Fillable Wireless Communication Facility Supplemental Permit Application and Applicant's (City of Lake Forest)

Fill Online, Printable, Fillable, Blank Wireless Communication Facility Supplemental Permit Application and Applicant's (City of Lake Forest) Form

Use Fill to complete blank online CITY OF LAKE FOREST (CA) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Wireless Communication Facility Supplemental Permit Application and Applicant's (City of Lake Forest)

On average this form takes 11 minutes to complete

The Wireless Communication Facility Supplemental Permit Application and Applicant's (City of Lake Forest) form is 8 pages long and contains:

  • 0 signatures
  • 43 check-boxes
  • 24 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Lake Forest

BROWSE CITY OF LAKE FOREST (CA) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Wireless Communication
Facility Supplemental Permit
Application and Applicant's
Guide
55136.00750\29446648.1 1
A permit is required for all facilities for the provision of wireless communication services.
Applicant’s for a Wireless Communication Facility (“WCF”) permit must complete and
submit this application with attached exhibits, in addition to any entitlement application
required pursuant to Lake Forest Municipal Code (LFMC) Chapter 9.162, and all
documentation requested thereunder.
Submit all application materials to the following location:
City of Lake Forest
Development Services Department
25550 Commercentre Drive, Ste. 100
Lake Forest, CA 92630
Appointments are available during business hours
(http://www.lakeforestca.gov/454/City-
Hours). Please call (949) 461-3491 to set up an appointment.
Complete the following application in its entirety. All written responses to the questions
below must be clear and legible. Several questions require you to attach supplemental
documentation and commentary to support your answers. All exhibits must be marked
as directed in the application. All supporting documentation must be clear and legible.
All exhibits must be stapled or bound to the application or properly ordered if the
application is submitted electronically.
In addition to a complete application(s) and public noticing requirements pursuant to
LFMC 7.34.040, WCF applicants must provide twenty (20) days advance written notice
to the City of an upcoming “shot clock” expiration date to provide the City with a final
opportunity to approve or deny the application before it is deemed approved.
55136.00750\29446648.1 1
Wireless Communication Facility Permit Application
Received: Initials_____ Date___________
1. Property address (or, if multiple locations are involved, attach list of each
location):_________________________________________________________
2. Assessor’s Parcel No(s): ____________________________________________
3. Applicable homeowner’s/business association:
________________________________________________________________
4. Contact information:________________________________________________
a. Wireless provider or operator:
Company Name:
Contact Person:
Street Address:
City, State & Zip:
Phone No.:
Email:
b. Applicant/Primary Contact:
Name:
Street Address:
City, State & Zip:
Phone No.:
Email:
Your property interest in the proposed location:
☐Lease ☐License ☐Ownership ☐Other:________________________
I. Contact Information
55136.00750\29446648.1 2
II. Application Type
For numbers 1 – 2 below, provide a description supporting your selections.
Attach all rules, regulations, agreements, court documents, or other materials on
which you base your response. Attach a description and supporting
documentation marked as Exhibit A.
1. Check the box(es) below that identify the statute(s) you believe govern(s) the
application request:
☐ Section 6409(a) of the Middle Class Tax and Job Creation Act of 2012 for
collocation or modification to an existing commission-authorized Wireless
Communications service
☐ Section 332(c)(7) of the Communications Act for the provision of personal
wireless communications facilities
☐ California Government Code Section 65964.1 (AB-57)
2. Check the box below pertaining to the shot clock you believe applies to your
application:
☐ 150 day shot clock for new facilities
☐ 90 day shot clock for modifications resulting in a substantial change
☐ 60 days shot clock for modifications that do not result in a substantial change
3. List below the application or permit numbers of all pending applications and
permits issued by the City to applicant (or a related company) which relate
directly or indirectly to this application. Include the date such permits were filed
and issued. Include attachments if necessary as Exhibit B.
i.
ii.
iii.
III. Description of Project Coverage and Purpose
1. Provide a narrative description of the project. Your response shall include, but
not be limited to, a description of the proposed facility or modification, the
anticipated construction activities involved, schedule for the same, the
maintenance requirements, and the number of antennas to be installed. Provide
any supporting documentation regarding the purpose of the project. Attach and
mark responses and documentation as Exhibit C1.
2. Check the box below that most accurately identifies the primary purpose of the
project:
☐Increase network capacity without adding new radio frequency coverage
☐ Provide significant new radio frequency coverage in areas without radio
frequency coverage
55136.00750\29446648.1 3
☐ Increase existing radio frequency coverage in area with coverage
☐ Other: _____________________________________________
3. Will the facilities proposed to be installed by the applicant be used for:
☐ Cable television or video entertainment services
☐ An Open Video System under FCC rules
☐ Any service not authorized by Applicant’s California Public Utilities
Commission Certificate
☐ None of the above
4. Provide a description identifying the geographic service area for the proposed
installation. Attach and mark as Exhibit C2.
IV. Project Location and Authorizations
1. If the facility will be sited in the Public Right-of-Way (“PROW”), state or provide
the following:
a. Your authority to locate the facility in the PROW (state law, federal law, or
franchise agreement); Attach and mark as Exhibit D1a.
b. If applicable, include a copy of the certificate of public convenience and
necessity (CPCN). Attach and mark as Exhibit D1b;
c. Whether a new pole (that is not replacing an existing pole) in an otherwise
permitted location is proposed. If so, provide a new pole justification
analysis to demonstrate why existing infrastructure cannot be utilized and
how the new pole is the least intrusive means possible. Attach and mark
as Exhibit D1c.
2. If the facility will be co-located on a structure owned by someone other than the
owner of the proposed installation, provide written authorization by any and all
property owners authorizing the placement of the facility on or in the property
owner’s property. Attach and mark as Exhibit D2.
3. If applicable, provide the following letter(s) of authorization to collocate, modify,
or provide services:
a. If the applicant is an agent, provide a letter of authorization from the owner
of the facility. Attach and mark as Exhibit D3a.
b. If the owner will not directly provide wireless communications services,
provide a letter of authorization from the person or entity that will provide
those services. Attach and mark as Exhibit D3b.
4. Are you willing to share facilities with another service provider? If so, provide a
description of your willingness to share facilities. Specify whether (1) you would
be willing to share an available conduit, fiber strands in a fiber cable, splice
boxes, or trenching costs in a joint construction project; (2) you reviewed pending
applications or recently granted permits in the City for opportunities to share
facilities. Attach and mark as Exhibit D4.
55136.00750\29446648.1 4
5. In areas where it would minimize the impact on residents and business, will you
be using directional boring? If not, why not. Attach and mark as Exhibit D5.
V. Radio Frequency (“RF”) Emissions and Monitoring Requirements
1. Provide proof or certification of completion of the RF emissions exposure
guidelines checklist contained in Appendix A to the Federal Communications
Commission’s (“FCC”) “Local Government Official’s Guide to Transmitting
Antenna RF Emission Safety”. Attach and mark as Exhibit E. The Guide can
be found at: http://wireless.fcc.gov/siting/FCC_LSGAC_RF_Guide.pdf .
2. Pursuant to the completed checklist referenced above, will the facility be
“categorically excluded” under the FCC regulations for RF emissions?
☐ Yes
☐ No
If you selected “No” above, provide a technically detailed report certified by a
qualified radio frequency engineer indicating the following:
a. The amount of RF emissions expected from the proposed facility;
b. The associated accessory equipment required;
c. The cumulative impacts of the other existing facilities at the site to the
extent permitted by federal law, including co-located facilities;
d. That the proposed facility individually or combined with the cumulative
emissions of on-site facilities will not exceed applicable standards set by
the FCC.
VI. Other Requirements
1. All other documentation certifying that all applicable licenses or other approvals
required by the FCC have been obtained to provide the services proposed in
connection with the application. Attach and mark as Exhibit F1.
2. If applicable, copies of all documents the applicant is required to file pursuant to
the Federal Aviation Administration regulations for the facility. Attach and mark
as Exhibit F2.
3. All other documentation required by the LFMC. Attach and mark as Exhibit F3.
VII. Exceptions to the Application Requirements
1. Do you believe you are entitled to an exception to the requirement(s) of this
application or the LFMC?
☐ Yes
☐ No
2. If you selected “Yes” above, provide all information and studies necessary for the
City to evaluate a request for an exception to the requirements of this application.
55136.00750\29446648.1 5
The narrative must demonstrate with clear and convincing evidence that denial of
the facility would violate state and/or federal law, violate any applicable provision
of the Lake Forest Municipal Code or deprive the applicant of its rights under
state and/or federal law. Attach and mark as Exhibit G.
VIII. Supplemental Materials for Projects Subject to 6409
1. You must complete this section if you selected the box in Section II titled “Application
Type” that indicates your project is subject to 6409. For parts (1) – (6), provide a
narrative description and any supporting documentation for the selections you make
below. Attach and mark as Exhibit H.
a. Is the application a request to permit an eligible facility (Class 7 as defined in
LFMC Sec. 9.162.040)?
☐ Yes
☐ No
b. Will the proposed project cause a substantial change in the physical dimension of
the structure? If yes, provide a written explanation of the changes and include in
Exhibit H.
☐ Yes
☐ No
c. Does the structure at issue involve an existing wireless tower or base station?
☐ Yes
☐ No
d. Check the box(es) below that are applicable to your project:
☐ Installation of new transmission equipment
☐ Removal of transmission equipment
☐ Replacement of transmission equipment
e. If your project does not involve excavation, tower or base station installation, or
tower or base station modification in the PROW, answer the following questions:
i. Does the project exceed the overall height of the structure on which it is
mounted by more than ten (10) feet?
ii. Will the project require excavation near the ground-mounted equipment?
iii. Will the project preserve all existing concealment elements of the current
tower or base station?
iv. Will the proposed collocation preserve all prior conditions of approval that
do not conflict with FCC regulations for a substantial change?
v. Does the project propose adding four or fewer additional equipment
cabinets?
55136.00750\29446648.1 6
f. If your project involves excavation, tower or base station installation, or tower or
base station modification in the PROW, answer the following questions:
i. Does the project propose a height increase wherein antennas exceed the
height of the City-standard signal pole, light standard or other apparatus to
which they are attached by more than six (6) feet?
☐ Yes
☐ No
ii. Does the project propose a width increase of less than 6 feet?
☐ Yes
☐ No
iii. Does the project propose excavation entirely within the anticipated lease area
of private property?
☐ Yes
☐ No
iv. Will the project preserve all existing concealment elements of the current
tower or base station?
☐ Yes
☐ No
v. Will the proposed collocation preserve all prior conditions of approval that do
not conflict with FCC regulations for a substantial change?
☐ Yes
☐ No
vi. Does the project propose adding four or fewer additional equipment cabinets?
☐ Yes
☐ No
55136.00750\29446648.1 7
IX. Certification
Applicant understands and agrees that no permit or approval may be issued until
Applicant has the legal right to use the Subject Property. Applicant agrees to comply
with the City’s land use and planning process (including public notification) for all
installations including but not limited to structures or facilities to be placed in or
adjacent to the City’s PROW. In the event Applicant is seeking to place facilities on
City-owned property, City will require a license agreement prior to the placement of
any facilities unless Applicant is exempt from such requirement under LFMC section
9.162.050(D)(8). Any necessary license agreement is entirely outside of City’s
regulatory process and is solely granted or denied in the City’s capacity as a
property owner. The applicant further agrees to provide all necessary information
requested by the City including required documentation to conduct applicable CEQA
review.
Signed under penalty of perjury, this _____ day of ___________________ , 201__.
Applicant/ Company Name:
Printed Name of Authorized Representative:
Signature of Authorized Representative:
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Wireless Communication Facility Supplemental Permit Application and Applicant's (City of Lake Forest)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 3 August 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document