97-114
CITY OF CAMPBELL
DEPT. OF PUBUC WORKS
70 North First 5t.
Campbell, CA 95008
(408) 866-2150 Issued /;( ,. 3 ~ 97 Application Date 1 -11 - q 7
Fax (408) 376-0958 Permit expires in 12 months '-r Application expires in 6 months
APPUCA TION - Applicllion is bcrdly IIIIlIe (or . Public worts PmDit ill ICCOrdIIIl:c widI Campbd1 MIIIIicipII Code. Scaioa 11.04. (Applftrinn Cllpira ill 6 IIIllIIIbs
if !be permit is DOt iuucd. Application Fee is 1IOIH'duDdIb1e.)
ENCROACHMENT PERMIT
(for working within the
public right-of-way)
Permit No.
X-Ref. tile
q7-114
A. wort Iddrcu or na IN . W. Corner of Grant & 2nd St.
Utilily IraICI1loc:l1lion
B. Ncm: of work 3' x5 I Hole in pavement to fix qas leak.
C. AlIXh four (4) copies of all qiDeaed plaos sIIowiDa Ibc Iocaioa mil alII:IIl ollbc work. .... filar (4) copies ollbc pI'dImi.ry BDP-'I Em- ol work. The
piIDs Iba1IIbow die reIIlion o(!be proposed wort 10 aisliDa surface II1II IIDlIerpuuDd ~aaaIlI. WbaI ~ by !be cay E!aJiDllcr, IIid pIIII bacaaIa . pill of
Ihis permit.
D. All wort shall conform 10 the City of Campbdl SWIdIrd Specifk:adoas II1II DcaiII for Public worts Coasauc:cioa;!be CiaIeraI Pamil r"",,,w-1iaIed 011 !be rnmc
lide; mil Ibc Special Provisions for this permit. listed below. Failure 10 lIbide by Ibcac ClIIDdiIiaaa .... pnlYiIiDDI may nauIt ill job IiIIMIowD redlor furf1:ilure 01 FaiIhfuI
hdonJlllDCC Surelic:s and cash dc:posils. (See GaIenl Pr:rmil r"",,,itWM 1II1II 2.)
E. THE CONTRACTOR MUST HAVE THIS 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.
NlIIIIC of Applicant PG & E T~ 725 - 21 7 6
Address 10900 N. Blaney ~~bupertino 95014 24 HOUR EMERGENCY TELEPHONE NO.
hlhis worlc bein& done by the property owner at their own residence?
Yes
No
The ApplicanlJ'Permitte bereby acrees by aff1Xin& their sipEue 10 this permit 10 bold die City of Campbdl. iIs off"JCCn. IIeIIIS II1II employees free. life II1II bIrmIca from
any c1aim or dcmaDd for damqes rcsuItin& from !be worlc coven:d by Ihis permit.
The ApplK:amlPmniaec bcrcby adaIowledees tbat Ibcy have rad .... IIIldenwId bolh !be from .... bIl:k of Ihis permit, .... Ibcy will iDfilrm Ibcir COUIIl:IDI{I) of !be
iDfOl"lllllion.
Aa:epIed
PG&E (emergency verbal)
(ApplicaDllPmDiu.ec) (liIo)
1/31/97
DIlC
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~r~?E;E~~t+~~~l~~.t~~.r~
. _3. Wad: ID be Slaked by a 1iI:cDsed 1.md SIII"ICYOf orOriEaaiDecr aDd two (2)CIllpiaaf die cuulII_ - tDdIIlPullfic WQlb~ ~ailniltcWtXt. .. .
4. Per Seaion4215 oftbe Gcr.....1lIIlaIt Code tbiI permit illIOtYllid for ~lIIIIiI U~Semc:e ~~)- bIleIIJIl1tified-.4d1eiDquily'
/ .identiflallion Jllllllberhas lIealeIIII:RCIllereonQSAJI!IoDel,.aoo.227-2600. :oi><USATlCX:EfNO. .......::;:::<:.::::..: .. .......... ....
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P'aMlT APPUCATIONFEE
PLAN CHECK DEPOSIT
SECURITY FOR FAITHFUl.
CONSTRUCTION CASH DEPOSIT
PLAN CHEClt at: INSPECTION FEE
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APPROVED FOR. ISSUANCE