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06/02/2003 09 25 FAY 209 =31 I0 CITY OF TRACY I ]003/003 Page 2 of 2 This perm t is issued pursuart to all provisions of City of Tracy Municipal Code. This permit is granted upon the express (.()ndition that the pet mittee shall be responsible for all claims and liabilities arising out of work performed under the 3ermit or arising out of permittee's failure to perform the obligations with respect to street maintenance. The perm;tee shall, and oy acceptance of the permit agrees to, defend indemnify, save and hold harmless the city, its o`fi 0ers and emp oye(;s, from and against any and all suits, claims or actions brought by any person for or on accoun of any bodily injuries, disease or illness or damage to persons and/or property sustained or arising in the construction of the work performed under the permit or in consequence or permittee's failure to perform the obligation: with respect to stri;et maintenance. PermitteE .agrees to abide by :he provisions of this permit. �-_Q PERIAITTEE'S SIGNATURE DATE Prior to excavation, Contracts- must contact the following to have below-ground facilities located (48 hours prior to work): UN DERGROUND SERVICE ALEFT To I Free: (800) 227-2600 Bo/d Service Center (2(9) 831-4420 Note: You are notified that Section 6500 of the Labor Code requires the issuance of a permit by the Division of Industrial safety of the State of California prior to the construction of any trench or excavation which is five feet or deeper aric into which a person is required to descent. Excavation in city street areas without an excavation permit may be punishable by _i fine. Permittee agrees that they hereby accept complete responsibility for coordination with, reporting to, and complying with the din action of, any and ,.II boards or districts, including but not limited to, San Joaquin County Local Health C)istnct and California Regional Water Quality Control Board, or any other regulatory agency having jurisdiction or authority o%er soil or ground water contamination such as that currently found at the site of this work, including the preservatio i of the health and safety of persons working near or in eny trench or excavation or on the surface of the constru:tion project, or am, persons passing by or observing, or any persons living in the vicinity of the construction project, for any reason whatsoever that may adversely, or otherwise affect the health or safety, now and in the f itu re, of these per-ons or group of persons. Furthermore, permittee hereby accepts complete responsibility for disposal of any petroleum affected soils, or ground wait ar, including reporting to and complying with the requirements of any, or all, of the stated, or any other, regulatory agencies as discussed above. c�L CITY INSP :CTOR'S COMPLETION REPORT PERMIT NUMBER - DATE OF (COMPLETION: Concrete: Asphalt: _ Sidewalk: Backfill: Paving: Size of Cut 5q. Ft. _ Inches- Paved By: INSPECTOR SIGN OFF