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487, Relocate stable, ApplicationROE VEST FOR HEARING • APPLICATION FOR: The Undersigned CITY OF ROLLING HILLS CONDITIONAL USE PERMIT L) LC a Name 4- 0 itz c %\o a. p . . Street Address is/are the owner(s) of or is/are in lawful possession of (2) has permission of the Owner 5'4. -21(4- Telephone Number Legal description of property situated at 11 I S G 8/ 4..- i 0 Lot 4,41 0J Street Address Describe in detail the nature of the proposed use and under what Section of the Zoning Ordinance the use is permitted in the zone in which it is located with a conditional use permit. i c_ n1 I\\ ► r r,u r.7- I `7 . \ (, . 0 I Z t= Will the proposed use be compatible with the uses in the surrounding area, and if so, why? l l-d C. NZ 442. Cr l T t n,, r-a 'T C.. IL) I (-4 e ? t4 (e) t) • will the grant of this conditional use permit be consistent with'and in furtherance of the public health safety and general welfare? 114 c C h / -a T" R. r 'T t el A U Ti-1 t= r?1-Rvts‘ot L ,e4e/r(..c:- Cnr iv) TO i c P i . o (z- () 1.-r) &. -. -- S 14\ r= r_; � FILING FEE A filing fee must accompany the application. Make check payable tos THE CITY OF ROLLING HILLS OWNER'S ACKNOWLEDGMENT 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 for 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 Q 15L t,.. t rl el , California this 4 day of 0 C. � C (J 2 , 19,9 2. By: By: 4 OP C nl Address City PROPERTY OWNER: OWNERS ADDRESS: TELEPHONE NO: PROPERTY ADDRESS: REQUEST FOR HEARING 7OR SITE PLAN REVIEW CITY OF ROLLING HILLS D2. Q. L.cG 4 C7 1' c I t a. c4 t O P 0. 2loc!- 4 0 lA!') P-TJ. LEGAL DESCRIPTION: LOT NO l 4 ! P. . 5 . t'3 $ CJ ASSESSORS BOOK NO7547 PAGE 4 PARCEL 2 8 AGENT'S NAME: 1D d tJ G, c 14 I T r! AGENT'S ADDRESS: 304 P L. PALE.. O 2 1 4- TELEPHONE NO: C3 t C7 '31 S - Z. 5 5 Cv --********************************************************************** NATURE OF PROPOSED PROJECT Describe in detail the nature of the proposed project, including what aspects of the project require a' Site Plan Review: 1 Gt N') 1S C.0 L) Q 1 - r t7:raC� 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. 1 t t t =1 L L- o LA) [: 0 Li �S l_. I t-I c_. i z c, ( tZ b -rW Coc)Q-rirl LHC t--i1.4R.1-10vc'�. Site Plan Review Application -9- 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. (IA G Q t S ., J tr. t& a? C-, LG. co L O n G 1a) 1 r- \1 E a%) L 1 `Ti. L G A Al?L/ F; • C-- T A T I C n) 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. 1 f-1G M A.1l9t ;l% dt= ► tC pGl.oP2C-".iAIA) 5 (Ts M T LL S L O P t x) C-7 I-J t L L 5 r n t;;_ C. t-d A MA C -reSP V)17 ,4 Q2 I t n1 /3► C-► C C. rJ 1 i , na tj ( &, i n,1 t T 5 11/4-f A. T U R A L L o c A-ri or) . 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. 1 r-I (Ha I re._ Art T Lit= �- 'f"i.� 5 P E AI4 2I= iJ ups m.`rtcvC. Q., LticAnrnni . Pe©Po5caf) L4h1D5c4lp.. 1 NCI «i I t�.t__ t t`4 PO o %/t j a-t e.I=-_ )0 4 f r 6, r, cru el 7r O A) Site Plan Review Application -10- E. How does the site development plan preserve the natural and undeveloped state of the Iot 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. 9 CI it4w\A1!S C_i. t -L- 15 tale)T A 5 vrTc)a2t= i tI M Q v t e.1.3 -i'L-1 C P r VJ '5 , F l4 t 4 L o r is R.E7A/1,1CcD 1N t-1A 17" MA-S tITI 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. 14P(oPo e5m.0 SG7141CtC 1= /a - L- R. t c, 1-1 T' 1 1+,\ L u At �, . 1,41 I T t--I -t o s t= ® F-- / (-1 tS Ir1 ar2 UA)rD/AJc7 &r 11-I r15o62I-{oan 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. 1i4L PDP05 ra 1-7cE-01= Lo e-'tmt.\-r k1tL 1-1 Au vV o-t 4 T 5 n tZ o �l U. 1.l t C_ 13 fa t-tt 0 of i,:, t-1 lL1'f' Site Plan Review Application -11- 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. to o t r't P ((I-r e. a.) ‘1 I eN A, m e- A i' , 1` 1 i r I e-, A i u c3 v IAt As )c2t=S ulttL Mnr 135'Al2 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: Oc.T 2., \ Site Plan Review Application -12- o� Signa L L. a Applicant For: OWNER'S DECLARATION I (We) declare under penalty of perjury that the foregoing is true and correct. Executed at Q. O t tz, t LLf , California, this 4 h day of OcToMt,� eta. , 1992- ffOLc. Lac". I-1tLL. c)O2-7 (address) NOTE: The Owner's Declaration can only be used if this application is signed in California. If this application is signed outside of California, the applicant should acknowledge before a Notary Public of the State where the signature is fixed, or before another officer of that State authorized by its laws to take acknowledgements, that he (it) owns the property described herein, and that the information accompanying this application is true to the best of his (its) knowledge and belief. Attach appropriate acknowledgment here. APPLICANT: t'& Y/, REPRESENTATIVE: e) . 41?f G COMPANY NAME: (:).-11tIV C A L-t COMPANY ADDRESS: 04- TTJot\ PL. Ppit.o5 CS. 40Z-T4 COMPANY PHONE NO. (3 t 0)375• 2ST4L DATE FILED to /i I1 Y FEE: ffir,77,57) RECEIPT NO: ii S'7 �UtM BY: ZONING CASE NO: 46f? TENTATIVE HEARING DATE: PROJECT ADDRESS: 4. OPe-c % DiNAb Site Plan Review Application -13- • 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 (11 la l L-L', , California this "N day of 0 CT O (3 G. tk. By: D A ---- By: Site Plan Review Application -14- 19 43- OFq-14 Vs Q.n i41 P.1) Address Q...OLLl U. 111c_c__5 City CITY OF ROLL/NO liILTaB ZONING CASE CERTIFIED PROPERTY OWNER'S LIST AFFIDAVIT STATE OF CALIFORNIA COUNTY OF LOS ANGELES ss I, D f1C,LA-‹ . cI4l4 iT1( , 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: 1--0 i 1 1 1 . c=r› C5 e- t Executed at Lo S kiC R D( A ?' S , California, this Q- day of 0 C, i 6 /51 P , 19 . Conditional Use Permit Variance Site Plan Review Zone Change Site Plan Review Application -15- % 4( & SIGNATURE DATE OCT; 9 2- Zo ING case NO. 4-8 7 ADDREsS BUILDING AREAS NET LOT AREA BUILDING PAD(S) RESIDENCE GARAGE SWI2+!ING POOL/SPA STABLE RECREATION COURT SERVICE YARD OTHER APPLICANT 4 Open Brand Dr. Lee CALCULATION OF LAT COVERAGE EXISTING PROPOSED 55,127 sq.ft. 55,127 sq.ft. 39,117 sq.ft. sq.ft. 3,465 sq.ft. sq.ft. 630 sq.ft. sq.ft., 720 sq.ft. sq.ft. 680 sq.ft. sq.ft. sq.ft. 96 sq.ft. sq.ft. 6,832 sq.ft. sq.ft. sq.ft. TOTAL 55,127 39,117 3,465 630 720 680 sq.ft. sq.ft. sq.ft. sq.ft. sq.ft. sq.ft. 6,832 sq.ft. 96 sq.ft. sq.ft. TOTAL STRUCTURES 5,591 sq.ft. 6,832 sq.ft. 12,423 sq.ft. % STRUCTURAL, COVERAGE 10.14 % 12.39 % 22.53 % PAD COVERAGE 14.29 % % 31.76 % DRIVEWAY PAVED WALKS & PATIO AREAS . POOL DECKING TOTAL FLATWORK % TOTAL FLARWORK COVERAGE TOTAL STRUCTURAL & FLATWORK COVERAGE % TOTAL COVERAGE 1,600 sq.ft. 870 sq.ft. 1,520 sq.ft. 3,990 sq.ft. 7.24 9,581 sq.ft. 17.38 -7- sq.ft. sq.ft. sq.ft. sq.ft. sq.ft. 6,832 sq.ft. 12.39 % sq.ft. sq.ft. 3,990 sq.ft. 7.24 16,413 sq.ft. 29.77 % • • DATE OCT,5/ 2- ZONING CASE NO. ¢e)7 ADDRESS APPLICANT PAD NO. 1 BUILDABLE PAD AREA RESIDENCE GARAGE STABLE (BARN) POOL RECREATION COURT ( CALCULATION OP BUILDING PAD COVERAGE 22,695 3,465 630 720 sq.ft. sq.ft. sq.ft. sq.ft. sq.ft. sq.ft. OTHER 96 sq.ft. TOTAL STRUCTURES ON PAD NO. 1 % BUILDING PAD COVERAGE 4,911 21.64 sq.ft. PAD NO. 2 BUILDABLE PAD AREA 16,422 sc.Et. RESIDENCE sq.ft. GARAGE • sq.ft. STABLE (BARN) 680 sq.ft. POOL sq.ft. RECREATION COURT ( ) OTHER TOTAL STRUCTURES ON PAD NO. 2 6,832 7,512 % BUILDING PAD COVERAGE 45.74 -8- sq.ft. sq.ft. sq.ft. • • City o/ R0/fi INCORPORATED JANUARY 24, 1957 ENVIRONMENTAL INFORMATION FORM (To Be Completed By Applicant) Date Filed ©c i , Ej, \C)t 1- NO. 2 PORTUGUESE BEND ROAC ROLLING HILLS. CALIF. 90274 (213) 377.1521 FAX (213) 377.7288 Zoning Case No. 4 8 % GENERAL INFORMATION 1. Applicant, address and telephone no. Ve Lee. 4 OPt.tt [-45(2AAD d2 ° . , D Sid- ciei- I- 2.. ! i Q. 2. Legal Owner, address and telephone no. (if different from above) P� 3. Address of project (0'S 04, is n \, �. Assessor's Book, Page, Parcel No. 7 ``7 G 7 / 4- / Z 5 Lot No. 1 k 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: (2.. 4d. C. l 45-a '4 L ca.5 Am t. Pur L.t r 1.462j4.. ' 5. Existing zoning district 1). A 5 — 6. Proposed use of site (project for which this form is filed): ^T' r= M ,J t(_ 0 13 Q.1 PROJECT DESCRIPTION 7. Site size 14 474 (1G 8. Net lot area 5 9 , 1 9. Total square°footage of structures 4 $ 2.4 10. Number of floors of construction t) -1- JUL 141992 11. Basement square footage •---� 12. Total combined flatwork and structural lot coverage t D. 4a, t 4 13. Will any exterior walls .be removed or relocated? Which walls? ('.1 C7 14. Will any interior walls be removed or relocated? Which walls? (a..0 15. Will the entire building structure require a new roof? dA O 16. Will the existing roof remain intact, with less than 200 square feet added? Y C'd5 17. Will cut and fill be balanced? Amount cut 1100 Amount fill t Z O C9 18. If residential, include the unit size, approximate sale price and household size.. expected. 19. Ifcommercial, indicate the type of project, whether neighborhood, city or regionally oriented, square footage of sales area, estimated employment per shift and loading facilities. 20. If this is industrial project indicate the type of project, estimated employment per shift, and loading facilities. 21. If institutional, indicate the major function, estimated employment per shift, estimated occupancy, loading facilities, and community benefits to be derived from the project. 22. Attach plans. 23. Proposed scheduling. Ck . (\ P- 24. If the project involves a variance, conditional use or rezoning application, state this and indicate clearly why the application is required. G. 01 P. I' cLET.Q01Goes, C=O i4 F1 C?.taNt`), ob OfiCr Are the following items applicable to the project or its effects? Discuss below all items checked yes (attach additional sheets as necessary). Yes No 25. Change in existing features of any bays, tidelands, beaches, lakes or hills, or substantial alteration of ground contours. 26. Change in scenic views or vistas from existing residential areas or public lands or roads. - 2- x .f 27. Change in pattern, scale or character of general area of project. 28. Significant amounts of solid waste or litter. 29. Change in dust, ash, smoke, fumes, or odors in vicinity. 30. Change in ocean, bay, lake, stream or ground water quality or quantity, or alteration of existing draining patterns. 31. Substantial change in existing noise or vibration levels in the vicinity. 32. Site on filled land or on sloe of 10 percent or more. T(4L' ',a a ukti..t.4commu••••-rte 33. Use or disposal of potentially hazardous materials, such as toxic substances, flammable or explosives. 34. Substantial change in demand for municipal services (police, fire, water, sewage, etc.). 35. Substantially increased fossil fuel consumption (electricity, oil, natural gas, etc.). 36. Relationship to a larger project or series of projects.. ENVIRONMENTAL SETTING 37. Describe the project site as it exists before the project, including information on topography, soil stability, plants and animals, and any cultural, historical or scenic aspects. Describe any existing structures on the site, and the use of the structures. Attach photographs of the site. Snapshots or polaroid photos will be accepted. Lot is partially developed within a developed gently rolling hillside. This lot has a minor drainage area on one side. There is a view corridor to the northeast. • • 38. Describe the surrounding properties, including information on plants and animals and any cultural, historical or scenic aspects. Indicate the type of land use (residential, commercial, etc.), intensity of land use (one -family, guest house, office use, etc.) and scale of development (height, frontage, set -back, rear yard, etc.). Attach photographs of the vicinity. Snapshots or polaroid photos will be accepted. The neighborhood has the usual animals, indigenous to the area, skunks, racoons, mice, domestic varieties. Minor landscaping exists at the front of the lot, majority of remainder is wild grass. There is a house, detached garage, swimming pool and stable existing on the site. one area -is one of single family residences, one unit per acre. The homes are all one story, most with pools and or stables. ENVIRONMENTAL IMPACTS (Please explain all "yes" and "maybe" answers on separate sheets.) 39. Earth. Will the proposal result in: a. Unstable earth conditions or in changes in geologic substructures? b. Disruptions, displacements, com- paction 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 earth- quakes, landslides, mudslides, ground failure, or similar hazards? -4- YES MAYBE NO x • • 40. Air. Will the proposal result in: a. Substantial air emissions or deterioration of ambient air qaulity? b. The creation of objectionable odors? c. Alteration of air movement, moisture or temperature, or any change in climate, either locally or regionally? 41. Water. Will the proposal result in: a. Changes in currents, or the course or direction of water move- ments, in either marine or fresh waters? b. Changes in absorption rates, drainage patterns, or the rate and amount of surface water runoff? YES MAYBE NO c. Alterations to the course or flow of flood waters? X d. Change in the amount of surface water in any water body? e. Discharge into surface waters, or in any alteration of surface water quality, including but not limited to temperature, dissolved oxygen or turbidity? f. Alteration of the direction or rate of flow of ground waters? g. Change in the quantity of ground waters, either through direct additions or withdrawals, or through interception of an aquifer by cuts or excavations? h. Substantial reduction in the amount of water otherwise available for public water supplies? i. Exposure of people or property to water -related hazards such as flooding or tidal waves? -5- x x • j. Significant changes in the temperature, flow, or chemical content of surface thermal springs? 42. Plant Life. Will the proposal result in: a. Change in the diversity of species, or number of any species of plants (including trees, shrubs, grass, crops, microflora and aquatic plants)? 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? 43. Animal Life. Will the proposal result in: a. Change in the diversity of species, or numbers of any species of animals (birds, land animals including reptiles, fish and shellfish, benthic organisms, insects or micro - fauna) ? b. Reduction of the numbers of any unique, rare or endangered species of animals? c. Introduction of new species of animals into an area, or result in a barrier to the migration or move- ment of animals? d. Deterioration to existing fish or wildlife habitat? 44. Noise. Will the proposal result in: a. Increases in existing noise levels? b. Exposure of people to severe noise levels? X YES MAYBE NO 1 -6- • • YES MAYBE NO 45. Light and glare. Will the proposal produce new light or glare? 7C 46. Land Use. Will the proposal result in a substantial alteration of the present or planned land use of an area? _x 47. Natural Resources. Will the proposal result in: a. Increase in the rate of use of any natural resources? b. Substantial depletion of any nonrenewable natural resource? 48. Risk of Upset. Will the proposal involve: a. A risk of an explosion or the release of hazardous sustances (including, but not limited to, oil, pesticides, chemical or radiation) in the event of an accident or upset conditions? b. Possible interference with an emergency response plan or an emer- gency evacuation plan? 49. Population. Will the proposal alter the location, distribution, density, or growth rate of the human population of an area? 50. Housing. Will the proposal affect existing housing, or create a demand for additional housing? 51. 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? -7- • • d. Alterations to present patterns of circulation or movement of people and/or goods? e. Alterations to waterborne, rail or air traffic? Yes Maybe Iio f. Increase in traffic hazards to motor vehicles, 52. Public Services. Will the proposal have an effect upon, or result in a need for new or altered governmental services in any of the following areas: a. Fire protection? b. Police protection? c. Schools? d. Parks or other recreational facilities? e. Maintenance of public facilities, including roads? f. Other governmental services? 53. Eneray. 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? 54. Utilities. Will the proposal result in a need for new systems, or substantial alterations to the following utilities: 7( a. Power or natural gas? X b. Communications systems? c. Water? d. Sewer or septic tanks? 1C e. Storm water drainage? X -8- • • f. Solid waste and disposal? 55. Human Health. Will the proposal result in: a. Creation of any health hazard or potential health hazard (excluding. mental health)? YES MAYBE NO b. Exposure of people to potential health hazards? X 56. Aesthetics. Will the proposal result in the obstruction of any scenic vista or view open to the public, or will the proposal result in the creation of an aesthetically offensive site open to public view? 57. Recreation. Will the proposal result in an impact upon the quality or quantity of existing receational opportunities? 58. Cultural Resources. a. Will the proposal result in the alteration of or the destruction of a prehistoric or historic archeological site? b. Will the proposal result in adverse physical or aesthetic effects to a prehistoric or historic building, structure, or object? JC c. Does the proposal have the poten- tial to cause a physical change which would affect unique ethnic cultural values? d. Will the proposal restrict existing religious or sacred uses within the potential impact area?. �C • • 59. Mandatory Findings of Significance. a. Does the project have the poten- tial to degrade the quality of the environment, substantially reduce the habitat of a fish or wildlife species, cause a fish or wildlife population to drop below self- sustaining levels, threaten to eliminate a plant or animal commun- ity, reduce the number or restrict the range of a rare or endangered plant or animal or eliminate important examples of the major periods of California history or prehistory? b. Does the project have the poten- tial to achieve short-term, to the disadvantage of long-term, environ- mental goals? (A short term impact on the environment is one which occurs in a relatively brief, definitive period of time while long-term impacts will endure well into the future.) c. Does the project have impacts which are individually limited, but cumulatively considerable? (A project may affect two or more separate resources where the impact is relatively small, but where the effect of the total of those impacts on the environment is significant.) d. Does the project have environ- mental effects which will cause substantial adverse effect on human beings, either directly or indirectly? YES MAYBE NO a! • • PALOS VERDES ESTATES (310) 375-2556 FROM L. A. (213) 772-1555 FAX (310) 376-36I6 WESTLAKE VILLAGE (605) 494.4499 FAX (605) 494-4221 SOUTH BAY ENGINEERING CORPORATION 304 TEJON PLACE PALOS VERDES ESTATES, CALIFORNIA 90274 'ENVIRONMENTAL INFORMATION Y. Lee 4 Open Brand Road RAYMOND L. OUIGLEY DONALD E. OAWSON CONSULTING ENGINEERS 39.b. The tennis court and stable relocation will result in grading of the northwestern portion of the property. 39.c. The northeastern area will be flattened to make room for the tennis court and corral. 41.b. The hard surface of the tennis court will result in an infitesimal decrease in the absorbtion rate but it is inconsequential as the natural drainage at the rear of the court. OE: Before the Lead Agency I/ accept this application as complete, the applicant must consult the lists prepared pursuant to Section 65962.5 of the Government Code and submit a' signed statement indicating whether the project and any alternatives are located on a site which is included on any such list, and shall specify any list. HAZARDOUS WASTE AND SUBSTANCES STATEMENT • The development project and any alternatives proposed in this application are contained on the lists compiled pursuant to Section 65962.5 of the Government Code. Accordingly, the project applicant is required to submit a signed statement which conta;ns 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: S. Regulatory identification number: 9. Date of List: Date For (Signature) (Applicant) -11- •TE: In the event that the pect site and any alternative_ are not listed on any list compiled pursuant to Section 65962.5 of the Government Code, then the applicant must certify that fact as provided below. I have consulted the lists compiled pursuant to Section 65962.5 of the Government Code and hereby certify that the development project and any alternatives proposed in this application are not contained on these lists. Date 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 COC.f.4..i)2. For lose (Signature) UU ( v Lea (Applicant)