68700 Avenida Lalo Guerrero | Cathedral City | California | 92234 www.cathedralcity.gov
Applicant:
Enclosed is Cathedral City’s Sidewalk Repair Assistance Program Application. Please review and complete the application forms, whic h includes the program application form and the no-fee encroachment permit application form.
When the completed application forms are completed and ready for submittal, please mail or drop off to the addres s below.
If there are any issues , the City will contact the property owner to resolve any irregularities with the subm itted application for ms. Applications are normally reviewed the same week they are received.
Once the application is approved, the AGREEMENT packet will be mailed to the applicant. The agreement packet will include the payment voucher that can be redeemed once the sidewalk repairs have been com pleted by the owner/owner 's contractor AND inspected by City Staff.
Please MAIL/DROP OFF documents to the address below.
If you have any questions regarding the enclosed documents, please call (760)-770-0319 or email [email protected].
Sincerely,
City of Cathedral City
Engineering Department
CATHEDRAL CITY
SIDEWALK REPAIR ASSISTANCE PROGRAM
APPLICATION
INSTRUCTIONS
City of Cathedral City
Engineer Department
68-700 Avenida Lalo Guerrero
Cathedral City, CA 92234
68700 Avenida Lalo Guerrero | Cathedral City | California | 92234 www.cathedralcity.gov
Cathedral City Sidewalk Repair Assistance Program Application Before you fill out the Application, please read the Program Information/Application Instructions and complete the application in its entirety.
The Community Development Block Grant requires demographic information for all program beneficiaries.
Applicant Name:
Last First Middle Initial
Co-applicant Name:
Last First Middle Initial
Address:
Applicant Telephone: Home: ( )- - Cell: ( )- -
Email:
Do you own this property? Yes No
Have you or the property received a notice of violation from Cathedral City Code Compliance for the condition of the sidewalk? Yes No
If yes, when? _____________ Please include Case# if known: _________________ Will the cost of the Sidewalk Replacement cause a financial hardship to you and your household? _____Yes _____N o If yes, please explain the financial hardship: ______________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ Please attach documentation (Examples include but are not limited to proof of unemployment, proof of outstanding debt, medical bills, etc.). Are documents attached to the application? __
__ Yes ___ No
68700 Avenida Lalo Guerrero | Cathedral City | California | 92234 www.cathedralcity.gov
Number in Household: Female Head of Household? Yes No Elderly or Disabled Household? _____Yes _____No A househol
d is defined as all persons occupying the same housing unit, regardless of their relationship to each other. The occupants could consist of one family, two or more families living together, or any other group of related or unrelated persons who share living arrangements.
Please note: Please select at least one from the following list that best describes your household racial characteristics. HUD requires the City of Cathedral City to report the following information for all recipients. HUD encourages self-reporting, but you are not required to furnish the following racial/ethnic information:
One Race Household: White
Black/African American
Asian
American Indian/Alaskan Native
Native Hawaiian/Other Pacific Islander
Multi-racial Household: American Indian/Alaskan Native and White Asian and White
Black/African American and White
American Indian/Alaskan Native and Black/African American Other Multi-Racial
Are you also Hispanic? _____Yes No
I hereby submit this application to the City of Cathedral City's Sidewalk Repair Assistance Program. I further certify that all ownership, occupancy, and code compliance information is accurate.
If the approving staff rejects the application, I understand that the City shall provide no assistance for this project.
By my/our own signature(s), I/we acknowledge receipt of, have read, and understand the City’s Sidewalk Repair Assistance Program and I/we agree to abide by the terms of the policy, the, and applicable City codes.
I/we, the undersigned, do hereby swear under penalty of perjury that all information contained on the application is true and correct to the best of my knowledge and belief.
Appl
icant Signature
________
____________________ Date: __________________
Co-Applicant Signature (if applicable)
________
____________________ Date: __________________
APPLICATION FOR
NO-FEE ENCROACHMENT
PERMIT APPLICATION FORM
Sidewalk Repair Assistance Program Application
PROPERTY IDENTIFICATION
Property Address:
Description of Work:
PROPERTY OWNER INFORMATION
Name: Tel:
Address: Email:
City: State: Zip:
ENGINEER INFORMATION
Name: Tel:
Address: Email:
City: State: Zip:
Eng. License No.: City Business License No.:
CONTRACTOR INFORMATION
Name: Tel:
Address: Email:
City: State: Zip:
Contractor’s State Lic. No.: City Business License No.:
REQUIRED SUBMISSIONS Office Use Only
Drawings 1st Sub 2nd Sub 3rdd Sub Approved Fee Due Fee Paid
Grading Plan Check - 3 Sets
Hydrology Report - 2 Sets
PM10 Package - Signed Set
FEMA Package – Signed Set
Fire Department Approval - 2 Sets
Retaining Wall Design & Details - 3 Sets
Engineer’s Estimate of Work - 2 Sets
Grading Permit
Encroachment Permit
Encroachment Permit Plot Plan
Other -
Lot: Tract: APN: Flood Zone:
R/W/Parkway: Drive Width LF: Sidewalk LF:
Lot Size: Cut (CY): Fill (CY):
Bldg PC #: B-Perm#: G-Perm#: E-Perm#:
Applicant’s Signature: Tel:
Email:
Date: