EXHIBIT 1
CITY OF GLENDALE
PUBLIC WORKS ENGINEERING
APPLICATION AND PERMIT FOR ENCROACHMENT
Date:
Encroachment Permit No.
Receipt No. of Non-Refundable Permit Fee:
Applicant:
Address:
Phone:
Location of Encroachment ____ ____________________________________________ Name and Address of owner of adjacent real property benefited by the encroachment:
Legal Description of adjacent real property:
Applicant shall provide 1 electronic copy of plan of the proposed encroachment.
Specific description and justification for encroachment:
Applicant agrees to satisfy all conditions attached hereto and to remove said structure upon revocation of this permit at no cost to the City of Glendale.
Approved:
Date Yazdan T. Emrani, P. E.
Director of Public Works
Non-Refundable
Fee: $1903.00
Extenet Systems, LLC.
300 E Magnolia Blvd, Ste. 400, Burbank, CA 91502
682-351-3335
Please see attached sheet for detailed scope of work.
This site will be a part of Verizon's 5G network.
Public Right of Way
01/31/2023
FRONT OF 1544 W KENNETH RD. (APN: 5622-027-018)
34° 10' 26.48" N 118° 16' 57.06" W
TRACT NO 4203 SE 55 FT OF NE 130 FT OF LOT 42
EP-823
Clerk
Rec
eipt Date
Receipt Time
Paid By:
Comment:
Receipt Number
City of Glendale, CA
Charge Code AmountDescription
Reference 1: Reference 2:
Reference 1: Reference 2:
Payment Method Reference AmountQuantity
Amount Tendered
Amount Applied
Change
Public Works Department
633 E. Broad
way
Room 209
Glendale, CA 91206
818-548-3945
Receipt
Patino, Adrian
03/06/2023
03:21:43
Extenet, Inc.
(951)453-4194
278944
ENC Encroachment
EP 821-825 $9,515.00
CCFR10 Credit Card Fee Recovery $237.87
Credit Card
Extenet, Inc.
1 $9,515.00
Cc Fee
Extenet, Inc.
1 $237.87
$9,752.87
$9,752.87
$0.00
CITY OF GLENDALE, CALIFORNIA 633 E. Broadway, Suite 201 Public Works Department Glendale, CA 91206-4310
Administration Division Tel (818) 548-3945 Fax (818) 242-7087 www.glendaleca.gov
May 2022
City of Glendale WF Policy, Requirements, and Application Guidelines
WIRELESS TELECOMMUNICATIONS FACILITY
ENCROACHMENT APPLICATION FORM
An applicant for placement of a wireless facility (WF) in the rights-of-way must obtain an encroachment permit from the City by submitting simultaneously, an application for an encroachment permit (as Item 17 to this form) and providing the other information as requested in this form.
You must use this form (latest version) and follow the Director’s Policy found at:
1. https://www.glendaleca.gov/government/departments/public-works/public-meetings-and-notices
2. Public Counter (633 E. Broadway Room 205, Glendale, CA 91206)
Questions about WFs should be directed to the City Public Works Department Engineering Division by calling (818) 548- 3945, however, any effective variance to the policy, requirements, and application guidelines can only be given by the Public Works Director in writing.
INITIAL SUBMISSION
WF applications may only be submitted at in-person appointments, which may be scheduled with the City’s Public Works Engineering department by calling (818) 548-3945. Submission appointments may be scheduled Monday-Tuesday 8 a.m. – 2 p.m. and Wed. – Thursday 8 a.m. – 12 p.m.
RESUBMITTAL PROCEDURES
If the City issues a notice of incompleteness, an applicant must timely resubmit a complete application. The City may exercise any rights available to it if a resubmittal is not timely or is itself incomplete, including rejecting the application. Resubmitt als shall be made in reply to the original assigned city staff member and to TLF ([email protected] ).
FORM OF SUBMISSIONS
Each WF site requires its own application.
Initial submissions shall be named in the following convention:
[applicant name]-[numerical number]-[calendar year]
Sample: XYZCompany-01-2022
Resubmissions shall be named in the following convention:
[applicant name]-[numerical number]-[calendar year]-RESUB[#] Sample: XYZCompany-01-2022-RESUB1
May 2022
City of Glendale WF Policy, Requirements, and Application Guidelines
Initial applications and resubmissions must be submitted in a n electronic format . The electronic form and all supporting documents must be in searchable PDF format and as individual documents (not a single PDF document/file). Each individual PDF document must be named to indicate the content of the file document. For example: ‘Attachment 1 - Photo Simulations’; ‘ Attachment 14 - RF Report’ ; ‘Attachment 19 - Acoustic Analysis’, etc. are acceptable file name formats.
May 2022
City of Glendale WF Policy, Requirements, and Application Guidelines
Encroachment Permit No. ___________ [From Item 17 on Checklist] Date: __
____ Receipt No. _______
Non-Refundable Wireless Processing Fee:
App
licant: ____________________________________________________ Add
ress: _____________________________________________________ Pho
ne: _______________________________________________________ Sub
mission Name1:_____________________________________________ App
licant’s Identifier for Wireless Facility
Wir
eless Provider: _________________________________________ Coo
rdinates for Wireless Facility: ____________________________ Locati
on of Encroachment: _________________________________
Adj
acent Zone # and Description: ____________________________ Location Type: □ Preferred X Non-Preferred
1 Please see page 1 “Form of Submissions”.
Extenet Systems, LLC.
300 E Magnolia Blvd, Ste. 400, Burbank, CA 91502
682-351-3335
Verizon Wireless
Public Right of Way
EP-823
01/31/2023
34° 10' 26.48" N 118° 16' 57.06" W
R1 I - LOW DENSITY RESIDENTIAL FAR DIST I
Extenet SCL Glendale 237-01-2023
May 2022
City of Glendale WF Policy, Requirements, and Application Guidelines
APPLICATION CHECKLIST – REQUIRED MATERIALS
The applicant shall submit all of the applicable materials listed in this checklist , and in addition, to the extent not included in the list below, the information required by Glendale Municipal Code Sec. 12.08.037, esp. sections D and G.