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COD_____________ CERTIFICATE OF DEMOLITION
COD -1- 7/24
PLEASE COMPLETE THE FOLLOWING INFORMATION (REQUIRED):
PROJECT ADDRESS
DATE STRUCTURE BUILT ZONE CLASSIFICATION
NAME OF HOA: PROJECT FILED WITH ARB (DATE):
APPLICANT(S) NAME
MAILING ADDRESS
CITY STATE ZIP
E-MAIL ADDRESS
TELEPHONE NO.
PROPERTY OWNER(S) NAME
MAILING ADDRESS
CITY STATE ZIP
E-MAIL ADDRESS
TELEPHONE NO.
THE APPLICANT AND PROPERTY OWNER HEREBY DECLARE UNDER PENALTY OF PERJURY THAT ALL
THE INFORMATION SUBMITTED FOR THIS APPLICATION IS TRUE AND CORRECT.
APPLICANT’S SIGNATURE DATE
PROPERTY OWNER’S SIGNATURE DATE
ACTION TAKEN
APPROVED DENIED
CONDITIONALLY APPROVED
NOTE: A DEMOLITION PERMIT WILL NOT BE ISSUED PRIOR TO ISSUANCE OF A BUILDING PERMIT FOR A
NEW RESIDENCE.
BY: DATE: EXPIRATION:
THERE IS A TEN (10) CALENDAR DAY APPEAL PERIOD FOR THIS APPLICATION. APPEALS MUST BE SUBMITTED IN WRITING TO THE
COMMUNITY DEVELOPMENT DIVISION WITH A $728.00 APPEAL FEE BY _______________ P.M. ON _______________________.
DATE FILED RECEIPT NO. PAID RECEIVED BY
309 E. Lemon Avenue
1950 R1
NONE
ERIC TSANG
440 E HUNTINGTON DR STE 323
ARCADIA CA 91006
MAIL@ERIC-DESIGN.COM
909.569.3737
309 LEMON LLC
1645 ORLANDO RD
PASADENA CA 91160
COD -2- 7/24
FILING REQUIREMENTS
In order for this application to be processed without delay, the application must include all of the following
materials. To ensure that your application package is complete, please check-off the boxes next to the
required application materials.
Completed application form
An Ownership Disclosure is required if the property is owned by a corporation, partnership,
trust, or non-profit. The disclosure must reveal the agent for service of process or an
officer of the ownership entity. The disclosure must list the names and addresses of all
the owners, and you must attach a copy of the current corporate articles, partnership
agreement, trust, or non-profit document, as applicable.
Filing Fee - $215 (Director’s Review)
Filing Fee - $1,454 (Referred to Planning Commission)
Full Evaluation (Primary Record (DPR 523A) form, Building Structure and Object form
(523B), and Location Map (DPR 523J).
A demolition plan (maximum plan size 11”x17” and provided on a USB) that shows the
location of the existing structure(s).
The following items are required if the projects consist of demolishing a multi-family project
that has more than 6 units, 3 or more commercial structures on a property; or it is not
exempt per CEQA (consult with Planning Staff).
Environmental Assessment Form – $75
Additional CEQA fees may apply if Planning Staff determines that there could
be potential impacts to historic resources.
The forms must be completed by an Accredited Architectural Historian or Historian that meets the Secretary
of Interior’s minimum professional qualifications. A list of Architectural Historian and Historian is available
from Planning Services.