2024-05-28_ATT7 Application Form 4604 Sepulveda Blvd — City Council Meeting Agenda, May 28, 2024

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APPLICATION FORM FOR A WIRELESS UTILITY PERMIT

TO PLACE FACILITIES IN THE PUBLIC RIGHT-OF-WAY

INSTRUCTIONS:

Persons applying for a wireless encroachment permit under the City of Culver City Municipal Code (the “Code”) for the installation and operation of wireless facilities in the public right-of-way must fill out this application form and submit two (2) physical copies (with all necessary information and documentation) and one electronic copy (with all necessary information and documentation) on a flash drive. All application materials should be submitted in person to the following location:

City of Culver City – Department of Public Works/Engineering Division 9770 Culver Blvd.

Culver City, CA 90232

Applications and resubmittals may only be submitted on Mondays and Tuesdays between 8:00 am and 4:00 pm. Please make an appointment to submit your application by calling 310-253-5600.

For additional information regarding application requirements and all other requirements, please review Chapter 11.20 and Section 11.20.065 of the Code and visit the Public Works Telecommunications Utility Permit webpage at:
www.culvercity.org/wireless. For questions, contact the Department of Public Works/Engineering Division at 310-253-5600. If your response to a question includes attachments, label the attachments with exhibit numbers that reflect the Part and Question number to which the exhibit corresponds. As examples: for information requested in Part A, Question 5.a), label the corresponding exhibit as “Exhibit A(5)(a)”; for information requested in Part C, Question 2.a).i, label the corresponding exhibit as “Exhibit C(2)(a)(i)”.

PART A: BASIC INFORMATION (ALL APPLICANTS)

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1. Contact Information

a) The applicant shall submit and maintain current at all times basic contact information set forth below. The applicant shall notify City of any changes to any of this information within fifteen (15) calendar days following any such change. This information shall include the following:

i) The identity, including name, company, address, email, and telephone number of the applicant: ________________________________________ ____________________________________________________________ ____________________________________________________________;

ii) The identity, including name, address, email, and telephone number of the owner of the proposed wireless facility, including official identification numbers and FCC certifications and, if different from the owner, the identity of the person or entity responsible for operating the proposed wireless facility: ______________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________;

iii) If the owner of the structure on which the proposed wireless facility would be installed is different than (ii) above, the identity, including name, address, email, and telephone number of the owner of the structure:
____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________;

iv) Name, address, email, and telephone number of a local contact person for emergencies: _________________________________________________ ____________________________________________________________ ____________________________________________________________.

2. Purpose of Wireless Facility
Is the proposed wireless communications facility to be used for the provision of “personal wireless services” as defined by 47 U.S.C. Section 332(c)(7)(C)(i) on a sole or comingled basis?

 No. Specify the type(s) of wireless communications services to be provided using the proposed facility: __________________________________________________.

 Yes. Specify the type(s) of personal wireless services:_____________________ ___________________________________________________________________.

Brad Ladua on behalf of Crown Castle Fiber LLC
200 Spectrum Center Drive, Suite 1700, Irvine, CA 92618 Crown Castle Fiber LLC is responsible for owning and operating the proposed wireless facility City of Culver City Engineering Department
Crown Castle 24/7 Network Operations Center (888) 632-0931 or [email protected] ■
Cellular Communications

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3. Type of Application
Please check the applicable box(es) and provide the information required below as an attachment to this Application, along with a written explanation identifying the facts relied upon to support the claimed treatment.
 Eligible Facilities Requests. Applicant asserts that the application qualifies as an “eligible facilities request” (EFR) (as defined in 47 CFR § 1.6100(b)(3), or any successor provision). Applicant shall submit the information required in the Application Requirements Part C, Section 1 below. The applicable FCC shot clock is sixty (60) days.

 Collocation – Small Cell Facility (Existing Structure). Applicant asserts that the application is being submitted for approval of a Collocation of a Small Wireless Facility, that is, the proposed facility both meets the definition of “small wireless facility” and is a “collocation” (both as defined by 47 C.F.R. § 1.6002).

Replacements of existing structures are not ““collocations”. Applicant shall submit the information required in Part B and the Application Requirements Part C, Section 3 below. The applicable FCC shot clock is sixty (60) days.

 Small Cell Facility (New Structure). Applicant asserts that the application is being submitted for approval to deploy a Small Wireless Facility (as defined by 47 C.F.R. § 1.6002(l)) involving placement of a new structure. Replacements of existing structures are considered new structures. Applicant shall submit the information required in Part B and the Application Requirements Part C, Section 3 below. The applicable FCC shot clock is ninety (90) days.

 Other Wireless Facility Expressly Permitted by State or Federal Law to be in the ROW. Applicant asserts that the application is being submitted for approval of a type of wireless services facility that applicable state or federal laws expressly permit to be in the City’s public rights-of-way. If you checked this box, please attach an explanation of the basis for your assertion, including citations to supporting law, and state what FCC shot clock you assert applies to this application, if any. Submit the information required in the Application Requirements Part C, Section 3 below. Also, complete Part B if you answered yes to Part A, Question 2.

 Permit Renewal. Applicant asserts that the application is being submitted for a renewal of an existing wireless encroachment permit or predecessor permit. If you checked this box, please submit a copy of the original permit, any prior renewals or extensions thereof, and the information required in the Application Requirements Section Part C(2) below.

Also check the following Waiver Request box if applicable to your application.

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 Waiver Request. Applicant asserts that its application includes a waiver request.

Applicant shall include a request for a waiver, as set forth in Section

11.20.065(F)(5) of the Code, and any additional information required in the Application Requirements Part C, Section 4 below. A request for waiver may be submitted at a later time if it is determined that the proposed facility, as originally submitted, will not meet the requirements and restrictions of the Code.

4. Application Fees

Applicant shall pay all applicable fees in the amounts established by the current fee schedule. In the event applicant has pre-paid all or a portion of applicable fees, please include a copy of the receipt from that transaction.

5. Franchises, Authorizations and Licenses

To have a complete application, the applicant must have: (a) authorization to use the public rights-of-way; (b) licenses to provide proposed services; and (c) authorization to use the proposed structure.

a) Does applicant have an existing franchise or other authorization to place wireless facilities in the public rights-of-way?
 No.

If no, the application will be considered incomplete.
 Yes.

If yes, explain source of applicant’s right to use the public rights-of-way and submit related documentation.

b) Has applicant obtained all applicable licenses or other authorizations to provide the services proposed in connection with the application, whether required by the Federal Communications Commission, California Public Utilities Commission, or any other agency with authority over the proposed services.  No.
 Yes.

If yes, submit related documentation such as FCC licenses or authorizations, a certificate of public convenience and necessity or a wireless identification registration (WIR) from the California Public Utilities Commission.

c) Is proposed wireless facility to be attached to a structure owned or controlled by a party other than the owner of the proposed wireless facility?  No.
 Yes.

If yes, identify the owner as one of the following:
■

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 The City.
 Other: _________________(insert name).

If you selected Other, provide a copy of the authorization or license to use the structure.

If you selected the City, select one of the following:
 I have a General Terms and Conditions master license or other agreement with the City for use of the facility. [If you check this box, provide the document.]
 I have no license or other agreement, but I am applying/have applied for one. [If you check this box, the application for a license or agreement must be provided, along with payment or proof of payment of required fees.]  I have no license or other agreement, and have not applied for a license or other agreement. By checking this box and signing below, you acknowledge and agree that the wireless encroachment permit that is the subject of this application is not a substitute for a license or other agreement to use any City facility, that such license or agreement must be separately applied for and that this wireless encroachment permit application will remain incomplete until the necessary license or other agreement has been approved by the City.

Agreed: ______________________________
PART B: PERSONAL WIRELESS SERVICES FACILITIES (RESPOND IF

APPLICABLE)

1. Based on the work proposed in connection with this project, identify any and all additional permits, approvals, or agreements (“Ancillary Permissions”) you contend must be issued (absent agreement) by the time the City must take action on this wireless application. It is the applicant’s responsibility to review Code, city policies and all state and federal regulations (including, but not limited to, FCC regulations) applicable to the deployment of this wireless facility and to thereby identify all Ancillary Permissions that will be needed before this project can be deployed. The applicant’s failure to conduct a thorough investigation and to identify all required Ancillary Permissions may be grounds for denying this application or for declaring it incomplete. For example, if the proposed wireless facility would be placed on a structure where historical review would be required, the applicant must identify the required historic review permit(s) here. Please identify all Ancillary Permissions that you contend will be required for your wireless project:

a) ___ Fiber Utility Permit
b) ___ Building Permit
c) ___ Electrical Permit

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d) ___ Traffic Control Permit
e) ___ Excavation Permit
f) ___ Historical Review Permit
g) ___ Other Permit(s). Identify: ________________

Alternatively, rather than identifying all Ancillary Permissions above, you may agree as follows by signing below: “I agree that, should this wireless application be granted, or granted subject to conditions, no work may be undertaken on the applied-for wireless facility until any required Ancillary Permissions which are not identified above have been applied for and obtained.”

Agreed: _______________________________

2. Please provide an attachment that identifies any Ancillary Permissions you identified in response to “1.” (above) and, with respect to each of those Ancillary Permissions, include the following completed checklist:
 I have the required permit. [If you check this box, attach the required permit.]  I don’t have this permit, but I am applying or have applied for one. [If you check this box, the application and all fees or proof of payment of all such fees must be provided.]
PART C: DETAILED APPLICATION REQUIREMENTS (RESPOND TO RELEVANT

SECTIONS)

The information required to be included in your application is dependent upon whether it is an eligible facilities request, a renewal of an existing permit, or any other application type. Please reference the appropriate section below for your application type to read a detailed list of its requirements. Additionally, regardless of the application type, each applicant must demonstrate their adherence to the Design and Development Standards for Wireless Facilities in the Public Rights-of-Way that are adopted by Resolution of the City Council pursuant to Chapter 11.20.065.D.1 of the Code.

1. ELIGIBLE FACILITIES REQUESTS: For an application asserted to be an eligible facilities request, the application must provide the following information:

a) Location and Zoning Information

i) Location of the project site, including the nearest registered address, the names of the two nearest cross streets, GPS coordinates, and the present zone designation of the project site.
ii) If the facility is proposed to be attached to an existing pole, provide the pole number. (To obtain a City-owned streetlight pole Facility ID number and to determine its small cell site status visit: Streetlight Inventory x
It is our understanding that no other permits will
be needed for this facility. All SOW is included in
the wireless utility permit application.

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iii) Applicant shall include signed documentation indicating that applicant is the owner or is authorized by the owner of the structure and/or property to install and operate the proposed facility.

b) Description of the Proposed Project

i) A description of the proposed facility(ies), including whether the project is a collocated facility or the replacement, removal, or modification of an existing facility.
ii) A detailed explanation as to why applicant asserts that the facility constitutes an eligible facilities request, including reference to and analysis of applicable FCC rules as they pertain to the proposed facility. iii) A list of all facilities and equipment proposed to be installed and the dimensions, weight, and manufacturer’s specifications for each. iv) A description of the concealment elements, if any, associated with the facilities as they will be modified, including but not limited to painting, and shielding as modified. The showing should be sufficient to demonstrate that the modifications will not defeat any existing concealment elements.

If there will be no concealment elements, so state.
v) A description of any ground disturbance necessary to complete the proposed project.
vi) A description of the site and any deployment outside the site necessary to complete the proposed project.
vii) If a collocation, a description of why this installation qualifies as a collocation within the meaning of the FCC rules.
viii) A description of all changes made to the facility from the date of the original installation (whether or not approved) and a description of the changes in height since January 22, 2012.
ix) A description of all changes to be made to the existing base station and/or tower, including, among other things, identifying precisely what changes will be made to the supporting structure.

c) Prior Approvals/Permits

i) A copy of all approvals and/or permits for the tower or base station that is to be modified, and any subsequent modification approvals and/or permits, and of any required conditions (imposed by the City and/or third party) placed on the initial or subsequent approvals and/or permits. ii) A showing that the facility, as modified, will be in compliance with existing conditions of the underlying approval(s)/permit(s), whether or not it is in compliance with conditions as of the date of application. There must be a plan submitted for correction of any non-compliant condition.

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d) Site Plan

i) Three (3) copies of a facility site plan, at a scale of 1”=20’ or larger, and including the following:
(1) A north-pointing arrow on each plan sheet;
(2) Title block with applicant’s name, owner’s name, and contact information;
(3) Depiction of the fully-constructed proposed facility; (4) Location of lot lines, streets (with street names), easements, and all structures and improvements, including accessory equipment, underground utilities and support structures, existing and proposed; (5) Existing and proposed elevations of all facilities, equipment, support structures, appurtenances, and other related structures; (6) Slopes, contours, trees and other pertinent physical features of the site, existing and proposed;
(7) All exterior lighting on the site, existing and proposed; (8) As to the nearest structure located on any properties abutting the site on which you are proposing to install your wireless facility, the location and use of that structure as well as the distance from that structure to the property line of the site on which you are proposing to install your wireless facility; and
(9) The location of parking for maintenance personnel.

e) Site Photograph(s)

i) Current color photographs of the site and its surroundings.

f) Visual Impact Analysis

g) Noise

i) Operation of wireless facilities shall comply with the noise regulations set in Chapters 9.04 and 9.07 of the Code and the noise element of the General Plan. Demonstrate compliance by providing, among other relevant information, a description of the facilities and/or equipment within the applicant’s project that are expected to induce or generate noise, as well as anticipated noise levels of said facilities and/or equipment. For facilities that generate noise, please provide testing data for noise assuming maximum facility utilization and operational utilization (worst Version August 26, 2019 Page 9 of 18

case) 10 feet from the source. Specify times and conditions during which noise generation will occur.

h) FCC Radio Frequency Standards

i) A report signed by a California licensed professional engineer, with expertise in radio communications facilities and the calculation of radio frequency emissions, that affirms, under penalty of perjury, that the proposed installation will be compliant with the FCC’s standards. The report must also contain the following:
(1) A description of each of the proposed antennas and all related fixtures, structures, appurtenances and apparatus, including the height above grade, volume in total cubic feet, materials, lighting, and the directionality of each antenna (e.g., omni, directional, etc.); (2) The frequency, modulation and class of service;
(3) A clear identification of areas, both vertically and horizontally, where exposure levels will exceed FCC standards for general public and occupational exposures. Please note that applicant’s analysis must show that it has appropriately taken cumulative exposures into account, and should show exposures based on “worst case” scenarios;
(4) A certification that the facility will comply with all applicable standards for radio frequency emissions, including cumulative effects, and a description of the manner in which the radio frequency emissions for the facility were calculated and the results of those calculations. Individual and cumulative emissions should be evaluated; and
(5) If the certification of the facility as currently installed, or as proposed to be modified, is subject to conditions designed to limit general public or occupational exposure, identify those conditions, and demonstrate that they have been satisfied, or describe when they will be satisfied.

i) Structural Analysis

with applicable laws and codes; 3) the structure’s capacity for additional collocated antennas; 4) the precise point at which the antennas shall be mounted; and
(3) A certification that the structure(s) on which the wireless facility (including all accessory equipment, such as radios, cabinets, etc.) will be placed can safely support the wireless facility; and that all elements of the wireless facility comply with applicable safety standards, including, without limitation, GO 95, 165, and 166.

j) Notice

i) Evidence that notice has been given consistent with Attachment 1 to all necessary parties.

2. RENEWAL REQUESTS: For a renewal of an existing permit, the application must provide the following information:

a) Location and Zoning Information

i) Location of the project site, including the nearest registered address, the names of the two nearest cross streets, GPS coordinates, and the current zone designation of the project site.
ii) If the existing facility is attached to a pole, provide the pole number. (To obtain a City-owned streetlight pole Facility ID number and to determine its small cell site status visit: Streetlight Inventory iii) Applicant shall include signed documentation indicating that applicant is authorized by the owner of the support structure and/or real property to continue operating the facility.

b) Description of the Project for Renewal

i) A description of the existing facility(ies).
ii) A list of all facilities and equipment currently installed and the dimensions, weight, and manufacturer’s specifications for each.
iii) A written description of the concealment measures applicant is using to aesthetically blend the facility to the immediate surroundings and to minimize its visual impact. This should include, but not be limited to, a description of concealment techniques, sizing and placement of elements of the facility (including undergrounding), measures to limit visibility of the facility from residential dwelling units, and the textures and colors used in the concealment process. If none, so state.
iv) A description of the site and any deployment outside the site. v) A description of all changes made to the facility from the date of the original installation (whether or not approved) and a description of the changes in height since January 22, 2012.

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c) Prior Approvals/Permits

i) A copy of all approvals and/or permits for the tower or base station and any subsequent modification approvals and/or permits, and of any required conditions (imposed by the City and/or third party) placed on the initial or subsequent approvals and/or permits.
ii) A showing that the facility is in compliance with existing conditions of the underlying approval(s)/permit(s). If the facility is not in compliance with conditions as of the date of application, there must be a plan submitted for correction of any non-compliance condition.

d) Facility Plan and Photograph(s)

i) Three (3) copies of the existing facility plan at a scale of 1”=20’ or larger and including a north-pointing arrow on each sheet and title block with applicant’s name, owner’s name, and contact information. ii) Current color photographs of the facility and its surroundings.

e) Visual Impact Analysis

i) A visual impact analysis, which shall include photographs, demonstrating from all four primary directions (north, south, east, and west) the visual impacts of the existing facility. Consideration shall be given to views from public areas as well as from private property.

f) Noise

i) Operation of wireless facilities shall comply with the noise regulations set in Chapters 9.04 and 9.07 of the Code and the noise element of the General Plan. Demonstrate continued compliance by providing, among other relevant information, a description of the facilities and/or equipment within the applicant’s project that induce or generate noise, as well as the noise levels of said facilities and/or equipment. For facilities that generate noise, please provide testing data for noise assuming maximum facility utilization and operational utilization (worst case) 10 feet from the source.

Specify times and conditions during which noise generation will occur.

g) FCC Radio Frequency Standards

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(1) A description of each of the antennas and all related fixtures, structures, appurtenances and apparatus, including the height above grade, volume in total cubic feet, materials, lighting, and the directionality of each antenna (e.g., omni, directional, etc.); (2) The frequency, modulation and class of service;
(3) A clear identification of areas, both vertically and horizontally, where exposure levels exceed FCC standards for general public and occupational exposures. Please note that applicant’s analysis must show that it has appropriately taken cumulative exposures into account, and should show exposures based on “worst case” scenarios;
(4) A certification that the facility is in compliance with all applicable standards for radio frequency emissions, including cumulative effects, and a description of the manner in which the radio frequency emissions for the facility were calculated and the results of those calculations. Individual and cumulative emissions should be evaluated; and
(5) If the certification of the facility as currently installed is subject to conditions designed to limit general public or occupational exposure, identify those conditions, and demonstrate that they have been satisfied, or describe when they will be satisfied.

h) Structural Analysis

i) A report signed by a California licensed professional engineer qualified in structural engineering, containing the following:
(1) In the case of a wireless facility attached to existing infrastructure, documentation of the ability of the structure to continue to support the antennas and any required maintenance;
(2) In the case of a facility with a support structure (e.g. monopole), documentation that the structure is capable of continuing to support the antennas (and any other equipment attached to or supported by the support structure) and complies with applicable laws and codes, as well as the structure’s capacity for additional collocated antennas; and
(3) A certification that the structure(s) on which the wireless facility (including all accessory equipment, such as radios, cabinets, etc.) is placed can continue to safely support the wireless facility; and that all elements of the wireless facility comply with applicable safety standards, including, without limitation, GO 95, 165, and 166.

i) Notice

i) Evidence that notice has been given consistent with Attachment 1 to all necessary parties.

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3. ALL OTHER APPLICATIONS: For all other types of applications, the following must be provided:

a) Location and Zoning Information

i) Location of the project site, including the nearest registered address, the names of the two nearest cross streets, GPS coordinates, and the present zone designation of the project site.
ii) If the facility is proposed to be attached to an existing utility pole, provide the pole number. (To obtain a City-owned streetlight pole Facility ID number and to determine its small cell site status visit: Streetlight Inventory
iii) Applicant shall include signed documentation indicating that applicant is authorized by the owner of the support structure and/or real property to install and operate the proposed facility.

b) Description of the Proposed Project

i) A description of the proposed facility(ies), including whether the project is a new facility, a collocated facility, or a modification to an existing facility. ii) If the application is for a small cell facility, an explanation asserting all of the grounds why the proposed facility constitutes a small cell facility. iii) If a new facility, the applicant shall include an explanation of whether the new facility could and will be designed to accommodate future wireless facilities.
iv) A list of all facilities and equipment proposed to be installed and the dimensions, weight, and manufacturer’s specifications for each. v) A written description of the concealment measures applicant proposes to use to aesthetically blend the facility to the immediate surroundings and to minimize its visual impact. This should include, but not be limited to, a description of proposed concealment techniques, sizing and placement of elements of the facility (including undergrounding proposed), measures proposed to limit visibility of the facility from residential dwelling units, and the textures and colors to be used in the concealment process. If none, so state.
vi) A description of any ground disturbance necessary to complete the proposed project.
vii) A description of the site and any deployment outside the site necessary to complete the proposed project.
viii)If a collocation, a description of why this installation qualifies as a collocation within the meaning of the FCC rules. Applicant must also provide the following:
(1) A description of all installation procedures and plans for the facility; and
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(2) A description of all changes to be made to the existing structure, which description will, among other things, identify precisely what changes will be made to the supporting structure.

c) Prior Approvals/Permits

i) If a wireless facility already exists on the site, provide the following:
(1) A copy of all approvals and/or permits for the tower or base station that is to be modified, and any subsequent modification approvals and/or permits, and of any required conditions (imposed by the City and/or third party) placed on the initial or subsequent approvals and/or permits.
(2) A showing that the facility, as modified, will be in compliance with existing conditions, whether or not it is in compliance with conditions as of the date of application. There must be a plan submitted for correction of any non-compliant condition.

d) Site Plan

i) Three (3) copies of a facility site plan at a scale of 1”=20’ or larger and including the following:
(1) A north-pointing arrow on each plan sheet;
(2) Title block with applicant’s name, owner’s name, and contact information;
(3) Depiction of the fully-constructed proposed facility; (4) Location of lot lines, streets (with street names), easements, and all structures and improvements, including accessory equipment, underground utilities and support structures, existing and proposed; (5) Existing and proposed elevations of all facilities, equipment, support structures, appurtenances, and other related structures (6) Slopes, contours, trees and other pertinent physical features of the site, existing and proposed;
(7) All exterior lighting on the site, existing and proposed; (8) Location use and approximate distance from property lines of the nearest structures on all properties abutting the site; and (9) The location of parking for maintenance personnel.

e) Landscape Plan

i) If any landscaped ground will be disturbed, three (3) copies of a landscape plan for the site, at a scale of 1/8”=1’ or larger, and including the following:
(1) Existing trees within fifty feet (50’) of the proposed wireless communication facility;
(2) Species, diameter and condition of all such trees;
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(3) Final disposition of all existing trees; and
(4) Species, location and sizes of trees and other vegetation proposed to be installed in conjunction with the wireless communication facility.

f) Site Photograph(s)

i) Current color photographs of the site and its surroundings.

g) Visual Impact Analysis

i) A visual impact analysis, which shall include photomontage, photo simulation or similar technique, demonstrating, from all four primary directions (north, south, east, and west) the potential visual impacts of the proposed facility. Consideration shall be given to views from public areas as well as from private property. The analysis shall assess the cumulative impacts of the proposed wireless communication facility and other existing wireless facilities in the area, and shall identify and include all feasible mitigation measures consistent with the technological requirements of the proposed facility.

h) Noise

i) FCC Radio Frequency Standards

i) A report signed by a California licensed professional engineer with expertise in radio communications facilities and the calculation of radio frequency emissions that affirms, under penalty of perjury, that the proposed installation will be compliant with the FCC’s standards. The report must also contain the following:
(1) A description of each of the proposed antennas and all related fixtures, structures, appurtenances and apparatus, including the height above grade, volume in total cubic feet, materials, lighting, and the directionality of each antenna (e.g., omni, directional, etc.); Version August 26, 2019 Page 16 of 18

(2) The frequency, modulation and class of service;
(3) A clear identification of areas, both vertically and horizontally, where exposure levels will exceed FCC standards for general public and occupational exposures. Please note that applicant’s analysis must show that it has appropriately taken cumulative exposures into account, and should show exposures based on “worst case” scenarios;
(4) A certification that the facility will comply with all applicable standards for radio frequency emissions, including cumulative effects, and a description of the manner in which the radio frequency emissions for the facility were calculated and the results of those calculations. Individual and cumulative emissions should be evaluated; and
(5) If the certification of the facility as currently installed, or as proposed to be modified, is subject to conditions designed to limit general public or occupational exposure, identify those conditions, and demonstrate that they have been satisfied, or describe when they will be satisfied.

j) Structural Analysis

i) A report signed by a California licensed professional engineer qualified in structural engineering, containing the following:
(1) In the case of a wireless facility attached to existing infrastructure, documentation of the ability of the structure to support the antennas, the proposed method of affixing the antennas and the precise point at which the antennas shall be mounted;
(2) In the case of a facility with a support structure (e.g. monopole), documentation that the structure is capable of supporting the antennas (and any other equipment to be attached to or supported by the support structure) and complies with applicable laws and codes, as well as the structure’s capacity for additional collocated antennas, and the precise point at which the antennas shall be mounted; and
(3) A certification that the structure(s) on which the wireless facility (including all accessory equipment, such as radios, cabinets, etc.) will be placed can safely support the wireless facility; and that all elements of the wireless facility comply with applicable safety standards, including, without limitation, GO 95, 165, and 166.

k) Notice

i) Evidence that notice has been given consistent with Attachment 1 to all necessary parties.

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l) Justification for Location/Collocation

i) A justification as to why the applicant chose the location for the proposed wireless communication facility. Such justification shall include a written assessment of not less than two (2) alternative locations considered by the applicant and the reasons why said alternative locations were rejected as candidates.
ii) A written explanation of the applicant’s investigation into collocating the proposed facility with an existing facility. Indicate whether collocation is or is not feasible and why.

m) Map of Applicant’s Existing Wireless Facilities and Coverage Assessment

i) A map and narrative description of all existing wireless facility sites used by the applicant which are located within the City, and any wireless facility sites located outside of the City but which provide coverage within any part of the City.

4. WAIVER REQUEST [if applicable]

a) If it is contended that the City is required by federal or state law to approve the facility, applicant must submit the information it relies upon to support that claim, identifying: (i) the legal standard it claims applies; (ii) the showings it relies upon for its claim; (iii) alternative legal standards that may apply that it claims to meet; and (iv) the showings it relies upon for those claims. Applicants are cautioned that, should they choose not to submit with respect to items (iii) and (iv), and the City believes that applicant misapplies or relies on the wrong legal standard, the waiver (and consequently the application) may be denied.

PART D: CERTIFICATION (ALL APPLICANTS)

I (we) hereby certify under penalty of perjury that (1) after diligent investigation, the information provided pursuant to this Application Form is true, accurate, and complete to the best of my (our) knowledge and belief; and (2) upon completion of the work proposed, the permitted personal wireless services facility will comply with all applicable laws, regulation, practices or other requirements under federal, state, or local law, including, but not limited to, building and electrical codes, the FCC’s radio frequency emissions standards, and the requirements of the Americans with Disabilities Act.

________________________________________________
Applicant’s Signature Date

___________________________
Applicant’s Printed Name
Brad Ladua
Digitally signed by Brad Ladua
Date: 2023.12.04 09:14:30 -08'00'
Brad Ladua
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Attachment 1

All applicants for Wireless Encroachment Permits shall comply with the following notice requirements:

1. Notice of the applicant’s pending application shall be mailed, by the applicant to the businesses and residences within a 500 foot radius of each of the proposed wireless facilities.

2. The contents of the mailed notice shall include, at a minimum:
a. A description of the location of each proposed wireless facility with sufficient specificity to allow notice recipients to be able to locate the involved location without requiring any additional information
b. Photo simulations of the proposed installation
c. The manner in which additional information may be obtained d. Any other information deemed necessary by the Director of Public Works or his/her designee

3. The applicant shall also post the notice in compliance with the following specifications:
a. In a conspicuous place at the location of the proposed wireless facility b. Be 12 square feet in sign area
c. A minimum of 4 feet in height from the ground level with a maximum height of 8 feet
d. Not be illuminated
e. Include the name and telephone number of the applicant f. Include the telephone number of the Public Works Department g. Contain only lettering whose size, style and color have been approved by the Director of Public Works
h. Include photo simulations of the proposed wireless facility i. Remain in place until completion of construction and final approval by the City j. Be removed, by the applicant, no later than 10 days after completion of construction and final approval of the project by Culver City

4. Submit to the Director of Public Works an affidavit verifying that the applicant has mailed and posted notices in full compliance with these notice requirements.

City Council Meeting AgendaMay 28, 2024

City Council Meeting Agenda
May 28, 2024