648, SFR addition of approx. 1175 s, Application05/01/02 WED 16:41 FAX 310 377 7288 CITY OF ROLLING HILLS
Ij004
• •
Ce1f, 4 //i4ng ✓6Ld INCORPORATED JANUARY 24, 1957
REQUEST FOR HEARING
CONDITIONAL USE PERMIT
NO. 2 PORTUOUESE BEND ROAD
ROLLING HILLS, CALIF. 90274
(310) 377-1621
FAX: (310) 377.728a
E-malt cityofrht@aolcom
NOTE: According to Section 17.24.020 of the Rolling Hills Municipal Code, illegal uses or structures we required to be
made conforming or shall be removed Therefore, you may be required to modify or remove any unauthorized or unlawful use
or structure on your property prior to or in conjunction with this application. In addition, pursuant to Resolution No. 900 of
the City Council, any use or structure which would require a discretionary permit but which is conducted without the
acquisition of said permit, shall be subject to retroactive discretionary permit process, and is subject to higher application fee.
PROPERTY OWNER:
OWNER'S ADDRESS:
TELEPHONE NO:
PROPERTY'S ADDRESS:
LEGAL DESCRIPTION:
AGENT'S NAME:
AGENT'S ADDRESS:
TELEPHONE NO:
�e • h44AY frm v
#/ d4'-fNf A/ o /V Aotvb.
(3/0) )77r`//47
ft( do/NI e4.IYo/v , f}o
LOT NO. ?iD '
ASSESSORS BOOK NO. CI PAGE / PARCEL
";91-4eA ,/4 /lie-Y -w - me Atic-.
`140/ /4/0cfor 4 . 3/0 J/lik qw E '. fora
(?i') 3z.17/1
NATURE O. PROPOSED PROJECT
Describe in detail the nature of the proposed use and under what Section of the Zoning Ordinance the
conditional use is permitted in the zone.
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Pnrited on Recycled Paper.
05/01/02 WED 16:41 FAX 310 377 7288 CITY OF ROLLING HILLS W 005
• •
Will the proposed use be compatible with the uses in the surrounding area, and if so, why?
eS /At T saicR/Vb /N6 /i•
Go c. - ' 7 v /s b6H)'k m,i T G/.v6
Will the grant of this Conditional Use Permit be consistent with and in furtherance of the public health safety
and general welfare?
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AoremideI LE • /04-A )N6
FILING FEE
A filling fee must accompany the application. Make check payable to the CITY OF ROLLING HILLS.
i
Bryant • Palmer• %to, Inc.
Jack K. Bryant ENGINEERS / Neil Stanton Palmer ARCHITECTS
2601 Airport Drive, Ste. 310, Torrance, CA 90505
Telephone: (310) 539-1161
(310)326.9111
Fax: (310) 325-0271
JOB
Ilerhilired*P76A/e6
SHEET NO 47 C9N/ O / " •
CALCULATED BY /c&/%j' PA.-1 •6t A-IUATF 51416. D' I
CHECK
EDDBBBYY ,Q,� /� fJ DATF �y
SCALF "^ " `( 66` ' "ctr'7T ' exn �.6/r
PORTION
(E) DRIVEN
TO B J.Y
REMVED
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Air fir /?-1't/ ,ec¢A" Vij4/10, .t Gam.
•
OWNER'S ICKNOWLEDGEMENT
Property development in Rolling Hills is govemed by ordinances of the CITY OF ROLLING
HILLS ("City") and by private dced 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 tut.
I, (We), the undersigned, acknowledge that the above statement has km fully read and its
admonition is completely understood.
Executed at 49o/4 y 404
this ' ? • day of /L1# c#
•
s G4vgav
�• Address
/ //$
city /
, California
,20G02—
. fZG: 4l diviA yer• (-41 niAc.-r 1/AE.
OWNER'S DECLARATION
I (We) declare under penaltyt.
of perjury that the foregoing is true and correct
Executed at__,/44 /fs'
this � j �'I day of /%lei/
By.
, California,
, 20 D 2_.
/�isys 4f4vs,".E'0✓
Address
`jec) /AV,
City / •
NOTE: The Owner's Declaration can only be used ij this application is signed in Calarnia. 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 7,y its. laws to take
acknowledgements, that Ise (it) owns the property described herein, and that the information
accompanying this application is true to the best of his (its) knowledge and belie Attach appropriate
acknowledgment here.
APPLICANT: DATE FILED
REPRESENTATIVE: FEE:
COMPANY NAME: RECEIPT NO:
COMPANY ADDRESS: BY:
ZONING CASE NO
TENTATIVE HEARING DATE:
COMPANY PHONE NO. (
PROJECT ADDRESS:
N 0/ leolliny
VARIANCE
REQUEST FOR HEARING
NOTE: According to Section I9.24.020 oldie Rolling Hills Municipal Code, illegal uses or structures we required to be
made conforming or shall be removed Therefore, you may be required to modify or remove any unauthorized or unlawful
use or structure on your property prior to or in conjunction with this application. In addition, pursuant to Resolution No.
900 of the City Council, any use or structure which would require a discretionary permit but which is conducted without
the acquisition of said permit, shall be subject to retroactive discretionary permit process, and is subject to higher
application fee.
7d/44A 4ek_-
INCORPORATED JANUARY 24, 1957
•
PROPERTY OWNER:
OWNER'S ADDRESS:
TELEPHONE NO.:
PROPERTY ADDRESS:
LEGAL DESCRIPTION:
AGENTS NAME:
AGENTS ADDRESS:
PHONE NO.:
z1
NO.2 PORTUGUESE BEND ROAD
ROLLING HILLS, CALIF. 90274
(310) 377.1821
FAX (310) 377-7288
Emalk cltyotrhOrroLcom
GrLi-/6 mitity iohpf•
(74h J C4Nyour• Iszl
?ioJ . 377 • %f(oG7
LOT NO.
ASSESSOR'S BOOK NO. S7 • PAGE /' / PARCEL
/i'91-rne/ -1. %/s;Ly i' r . M., di( hi-0 • /'^'G
u0/ MiLPmer tr- v 4 f-oc•ect✓ 44- . lora<
(3io)
Describe in detail the nature of the proposed use, including what aspects of the project require a Variance.
ft 51o&'i b ,4 6%e• */'I7/8/(/ it • ze Pk/Jr/XL
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®P,Intiod on Reevcted Pups'
Criteria to be satisfied for grant of Variance
Such change is based upon the following described exceptional or traordinary circumstances or
1 conditions that do not apply gully to other property in the same vicinit d zone.
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o f AG 1.-afli)6 T/1t Gsheb, E • /r.•eV/Ar4 / r• /2- Poi:
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EXrAgyeb/artKy L//eeutr ST4-"v I ter v.4,,,p .7 71 1/re.
Such change will not be materially detrimental to the public welfare nor injurious to the property or
improvements in such vicinity and zone where property is located because
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b M eirials bec41/./e /7f .',9/'P it/cF .wow Ae. •
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FILING FEE
A filing fee must accompany the application. Make check payable to: CITY OF ROLLING HILLS.
No Sl re Govc`:RAG eCrtc..t•T/o eVS ALS:M4u/eV vAic-NA-Av6 E/7
1 To fdc 1.615 bit/vv./AT -(41J 44G�
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. �,c�o /.cwcE�, ,v�� s
• •
. REQUEST FOR NEARING
FOR SITE PLAN REVIEW
NOTE: According to Section 17.24.020 of the Rolling Hills Municipal Code, illegal uses or structures are required to be
made conforming or shall be removed. Therefore, you may be required to modem or remove any unauthorized or unlawful
use or structure on your property prior to or in conjunction with this application. In addition, pursuant to Resolution No.
900 of the City Council, any use or structure which would require a discretionary permit but which is conducted without
the acquisition of said permit, shall be subject to retroactive discretionary permit process, and is subject to higher
application fee.
PROPERTY OWNER:
OWNER'S ADDRESS:
TELEPHONE NO:
PROPERTY'S ADDRESS:
LEGAL DESCRIPTION:
AGENT'S NAME:
AGENT'S ADDRESS:
TELEPHONE NO:
/ . v#At.r c ,v yo, 06-p
(3/0) 377 `114,47
-Mivc • 41-Ar yolv Aofrd
LOT NO. 20
ASSESSORS BOOK NO. £7 PAGE /-/ PARCEL
M-r-mf1C / 4• /4/\ i4,vi p Mt/t Are Ate-.
260/ 4-//z-foi2.7" ,b/L. #.3/o 7' Afl Ne CR; 9DSoC7-
(3/0) 3>G. 9///
NATURE OF PROPOSED PROJECT
Describe in detail the nature of the proposed project, including what aspects of the project require a Site
Plan Review:
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of/ #%J E ,,O/TIo' • . Zi7s• SJ
G, /fie- /oo/7 / Al • 77D' f'ier
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Ji / A6 ✓/6'1ti /S /z�40,<, Thtt
4'C /r/O J ek GeEvS /o-fl-a .t', f,
Describe and delineate on plans any new basement area square footage /%e/✓G•
• •
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.
Y . rff"I S . PiQzotl5- -r" /S .Daw, O,o'f' L E 4
/irr /t.�tit f'D • A/6 1744 te.../.v4. h 'VJ E.5 -
B. How does the project preserve and integrate into the site design, to the maximum extent feasible, existing natural
topographic features of thle 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.
. if/.f P.etdt—r 2>Q6S i(/or 4-TTlC 7 Ojc/1r/4/6
A&Yori• ,gv14-0/41.6
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PM4 P/Nt, Trzs$ (in}-/J �..,,t.V off. //.) .
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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 or redirect drainage flow
unless into an existing drainage course. Explain the nature and extent of the impact of grading and proposed
minimization on lots.
/ 1674 d* 4f" t; f Ato r 4 i- i< yN6 74010 6R4P/t'(
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.
/r'/1 %A 7'7.v6
fw -c/L_ A,/ b,
• •
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.
/`'ere/et, 1io7 CWrA b e /S w r /-r / 9?c/m vM't / - .lf i1y
/g'E Nor*O :57-Arerei/z41.., Cov ie./46-.
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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 shill be imposed where necessary
to assure proportionality and openness. Explain how the proposed project setbacks compare with the existing
setbacks of neighboring properties.
•
P4aPaf f lt.oe16GT s r;s xr' e/e- • lr, rig -/A/ • M6-re-Al eb
Giry .TEref eAfr, /f-A-l'-ma#v/tiv I'/i-Axon
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.
V` P-/ ttiii-r . MVO . &rr)V ,'v G/,z,6049- 7 t )('t-
/2in,/N
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.
yam.(. /r kW/ G — e erlinItrel 6%42 ./7- /1 Ivor-
re V/A6 114 64 / M - oc,6r J
• •
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 true and rrect t to the best f my knowledge and belief.
Date: 3.. l'S - 0 - • -4 v! / '
Signature /e../e/ r L /fn elI--..¢ 4A- • .
For: G/""/!o %Y1i Y ih'fr/h ff-A)
Applicant
FILING FED
A filing fee must accompany the application. Make check payable to: CITY OF ROLLING HILLS
DATE • 41/IO2-- ZONING CASE NO.
BUILDING AREAS
NET LOT AREA
BUILDING PAD(S)
RESIDENCE
GARAGE
SWIMMING POOL/SPA
STABLE
RECREATION COURT
/ 7ENN15
SERVICE YARD
OTHER
NEW BASEMENT AREA
(Volume to be included in grading quantities.)
ADDRESS
APPLICANT
•
J ✓Dh/N'S Gov yoAl J D
flLFMArl
CALCULATION OF LOT COVERAGE
TOTAL STRUCTURES
% STRUCTURAL
COVERAGE
% TOTAL PAD
COVERAGE
EXISTING
75, 496 sq.ft.
sq.ft.
sq.ft.
sq.ft.
sq.ft.
sq.ft.
7; 26 4r sq.ft.
4 sq.ft.
• 4- sq.ft.
PROPOSED TOTAL
$ sq.ft. 7S, 4/6 • sq.ft.
' sq.ft. .30j 990 sq.ft.
l : 7 sq.ft. 5, 66/ sq.ft.
Teo sq.ft. 770, sq.ft.
sq.ft. 9710 sq.ft.
sq.ft. 558 • sq.ft.
sq.ft. ' `, 03o sq.ft.
sq.ft. sq.ft.
sq.ft. $" sq.ft.
/3, 2b sq.ft. 011 sq.ft. 14 1 s sq.ft.
! 7,59 % •,g. % f ?. %
It'Z;b& % $' % .4$.M %
DRIVEWAY 7, 6 &3 sq.ft. ' <7'144 sq.ft. ,95'I sq.ft.
PAVED WALKS AND ¢� /31 2 3b ,sq.ft. 3, 693
PATIO AREAS - sq.ft.
POOL DECKING - i sq.ft. sq.ft. 1
OTHER PAVED
DRIVEWAYS, EASEMENTS
TOTAL FLATWORK
% TOTAL FLATWORK
COVERAGE
sq.ft. sq.ft. "19-
sq.ft.
sq.ft.
sq. ft.
12, 355 sq.ft. <9eZ> sq.ft. 1/, 373 sq.ft.
/G.36 % • •19" % SLYP %
TOTAL STRUCTURAL &
FLATWORK COVERAGE, 2? 4%39 sq.ft.
% TOTAL COVERAGE 33.4b %
sq.ft.
So! 36,$ sq.ft.
%
sq.ft.
•
DATE 41/ /07' ZONING CASE NO.
•
•
ADDRESS , / Joh'NCANYcr4 Rook)
APPLICANT )7LQp, ,
CALCULATION OF BUILDING PAD COVERAGE
PAD NO. 1 /-10a
BUILDABLE PAD AREA 23, °9¢ NIL
661
RESIDENCE 51
sq.ft.
GARAGE 770 sq.ft.
STABLE (BARN) '$' sq.ft.
POOL ' -0- sq.fi.
RECREATION COURT
( 1 & sq•ft.
OTHER .. '$" sq.ft.
TOTAL STRUCTURES ON PAD NO. 1 (o, 431 sq.ft.
% BUILDING PAD COVERAGE 2%•85 %
PAD NO. 2 P4e1-•
BUILDABLE PAD AREA /. Pi79 sq.ft.
RESIDENCE 4 sq.ft.
GARAGE . • -e' sq.ft.
STABLE (BARN) 19" sq.ft.
POOL P- SPA q 70 sq.ft.
RECREATION COURT
( ) -66 sq.ft.
OTHER 4' sq.ft
TOTAL STRUCTURES ON PAD NO. 2 6170 sq.ft.
BUILDING PAD COVERAGE 5 %•q+ %
sq.ft.
sq.ft.
sq.ft.
sq.ft.
sq.&
DATE'///07 ZONING CASE NO.:
ADDRESS % ✓GN'S CAA!yoi
APPLICANT I90P/14AN
CALCULATION OF BUILDING PAD COVERAGE
PAD NO.3 %NMS Gji/I2T
BUILDABLE PAD AREA gi G
RESIDENCE $
GARAGE
STABLE (BARN) -&
POOL
RECREATION COURT
reNNi 5 sq.ft.
nit- . .
TOTAL STRUCTURES ON PAD NO. 1 ?) 30 sq.ft.
% BUILDING PAD COVERAGE . 761. 67. 3 %
pAD NO. 4 4r
BUILDABLE PAD AREA
RESIDENCE
GARAGE
STABLE (BARN)
POOL
RECREATION COURT
OTHER
•
437/
558
sq
sq.it.
sq.R
sq.ft.
sq.R
sq.ft.
.g. sq.ft.
TOTAL STRUCTURES ON PAD NO. 2 sq.ft.
% BUILDING PAD COVERAGE 40. 7 %
• •
MAXIMUM DISTURBED AREA:
BUILDING PAD = 23,094 SF
TENNIS COURT = 7,030 SF
STABLE = 558 SF
POOUSPA/DECKING = 1,517 SF
DRIVEWAYS = 4,702 SF
WALKWAYS = 1,176 SF
RESIDENCE = 318 SF
TOTAL = 38,395 SF
38.395
75,496 = 50.8% VARIANCE REQUIRED
MAR-13-2002 WED 07:35 AM BRj NT PALMER SOTO INC FAX NO. 310 325 0271 P. 02
OWNER'S A_CJCNOVVLEDGEMENT
Property development in Rolling Hills is govemed 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 fol.
I, (We), the undersigned, acknowledge that the above statement has been fully read and its
admonition is completely understood.
Executed at
/l'44'4
, California
this /.? A • day of 41, e# , 20 D2 __
/ tyfvs Gf4 y,✓ ed.
Address /
City /
MAR-13-2002 WED 07:35 AM B NT PALMER SOTO INC FAX NO. .310425 0271 P. 03
Az.; # de/Wsdefrws etule. .. J/414Aef/ps.v c6.
OWNER'S DECLARATION
I (We) declare under penalty of perjury that the foregoing is true and 'correct.
Executed at
Ye)/47 /1//4-
this /, j 144 day of /fAletai
By:
, California,
,20D2•
-
hi s C,tc,,,w-" oed
Address
£o.//, 9 'CCS
City
NOTE: The Owner's Declaration can only be used if this application is signed in Calijornia. 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 office; 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
REPRESENTATIVE: FEE:
COMPANY NAME: RECEIPT NO:
COMPANY ADDRESS: BY:
ZONING CASE NO
TENTATIVE HEARING DATE:
COMPANY PHONE NO. ( )
PROJECT ADDRESS:
_..MAR-13-2002 WED 07:35 AM BRYANT PALMER SOTO INC
FAX NO. 310 325 0271 P. 02
• •
4 2 * 4 , ,v min e .
,-✓' /0" fM'v % el? A/ 74 Vi1j% ,.
OWNER'S ACKNOWLEIX MRNT
Property development in Rolling Hills is govemed 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 fat.
I, (We), the undersigned, acknowledge that the above statement has been fully read and its
admonition is completely understood.
Executed at 40o/i /'/4- , California
this / ? 0 • day of /Yf,4_iLGi/ , 20 d 2_...
/ . s44''4/.
Address
Cio/I i►s /�S
Y
MAR-13-2002 WED 07:35 AM BRYANT PALMER SOTO INC FAX NO. 310 325 0271
•
A : #1 oloppvs el -Nye -kJ' • #'P'n "�;..r���N�E.
f„-.. cr/f-e /eLi-4/ 17-e01.1/
OWNER'S DECLARATION
P. 03
I (We) declare under penalty ofperjury that the foregoing is true and correct.
Executed at �pyli ifi his' , California,
,20 O2—
this /� 144 day of ',gotta/
By:
/ 7 '4's eiPe we, X'.✓
Address •
City /
NOTE: The Owner's Declaration can only be used f this application is signed in California. 1f 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
REPRESENTATIVE: FEE:
COMPANY NAME: RECEIPT NO:
COMPANY ADDRESS: BY:
ZONING CASE NO
TENTATIVE HEARING DATE:
COMPANY PHONE NO. ( )
PROJECT ADDRESS:
A
City (PI Rotting _AIL
ENVIRONMENTAL INFORMATION FORK(
(To Be Completed By Applicant)
INCORPORATED JANUARY 24, 1957
NO. 2 PORTUGUESE BEND ROAD
ROLLING HILLS, CALIF. 90274
(310) 377-1521
FAX (310) 377-7288
E-mail cltyofrh@aol.com
Date Filed Zoning Case No.
GENERAL INFORMATION
1. Applicant(s) /6 _ n'i, /* in ✓ Tel. (3/0 ) 371 ' .YG6
Go /etlrlf' 4uf.t, /Z /F.fk, re•y9'A./'L' J b're•
Address plc ,r �` .7 o fo�1-N �- •
ti 90r0 s.
2. Legal Owner(s) G/C//6 r h'Nlizy thPm/Y%-i Tel. (3f0 .�
'-i GiTeW.. 4/-/v>/40j •
Address
3. Project Address d'/tN1 c J /O n/ ,t .
Assessor's Book No. r/ - %/1 - T� / Lot No. '
4 Oth Iated permits and other public approvals required for this project, including those required
by ci egional, state and federgl agencies:
if r6 /1-4/J A6-✓/�11/. 11/1-/z 4-At , /3y/ Ln PE/ztvl /r.r
5. Existing zoning district
6. Proposed project/use of site Xs00/T/e''`r Tv �ir'/IT/^46 AV /1 Gr✓
PROJECT DESCRIPTION GI
7. Site size i!tiG ? ,4->✓ . 98 , Pro c j
8. Net lot area 75/ 1-9Co -5g "Net Lot Area" means the total area included within the lot lines of
the lot or parcel of property, exclusive of: (a) the entire area within a recorded roadway easement
plus the area within ten (10) feet measured perpendicular to the edge of the roadway easement;
(b) the ten (10) foot perimeter of the lot perpendicular to the property lines; (c) any private drive or
driveway that provides access to any other. lot or parcel; and (d) the access strip portion of a flag
lot."
9. Total square footage of structures
10. Number of floors of construction
11. Basement square footage
q9S /tI L- reAw1 cov/4,, tot JfA-rsL-6
og* • CO )
/4/1 (0)
February 2002
Environmental Information Form
I-1
®P, .+iprl un Fiery, latl I+nl �+•�
• •
12. Total combined flatwork and structural lot coverage `2A 3 kg 5fr (31% 92 °/r,
13. Will any exterior walls be removed or relocated? Which walls? MC- 7- Ar6/47,t- w91-t C T1-vp
9v f�Xl t W6 it
14. Will any interior walls be removed or relocated? Which walls? X .0 lveST FNo f'I i enw-, N/N6)
15. Will the entire building structure require a new roof? 1/O'
16. WIII the existing roof remain intact, with less than 200 square feet added? tea"///ry' /S
17. Driveway Access and Parking: h40,c,. 74p l�F'
a. Is a new driveway accessway proposed? iv'a • (Requires Traffic Commission Review).
fro ajl:
b. Number of driveway(s) Existing? 'Ji rryjL-6- • Proposed? '4 6-
(Second driveway requires approved Conditional Use Permit from Planning Commission).
c. Width of driveways) Existing? Vi4� les • � � 'Proposed? -r 'c'
(Maximum of 20 foot width unless approved by the Planning Commission).
d. Does first 20 feet of driveway have a maximum grade of 7%?
(Maximum of 7% for first 20 feet of driveway required). ` Existing? Proposed? 117116 .
e. Grade of drivewa s ? Existin ?' -t Z ,6 • 7i. ? _ •
Y() g Sir9eL'' Proposed?
(Maximum of 12% unless approved by the Plannirig Commission). /a, ,-04.-,rt# . a.
f. Has site plan been reviewed by Los Angles County Fire Protection Engineer to meet
current driveway access requirements? N° '
Explain CX./f!r/A/L ?d Amy/AJ• Atfvm C eA.e✓/Ov1 41PF-e",;(1.--t
Does driveway cover more than a maximum 20% of the area of the yard in which it is
located? //n •
Explain
h. Does uncovered parking prea cover more than a maximum 10% of the area of the yard in
which it is located? Al
Explainpl�
i. sac vehicular accessway to stable and corral have a maximum slope of 25% or
less? Y C. Stable and corral average vehicular access slope /o%. • .
j. Does property have an above ground garage with a minimum capacity of
2 cars? YtS With guest house a minimum of 3 rs? b'/
lei • f'�Paf6Q G�i- 6� /�v�T/o�►-�. lc,�c�fp-ia,6 ,lice-&Zw4.`� �s1,n�fr✓6.
18. Grading quantities shall be balanced. Amount cut 4-7r e. . . Amount fill 7 e
(Include any basement cut in grading quantities).
19. Area of disturbance. 40% of net lot area maximum; any remedial grading (temporary disturbance),
any graded slopes and building pad areas, and any nongraded area where impervious surfaces
will remain or areproposed to be added.
Square feet B . Percentage of Net Lot Area 50•8 c/
g•
20. If residential, include the unit size. Square feet
S Gc-/ 'r fiX0fE,5.
February 2002
Environmental Information Form
1-2
• •
• 21. 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.
WA-
22. If industrial, indicate the type of project, estimated employment per shift, and loading facilities.
23. If institutional, indicate the major function, estimated employment per shift, estimated occupancy, •
loading facilities, and community benefits to be derived from the project.
24. Attach plans.
25. Proposed scheduling. ft 'r GoA✓tfr. joy, i .. -6D
26. If the project Involves a site plan review, variance, conditional use or rezoning application, state
this and indicate clearly why the application is required.
d/T/ 4iI ,'- VJ . 4'a /17t#n! ' jS. /ern `fA.
✓fi-fLi,4N - ; sA- o, ..P/1Tde2,6r9i1/4(e-e
er- eh,70 I14-)o/ vn/t— •
(‘1011774,4 s o/,) ,
ENVIRONMENTAL SETTING
27. Describe the project site as it exists before the project, including information on topography, soil
stability, plants and animals, and any cu4iral, 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.
t/T& /S 4- v. yr ,• . I'/ f wf1-H-
Lxi'r/,46Ani,r &, ,VN/1 Cd244.9.- screw ye-..
/.A 1efs/i6 /t m,q V, & Aivi cwdqcSt'i 7,- E r/5•
5/ r /.vim b s 41.' Y M ofr .*
Vo6er/i-veAl.
February 2002 .
Environmental Information Form
1-3
• •
28. 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.
f d6 .g ivl /may ,g-A( h -- STY4-6 m
• Mi4- 4& L Se-ri''/d6.,
l am: / /6-/6 ,0c I 4161 49,v h h c y Se& aleip
oerrs f vi6l friw-y," 7 'e k .N iej
29. Is the proposed project consistent with:
City of Rolling Hills General Plan
Applicable Specific Plan
City of Rolling Hills Zoning Ordinance
South Coast Air Quality Management Plan
Congestion Management Plan
Regional Comprehensive Plan
30. Have any of the following studies been submitted?
_ Geology Report
_ Hydrology Report
_ Soils Report
Traffic Study
Noise Study
Biological Study
_ Native Vegetation
Preservation Plan
_ Solid Waste Generation Report
_ Public Services/
Infrastructure Report
1-4
No WA
Nor Ajec &-fre9 y
_ Historical Report
_ Archaeological Report
_ Paleontological Study
_ Line of Sight Exhibits
Visual Analysis
_ Slope Map
_ Fiscal Impact Analysis
_ Air Quality Report
_ Hazardous Materials/
Waste
February 2002
Environmental Information Form
• •
EVALUATION OF ENVIRONMENTAL IMPACTS:
1 A brief explanation is required for all answers except ."No Impact' answers that are adequately
supported by the information sources a lead agency cites in the parentheses following each
question. A "No Impact" answer is adequately supported -the referenced information sources
show that the impact simply does not apply to projects like the one involved (e.g. the project falls
outside a fault rupture zone). A "No Impact" answer should be explained where It is based on
project -specific factors as well as general standards (e.g. the project will not expose sensitive
receptors to pollutants, based on a project -specific screening analysis).
2. All answers must take account of the whole action involved, including off -site as well as on -site,
cumulative as well as project -level, indirect as well as direct, and construction as well as operational
impacts.
3. Once the Lead Agency has determined that a particular physical impact may occur, then the
checklist answers must indicate whether the impact is potentially significant, less than significant
with mitigation, or less than significant. "Potentially Significant Impact" is appropriate if there is
substantial evidence that an effect may be significant. If there are one or more "Potentially
Significant Impact' entries when the determination is made, an EIR is required.
• 4. "Negative Declaration: Less Than Significant With Mitigation Incorporated" applies where the
incorporation of mitigation measures has reduced an effect from "Potentially Significant Impact" to
a "Less Than Significant Impact." The Lead Agency must describe the mitigation measures, and
briefly explain how they reduce the effect to a less than significant level (mitigation measures from
Section XVII, "Earlier Analyses," above may be cross-referenced).
5. Earlier analyses may be used where, pursuant to the tiering, program EIR, or other CEQA
process, an effect has been adequately analyzed in an earlier EIR or negative declaration. See
State CEQA Guidelines Section 15063(c)(3)(D). In this case, a brief discussion should identify
the following:
a. Earlier Analysis Used. Identify and state where they are available for review.
b. Impacts Adequately Addressed. Identify which effects from the above checklist were within
the scope of and adequately analyzed in an earlier document pursuant to applicable legal
standards, and state whether such effects were addressed by mitigation measures based on
the earlier analysis.
c. Mitigation Measures. For effects that are "Less Than Significant With Mitigation Measures
Incorporated," describe the mitigation measures which were incorporated or refined from the
earlier.document and the extent to which they address site -specific conditions for the project.
6. Lead agencies are encouraged to incorporate into the checklist references to information sources
for potential impacts (e.g., general plans, zoning ordinances). Reference to a previously prepared
or outside document should, where appropriate, include a reference to the page or pages where
the statement is substantiated.
7. Supporting Information Sources: A source list should be attached, and other sources used or
individuals contacted should be cited in the discussion.
8. This is only a suggested form, and lead agencies are free to use different formats; however, lead
agencies should normally address the questions from this checklist that are relevant to a project's
environmental effects in whatever format is selected.
9. The explanation of each issue should identify:
a. the significance criteria or threshold, if any, used to evaluate each question; and
b. the mitigation measure identified, if any, to reduce the impact to less than significance.
February 2002
Environmental Information Form
1-5
• •
1
Issues:
PotentiaAy Lass Than
With Less Than
Sifgrt�pificantactMitigation g=
Sint
. L AESTHETICS,— Would the project:
a) Have a substantial adverse effect on a scenic vista? 0 0
b) Substantially damage scenic resources, including but 0 0
not limited to, trees, rock outcroppings, and historic
buildings within a state scenic highway?
c) Substantially degrade the existing visual character or .0 0 0
quality of the site and its surroundings?
d) Create a new source of substantial Tight or glare which 0 0 0I<
would adversely affect day or nighttime views in the
area?
No'
Impact
IL AGRICULTURE RESOURCE2:
In determining whether impacts to agricultural 0 0 0 >4r.
resources are significant environmental effects, lead
agencies may refer to the California Agricultural Land
Evaluation and Site Assessment Model (1997)
prepared by the California Dept. of Conservation as an
optional model to use in assessing impacts on
agriculture and farmland. Would the project:
a) Convert Prime Farmland, Unique Farmland, or 0 0 0
Farmland of Statewide Importance (Farmland), as
shown on the maps prepared pursuant to the
Farmland Mapping and Monitoring Program of the
Califomia Resources Agency, to non-agricultural use?
b) Conflict with existing zoning for agricultural use, or a 0 0 0
41(
Williamson Act contract?
c) Involve other changes In the existing environment 0 0 0
')<
which, due to their location or nature, could result in
conversion of Farmland, to non-agricultural use?
IL AIR QUALITY —Where available, the significance
criteria established by the applicable air quality
management or air pollution control district may be
relied upon to make the following determinations.
Would the project:
a) Conflict with or obstruct implementation of the 0 0 CI
applicable air quality plan?
February 2002
Environmental Information Form
1-6
Potenti_My Significant VVIth LASS Than
( S� No
Impact
b) Violate any air quality standard or contribute ❑ ❑ ❑A/
substantially to an existing or projected air quality •
violation?
c) Result in a cumulatively considerable net increase of 0 0 0A/
any criteria pollutant for which the project region is
non -attainment under an applicable federal or state
ambient air quality standard (including releasing
emissions which exceed quantitative thresholds for
ozone precursors?
d) Expose sensitive receptors to substantial pollutant 0 0 0
al‹.
concentrations?
e) Create objectionable odors affecting a substantial 0 0 0
number of people?
1Y. BIOLOGICAL RESOURCES — Would the
project:
a) Have a substantial adverse effect, either directly or
through habitat modifications, on any species
identified as a candidate, sensitive, or special status
species In local or regional plans, policies, or
• • regulations, or by the Califomia Department of Fish
and Game or U.S. Fish and Wildlife Service?
b) Have substantial adverse effect on any riparian habitat
or other sensitive natural community identified in local
or regional plans, policies, regulations or by the
Califomia Department of Fish and Game or U.S. Fish
and Wildlife Service?
c) Have a substantial adverse effect on federally
protected wetlands as defined by Section 404 of the
Clean Water Act (including, but not limited to, marsh,
vemal pool, coastal, etc.) through direct removal,
filling, hydrological interruption, or other means?
d) Interfere substantially with the movement of any native
resident or migratory fish or wildlife species or with
established native resident or migratory wildlife
corridors, or impede the use of native wildlife nursery
sites?
e) Conflict with any policies or ordinances protecting
biological resources, such as a tree preservation
policy or ordinance?
f) Conflict with the provisions of an adopted Habitat
Conservation Plan, Natural Community Conservation
Plan, or other approved local, regional, or state
habitat conservation plan?
❑ ❑ ❑
.,,,
❑ ❑ 0
.(.
=‹❑ ❑ ❑
❑ ❑ , ❑
„,-
❑ ❑ ❑
,,,,
❑ ❑ ❑
1-7
February 2002
Environmental Information Form
• •
Pc'ene'
Lees Than
Significant VVith
Mitigation
l,ca��tiu��
Less Than.
ImpactSignificant No
y1 CULTURAL RESOURCES — Would the project:
a) Cause a substantial adverse change in the significance 0 ❑ O
of a historical resource as defined in §15064.5 of the
State CEQA.Guidelines?
b) Cause a substantial adverse change in the 0 0 0
significance of an archaeological resource pursuant to
§15064.5 of the State CEQA Guidelines?
c) Directly or indirectly destroy a unique paleontological 0 0 0
resource or site or unique geologic feature?
d) Disturb any human remains, including those interred 0 ❑ ❑
outside of formal cemeteries?
yj, GEOLOGY AND SOILS — Would the project:
a) Expose people or structures to potential substantial
adverse effects, including the risk of Toss, injury, or
death Involving:
i) Rupture of a known earthquake fault, as delineated ❑ 0 0
Kt
on the most recent Alquist-Priolo Earthquake Fault
Zoning Map issued by the State Geologist for the
area or based on other substantial evidence of a
known fault? Refer to Division of Mines and Geology
Special Publication 42.
'.ii) Strong seismic ground shaking? 0 0 0
iii) Seismic -related ground failure, including 0 ❑ 0
liquefaction?
iv) Landslides? 0 0 0 ) I ( 11\ _ ,
b) Result in substantial soil erosion or the loss of topsoil? 0 0 0
c). Be located on a geologic unit or soil that is unstable, 0 0 0
or that would become unstable as a result of the i
project, and potentially result in on- or off -site
landslide, lateral spreading, subsidence, liquefaction f
or collapse?
d) Be located on expansive soil, as defined in Table 18- 0 0 0 4
1 B of the Uniform Building Code (1994), creating
substantial risks to life qnd property?
icto .
e) Have soils incapable of adequately supporting the 0 0 ❑
use of septic tanks or alternative waste water disposal
systems where sewers are not available for the
disposal of waste water?
February 2002
Environmental Information Form
1-8
. ID
an
Potentially Significant
W Less Then
Significant M Ssacjnt
Impact ImNo
pact
Y11. bAZARDS AND HAZARDOUS MATERIALS -
Would the project:
a) Create a significant hazard to the public or the 0 ❑ 0
environment through the routine transport, use, or
disposal of hazardous materials?
b) Create a significant hazard to the public or the 0 ❑ 0 .1(
environment through reasonably foreseeable upset
and accident conditions involving the release of
hazardous materials into the environment?
c) Emit hazardous emissions or handle hazardous or 0 0 0 ,
acutely hazardous materials, substances, or waste
within one -quarter mile of an existing or proposed
school?
d) Be located on a site which Is included on a list of 0 0 0
hazardous materials sites compiled pursuant to
Govemment Code Section 65962.5 and, as a result,
would it create a significant hazard to the public or the
environment? /'
e) For a project located within an airport land use plan 0 0 0 /i
or, where such a plan has not been adopted, within
two miles of a public airport or public use airport,
. would the project result in a safety hazard for people
residing or working in the project area/
f) For a project within the vicinity of a private airstrip, 0 0 0
' would the project result in a safety hazard for people
residing or working in the project area? •
g) Impair implementation of or physically interfere with an 0 0 0'4(
adopted emergency response plan or emergency
evacuation plan?
h) Expose people or structures to a significant risk of ❑ 0 0
4C-(P
loss, injury or death involving wildland fires, including
• where wildlands are adjacent to urbanized areas or i
where residences are intermixed with wildlands?
February 2002
Environmental Information Form
1-9
Less lban
P°tentialYsignrmi Significant
Mitigation
. 'Wad
Less Than
Sig=
yfjl. HYDROLOGY AND WATER QUALITY —
Would the project:
a) Violate any water quality standards or waste discharge ' D 0 0
requirements?
b) Substantially deplete groundwater supplies or
Interfere substantially with groundwater recharge
such that there would be a net deficit in aquifer
volume or a lowering of the local groundwater able
level (e.g., the production rate of preexisting nearby
wells would drop to a level which would not support
existing land uses or planned uses for which permits
have been granted?
c) Substantially alter the existing drainage pattern of the 0 D 0
site or areas including through the alteration of the
course of a stream or river, in a manner which would
result in substantial erosion or siltation on- or off -site?
d) Substantially alter the existing drainage pattern of the 0 0 0
site or areas including through the alteration of the
course of a stream or river, in a manner which would
result in flooding on- or off -site?
e) Create or contribute runoff water which would exceed 0 0 0
. the capacity of existing or planned storm water
drainage systems or provide substantial additional
sources of polluted runoff?
f) Otherwise substantially degrade water quality? 0 0 0
g) Place housing within a 100-year flood hazard area as D D 0
mapped on a federal Flood Hazard Boundary or Flood44
Insurance Rate map or other flood hazard delineation
map?
h) Place within a 100-year flood hazard area structures 0 0 0
.(.
which would impede or redirect flood flows?
i) Expose people or structures to a significant risk of loss, D 0 0
injury or death involving flooding, including flooding as
a result of the failure of a levee or dam?
j) Inundation by seiche, tsunami, or mudflow? 0 0 0
Irnpact
D D D
I - 1 0
February 2002
Environmental Information Form
• •
PolontiallY Sint with
SirtinPSImpact
ignificant
r.
�
IL J..AND USE AND PLANNING —Would the
project:
•
a) Physically divide an established community? ❑ ❑
b) Conflict with any applicable land use plan, policy, or
regulation of an agency with jurisdiction over the
project (including but not limited to the general plan,
specific plan, local coastal program, or zoning
ordinance) adopted for the purpose of avoiding or
mitigating an environmental effect?
c) Conflict with any applicable habitat conservation plan or' 0 04(
❑
natural community conservation plan?
❑ ❑ ❑
X, MINERAL RESOURCES —Would the project:
a) Result in the loss of availability of a known mineral 0 0 0)1(
resource that would be of value to the region and the
residents of the state?
b) Result in the Toss of availability of a locally -important 0 O 0
mineral resource recovery site delineated on a local .aok/
general plan; specific plan or other land use plan?
XI. NOISE —Would the project result in:
a) Exposure of persons to or generation of noise levels in 0 0 ❑
excess of standards established in the local general
plan or noise ordinance, or applicable standards of
other agencies?
b) Exposure of persons to or generation of excessive 0 ❑ 0)(1
groundbome vibration or groundbome noise levels?
c) A substantial permanent increase In ambient noise 0 0 0
levels in the project vicinity above levels existing
without the project?
d) A substantial temporary or periodic increase in ambient ( 0 0 0
noise levels in the project vicinity above levels
existing without tPAROci?t.,e04/sr/ .r/e7-iti /fc,nv/, 0Nk
e) For a project located within an airport land use plan or, 0 0 ❑
where such a plan has not been adopted, within two ' ac
miles of a public airport or public use airport, would
the project expose people residing or working in the
project area to excessive noise levels.
f) For a project within the vicinity of a private airstrip, would 0 0 0AC'
the project expose people residing or working in the
project area to excessive noise levels?
February 2002
Environmental Information Form
Less Than
with Less Than
S= Mitigation �Incorporation.• I
Xll. POPULATION AND HOUSING— Would the
project:
•
a) Induce substantial population growth in an area; either 0 ❑
directly (for example, by proposing new homes and
businesses) or indirectly (for example, through
extension of roads or other infrastructure)?
b) Displace substantial numbers of existing housing,
necessitating the construction of replacement
housing elsewhere?
c) Displace substantial numbers of people, necessitating ❑ ❑ 0
• the construction of replacement housing elsewhere?
mil. PUBLIC SERVICES
a) Would the project result in substantial adverse physical
impacts associated with the provision of new or
physically altered govemmental facilities, need for
new or physically altered governmental facilities, the
construction of which could cause significant
environmental impacts, in order to maintain
acceptable service ratios, response times or other
performance objectives for any of the public services:
❑ ❑ o
No
Impact
Fire protection? 0 0 0
Police protection? 0 0 0
Schools? 0 ❑ 0 >I-?''
Parks? ❑ 0 0
Other public facilities? 0 0 0
XIV, RECREATION
a) Would the project increase the use of existing
neighborhood and regional parks or other
recreational facilities such that substantial physical
• deterioration of the facility would occur or be
accelerated?
b) Does the project include recreational facilities or
require the construction or expansion of recreational
facilities which might have an adverse physical effect
on the environment?
❑ ❑ ❑'
❑ ❑ ❑
1-12
February 2002
Environmental Information Form
Fobintialy
�nt VVMh �r�ant
Impact
x/. TRANSPORTATION/TRAFFIC—Would the
project:
No
Impact
a) Cause an increase in traffic which is substantial in 0 0 ❑
relation to the existing traffic Toad and capacity of the
street system (i.e., result in a substantial increase in
either the number of vehicle trips, the volume to
• capacity ratio on roads, or congestion at
intersections?
b) Exceed either individually or cumulatively, a level of 0 0 0 kr
service standard established by the county,
congestion management agency for designated
roads or highways?
c) Result in a change in air traffic patterns, including either 0 0 0
an increase in traffic levels or a change in location that
results in substantial safety risks? •
d) Substantially increase hazards due to a design feature 0 0 0 .(
(e.g., sharp curves or dangerous intersections) or
incompatible uses (e.g., farm equipment)?
e) Result in inadequate emergency access? 0 0 0
f) Result in inadequate parking capacity? CI 0 Z1
g). Conflict with adopted policies, plans, or programs 0 0 0
supporting altemative transportation (e.g., but
turnouts, bicycle racks)?
)CVI‘ UTILITIES AND SERVICE SYSTEMS —
Would the project:
a) Exceed wastewater treatment requirements of the 0 0 0XI/1
applicable Regional Water Control Board?
b) Require or result in the construction of new water or 0 0 0A(
wastewater treatment facilities or expansion of
existing facilities, the construction of which could
cause significant environmental effects?
(
c) Require or result in the construction of new storm ❑ 0 0
• water drainage facilities or expansion of existing
facilities, the construction of which could cause
significant environmental effects?
d) Have sufficient water supplies available to serve the 0 0 0
project from existing entitlements and resources, or`e
are new or expanded entitlements needed?
1-13
February 2002
Environmental Information Form
•
SEentialy W Lees Than
Leis Then
S� Sit INo
mpact
e) Result in a determination by the wastewater treatment 0 .0 0
provider which serves or may serve the project that it
has adequate capacity to serve the project's
projected demand in addition to the provider's
existing commitments?
. f) Be served by a landfill with sufficient permitted capacity 0
to accommodate the project's solid waste disposal
needs?
O 0 O
g) Comply with federal, state, and local statutes and
regulations related to solid waste?
O ` OXre
XVII. STORM WATER OUg.ITY IMPACTS —Would
the project:
a) During construction result in potential impact on storm 0 0 0
water runoff?
b) Post -construction result in potential impact on storm • ❑ 0 0
• water runoff?
c) Result in potential for discharge of storm water from areas 0 0 0 Ar
from material storage, vehicle or equipment fueling,
vehicle or equipment maintenance (including washing),
waste handling, hazardous materials handling or
• _ storage, delivery areas or loading docks, or other outdo(
work areas?
d) Result in potential for discharge of storm water to impair 0 0 0 A(
the beneficial uses of the receiving waters or areas that
provide water quality benefit?
•
e) Result in potential for discharge of storm water to cause O 0 0
A('
significant harm on the biological integrity of the
waterways and water?
f) Result In potential for significant changes in the flow 0 0 0 Ar
velocity or volume of storm water runoff that can cause
environmental harm? ' )1(
g) Result in potential for significant increases in erosion of 0 0 ❑ the project site or surrounding areas?
February 2002
Environmental Information Form
1-14
Less Then
Significant With
Mitigation
XVIIIL MANDATORY FINDINGS OF
SIGNIFICANCE
a) Does the project have the potential 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
community, reduce the number or restrict the range
of a rare or endangered plant or animal or eliminate
important examples of the major periods of Califomia
history or prehistory? •
b) Does the project have impacts that are individually 0 0 0
limited, but cumulatively considerable?4)e
('Cumulatively considerable' means that the
incremental effects of a project are considerable
when viewed in connection with the effects of past
projects, the effects of other current projects and the
effects of probable future projects.)
c) Does the project have environmental effects which 0 0 0
will cause substantial adverse effects on human
dk°..
beings, either directly or indirectly?
Less Then
Si=
No
impact
February 2002
Environmental Information Form
1-15
NOTE: Before the Lead Agency can accept this application as complete, the applicant must consult the
lists prepared pursuant to Section 65962.5 of the Govemment 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 attematives proposed in this application are contained on the lists
compiled pursuant to Section 65962.5 of the Govemment Code. Accordingly, the project applicant is
required to submit a signed statement which contains the following information:
1. Name of applicant:
CA4--ia MAY ;MI-1114-4-1 •
2. Address: 41.7 SD4"(.r G'/D/✓ .,Q
Ad films)M , %�It�fii
3. Phone Number: .i 7 7
4. Address of Site (street name and number if available, and ZIP code):
e.ovyotr. AP
5. Local Agency (city/county):
G/7y
6. Assessor's book, page, and parcel number:
do•
7. Specify any list pursuant to Section 65962.5 of the Govemment Code: STATE OF
CALIFORNIA HAZARDOUS WASTE AND SUBSTANCES SITES LIST (available at
City Hall),
8. Regulatory identification number.
9. Date of List: JULY 1992
Date 1.13 • D'1/
Signature
14-err/f 01z,hn e-c A-/,- .
For 4.,/9-/ , f y nbf41i4-A/
Applicant
1-16
February 2002
Environmental Information Form
• •
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 Govemment Code, then the applicant must certify that fact as provided below.
I have consulted the: fists compiled pursuant to Section 65962.5 of the Govemment Code and hereby
certify that the development project and any alternatives proposed in this application are flat contained on
these lists.
Date
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 best of my ability, and that the
facts, statements, and information presented are true and correct to the best of my knowledge and belief.
Date
For
Signature
Applicant
February 2002
Environmental Information Form
1-17