ATTACHMENT C
Statutory Exemptions. State code number:
_______________________________________________
Print Form
Notice of Exemption Appendix E
From: (Public Agency): ____________________________
To: Office of Planning and Research
P.O. Box 3044, Room 113 _______________________________________________Sacramento, CA 95812-3044 County Clerk
(Address)
___________________________
___________________________
County of: __________________
Project Title: ____________________________________________________________________________ Project Applicant: ________________________________________________________________________ Project Location - Specific:
Project Location - City: ______________________ Project Location - County:
Description of Nature, Purpose and Beneficiaries of Project:
_____________________
Name of Public Agency Approving Project: _____________________________________________________ Name of Person or Agency Carrying Out Proj ect: ________________________________________________ Exempt Status: (check one):
Ministerial (Sec. 21080(b)(1); 15268);
Declared Emergency (Sec. 21080(b)(3); 15269(a));
Emergency Project (Sec. 21080(b)(4); 15269(b)(c));
Reasons why project is exempt:
Lead Agency
Contact Person: ____________________________
Area Code/Telephone/Extension: _______________
If filed by applicant:
1. Attach certified document of exemption finding.
2. Has a Notice of Exemption been filed by the public agency approving the project? Yes No
Signature: ____________________________ Date:
Signed by Lead Agency
Signed by Applicant
Authority cited: Sections 21083 and 21110, Public Resources Code. Date Received for filing at OPR:
Reference: Sections 21108, 21152, and 21152.1, Public Resources Code. _______________
Categorical Exemption. State type and section number: ____________________________________ ______________________________________________
______________ Title: _______________________
Revised 2011
City of Victorville
14343 Civic Drive, PO Box 5001
Victorville, CA 92392
San Bernardino
385 North Arrowhead Avenue, Second Floor
San Bernardino, CA 92415
Doris Davies Ribbon Gutter Reconstruction Project
City of Victorville
Doris Davies Park, 16451 Pebble Beach Drive, Victorville, CA 92395 Victorville
San Bernardino
Project will restore a concrete ribbon gutter and flow path through the park protecting the public and existing infrastructure.
City of Victorville
City of Victorville
X
§15301(c)
Project is replacement and minor alteration of infrastructure damaged in storm.
Fredy A. Bonilla, City Engineer
760-955-5158
City Engineer