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Planning Division Development Services Building 38250 Sierra Highway Palmdale, CA 93550 661/267-5200 [EMAIL REDACTED] [EMAIL REDACTED] 1 of 4 Updated 10/2024 Zoning Clearance - Occupancy Review Form For Commercial Businesses Fee: $84 1. Complete and sign the application (for a new business or change of ownership in a commercial location). 2. Page two must be signed by the property owner (if the applicant is not the owner of record or may provide a current lease agreement). 3. If alcohol sales are proposed, submit two copies of a floor plan indicating the square footage and percentage of floor area dedicated to the sale and display of alcohol and one vicinity map indicating sensitive uses (i.e. schools, churches, residences, parks, other alcohol sales establishments, etc.) within a 1,000-foot radius of the proposed site. 4. Pay for the ZC with the Business Support Center—661/247-8384, or email [EMAIL REDACTED]. Business Information Name of Business: Business Address: Suite/Unit Number: Zip Code: Detailed Description of Business: New business: Yes / No If ‘no’, please explain the request for change below (i.e. change of ownership): Square footage of building/suite: Number of parking spaces available: *Prior use of building/suite: Is parking paved and striped? Yes / No *(Do Not Leave Blank- if you do not know, please ask the owner/leasing manager or call business license at 661/267-5434) Business Owner: Name: Address: Telephone No.: Email: Contact Owner: Name: Address: City: State: Zip: Telephone No.: Email: Property Owner: Name: Address: City: Zip: Telephone No.: Email: Business Permit Information Please check mark if any of the following products or services are being provided by your business Adult-oriented business Entertainment Game arcades Gun dealers Massage establishment/massage technicians Pawnbrokers and secondhand dealers Sidewalk vending Mobile vending Tobacco/smoking product retailer ---PAGE BREAK--- Planning Division Development Services Building 38250 Sierra Highway Palmdale, CA 93550 661/267-5200 [EMAIL REDACTED] [EMAIL REDACTED] 2 of 4 Updated 10/2024 Property Owner Authorization Letter Address or Assessor’s Parcel Number(s): If the applicant is not the owner of record, then a letter authorizing the applicant to represent the owner(s) must be submitted. Note: All owners must sign as their names appear on the deed to the land. This letter shall serve to notify and verify that I/we are/are the legal owners of the property described and attached hereto and do hereby authorize the applicant to file and represent my/our interest in the above- referenced applications(s). I/we have read this Letter of Authorization and know the contents thereof, and so hereby certify (or declare) under penalty of perjury under the laws of the State of California that the information contained in the above-referenced application(s) is true and correct. Owner(s) of Record: Printed Name Signature Date Printed Name Signature Date **If the property management company or leasing manager is signing on behalf of the Owner of Record”, a letter must be provided giving the property owner permission to the signing agent. Or the business owner may provide a copy of the current lease agreement. ---PAGE BREAK--- Planning Division Development Services Building 38250 Sierra Highway Palmdale, CA 93550 661/267-5200 [EMAIL REDACTED] [EMAIL REDACTED] 3 of 4 REV. 10/2024 Business Operational Information – please check either Yes or No for each question. Yes No Will any portion of the use be conducted outside of an enclosed building? **Does the use involve any public assembly? (i.e. church, halls, Are any building alterations or additions proposed? Has the space been altered, or will it be altered for new occupancy? Does the use involve: Welding or open flame operation? Flammable liquids (storage, handling, etc.)? Dust-producing operation (woodworking, etc.)? Plastic (storage, handling, use)? Compressed Gas (storage, handling, use)? High-Piled Combustible Storage (over Tire Storage (over Vehicle repair or maintenance facilities? Storage of vehicles? Outdoor storage of equipment or materials? Provide an explanation for any “Yes” answers: **CA Building Code 303.1 Assembly Group A. Assembly Group A occupancy includes, among others, the use of a building or structure, or a portion thereof, for the gathering of persons for purposes such as civic, social or religious functions; recreation, food or drink consumption or awaiting transportation. Alcohol Sales If your business involves on-sale or off-sale sales of alcoholic beverages, please complete the following information pursuant to City of Palmdale Ordinance No. 1262. A Conditional Use Permit may be required in conjunction with a request for alcohol sales. Contact the City of Palmdale Planning Division at 661/267-5200 for a copy of the Ordinance or for further information regarding the sale of alcoholic beverages. Is this an alcohol sales use? Yes / No Do you currently have an ABC license? Yes / No License Type: License Date What is the gross floor area designated for alcohol sales (including the sale, display, storage, bar, seating, dance floor, and billiards area)? I certify that the information above is true and accurate to the best of my knowledge Business Owner Signature Date ---PAGE BREAK--- 4 of 4 REV. 10/2024 THIS PAGE FOR OFFICE USE ONLY PLANNING DIVISION Zoning: APN: New Use? Yes No Is use allowed? No Yes with SPR/CUP Existing SPR/CUP Use is to be established in the existing buildings. Therefore, the requirement for Site Plan Review is waived by the Planning Manager through the issuance of this Zoning Clearance pursuant to ZO Chapter 2, Section 26.03. Does use meet applicable Zoning Ordinance requirements? Yes No Does use comply with the terms & conditions of existing entitlement? Yes No Is use consistent with the General Plan? Yes No Is a Business Permit required? Yes No Use Permitted – Use permitted subject to compliance with all Building Codes, Municipal Codes, and issuance of a Business License. USE DENIED Comments INDUSTRIAL WASTE DISCHARGE PERMIT Permit required? Yes No IW Permit No.: Type of Permit: FSE Auto Std. 5-Year Tenant improvements planned: Yes No Anticipated occupancy: Does the facility have an existing GRD/grease interceptor? Yes No Is a Grease Removal Device required? Yes No Courtesy facility inspection required? Yes No Permit application complete: Yes No Comments: Date BUILDING AND SAFETY DIVISION Change of occupancy: applicant must submit detailed plans showing compliance with all current code requirements for occupancy. Need further clarification of proposed use. Submit fully dimensioned plans showing existing conditions, all alterations, and proposed uses of all areas. (Minimum plans required, floor plan, and site plan.) Occupancy inspection permit application must be completed, occupancy permit fees paid, and all corrections complied with prior to approval and occupancy. Continuing use of an existing building. No additional requirements. Gas____ Electric____ Water____ service has been disconnected. A courtesy safety inspection is required. Other comments: Requirements discussed at counter Requirements discussed by phone Requirements put in HdL notes Building And Safety Preliminary Review THIS PAGE FOR OFFICE USE ONLY