95-265
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arY OF CAMPBElL
DEPT. OF PUBUC WORKS
'JO North First St.
Campbdl. CA ~
(408) 866-2150
Permit No. L15. '205
X-Ref. file
ENCROAaINENI'
(for wortiJI& withiD !be
::~t1~jcr I
Permit apift:a iD U IDOL
App6catioG Date 1/ /J~J7r
App6catioG apiteI iit 6 IDOL
Utility treDCb IocatioG
_~ I DE" .......,..; p..1-- K..
C AltaCb four (4) copies or all capccrod cSnIwiDIlbowiIIa!be IocatioG, alCDt aDd IIiaI 'tJII& or tile wort. nc dnwiD& IbalIIbaw tile I'CIatiaIl or !be
JlIOPOICd wort to eziltiDllUJface aDd uacSerpouDd improW;IDCIltl. Wbaa IIpIII'IMlS bf !be Cty ~, laid cSnwiDI bccolIIcI a put or tbiI pcrmiL
D. AD wen IbaIJ coaform to !be Oty'1 Ocaenl CoDditioDI, S&aDdard CoaItrudioD ProviIioaI aDd S&aDdard QlaItruCtioG DcWIa for Public Wadis
ec.tnactioD; die Geaenl Permit Cooditioallilted ClD die rcwne aide; aDd .. Special ~ for tbiI permit. lilted bdow. Narc to abide bf
dIeIe coadital _ ~ may rault iD job Ibut-don _lor forfeiture or PaitbfuI Paformaace SureDea aad CMb depoIitl. (See Geaenl
Permit CoIIditall _ 2.)
E. A IIOIlJ'efuDdable appIicatiOD fee mlllt IICCIOIIlpUI1 tIIia .....tiOD.
Name or Applicant ~_Sp..;.... ~J.s..e:..~A--TE...E- C-=-.c,-n--:--,A....J'(
T~
Addrell 122.-1 -5----->. ~c~r---'1 ~ E:::. .;
"
,-r- -,
.._ _' ~ '--- c:>s t:=:._
,
CA
C--LJ::, i 2...~
VNo
II tbiI wen beiDa dODe by the property OWDCr at their on reaidcDcc?
Yea
Complete _ attach Workers' CompellAtioG _ CoDtrllCtOr lDformatioG formL
'J1Ie AppIic:aDt/permittee hereby qreea by atfbdD& their IipatuIC to tbiI permit to bold !be Cty or <,-..".....tt. ita ofticers, apDts ad empic,-a flee, are
_ barmIea from allY daim or demand for damIp raultiD& from !be wen CIOYCrod by tbiI permiL
print/Ii&n
NO'I"ES: ALL WORK SHAlL CONFORM wrrn nIB ATfAOfBD, APPROVED PLANS AND ALL APPUCABLE CAMPBELL srANDARD
DRAWINGS AND CONDmONS.
nIB CONTRACIOR MUST HAVE nns PERMIT AND APPROVED PLANS AT nIB srre AND MUST NOTIFY nIB PUBUC WORKS
DEPARTMENr AT lEAST TWO DAYS BEfORE STARnNG WORK.
NonCE MUST BE GIVEN 1'0 PUBUC WORKS AT lEAST 24 HOURS BEfORE RESfARnNG ANY WORK.
SPECIAL PROVISIONS
_1.
Sheet IbaIJ DOt be ClpcD cut for UDderzrouod iDstallatiODL NiDimum cuts may be allowed for CDIl~ 01' CIplcntiOD bola. SudI cuts must
be 5tlCCifica1lv amlfCM:d bv the IDSDCctor urior to cu~
PaYemeDt may be cut for uacSerzrouod iDstallatioal _ mlllt be ratoRd iD acc::ordaDCC with !be Utility TreDdI RatoratiOD SIaDdud I>rniDI-
Wort to be ataked by a liceued LueS ~ or CMII!.DaiDCCr _ two (2) copies or !be cut abccts aeat to !be Public Worb DepartmeIlt
before starting wort.
!II}J.er flhUL J& C()(J~IAlAfW wf/N )/t'A) WLA~Nr JAjOI/AL All lJ?JiAfE:/Jw",./f/lh,
_2.
-}
.:L4.
srANDARD
AMOUNT
REC"PJPT NO.
Q
PERMIT APPUCAnON PEE
PlAN OIECK DEPOSIT
SURErY FOR FAITHFUL PERFORMANCE
CASH DEPOSIT
PlAN OIECK .t INSPECI10N
Next $30,000-$80,000 10%; Amount
$210.00
SSOO.OO
(100% OF ENG. ESI'.)
(4% OF SURErY, SSOO NIN)
(PlRSf .$30,000 14%;
$80, miD)
$;;).:2 5, (,) 0
S -
S
$ --.J
S /..1 () . ()(~
G.2
APPROVIID FOR ISSUANCE
(ICe other side)
* *
b:PW PERMrf/Rev.4/94
USA phone (800) 642-2444
TICKET NO.