97-148
CITY OF CAMPBELL
DEPT. OF PUBLIC WORKS
70 North First St.
Campbell, CA 95008
(408) 866-2150
Fax (408) 376-0958
Issued
Permit expires in 12 months
4
- Permit No.
, X-Ref. file
97-148
ENCROACHMENT PERMIT
(for working within the
public right-of-way)
S/9 "
,...tiN
Application Date 4/15/9 7
Application expires in 6 months
APPUCA nON - 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.)
A. Work address or tract #
66 El Caminito (s/s of El Caminito, 200' e/o Winchester)
Utility trench location
B. Nature of work
EMERGENCY Gas Main Repair - 4'x4' hole in street
C. Attach four (4) copies of an engineered plans showing the location and extent of the work. and four (4) copies of the preliminary Engineer's Estimate of work. The
plans shall show the relation of the proposed work to existing surface and underground improvements. When approved by the City Engineer, said plan becomes a part of
this permit.
D. All work shall conform 10 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.)
E. THE CONTRACTOR MUST HAVE THIS 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
Pacific Gas & Electric
(print name)
Blanev, Cupertino 95014
Telephone 7 2 5 - 21 7 6
Address 1 0 9 0 0 N.
24 HOUR EMERGENCY TELEPHONE NO.
Is this work being done by the property owner at their own residence?
Yes
No
The ApplicantlPermittee 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.
Accepted
Gwynn Holst (EMERGENCY VERBAL)
(Applicant/Permittee) (sign)
4/15/97
Date
SPECIAL PROVISIONS
_1.
Street shall not be open cut for underground installations. Minimum cuts~be allowed {or connections or exploration hoIes.d Suchcuis maybe soc:citicallv
approved bv the Inspector prior to cutting.
Pavement may be cut.for underground installationsliridmuslbe restored in accordance with the Utility Trench Restoration StaIIdartI Details, Method" A" Backfill,
unless otherwise approved by Inspector.
Work to be staked by a licensed Land Surveyor or Civil Engineer and two (2) copies of the cut sheets sent to the Public WorksDepartmenl before staning work.
Per Section 4215 of the Government Code this permit is nOI valid for excavations until Underground Service Alett (USA) has been notified and lhe inquiry
identifICation number has been enteredherean;tJSAPhone 1-800-227-2600 ...... U TJCKET.N. O. .
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_2.
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SEE PUBLIC WORKS FEE SCHEDULE FOR CURRENT FEES
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AMOUNT
RECf)NO._::
...
PERMIT APPLICATION FEE
PLAN CHECK DEPOSIT
SECURITY FOR FAITHFUL PERFO
CONSTRUCTION CASH DEPOSIT
PLAN CHECK & INSPECTION FEE
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$
S
$ Jd.- <i
61
APPROVED FOR ISSUANCE
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FROM COASTAL PAVING 2595772
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t: RstaI Paving Inc.
(40') 9...1550
Fax (A08) 259-5772
851 N. King Rood. Son Jose, CalifornIa 95133
TO: 308 oIL ~j)y tdc:S;-h,C FROM: 4t/vplo P"1~".vC;-Z-
FAX#: &oi):?76-07)~ DATE: .ij/ZZ/77
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MESSAGE/ITEMS ENCLOSED: Co4.~~ PAt/l/t ~/t<- BS U/D7Lt:-tAIf
~_ ./-0 W'/lONJ t--IS/75D &.c:ZCO~
-PC.~A~':; ~(A..Y1r;:: 1/ .voJ /(I</u$ A,,</y ?i>J1iK#opJ ~;.!.i f/at,.I
ORIGINAL 0 WILL ~ILL NOT FOLLOW IN THE MAIL.
WE ARE TRANSMITTING A TOTAL OF -L-PAGES. INCLUDING THIS COVER SHEET.
IF YOU DO NOT RECEIVE ALL PAGES OF THE FAX, PLEASE CALL OUR OFFICE AT (408) 988-7550.
GRIND 2 II DEPP, INSTALL PETROTAC AND PAVf:
TAG 064660 (3) AREAS 2" DEEP
ADDRESS: 6a4-ASH CT. 510 ARC RD,
TAG 79034 (1) AREA Z' DEEP
ADDRESS: 66 EL CAMINITO AVE. @ WINCHESTER
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