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ENC2009-00028L]:~ _. ~I~ 2!i'~9'• 2:/~`~r(1~O837r,= ? C i'~,~ i,~' ~ ~' I f;r, f1J~f~1<S ~;:. ~~La Fr~, ~ 02/F3a -..... r u -- - -~ Permit N~,:~(',~,~' °-~-----~ c__ t CiTY OFCAMPBEII ENCRBACHr~tENfTPSRMIS }t.Rcf. File DEPT.Op PUDLICwoRRS {forwarktng whhin the publ App{(cation pat® ~' , q0 Nottb First Street rfghaOFway1 / ~ Apphc&tlon ExplrOtlon Date `~ 7 't Campbell, t:A95008 Issued 2" r ~ <%' APN Ph. (4091866.2150 Fx. (448} 378.0958 permit Expiration Date Z/ (~ ,r~G APp~ICATION - AppIICAtIen is hereby madE for a Puhllc Works Permit In aCCOrdence with Campbell n4unlcrpal Code, Section 11.04. (Application explrea In sfx (G) morrths if thr. permit f 9 nat issued, Application Fee 1s nan-refundehle,l A, Work Address or Tract No.: Utll Iry Trench Locate on: D. Nature of Wark: C. Attach four (41 copies of an englneerEd Ian show the locat:o a a axiom ~~ ~~ ~d wv~y, ~"~'~~' "~ -"~•-- - -~ - a roved P g Estimate of work, ?he plans shall chew the rElatlo of the prapos Ork to extsting SurfaCV end underground Improvements. WheP pp tay the Clty Engineer, 6i<td plan becomes a partof this permit. D, All wOrit shall conform to the City of Campbell5tandard 5peC1(lcatlehs and Details for PuhIIcVJorks ConstNCtlon; the General permit Cendltlons het?d on tfrp reverse side; and the Spedal Provisions for this pCrmlt, listed below. Fa~iure to abide by these conditions and provisions may result In Job shutdown and/orforfelture of FalthPul Parfermance Sureties and cash deposits. (See General P6rmlt Cendklens 1 and 2J E. The Contractormuslhav9thlspermitandappravedplansattheslteandmustnotlfythePublicWOrksbepartmentatleasttwodaysberorc stertrng work. Notice m Rt be glvAn to public Works at least 2h ,hours before rastenfng any work. T leph F7 ~ ~' ~~-~ 1~ p~`J . . , NameofAppllcent; ~ ~, '. ~~~' f ~ ~ _. .......__, e one .... .. ..,,, ............. ......~,,..., ~1 ~ i ......................... Address: 1. ~,~©~. ~,...~.! ~ ~~~ r`G ..,....,... , .....,..,. - ,C~!Jq ,,.,,._,. ... C-Mali Address: '~ R ~} 2R-HOUR F.MERGANGY PNONR NUMBER; .... ---- 9 P .., yraq ees byaffl>ting therlr6 nnatudence7 ~~ YE5 ~ NQ ~ ~~~, ~'~„~ ~ ~~ The A w 1lenndPermvittee hereB..,... '. _.__.. , ... pp ttt to this permk to hold the Clry of Campbell, its officers, agents, and empleyv~9 free, safe end hermiess from any ciatm or demand for damages resulting from thework covered by t1~Is permlr, The AppllcanUPerrrltteo h?reby OCknvwl2dges that they have read and understated both th® front and back of this permit, and they will inform their contractor(s) of the information. Applleant is advised that upon Issuance of this p rmlt property owner, or property owners successors, shall be responsible for any end :+II damages a Is g ou of the condition ny private ( nt n the publ Ic right-oF Way. ~` d O ~Z t~d: ~~ ,' ~ ~/1' r'f A~~p t D ~ Y O p a e ~ (ApplicantPermitte?) ,gn) ~.. Oa lPrlntName) Date (Contracto.) - ` - U Z J ~ SpECIAI..P,R y15O 1~iN5; be allowed for connCCtlons or explorntlan holes. Such cuts ~_t, Street shall nor be open Cut for underground tnetellatlvns. Minimum cuts mnv W ~ Q ~ ~ecl~r,~jk~.i?P..C'~~.ti~.e~8;•pg~4LRLlQLt1L>tiul.~D~~ ent may be cut for underground installations and must be restored In accvrdanca with rho Standard Details ranch Restoration Methalh/ L1.~ ~ P . avem "A^, unless otherwise a9provsd by ihA Pnglneer. work to be stdkOd by a IICen9Ed Land Surveyor or Clvll Eng{neer and two (2) Cvples of thG cut sheets sentry the Puh11c Works F]epartment 3 . before starting work. Per Sfctlon 4235 of the Government Code this permlr Is not valid For eKCAVdtions until Underground ServlCe AIeR (USA) hag been notlfled and 4 ~, , the Ingttlry-dentlfication number has been entered hereon, U5A phone: 1-900727-2600. USATICKET N0, wner shall execute an Agreement for private improvements In the Pubht R{ght-of-Woy, WhlCh s1t011 be ~S. Prtorty any work, the property o rseerdcd, 4ubilcNvtlFlCatlonRequ(remc 5: ~7. SEE_QU6~ WO h5 ,~$fl VAT FEES AMOUN S ~y S RECEIPT NO- L, ~ - _- '" ~ peaMir APPLICATION FEfl ~ PLAN CHECK DEpOSfr SECURITY f0R FAfTNFUL FERI'ORMANCE/LABOR & MATERIALS . $ - '-'~"'"~ CONSTRU[TION CA5W OEPOSIt $ Z ~ ~_ Lu _ PLAN CHECK &(NSPECTION FEE APPROVEDFdRISSUANCB For City nglnaar Date Permit Exp1rA91 ~ Months After Qate of Issuance ~~, . ~.. ~ t 1 , i ~ ~ ~ i rl '; ; , .t ,