91-133
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M I
CI'1'Y or CAKPBEU.
DEP'1' . or PUBLIC 1IORItS
70 Harth rizwt St.
e...,N!.1, CA 'IDOl
(401) "1-2150
~t Ho.
91-133
EHCROA~ ~
(for vork1n9 in tb.
pllbl1c d9bt_f_aYI X-lWf. fUa
~ed ..3,j c;/ 9 I AppllcaUon Data 3/19/91
Puait upu.. 111 12 -. Appl1cation up1zu in 6 110..
APPL%CA'1'%OH - Application ill buwby _de for a Public Worb Perait in acc:ordanca vitb CAllpbell
IIWllclpal COda, hation 11.04. (Application upu.. ill , -=tba if perait not pIllled)
A. WOrk addna. or tract .
otU1ty tnncb location
62 PAflF. ~'1'RF.F.'1'
65' s/o Mapa1e Ave.
II. .atun of workl Emerqencv service leak
c. Attach U". (I) cop1_ of a dravinq aIlovinq t:be location, extant and cU..naiona of tbe work
'file dravinq llball aIlov tba ralation of t:be propo.ad work = aiatinq nrfaca and underqroand
iJlprav-.nta. WIlan &ppravad by t:be city En91nMr, Aid clrawiD9 ~. a part of 1:hia penit.
D. 'fila General Conditiona for &11 pendta an lilltad on t:be NYane .id.. Spacial Prcwillicma for
tbJ.. pendt an latad belov. railure = abida by tIla.e conditiona and pravillicma _y r&8Ult
ill job aIlut-dcnrn and/or forfeiture of raithful Perfomanc:e Banda ucl CUb dapoeita. (S..
General COftditiona 1 and 2).
Z. All application f.. ...t ac:ccmpany 1:hia application. '1'!1ia ill aon-rafWldable.
.... of Applicant S . J . W . C . '1'e1epboMI
AddrH. 1 ,}:}l ~ Bascom Ave. San .Tose 95128
la tb1a work baincJ done by tile property cnrnar at t:beir own raIIidanc:a7 ---:tH _no
CcnIpleta and .ttach Worken' COIIpanaation aDd contractor Inforaation fona.
'file Applican1:/Pu1I.ittaa baraby .CJrH8 by .ffixir19 tIleir .i9ft&t1In = 1:hia'pemit to bold tile City
of
CUlpbell, iu off1cara, .9aftta and aployee. fraa, Afe and banl... fJ'aa any Cl.ia or daaml for
claaaV" ra.ultin9 fZ'CIII t:be work cavend by 1:hia penit.
'file Appl1cant/'enaitt.e bereby acJtnovledge. tbat tIley baye raad and understand both tile front and
back of tb1. penait, and tbat tIley wUl infona tIleir contractorc.) of tile inforaation.
A~~ G1ennette (Emergency verbal)
Applicant (Permittee) print/.ivn Data
HarES I ALL NOJUt 8BALL CD1CP01Ur wr1'B 'I'D A1"rACBED, APPROVED PLUI8 AlII) ALL APPLICAIILZ CAIIPIIZLL
STANDARD DRAwnrc:s AlII) CDlfDrnon.
'I'D CDltTRAC'l'OR MUS'l' DVI: '1'IIU PERIII'1' AIfD APPINVED PLUS AlII) IIUS'1' IID'1' Wl'l'JI 'I'D P.W. IRSPZCTQ1t OK
'I'D SITE Nt LZAST '1'110 laYS IID'OU ftAR'1'DlG 1IOIIJt.
HO'1'%CZ 1IDS'l' BE GIVJ:If 'I'D PDIII.tC 1IORD Nt LZAST 2. BOORS urou RESTAIl'1'DIc: AllY 1fORI:.
SP!:eTAL PROVISYDHS
_1.
Straat aba11 not be open cat for underlJZ'OUDd 1nata11ationa. JU.niaua c:ut:a _y be &1lond
for connectiona or explontion bel... 81Ic:b cata aurt be _c:ific:al1 v almraved bv ~.
rft~.~~r .
paveaant _y be ~ for 1mderqraund u.tallationa aDd -.at be raatorad in aCCOZ'dance v1tb
tbe 0t1l1ty '1'rench b8t0nUon StaDdard Drawirl9.
Work = be atakad by . 11canead 1ADd Suneyor or civU ZD9ineer UId bra (2) copt.. of tile
cat abeeta eut to tile Public Work Dept.ar'Clant bafora atart1n9 work.
Tbe boura of work an l1a1tad to outa1da tile ~ of 7-1 .... and 3-1 p... for any vark
affect1nq . traffic lana.
v-a.
_3.
_4.
_5.
'11-1 ,
ftAJIDAJm
ucryPl' NO.
AIImJR'p
$ l&->-7 , cO
$
$
$
$ \OC>.CU
Cf
PDKr1' APPLIc:n'IOK PD
Pl.Uf CBEc:Jt DZPOSI'1'
('50.00)
$100.00
$100.00
BOND PaR FAl'1'BI'OI. PERl'OJDWrCZ (lOOt OF ElfG. ZI'1'.)
CASH DZPOSI'1' ($200.00) (n or IIOHD, '500 lID)
Pl.Uf CBEc:Jt , IRSPEC'1'IOR PD ('0 - $100,000 lot,
$100,000 - $500,000 ,t, $~~'OOO and 7t, $100 lID)
APPROVED FOR ISSUAHCZ L~~
for City n.er
(SEE: anIDl SIIE)
~
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Date