492, Master bedroom addition and en, ApplicationThe undersigned
4)IbsS0
Street Address
!SUES? FOR HEARING
FOR ZONE VARIANCE
CITY OF ROLLING HILLS
I /Mv7 INA
Name
(alb) 544 ,177-7
Telephone Number
(1) is/are the owner(s) or is/are in lawful possession of
(2) has permission of the owner
Legal description of property Situated at
Lot Tract
) VALINMSeftr LA1111
Street Address
Describe in detail the nature of the proposed use, including what aspects of the .
project require a Variance.
•
MST- OP- � MAD M» �XI�I�Cr
rikAT s
Criteria to be satisfied for grant of Variance
Such change is based upon the following described exceptional or extraordinary
circumstances or conditions that do not apply generally to other property in the
'same vicinity and zone.
7 I\D Pl ra- 7t1C f - 2 WP'c`f t6 AL436kby
C.,tr-
Such change will not be materially detrimental to the public welfare nor injurious to
the property or imn-nvements in such vicinity and zone where property -is located because.
M5 Rase. AlteriA Viv f s s ltkE t n iz- .,NIz J Tr
f lb AL IA UID ! mukkmAL, t A it •
FILING FEE
A f i l ina top
• i
•
PROPERTY OWNER:
OWNERS ADDRESS:
TELEPHONE NO:
PROPERTY ADDRESS:
REOU$8T FOR BEARING
FOR SITE PLAN REVIEW
CITY OF ROLLING HILLS
(%eCX,1 4 r\ MAA
W (UU Atl1S 126- LAE.-
J E • 41•227n vof-k • 919•10e0
WILUANk p5uf L ..
LEGAL DESCRIPTION: LOT NO
ASSESSORS BOOR NO PAGE PARCEL'
AGENT'S NAME:
AGENT'S ADDRESS:
TELEPHONE NO:
************************************************************** *******
NATURE OF PROPOSED PROJECT
Describe in detail the nature of the proposed project, including what
aspects of the project require a Site Plan Review:
A 5r t TLAfi I 1 leafzeputrED 5Act,'K t. j -rtbli 1
2'0, or -ram. Mgt n& UIltilh /lex, -tom. Am -nark 6 F L
'n) MissiEf tope AnD m►% A t VsfAILXIQFSaM
to . n srtnU 2FAAW(/E AfEA.
SITE PLAN REVIEW CRITERIA
Site plan review criteria upon which the Planning Commission must make
an affirmative finding. Describe in detail the project's conformance
with the criteria below:
A. Is the project compatible with the General Plan, the Zoning
Ordinance and surrounding uses? Explain how it compares to the
sizes, setbacks and other characteristics of neighboring houses.
rfi leg- la sirkIL - 11 s1Zt.1?) tat - i iiiv lb b sn T
\ DLA-TE. isoW s reAct u MErcir7.1 AffedivrircgAL 'ITf L rMD
ust. c,itmscsr t\T harm a M - wit
Site Plan Review
Application -9-
0•
B. How does the project preserve and integrate into the site design,
to the maximum extent feasible, existing natural topographic
features of the lot including surrounding native vegetation, mature
trees, drainage courses, and land forms (such as hillsides and
knolls) ? Explain how the project preserves and integrates existing
natural features.
i VAL PAVE MOW-- . %rig on E t5j1f1Cs T\ its SE E,.
"TlefrE. WILL 16E. r GPM& D$ tM&E. PA.-NEW-7 MU- Ng" BE.
i ikD 66 MT:4, Ale lb E .
C. How does the site development plan follow natural contours of the
site to minimize grading? Extensive grading and recontouring of
existing terrain to maximize buildable area shall not be approved.
Graded slopes shall be rounded and contoured so as to blend with
existing terrain. Grading shall not modify existing drainage
redirect drainage flow unless into an existing drainage course.
Explain the nature and extent of the impact of grading and proposed
minimization on lots.
11-T_ f'4?-6..Nraff tliST fauNIft., 6rAtoll,r.
D. To what extent does the site development plan preserve surrounding
native vegetation and supplement it with landscaping that is
compatible with and enhances the rural character of the community?
Landscaping should provide a buffer and transition zone between
private and public areas. Explain how the project preserves native
vegetation, integrates landscaping and creates buffers.
lift) t - r SAl Nltr WU- .i2EMNE.b Or. Ar ' .b Enc -Avv, -
mkt
%3wiEwhi fular-th6- 6#42716e„ --)trottAbrti otitikE12-
suwan ilLT 61N AW'r h&O L
Site Plan Review
Application -10-
0•
• •
E. How does the site development plan preserve the natural and
undeveloped state of the lot by minimizing building coverage? Lot
coverage requirements shall be regarded as maximums and the actual
amount of lot coverage permitted should depend upon the existing
buildable area of the lot. Explain how the lot coverage proposed
compares with lot coverage square footage and percentages on
neighboring lots.
"Mt Lt3r CtsV t-sr. tAmmtvarz, , I&UA tSf 1Y-AAG-
AR 1 ! 4S . T+t.t. Easroak, ositAs &.r-
F. Is the site development plan harmonious in scale and mass with the
site, the natural terrain and surrounding residences? Setbacks
shall be regarded as minimums and more restrictive setbacks shall
be imposed where necessary to assure proportionality and openness.
Explain how the proposed project setbacks compare with the existing
setbacks of neighboring properties.
Chotab1 M T> PC r.1Ai Ml_ Is tN-Aolettz
-
W vnc rvz- A YmminAV W ,fin.& rra 6f 1 W .
XI W - l& 114Autrxieb A 1D ,A catQ Yir (i / t PA -
G. Is the site development plan sensitive and not detrimental to
convenience and safety of circulation for pedestrians and vehicles?
Explain how the number and types of vehicles relate to the driveway
location, design, trip data, landscaping and other on -site parking
or storage areas.
?MEV-4N\ Mb VEk tc1 l - rrtc Aft t )h, ffecrED.
Site Plan Review
Application -11-
i•
O.
H. Does the site development plan conform with the requirements of the
California Environmental Quality Act? Explain how the project
impacts the environment, e.g. significant impact, proposed
mitigation measures.
71144, 1 "c-4511111A v rn 11 cAU ik Emitt 110 L..
Lrf ACT ItD WILL. AVE Sv tre A CT lM '
I hereby certify that the statements furnished above, and in attached
exhibits, presents the data and information required for the site plan
review criteria evaluation to the best of my ability; and, that the
facts, statements and other information presented are te and correct
to the best of my knowledge and belief.
Date:
/- 93
Signature
For:
Applicant
Site Plan Review
Application -12-
0•
OWNER'B DECLARATION
I (We) declare under penalty of perjury that the foregoing is true and
correct.
Executed at Hi (.,(, 5 , California,
U
this day of /='-C'16 , 199,E
0 (address)
NOTE: The Owner's Declaration can only be used if this application is
signed in California. If this application is signed outside of
California, the applicant should acknowledge before a Notary Public of
the State where the signature is fixed, or before another officer of
that State authorized by its laws to take acknowledgements, that he (it)
owns the property described herein, and that the information
accompanying this application is true to the best of his (its) knowledge
and belief. Attach appropriate acknowledgment here.
APPLICANT: DATE FILED 2////3
REPRESENTATIVE: 1Y/LT9A E: (,�i�0 / Q/ 4- (Z,Sb /6t Qaa)
COMPANY NAME: RECEIPT NO: KAW
COMPANY ADDRESS :1 cipvimM ecob. BY:
_TOITAActioulDfilok ogxv ZONING CASE NO: oz.
COMPANY PHONE NO 1 7t b) tot&aVot TENTATIVE HEARING DATE: 3'
PROJECT ADDRESS:') IACJA AS& LArtt.
Site Plan Review
Application -13-
00
OWNER'S ACKNOWLEDGEMENT
Property development in Rolling Hills is governed by ordinances of
the City of Rolling Hills ("City") and by private deed restrictions
enforced by the Rolling Hills Community Association ("RHCA").
The land development permit process of the City and the RHCA are
completely independent and separate. Both must be satisfied and
approval given by both the City and the RHCA to develop property in
Rolling Hills. An approval by either the City or the RHCA does not mean
or imply or ensure approval by the other.
The suggested sequence of property development is to obtain City
approvals first.
I, (We), the undersigned, acknowledge that the above statement has
been fully read and its admonition is completely understood.
Executed at jQ CL '.Jd_ 0 1 LL y , California
this r µ 5 7i day of j-t- f j , 19,
By:
By:
Address
1-6U 1r117. RILLS
City
Site Plan Review
Application -14-
•
CITY OP ROLLING HILLS
TONING CASE
CERTIFIED PROPERTY OWNER'S LIST
AEFIDAVI!
STATE OF CALIFORNIA
COUNTY OF LOS ANGELES
SS
I, , declare
under penalty of perjury that the attached list contains the names and
addresses of all persons to whom all property is assessed as they appear
on the latest available assessment roll of the County within the area
described and for a distance of one thousand (1,000) feet from the
exterior boundaries of property legally described as:
Executed at /D L LJ •v c //i tLS
this i day of F-th
.-
SIGNATURE
Conditional Use Permit
Variance
Site Plan Review
Zone Change
Site Plan Review
Application -15-
(�l
, California,
, 19 M
,, 101.r�
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Vicinity Map scale 1" = 800'
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• 41
•
DATE
BUILDING AREAS
NET LOT AREA
BUILDING PAD(S)
RESIDENCE
GARAGE
SWIMMING POOL/SPA
STABLE
RECREATION COURT
( )
SERVICE YARD
c(W)
ZONING CASE NO.
TOTAL STRUCTURES
% STRUCTURAL COVERAGE
% PAD COVERAGE
DRIVEWAY
PAVED WALKS
S. PATIO AREAS
POOL DECKING
TOTAL FLATWORK
% TOTAL FLATRORK
COVERAGE
TOTAL STRUCTURAL
& FLm0RK COVERAGE
% TOTAL COVERAGE
CALCULATION OF
EXISTING
1$j4sq.ft.
1 5sq.ft.
2.5eSsa.ft.
(D(ot sq. ft.
1 V2.sq.ft.
IRIS sq.ft.
221S sq.ft.
sq.ft.
46-0 sq.ft.
2.c c sq.ft.
¥Lb sq.ft.
81S sq.ft.
(o$1S sq.ft.
8.%
14 t2 sq.ft.
,2 %
ADDRESS WluJ FJJy 1NE
APPLICANT WOW
LOT COVERAGE
PROPOSED
sq.ft.
sq.ft.
sq.ft.
sq.ft.
sq.ft.
sq.ft.
IIMMA
MOP
son
sq.ft.
sq.ft.
sq.ft.
sq.ft.
TOTAL
76,477sq. ft.
l9 iiSsq.ft.
3PlSsa.ft.
WW2 sq.ft.
511- sq.ft.
?-16-sq.ft.
221S sq.ft.
sq.ft.
456sq. ft .
sq.ft. ?23D sq.ft.
'32k sq.ft. 2?S8(P sq.ft.
sq.ft. &h. sq.ft.
32� sq.ft. 4401,4 sq.ft.
44611
8.1 %
terv:4
sq.ft. sq.ft.
19 .c) %
• • •
DATE ZONING CASE NO. ADDRESS 41 Ntii..iNA.P6U `6 - fie
APPL I CANT l In Y1
CALCULATION OF BUILDING PAD'rRAGE
PAD NO. 1
BUILDABLE PAD AREA tbf�_sq.ft.
RESIDENCE 1,F1S sa.ft.
GARAGE sa.ft.
STABLE (BARN) sq.ft.
POOL 512_ sq.ft.
RECREATION COURT
TOTAL STRUCTURES ON PAD NO. 1 4,
sq.ft.
4156 sq.ft.
sq.ft.
% BUILDING PAD COVERAGE 25►6 $
PAD NO. 2
BUILDABLE PAD AREA
RESIDENCE sq.ft.
GARAGE sq.ft.
STABLE (EARN) sq.ft.
POOL sq.ft.
RECREATION COURT
sq.ft.
OTHER sq.ft.
TOTAL STRUCTURES ON PAD NO. 2 sq.ft.
% BUILDING PAD COVERAGE
-8-
i• ••
City O/ /1E'O/fLfl ...Jh/LS INCORPORATED JANUARY 24, 1957
ENVIRONMENTAL INFORMATION FORM_
(To Be Completed By Applicant)
Date Filed
GENERAL INFORMATION
NO. 2 PORTUGUESE BEND ROAD
ROLLING HILLS, CALIF. 90274
(213) 377-1521
FAX: (213) 377.7288
Zoning Case No.
1. Applicant, address and telephone no. PI,
2. Legal Owner, address and telephone no. (if different from
above)
3. Address of project 4) VAUUVUMAIrer Lilt.
Assessor's Book, Page, Parcel No.
Lot No.
ink
4. List and describe any other related permits and other public
approvals required for this project,including those required
by city, regional, state and federal agencies:_
5. Existing zoning district
6. Proposed use of site (project for which this form is filed):
_,fit rtL '('b fi-ZCI'`-1111�l- S111M_ 'ID fV
PROJECT DESCRIPTION
7. Site size
8. Net lot area 1641 644
9. Total square footage of structures y 18'y ST.
10. Number of floors of construction ONE..
-1-
4. irtr,n
•• ••
11. Basement square footage Mi/A
12. Total combined flatwork and structural lot coverage it•
13. Will any exterior walls be removed or relocated?ich walls?
VIE a ' t E tqr l‘bfilk. POD of 0
14. Will any interior walls be removed or relocated?hich walls?
Site 10--t1t w vr'ur 12a04 klkb Ift STIPA AT Inv- efrzatay
15. Will the entire building structure require a new roof? i
16. Will the existing roof remain intact, with less than 200
square feet added? nis
17. Will cut and fill be balanced? A/A Amount cut '(1/ek
Amount fill 11 / 1
18. If residential, include the unit size, approximate sale price
and household size expected.
19. If commercial, indicate the type of project, whether
neighborhood, city or regionally oriented, square footage of
sales area, estimated employment per shift and loading
facilities. tl/Pt
20. If this is industrial project indicate the type of project,
estimated employment per shift, and loading facilities. //A
21. If institutional, indicate the major function, estimated
employment per shift, estimated occupancy, loading facilities,
and community benefits to be derived from the project. I\Pc
22. Attach plans..
23. Proposed scheduling. 6Z5Y1. 1,5,7 'j' 116t r,
24. If the project involves a variance, conditional use or
rezoning application, state this and indicate clearly why the
application is required. hIsheRautivo
Are the following items applicable to the project or its effects?
Discuss below all items checked yes (attach additional sheets as
necessary).
Yes No
lk 25. Change in existing features of any bays, tidelands,
beaches, lakes or hills, or substantial alteration
of ground contours.
26. Change in scenic views or vistas from existing
residential areas or public lands or roads.
- 2-
. •
• •
27. Change in pattern, scale or character of general
area of project.
28. Significant amounts of solid waste or litter.
29. Change in dust, ash, smoke, fumes, or odors in
vicinity.
30. Change in ocean, bay, lake, stream or ground water
quality or quantity, or alteration of existing
draining patterns.
31. Substantial change in existing noise or vibration
levels in the vicinity.
32. Site on filled land or on slope of 10 percent or
more.
33. Use or disposal of potentially hazardous materials,
such as toxic substances, flammable or explosives.
34. Substantial change in demand for municipal services
(police, fire, water, sewage, etc.).
35. Substantially increased fossil fuel consumption
(electricity, oil, natural gas, etc.).
36. Relationship to a larger project or series of
projects.
ENVIRONMENTAL SETTING
37. Describe the project site as it exists before the project,
including information on topography, soil stability, plants
and animals, and any cultural, historical or scenic aspects.
Describe any existing structures on the site, and the use of
the structures. Attach photographs of the site. Snapshots
or polaroid photos will be accepted.
Tar_ e2CtsnN1b-- tk61iS$ AA
FOLDtn. PAD A
fADDt -iE n t5 cart' 14174,.E ! AM caffik.
L h4 -A d - it ,-mt.isA art Nit 1
-16- , n { / r t4 . sry kT -tom.. F-1> or A ail -.DE #
w 11006t4lam-.
-3-
�i 0•
38. Describe the surrounding properties, including information on
plants and animals and any cultural, historical or scenic
aspects. Indicate the type of land use (residential,
commercial, etc.), intensity of land use (one -family, guest
house, office use, etc.) and scale of development (height,
frontage, set -back, rear yard, etc.). Attach photographs of
the vicinity. Snapshots or polaroid photos will be accepted.
u snttn& terelistzTV7 f-IEGIDEffriAL, llat fMt1(
vAtkir AtE is VT( (9364.E. VME tAsettren
en M.Wki, - Lkite. Are s tft
ENVIRONMENTAL IMPACTS
(Please explain all "yes" and "maybe" answers on separate
sheets.)
YES MAYBE NO
39. Earth. Will the proposal result in:
a. Unstable earth conditions or in
changes in geologic substructures? 4(
b. Disruptions, displacements, com-
paction or overcovering of the soil? -k
c. Change in topography or ground
surface relief features?
d. The destruction, covering or
modification of any unique geologic
or physical features?
e. Any increase in wind or water
erosion of soils, either on or off
the site?
f. Changes in deposition or erosion
of beach sands, or changes in siltation,
deposition or erosion which may modify
the channel of a river or stream or the
bed of the ocean or any bay, inlet or
lake?
g. Exposure of people or property
to geologic hazards such as earth-
quakes, landslides, mudslides,
ground failure, or similar hazards?
-4-
0• ••
40. Air. Will the proposal result in:
a. Substantial air emissions or
deterioration of ambient air qaulity?
b. The creation of objectionable
odors?
c. Alteration of air movement,
moisture or temperature, or any change
in climate, either locally or
regionally?
41. Water. Will the proposal result in:
a. Changes in currents, or the
course or direction of water move-
ments, in either marine or fresh
waters?
b. Changes in absorption rates,
drainage patterns, or the rate and
amount of surface water runoff?
c. Alterations to the course or
flow of flood waters?
d. Change in the amount of surface
water in any water body?
e. Discharge into surface waters,
or in any alteration of surface
water quality, including but not
limited to temperature, dissolved
oxygen or turbidity?
f. Alteration of the direction or
rate of flow of ground waters?
g. Change in the quantity of ground
waters, either through direct additions
or withdrawals, or through interception
of an aquifer by cuts or excavations?
h. Substantial reduction in the
amount of water otherwise available
for public water supplies?
i. Exposure of people or property
to water -related hazards such as
flooding or tidal waves?
-5-
YES MAYBE NO
4(
• •
•0.
j. Significant changes in the
temperature, flow, or chemical
content of surface thermal springs?
YES MAYBE NO
4t
42. Plant Life. Will the proposal result in:
a. Change in the diversity of species,
or number of any species of plants
(including trees, shrubs, grass, crops,
microflora and aquatic plants)? i1K
b. Reduction of the numbers of any
unique, rare or endangered species of
plants?
c. Introduction of new species of
plants into an area, or in a barrier
to the normal replenishment of 41K
existing species?
d. Reduction in acreage of any
agricultural crop?
43. Animal Life. Will the proposal result in:
a. Change in the diversity of
species, or numbers of any species of
animals (birds, land animals
including reptiles, fish and shellfish,
benthic organisms, insects or micro -
fauna)?
b. Reduction of the numbers of any
unique, rare or endangered species of
animals?
c. Introduction of new species of
animals into an area, or result in a
barrier to the migration or move-
ment of animals?
d. Deterioration to existing fish
or wildlife habitat?
44. Noise. Will the proposal result in:
a. Increases in existing noise
levels?
b. Exposure of people to severe
noise levels?
-6-
�! ••
YES MAYBE NO
45. Liaht and alare. Will the proposal
produce new light or glare?
46. Land Use. Will the proposal result in a
substantial alteration of the present or
planned land use of an area?
47. Natural Resources. Will the proposal
result in:
a. Increase in the rate of use of
any natural resources?
b. Substantial depletion of any
nonrenewable natural resource?
48. Risk of Unset. Will the proposal involve:
a. A risk of an explosion or the
release of hazardous sustances
(including, but not limited to, oil,
pesticides, chemical or radiation)
in the event of an accident or upset
conditions?
b. Possible interference with an
emergency response plan or an emer-
gency evacuation plan?
49. Population. Will the proposal alter the
location, distribution, density, or growth
rate of the human population of an area?
50. Housina. Will the proposal affect existing
housing, or create a demand for additional
housing?
51. Transportation/Circulation.
proposal result in:
a. Generation of substantial
additional vehicular movement?
Will the
b. Effects on existing parking
facilities, or demand for new
parking?
c. Substantial impact upon existing
transportation systems?
-7-
1�
••
Yes Maybe No
d. Alterations to present patterns
of circulation or movement of people
and/or goods? 4(
e. Alterations to waterborne, rail
or air traffic?
f. Increase in traffic hazards to motor vehicles, tit
52. Public Services. Will the proposal have
an effect upon, or result in a need for
new or altered governmental services in
any of the following areas:
a. Fire protection?
b. Police protection?
c. Schools? .(
d. Parks or other recreational
facilities? dk
e. Maintenance of public facilities,
including roads? "Nlk
f. Other governmental services?
53. Eneray. Will the proposal result in:
a. Use of substantial amounts of
fuel or energy? qe
b. Substantial increase in demand
upon existing sources of energy, or
require the development of new sources
of energy?
54. Utilities. Will the proposal result in
a need for new systems, or substantial
alterations to the following utilities:
a. Power or natural gas?
b. Communications systems?
c. Water?
d. Sewer or septic tanks?
e. Storm water drainage?
-8-
••
f. Solid waste and disposal?
55. Human Health. Will the proposal result
in:
a. Creation of any health hazard or
potential health hazard (excluding
mental health)?
YES MAYBE NO
b. Exposure of people to potential
health hazards? t
56. Aesthetics. Will the proposal result in
the obstruction of any scenic vista or
view open to the public, or will the
proposal result in the creation of an
aesthetically offensive site open to
public view?
57. Recreation. Will the proposal result
in an impact upon the quality or quantity
of existing receational opportunities?
58. Cultural Resources.
a. Will the proposal result in the
alteration of or the destruction of a
prehistoric or historic archeological
site?
b. Will the proposal result in
adverse physical or aesthetic effects
to a prehistoric or historic
building, structure, or object? 4,C
c. Does the proposal have the poten-
tial to cause a physical change which
would affect unique ethnic cultural
values?
d. Will the proposal restrict existing
religious or sacred uses within the
potential impact area? d�
•• 4110
59. Mandatory Findinas of Significance.
a. Does the project have the poten-
tial to degrade the quality of the
environment, substantially reduce the
habitat of a fish or wildlife
species, cause a fish or wildlife
population to drop below self-
sustaining levels, threaten to
eliminate a plant or animal commun-
ity, reduce the number or restrict
the range of a rare or endangered
plant or animal or eliminate
important examples of the major
periods of California history or
prehistory?
b. Does the project have the poten-
tial to achieve short-term, to the
disadvantage of long-term, environ-
mental goals? (A short term impact on
the environment is one which occurs
in a relatively brief, definitive
period of time while long-term
impacts will endure well into the
future.)
c. Does the project have impacts
which are individually limited, but
cumulatively considerable? (A
project may affect two or more separate
resources where the impact is relatively
small, but where the effect of the total
of those impacts on the environment is
significant.)
d. Does the project have environ-
mental effects which will cause
substantial adverse effect on human
beings, either directly or
indirectly?
YES MAYBE NO
NO•410
Before the Lead Agency can accept this application as
complete, the applicant must consult the lists prepared pursuant to
Section 65962.5 of the Government Code and submit a signed
statement indicating whether the project and any alternatives are
located on a site which is included on any such list, and shall
specify any list.
HAZARDOUS WASTE AND SUBSTANCES STATEMENT
The development project and any alternatives proposed in this
application are contained on the lists compiled pursuant to Section
65962.5 of the Government Code. Accordingly, the project applicant
is required to submit a signed statement which contains the
following information:
1. Name of applicant: Iwo 6efaiN WO
2. Address: 1 IMLW.#df & LAM
¥1LW r 14147
3. Phone Number: (4) ✓ t ' S-1S I 60 51 ,1,088
4. Address
fooff- Site (street name and number if available, and ZIP
code); '_�`7/ A LL i A fro t4-.0 Lr"
5. Local Agency (city/county):
e £s7z; /4'7/5
6. Assessor's book, page, and parcel number:
7. Specify any list pursuant to Section 65962.5
of the
Government
Code: �0? CEOuad-e,?a/ 2GS�f
8. Regulatory identification number: i/
9. Date of List: V /1,1 I 1 Z Date ,) / -7
! J
(Signature)
For
(Applicant)
III
NOTE • In the event that the project site and any alternatives
are not listed on any list compiled pursuant to Section 65962.5 of
the Government Code, then the applicant must certify that fact as
provided below.
I have consulted the lists compiled pursuant to Section
65962.5 of the Government Code and hereby _certify that the
development project and any alternatives (proposed in this
application are not contained on these lists.
Date 5'3
For
(Signature)
(Applicant)
CERTIFICATION: I hereby certify that the statements furnished
above and in the attached exhibits present the data and information
required for this initial evaluation to the bes--of my ability, and
that the facts, statements, and information pr ted are true and
correct to the best of my knowl ge and belie
Date
For
(Signature)
(Applicant)