95-281
CTY OP CAMPBELL
DEPT. OP pUB1JC WORKS
10 North fiJst St.
CampbcU. CA ~
(0) 1166-2150
BNCROAawENf PElU4IT
(for warkiDa wi&biD tbc
public npt-d-way)
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Permit apira ill 12 IDOL .m
Permit No.
X-Ref. file
95-281
Appticaac. Date 1 2 / 21 / 9 5
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GI . APPUCAnON _ Apptic:aDoD illIcreb1lUde ror. Public Warb Permit ill aI:lCillIdaDCC witIa ('...".... YUIIicipU Code, SectiaD 11.04. (ApplicaDoD apiJa
.= g ill 6 IDOIlthl if tbc permit iI DOt iIIucd).
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~ ~ A. WortaddrellortnCt# N/S of street in front of 705 El Patio Drive x-street
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Utility ueDCh IocaDoD
EMERGENCY Gas Leak Repair
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C. Attadl four (4) copies of aD eqiDccred dmria& IbowiD& tbc Iclc::aDoD, usat aDd ~ ~ of &be 110ft. nc dmriJl& Iba11 .,.. &be IdaDoa of tbe
propclICd wort to CliltiDlIUIfacc aDd ~..o.oDd b.aprovemcDlL WbcD ~ by &be Oty PAp_. laid dmriJl& becaIDeI · put of this permiL
D. All wort dIa1l c:oaform to tbc Oty'1 Gateral CaDdidoal, SIaDdard CoaItnJCIioIl PrcMIioaI aDd SIaDdard ('.oaIanIctiaD DctaiII for PubIi&: Worb
~ tbc Gcaeral Permit CclDditioaa lilted OIl tbc rcvase lid&; ud tbc Special PrcwiIioa& ror dIiI permit, lilted bdDIr. Paihue to abide by
tbac CDDditioal aDd prc:MsiODI may rault ill job lhut4JwD aDd/or forfcituft of Paithful PafOllDUlCC Sureties ud QIh depoIitl. (See Gcaeral
Permit CoDditioa& 1 ud 2.)
E. A DClIl!CfuDdable app1icaac. fee mUll ~"1 tbiI appticatiOD.
Pacific Gas & Electric
Name of Applicant
Tdepboae
725-2176
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10900 North Blaney Avenue, Cupertino, CA 95014
II this wort being doDc by tbc property onef at tbcir an raidcDCIe?
Yes
No
Complete aDd attach Workers' CompeuaDoD aDd Coatftdor lDformatiOD fonDL
The AppIicanttperminee hereby qrcea by aIfiJ:iD& their IipatuJC to tbiI permit to bold tbc oty of <>'T'"'u, ill afticcrs, apll ud ~ fftc, Ale
aDd twmIca from aDY claim or dcmaDd for damapI raultiD& holD tbc wort covered by tbiI permiL
The AppIicanttpermittcc hereby aclalCJlwkd&el that tbcy have read aDd \IDdcrIWld both &be frODt aDd bKk of this permit, aDd tbcy wiD iDlorm tbeir
CIODtraC'tOr(I) of the iDlormatioD.
Julie Coffland
A&:ecpted
12/21/95
NOTES: ALL WORK SHALL CONfORM wrm 1HB A1TAOIED. APPROVED PLANS AND ALL APPUCABLE CAMPBELL STANDARD
DRAWINGS AND CONDmONs.
(Applicant (permittee) priIlt/1ip
Date
1HB CONI'RACTOR MUST HA VB nus PERMrI' AND APPROVED PLANS AT nIB srre AND MUST NOT1PY 1HB PUBUC WORKS
DEPARTMENT AT I.J:AST lWO DAYS BEFORE STAR11NG won
NOTICE MUSI' BE GIVEN TO PUBUC WORKS AT LEASI' 2A HOURS BEFORE RPSI'AR11NG ANY won
SPECIAL PROVISIONS
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1:
Street sbal1 DOl be opeD cut for v.DdcrpOUDd iDItaI1atiODL NiDimWII cull may be aDawecl fOl' CIODIICCtioaa or apor.tiOD bola. Such cull m\llt ~
be medfic:allv atJI:I!'CM:d bv the Inmector tlrior to cuttUl2. 0
hvemcDt may be cut for UDdcJlfOWld iDItalIatioal aDd mUll be n:saored in accorctuce with &be Utility TreDdI Rcstoraac. SCaDdard 0rIwiDI- t:l:l
Wort to be staked by a licellled LaDd s.uw,or or aYiI EqiDecr ud two (2) copies of tbc cut &beell seDt to the Public Worts DepattJDCDt t:j
before IWtiD& work. I n
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Sl'ANDARD
AMOUNI'
RErFfllIT NO.
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PERMIT APPUCAnON PEE sno.OO
PLAN amcK DEPOSrT S5OO.oo
SURElY FOR PAlIHPUL PERFORMANCE (1~ OF ENG. EST.)
CASH DEPOSIT (4" OP SURErY. SSOO NIN)
PLAN OIECK a: INSPECI10:EN zj (PlRSrt:!~OOO 14";
Next $3O.~$80.000 10%; Amowlt . ~$80' . miD)
APPROVED FOR ISSUANCE - -
for City f
h:PW pERMIT/Rev.4/94 (see otheuidc)
USA phone (800) 642-2444 TICKET NO.
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