96-135
CTYOFc.JIA eEl V E ~
Derr. OF PUBUC WORKS
'70 North P"mt St. MAR 8 1996
Campbc1l, CA 9Srol
(408) 866-2150 i-'U ,.1 "., ....,.,; ....,.< ,\.:;
.'l,DMINISTRATlON
ENCROACHMENT PERMIT
(lor wortiq within the
public rip(4) r-
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. :/1'~-135
PenDlt No.
X-Rd. file
Applicatioa Da~),{t1rc!c 7, 1 b
Applicatioa czpirc:I ill 6 ID05. '
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APPUCATION - Applicatioa . bcreby made for a Public Worb Permit ill 8Cl.'IOrCSaDce with c...".....u NWIic:ipaI Code, Soc:tioa lUM. (Applicatioa apira
ill 6 IDOIItbI if the permit . DOt iIIucd).
A. Wort addrca or u.ct #
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Utility trcoch Iocatioa
B. Nature 0( wort
fftJT@AL Aub, 70
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C Attacb four (4) copies 0(1.1I capccred dawiIl& IbowiD& the Iocatioo, CIlCOt ad \ti~ 0( the worL Tbc drwwiD& IbaIlIbow tbc rcIatioD 0( tbc
propcIIed wort to ai&tin& lIIrface ad UDCIergrouad iIDproYemeIlts. WbeIl appr'C'Wld by (be Oty E.qiDeer, aid 4nwiDJ bccomc5 a put 0( tbiI permit.
D. AD wort IbaIl coaform to the aty'1 Gcoenl CoIldidoal, StaDdard CaaItnIctioG ProviIioaI ad Studud CaaItnIctioG DcWII for Public Worts
CoaItructioa; the GeDeral Permit CoDditioalliaed OIl the I'CWIIe aide; aDd the Special ProviIioaI for tbiI permit, Iiaed below. Peihue to abide by
the<< COIIditiom and praYisioas may result ill job lhut-4owD ud/or forfei~ 0( Faithful PetfOl'lDUOe Sureties ud CMh dc:poQts. (See Geaeral
Permit Coaditiolls Iud 2.)
E. A DOIU"CfuDdable applicatioa fee mua accompuly this appIDtioa.
sA-JJ J'P((;" UJl+T~fl
Addras 122 ( ~ ' CAS'taM Me.
Name of Applicant
Tdcpbooe 2.71 - 7 P t.( 6
q 5l2~
(lA
II this wort being dooe by the property 0WDer at their OWII reaideoce?
Yea
Complete and attach Workers' Compensatioa ud Cootnlctor Informatioa fOl'mS.
The AppIicant/penninee hereby agrees by affixiJII their lipature to this permit to bold the Oty d Campbell, _ ofticers, qoeata ad ~ free, aafe
and harmless from any claim or demand for damages reaulting from the wort COY'Cred by this permit.
enninee hereby acknowledges that they have read and Utlderstand both the front and bact d this permit, ad they will inform their
e information. .
o.~
Aa:epted
NOTES: ALL WORK SHAll. CONFORM WI1lIlHE ATIAOIED, APPROVPD PlANS AND ALL APPUCABLE CAMPBElL STANDARD
DRAWINGS AND CONDmONS.
TIlE CONfRACfOR MUST HAVE nus PERMIT AND APPROVED PLANS AT TIlE SITE AND MUST NOllPY TIlE PUBUC WORKS
DEPARTMENT AT LEAST lWO DAYS BEFORE STARTING WORK.
NOTICE MUST BE GIVEN TO'1>UBUC WORKS AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK.
SPECIAL PROVISIONS
_1.
~
_3.
~.
Street sbaII DOt be open cut for UDCIerground iDRa11atioal. Minimum cuta may be alIoMc1 for c:oonectioaI; or aplomtioa boles. Such cuta must
be &Decific:a1lv aoof'OYed by the Insoector tlrior to cuttin2.
Pavement may be cut for UDCIerground iDstalIatiolls ud mull be restored in ac:cordaDce with the Utility TreDdI R.cstoratioa StaDdard Drawing.
Wort to be staked by a licellled Land SuIYeyor or CiYiI Eqineer ud two (2) copies 0( the cut 1bee1lICnt to the Public Worts Department
before starting wort.
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STANDARD
AMOUNf
S coUS,OO
s
S
$
$/J./u'.CJ ()
)~
RECEJYf NO.
APPROVPD FOR ISSUAN
$210.00
SSOO.OO
(100% OF ENG. EST.)
(4% OF SURElY, SSOO MIN)
(PIRST $0-$30,000 14%;
$200 min)
Q.
PERMIT APPUCATION PEE
PlAN OIECK DEPOSIT
SURElY FOR FAITHFUL PERFORMANCE
CASH DEPOSIT
PlAN OIECK &. INSPECIlON
Next $3O,OCXJ..S80,OOO 10%j Amoun ~te
-
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c.
Date
* *
h:PW PERMIT/Rev.4/94 (ace other aide)
USA phone (800) 642-2444 TICKET NO.
(1jO()J( I. ~" ) I- (3/6 J( /.)o).r /0') ~ tj,)4-b~
CITY OF CAMPBELL
FIELD ENGINEER'S DAILY REPORT
ITEM
cc:
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CONTRACTOR: tP ,/W. ;::;~.
DESCRIPTION
PROJECT NO. 9b-/'S r"
REPORT NO:
DATE: }O /1 9&
WEATHER: FAIR.
INSPECTOR: K. ~G'.-511ALL
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PAGE: /
OF I
CITY OF CAMPBELL
FIELD ENGINEER'S DAILY REPORT
<)O'WG DM~& k
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CONTRACTOR: (2vJ F7~c-L
PROJECT NO. qt ~ r
REPORT NO: J
DATE: 4--n ~ 7t.,
WEATHER: OIJ.UCA-5,i
INSPECTOR: K. ~51fALL
ITEM
DES CRI Pl'ION
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