96-179
CITY OF CAMPBELL
DEP1. OF PUBLIC WORKS
70 North First St.
Campbell, CA 95008
(408) 866-2150
Fax (408) 376-0958
lit No.
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kt<ef. File
9to - /'7 c;
Application Date
Application expires in 6 mos.
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APPLICATION - Application is hereby made for a Public Works Permit in accordance with Campbell Municipal Code, Section 11.04. (Application
expires in 6 months if the permit is not issued Application Fee is non-refundable).
B. Nature of work
C. Attach four (4) copies of engineered plans showing the location and extent of the work, and four (4) copies of the preli~1E~!eer's . ':l
Estimate of work. The plans shall show the relation of the proposed work to existing surface and underground improvements. Wh~e\~prO~~"fON
the City Engineer, said plans become a part of this permit. .....0 \",,\s.nt~"
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D. All work shall conform to the City of Campbell Standard Specifications and Details for Public Works Construction; the General Permit Conditions
listed on the reverse side; and the Special Provisions for this permit, listed below. Failure to abide by these conditions and provisions may result in
job shut-down and/or forfeiture of Faithful Performance Sureties and cash deposits. (See General Permit Conditions 1 and 2.)
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E. THE CONTRACTOR MUST HAVE TIllS PERMIT AND APPROVED PLANS AT THE SITE AND MUST NOTIFY THE PUBLIC WORKS
DEPARTMENT AT LEAST TWO DAYS BEFORE STARTING WORK. NOTICE MUST BE GIVEN TO PUBLIC WORKS AT LEAST 24 HOURS
BEFORE RESTARTING ANY WORK.
Name of Applicant/Permittee~~""--,,,,/ 9~ v... (..1 /~ j; ~1 ~..
Address / ~d / ,-.J? ;Be"'J f\.fl..-./Y') ,,/ ()/v-(7j.
Is this work being don'e by the property owner at their own residence? Yes
Telephone
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No
The Applicant/Permittee hereby agrees by affixing their signature to this permit to hold the City of Campbell, its officers, agents and employees free,
safe and harmless from any claim or demand for damages resulting from the work covered by this permit.
The Applicant/Permittee hereby acknowledges that they have read and understand both the front and back of this permit, and they will inform their
contractor(s) of the information:
(ApplicantlPermittee )
Date
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2719,28
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JUN-25-:36 TUE
7:1:3 R W FRENCH CONSTRUCTION
2266255
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;:.C;? l&R~W. French
~ Construction, Inc.
~ General Engineering Contr...cto,.
CJ Uc. No. 576570
FAX NOTIFICATION
OUR FAX# (408) 2266255
FAX TO:
CITY OF SAN JOSE-PUBLIC WORKS DEPT. HIP OR TRISH 277-3756
CITY OF SAN JOSE-DEVELOPMENT DICK TSURUMOTO 277-3158
seCT A-ROAD OPERATIONS LARRY FRYE 993-9857
CITY OF SARATOGA ENGINEERING DEPT. ERMIN DORSEY 141-1049
V CITY OF CAMPBELL PUBLIC WORKS DEPT. RANDY WESTFALL 37'-0958
CITY OF LOS GATOS ENGINEERING DEPT. KEVIN FLAVIA 354-8431
CITY OF MONTE SERENO PUBUC WORKS DEpT. JOHN TURCHAN 395-7653
CITY OF CUPERTINO PUBLIC WORKS DEPT. CHUCK CHEVALIER 777-3333
ATTENTION:
FAX "
FROM: TED DEXTER
DATE & TIME: V I U't1996
MESSAGE, @~
WATER SERVICE WORK
TYPE:
B=BASE PAVING
F-N/C=PINISH PAVE wNOT COMPLETE"
P""FINlSH PA VE ~JOB COMPLETEw
CGB-CONCRETE GATE BOX
CR==CONCRETE REPLACEMENT
SC=SA W CUITING
WSI=NEW WATER SERVICE lNSTALLATION
WSR::.:WATER SERVICE REPAIR
7;UO~ PM
'-
DATE:
" I ~1996
WORK ACTIVITY LOG
-=
CITY
PERMIT NUMBER
toeA nON
TYPE
ZONE MESSAGE NUMBER
O~1t.L Q'v/11
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421 Umbarger ROQd 0 San Jose, California 95111 0 (408) 226-5200 (] Fax (408) 226-6255