odIer 1icIe)
USA phone (800) 642-2444 TICKET NO.
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~ OF CAMPBELL
FIELD ENGINEER' S DAILY REPORT
t.j?O U K;rr- Av-t-.
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CONTRACTOR: J - JOJ-e W" lev (ct.
DESCRIPl'IOH
01'4.- .s e C.f-/~ u6 5/ u<e. .....,'" Ik-
W/ P C .L.
LJq.f-~
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PROJECT HO. ?J- ZS7
REPORT BO: /'
DATE: )/6/"
WEATHER: f? (1. ; ~
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