California Code of Regulations
Title 14 - Natural Resources
Division 5 - San Francisco Bay Conservation and Development Commission
Appendices
Appendix N - Application Checklist

Current through Register 2024 Notice Reg. No. 38, September 20, 2024

*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: [] Individual [] Private Entity [] Government [] Non-profit

Name: ___________________________

Address: ___________________________

City, State, Zip: ___________________________

Telephones: ___________________________

b. OWNER'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.

___________________________

___________________________

Printed Name of Owner

c. APPLICANT: [] Individual [] Private Entity [] Government [] Non-profit

Name: ___________________________

Address: ___________________________

City, State, Zip: ___________________________

Telephones: ___________________________

d. 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.

___________________________

___________________________

Printed Name of Applicant

e. Co-APPLICANT: [] None [] Individual [] Private Entity [] Government [] 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.

___________________________

___________________________

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?

[] YES [] NO

If "Yes", completed Box 5.

e. Does the project involve development within the shoreline band around San Francisco Bay?

[] YES [] 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: ______________________________

[] None

d. ID number(s) of previous BCDC permit(s) issued for work on this site: ______________________________

[] 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?

[] YES [] 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?

[] YES [] 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:

___________________________

___________________________

___________________________

___________________________

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.)

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.