91-123
CITY OF C&IIPBELL
DZPT. or PUBLIC IIOJUtS
70 North rtr.t st.
:>....1".~1l, CA '5001
.,;"., (401) .....2150
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pCROACHMEHT PERMrI'
(for workinq in th.
public ri9b1;_f_.y)
ISlWed ~k/
Pez1Iit in 12 _.
Pemit No.
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X-Ref. fil.
Appl1caUon Date 2-/;; 5"/9/
Application expirU in 6 110..
APPLICA'1'%OIf - Application 18 bereby ..d. for a PI1bl1c Wora Penlit: in accordance with c:a.pbell
Municipal COd., Section 11.04. (Appl1caUon expirea in 6 IIOntba if pemit not: pulled)
A.
Work addreaa or tract: .
515 E. Campbell Avenue, Campbell, CA
II.
Utility t.rencb location
..tDra of work: Install utilities as indicated on attached sketch.
SDlfE80687
c.
Attach five (!I) copi_ of a drawinq abowinq th. location, extent and dia.naione of th. work
Th. dravinq aball allOW tb. relation Of tb. propo.ed work to aistinq .urface UId Imd.rqround
bprov-.sta. When approved by the City Enqineer, ..id drawineJ becGIIe. a part: of tbia peftlit.
D.
Th. General COndltiona for all penita an listed on tbe raveree .id.. Spacial Pravisiona for
this penait an listed below. railure to abide by th... concUtiona and prov18iona _y reault
in job aIlut-down and/or forfeiture of raithful Perfonaence Bonds and cash d.po.ita. (8_
General conditione 1 and 2).
B. An application f_ _t aCCOJllNUlY tbis application. Th18 is non-refuJ1clel..
.... of Applicant Pacific Gas and Electric Co. 'l'alepbone: 725-2114
~~. 10900 N. Blaney Avenue, Cupertino, CA 95014
Is tbi. work beinq don. by th. property owner at th.ir own re.idence7 ---3-
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C01Iplete and attach Morken' c:aapensation and contractor Infonl&tion fOnl&.
The AppUcant/Penittee bereby aqnu by affixinq tbeir siqnatun to tbis'parait to bold tbe City
of .
ClIJIIpDell, ita officers, aCJenta and .-ploy.e. free, .af. and barwJ.... fJ:'Oll any claia or daand for
duaq.. ~u1tin9 frca t:be work covered by this pem1t.
ft. Appiicant: ~p '~i t:t:1te bere q.. ~at they bave read and und.ratand both th. front and
back of thi., j,nfo e r contract:or(.) of th. infonaation.
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A~&U 2/20/91
Applicant (Pena tt_) print/a
Michael S Blodgett
NOTES: ALL WOB SHALL COHI'OlUI 1fr1'B 'l'BE A'l"l'AamD, APPRDVZD ~ AlII) ALL APPLICAllLE CAllPIBLL
STANDARD DRAWIHGS AlII) CDHDI'1'%OICS.
'l'BE COIftRAC'f'DR MUST BAft 'l'IIIS PDIIIT AHD APPIWflD P!.UIS AIID .:1S'1' IIBft Wl'f'II 'l'BE '.W. DflPBC'rOR OK
'l'JIB SID Nt I.&U'1' '1'110 Da.YS IID'OD S'l'AR!l'IHG WOItK.
HO'l'ICI: JIDST lIB GIVD 'l'O POIILIC WORD Nt LUS'l' 24 IIOUU araa DITARTDIG AllY WOU.
Date
SPE~AL PROVYSYOHB
_1.
Street ahall not be open cat: for under;round inat:a1lationa. Klniaua cuta ..y be allowed
for connect:iona or exploration bol... Such cuta lII1.t be .aecificallv almrove bY th.
In.".et:ar.
.av...nt ..y be cat for underqrouncl1nat:a1lationa and ..-t: be ~rad ill accordance witb
tbe Utility 'french -..t:oration St:ancIsrd DravineJ.
WOrk to be at:aUd by . licen.ed Land Sun'eyor or CivU ZftCJinear and two (2) copi.. of tbe
cat: u-ta .ent: to tbe PI1blic Work Deptartaent bef\)re at:&rtinlJ work.
Th. bours of work an l1aited to outaid. the bours of 7-9 .... and 3... p... for any work
atfect:in9 a traffic lane. /. ,
A)/WA/.J-:rR~:.v -SAFt=:7'WO Ll;/Af A~.h~77t/AN4 VE7-1It:.',U_A~ 7'7tRpC'L AT" AU. n-""'E$
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D~YPr MO.
PERMIT APPLIClTIOK FIZ ($50.00) S100.00
PLM CllBa DUOSlT SIOO.OO
8O.D lOR l'AI'l'BlUI. PDlORllARCI: (loot or ElIG. 1ft.)
CASII DUOSlT (1200.00) (n or 8OIfD, SIOO lID)
PLM CllBa , IHSPECTIOK FE! (SO - $100,000 lot,
$100,000 - $500,000 ", $!So $100 lID)
APPROVZD !'OR ISSUAIICl:
$ /pI:). /)0
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(SEE ODD SIrEl