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563, Construct an additional 2-car , ApplicationZ. Ana City 0/ VARIANCE REOUEST FOR HEARING. PROPERTY OWNER: MR . HOWARD H. HALL • INCORPORATED JANUARY 24, 1957 NO. 2 PORTUGUESE BEND ROAD ROLLING HILLS, CALIF. 90274 (310) 377-1521 FAX: (310) 377-7288 OWNER'S ADDRESS: 7 Portuguese Bend Road Rolling Hills,CA. TELEPHONE NO.: 377-9808 PROPERTY ADDRESS: 7 Portuguese Bpnr1 Rnad LEGAL DESCRIPTION: LOT NO. 41 ASSESSOR'S BOOK NO. PAGE PARCEL AGENT'S NAME: Richard M. Linde AIA Architect AGENTS ADDRESS: TELEPHONE NO.: 713 Calle Miramar Redondo Beach , CA. 375-0428 Describe in detail .the nature of the proposed use, including what aspects of the project require a Variance. A portion of the proposed remodeling and addition to this residence incorporates a partial ennlnsiirP of fh euigfing covered front porch_ This portico is approximately 5'-0" into the 50'-0" front setback. 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. The small area for the living room exstension into the existing front porch is in line with the existina walls of the residence front setback and therefore would.not apply to other property conditions. �• c •otl o^ a ,cvc i..,i P"4 n,., • • 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 The granting of this variance would not be detrimental to the community since the roof structure,columns and beam are existing in the front porch area. FILING FEE A filing fee must accompany the application. Make check payable to: THE CITY OF ROLLING HILLS. PROPERTY OWNER: OWNER'S ADDRESS: TELEPHONE NO: REOUEST FOR HEARING FOR SITE PLAN REVIEW Mrz • NowArzO Rat- L 1 t-►'UG u e-se ta►-112 (►a-2211- 41508 r?417 . rtwita PROPERTY'S ADDRESS: -] QORTOGtaSE 1-2 f2.0112 LEGAL DESCRIPTION: LOT NO. 41_. ASSESSORS BOOK NO. AGENT'S NAME: AGENT'S ADDRESS: TELEPHONE NO: PAGE PARCEL IZtG1-M7 M. L 1 t 112e Pt •1 • A • A.acN-rteCT --1 I G�LLE MIRI MAR- t7-Etbt4 f 3 tb) 3-1, -0 428 NATURE OF PROPOSED PROTECT Describe in detail the nature of the proposed project, including what aspects of the project require a Site Plan Review: -r�L chop e 9r2Oca:3S TO CoWSTt'w ext pt.) I.DD►7100,4- TU, D GM2 ACLPGE t -r14270- tMPt?CA:en epPNv P emshe-f to .►STtJG i7eSIDet-Ac Au ‘OGC2f7-0747. LivttaG PCLPzp• OF ►16S 17. SITE PLAN REVIEW CIFERIA • 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. '1"141% 142-121, OF oeu1•) Far?, T1-L19 olora, e,r, ADpt-4,10L -rA'C 6 i M- pipN Pt.sD 2ot,tt oar,iNAuCe, Z'f' tS 0•21002-E1131. wt"r44- TI f SuR2-Doi.+ploG prweri iss tg S1�I� Pt!(7 �-t25)*Cti 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. -The t%'b tp ND Gt2isint-'Ya t ND 1-1.1.Frt2eGDf w1t.1- 112.1--h 1Erv. 1 t wG 1 eti f-A 74t y pun ve1: -f-a-t-t a5 • 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. ►�D G r";Act 5G Pepu t a J . 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. pr-ietan -t7 pact] me:sr to L L L 1.5e'f I=Fp t -r -1-14FL rlrw fit! t711�� Vsa--1-1•-4t oa WI c tt- CAGa IT w lLt- pot G441►454. C 11A Cyl►D (L o P -r tif2_ Conrt in o p t-N . 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. -r . 'CZt7 +U t2AL L. ccue-rliir..� V-0R-TNFt PIRb z2 PtZlt,+f2C.1 t ,- t �',Cc bIo IutI.t otg.Low `tkaf2. /4.1..1.DtoPtbt.e 1 - Tµs API-prou1t4G . Tt-4� j.lh r2-2 G,Ppe =a 2- F:4.145r i t--% Nov N V u g q . $°/o I u W 44.4614. Gt -r 472. C1-ufZat PP P oL'Gul7XLa4,1Germ:3141E4, Fts00 t'Lp 1 'L. LI Lui +4 -r 4f2 004414evai Pa 'i-�'��i . 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: 13PCtt. Foty -r ( - tor!o pat?' eGrT P4 t • I-1afL G t4vi 101-1›t4LI41 Gr2-1+MsR,A p► t' U 4tt-t— pr a ep Fer7OLYS vf►D SPPGt� 1+ t S Gory) Pir't t3Le_ 4.31+4 l.71A - . 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. "Twig Friocivezo '12 J e-T u..) t L. 1. E1.p.k1 1-s t P z -r 61J -t- .t r L1 +io v N 1� L✓' A FOfy - PI P iZ rrz I ► S R t-e f% V a.la 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. 1.6 -f^NFi t 'T OF Duty- 1/-1ac .) Lris.34e , T1.14F. f 7 F-ac21t.G?' CouFotz 4 -ro -h+ C# t Farmst !- E.uutr tv i,I-*L— ecuA1i14H ACD, • • 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 correct to the best of my knowledge and belief. Date: Signature For: 12-I Cdl.P►'2Q M . L t 1,-11;r . Al 24.444 ie,C[' Applicant DATE BUILDING AREAS NET LOT AREA BUILDING PAD(S) RESIDENCE GARAGE ZOING CASE NO. ADDRESS 2" V bra unpr, APPLICANT MIS • 14a-1142P i4 CALCULATION OF LOT COVERAGE SWIMMING POOL/SPA STABLE (-urtl RECREATION COURT ( ) SERVICE YARD OTHER CO3RG H EXISTING 511- sq.ft. , S .2 sq.ft. 2-611 Z sq.ft. 4-1 sq.ft. sq.ft. 0 sq.ft. 0 sq.ft. a sq.ft. '.31 sq.ft. TOTAL STRUCTURES 4 b 5 0 sq.ft. % STRUCTURAL g , 3 % COVERAGE % TOTAL PAD O COVERAGE -3 DRIVEWAY /2 Z 0 (, sq.ft. PAVED WALKS AND PATIO AREAS 114- sq.ft. POOL DECKING b sq.ft. TOTAL FLATWORK 2q $O sq.ft. % TOTAL FLATWORK COVERAGE (o . I % TOTAL STRUCTURAL & FLATWORK COVERAGE —1030 sq.ft. % TOTAL COVERAGE 1 4-. 4- % PROPOSED TOTAL sq.ft. 48,sq.ft. D sq.ft. 4$, ?- sq.ft. ('J 6 It 116 $ sq.ft. ' 40 sq.ft. 53 3 sq.ft. /3sq.ft. o sq.ft. D sq.ft. 43 0 sq.ft. sq.ft. 0 sq.ft. 10 0 sq.ft. 430 sq.ft. 328( sq.ft. b sq.ft. 100 sq.ft. 430 sq.ft. —It CO sq.ft. 1h•.Co % %O %D • 15`(5 sq.ft. '31 S1 sq.ft. 22 2. sq.ft. sq.ft. sq.ft. o sq.ft. 11611 sq.ft. 4-•i'11 sq.ft. 3.1 % G1 • `tom % 445 41 sq.ft. 10.0% 11. ' 11 sq.ft. 'Z4.4• % DATE ZON NG CASE NO. ADDRESS uGiu 1N V2 C7 APPLICANT to t*arZQ CALCULATION OF BUILDING PAD COVERAGE PAD NO. 1 BUILDABLE PAD AREA sq.ft. RESIDENCE 414-0 sq.ft. GARAGE 13go sq.ft. STABLE (BARN) lk **D sq.ft. C Fu iv ttt- POOL D sq.ft. RECREATION COURT OTHER sq.ft. 5 3 a sq.ft. TOTAL STRUCTURES ON PAD NO. 1 t OD sq.ft. % BUILDING PAD COVERAGE 4 . Co % PAD NO. 2 MA, BUILDABLE PAD AREA sq.ft. RESIDENCE sq.ft. GARAGE sq.ft. STABLE (BARN) sq.ft. POOL sq.ft. RECREATION COURT ( ) sq.ft. OTHER sq.ft. TOTAL STRUCTURES ON PAD NO. 2 sq.ft. % BUILDING PAD COVERAGE OWNER'S DECLARATION I (We) declare under penalty of perjury that the foregoing is true and correct. Executed at A2,e6 G1 , , California, this GJ day of ,, ,, , 199 -7 By: By: _ 1)Q ,"% -ems'' Qfn,6� Address (1L0O-'- 7 h-i 7 cll.- 41 D-71/ 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: , ^-(-� 7J fkm DATE FILED 7`y hi REPRESENTATIVE: E,c 'd ucLle, FEE: 0214 afet,cc(A 11176-6 f p LI COMPANY NAME: Ett c_k41.p_e . RECEIPT NO: 6 496 COMPANY ADDRESS: BY: GIMvt, ZONING CASE�: 5�3 TENTATI7 HEARING DATE: COMPANY PHONE NO. ( PROJECT ADDRESS: s' I 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 � this /� /.L .day of � — p By: By: , California ,19q c)/hle---/- Address /V/661- City/ eOa 74( c,Ey ofia ern9 JUL ENVIRONMENTAL INFORMATION FORM (To Be Completed By Applicant) Date Filed e4 A P&.tv`h 3'/4 /1 / Zoning Case No. 563 GENERAL INFORMATION. 1. Applicant(s) M2 , HOW to t-2 o }-4 A Lt— Tel. (3 t D) 3+i "� -- 61508 Address 1 f Ot2T(i G lI as e caEhJ t' (?OAD IZoLL1t 1.'1G 14-t Ll- 9 2 Legal Owner(s) PME AS A tl i< Tel. ( ) Address 3. Project Address 7 F O 2.-Toc l e l'E X7 f20Pt7 Assessor's Book No. Lot No. *I • INCORPORATED JANUARY 24, 1957 NO. 2 PORTUGUESE BEND ROAD ROLLING HILLS, CALIF. 90274 (310) 377-1521 FAX: (310) 377-7288 E-mail: cityofrh@aol.com 4. Other related permits and other public approvals required for this project, including those required by city, regional, state and federal agencies: 4-1 orne A. ix'.-i oat 1 C) (4f204-1-I✓ eG- (24L.r Ca m rodirz*) 5. Existing zoning district 6. Proposed project/use of site ,t7r7t-1't b [ e't 1tGt. Ce- PROJECT DESCRIPTION 7. Site size G-t 1-743g ; (L ► 424-/tc) 6 2, 521 S , i✓ 8. Net lot area 1,I Ipt . "Net Lot Area" means the total area included within the lot lines of a 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 , • (E7.19'Cia. 1100 •F (RzoR:egt ) 10. Number of floors of construction 11. Basement square footage C 12. Total combined flatwork and structural lot coverage 1(1 131'•7 ' ' P 13. Will any exterior walls be removed or relocated? Which walls? f)O12r - twoVt---M/ lz¢ 5. ' . 14. Will any interior walls be removed or relocated? Which walls? M<9Tls tZ tr► . 15. Will the entire building structure require a new roof? YE9 4-15-97 -1- ®P.rr.tpri (Jr! ' • ! 16. Will the existing roof remain intact, with Tess than 200 square feet added? t.1O 17. Grading quantites shall be balanced. Amount cut n Amount fill 0 (Include any basement cut in grading quantities.) 18. Area of disturbance. 40% maximum; any remedial grading (temporary disturbance), any graded slopes and building pad areas, and any nongraded area where impervious surfaces will remain or are proposed to be added. Square feet (j Percentage of Net Lot Area 19. If residential, include the unit size. Square feet 4'14'0 S. F • 20. 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. 21. If industrial, indicate the type of project, estimated employment per shift, and loading facilities. 15 22. If institutional, indicate the major function, estimated employment per shift, estimated occupancy, loading facilities, and community benefits to be derived from the project. AI • 23. Attach plans. 24. Proposed scheduling. ' /+AtDt CONS--r.uc,4irn. 1GURg 25. If the project involves a site plan review, variance, conditional use or rezoning application, state this and indicate clearly why the application is required. Gt-t !r 4. 0 0vV tv.u) 1Z REepu t ►27 - F 47 A riv-t-►a ID t g &. loOC) S, F . Are the following items applicable to the project or its effects? Discuss below all items checked yes (attach additional sheets as necessary). YES .2 26. Change in existing features of any bays, tidelands, beaches, lakes or hills, or substantial alteration of ground contours. 27. Change in scenic views or vistas from existing residential areas or public lands or roads. 28. Change in pattern, scale or character of general area of project. -2- YES NQ X 29. Significant amounts of solid waste or litter. )( 30. Change in dust, ash, smoke, fumes, or odors in vicinity. ,)( 31. Change in ocean, bay, lake, stream or ground water quality or quantity, or alteration of existing draining patterns. A. 32. Substantial change in existing noise or vibration levels in the vicinity. X_ 33. Site on filled land or on slope of 10 percent or more. )C 34. Use or disposal of potentially hazardous materials, such as toxic substances, flammable or explosives. 1_ ' 35. Substantial change in demand for municipal services (police, fire, water, sewage, etc.). A. 36. Substantially increased fossil fuel consumption (electricity, oil, natural gas, etc.). )( 37. Relationship to a larger project or series of projects. ENVIRONMENTAL SETTING 38. 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. __ z -ropy G al..F‘41.1 or SAe - 0114veR- fi1� P►� ta91.r k• ► % ►.9 f2C-C t►C2(.1 Fop_ ' -- on -At ► 060 e. , rze i awl-,cr 14447 .AfLaGPL 13-114.a Lu ►—rl—U Muam) aAS , w pL.44 aufl 'LP1,-5O SC pi v..1 39. 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 (me -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. T%-t t 5 1G h Co tZprs 2 - Lu I TU p.I.aCA`w I4-1- r.(Z-- CA i.+yoa t2 't sour K aziouc' r - t?v.At A q►ott - T'aC1 ' ►,GLtd. Pt* M1 L�l 1 t c i , . 714 •'tut U(2 2OU 1)-s A t2e-- �?t N' 4i-a r -3- • ENVIRONMENTAL IMPACTS (Please explain all "yes" and "maybe" answers on separate sheets.) 40. Earth. Will the proposal result in: a. Unstable earth conditions or in changes in geologic substructures? b. Disruptions, displacements, compaction or overcovering of the soil? 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 earthquakes, landslides, mud slides, ground failure, or similar hazards? 41. Air. Will the proposal result in: a. Substantial air emissions or deterioration of ambient air quality? b. The creation of objectionable odors? c. Alteration of air movement, moisture or temperature, or any change in climate, either locally or regionally? 42. Water. Will the proposal result in: a. Changes in currents, or the course or direction of water movements, 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? YES MAYBE NQ X_ 4 X X -4- • • YES MAYBE NI f. Alteration of the direction or rate of flow of ground waters? _ _ i<. 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? Significant changes in the temperature, flow, or chemical content of surface thermal springs? J. 43. Plant Life. Will the proposal result in: a. Change in the diversity of species, or number of any species of plants (including tress, shrubs, grass, crops, microflora and aquatic plants)? 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 existing species? X X d. Reduction in acreage of any agricultural crop? _ X 44. Animal Life. Will the proposal result in: a. Change in the diversity of species, or numbers of any species or numbers of any species of animals (birds, land animals including reptiles, fish and shellfish, benthic organisms, insects or microfauna)? 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 movement of animals? d. Deterioration to existing fish or wildlife habitat? 45. Noise. Will the proposal result in: a. Increases in existing noise levels? b. Exposure of people to severe noise' levels? 46. Lieht and Glare. Will the proposal produce new light or glare? 47. Land Use. Will the proposal result in a substantial alteration of the present or planned land use of an area? -5- • • 48. 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? 49. Risk of Unse4. Will the proposal involve: a. A risk of an explosion or the release of hazardous substances (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 emergency evacuation plan? 50. Population. Will the proposal alter the location, distribution, density, or growth rate of the human population of an area? 51. Housing. Will the proposal affect existing housing, or create a demand for additional housing? 52. Transportation/Circulation. Will the proposal result in: a. Generation'of substantial additional vehicular movement? b. Effects on existing parking facilities, or demand for new parking? c. Substantial impact upon existing transportation systems? d. Alterations to present patterns of circulation or movement of people and/or goods? e. Alterations to waterborne, rail or air traffic? f. Increase in traffic hazards to motor vehicles? 53. 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? e. Maintenance of public facilities, including roads? f. Other governmental services? YES MAYBE NQ x x y x x -6- 54. Energy. Will the proposal result in: a. Use of substantial amounts of fuel or energy? b. Substantial increase in demand upon existing sources of energy, or require the development of new sources of energy? 55. 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? f. Solid waste and disposal? 56. Human Health. Will the proposal result in: a. Creation of any health hazard or potential health hazard excluding mental health? b. Exposure of people to potential health hazards? 57. 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? 58. Recreation. Will the proposal result in an impact upon the quality or quantity of existing recreational opportunities? 59. 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? c. Does the proposal have the potential 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? YES MAYBE NQ x x -7- • • YES MAYBE _IQ 60. 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 California history or prehistory? b. Does the project have the potential to achieve short-term, to the disadvantage of long-term, environmental 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 environmental effects which will cause substantial adverse effect on human beings, either directly or indirectly? -8- 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 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. I-IZARDOUS 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: M i�z . 1-40W A412-'D 4 k-► L 2. Address: % Pbrztuque. 'QDPc,. Poi-L1 NG N'L1,9 , Gra 3. Phone Number: (.510) 3T ^ a SO b' 4. Address of Site (street, name and number if available, and ZIP code): % ft,t2--ro6u e,awl7 12C4Pi7 Tol 1. l G h� 1 L+9 Gam-. o2i �1-- • 5.. Local Agency (city/county): 20U-4 Oi.,s, l--k-1LL `3 CL • N. 6. Assessor's book, page, and parcel number: 7. Specify any list pursuant to Section 65962.5 of the Government 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 a lcJcr Signature' For Applicant v -9- 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 nit contained on these lists. Date Signa For Applicant 40, 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 forms\environm.app IQ cr Signature For Applicant -10-