96-134
ENCROAOfNENI' PERMIT
(for wortiDg withiD the
public Ii&bt-4-wl1)')
J.ued 3/ 2 ~ ~ r AppIieatioa D.te 3 ' e.- ~ h
;OM\NISiRA110i" !'amit expira ill U IDOL AppIieatioa czpUa ill 6 IDOL
APPUCATION - AppIieatioa iI hereby made for a Public Worb Pamit ill aa:orcSaDce with ("..a"'J'bdl NIII1icipeJ Code, Sectioa 1UN. (Applieatioa czpUa
ill 6 moaths if the permit iIi DOt iIIucd).
eo." If! ," i t~
CTY Of coPtp.a- \C
D~.OPP~UCWO~ ~
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(408) 866-2150
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A Wort addrcaortnct# Mo~r:;1"A w"'< , BAsc.oM MIVIAPo, f!./1Il ~
Utility treDeh Iocatioa M 0 ~ E .. A W1\~:' r3A ~GO tv1 "" I P tAlA'( f!./ W ~
B. Nature o{wort LN,Af'*-. MA I JJ IN S,AL-LA,I 0 N (~b,. 0 I Z )
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C Attadl four (4) copies 0{ aa eqiDcered c1nnriDc Ibowiq the kxatioa, atcat aad di", r~ of &be wort. The cInwiq IbaII __ &be rdatioa oflbc
pI'OpOIed wort to exiItiD& lWfaoc aad UDderpoulld ~IL Wbea approved by the Qty &peer, laid dnwiDc bccomc& . put of thiI permit.
D. AD wort IbaD COIlform to the aty'IOcocnl CaDditiolll. Studanl Cooaruc:tioa ProviDoaI aad Studanl Cooaruc:tioa DctaiJa b Public Worb
Coamuctioa; the GeDenl Permit Coaditioaa IiaecI CICl the reverse Iide; aad the Special ProviDoaI for ... permit, IiaecI below. Failure to abide by
these coaditioas aIId proYisioaI may result ill job Ibut~ aM/or forfeiture 0{ Paithful hrfOl'lDaDCe Suretiea aIId calli depoiilL (See Ococral
!'amit Cooditioas 1 aIId 1.)
E. A DOIlJ'efuDdable app\icatioa fee muR aa:ompaay thiI appIicatioa.
Name of Applicant ~A ~ :1o~ ~ 1A~,~1t Co , Tdcpbooe Z1Cj -18tt!E-
A4dI'C5S IZZI. 7. BA~u>jv1 AVe.. ~AN :r().>~, C-fL 4~'2e
,
1& thiIi wort being doae by the property OWDcr at their owul'ClidcDce? Yes V No
Complete and attach Worlr:el$' CompellU.tioa aad Cootnctor Informatioa f~
The Applicant/permittee hereby lIIJ'CCI by affixiq their Iipa~ to tbiI permit to bold &be Qty 0{ Campbell, ita oftic:ers, aplll aad ~ me, lIlfe
aad Iwmles5 from aay claim or demand for damages reaulting from the wort CXM:red by thi5 permit.
The Applicant/permittee hereby aclrnowledges that
COCltrllctOr(5) of the information. '
both the front aIId bact of thiIi permit, aIId they will worm their
Accepted ~~N BAtJAR~$
(Applicant (permi ,
D.te
fL-.
NOTES: AlL WORK SHAll CONFORM wrrn TIlE ATIAamD, APPROVED PL\NS AND AlL APPUCABLE CAMPBElL STANDARD
DRAWINGS AND CONDmONS.
TIlE CONTRACfOR MUST HAVE TInS PERMIT AND APPROVED PlANS AT TIlE SITE AND MUST NOTIFY TIlE PUBUC WORKS
DEPARThfENf AT LEAST TWO DAYS BEFORE STARTING WORK.
NOTICE MUST BE GIVEN T01>UBUC WORKS AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK.
SPECIAL PROVISIONS
_1.
Ll.
_3.
..L4.
Street IbaD DOt be opeD cut for UDderground iDIta1Jatioal. Minimum CUll may be alIoftd for COIlDeCtioas or expioratioa bob. Such CUll ~
be 5tlecificallvauol"OYed by the Insoector tlrior to cu~
PlIYemeDt may be cut for UDderground iDIta1Jatioas aIId muR be reItOred ill aa:ordaDce with the Utility TrcDCh R.eatoratioa Staodard Drwwing.
Wort to be staked by a 1iceD5ed Land ~ or QYiJ &peer aIId two (2) copies 0{ the cut IbcelllCDt to the Public Worb DepanmeDt
before starting WOrL
CfJ.JUJNMI:- VJ/U, IAlrnJ #trMbOw.Nf:.~$ M.OilIOt.. Ct:rA/pA1U4L4$ Acc.c>'.> ro A~ ,</A.jJ4S$U J(1A1ZJ
ilif,fttC)w~5 .
STANDARD
AMOUNT
s31'f.v~
s --
$
$
$770,1,) t.
RECEIPT NO.
PERMIT APPUCATION PEE
PlAN DIECK DEPOSIT
SURETY FOR PAIlHFUL PERFORMANCE
CASH DEPOSIT
PlAN DIECK & INSPECIlON
Next $30,000-$80,000 10%;
APPROVED FOR ISSUANCE
$210.00
SSOO.OO
(100% OF ENG. EST.)
(4% OP SURElY, SSOO MlN)
(PlRSI' ~$30,OOO 14%;
than $80,000 , S200 miD)
(2
&.
3
Date
* *
h:PW PERMIT/Rev.4/94
USA phone (800) 642-2444 TICKET NO.
(')50 xl,b6) +(J,J( Idf~) "'" #/70
(see other side)