96-139
an' Of CAMPBELL
DEPT. OF PUBUC WORKS
10 North Pint St.
Campbell, CA ~
(~) 866-2150
ENCIlOAan.mm- PERMIT
(for wortiq witbiD the
public ri&ht4 )
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PmlUt No.~ b" 151
X-Rd. file
AppIicatioll Date 2> - S - 9(P
Applicatioll c.zpircs ill 6 IDOL
APPUCAll0N _ AppIicatioll iI bcreby made for. Public Worts Permit ill ea:ordaDce with CampbcU NwUcipaI Code, SoctiocI11.CM. (Applicatioll apita
ill 6 IDOIIths if the permit iI DOt iIlAaed).
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A. Wort addrca or u.ct #~50 S. ~~ A'lf...
UtilitymDChlocatioll \CO'te./re. ~A.I2J2..lSDN p..\JE. Ot--l S,/SIDE.
B. Natureohort F'"\eE:. SE:J2..\JrLE. \NST~LL~"""ON
~~'LToN flt...'iE. .
E." - '2...\4.
C AttadI four (4) copies of all eagiDcered dnwiDC IbowiD& the IocatioG, ClllCDt aDd di.m~:oDoaI of tbc wort. De dnwiD& IbaIlIbow tbc Jdatioa of tbc
JlI'OP'C*d wort to existin& swface aDd UDdetp'OUDd improvemetltl. WbeIl ~ by the aty ~, aid 4mriDc bcalmeI . part of thiI permit.
D. All wort IbaD CODform to the Cty'1 GcocnJ CoGditioGl, StaDdud CoaitNctioa I'roviDoaI aDd StaDdud CoaitNctioa DcWI5 for Public WOiU
Coastructioc; the GeDCnJ Permit CoDditioalliaed 011 the ~ lick; aDd the Special ProviIioaI for tU permit, Iiaed bdow. Pailure to abide by
these COIIditioas and ~ may result ill job Ibut-dowll and/or forfeiture of faithful PerformaDOe Sureties ud CIlIb depo5iu.. (See Gcocral
I'crmit Cooditioas 1 and 2.) dl. '0 AaD<<
E. A ooarefuDdable applic:atioll fee muA acoompeay thiI appticatioll. #' (I ,-n
Name of Applicant SMl ..Jc:1;E. 'NA:Tr:.Q CD.
Addras \2.2\ 6. ~a::>t-A A.~E.. sAJJ J~ . fA. 1f;/?1S
,
II this wort being dooe by the property OWDer at their OWD reaideooe? Yea V No
Tdepbooe 1...7Q-7M7
RECEIVED
MAR 121996
Complete and attach Worte~' CompellAtioII and Cootractor lnformatioo f~
The ApplicaDt/permittee hereby agrees by afIUiD& their lipatllre to thiI permit to bold tbc Oty of CampbcU, ita ofticers., 8FD~IlUltI~~'tafc
and hann1ess from any claim or demand for damage& Il:SUIting from the wort ~red by this permit.
The AppIicant/permittee hereby acknowledges that they have read and understand both the front and bact of this permit, aDd they will inform their
cootractor(s) of the information.
3-!3-96?
Date
NOTES: AlL WORK SHALL CONFORM wrrn nIB ATIAOIED, APPROVED PlANS AND AlL APPUCABLB CAMPBELL srANDARD
DRAWINGS AND CONDmONS.
nIB CONrRAcroR MUSf HAVE TInS PERMIT AND APPROVED PLANS AT nIB SITE AND MUsr NOTIPY nIB PUBUC WORKS
DEPARTMENT AT LEAST lWO DAYS BEFORE srARTING WORK.
NOTICE MUSf BE GIVEN TO'PUBUC WORKS AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK.
SPECIAL PROVISIONS
_2.
~:
Street IbaD DOt be opeD cut for underground iDItallatiooL NiDimum CUtl may be a1IoMcl for COODCCtioaI or uploratioa boles. Such cutl must
be SDeCificallv aDtlroved by the Insoector >>rior to cuttiM..
PnemeDt may be cut for UDderground iDItallatioal and must be restored ill aa:ordaDcc with the Utility Treocb R.eItoratioo Standard Drawing.
Wort to be staked by. 1ioensed Laud Surveyor or Civi1 &gincer ud two (2) c:opieI of the cut IbeetllCDt to the Public WOiU DepartmeDt
before starting wort.
Llol.t4t~ cJ1= M~~ M(r:c1 J/IJf-.. -1"'~Lu:.O I./IfJ-'t qlfMlL- !;Ptk ,
_1.
APPROVED FOR ISSUANCE
STANDARD
5210.00
SSOO.OO
(100% Of ENG. ESf.)
(4% OF SUREI"Y, SSOO MIN)
(PIRSf $0-$30,000 14%;
$80, miD)
AMOUNT
s 3.15. /) ~
S
S
S
s J.J.o ,QO
RECEIJ'T NO,
PERMIT APPUCAll0N FEE
PlAN DIECK DEPOSIT
SURElY FOR FAfIlIFUL PERFORMANCE
CASH DEPOSIT
PlAN DIECK &. INSPECI10N PEE
Next $3O.~$8O,OOO 10%; Amount
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h:PW PERMIT/Rev.4/94
USA phone (800) 642-2444
(see other side)
TICKET NO.
CITY OF CAMPBELL
il.-~ r \ I -
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PROJECT NO. it "/59
REPORT NO: I
DATE: 4. ---4 -r;~
FIELD ENGINEER I S DAILY REPORT
c; ~ V)C~' r: r..; f:
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CONTRACTOR: );!, trt1...-c,'
WEATHER: ,
c.u r
INSPECTOR: K. ~51fALL
ITEM
DESCRIPl'ION
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PAGE: I
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