Eligible Facility Request - Sprint - 2018~ I~A'1'E flZECEIVED
(City Date Stamp)
JAN 0 5 2018
CIiY OF C,4NiP8ELL
Pl_:~P~lNlf~1G DEPT:
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Commuluty Development Department
PI~OrECT' INTAKE
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File No• °~~"`~/°'''~~ '~J
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Checked in by:
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Project Address: ~®~ ~~~~~CSI~~ U`~~~ _., _. ./lsscssor'sParcellVunnUcr: 28$ 01 _022
At (E) cell site on PG&E tower, replace antennas, and install
General Project Description:
RRUs. In (E) equipment cabinets, install baseband unit and batteries.
1~PP.LICANT.INTQ~2I~IATIQN ........ : ... ... - • - .. .. - ............ :': ~:;;: , :~`~: ~'> _ .~ ~~ `~;{,.- ~'
_ S rint c/o Leah Hernikl ~ L 'J '~ ~ ~~` -' /~•
Naure• p ' Signature (see ac:Knonvledge:ments)~ .%/_.~•~~ /~/ -~=^'~!,~s'F'~
95003
4.10 Clubhouse Dr ~a~tC3S statelzi ~~
Address: City: p:
Phone: (408)799 1182
408 799 1182
Mobile; (__) - Email:
Ihernilcl@j5ip.com
:_°PROPCRTY~~(J~6~t!,NER;INFOIZ)aU[ATIOh1':;•::;=~= =::>>.;:::.. .... ... .. ... ...... . ... ./. .... ...... ...._ .
Narne•. ~~`°'~ Si afttre(see~aclrnowledgements):_ ,/ .. '' ~~~..~~
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Address:
City:
State/Zip:
Phone: {) - MoUilc: 4( 5).961 7Q42 n~~_ david.ney@pge.com
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Submittal of this development application and signa[ure by the Applicant anti Property Owner constitutes ackuo~vledgment of the
following by all !ru•ties: (1) '!'hat tine information sidimitted with this application is true and accl~rate to fire best of my l.~noivledge azrd
belief. I understand that the Ciry is not responsible for inaccuracies in information presented, and that inaccuracies may invalidate any
approval or clearance granted; (Z)11ie project Site is ttotincluded on the fL~zardous Wastes and Substances Sites List pursuant to Cal. Gov.
Code §65962.5; (3) A vested right to a ]anti use entitlement or braiding pernut will not be conferred without additional approval by the
West'ValIey Sazrilation District; and (9) The City of Campbell is granted release to copy and reproduce electronically, in whole or in part;
drawings and all other materials submitted with this development application far the City's regulatory, administrative, azid legalfuncfions,
including sharing of information with other governmental entities and #or compliance with the Califouua public Records Act (CpftA); (5} 1t
is understood that the application is submitted'at risk`, and that applicationrnateria7s may be required to be modified, and if denied, sha)1
not be reimbursed application fees. Tf any of these statements cannoebe affirma[ively aclmowledged, please inform the planner bcjnm.
subutittinga development application.
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JAN 0 5 2018
CITY OF CAIUIPBBLL
PL~,iti~!IfelG DEPT.
CITY of CAMPBELL
Community Development Department
Eligible Facility Request Application
Applications for a wireless communications facility must be made in person by someone with authority to act on
behalf of the applicant during the planning division public counter hours. Applications and any subsequent
resubmittal that are not made in person by someone with authority to act on behalf of the applicant and during
scheduled times shall not be accepted for filing and will be returned. The staff planner who is on duty when your
application is submitted will give the application a cursory review for completeness. If any of the following items
are not provided, in full, the application will not be accepted. Further, please be advised that the submission of
materials and information, including when responding to a notice of incompleteness, must be given to the City in
one ( 'ubmittal packet.
1. Application. A fully completed and executed City application form, including Supplemental Forms A, B,
& C.
~f.
2. Application filing fees. Application fees, in a payment format accepted by the City finance department,
as may be amended from time to time.
tea. Planning Division Fees: $57.00 Zoning Clearance Fee (FY18)
(~ 3. Written statement; Type of approval sought. A written narrative describing the project in detail
(including a summary of facility equipment) and explaining why the permit qualifies as an eligible facility
i' request.
4., City-owned. If the proposed facility is to be located on a City-owned building, pole, or other structure, the
~'' application must be signed by an authorized representative of the City and accompanied by the license or
other agreement authorizing applicant's use of such City-owned property.
5: Independent consultant deposit. A fee deposit, if required, to reimburse the City for its costs to retain
an independent consultant to review the technical aspects of the application.
~~;
6. Site and construction plans. Complete and accurate plans, drawn to scale, signed, and sealed by a
California-licensed engineer, land surveyor, and/or architect, which include, at a minimum, the following:
b. Building Division Fees: Due to the complexity of permit fees for new construction, it is required
that you visit the Building Inspection & Safety Counter to determine the amount required for the
j' building permit fee.
a. Number of Plan Sets:
i. Seven (7) full-size sets (24" x 36") Must FOLD to 8 1/2" X 11" size.
1. At least two much be "wet-signed" and stamped by a State of California licensed
architect or engineer).
ii. Two (2) "wet-signed" reduced sets (11" x 17")
iii. One (1) Digital Copy of plans and associated materials on USB / CD
1. PDF Format in 24" x 36" scale / 300 dpi and 11" x 17" scale / 300 dpi
b. Minimum Details to Include on Plan Drawings:
i. A site plan and elevation drawings for the facility as existing and as proposed with all
height and width measurements explicitly stated.
ii. A depiction, with height and width measurements explicitly stated, of all existing and
proposed transmission equipment.
iii. A depiction of all existing and proposed utility runs and points of contact.
iv. A depiction of the leased or licensed. area of the site with all rights-of--way and easements
for access and utilities labeled in plan view and including legal boundaries of the leased,
licensed or owned area surrounding the proposed facility and any associated access or
utility easements.
L ' '
Eligible Facility Request Application -Submittal Requirements Overview Page 2 of 2
v. A demolition plan (if applicable).
~ > ~ 7. Prior permits. True and correct copies of all previously issued permits, including, without limitation, all
required conditions of approval. For eligible facilities requests, the application must also include a
;certification by the applicant that the proposal will not violate any previous permit or conditions of approval
~~ or why any violated permit or conditions does not prevent approval under Section 6409(a) and the FCC's
regulations implementing this federal law.
`1.0 8. FCC compliance; Affirmation of radio frequency standards compliance. An affirmation, under
penalty of perjury, that the proposed installation will be FCC compliant and will not cause members of the
general public to be exposed to RF levels that exceed the MPE levels deemed safe by the FCC. The
application shall include an RF report (or other documentation) acceptable to the City, evidencing that the
proposed facility, as well as any collocated facilities, and cumulative conditions will comply with applicable
,`' FCC standards and regulations, (including, but not limited to, federal RF exposure standards and
exposure limits). Documentation of FCC compliance shall be required for all wireless communications
facility permits, including, without limitation, permit modifications.
9. Required Licenses or Approvals. Evidence that the applicant has all current licenses and registrations
from the FCC, the CPUC, and any other applicable regulatory bodies where such license(s) or
;' registration(s) are necessary to provide wireless communication services utilizing the proposed wireless
communication facility.
10. Structural analysis. A structural analysis, prepared, signed, and sealed by aCalifornia-licensed
engineer that assesses whether the proposed wireless communications facility complies with all
applicable building codes.
~~ a. Four (4) sets in 8%z" x 11"format and "wet-signed".
11. Other permits. An application for an eligible facility request shall include all permit applications with all
required application materials for each and every separate permit required by the City including, but not
limited to, a building permit (see Attachment A) and an encroachment permit (if applicable).
12. Other information. Such other information as the City may require, as specified in publically available
materials, including, but not limited to, information required as stated on the City's website.
• ~ ,.. ~ Telecommunications US MaiC
' 1` ~ ~7~1al~ FPS c.13[t~ Business.0eveloprrienl Paci(c Gas and Electric Company
~~~s~trlc ~f111SJu16 ... 245MarkeYStreet
- ~ ~ Mail Code N10Q
- San Francisco, CA 94105-1702
W E D ~ (. ~ ~ E ~ [ 1~1 E fi G V."' Fax: 415.973-3884
IL~Ir~~>I° ®~ A~>i>rl~~lr~~~~~®~ - IF~~ ~>r~®g~~~°ti~ _
~~~~~~
Wic•eless Pb•ovicler: Spp•int ~pect~•uan 1<Zealty Company,lL><,C
Location: 701 Creelcside Way JAN 0 5 2018
A~~r: 2ss-o1-022
~~1C: L35-43-443 C1TY Q~ C~,11~PBELL
PL.>~:l~l l~gt,; tar l".
l~acilfie ~a~ and lElecti•ic Company (~~~]E), hs the owneA• oif the g~u•ope~•ty ~•e~efl'encecl
.above, and pu~•§tvant to the terms and co~aditions of I~1[a~>tep• Ylicense Agt•eernent >co~•
Antenna Attaclire~cnts cnteyed into by and betdveen ~~~iE anti ~p~•int Specta•um L.P., a
-~elawa~•e lipnitecl paa•ty~e~•ship (l1.gCEI~tS1ElE) clatecl ~epten~beg• 6, 1y96, (Wip•eless
~p•oviclefl•), he~•eby atethog•izes the Wia•eless I'g•ovidcr, its agents, and cont~•actoii•s to:
o Access the PGcX;l; Land referenced above, following advanced notice to PG&E.
o Conduct necessary activities such as site. design visits, radio frequency tests subject to PG&E's.
prior review and approval.
o Apply for ai--d obtain all land use approvals and permits,,which are alipropriate for the installation,
construction, and continued operation of ~ wu•eless communications site (including antennas and
all ancillary equipment and structures}.
'T'his Le%ter of Authoc•izatiou is subject to the following conditions:
o The Wireless Provider shall be solely responsible for satisfying all conditions of approval that
may be contained in a conditional use permit issued by the responsible. jurisdiction on f~elialf of
"owner," "applicant" and/or "development permit holder" as referenced in the conditional use
permit for as long as the same may exist (without regard to the term of the Master License
Agreement). Prior tothc issuance of any conditional use permit, all conditions of approval,
associated with permit must be reviewed and approved by PG&E's Land Department.
o As the applicant, the Wireless Provider shall be solely responsible for the payment of al.l agency
fees including, but. not limited to application fees, costs ofagency review and permitting fees:
o Before entering the PG&E Laiui, the Wireless Provider, shall fin•nish PG&E's Land Department with
satisfactory evidence that the Wireless Provider has procured the ii~stiraiice policies and coverages set forth
in the. Master License Agreement.
o The Wireless Provider shall provide 2.4-Hour advanced notice to PG&E's Lancl Department prior to, ent>y on
the PG&E Land by contacting Morgan Bunone at (41 S) 973-555.9.
The Wireless Provider, its agents.and contractors shall .not interfere with or impair PG&E's use of
the PG~.E Facilities and Laiul.
0 1:IZe Wireless Provider's activities under this Letter of Authorization are subject to all of the terms
and coiiditioits set forth in Master License Agt•eemeut.
Date: ~ ~S
Morgan I3unone
Lend Agent, I and anagement
Pacific Gas and Electric Company
Site # SNX-Sr-25xc-826 D4-Macro Upgrade
Site Name; El Patio Substation
Rev 1 4:8.09