525, Construct a stable, corral & d, ApplicationCi1 0/ ie0m Jh/i,
REOUEST .FOR HEARING
CONDITIONAL USE PERMIT
INCORPORATED JANUARY 24, 1957
NO. 2 PORTUGUESE BEND ROAD
ROLLING HILLS, CALIF. 90274
(310) 377.1521
FAX: (310) 377.7288
PROPERTY OWNER: fA e1 rD is P, QA T 01)12. N 1 G 2
OWNER'S ADDRESS: 3 (� �2 �S 1�n \- ,G
TELEPHONE NO: 5 4.1- 473 9 Q
PROPERTY'S ADDRESS: Cl c- Asa, nj
LEGAL DESCRIPTION: LOT NO. 9' J1 -D
ASSESSORS BOOK NO.15 V' PAGE 0 16 PARCEL 010
AGENT'S NAME: GJou r“ CLAN) E.n16. 'Dag A - VT IE
AGENT'S ADDRESS: 33 0 4 Tr.1 to 7) P L, P J G. 6 2 7 4.
TELEPHONE NO: ('3 1 O) '?a') - ?_ 5 c3 b,
NATURE OF 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.
� 2G c-) Cel l� � ItiC.1
®P.,rtny On P:. •. e',P. P.,....
Will the proposed use be compatible with the uses in the surrounding area, and if so, why?
c_ V e• l_. 1 E. tJ CO V R A C-: r)
2t AC..,G. NIrz. I'bT6 1 M !
' - t Crt l—I (2) p 2 I-1®o la
Will the grant of this Conditional Use Permit be consistent with and in furtherance of the public
health safety and general welfare?
tt-I 1t en pr.l Ot= rt.-It I=C_ t Ltr
14.t_ L)I r e wt enune.a..nstoOF
"r t-1 e ,a a.V-i? i Los I A 61tE.,.� �s) 'D EP T. ea r
r-6 Lnr, A
FILING FEE
A filling fee must accompany the application. Make check payable to the CITY OF ROLLING
HILLS.
OWNER'S DECLARATION
I (We) declare under penalty of perjury that the foregoing is true and correct.
Executed at U L L. t cJ 1-1 t L L ► , California,
this 2 n d day of M A T2. G u
By:
By:
iDd a
Address
IRD LEI I -la
%I,(,)?,0) i,Q h,
)15
19 9 5
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:
REPRESENTATIVE: bid
COMPANY NAME: SlAttx,
COMPANY ADDRESS:
Ito-tatu
COMPANY PHONE NO. ('S(Dl 31 Z CST
PROJECT ADDRESS: 00 61eAginaail/
DATE FILED 3/ 0 /0432,0-7)
-
FEE:
RECEIPT NO:
BY: Zit
ZONING CASE NO: 52, 5r
TENTATIVE H ARING DATE:
• •
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 o Lt..%, California
this 2 day of M n 2 c,„ 1A , 19 5" .
By: a /AI L t.)1") Lek
By:
Cx, PcJ
Address
If/L y-Ells
City
• •
CITY OF ROLLING HILLS
ZONING CASE
CERTIFIED PROPERTY OWNER'S LIST
AFFIDAVIT
STATE OF CALIFORNIA
COUNTY OF LOS ANGELES ) ss
CITY OF ROLLING HILLS )
1, V O C, L eS . / T i' i E. , 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:
PoQ. LO-- 5% L.A.C..n. I
Executed at 1i..p' V 0.m Ee,—A ; Es , California, this
'r-LN
Conditional Use Permit
Variance
Site Plan Review
Zone Change
day of ("t ca Qc, 1_1 ,19 9 5
SIGNATLtRE
PROPERTY OWNER:
OWNER'S ADDRESS:
TELEPHONE NO:
PROPERTY'S ADDRESS:
REOUEST FOR HEARING
FOR SITE PLAN REVIEW
C f2 'R r G,.
541— S90
LEGAL DESCRIPTION: LOT NO. I:5 7 - D
ASSESSORS BOOK NO.7'j 6 7 PAGE 016
AGENT'S NAME:
AGENT'S ADDRESS:
TELEPHONE NO:
PARCEL 01 O
?) o 4- T t�..) o ►a P L. P \l L n o Z/ 4—
o) 3"75 -ZSS(.3
NATURE OF PROPOSED PROJECT
Describe in detail the nature of the proposed project, including what aspects of the project require
a Site Plan Review: II
—r i t, G- 3 C. c 22 A L S; T) r 2 1 NI
A
• •
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.
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IS
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.
't 4 t: P R o J tr. G—i ' t 5 'D a 5 t c-7/.t c A R n t.J tJ r-1 1.4 E.
L=XtST(i.Jc /12��5 /T FL�ITTLa1 4. G-ats.-Nt rLt)
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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 redirect
drainage flow unless into an existing drainage course. Explain the nature and extent of the impact of grading
and proposed minimization on lots.
`o ova. pit) .1 )t t,4 A G, L= I S, /mil 0 T A L- T e=. PC D
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.
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• •
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.
5 T,4 f3 / ! 5 C-I t_ n ,.) L 13 U t t_ p l ►,� ��
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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 shall be imposed where
necessary to assure proportionality and openness. Explain how the proposed project setbacks compare with the
existing setbacks of neighboring properties.
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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.
A 1 C) ` v l i n 'C) 2 t \ r'=. \eO? 1 Lt . G. Ki t` nJ Ja t-rt
114 r=: f)p I\1L- 1,34e1 l) (PQ.oII) h Tt-1 C 5T4 ( L�
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.
l
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: 3 - (o - I;
Oel - fnge 5/;/Z:
Signatur
For: dilt&d1 40E1)& 1 drvfitQAIE .
Applicant
•-'LN1t
• LAJINL1.V 1...,11.yC 1Nv. t►L JJ
APPLINT
CALCULATION OF LOT COVERAGE
BUILDING AREAS EXISTING PROPOSED TOTAL
NET LOT AREA 188,744 sq.ft. 188,744 sq.ft. 188.744 sq.ft.
BUILDING PAD(S) 55, 800 sq.ft. 23,178 sq.ft. 78, 978 sq.ft.
RESIDENCE 5, 286 sq.ft. — sq.ft. sq.ft.
GARAGE 1,070 sq.ft. sq.ft. sq.ft.
SWIMMING POOL/SPA 830 sq.ft. sq.ft. — sq.ft.
STABLE sq.ft. 1,424 sq.ft. 1,424 sq.ft.
RECREATION COURT
( ) — sq.ft. — sq.ft. — sq.ft.
SERVICE YARD 300 sq.ft. — sq.ft. 300 sq.ft.
OTHER POOL HOUSE 800 sq.ft. sq.ft. sq.ft.
TOTAL STRUCTURES
% STRUCTURAL
COVERAGE
8,286 sq.ft. 1,424 sq.ft.
4.4 %
9,710 sq.ft.
5.1 %
% TOTAL PAD
COVERAGE 14.8 % cJc 12.3 %
DRIVEWAY 8.585 sq.ft. — sq.ft. — sq.ft.
PAVED WALKS AND
PATIO AREAS 9,461 sq.ft. — sq.ft. — sq.ft.
POOL DECKING — sq.ft. sq.ft. — sq.ft.
TOTAL FLATWORK 18,046 sq.ft. — sq.ft. — sq.ft.
% TOTAL FLATWORK
COVERAGE 9.6 % — %
TOTAL STRUCTURAL & FLATWORK
COVERAGE 26,332 sq.ft. sq.ft. 27,756 sq.ft.
% TOTAL COVERAGE 14.0 %
14.7 %
• •
DATE
ZONING CASE NO. ADDRESS
APPLICANT
CALCULATION OF BUILDING PAD COVERAGE
PAD NO. 1
BUILDABLE PAD AREA 15'5 800 sq.ft.
RESIDENCE 5 2 810 sq.ft.
GARAGE ( 0 1 0 sq.ft.
STABLE (BARN) sq.ft.
POOL 8 3 0 sq.ft.
RECREATION COURT
( ) sq.ft.
OTHER (Pool Hooyc.,)
TOTAL STRUCTURES ON PAD NO. 1
% BUILDING PAD COVERAGE
PAD NO. 2
BUILDABLE PAD AREA
RESIDENCE
GARAGE
STABLE (BARN)
POOL
RECREATION COURT
80 0 sq.ft.
B 2 S (o sq.ft.
14,8 %
2 3 118 sq.ft.
sq.ft.
sq.ft.
1 4 2 4 sq.ft.
sq.ft.
sq.ft.
OTHER sq.ft.
TOTAL STRUCTURES ON PAD NO. 2 14. Zq- sq.ft.
% BUILDING PAD COVERAGE % , I %
DATE 3 /f I r ZO ' NG CASE NO YS' ADDRESS 0 (vd
APPLICANT e'A%. o'd'`
CALCULATION OF LOT COVERAGE
BUILDING AREAS EXISTING PROPOSED TOTAL
NET LOT AREA 188.744 sq.ft. 188.744 sq.ft. 188.744 sq.ft.
BUILDING PAD(S) 46.452 sq.ft. 11.120 sq.ft. 57,572 sq.ft.
RESIDENCE 5' 286 sq.ft. sq.ft. sq.ft.
GARAGE 1,070 sq.ft. — sq.ft. — sq.ft.
SWIMMING POOL/SPA 830 sq.ft. sq.ft. — sq.ft.
STABLE sq.ft. 1,424 sq.ft. 1,424 sq.ft.
RECREATION COURT
( ) — sq.ft. sq.ft. — sq.ft.
SERVICE YARD 300 sq.ft. sq.ft. 300 sq.ft.
OTHER P00L HOUSE 800 sq.ft. sq.ft. sq.ft.
TOTAL STRUCI-URES
8,286 sq.ft. 1,424 sq.ft.
% STRUCTURAL 4.4 %
COVERAGE
9,710 sq.ft.
5.1
% TOTAL PAD
COVERAGE 17.8 % 12.8 % 16.9%
DRIVEWAY 8.585 sq.ft. — sq.ft. — sq.ft.
PAVED WALKS AND
PATIO AREAS 9,461 sq.ft. sq.ft. — sq.ft.
POOL DECKING sq.ft. sq.ft. — sq.ft.
TOTAL FLATWORK 18,046 sq.ft. sq.ft. — sq.ft.
% TOTAL FLATWORK
COVERAGE 9.6 % — % — %
TOTAL STRUCTURAL & FLATWORK
COVERAGE 26,332 sq.ft. sq.ft. 27,756 sq.ft.
% TOTAL COVERAGE 14.0 %
14.7 %
C1i o/ Ailing JUL
INCORPORATED JANUARY 24, 1957
ENVIRONMENTAL INFORMATION FORM
(To Be Completed By Applicant)
NO. 2 PORTUGUESE BEND ROAD
ROLLING HILLS, CALIF. 90274
(310) 377-1521
FAX: (310) 377-7288
Date Filed Zoning Case No.
GENERAL INFORMATION
1. Applicant C3o tJ T t-1 Pis 4) I PIG t tJ G !~ 2 t fJ &, Tel. •3 7 h - 2 S5'4" (p
Address
2. Legal Owner
Address
730 4- i �..i 6 f) PL. P.) . G. cl v z 7 41-
G-1 f�i2� Dc=N2A Foci A 1E.g2. Tel. 5 41 -890S
3. Project Address A (,. (5 (Ve.1.
Assessor's Book, Page, Parcel No. 1 ai 61 - 0 I 6 - 010 Lot No.
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:
DrsPr. V3L.Dc �raGc -'ta)
5. Existing zoning district 12 A - 2,.
6. Proposed project/use of site: S TAN /�j _E, C v (Q A L. cd. "n 2r Sc-,AC-r (�
R t r\1 G�
PROJECT DESCRIPTION
7. Site size 'J , 0 4-c
8. Net lot area Qj _ 1 4 4- , a . CA. .
r t
9. Total square footage of structures $ Z $
10. Number of floors of construction 0 0
11. Basement square footage
12. Total combined flatwork and structural lot coverage 2 43 3 5 2. g
13. Will any exterior walls be removed or relocated? Which walls? 11 0
14. Will any interior walls be removed or relocated? Which walls? N (�
15. Will the entire building structure require a new roof?
• •
16. Will the existing roof remain intact, with less than 200 square feet added?
17. Will cut and fill be balanced? Amount cut I to 0 45
Amount fill ((z, 4 co"
18. Area of disturbance. Square feet Z. � 1 1$ . Percentage of lot 1 ''2 ,
19. If residential, include the unit size. Square feet
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.
22. If institutional, indicate the major function, estimated employment per shift, estimated occupancy,
loading facilities, and community benefits to be derived from the project.
I\l
23. Attach plans.
24. Proposed scheduling. 4 eD A P
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.
1 T t P L A /.1 2 t:vn; -- C- t2 D !Jeri
Are the following items applicable to the project or its effects? Discuss below all items checked yes (attach
additional sheets as necessary).
YES 1V4
X 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-
• •
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.
Z{ 32. Substantial change in existing noise or vibration levels in the vicinity.
33. Site on filled land or on slope of 10 percent or more.
▪ 34. Use or disposal of potentially hazardous materials, such as toxic substances, flammable
or explosives.
35. Substantial change in demand for municipal services (police, fire, water, sewage, etc.).
X 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.
gOCLit' , tDE eXt3TR m6, 14 At) E. ! G-i /a+RQr-.t=
Prang.. WAu5G.
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 (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.
S 1 to \ Z t•-et IL..'-? l-1 o t-fl ) 1:5. 4 �a
c12. PE.R L.Q
-3-
i
• •
ENVIRONMENTAL IMPACTS
(Please explain all "yes" and "maybe" answers on separate sheets.)
YES MAYBE NQ
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
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 freshwaters?
X
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? —X.
d. Change in the amount of surface water in any water body? — X
e. Discharge into surface waters, or in any alteration of
surface water quality, including but not limited to
temperature, dissolved oxygen or turbidity? — — X.
-4-
•
YES MAYBE NQ
f. Alteration of the direction or rate of flow of ground waters?
B. 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?
j. Significant changes in the temperature, flow, or chemical
content of surface thermal springs?
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?
d. Reduction in acreage of any agricultural crop?
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 Resource4. 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 Ue . 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. Transnortation/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 L1Q
X
- - -,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 tothe 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?
X MAYBE ND
x
y
X
1C
X
-7-
60. Mandatory Finding 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 intb 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?
YES MAYBE LIQ
x
-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 isincluded 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:
2. Address:
3. Phone Number:
4. Address of Site (street name and number if available, and ZIP code):
5. Local Agency (city/county):
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
Signature
For
Applicant
-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 Agt contained on these lists.
Date MC11 95
Signature
For '0t1 iW f�j Ali �=- C-nI..1t=,t=.2t�iC-�
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 M t Q C 1a 11 1019
forms\environm.app
, { *4
Signature Cl
For OoTI-I F3is C-r111(�t'�It')67
Applicant
-10-