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`` `-`-`-````````````- TO ALL PERSONS APPLYING FOR A CONDITIONAL USE PERMIT The purpose of a Conditional Use Permit is to insure that the use requested will be compatible with other existing and permitted uses located in the area. The procedure for the processing of a Conditional Use Permit application is as follows: 1. Submit a complete application to the Community Development Department on the Thursday six weeks before the scheduled Planning and Environment Commission meeting. 2. The Community Development Department staff will set the date of public hearing before the Commission at a regular meeting and will circulate the required hearing notices. 3. The Planning and Environment Commission either approves with conditions, or denies applicant's application. 4. The Planning and Environment Commission's decision is subject to appeal to the City Council within twenty (20) calendar days. THE COMMUNITY DEVELOPMENT DEPARTMENT STAFF WILL BE HAPPY TO ASSIST YOU. SHOULD YOU HAVE ANY QUESTIONS CONCERNING YOUR APPLICATION, PLEASE DO NOT HESITATE TO CONTACT THE DEPARTMENT: TELEPHONE - (562) 866-9771, EXTENSION 2343 SPECIAL NOTES You are advised NOT to obtain any loans or loan commitments on your property, or to clear the land, or do any work whatsoever that is dependent on final approval of your application. Anything you do before final approval will be at your own risk. Do not assume that your case has been finally approved until you are officially notified of such decision in writing by the City. Final approval requires favorable action by the Planning and Environment Commission. The decision of the Planning and Environment Commission is subject to appeal to or by the City Council. A decision of the Planning and Environment Commission is final only if no appeal is filed within the prescribed appeal period.

Page 2 Also, remember that final approval alone may not be enough. READ the notice of the decision and the RESOLUTION OF APPROVAL of the Planning and Environment Commission on which the decision is based. It is necessary that the project comply with ALL the conditions as set forth in the Resolution of Approval. COMMUNITY DEVELOPMENT DEPARTMENT CITY OF LAKEWOOD Revised 6/25/2018

Page 3 CITY OF LAKEWOOD CONDITIONAL USE PERMIT APPLICATION INSTRUCTIONS A COMPLETED APPLICATION MUST INCLUDE: 1. A FILING FEE OF $775.00 (FENCES - $300.00) 2. FEE FOR NEGATIVE DECLARATION (IF APPLICABLE) - $600.00 A $75.00 check payable to the Registrar-Recorder/County Clerk for posting on the Notice of Intent A $75.00 check payable to the Registrar-Recorder/County Clerk for posting on the Notice of Determination 3. 4. APPLICATION FORM PROPERTY OWNERSHIP LIST Prepare a list of property owner names, mailing addresses, and mailing labels for ALL property that fall wholly and/or partially within a 300-foot radius of the property under consideration including properties that are outside the City of Lakewood boundaries. Include all owners of the property being filed upon. These names and addresses must be from the latest available County Tax Assessor rolls. Number each name. This list must be signed. An inaccurate or incomplete list will be cause to remove the case from the agenda or require a rehearing of the case. 5. MAPS (2) Submit one (1) each of the following maps prepared at a scale no smaller than one inch (1") equals 200 feet, showing all streets, highways, alleys, right-of-ways, and lot cuts. Include tract and lot numbers. All lots and parcels must be completely dimensioned. Dull finish, Osalid bluelines, or black and white prints are required. A. Prepare and submit one (1) map showing a 300-foot radius around the subject property and show the property ownership by using the corresponding numbers from the Property Ownership List. One set of typed mailing labels is required showing names and complete mailing addresses, including zip codes, of property owners.

Page 4 B. Prepare and submit one (1) map showing types of land use and zoning within a 500-foot radius of the subject property. 6. PLOT PLAN, FLOOR PLAN, ELEVATIONS (10 COPIES EACH) Plot plans, floor plans (if required), and elevations (one copy in color) should be drawn to a scale of not less than 1/16" equals one (1) foot. Clearly show all buildings, walls, parking, landscaping and subsurface utilities so located or proposed to be located on the property; the height, size, and shape for each; and distance from all property lines. All plans must be accurately drawn and completely dimensioned. Required copies must be folded to fit inside a legal size folder. Rolled plans will not be accepted. 7. PICTURE(S) OF THE SITE AND ANY ADDITIONAL EXHIBITS APPLICANT MAY WISH TO PRESENT. 8. WRITTEN AUTHORIZATION FROM THE PROPERTY OWNER IF OTHER THAN APPLICANT. 9. PROOF OF OWNERSHIP OF THE PROPERTY (SUCH AS A COPY OF THE DEED OR TITLE REPORT).

Page 5 CITY OF LAKEWOOD C O N D I T I O N A L U S E P E R M I T 1. APPLICANT ADDRESS ZIP CODE TELEPHONE EMAIL MOBILE PHONE 2. PROPERTY OWNER ADDRESS ZIP CODE TELEPHONE 3. ARCHITECT/ENGINEER ADDRESS ZIP CODE TELEPHONE 4. SITE ADDRESS 5. ZONING 6. LEGAL DESCRIPTION (Lot and Tract Number) 7. THE ABOVE DESCRIBED PROPERTY WAS ACQUIRED BY APPLICANT/OWNER Date What original deed restrictions, if any, concerning type of improvements permitted were placed on the property involved? Give date said restrictions expire (You may attach a copy of the original printed restrictions in answer to this question after properly underscoring those features governing the type and class of uses permitted thereby.

Page 6 8. PROPOSED CONDITIONAL USE PERMIT USE 9. NAME OF BUSINESS (if applicable) 10. NATURE OF APPLICATION IF THE APPLICATION IS FOR A BUSINESS, PLEASE PROVIDE THE FOLLOWING INFORMATION WHERE APPLICABLE: 1. Days and hours of operation: 2. If the application is for a restaurant/bar business, please provide the maximum number of chairs and/or stools within your business and include all outdoor patio/deck seating: 3. If the application is for a vocational school, please provide the maximum number of students and staff that you will be within the tenant space at any given time: 4. If the application is for an indoor commercial recreation use, please provide the maximum number of clients you anticipate to accommodate at any given time:

Page 7 CITY OF LAKEWOOD DEPARTMENT OF COMMUNITY DEVELOPMENT NOTE: The Code requires that the conditions set forth in the following Sections 1, 2, 3, and 4 below MUST be established before a Conditional Use Permit can be granted. (Explain in detail wherein your case conforms to the following requirements.) 1. THE SITE FOR THIS PROPOSED USE IS ADEQUATE IN SIZE AND SHAPE - EXPLAIN 2. THE SITE HAS SUFFICIENT ACCESS TO STREETS AND HIGHWAYS, AND IS ADEQUATE IN WIDTH AND PAVEMENT TYPE TO CARRY THE QUANTITY AND QUALITY OF TRAFFIC GENERATED BY THE PROPOSED USE EXPLAIN 3. THE PROPOSED USE WILL NOT BE MATERIALLY DETRIMENTAL, NOR HAVE AN ADVERSE EFFECT UPON ADJACENT USES, BUILDINGS, OR STRUCTURES - EXPLAIN 4. THE PROPOSED CONDITIONAL USE WILL NOT BE IN CONFLICT WITH THE GENERAL PLAN OR ANY OF ITS ELEMENTS - EXPLAIN

Page 8 THIS PAGE TO BE COMPLETED BY COMMUNITY DEVELOPMENT STAFF ONLY This is to certify that the foregoing application form has been inspected by me. It is thorough and complete and conforms with the provisions of the Lakewood Municipal Code. $ Date Filed CUP Case No. Fee Paid Date of Hearing By Community Development Department

Page 9 APPLICANT'S AFFIDAVIT STATE OF CALIFORNIA ) CITY OF LAKEWOOD ) ss. COUNTY OF LOS ANGELES ) I am the (state whether owner, lessee, purchaser or agent) of the property involved in this application. I have familiarized myself with the requirements of the Zoning Ordinance in this matter. The statements and answers are true to my own knowledge and present the argument in behalf of the application, except as to those matters which are therein stated upon my information or belief, and as to those matters I believe to be true. I certify and declare under penalty of perjury that the foregoing is true and correct. Executed on, at Corporate Name (if any) Signature Phone No.

Page 10 CERTIFIED PROPERTY OWNER'S LIST (CCP 2015.5) City of Lakewood CUP Case No. The following is a list taken from the latest available Los Angeles County Assessment roll, of all persons to whom all property is assessed for a distance of 300 feet from the exterior boundaries of the subject property, described as Lot and Tract No. Address NAME STREET ADDRESS CITY

Page 11 I hereby certify (or declare) under penalty of perjury that the foregoing is true and correct. Date Signature

Donna s Radius Maps Donna Scales and Dana Scales-Molino 684 S. Gentry Lane Anaheim, CA 92807 Telephone: (714) 921-2921 Mobile: (714) 458-4758 E-mail: ddradiusmaps@sbcglobal.net AM Mapping Services Anna M. Smit Telephone: (909) 466-7596 Telephone: (626) 403-1803 E-mail: ammappingserv@aol.com GC Mapping Service, Inc. 3055 West Valley Boulevard Alhambra, CA 91803 Telephone: (626) 441-1080 Fax: (626) 441-8850 E-mail: gcmapping@radiusmaps.com Susan Case Inc-Radius Maps & Lists 917 Glenneyre Street, #7 Laguna Beach, CA 92651 Telephone: (949) 494-6105 E-mail: orders@susancaseinc.com Website: www.susancaseinc.com TMG Solutions, Inc. 19401 S. Vermont Avenue, Suite B 201 H Torrance, CA 90502 Telephone: (310) 532-0446 E-mail: lanny@tmgsolutions.net Kimberly Wendell P.O. Box 264 Los Alamitos, CA 90720 Telephone: (562) 431-9634 E-mail: kimwendell@socal.rr.com Ownership Listings & Radius Maps Telephone: (949) 542 MAPS (6277) E-mail: info@ownershiplistingservice.com List of Radius Map Services Radius Maps Company 211 S. State College Boulevard Anaheim, CA 92806 Cell: (714) 323-6031 Office: (888) 272-3487 radiusmaps@gmail.com www.radiusmapscompany.com Advanced Listing Services Inc. Denise Kaspar Telephone: (949) 361-3921 E-mail: Denise@Advancedlisting.com Website: http://www.advancedlisting.com Joe Moreno and Sue Moreno 12106 Lambert Avenue El Monte, CA 91732 Telephone: (626) 350-5944 Fax: (626) 350-1532 E-mail: moreservices@sbcglobal.net Michael Pauls Associates 203 Argonne Avenue, #141 Long Beach, CA 90803 Telephone: (562) 434-2835 Fax: (562) 434-4301 michael@michaelpaulsassociates.com Ownership Listing Service Cathy McDermott Telephone: (951) 699-8064 Fax: (951) 699-8064 E-mail: ownershiplistingservice@hotmail.com Szeto & Associates Stan Szeto Telephone: (626) 512-5050 Fax: (323) 838-0515 stanleyszeto@sbcglobal.net N.P.S. + Associates Nick Vasuthasawat, President 396 W. Avenue 44 Los Angeles, CA 90065 Telephone: (323) 801-6393 Fax: (323) 227-5463 E-mail: nicksplanningservices@gmail.com Website: www.npsassociates.com Please note that this list is provided as a reference only and is provided as a convenience. The companies listed above are not listed in any particular order. The City does not provide recommendations for any particular company. You are not restricted to using only the companies on this list. You are not required to hire a company to prepare the property owner list you may prepare the labels yourself by acquiring the required maps at the public counter and gathering the property owner information at the Los Angeles County Tax Assessor s Office. The businesses on the list are not arranged in any particular order.