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CITY OF FONTANA Department of Engineering 8353 Sierra Avenue, Fontana CA 92335 Phone (909) 350-7610 ENGINEER / LAND SURVEYOR EASEMENT DEED / LEGAL DOCUMENTS PLAN CHECK APPLICATION [EMAIL REDACTED] Phone: Mobile: Email: PROJECT INFORMATION MASTER CASE No.: (MCN, TTM, TPM, ASP, DRP, BPC No.) Staff Use Only ENGINEERING PC No.: Description of Project: (Map / No. of Lots) LEGAL PROPERTY OWNER Contact Person: Project Location & Specific Plan: Assessor's Parcel No & Address: Phone: Mobile: Email: APPLICANT Contact Person: Company Name: Address: Contact Person: Company Name: Phone: Mobile: Email: Address: Company Name: Address: REVISED 9/12/19 - AT/RG Page 1 of 3 ---PAGE BREAK--- OWNER / APPLICANT CERTIFICATION LANDSCAPE ARCHITECT Contact Person: I certify that I am presently the legal owner of the above-described property or can act as an agent on their behalf. Further, I acknowledge the filing of this application and certify that all above information is true and correct. Company Name: Phone: Mobile: Email: Address: Signature: Date: Print Name and Title: REVISED 9/12/19 - AT/RG Page 2 of 3 ---PAGE BREAK--- Provided: Quantity: 1 Set 1 Set 1 Set 1 Set 1 Set Note: CITY OF FONTANA DEPARTMENT of ENGINEERING THIS FORM MUST BE SUBMITTED WITH FIRST PLAN CHECK (INCOMPLETE APPLICATIONS WILL BE REJECTED) the Easement Deed document PLAN CHECK CALCULATION FORM EASEMENT DEED PLAN CHECK FEES LEGAL DOCUMENT Easement Deed / Legal Document Latest Preliminary Title Report (within 6 months) Latest Assessor's full size map All record references used in the establishment of the Easement Deed / Legal Document Calculations showing the closure and area of the distinctive border for irregular parcels License Land Surveyor or License Civil Engineer under RCE#33,965 is to fill out Initials: 4th and subsequent plan check reviews will require additional plan check fees and will be based on Time & Material. CERTIFICATE OF CORRECTIONS VACATIONS Summary…………………$800.00 + Advertising Cost Full……………………….$1,100.00 + Advertising Cost REVISED 9/12/19 - AT/RG Page 3 of 3 ---PAGE BREAK--- RECORDING REQUESTED BY: APN Address Date Sheet of CITY OF FONTANA Once Recorded, Return To: City of Fontana Section 27383 Documentary Tax Due: $None By: EASEMENT DEED FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, does Department of Engineering 8353 Sierra Avenue Fontana, California 92335 NO RECORDING FEE REQUIRED: This document is exempt from fee Pursuant to Government Code Property Owner hereby grant, to the CITY OF FONTANA, a Municipal Corporation ("Grantee"), an EASEMENT for street, highway, and public utility purposes over, under, and upon the real property in the City of Fontana, County of San Bernardino, State of California described as follows: Said Easement Deed is more specifically described in Exhibit and shown on Exhibit both attached hereto. City Index No. ---PAGE BREAK--- By: Sheet of CALIFORNIA ALL-PURPOSE ACKNOWLEDGEMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of the document. State of California NAME(S) OR SIGNER(S) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity (ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s), acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws County of San Bernardino On before me, Notary Public, DATE NAME, TITLE OF OFFICER Personally appeared , Ricardo Sandoval, P.E, P.L.S. of the State of California that the foregoing paragraph is true and correct. Witness my hand and official seal. SIGNATURE OF NOTARY PUBLIC CITY OF FONTANA ACCEPTANCE CERTIFICATE This is to certify that the interest in real property conveyed by the deed or grant deed dated from to the City of Fontana, a Municipal Corporation is hereby accepted by the undersigned officer pursuant to authority conferred by Resolution 91-152 of the City Council adopted on July 16, 1991; and the grantee consents to the recordation thereof by its duly authorized officer. City Engineer City of Fontana City Index No. ---PAGE BREAK--- Sheet of City Index No. EXHIBIT Legal Description ---PAGE BREAK--- City Index No. EXHIBIT DEED PLAT Sheet of