PUBLIC WORKS DEPARTMENT – ENGINEERING DIVISION
9770 Culver Blvd., 2ND
Floor
Culver City, CA 90232
(310) 253-5600
APPLICATION FOR STREET USE (SU) PERMIT
Sidewalk Driveway Approach Street Paving (AC/PCC
PERMIT SUB-TYPE
JOB ADDRESS: ___________________________________ Building Permit #: ______________________ LOCATION: ____________________________________________________________________________ )
Driveway Curb Ramp Parkway Landscaping
Curb and/or Gutter Alley Intersection Other:
Parkway Drain/Curb Drain
Metered Non-Metered
ADDITIONAL:
APPLICANT:
Parking Space Rental Required WORKING DAYS (Required):
Rev. Aug. 2020 Page 1
Name: __________________________________________________________________________________ Mailing Address:
________________________________City/Zip: ___________________________________ Contact Phone
#: ___________________________Email: _____________________________________ ___ CONTRACTOR:
Name: __________________________________________________________________________________ Address: _____________________________________________________ State License: _______________ Contact Phone #: ___________________________Email: _______________________________________ Contractor's State License Number/Type: _____________________________________________________ PROPERTY OWNER:
Name: _________________________________________________________________________________ Address: ____________________________
________ City / Zip: ____ ______________________________ Contact Phone
#: ___________________________Email: _______________________________________ PURPOSE OF PROJECT:
APPLICATION DATE:
DATE RECEIVED BY STAFF:
Rev. Aug. 2020 Page 2
PROVIDE SITE PLAN, FULLY DIMENSIONED, AND PHOTOGRAPHS OF EXISTING CONDITIONS.
Include all streetlights, water/gas utility pull box(es), vaults, manholes, street trees, fire hydrants, traffic signals, sidewalk, curb, gutter, etc. on Site Plan.
• Concrete mix for all improvements along public right-of-way shall be 560-C-3250. • Unless otherwise noted, all work shall be performed in accordance with the current edition of the Standard Specifications for Public Works Construction, and any amendments thereto, other City standards, and to the satisfaction of the Public Works Director/City Engineer, or his/her designee.
LIGHTING PATTERN
PRODUCT A - 4” SMALL GLOBES
QUICK FACTS:
• RGB+ (FULL COLOR SPECTRUM + COOL WHITE + WARM WHITE)
• BLACK WIRE
• 4” SQUARE
• 1-FT APART
• .25 AMPS PER GLOBE
• IP65 RATED (WATERPROOF)
• UL
• UV PROTECTED (SHELLS WON’T YELLOW)
• MADE TO ORDER, CUSTOM