NOTICE OF EXEMPTION FROM
TIMBERLAND CONVERSION PERMIT
FOR SUBDIVISON
State of California
Department of Forestry
And Fire Protection
RM-91 (Rev 7/07)
PROJECT NAME:______
The Director of the Department of Forestry and Fire Protection may exempt properly authorized development of subdivisions on forest land from the requirement of the Timberland Conversion Permit where the owner can present proper documentation of approval by local government. Pursuant to Sections 4621-4628, Public Resources Code, and regulations contained in Title 14, California Code of Regulations, specifically Section 1104.2, (I/We)
______
Name(s) Telephone Number
______
Address City State Zip Code
do hereby Notice the Director of Forestry and Fire Protection of exemption from the requirements for a Timberland Conversion Permit to convert ______acres of timberland as defined by Section 4526 of the Public Resources Code to a subdivision.
Conversion of this timberland will require the cutting of timber, subject to provisions of the Forest Practice Act, Sections 4561-4561.2, 4587, and 4588, Public Resources Code, Board of Forestry Regulations, and Rules of the Forest District indicated: Coast, Sections 913-913.8; Northern, Sections 933-933.7; Southern, Sections 953-953.10; Title 14, California Code of Regulations. Specifically, as required by Section 4581, Public Resources Code, no timber operations may begin until a Timber Harvest Plan (THP) has been submitted to the department, and been found to be in conformance with all laws, rules, and regulations.
If all or part of this conversion area has been designated as a Timberland Production Zone (TPZ), then the property is not eligible for exemption from the Timberland Conversion Permit (TCP) procedures.
Said timberland to be converted is located within the parcels of land described below, and shown in the shaded area on the attached plat and/or map, which is herewith submitted and made part of this Notice.
LOCATION:
SubdivisionSectionTownshipRange Base & Meridian
______
______
The recorded interest in this timberland is held in the name of______
under deed dated ______recorded in Volume ______at page ______of the
official records of the County of ______. The Assessor’s Parcel Number(s) are:______
______.
ENVIRONMENTAL COMPLIANCE OR CEQA
Has a local government agency (County, City, or District) prepared an EIR or Negative Declaration for this Project? Yes. What is the State Clearinghouse or other agency number for this project? SCH Number ______.
NOTICE OF DETERMINATION
Has a Notice of Determination been filed by the local government agency (County, City, or District) with the State Clearinghouse or with the appropriate county clerk? Yes . A copy of the approved Notice of Determinationmust be enclosed.
ADDITIONAL MAPS
A copy of the approved tentative or final approved subdivision map must be attached.
LOCAL AGENCY DOCUMENTATION
Tentative Subdivision Map
Has a local government agency (County, City or District) approved a tentative subdivision map? Yes .
What is the date of map approval ______. (Submit a copy with Notice).
Required Use Permits
If required by the local government agency (County, City or District), have the required use permits and other approvals been granted? Yes No additional permits required . What are the permit titles and date of agency approval? ______.
Submit a copy withnotice.
(I/We) hereby grant the Director authority to order periodic inspections of the project’s progress, recognizing that if the subdivision development project is not completed or if it is abandoned, the Director may take corrective action pursuant to Public Resources Code 4605-4611 to have restocked those parts of the area from which timber has been harvested and which do not meet the stocking requirements of this chapter. Further, the project shall be deemed abandoned or not completed if: (a) the county or city tentative map approval has expired and (b) no further work has been carried on to complete the subdivision for three years after the expected date of completion stated in the Timber Harvesting Plan (THP).
(I/We) hereby declare a Bona Fide intent as defined in Section 1102, Title 14, California Code of Regulations (CCR) to conform with the conditions of and successfully execute the conversion, including such conditions as may be made a part thereof as a result of the environmental review required under the California Environmental Quality Act (CEQA), and to conform with the conditions of the Timber Harvesting Plan (THP) required under the Forest Practice act.
CERTIFICATION
I (We), ______, say: I (We) own, or am one of the owners of the property described above and intend to use this land for ______. Conversion of this land will commence about ______,. 20___, and will be completed on or before ______20____.
I (We), declare under penalty of perjury that I (we) have read fully the above Notice, and attached documentation, and that all statements made and information contained therein are true and correct to the best of my (our) knowledge and belief.
Executed on ______, 20___, at ______California.
______
Printed Name(s) of Property Owner(s) Printed Title
______
Signature of Property Owner(s) Date
If signing for a partnership, corporation, or other organization, the signer must be a partner, corporate or organization officer, or furnish power of attorney authorizing signature as the owner’s agent. If a signatory is in a state other than California, he must sign this certification before a Notary Public.
If project will not be completed by the date specified above, it will be necessary to file for an extension prior to this date. The Department normally approves exemptions for a maximum of five years unless the applicant justifies a longer period of time with this Notice.
ADDITIONAL INFORMATION AND DOCUMENTATION
TIMBER OWNER(S) (If Different)
______
Names Telephone Number
______
Address City State Zip Code
DEVELOPER(S) (If Different)
______
Names Telephone Number
______
Address City State Zip Code
The California Department of Forestry and Fire Protection will concur in writing to the Landowner that the proposed conversion is exempt from the requirement of a Timberland Conversion Permit per California Code of Regulations Section 1104.2
In the event that this Notice (with Attachments) is incomplete or inaccurate, it will be returned to the Landowner. The requirements of California Code of Regulations Section 1104.2(c) will not be met if this Notice is returned.
Note: The landowner should notify Cal Fire when the project is completed.
Reminder: There are a number of places in this form where (I/We) occurs. Please cross out one of these throughout the form.
TIMBERLAND CONVERSION PLAT
Applicant(s) Name(s)
Section(s) Township Range B&M
Scale inch(es) = 1 mile
Show section numbers in center of section on plat. Entire plat may be used as one section or as halves of adjoining sections if needed for large-scale detail.
Show the conversion area not in a Timberland Production Zone or the Coastal Zone by
Show the conversion area in a Timberland Production Zone by
Show the area in a Coastal Zone by
(Do not use color shading - it will not photocopy)
Show the timbered area to be cut for conversion only. (Show to the nearest practical boundaries, such as regular 40-acre land subdivision, main roads, streams, or ridges within your property
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