El Segundo, CA · Los Angeles County
Certified List of Property Owners and Occupants Affidavit
Project applicants use this affidavit to certify a list of nearby property owners and occupants for a site within 150 feet.
What this form is
This affidavit certifies an attached list of property owners and occupants within 150 feet of a project site. It identifies owners using the latest available Los Angeles County Assessment roll and lists occupant addresses within that distance. The signer certifies under penalty of perjury that the information is true and correct, and provides a signature, date, printed name, and Environmental Assessment number.
Who needs it
A project applicant or other signer providing a certified list of nearby property owners and occupants can complete this affidavit.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This document is signed without a notary; the signer certifies under penalty of perjury and signs and dates the affidavit.
How to submit this form
- 1
Download the Affidavit
Download the Certified List of Property Owners and Occupants Affidavit.
- 2
Complete the Affidavit
Provide the project site's legal description, Environmental Assessment number, printed name, signature, and date.
- 3
Gather the Attached List
Attach the list of property owners and occupant addresses within 150 feet of the project site.
- 4
Submit to the City
Submit it to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- What does the affidavit certify?
- It certifies that an attached list gives property owners from the latest available Los Angeles County Assessment roll and occupant addresses within 150 feet of the project site.
- What information does the signer provide?
- The form has spaces for the project site's legal description, the signer's signature and printed name, the date, and an Environmental Assessment number.
- Do I need a notary for this affidavit?
- No. This document is signed without a notary; the signer certifies under penalty of perjury and signs and dates the affidavit.
- How do I submit the affidavit?
- Submit it to the city department named on the form; check the city website for current contact details.