Please explain:
I understand that review and approval of this preliminary CEQA checklist does not
constitute approval for any administrative review, conditional use permit, variance, or exception
from any other City regulations which are not specifically the subject of this application. I
understand further that I remain responsible for satisfying requirements of any private
restrictions or covenants appurtenant to the property. I understand that the Applicant and/or
Owner phone number listed above will be included on any public notice, if any, for the project.
I certify that I am the applicant and that the information submitted with this preliminary
CEQA checklist is true and accurate to the best of my knowledge and belief. I understand that
the City is not responsible for inaccuracies in information presented, and that inaccuracies may
result in the revocation of any permits as determined by the City. I further certify that I am the
owner or purchaser (or option holder) of the property involved in this application, or the lessee or
agent fully authorized by the owner to make this submission, as indicated by the owner’s signature
above.
I certify that statements, if any, made to me about the time it takes to review and process
this application are general. I am aware that the City has attempted to request everything
necessary for an accurate and complete CEQA review of my proposal; however, that after this
preliminary CEQA checklist and/or application has been submitted and reviewed by the City
Administrator’s Office, it may be necessary for the City to request additional information and/or
materials. I understand that any failure to submit the additional information and/or materials in
a timely manner may render the application inactive and that periods of inactivity do not count
towards statutory time limits applicable to the processing of this application.
Signature of Applicant: __________________________________________________
Date: ______________________________________
I HEREBY
CERTIFY
, UNDER PENALTY OF PERJURY, THAT ALL THE
INFORMATION PROVIDED ON THIS APPLICATION IS TRUE AND CORRECT.
CEQA Review done by: ______________________________________________Date: ___________________________
Findings: Exempt Needs Additional Information
Notice of Exemption completed by: ___________________________________Date: _____________________________
FOR
OFFICE
USE
ONLY
