Cal. Code Regs. Tit. 27, div. 1, 4, ch. 1, pt. II, art. 10, app A

Current through Register 2024 Notice Reg. No. 50, December 13, 2024

Appendix A

Certified Unified Program Agency (CUPA) Application Cover Sheet Completeness Checklist

JURISDICTION NAME:	___________________________
CONTACT PERSON NAME:	___________________________
ADDRESS:	___________________________
MAILING ADDRESS (if different):	___________________________
DATE OF APPLICATION:	___________________________
TELEPHONE NUMBER:	__________________	FACSIMILE NUMBER:	___________________________

ITEM	DESCRIPTION	CITATION	PAGE #
1	Appendix A (this checklist)	15150(e)(1)
2	Demographic Information	15150(e)(4)
3	Applicant Information	15150
4	Implementation History	15150(e)(16)
5	Geographic Scope	15150(e)(2) and (3)
6	Structure of CUPA	15150(e)(5)
7	Authorization	15150(c)
7A	Regulatory Authority
7B	Ordinances & Resolutions	15150(c)(1) and (2)
8	CUPA and PA Issues	15150(d)
9	Unified Program Implementation Plan	15150(e)(6)
10	Consolidated Permit Plan	15150(e)(10)
11	Inspection & Enforcement Program Plan	15150(e)(11)
12	Fee Accountability Program	15150(e)(12)
12A	Staff Resource Adequacy	15170(b)(3)(A-E)(b)(4) and (b)(5)
12B	Budget Adequacy/Annual Funding	15150(e)(14)15170(c)
12C	Contents of Fee Accountability Program and Cost Calculation Methods	15170(f) 15210(b)(1)
13	Single Fee Implementation Plan	15150(e)(13)
14	Reporting & Auditing Requirements	15150(e)(15)
15	Recordkeeping & Cost Accounting Systems	15150(e)(17)
16	CCR, Title 22, Section 66272.10 - Compliance	15150(e)(18)
17	Training and Technical Expertise	15150(e)(7)
18	Administrative Procedures	15150(e)(8)
19	Additional Program Elements	15150(e)(19)
20	No Adverse Impacts/Less Fragmentation/Coordination and Consistency	15150(e)(20) and (21)
21	Certifications	15150(e)(8), (14) and (15)
22	Signature of Authorized Representative	15150(b)
23	County Waiver of Surcharge Assessment (Optional)	HSC 25404.5(d)
TABLES
1	Enumerations/Demographic Information	15150(e)(4)
2	Summary of Program Activities	15150(e)(16)
3	Time Allocation of Staff	15150(e)(13) 15170(b)
4	Training and Technical Expertise	15150(e)(7)
5	Reporting and Auditing Requirements	15150(e)(8-14)
6	Surcharge Transmittal Report	15290(a)(1)
7	Annual Single Fee Summary Report	15290(a)(2)
CHARTS
1	Implementation Timeline	15150(e)(6)(A)
FIGURE
1	Organizational Chart	15150(e)(5)
	Only one signature will be required for the Certified Unified Program Agency Application. Please see the signature block located in Appendix B (Certification Sheet).
(CalEPA rev. 10/17)

Cal. Code Regs. Tit. 27, div. 1, 4, ch. 1, pt. II, art. 10, app A