Home Table of Contents

Appendix N Application Checklist

14 CA ADC Div. 5 App. NBarclays Official California Code of Regulations

Barclays California Code of Regulations
Title 14. Natural Resources
Division 5. San Francisco Bay Conservation and Development Commission
Appendices
14 CCR Div. 5 App. N
Appendix N Application Checklist
Currentness
Abbreviated Regionwide Permit
Empty Checkbox​ Abbreviated Application Form:
One fully completed and signed original
Empty Checkbox​ Large Scale Project Site Plan
One Copy
Empty Checkbox​ 8 1/2″ x 11″ Project Site Plan
One Copy
Empty Checkbox​ 8 1/2″ x 11″ Vicinity Map
One Copy
Empty Checkbox​ Proof of Legal Interest
One Copy
Empty Checkbox​ Permit Processing Fee
As Specified in Appendix M
__________
*Additional drawings are needed for projects that are evaluated by the Commission's Design Review Board or Engineering Criteria Review Board.
Application Information
Box 1 Applicant Information
a. PROPERTY OWNER: Empty Checkbox​ Individual Empty Checkbox​ Private Entity Empty Checkbox​ Government Empty Checkbox​ Non-profit
Name:
 
Address:
 
City, State, Zip:
 
Telephones:
 
b. OWNER'S REPRESENTATIVE: Empty Checkbox​ None
Name:
 
Address:
 
City, State, Zip:
 
Telephones:
 
Affiliation to Applicant:
 
I hereby authorize
 
to act as my representative and bind me in all matters concerning this application.
 
Signature of Owner
Date
 
Printed Name of Owner
c. APPLICANT: Empty Checkbox​ Individual Empty Checkbox​ Private Entity Empty Checkbox​ Government Empty Checkbox​ Non-profit
Name:
 
Address:
 
City, State, Zip:
 
Telephones:
 
d. APPLICANT'S REPRESENTATIVE: Empty Checkbox​ None
Name:
 
Address:
 
City, State, Zip:
 
Telephones: __________/__________/__________
Affiliation to Applicant:
 
I hereby authorize
 
to act as my representative and bind me in all matters concerning this application.
 
Signature of Applicant
Date
 
Printed Name of Applicant
e. Co-APPLICANT: Empty Checkbox​ None Empty Checkbox​ Individual Empty Checkbox​ Private Entity Empty Checkbox​ Government Empty Checkbox​ Non-profit
Name:
 
Address:
 
City, State, Zip:
 
Telephones: __________/__________/__________
f. CO-APPLICANT'S REPRESENTATIVE:
None
Name:
 
Address:
 
City, State, Zip:
 
Telephones: __________/__________/__________
Affiliation to Applicant:
 
I hereby authorize
 
to act as my representative and bind me in all matters concerning this application.
 
Signature of Applicant
Date
 
Printed Name of Applicant
Box 2 Certification of Accuracy of Information
I hereby certify under penalty of perjury that to the best of my knowledge the information in both Part 1 and Part II of this application and all attached exhibits is full, complete, and correct, and I understand that any misstatement or omission of the requested information or of any information subsequently requested shall be grounds for denying the permit, for suspending or revoking a permit issued on the basis of these or subsequent representations, or for the seeking of such other and further relief as may seem proper to the Commission.
 
Signature of Owner or Date
Owner's Representative
 
Signature of Applicant or Date
Applicant's Representative
 
Signature of Co-Applicant or Date
Co-Applicant's Representative
Box 3 Project Information
a. Project Name:
 
b. Project Description:
 
 
 
c. Date work is expected to begin:
 
Date work is expected to be completed:
 
d. Does the project involve the placement of fill of ant type in San Francisco Bay or within a salt pond, a managed wetland, or a certain waterway?
Empty Checkbox​ YES Empty Checkbox​ NO
If “Yes”, completed Box 5.
e. Does the project involve development within the shoreline band around San Francisco Bay?
Empty Checkbox​ YES Empty Checkbox​ NO
If “Yes”, complete Box 6.
f. Total Project Cost: $____________________
Box 4 Site Information
a. Street Address:
 
b. City, County, State, Zip:
 
c. Assessor's Parcel: ______________________________
Numbers: ______________________________
Empty Checkbox​ None
d. ID number(s) of previous BCDC permit(s) issued for work on this site: ______________________________
Empty Checkbox​ None
e. Provide a brief description of the existing condition of the site, including the present elevations, current vegetation, existing structure and use of the site.
Box 5 Bay Fill Information
(“Fill” means earth or any other substance or material, including pilings or structures placed on pilings, and structures floating at some or all times and moored for extended periods, such as houseboats and floating docks. Cal. Gov. Code Section 66632(a))
a. What is the basic purpose of the new fill in the Bay?
 
 
b. Total volume of water, marsh, or salt pond to be filled: __________ cubic yards
c. Area to be covered with solid fill: __________ square feet
d. Area to be covered with floating fill: __________ square feet
e. Area to be covered with pile-supported fill: __________ square feet
f. Area to be covered with cantilevered fill: __________ square feet
g. Area to be covered with any other type of fill:
(Specify type of fill):
__________ square feet
h. Total area to be filled: __________ square feet
Box 6 Shoreline Band Information
(“Shoreline band” means “...all territory location between the shoreline of San Francisco Bay...and a line 100 feet landward of and parallel with that Line...” Cal.Gov.Code Section 66610(b))
a. Types of activities to be undertaken or materials to be placed along the shoreline:
 
 
b. Will the project be located within a water-oriented priority use area that is designated in the San Francisco Bay Plan?
Empty Checkbox​ YES Empty Checkbox​ NO
If “No,” go to section (c).
If “Yes,” indicated which priority use the area is reserved for:
 
Will the project use be consistent with the priority use for which the site is reserved?
Empty Checkbox​ YES Empty Checkbox​ NO
If “Yes,” go to section (c).
If “No,” attach an explanation of how the project can be approved despite this inconsistency.
c. Provide dimensions of portions of all structures to be built within the shoreline band, including length, width, area, height, and number of stories:
 
 
 
 

Credits

Note: Authority cited: Section 66632, Government Code; and Section 29201(e), Public Resources Code. Reference: Sections 65940-65942, 66632(b), 66632(f) and 84308, Government Code; Sections 21080.5, 21082 and 29520, Public Resources Code; and San Francisco Bay Plan.
History
1. New Appendix N filed 8-6-96; operative 9-5-96 (Register 96, No. 32).
2. Amendment of application checklist and new Note filed 10-14-2004; operative 10-14-2004 pursuant to Government Code section 11343.4 (Register 2004, No. 42).
3. Change without regulatory effect amending and relocating Appendix N from chapter 17 to chapter 240 filed 12-31-2020 pursuant to section 100, title 1, California Code of Regulations (Register 2021, No. 1). (OAL review extended 60 calendar days pursuant to Executive Order N-40-20.)
This database is current through 6/21/24 Register 2024, No. 25.
Cal. Admin. Code tit. 14, Div. 5 App. N, 14 CA ADC Div. 5 App. N
End of Document