HomeMy WebLinkAbout2011/07/19 Item 08 Attachment A Appendix_S_Certificate_of_Appropriateness_Form
Certificate of Appropriateness
Applies to all proposed alteration, modifications s or demolitions to historical resources, and
discretionary projects that propose impacts to historical resources.
8
Permit Category or Discretionary Action:
Building Permit CUP Variance DRC Other
Property Address:
Assessors Parcel Number ():
APN
Property?s Historical Status:
Site #__________________
Designated Historical Resource
Eligible Resource (Included on Local Historical Resource Inventory or Eligibility Determination Form-attached form)
Owner Name, Address, Telephone:
Applicant Name, Address, Telephone:
Owner(s) Signature(s)
:__________________________________ _______________________________________
:__________________________________ _______________________________________:__________________________________ _______________________________________
Proposed Project Description (attach additional sheet if necessary):
Alteration Addition Demolition New Construction Other
Other Other
Proposal Description:_______________________________________________________________________________
Proposal Description:_______________________________________________________________________________ Proposal Description:____________________________________________________________________________
___
Property Description: If Designated or in the inventory you may submit the property Inventory Worksheet
ntory you may submit the prntory you may submit the pr
Year Built ():
exact or approximate age
Property Type ():
residential, commercial, industrial
residential, commercial, industrialresidential, commercial, industrial): ):
Building Height / Stories:
Exterior Building Materials ():
roof & siding materials
roof & siding materialsroof & siding materials
): ):
Property Photographs:
Attach current property photos to provide full exterior view of all four elevations.
Attach current property photos to provide full exterior view of all four elevations
City of Chula Vista - Planning & Building Department- Historical Resources
276 Fourth Avenue, Chula Vista, CA 91910 1-20-2010
Certificate of Appropriateness
Applies to all proposed alteration, modifications s or demolitions to historical resources, and
discretionary projects that propose impacts to historical resources.
Zoning Administrator Section (To be completed by Zoning Administrator or City Staff)
Historic District/Overlay Zone/Planning Area:
Required Certificate of Appropriateness (COA) Category (Based on Provided Project Description):
Minor Alteration COA (ZA_____ or HPC_______) Major Alteration COA (HPC)
Demolition COA (Major/HPC) Discretionary COA (Minor____Major____)
Required Documents:
Additional Information Necessary from Applicant:
DPR 523 A (Primary Record) & B (Building, Structure, Object Record) Forms
CRHR Status Code Determination (list status code assigned on submitted DPR Forms _________
Expert Technical Analysis Report
Resource Eligibility ? Yes ______________ No____________ (If No, no further review is required)
(If No, no further review is required)
(If No, no further review is required)
Impacts Analysis
The Secretary of the Interiors Standards for the Treatment of Historic Properties
Design Review analysis utilizing
The Secretary of the Interiors Standards foThe Secretary of the Interiors Standards for the Treatment of Historic Propertiesr the Treatment of Historic Properties
The
Mitigation Measures recommended (if necessary based on impacts identified Design Review analysis utilizing
impacts identified Design Review analysis utilizing impacts identified Design Review analysis utilizing
Secretary of the Interiors Standards for the Treatment of Historic Properties
the Treatment of Historic Propertiesthe Treatment of Historic Properties
Findings of Fact: __________
(Must meet all three findings of fact):
(Must meet all three findings of fact): (Must meet all three findings of fact):
1. That the proposed work conforms to The Secretary of the Interior?s Standards for Treatment of Historic Properties;
1. That the proposed work conforms to The Secretary of the Interi1. That the proposed work conforms to The Secretary of the Interior?s Standards for Treatment of Hior?s Standards for
Treatment of Hi
2. That the proposed work is consistent with the General Plan, applicable design guidelines, or other policies adopted by
Plan, applicable design guidelines, or other policies adopted by Plan, applicable design guidelines, or other policies adopted by
the HPC or Council; and
3. That the proposed work shall not adversely affect the exterior features of the historical resourceHistorical Resource or
3. That the proposed work shall not adversely affect the exterior features of the historical resourceHistorical Resource or 3. That the proposed work shall not adversely affect
the exterior features of the historical resourceHistorical Resource or
its special character, interest or value of its neighboring improvements and surroundings, including façade, setback,
e of its neighboring improvements and sue of its neighboring improvements and su
roof shapes, scale, height and relationship of material, color and texture such that the historic Integrity is diminished.
relationship of material, color relationship of material, color
COA Determination
Minor COA (attached written Findings of Fact) ZA______ or HPC________
gs of Fact) ZA______ or HPC________ gs of Fact) ZA______ or HPC________
Approved without conditions
Minor COA Issued with conditions Denied
Minor COA Issued with conditions Minor COA Issued with conditions
Major COA (attach written Findings of Fact) HPC only
Major COA (attach written Findings of Fact) HPC only Major COA (attach written Findings of Fact) HPC only
Approved without conditions
Approved without conditions Approved without conditions
Approved with conditions Denied
Approved with conditions Approved with conditions
City of Chula Vista - Planning & Building Department- Historical Resources
276 Fourth Avenue, Chula Vista, CA 91910 1-20-2010