Appendix a. Certified Unified Program Agency (Cupa) Application Cover Sheet Completeness Checklist, Article 10. Business Reporting to Cupas, Part II. Operations, Subdivision 4. State Delegation, Division 1. General Functions and Responsibilities, Title 27. Environmental Protection, California Code of Regulations

California Code of Regulations (Last Updated: August 6, 2014)

Title 27. Environmental Protection

Division 1. General Functions and Responsibilities

Subdivision 4. State Delegation

Part II. Operations

Article 10. Business Reporting to Cupas

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\or 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)(3), (e)(2)
6	Structure of CUPA	15150(e)(5)
7	Authorization	15150(c)
7A	Regulatory Authority
7B	Ordinances & Resolutions	15150(c)(1) & (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 Plan	15150(e)(11)
12	Fee Accountability Program	15150(e)(12)
12A	Staff Resource Adequacy	15170(b)(3)(A-E) (b)(4), (b)(5)
12B	Budget Adequacy/Annual Funding	15150(e)(14) 15170(c)
12C	Contents of Fee Accountability Program	15170(f)
	and Cost Calculation Methods	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	Title 22, CCR, Section 66272.10 Compliance	15150(e)(18)
17	Training and Technical Expertise 15150(e)(7)
			15150(e)(8)
18	Additional Programs Elements	15150(e)(19)
19	No Adverse Impacts/Less 15150(e)(20)
	Fragmentation/Coordination and Consistency	15150(e)(21)
20	Certifications	15150(e)(9)
			15150(e)(14)
			15150(e)(15)
21	Signature of Authorized Representative	15150(b)
22	County Waiver of Surcharge Assessment HSC 25404.5(d)
	(Optional)

TABLES
1	Enumerations/Demographic Information	15150(e)(4)
2	Summary of Program Activities	15150(e)(16)
3	Time Allocation of Staff	15150(e)(14)
		15170(b)
4	Training and Technical Expertise	15150(e)(7)
		15150(e)(8)
5	Reporting and Auditing Requirements
6	Reporting and Auditing Requirements
7	Surcharge Transmittal Report 15250(b)
8	Annual Single Fee Summary Report	15280(b)

CHARTS
	Implementation Timeline	15150(e)(6)(A)

FIGURE
	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 Attachment 2 (Certification Sheet).