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CITY OF CAMPBELL
DEPT. OF PUBLIC WORKS
70 North First St.
campbell! CA 95008
(408) 86b-2l50
APPLICATION - Application is hereby made for a Public
Municipal Code, Section 11.04.
Permit No. gg - :2.....D 3
X-Ref. tUe
Application Date ~\ 10 I ~~
~~ mos. expires ~
Works Permit in accordance with Campbell"
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PUBLIC WORKS PERMIT
(ror worK1ng 1n ~ne
public right-of-way)
Issued ~ - Il- ~"S'
Perml~ eKp1rea In
A. Work address or tract I 60 San Tomas Aquino
Utility trench location SDlf41E07027
B. Nature of work: Install utilities as indicated on the attached sketch.
C. Attach five (5) copies of a drawing showing the location, extent and di.ensions of the work
The drawing shall show the relation of the proposed work to eXisting surface and underground
improvementa. When approved by the City Engineer, said drawing become. a part of this permit.
D. The General Condition. for all permits are listed on the reverse side. Special Provisions for
this permit are listed below. Pailure to abide by these conditions and provisions may result
in jOb shut-down and/or forfeiture of Faithful Performance Bonds and cash deposits. (See
General Conditions 1 and 2).
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E. An application fee must accompany this application. This
Name of Applicant Pacific Gas and Electric Company
10900 N. Blaney Ave. Cupertlno ~~U14
is non-refundable.
Telephone:
725-2114
Address
Is this work being done by the property owner at their own residence?
Complete attached Workers' Compensation and Contractor for.s.
The APilicant/permittee hereby agrees by affiXing their signature to
Campbe 1, its officers, agents and employees free, safe and harmless
damages reSUlting from the work covered by this permit.
The Applicantl e mittee hereby acknow
back of this mit, and that th y
ACCEPTED L rence H. Berg
_yes
no
this permit to hold the City of
from any claim or demand for
u.~.
dges that they have read and understand both the front and
1 inform their contractor(s) of the information.
8-9-88
NOTES: L WORK SHALL CONFORM WITH AND ALL APPLICABLE CAMPBELL
STANDAR DRAWINGS AND CONDITIONS.
THE CONTRACTOR MUST HAVE THIS PERMIT AND APPROVED PLANS AND MUST MEET WITH THE P.W. INSPECTOR ON
THE SITE AT LEAST TWO ,DAYS BEFORE STARTING WORK.
NOTICE MUST BE GIVEN TO PUBLIC WORKS AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK.
SPECIAL PROVISIONS
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Street shall not be open cut for underground installations. Minimum cuts may be allowed
for connections or exploration holes. Such cuts must be specifically approved by the
Inspector.
~.vement may be cut for underground installationa and must be restored in accordance with
the Utility Trench Restoration Standard Drawing.
Work to be staked by a licensed Land Surveyor or Civil Engineer and two (2) copies of the
cut sheets sent to the Public Work Dept. before starting work.
The hours of work are limited ~ outside the hours of 7-9 a.m. and 3-6 p.m. for any work
affecting a traffic lane.
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PERMIT APPLICATION FEE
PLAN CHECK DEPOSIT
(R-l)
($35.00)
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STANDARD
AMOUNT
RECEIPT NO.
$50.00
$500.00
(100' OP ENG. EST.)
($200) (4\ OF BOND,$500 MIN)
(7\ OF F.P. BOND
4.~NJ
$ 5D.00
$
$
$
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BOND FOR FAITHFUL PERFORMANCE
F. P. (CASH) DEPOSIT
PERMIT FEE
$ 3S-. DO
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APPROVED FOR ISSUANCE
f: PWPERMIT
Revised 7/87