96-165
CT';' or CAMPBEI...L
DEPT. OF PUBLIC WORKS
70 North First St.
Campbell, CA 95008
(408) 866-2150
Fax (408) 376-09S8
ENCRC.\CH:.rE~'~ PC:RMIT
(for working within the
public right-of-way)
Issued ~ -:::\/( q LfI
Permit expires in 12 mos.
Permit r-;,.
X-Ref. file
g6-16l:\
Application Date 5/7/9 6
Application expires in 6 mos.
APPUCA TION . Application is hereby made for a Public Worts PmDit in ICCOI'daDl:e wilb Caqlbe1l MIIIIicipal Code, SecUon 11.04. (Applicldon expires in 6 moJllhs
if lbe permit is DOt issued. Application Fee is _refundable.)
A.Workaddress orlrllCl' 100 Sunnyoaks (west of San Tomas Expy & Campbell)
Ulility lmICh location
B. NIalreofwork EMERGENCY gas leak
C. Aaach four (4) copies of an engineered plans sbowiDa lbe locIUoII and ateIIl of lbe work, and four (4) copies of lbe prelimiJuIry EDainecr's EstimIIe of work. The
plans sban show !he relation of lbe proposed work 10 eUstin& surfaee and uncIe:rpound improvemenll. When IpproYed by lbe City EDainecr, said plan becomes a part of
chis permit.
D. All work sball conform 10 die City of ~bell Standard SpedficaDons and Dclails for Public Works Conslnll:Uon; lbe GaIenl PmDit Coadidons listed on lbe reverse
side: and !be Special Provisions for Ibis permit, listed below. Failure 10 abide by these c:oodiUons and provisions may result in job sbut-down and/or forfeiture of Faithful
PmOJ'lllllla Sureties and cash deposits. (See Gcnera1 Permit Conditions 1 and 2.)
E. THE CONTRACTOR MUST HA VB nus PERMIT AND APPROVED PLANS AT THE SITE AND MUST NOTIFY THE PUBUC WORKS DEPARTMENT AT
LEAST TWO DAYS BEFORE STARTING WORK. NOTICE MUST BE GIVEN TO PUBUC WORKS AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK.
Name of Applicanl Pacific Gas & Electric Telephone 725-2012
24 HOUR EMERGENCY
Address 10900 N. Blaney Ave, Cupertino, CA 95014 TELEPHONE NO.
Is Ibis work being done by Ibe property owner at their own residence?
Yes
No
The AppliCatlllPermittee hereby agrees by afflXina their si&nature 10 Ibis permit 10 holcllbe City of CaqlbdI, ill offic:cn, aaems and eqlloyees free, safe and barmless from
any tlaim or demand for damages resultina from lbe work covered by Ibis permit.
The ApplicantlPennittee hereby acknowledles that they bave read and understand hoIh lbe front and bIcIt of chis permit, and they wW inform their COIIInCIOI'(s) of lbe
information.
Ac:a:pted
Sandra
(emergency verbal)
(Applicant/Permittee) prinUsip
5/7/96
Date