97-141
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~ :; ~,.. Is this work beinq done by the property owner at their own ra8idancel --yu bo
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~ S t e Complete and attach Workers' Coapenaation and COntractor Intoraation rOng.
t; :; .~ ~ The Applicant/Permittee hereby aqne. by arrixJ.nq their dqnaturll to t:hU perait to bold the City or
: ~ - -a. campbell, ita otticers, aqents and urploye_ rree, ure and banll_. troa any cla1a or daand tor
... ~ v c' damages re.ultinq frcm the work covered by thiJI permit.
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CIoty or CAMPBELL
DEPT. (iF POBLIC WO~
70 North Fint st. ~
ca.pbell, CA 95008
(40B) 866-2150
~'naitHo. 97 - /4/
..-bt:. 'tUe
Application Date .3/31/9 I
Application apiraa ~ in , lIOII.
APPLICATION - Application 18 hereby ..de for a Public Worka Permit in accordaDce with CUpbell
Municipal c;ode, Section 11.04. (Application apiru in 6 IIOIlt:bII U the peraJ.t ia DOt iaaued)
A. Work addreu or tract . / B 7 [;VJJJJY VA IC5 A t4
/IIR' &-.4sr Dr Dell L}J/ SuIJILJY LJ~ AU'E
J?LAc I.lt/b Pi/OAJB ~ev-/ce
Utility trench location
B.
Nature at work:
c. Attach .even (7) copies at an enqineered dravinq lIhovinq the location, extent and cUaUUlioM of
the work. The drawinq aball lIhow the nlation of the propo.ed work to ex1at1n9 aurtace and
underqround iJIIprov..ents. When approved by, the City En9lneer, aaid dravinq t..--. a part ot
this permit.
All work lIhall contonl to the City'. Cananl Conctitiou, st:aDdaJ:rS Ccnat::nctlon Proviaiona and
Standard COn.truction DetaU. tor Public Worka Construction, the Ceneral Pera1t COnd.1tiona
U.ted on the revarae aide, and the Special. Proviaiou. tor t:hU penUt, l1atec1 below. Failure
to abide by the.e conclit1ona and providona ..y reault in job abut'-dovn &bdIor fOrfeiture ot
Faithful Performance Sureti_ and cash depodta. (8.. c:en.ra1 Plmlj,1: liiOnd.1ti~ 1 Cd 2J.
E. A nonrefundable application t~ 1IIU8~ aCCCDlpany tbiJI application. IJI (c'~r(.t; 1',~ 3~ '11;)...3
Name ot Applicant fA::t ~~L(""" JlJe.I J 1'e1epboaea U4k- '7J3~
Address 'Sr75/ ~~ h/Z}' 57: 4(y, ?fJO 5Ir-:1t1 'StJS'i!! . C? 9513'/
The Applicant/Per1ll1ttee hereby aeknovlec1qes that they have nad and understand both the front and
bock ot thio _t, ODd that thoy vi!}Jnt.... thok2~ctor(oJ ot tho intO""'t! ., /
ACCEPTED W/f-/Utt1l /1IUIZIt.:. r~~ ~~ -:JBb/??
Applicant (Penlittee) print/a1qn Oat.
N'~- '/679 S'
NOTES: ALL WORlt SHALL CONl'OiQI WITH THE ATTACHED, APPROVED PUNS AHD ALL APPLICABLE CAKPBELL
STANDARD DRAWINGS AND CONDITIONS. IE I V E D
THE CONTRACTOR HOST HAVE THIS PERKIT AND APPROVED PLlHS AT THE SITE AND KOJiA.r<<ixJ '1'H! P.W.
INSPECTOR AT 'tHE SITE AT LEAsT 'l'NO DAYS BUORE STARTING WORlt. APPLICANT HOST CONTACT THE INSPECTOR
TO ARRANGE A FInD KEETINc:. MAR 3 ~, 1991
NOTICE HOST BE GIVEN TO POBLIC WORKS AT LEAST 24 BOtJltS BEFORE RESTAIl'l'DfG ANY WORlt.
1-"
~DNilNISTr.:~ j "):,,
SPECIAL PROVISIONS
_1.
Street ahall not b. open cut tor underqround inataJ.lationa. X1niJam cuts ..y be allowed
tor connection. or exploration hole.. Such cuta II11l1t be ,lmfH!itIellllv Illmroved. bv the
InsDector DrIor to cuttI~q.
PavUlent may be cut tor unc1erqround lnataJ.latiou and .uat be restored in aCCOrdance with
the Otility Trench R-torstion Standard Dravinq.
Work to be ataked by a l1eenaed Land SUneyor or C1vU En9lDHr and two (2) aopi_ ot the
cut sh.ets .ent to the Publie Work Departaent beton 8tartinq work.
The hours ot work are limited to ouaide the hours ot 7-9 .... and 3-6 p... tor any work
attectinLa tra,t ,ie 1 e. t 1'~ 1.&$ 4. fro;) t-f$l-vC, . co ~ L..
_2.
_3.
__po
--L-5.
,.Jcr(5.: tb NQ1' iA~5 ,Hf;,S5 c1rA-"'1Mrl7fJ PI5M1rr Af)Uc4TjG/\j;I /,,) 7J;f1Y PlA:t~ .
AUd 11~/J ~/lorll'~M<L ,
B'I'AHnA'W
~
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RE~P'l' NO.
a
PERKIT APPLICATION FEE
PU.N CHEa DEPOSrr
SORETr FOR l"Arl'HroL PERPORKANCE
CASH DEPOSrr
PU.H CHEa 5 DfSPECTION FEE
Next $30,000-$80,000 lot,
APPROVED FOR ISSUANCE
$210.00 $
$500.00 .
(100' or ENG. EST.) $
(4' or SORETr, $500 M%B) .
$0-$30,000 lU, $ /;).0_
$80,000 7', $200 aiD.)
-
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