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12/20 APPLICATION FOR CONDITIONAL USE PERMIT PROPOSED USES WITHIN EXISTING BUILDING City Use Only Planning Division Case No.: 38250 Sierra Highway Palmdale, CA 93550 Date: (661) 267-5200 [EMAIL REDACTED] Received by: INSTRUCTIONS TO APPLICANT The following application form is provided for all applicants requesting approval of a Conditional Use Permit. The applicant must complete the attached forms as prescribed and submit the following information before the application can be accepted by the Planning Division. SUBMITTAL CHECKLIST NOTE: ALL PLANS SHALL BE INDIVIDUALLY FOLDED BY PLAN TYPE BY APPLICANT TO A MAXIMUM 8½” x 11” SIZE. STACK-FOLDED, STAPLED, ROLLED, OR BOUND PLANS WILL NOT BE ACCEPTED. PLANS MAY ALSO BE PROVIDED ON 11” X 17” PAPER. The completed application and required submittal items Copy of the Development Advisory Board (DAB) letter (if applicable) Two sets of property owner (including APN) and occupant mailing labels (self-sticking) for all properties within 500 / 700 / 1,000 feet of the subject property (see attached requirements) One copy of the mailing list in tabular form containing all the information on the above labels (see attached requirements) One radius map (see attached requirements) The original Mailing Label Certification The original Public Hearing Sign Removal Authorization The original and two paper copies of the Owner Authorization Letter ---PAGE BREAK--- 12/20 Two paper copies and an electronic copy of the legal description of the property Vicinity map at a scale clearly indicating the subject parcel(s) and showing the existing major street patterns, adjoining projects, subdivisions, creeks, railroads and other significant landmarks within a minimum of one mile of the exterior boundaries of the site on 8½” x 11” paper. Note: Thomas Guide maps are not acceptable. Detailed description of existing and/or proposed business operations. Please include the proposed hours of operation. 15 copies of the Site Plan identifying the location of the proposed use within the shopping center and drafted in compliance with the Plan Preparation Guidelines (see attached requirements) Photographs showing all sides of the building 10 floor plans drafted in compliance with the Plan Preparation Guidelines indicating the total gross floor area and the percentage of merchandise which consists of tobacco or smoking products and paraphernalia and/or the sale, display and storage areas of alcohol and/or areas utilized for live entertainment/amplified music. Three copies of a detailed security plan. The applicant is encouraged to contact Public Safety at 661/267-5170 for coordination or clarification of any security conditions or concerns regarding the proposed project. Map demonstrating distance separation to sensitive uses schools, churches, parks, and other alcohol or tobacco uses) Additional submittal requirements may be requested on a case-by-case basis CD containing site plan, floor plan, and photographs of the existing plan Tobacco uses are required to submit additional items (see attached requirements) Complete Fire Department Transmittal Letter (attached). Once case number is supplied, submit this form to project’s online submittal with the Los Angeles County Fire Department through the EPIC-LA permitting system. Pursuant to the California Environmental Quality Act, the Planning Division will review the project and determine areas of potential environmental impact. FEE CALCULATIONS Base Fee $ 1,035 Notice of Exemption: $ 150 City of Palmdale Fish and Wildlife Processing Fee: $ 25 @ $1.65 / label: # of labels Public Hearing Notice: $ 300 GIS Fee 5% of Rounded up to nearest dollar: $ 52 TOTAL FEE RECEIVED: ---PAGE BREAK--- 12/20 CONDITIONAL USE PERMIT APPLICATION FOR USE PERMITS Type of Use: Alcohol* Tobacco* Tattoo Establishment Second Hand Merchandise Other Was a Pre-Application filed? Yes No If yes, reference DAB: REQUEST TO ESTABLISH: Total Sq. Ft. for Requested Use: Shopping Center Name: Project Address: Assessor’s Parcel Number(s): Type of ABC License Requested: Existing Zoning: Existing General Plan: APPLICANT: Name: Address: City: State: Zip: Telephone No.: ( ) Fax No.: ( ) Email Address: CONTACT PERSON: Name: Address: City: State: Zip: Telephone No.: ( ) Fax No.: ( ) Email Address: *Contact Information: State of California State Board of Equalization Office Department of Alcoholic Beverage Control Van Nuys - (818) 904-2300 6150 Van Nuys Blvd., Room 220 www. boe.ca.gov Van Nuys, CA 91401 (818) 901-5017 [EMAIL REDACTED] ---PAGE BREAK--- 12/20 OWNER AUTHORIZATION LETTER CASE NUMBER(S): 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 am/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 (Include extra sheets if necessary): Printed Name Signature Date Printed Name Signature Date I certify under penalty of perjury that I am the applicant and that the foregoing statements and answers herein contained and the information herein submitted, are in all respects true and correct. APPLICANT / APPLICANT’S REPRESENTATIVE: Printed Name Signature Date Address (including City and State) Telephone Printed Name Signature Date Address (including City and State) Telephone SUBSCRIBED AND SWORN TO BEFORE ME THIS DAY OF NOTARY PUBLIC ---PAGE BREAK--- 12/20 CITY OF PALMDALE PLANNING DIVISION MAILING LABEL CERTIFICATION CASE NUMBER(S): I certify under the penalty of perjury that on the day of the attached property owners list contains the names and addresses of persons to whom property is assessed as they appear on the latest available equalized assessment roll of the County of Los Angeles within the subject property and for the parcels within 500 feet of the boundary of the subject property. PLEASE PRINT ALL INFORMATION EXCEPT SIGNATURE. Name: Title: Company: Address: City / State: Phone: ( ) Signature: Date: ---PAGE BREAK--- 12/20 LEAVE THIS AREA BLANK Applicant’s Name Address City, State, Zip Code THIS FORM MUST BE USED TO CREATE MAILING LABELS. Use the following format: Owner’s Name Address City, State, Zip Code Assessor’s Parcel No. Name Address City, State, Zip Code Representative / Engineer Name Address City, State, Zip Code ---PAGE BREAK--- 12/20 CITY OF PALMDALE PLANNING DIVISION PROCEDURES FOR PROJECT SITE SIGN POSTING In order to increase public awareness of pending development proposals requiring public hearings, the City of Palmdale has included “Project Site Sign Posting” in its public hearing notice procedures. The applicant of a proposed project scheduled for a public hearing before the City Council, Planning Commission, or Planning Manager is required to post a sign with public hearing information, which will be visible to the public right-of-way from the subject site. Late or inaccurate sign posting will cause postponement of the public hearing for the case. CASES REQUIRING SITE PLAN POSTING: Annexations Appeals Amendments, Revisions or Extensions of Time Conditional Use Permits General Plan Amendments Prezone Changes Site Plan Reviews Specific Plans Subdivisions Tentative Maps Variances Zone Changes SIGN SPECIFICATIONS: 1. SIZE: Dimensions shall be four feet by eight feet (see Figure 2. HEIGHT: Sign shall be six feet in height (see Figure 3. MATERIALS: ½ inch plywood (minimum). Sign shall be constructed with 4” x 4” supporting posts placed at a minimum depth of two feet with 2” x 4” cross supports as shown in the diagram (see Figure 4. LOCATION: A minimum of feet inside the property line in residential zones, and a minimum of one foot inside the property line in commercial and industrial zones. Shall be located in the area most visible to the public on the project site. 5. COLOR: Cyan background with black lettering (see Figure 6. LETTERING: Shall be block style. 7. LIGHTING: Shall NOT be illuminated. 8. Sign shall include ONLY the information provided by the assigned planner. If it becomes necessary to revise the information required on the sign, such as a change in the number of lots or square footage of buildings, it shall be the responsibility of the applicant to obtain approval of such revision(s) from the assigned planner. ---PAGE BREAK--- 12/20 SIGN SCHEDULE: 1. Sign shall be posted a minimum of 10 days prior to the hearing date. It shall be the responsibility of the applicant to contact the Planning Division to obtain the appropriate date and time. 2. Hearing date on the sign shall be changed for Commission items which are continued or are to be heard by the City Council including. Said date shall be changed a minimum of 11 days prior to the hearing. 3. Sign shall be removed within 14 days following the Planning Commission hearing date or IMMEDIATELY following final City Council action. It is recommended that the cost of sign removal be included in a sign contract with the sign company. ---PAGE BREAK--- 12/20 Figure 1 Figure 2 ---PAGE BREAK--- -10- 12/20 CITY OF PALMDALE PLANNING DIVISION PUBLIC HEARING SIGN REMOVAL AUTHORIZATION Case Number(s): Assessor’s Parcel Number(s): Location (address if available): Approximately Feet N or S of (Circle) (Street Name) Approximately Feet E or W of (Circle) (Street Name) By this signature, I acknowledge that I understand the requirements for posting the subject property for public hearing and do agree to pay all costs for the removal and storage of said public hearing sign if it is not removed within 14 days of the final hearing for this/these case(s). Applicant/Agent: Date: Owner: Date ---PAGE BREAK--- -11- 12/20 PLAN PREPARATION GUIDELINES All required plans shall be prepared accurately by a qualified individual registered civil engineer, licensed architect, licensed building designer), drawn to a standard engineering scale 1”=20’, 1”=50’, 1”=100’, 1”=200’) or architectural scale that is appropriate to the project size and able to clearly define and identify all required information. Please note that although the Planning Division does not require plans to be stamped and signed by a licensed professional, these items might be required by other divisions (i.e. Building and Safety, Engineering, etc.). Please ensure all plans include the following: A. SITE PLANS: 1. Title Block containing: a. Name, address and phone number of the developer and/or owner. b. Name, address and phone number of person preparing plan. c. Address of project. 2. Legend containing: a. The Assessor’s Parcel Number (APN). b. Scale. c. A legal description of the property sufficient to locate the property. d. Existing and proposed zoning and General Plan designations. e. Date of plan preparation with revision date plate. f. Statement indicating current and proposed land uses. g. Statement indicating gross and net acreage (after dedications) of property. h. Gross square footage of structure(s) (existing and proposed) including a breakdown of net leasable floor area and linear and square footage of seating (if applicable); indicate estimated square footage proposed for each different use within the structure(s); and density analysis (residential only). i. Lot coverage (area of site covered by structures) expressed as percentage of site or Floor Area Ration (if applicable). j. Square footage of landscaping, existing and proposed, with dimensions and amount of landscaped area expressed as a percentage of the entire site, and a percentage of the interior parking area (that is, exclude landscape areas located in the required setback areas). k. Number of parking spaces required and provided (breakdown by proposed uses, if more than one, and show calculations for each); list separately the number of covered, handicapped, uncovered, compact, bicycle, and loading zone spaces provided. l. Type of building construction. m. Type of building occupancy and number of employees. ---PAGE BREAK--- -12- 12/20 3. Plot Plan Showing: a. North-arrow. b. Boundaries - Existing and proposed lot lines, numbers, and areas. c. Easements - Locations, dimensions, and type of all easements. d. Grades - Existing and proposed including building pad elevations, streets, adjacent grades within 100 feet of project boundary; show by contours at adequate intervals. e. Structures - Locations, footprints, dimensions, distances between structures and property lines and use of existing and proposed structures within project and extending 50 feet beyond project borders. Show open stairways and other projections from exterior buildings walls, including entrances and exits, and handicap ramps. f. Fences and Walls - Location, elevation, height, and composition of all existing and proposed walls, fences, and retaining walls. g. Yards - Distance between exterior walls of structures and other such walls and property lines. Indicate location of any dedicated yards. h. Circulation/Parking - Completely dimensioned layout of internal driveways, aisles, parking stalls, loading spaces, vehicle ingress and egress to site, and sidewalks or other pedestrian walkways, and handicapped access for the site conforming to Title 24 of the California Administrative Code. Include appropriate required markings for handicap parking and loading zones, etc. Indicate number of required and proposed parking spaces, including handicap spaces, bicycle spaces, and loading zones. Identify and give direction of all one-way aisles. i. Streets - Location and cross-sections of existing and proposed rights-of-way, enriched parkways, left turn lanes, improvements (sidewalks, curbs, gutters, driveways, and landscaping), all completely dimensioned (on-site and off-site). j. Drainage Facilities - Location, type, and size (on-site and off-site). Show how project is to handle storm water and cross drainage to or from adjacent properties. k. Lighting - Location and size of all exterior lighting standards and devices. l. Refuse - Location of refuse disposal areas. m. Storage - Location of outside storage areas and indication of screening method. n. Utilities - Location, sizes, and dimensions of all existing and proposed underground and above ground utilities and equipment (on-site and off-site). List name, address, and phone number of all affected utilities. Show proposed screening of electrical transformer and Water District backflow device. o. Sign Location - Location of all existing and proposed free-standing signs. p. Trees - Location, existing grade, circumference, area of dripline and species of all existing trees on site (may require a separate tree report). q. Adjacency Items - All existing uses, structures, walls, fences, yards, drainage facilities, lighting, signs, parking, driveways, trees, and grades within 100 feet of the project boundary. r. Barriers - Location and dimensions of all wheel/bumper stops and concrete headers separating vehicular areas from landscaped areas. ---PAGE BREAK--- -13- 12/20 4. Vicinity Map: a. A Vicinity map of the area to be developed showing adjoining projects, creeks, railroads, major cross streets, and other data sufficient to locate the proposed project in relationship to the surrounding community. B. BUILDING ELEVATIONS: 1. All pertinent horizontal and vertical dimensions of existing (if applicable) and/or proposed structures. Height measurements shall be made from grade to the highest point of construction. 2. Architectural elevations of each exposure (front, rear, both sides) of each building or structure type: a. Show rooftop equipment and demonstrate parapet screening (identify screening material). b. Show adjacent structures on street elevation. c. Include a composite elevation from street level if multiple buildings are proposed (incorporate the profile of landscaping and structures or equipment adjacent to such elevations). d. Label each elevation with a directional (north, south, etc.) orientation. 3. Type of roof, window (reflectively), and wall materials (finished surface) to be used. 4. Accurate color of materials (1 copy of typical elevation or perspective rendered in accurate color). 5. Location(s) and dimensions for all sign, graphics, or other advertising displays proposed on-site; indicate type, color, copy (if known) and materials of construction. (NOTE: If a separate sign plan is required for this project, make sure that the information contained in both is the same). 6. Roof plan showing the direction of roof elements and equipment, exterior lights, vents, ducts, and other exterior mechanical utility equipment. C. COLORS AND MATERIALS CARD: 1. The colors and materials sample card shall be no larger than 8½” x 11” and shall contain representative samples of all external colors and materials of construction proposed for use on the project. Samples must be consistent with the information shown on the elevations. The card shall also identify the project location, name and address, and bear a prominent label indicating the Case Number(s) it is associated with (leave space for staff to add the number). ---PAGE BREAK--- -14- 12/20 D. FLOOR PLANS: 1. All room and area dimensions including existing rooms/areas adjacent to the proposed construction and overall dimensions. 2. The proposed use of all rooms and areas identified and the amount of gross floor area for each proposed use. 3. Occupant load calculations and Occupancy Classification for each room or area and the entire structure. 4. Provisions for accessibility to the elderly and physically disabled which are required by law for buildings and facilities to be used by the public. 5. Statement indicating whether or not automatic fire sprinkler systems will be used in the structure. E. CONCEPTUAL GRADING/DRAINAGE PLANS: 1. Show the proposed shape, height, and grade of the site including the direction of drainage flow, existing trees, and percent of grade (Slope Map). 2. Indicate all proposed cuts and fills coordinated with the proposed phasing of the project. 3. Indicate all quantities of cut and fill and their ultimate disposition. 4. Indicate all erosion control measures including proposed detention basins and retaining walls. 5. Provide cross-sectional profiles for existing and proposed grade changes. 6. Show location of perimeter walls, if applicable, and relationship of the walls to slopes and other walls, existing and proposed. Where existing and proposed walls are shown, identify distance between wall faces and indicate grade differential, if any. F. CONCEPTUAL LANDSCAPING / IRRIGATION PLANS: 1. A rendered plan graphically identifying by symbol and notes the types of proposed plantings. a. Turf shall be indicated by a symbol distinct from shrub and ground cover symbols. b. Existing and proposed berms shall be identified by general shape and gradient. 2. A reasonable representation of the proposed number of trees without calling out exact quantities. ---PAGE BREAK--- -15- 12/20 3. A legend which identifies the plant material (botanical and common names) with a breakdown in percentages of the various container sizes for each tree and shrub symbol 25% 15-gal.), for each plan graphic symbol. 4. The proposed method and type of irrigation shall be indicated by notes. If multiple systems of irrigation are used, clearly identify on the plan where each type of system will be used. a. In notes, the irrigation concept should include a proposed water management strategy. 5. Existing trees shall be shown on the plan. G. RADIUS MAP: 1. The radius map must show the subject parcel(s) and all properties within 500 / 700 / 1,000* feet of the boundaries of the subject parcel(s). If the surrounding parcel owners are not excessive, indicate the Assessor’s Parcel Number of every parcel within or touching the radius line on the map. List the Parcel Number on the mailing label, also. If impractical to list Parcel Numbers on the map, cross- reference to the tabular mailing list. *The radius for the surrounding property is calculated on the subject property size: 20 acres or less – 500’ radius 21 acres to 159 acres – 700’ radius 160 acres or more – 1,000 radius ---PAGE BREAK--- -16- 12/20 Planning Division FIRE DEPARTMENT TRANSMITTAL LETTER This form will serve as the cover sheet for this project’s online submittal to the Los Angeles County Fire Department through the EPIC-LA permitting system. It is essential that this project be submitted to EPIC-LA as soon as possible after it is assigned to a case number, so that the review process is not delayed. Development Advisory Board comments or Conditions of Approval may be postponed if the project is not submitted in a timely manner. Applicant’s Name: Phone: Email: Project Location (address or vicinity): Assessor’s Parcel Number(s) (APN): Project Description: The instructions below outline how to submit a project to EPIC-LA. If you have questions or encounter issues during the submittal process, please reach out to Wally Collins at [EMAIL REDACTED] or (323) 890-4243. 1. Go to epical.lacounty.gov. 2. Click “Login or Register”. If you already have an account with EPIC-LA, sign in now. If you do not, please register for a new account. 3. Click “Apply”. Then, select the permit type that matches the EPIC-LA Designation listed below. 4. Follow the prompts to enter information related to your project. When you reach the Attachments screen, be sure to upload this worksheet as a “City Transmittal Letter”. 5. Email a copy of your invoice or receipt to your case planner to let them know that the item has been submitted. City Use Only Case Number: Case Planner: Email: EPIC-LA Designation: Fire – Land Development – City Requests – □ One Stop Counseling □ Lot Line Adjustment □ Tentative Parcel Map □ Conditional Use Permit □ Site Plan Review □ Zone Change □ Tentative Tract Map □ Other