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ZONE CHANGE AND PRE-ZONE APPLICATION Case No.: Planning Division 38250 Sierra Highway Date: Palmdale, CA 93550 (661) 267-5200 Received By: [EMAIL REDACTED] Print Name INSTRUCTIONS TO APPLICANT The following application form is provided for all applicants requesting a change of zoning or pre-zoning with the City of Palmdale. The applicant must complete the attached form as prescribed and submit the following information before the application can be accepted by the Planning Division. ZONE CHANGE SUBMITTAL CHECKLIST The completed Application A copy of the Development Advisory Board (DAB) letter (if applicable) Three copies of the Title Report for the subject property prepared within the last six months which includes a declaration of all easements of record and copies of all easement/declaration instruments referenced. Note: Preliminary Subdivision Reports are not acceptable. 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 and two copies of the Owner Authorization Letter ---PAGE BREAK--- The original and two copies of the Hazardous Materials/Waste Products Certification The original Public Hearing Sign Removal Authorization A vicinity map at a scale clearly indicating the subject parcel(s) and showing the existing major street patterns, adjoining zoning, projects, subdivision(s), creeks, railroads and other significant landmarks within a minimum of one mile of the exterior boundaries of the site on 8 ½” by 11” paper. Note: Thomas Guide maps are not acceptable. Pursuant to the California Environmental Quality Act, the Planning Department will review the project and determine areas of potential environmental impact. Special studies including, but not limited to, traffic, biological, noise and archaeological may be required. This information may also be obtained through preliminary project review by the Development Advisory Board (DAB). FEE CALCULATIONS** Base fee: $ 3,000 @ $50/acre: # of acres to 200 acres @ $25/acre: # of acres over 200 acres Initial Environmental Study: $ 950 City of Palmdale Fish and Wildlife Processing Fee: $ 25 @ $1.65/label: # of labels 300 Public Hearing Notice: $ GIS Fee 5% of TOTAL FEE RECEIVED: $ **Additional State and/or County fees will be required prior to project approval. If you have any questions regarding this application packet or required materials, please call the Planning Division. ---PAGE BREAK--- APPLICATION FOR ZONE CHANGE/PRE-ZONE Pre-Zone No.: Zone Change No. Request to Change Zone From: to on acres. Was a Pre-application filed? Yes No If yes, Ref.: DAB- Project Location: Assessor’s Parcel Number(s): Approximately feet N or S of (Circle) (Street) Approximately feet E or W of (Circle) (Street) Is this part of an existing tract? Yes No If yes, indicate Tract and Lot/Parcel Nos.: List all related applications being filed with this project: List case number(s) of all previous applications filed on the site: APPLICANT: Name and Email: Address: City: State: Zip: Telephone No.: ( ) OWNER: Name and Email: Address: City: State: Zip: Telephone No.: ( ) ENGINEER/REPRESENTATIVE: Name and Email: Address: City: State: Zip: Telephone No.: ( ) Use additional sheets in the case of multiple parcel numbers, owners, etc. Please include in mailing list all other persons to be notified regarding this application. ---PAGE BREAK--- 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: Phone: ( ) Signature: Date: ---PAGE BREAK--- 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--- 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 Telephone Printed Name Signature Date Address Telephone Subscribed and sworn to before me this day of NOTARY PUBLIC NOTE: ATTACH LEGAL DESCRIPTION OF PROPERTY TO THIS DOCUMENT. ---PAGE BREAK--- CITY OF PALMDALE PLANNING DEPARTMENT HAZARDOUS MATERIALS / WASTE PRODUCTS CERTIFICATION Pursuant to Section 65962.5(F) of State Government Code, project applicants must identify whether a project site contains any hazardous materials and/or wastes included on any list compiled by the State Department of Health Services, the State Water Resources Control Board or the California Integrated Waste Management Board or are known by the owner or applicant. These lists generally identify sites that have pending corrective action regarding leaks or migration of hazardous materials. CERTIFICATION I have consulted the list compiled pursuant to Section 65962.5 of the Government Code and hereby certify that the project site and any alternatives to the project are are not identified on any of these lists. I further certify that, to the best of my knowledge, there are are not such hazardous materials on this site. Assessor’s Parcel Number(s): Case Number(s): Project Location (address if available): Approximately Feet N or S of (Circle) (Street Name) Approximately Feet E or W of (Circle) (Street Name) Use additional sheets if necessary. Date Owner’s Signature Date Owner’s Signature Date Applicant’s Signature If the site is listed, which listing agency has identified the site? If the site is listed, what is the Regulatory Identification Number associated with the site? NOTE: Before the Lead Agency can accept the application as complete, this certification must be reviewed and signed by the project owner(s) and applicant. ---PAGE BREAK--- 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: Green background with black letters (see Figure 6. LETTERING: Shall be block style with 4” major letters and 2” minor letters. 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 ---PAGE BREAK--- responsibility of the applicant to obtain approval of such revision(s) from the assigned planner. 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, but not limited to, Zone Changes, General Plan Amendments, Specific Plans, and appealed items. 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--- Figure 1 Figure 2 -10- ---PAGE BREAK--- 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: -11-