96-193
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PUBLIC WORKS
~HtSrRATJON
APPUCATION. AppOcaDoc i5 bc:rcby made for. Public Wons Pc:nnlt in accordanc:e with CampbeD NwUcipal Code, Sectioa 11.04. (Applicatioo expires
in 6 months if the permit is DO( ia:ucd).
A Worh&l~ or tract # I ~ 1 J 'V ~LL. A v~
Utility uencb Jocatioo lOll \7~u..- A\J(("
B. Natl1reofwon.: R~D\JIIJ& :VAMAU~/) LA~I.Je.1'~ ~ RbPLAe...IA)br ~&lhP_ uJ U. G<. VAUL:f.
't No.
^' _..1. file
CJb- 10--3
aTYvrCAMPslLE eEl V E.
DEPT. OF PUBUC WORKS
~~ ~JUN 171996
(4CS) ~21SO
I&ued
!'amit
Appliatioo Date &/1 7 / '1 (p
Applicatioa c.xpUu in 6 !DOE.
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C Ataeb fOW" (4) ~ 0( an engineered c1rawin& sbowini the Jocation, extent and ~~ of the work. The drwwin& shaIIlbow the ~tioo of the
proposed won.: to c.xi.st:ing surface and underground improYements. When approo.oed by the uty ~r, aid dnrwi.ng beromc:s a part of this permit.
D. All Yo'Or\: w.lI rooform to the City's General Oxiditioos., Standard ~ ~ and Standard Coostructioa I.)c.W1s for Public worts
. Coomuctioo; the General Permit Cooditioos ~ OQ the reverse Qde; and the Special f'roo,ia:ioos for this permit, listed below. Failure to abide by
these cooditioos and ~ may result in job shut-down and/or forfeitl1re 01 Faithful Perfonnanc:e Swetic:$ and c:ad1 depolcits. (See General
Permit Cooditioos 1 and 2.)
E. A nc=efu.n&ble application fee must ~ this ~tion.
Name of Applicant fAtlrtL ~ / ~HIIlL~,y' \J~'6~
Add~ ?41~ ~. I ~'( I R()()M laD ?;AtJ f~ 1
Tdepbooe.fDf& .4t(~ -11~7
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Is this Yo'Or\: being dooe by the property owner at their own residence'?
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Yes
No
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Complete LDd .tach Worke~' Compens.ation and Coctractor lnIormatioc forms..
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The ApplicantjPermittee hereby agrees by a.ffixing their Apal\lre to this permit to bold the Ory 0( Campbe.ll. its officers, &genu and ~ free, safe
and harmless from any claim or demand for damag'C$ ~ting from the won.: COYered by this permit.
..
Date
NOTES: All WORK SHAll CONFORM wrrn '!HE A TIAO!ED, APPROVED PlA"'5 AND AlL APPUCABLE CAMPBEll. STA.~'DARD
DRAWINGS M'D CONDmONS.
THE COl\'TRACI'OR MUST HAVE TIllS PERMIT AND APPROVED PlANS AT THE srre AND MUST NOTIFY nre PUBUC WORKS
DEI' ARTh{E]I.'T AT LEAST TWO DAYS BEFORE STARTING WORK.
NOTICE MUST BE GIVEN TO PUBUC WORKS AT l..FAST 24 HOURS BEFORE RESfARTING ANY WORK.
SPECIAL PROVISIONS
_1. Street shall DOt be opeD cut for underground installatioos. Minimum cuts may be allowed for c::onnectioDs or cxpIoratioc bok:$. Such cuU ~
be SDecificallv aool"ClY'td bv the lnsoector Drier te cuttin2.
_2. Pavement may be cut for underground inmllatioos and must be restored in accordance with the Utility TreDCh R,e$toratioc Standard I>rz,r.ing.
_3. Work to be staked by a liceD5Cd Land Swveyor or Civil Engineer and two (2) c:opies 01 the cut sbeeU &.ent to the P\lblic WorU DepArtment
before starting worL
_4.
APPROVED FOR ISSUANCE
STANDARD
$210.00
$SOO.oo
(100% OF ENG. EST.)
("% OF SUREIY, $SOO MIN)
(FIRSI' $O-$3O,OOl14%j
7% min)
AMOUNT
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RECEIPT NO.
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PERMIT APPUCATION FEE
PlAN 01ECK DEPOSIT
SUREfY FOR FAlTIIFUL PERFORMANCE
CASH DEPOSIT
PlAN CHECK &. INSPECTION
Ncn $3O,OOl-$80,OOlIO%j Amount
---
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Date
'* '*
h:PW PERMIT/Rcv.4/94
USA phone (800) 642-2444
(see other side)
TICKET NO.
ISSUE
1
DATE
6/96
VICINITY MAP
:J EL CAMINII 0 i
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TG 66 A-5
POINTS OF CONTACT
PERMIT DWG.
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PACIFC BELL
SHIRLEY WEBB-ENGINEER - 408-493-7133
NEAL KEPHERT-C.O.MAINTENANCE - 408-973-7534
PHIL SASARI-PLANNING ENGINEER - 408-493-7178
NORTHST AR TELECOMM
BEN GREENWOOD-ENGINEER - 408-232-0572
DATE
CONST.ARC COMP
f"-:;H;J; w~ ;G;E;E;:N;D;';W;S;- CURTISS GREENWOOD- I
I FOR NORTHSTAR TELECOMM SERVICES, INC, UNDER CONTRACT TO PACIFIC BELL I
I FOR QUESTIONS AND ASSISTANCE ON THIS JOS PLEASE CALL: I
I SHIRLEYWEBB ON 408-493-7133 I
I PLEASE REPORT ALL LOST TIME AND MATERIALS CAUSED BY THIS WORK I
ORDER TOROSIN NIDEROST ON 408-493-7078,
I WE ARE VERY INTERESTED IN YOUR OPINION OF THIS WORK ORDE~, I
L ~L1:!O~ ~E.::.O:2:. W~H ~U~C~M~T.:..A~ S.::?~S~N~ _ _ _ J
GEO/CO N4-10
EXCH SNJS-12
ENGR S.WEBB ICFG TEL 408-493-7133
ENGR ARC 9 UHBMS
TYPE OF CONST
UG CABLE,FIBER & LT. SPAN
RO/EST NO N4-1519S
DWG I OF 5 P504
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