96-103
an' Of CAMPBELL
DEPT. Of PUBUC WORKS
10 North F.m St.
Campbell, CA 9SOO8
(<408) ~2150
ENCIlOACIMENf PERMIT
(lor wortiJII withiD the
public ri&bt4-->,~
IIIued 1./10 /i ~
Pamit ~ ill U -../J/IJ
Permit No.
X-Rd. file
96 -103
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APPUCAnON - App6catioa is hereby made for a Pubtic Worb PamJt ia 8CClOI'IIuce with ~JI NUIIidpeI Code, Soctioa tUN. (Applic:atioa apira
ia 6 IDOIIths if the permit. DOC i&ucd).
A. Wort addrca or tnct #
,
B. Natuft ol wort
C. Attacb four (4) copies ol u cap.eetcd drawia& IbowiIIc the Ioc:atioa, atcDt aad dill" r'1 0lIl ol the work. The drawia& IbaJJ Ibow the KIatioa ol the
JlI'OPCl'ed wort to cmtiD& lUlfacc aad uacSctp'OUDd iIaprcwaDalts. Whea ~ by the Qty p~. laid dnwiac becorDca a put ollU permit.
D. AD wort IbaIJ c:oaform to the Oty'1 GcDenI CclDdidoal, S&aDdard CoaItnIctioIl ProviIioaI aad S&aDdard CoaItnIctioIl Dc&aiII (or Public Worb
Coastructioa; the GcoeraI Permit CclDditioallilted OD the awene Iide; aad the SpecialI'rcMlioal (or daiI permit. lilted below. PeiIae to abide by
these coaditioas aad proYisioaI may result ill job lbut-doWD aad/or forfeiture ol PaithfuI PcrfOl'lDUCC Sureties aad CMh deposits. (See Oeaenl
Permit Coadi~ 1 aad 2.)
E. A DOIU'CfuDdable appIicatioa fee must IICICOIII:Jl8II tbiI appIicatioa..
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Addrca
Name ol Applicant
1221 S. BASCOM AVENUE
SAN JOSE WATER COMPANY
Tdepbooe
279-7810
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dJ}j/l .,
Complete and attach Worters' Compensatioo aad Coatractor Informatioo f~ <', r- . 0 ~ '
1,9
The AppIic::aDtjPerminee hereby agrees by atfixiD& tbelr lipature to daiI permit to bold the aty ol C-.."....u. ia ~~t&.ud ~ free, Ale
and barmlea from any claim or demand for 4amap resulting from the wort CXM:rcd by this permit. . II\1/S l,
';'i, <.~'\ l /~"
The AppIiC&ntfPerminee hereby ICkDowtedgeI that they have read aad uoderstud both the froat aDd Net ol this permit, and they wiD i'a:f<Xm their
cootractor(s) or the information.
.......... SAN JOSE WATER COMPANY! Q~ -lVYJA-< L
(Applicant (permittee) print/Rgn
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Is this wort being doae by the property owuer at their own raidcDoe?
Yes
x
No
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NOTES: AU. WORK. SHAll CONFORM wrrn TIlE ATIAOIED, APPROVED PlANS AND AU. APPUCABLE CAMPBELL SI'ANDARD
DRAWINGS AND CONDmONS.
TIlE CONfRAcroR MUSf HAVE nus PERMIT AND APPROVED PlANS AT TIlE SI1E AND NUSI' N01lPY TIlE PUBUC WORKS
DEPAR1MENf AT LEAST TWO DAYS BEFORE SI'ARTING WORK.
NOTICE MUST BE GIVEN TO PUBUC WORKS AT LEAST 24 HOURS BEFORE RESfARTING ANY WORK.
SPECIAL PROVISIONS
_1. Street Iha1J DOC be open cut for UDdergrouod iDmlIatioas. NiDimum cuts may be ~ for CIOIlDCctioaI or uploratioa boles. Such cuts must
be soecificallv anoroved by the InsPector Door to cuttin2.
_2. P_ment may be cut for UDdergrouod inRalIatioal and must be restored ill IICXlOrdaDce with the Utility TreDCb Ilc:storatioa S&aDdard I>rlIwing.
_3. Wort to be staked by a licellled LaDd Surveyor or Qyj) EDgiDeer aad two (2) copies ol the cut lbeets scat to the Public Worts Depertmeat
/' before aarti.ng wort. I .) )
...'-4. c;!t~-.j7: ;:~.Ji:'J..~"')';.oPJ;:~ ~:f://).U.,-' /.<;R., ~E:.++I.L.ITI'-J H 6)(./%#& 'fI.vJ ~
APPROVED FOR ISSUANCE
$210.00
SSOO.OO
(100% Of ENG. ESf.)
(4% Of SURElY, SSOO MIN)
(PI ~$30,OOO 14%;
miD)
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SfANDARD
AMOUNf
$ ddS'. () 0
$ ~
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$
$/.)0.<.6
RFL'Fll"T NO.
0.
PERMIT APPUCATION FEE
PLAN DIECK DEPOSIT
SURElY .FOR FAITHFUL PERFORMANCE
CASH DEPOSIT
PLAN amcK &. INSPECTION
Next $3O,OOO-S80,OOO 10%; Amouat
&
/'/1.5~
Date
* *
h:PW PERMIT /Rev.4j94
USA phone (800) 642-2444
(see other side)
TICKET NO.
CITY OF CAMPBELL
3~ $L<M.1 S'iU
PROJECT NO. 96 -/63
REPORT NO:
FIELD ENGINEER'S DAILY REPORT
CONTRACTOR: /d vJ (/1f;;AI dJ .
DATE: I 3, 9 G, ,
WEATHER: Ov<u'cA ~
INSPECTOR: K. ~G:.51fALL
ITEM
DES CRI Pl'I ON
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