APPLICATIONS
CITY PLANNING APPLICATION
THIS BOX FOR CITY PLANNING STAFF USE ONLY
ED1 Eligible AB 2097 Eligible
Case Number:
Env. Case Number:
Application Type:
Case Filed With (Print Name): Date Filed:
Application includes letter requesting:
Waived Hearing Concurrent hearing Hearing not to be scheduled on a specific
date (e.g. vacation hold)
Related Case Number(s):
THIS SECTION TO BE COMPLETED BY THE APPLICANT
Provide all information requested. Missing, incomplete or inconsistent information will cause delays.
All terms in this document are applicable to the singular as well as the plural forms of such terms.
Refer to the City Planning Application Filing Instructions (CP-7810) for more information.
1. PROJECT LOCATION
Street Address1: Unit/Space Number:
Legal Description2 (Lot, Block, Tract):
Assessor Parcel Number: Total Lot Area:
2. PROJECT DESCRIPTION
Present Use:
Proposed Use:
Project Name (if applicable):
1
Street Addresses must include all addresses on the subject/application site (as identified in ZIMAS—[Link]
2
Legal Description must include all contiguously owned properties (even if they are not a part of the proposed project site).
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Describe in detail the characteristics, scope and/or operation of the proposed project:
Additional Information Attached: YES NO
EXISTING SITE CONDITIONS
Complete and check all that apply:
Site is undeveloped or unimproved Site is located within 500 feet of a freeway
(i.e., vacant) or railroad
Site has existing buildings Site is located within 500 feet of a sensitive
(provide copies of building permits) use (e.g., school, park)
Site is/was developed with uses that could Site has special designation
release hazardous materials on soil and/or (e.g., National Historic Register, Survey LA)
groundwater (e.g., dry cleaning, gas station,
auto repair, industrial)
PROPOSED PROJECT INFORMATION
Check all that apply or could apply:
Demolition of existing buildings/structures New construction: square feet
Relocation of existing buildings/structures Additions to existing buildings
Removal of any on-site tree Interior tenant improvement
Removal of any street tree Exterior renovation or alteration
Removal of protected trees onsite/in public Change of use and/or hours of operation
right-of-way Uses or structures in public right-of-way
Grading Phased project
Haul Route
HOUSING COMPONENT INFORMATION
Number of
Residential Units: Existing - Demolish(ed)3 + Adding = Total
Number of
Affordable Units4: Existing - Demolish(ed) + Adding = Total
Number of Market
Rate Units: Existing - Demolish(ed) + Adding = Total
Mixed Use Projects, Amount of Non-Residential Floor Area: square feet
3
Number of units to be demolished and/or which have been demolished within the last five years.
4
As determined by the Los Angeles Housing Department.
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PARKING INFORMATION
Is the project utilizing AB 2097? YES NO
If Yes, provide a date-stamped ZIMAS Parcel Profile Report including AB 2097 Eligibility information.
Provided # of Parking Spaces: Required # of Parking Spaces:
Parking Minimum Checklist
The following checklist will determine if parking minimums can be imposed on a Project under AB 2097.
Parking minimums cannot be imposed if the proposed project meets any of the following criteria.
Check all that apply:
Include a minimum of 20 percent of the total dwelling units for Very Low, Low, or Moderate-Income
households, students, the elderly, or persons with disabilities
Contain fewer than 20 dwelling units
Are subject to parking reductions of any other applicable law (by satisfying the applicable eligibility
requirements)
PUBLIC RIGHT-OF-WAY INFORMATION
Have you submitted the Planning Case Referral Form to BOE? (if required) YES NO
Is the project required to dedicate land to the public right-of-way? YES NO
If so, what is/are the dedication requirement(s)? feet
If dedications are required on multiple streets, identify as such:
3. ACTION(S) REQUESTED
Provide the Los Angeles Municipal Code (LAMC) Section that authorizes the request and (if
applicable) the LAMC Section or the Specific Plan/Overlay Section from which relief is sought,
and follow with a description of the requested action.
Does the project include Multiple Approval Requests per YES NO
LAMC Section 12.36?
Authorizing Code Section:
Code Section from which relief is requested (if any):
Action Requested:
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Authorizing Code Section:
Code Section from which relief is requested (if any):
Action Requested:
Additional Requests Attached: YES NO
4. RELATED CITY PLANNING CASES
Are there previous or pending cases/decisions/environmental clearances YES NO
on the project site?
If YES, list all case number(s):
If the application/project is directly related to one of the above cases, list the pertinent case numbers
below and complete/check all that apply (provide copy).
Case No.: Ordinance No.:
Condition Compliance Review Clarification of Q (Qualified) Condition
Modification of Conditions Clarification of D (Development) Limitation
Revision of Approved Plans Amendment to T (Tentative) Classification
Renewal of Entitlement Plan Approval subsequent to Main Conditional Use
For purposes of environmental (CEQA) analysis, is there intent to develop a YES NO
larger project?
Have you filed, or is there intent to file, a Subdivision with this project? YES NO
If YES, to either of the above, describe the other parts of the projects or the larger project below,
whether or not currently filed with the City:
5. RELATED DOCUMENTS / REFERRALS
To help assigned staff coordinate with other Departments that may have a role in the proposed
project, provide a copy of any applicable form and reference number if known.
Are there any recorded Covenants, affidavits or easements on this property?
YES (provide copy) NO
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6. PROJECT TEAM INFORMATION (COMPLETE ALL APPLICABLE FIELDS)
APPLICANT
Applicant5 Name:
Company/Firm:
Address: Unit/Space Number:
City: State: Zip Code:
Telephone: E-mail:
Are you in escrow to purchase the subject property?: YES ✘ NO
PROPERTY OWNER OF RECORD Same as applicant Different from applicant
Name (if different from applicant):
Address: Unit/Space Number:
City: State: Zip Code:
Telephone: E-mail:
AGENT / REPRESENTATIVE NAME:
Company/Firm:
Address: Unit/Space Number:
City: State: Zip Code:
Telephone: E-mail:
5
An applicant is a person with a lasting interest in the completed project such as the property owner or a lessee/user of a project.
An agent/representative is someone filing an application on behalf of a client.
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OTHER (E.G. ARCHITECT, ENGINEER, CEQA CONSULTANT):
Name:
Company/Firm:
Address: Unit/Space Number:
City: State: Zip Code:
Telephone: E-mail:
Primary Contact for Project Information6
(Select only one. Email address and phone number required.)
Owner Applicant ✘ Agent/Representative Other:
To ensure notification of any public hearing as well as decisions on the project, make sure to include
an individual mailing label for each member of the project team in both the Property Owners List and
the Abutting Property Owners List.
6
As of June 8, 2022, the Primary Contact for Project is required to have an Angeleno Account and register with the Ethics Commission
for Significant Project Entitlements, as defined in LAMC Section 49.7.37(A)(6). An email address and phone number shall be required
on the DCP Application Form, and the email address provided shall match the email address used to create the Angeleno Account.
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PROPERTY OWNER AFFIDAVIT
Before the application can be accepted, the owner of each property involved must provide a notarized
signature to verify the application is being filed with their knowledge. Staff will confirm ownership based
on the records of the City Engineer or County Assessor. In the case of partnerships, corporations,
LLCs or trusts an officer of the ownership entity so authorized may sign as stipulated below.
• Ownership Disclosure. If the property is owned by a partnership, corporation, LLC or trust, a
disclosure identifying an officer of the ownership entity must be submitted. The disclosure must
list the names and addresses of the principal owners (25% interest or greater). The signatory
must appear in this list of names. A letter of authorization, as described below, may be submitted
provided the signatory of the letter is included in the Ownership Disclosure. Include a copy of the
current partnership agreement, corporate articles, or trust document as applicable.
• Letter of Authorization (LOA). An LOA from a property owner granting someone else permission
to sign the application form may be provided if the property is owned by a partnership, corporation,
LLC or trust or in rare circumstances when an individual property owner is unable to sign the
application form. To be considered for acceptance, the LOA must indicate the name of the person
being authorized the file, their relationship to the owner or project, the site address, a general
description of the type of application being filed and must also include the language in items A-D
below. In the case of partnerships, corporations, LLCs or trusts the LOA must be signed and
notarized by the authorized signatory as shown on the Ownership Disclosure or in the case of
private ownership by the property owner. Proof of Ownership for the signatory of the LOA must be
submitted with said letter.
• Grant Deed. Provide a Copy of the Grant Deed If the ownership of the property does not match
City Records and/or if the application is for a Coastal Development Permit. The Deed must
correspond exactly with the ownership listed on the application.
• Multiple Owners. If the property is owned by more than one individual (e.g. John and Jane Doe or
Mary Smith and Mark Jones) notarized signatures are required of all owners.
a. I hereby certify that I am the owner of record of the herein previously described property
located in the City of Los Angeles which is involved in this application or have been
empowered to sign as the owner on behalf of a partnership, corporation, LLC or trust as
evidenced by the documents attached hereto.
b. I hereby consent to the filing of this application on my property for processing by the
Department of City Planning.
c. I understand if the application is approved, as a part of the process the City will apply
conditions of approval which may be my responsibility to satisfy including, but not limited to,
recording the decision and all conditions in the County Deed Records for the property.
d. By my signature below, I declare under penalty of perjury under the laws of the State of
California that the foregoing statements are true and correct.
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Property Owner’s signatures must be signed/notarized in the presence of a Notary Public.
The City requires an original signature from the property owner with the “wet” notary stamp.
A Notary Acknowledgement is available for your convenience on following page.
Signature: Date:
Print Name:
Signature: Date:
Print Name:
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SPACE BELOW FOR NOTARY’S USE
CALIFORNIA ALL-PURPOSE ACKNOWLEDGEMENT CIVIL CODE ‘1189
A notary public or other officer completing this certificate verifies only the identity of the individual
who signed the document, to which this certificate is attached, and not the truthfulness, accuracy,
or validity of that document.
State of California
County of
On before me,
(Insert Name of Notary Public and Title)
personally appeared , who
proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are
subscribed to the within instrument and acknowledged to me that he/she/they executed the same
in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the
person(s), or the entity upon behalf on which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing
paragraph is true and correct.
WITNESS my hand and official seal.
(Seal)
Signature
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APPLICANT DECLARATION
A separate signature from the applicant, whether they are the property owner or not, attesting to the
following, is required before the application can be accepted.
a. I hereby certify that the information provided in this application, including plans and other
attachments, is accurate and correct to the best of my knowledge. Furthermore, should the
stated information be found false or insufficient to fulfill the requirements of the Department of
City Planning, I agree to revise the information as appropriate.
b. I hereby certify that I have fully informed the City of the nature of the project for purposes of
the California Environmental Quality Act (CEQA) and have not submitted this application with
the intention of segmenting a larger project in violation of CEQA. I understand that should the
City determine that the project is part of a larger project for purposes of CEQA, the City may
revoke any approvals and/or stay any subsequent entitlements or permits (including certificates
of occupancy) until a full and complete CEQA analysis is reviewed and appropriate CEQA
clearance is adopted or certified.
c. I understand that the environmental review associated with this application is preliminary, and
that after further evaluation, additional reports, studies, applications and/or fees may be required.
d. I understand and agree that any report, study, map or other information submitted to the City
in furtherance of this application will be treated by the City as public records which may be
reviewed by any person and if requested, that a copy will be provided by the City to any person
upon the payment of its direct costs of duplication.
e. I understand that the burden of proof to substantiate the request is the responsibility of the
applicant. Additionally, I understand that planning staff are not permitted to assist the applicant
or opponents of the project in preparing arguments for or against a request.
f. I understand that there is no guarantee, expressed or implied, that any permit or application
will be granted. I understand that each matter must be carefully evaluated and that the
resulting recommendation or decision may be contrary to a position taken or implied in any
preliminary discussions.
g. I understand that if this application is denied, there is no refund of fees paid.
h. I understand and agree to defend, indemnify, and hold harmless, the City, its officers, agents,
employees, and volunteers (collectively “City), from any and all legal actions, claims, or
proceedings (including administrative or alternative dispute resolution (collectively “actions”)),
arising out of any City process or approval prompted by this Action, either in whole or in part.
Such actions include but are not limited to: actions to attack, set aside, void, or otherwise
modify, an entitlement approval, environmental review, or subsequent permit decision; actions
for personal or property damage; actions based on an allegation of an unlawful pattern and
practice; inverse condemnation actions; and civil rights or an action based on the protected
status of the petitioner or claimant under state or federal law (e.g. ADA or Unruh Act). I
understand and agree to reimburse the City for any and all costs incurred in defense of such
actions. This includes, but is not limited to, the payment of all court costs and attorneys’ fees,
all judgments or awards, damages, and settlement costs. The indemnity language in this
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paragraph is intended to be interpreted to the broadest extent permitted by law and shall be in
addition to any other indemnification language agreed to by the applicant.
i. I understand that the City is protected by numerous statutory immunities from liability for
damages that may be caused by its land use regulatory actions, as set forth in Government
Code, section 818, et seq. For instance, the City cannot be held liable for personal or property
injuries or damages allegedly caused by its approval and issuance of any discretionary
permit, entitlement or approval (Gov. Code § 818.4), or its failure to inspect or its negligence
in inspecting a property for the purpose of determining whether the property complies with or
violates any permit, entitlement or approval or contains or constitutes a hazard to health or
safety (Gov. Code § 818.6).
j. By my signature below, I declare under penalty of perjury, under the laws of the State of
California, that all statements contained in this application and any accompanying documents
are true and correct, with full knowledge that all statements made in this application are subject
to investigation and that any false or dishonest answer to any question may be grounds for
denial or subsequent revocation of license or permit.
The City requires an original signature from the applicant. The applicant’s signature below does not
need to be notarized.
Signature: Date:
Print Name:
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NEIGHBORHOOD CONTACT SHEET (OPTIONAL)
7. SIGNATURES
Signatures of adjoining or neighboring property owners in support of the request are not required
but are helpful, especially for projects in single-family residential areas. Signatures may be provided
below (attach additional sheets if necessary).
NAME (Print) SIGNATURE ADDRESS KEY # ON MAP
REVIEW of the project by the applicable Neighborhood Council is not required but is helpful. If
applicable, describe, below or separately, any contact you have had with the Neighborhood Council
or other community groups, business associations and/or officials in the area surrounding the project
site (attach additional sheets if necessary).
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