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HomeMy WebLinkAboutMCUP 07-04X1; SD06378A T-MOBILE CALAVERA HILLS PARK; Minor Conditional Use Permit (MCUP)LAND USE REVIEW APPLICATION P-1 Deveiooment Services Planning Division 1635 Faraday Avenue (760) 602-4610 www.carlsbadca.gov APPLICATIONS APPLIED FOR: (CHECK BOXES) Development Permits D Administrative Permit D Coastal Development Permit (*) D Minor ~onditional Use Per:,ut(*) D Minor _ ~ Extension D Environmental Impact Assessment D Habitat Management Permit D Minor D Hillside Development Permit (*) D Planned Development Permit D Residential D Non-Residential D Planned Industrial Permit D Planning Commission Determination D Site Development Plan D Special Use Permit D Tentative Tract Map D Variance D Administrative (FOR DEPT. USE ONLY) Legislative Permits ~ 07-04-XI D General Plan Amendment D Local Coastal Program Amendment (*) D Master Plan D Amendment D Specific Plan D Amendment D Zone Change (*) D Zone Code Amendment List other applications not specified □ □ □ (*) = eligible for 25% discount (FOR DEPT. USE ONLY) NOTE: A PROPOSED PROJECT REQUIRING MULTIPLE APPLICATIONS MUST BE SUBMITTED PRIOR TO 3:30 P.M. A PROPOSED PROJECT REQUIRING ONLY ONE APPLICATION MUST BE SUBMITTED PRIOR TO 4:00 P.M. ASSESSOR PARCEL NO(S).: PROJECT NAME: T-Mob, le 0v+ Ct\.l~\/erP\ W-i\ ls 'Po..,\< ~RIEF D~SCRIPTION OF PROJECT: e ' • ~ • 1v 1 Q., ' 'ry \-'t-1\0~1\-e \'Jh--eless c-OW'WI ~~ ½ 0, :ba \ l +;,e;\ d oOWl, l, BR1EF LEGAL DESCRIPTION: "t\\ov°\--P'ilt:r10V\ BF L-ot '':r' of ?t>..vivho ¥¾!Ml µeJ \ovt.k r \ V\, {l.-i-t c1,:+ trf C1J.:,\~ o~, ~\,lvJ-~ .. vf ~V\ DiE7f)O/ Si-Pvte vf c~~-ttl,\t\A6'\ 1-44\"] Gt \O\$~(oW D,·,\/e LOCA. ION OF PROJECT: STREET ADDRESS ON THE: SIDE OF (NORTH, SOUTH, EAST, WEST) 6 lo,s~ ~vJ \),\ \J-e (NAME OF STREET) BElWEEN Ssker WrAt AND (NAME OFTREET) utv~$~d \f~\_\CA~-e "t,,\J-e, (NA E OF STREET) P-1 Page 1 of 5 Revised 07/10 OWNER NAME (Print): Ctt""( o{2 CttdsbPd MAILING ADDRESS: u02~ £"'.,Adu,..'( A-ve-¥\IA-e CITY,STATE,ZIP: U\{'\:st>O\J, C.-ft C\~ooe, TELEPHONE: (7 bO) Y~:1-"l. ~Pl'> EMAIL ADDRESS: jOe •<jO.<'\\\)~@a~\.swJ.cove, QV I CERTIFY THAT I AM THE LEGAL OWNER AND THAT ALL THE ABOVE INFORMATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. APPLICANT NAME (Print): \--\Aot) \ f MAILING ADDRESS: \(n{)q-,-\J-tS_½)_S_o_mw\-o __ Y_¥w_1_*-.-2-o lo CITY, STATE, ZIP: ~vi. O):R?Ot vt4-CJ'l--l '2--( TELEPHONE: 01~-1,$L.f-(o l3 '1 EMAILADDREss: k\rt,'oo\~c¥:@ ±-vi,tobile I ~oM EGAL REPRESENTATIVE OF THE OWNER ION IS TRUE AND CORRECT TO APPLICANT'S REPRESENTATIVE (Print): t,.;\ \'t CV\e,-lJ.if-€ MAILING ADDREss: "i. ~ ~ 3 R-OV\ so V'I cour-\-. <; !Mj:e tJ ' c1TY, STATE, z1P: °SrNJ' 't)~ 0 , C:& g 2 U \ TELEPHONE: ( ~')0 ) {Q '$-{) -3 l? Q EMAIL ADDRESS: x-oberT• \::<:-45@ Wvi-\--cvt e,( I j I COW'\ I CERTIFY THAT I AM THE LEGAL REPRESENTATIVE OF THE HE ABOVE INFORMATION IS TRUE AND NOWLEDGE. ~ '2--2-0 '2-- DA TE IN THE PROCESS OF REVIEWING THIS APPLICATION IT MAY BE NECESSARY FOR MEMBERS OF CITY STAFF, PLANNING COMMISSIONERS OR CITY COUNCIL MEMBERS TO INSPECT AND ENTER THE PROPERTY THAT IS THE SUBJECT OF THIS APPLICATION. I/WE CONSENT TO ENTRY FOR THIS PURPOSE. NOTICE OF RESTRICTION: PROPERTY OWNER ACKNOWLEDGES AND CONSENTS TO A NOTICE OF RESTRICTION BEING RECORDED ON THE TITLE TO HIS PROPERTY IF CONDITIONED FOR THE APPLICANT. NOTICE OF RESTRICTIONS RUN WITH THE LAND A B ND ANY SUCCESSORS IN INTEREST. FOR CITY USE ONLY P-1 Page 2 of 5 MAY O 8 20i2 CITY OF CARLSBAD PLANNING DIVISION DATE STAMP APPLICATION RECEIVED Revised 07/10 LETTER OF AUTHORIZATION Calavera Hills Community Park -T-Mobile site SD06378 May 2, 2012 To Whom it May Concern: The City of Carlsbad, owner of Calavera Hills Community Park located at 2997 Glasgow Drive, Carlsbad, California (the "Subject Property'') hereby authorizes Mitchell J Archtiecture, its employees, agents, and contractors to file and complete any applications necessary to obtain required land use entitlements on T-Mobile' s behalf for the T-Mobile site located at the Subject Property. Regards, Joe a City of Carlsbad Property and Environmental Management Facilities Division ~ • ·Mobile•' May 2, 2012 City of Carlsbad Planning Department 1635 Faraday Avenue Carlsbad, CA 92008 RE: Letter of Authorization for Mitchell J Architecture Dear Sir or Madrun: T-Mobile West Corporation a subsidiary ofT-Mobile USA Inc. 10509 Vista Sorrento Parkway, #206 San Diego, California 92121 T-Mobile hereby authorizes Mitchell J Architecture and its employees, contractors, and agents to file and complete any applications necessary to obtain required land use entitlements for existing or proposed T-Mobile wireless communications facilities located in the City of Carlsbad. Please contact me with any questions or concerns at (858) 334-6139. Development Manager, San Diego CARLSBAD DISCLOSURE STATEMENT P-1(A) Development Services Planning Division 1635 Faraday Avenue (760) 602-4610 www.carlsbadca.gov Applicant's statement or disclosure of certain ownership interests on all applications which will require discretionary action on the part of the City Council or any appointed Board, Commission or Committee. The following information MUST be disclosed at the time of application submittal. Your project cannot be reviewed until this information is completed. Please print. Note: Person is defined as "Any individual, firm, co-partnership, joint venture, association, social club, fraternal organization, corporation, estate, trust, receiver, syndicate, in this and any other county, city and county, city municipality, district or other political subdivision or any other group or combination acting as a unit." Agents may sign this document; however, the legal name and entity of the applicant and property owner must be provided below. 1. 2. P·1(A) APPLICANT (Not the applicant's agent) Provide the COMPLETE. LEGAL names and addresses of ALL persons having a financial interest in the application. If the applicant includes a corporation or partnership, include the names, titles, addresses of all individuals owning more than 10% of the shares. IF NO INDIVIDUALS OWN MORE THAN 10% OF THE SHARES, PLEASE INDICATE NON-APPLICABLE (N/A) IN THE SPACE BELOW. If a publicly-owned corporation, include the names, titles, and addresses of the corporate officers. (A separate page may be attached if necessary.) Person_________ Corp/Part_l_-_M_Ot,~\\-£~----- Title__________ Title See t1y{\-gd,y,J l \ :s± Address_________ Address \2,qw St: 'Yot1tl <:,\-, J ~1€\J\,lf1 vJ f\- r ll.~o~~ OWNER (Not the owner's agent) Provide the COMPLETE, LEGAL names and addresses of ALL persons having any ownership interest in the property involved. Also, provide the nature of the legal ownership (i.e., partnership, tenants in common, non-profit, corporation, etc.). If the ownership includes a corporation or partnership. include the names, titles, addresses of all individuals owning more than 10% of the shares. IF NO INDIVIDUALS OWN MORE THAN 10% OF THE SHARES, PLEASE INDICATE NON-APPLICABLE (N/A) IN THE SPACE BELOW. If a publicly-owned corporation, include the names, titles, and addresses of the corporate officers. (A separate page may be attached if necessary.) Person <J?e.. bM~ Corp/Part __________ _ Title ~-h,y.1:w,oJ J~ ~~ Title ____________ _ Address C/o S W: A'-'• (1.--:bbJ , CA 9wo(( Address ____________ _ Page 1 of 2 Revised 07/10 ' . 3. NON-PROFIT ORGANIZATION OR TRUST If any person identified pursuant to (1) or (2) above is a nonprofit organization or a trust, list the names and addresses of ANY person serving as an officer or director of the non- profit organization or as trustee or beneficiary of the. Non Profit/Trust ________ _ Non Profit/Trust. _________ _ Title ___________ _ Title. _____________ _ Address. __________ _ Address ____________ _ 4. Have you had more than $500 worth of business transacted with any member of City staff, BoardszCom. sions, Committees and/or Council within the past twelve (12) months? D Yes No If yes, please indicate person(s):. ___________ _ NOTE: Attach additional sheets if necessary. I certify that all the above information is true and correct to the best of my knowledge. \L,,+-'=a~coolt :fo£ 't-tvtob~ Le Print or type name of owner Print or type name of applicant f owner/applicant's agent if applicable/date Print or type name of owner/applicant's agent P-1(A) Page 2 of 2 Revised 07/10 T-Mobile Executive Bios ~ Espanol Coverage Store Locator San Diego. CA ~ • ·,;\'lobile· Shop Explore Coverage Support Business Company Information Overview Awards Government & Investor Relations Jobs Code of Conduct Consumer Safety Regulatory Information Quick Facts Global Presence History T-Mobile Senior Leadership Team T-Moblle Senior Leadership Team PhlllppHumm CEO and Prasldent Jim Alling Page 1 of 1 Your Account: Log ,n / Sign up Cart T-Mobile Search Chief Operations Officer Cole Brodman Chief Msrl{st/ng Officer PeterE-11' Ch/sf Suategy Offtcer Dave MIiier Chief Legal Officer and General Counsel Michael Morgan \ 1.. q 1,,,0 5~ ~ ~+-i,, S+reetf- ~l-e \l V-e, w r+ q~G0~ Chief Financial Officer Larry Myers Chief People Off/Ger NevllleRay Chief Technology Officer Inquiries? For commercial questions or customer service inquiries, Contact Us , Back to About T-Mobile ':)t100. Checi<, Order Status Return Policy HotSpot Business Puerto Rico -;-.r,/ob1i0 io1 Developers Retailers Real Estate Affiliates c,,1nr8ny About T~Mobile Jobs Press Deutsche Telekom 1ntemat1onal Contact Us Privacy Policy Privacy Resources Consumer information Public Safety,1911 Terms & Conditions Terms of Use ©2002-2012 T-Mobile USA, Inc Join us: I) rJ ~ Hi http://www.t-mobile.com/Company /Companylnfo.aspx?tp=Abt_ Tab_ CompanyOverview&t... 5/2/2012 ~ "-'.,. ~·•" ~ CITY OF CARLSBAD PROJECT DESCRIPTION P-1(8) Development Services Planning Division 1635 Faraday Avenue (760) 602-4610 www.carlsbadca.gov PROJECT NAME: ~---Mob~\e 4-u\CA__\I~ ~~l $ -Zark APPLICANT NAME: _\-_~--'-~---=0'-'-b-~_\-e ______________ _ Please describe fully the proposed project by application type. Include any details necessary to adequately explain the scope and/or operation of the proposed project. You may also include any background information and supporting statements regarding the reasons for, or appropriateness of, the application. Use an addendum sheet if necessary. P-1(8) Page 1 of 1 Revised 07/10 <<, ~ CITY OF CARLSBAD HAZARDOUS WASTE AND SUBSTANCES STATEMENT P-1 (C) Development Services Planning Division 1635 Faraday Avenue (760) 602-4610 www.carlsbadca.gov Consultation of Lists of Sites Related to Hazardous Wastes (Certification of Compliance with Government Code Section 65962.5) Pursuant to State of California Government Code Section 65962.5, I have consulted the Hazardous Waste and Substances Sites List compiled by the California Environmental Protection Agency and hereby certify that (check one): ~e development project and any alternatives proposed in this application are not contained on the lists compiled pursuant to Section 65962.5 of the State Government Code. D The development project and any alternatives proposed in this application !!! contained on the lists compiled pursuant to Section 65962.5 of the State Government Code. APPLICANT PROPERTY OWNER Name: \-M,;OPl \-e Name: Ct-\'f ,-F Ct,..rl5 Ovt.6 Address:\ Os-DO\ \J~s-\vl Sf) rr-eJtv ~~ ¾0 Address: Vo?&:" ~ f:vVAlti., ~"" \)\~'u; 0ft ?\'?,{"l-·( ½M:l5W 6f\: j,Z,00~ Phone Number: (fbSl) ~ 3£{-(Q ( 3g Phone Number:C-10O) lj'3L-{-'1.8g3 AddressofSite: 2__qq7 G,la5:)<oW Dr-t\Jt:, Local Agency (City and County): ~ \5 -\>N1,, "XtV\ D \§j O LlJ\AV\,i---f Assessor's book, page, and parcel number: \ 0J -~ Q l -3 ~ Specify list{s): "No V\..e Regulatory Identification Number: ______________________ _ Date of List: _____________________________ _ The Hazardous Waste and Substances Sites List (Cortese List) is used by the State, local agencies and developers to comply with the California Environmental Quality Act requirements in providing information about the location of hazardous materials release sites. P-1(C) Page 1 of2 Revised 07/10 HAZARDOUS WASTE AND SUBSTANCES STATEMENT P-1 (C) Development Services Planning Division 1635 Faraday Avenue (760) 602-4610 www.carlsbadca.gov Per the California Environmental Protection Agency's website, "While Government Code Section 65962.5 [referred to as the Cortese List] makes reference to the preparation of a "list," many changes have occurred related to web-based information access since [the amended statute's effective date in] 1992 and this information is now largely available on the Internet sites of the responsible organizations. Those requesting a copy of the Cortese "list" are now referred directly to the appropriate information resources contained on the Internet web sites of the boards or departments that are referenced in the statute." Below is a list of agencies that maintain information regarding hazardous waste and substances sites. Department of Toxic Substances Control www.calepa.ca.gov/sitecleanup/CorteseList/default.htm www.calepa.ca.gov/database/calsites www.envirostor.dtsc.ca.gov/public EnviroStor Help Desk (916) 323-3400 State Water Resources Control Board http://geotracker.waterboards.ca.gov/ County of San Diego Department of Environmental Health Services www.co.san-diego.ca.us/deh Hazardous Materials Division www.sdcounty.ca.gov/deh/hazmat/hazmat permits.html Mailing Address: County of San Diego Department of Environmental Health P.O. Box 129261 San Diego, CA 92112-9261 Call Duty Specialist for technical questions at (619) 338-2231, fax (619) 338-2377 Environmental Protection Agency National Priorities Sites {"Superfund" or "CERCLIS") www.epa.gov/superfund/sites/cursites {800) 424-9346 or (702) 284-8214 National Priorities List Sites in the United States www.epa.gov/superfund/sites/npl/npl.htm P-1(C) Page 2 of 2 Revised 07/10 ~ «~-. ~ CITY OF CARLSBAD TIME LIMITS ON DISCRETIONARY PROJECTS P-1(E) PLEASE NOTE: Development Services Planning Division 1635 Faraday Avenue (760) 602-4610 www.carlsbadca.gov Time limits on the processing of discretionary projects established by state law do not start until a project application is deemed complete by the City. The City has 30 calendar days from the date of application submittal to determine whether an application is complete or incomplete. Within 30 days of submittal of this application you will receive a letter stating whether this application is complete or incomplete. If it is incomplete, the letter will state what is needed to make this application complete. When the application is complete, the processing period will start upon the date of the completion letter. If you have any questions regarding application submittal requirements (i.e., clarification regarding a specific requirement or, ;he~;;I requirements are necessary for your particular application} please call (760) 0 -~ F ,,/---- Applicant Signature: Staff Signature: Date: To be stapled with receipt to the application P-1(E) Page 1 of 1 Revised 07/10 INSTRUC'.QONS: STORM WATER STANDARDS QUESTIONNAIRE E-34 Development Services Land Development Engineering 1635 Faraday Avenue 760-602-2750 www.carlsbadca.gov To address post-development pollutants that may be generated from development projects, the City requires that new development and significant redevelopment priority projects incorporate Permanent Storm Water Best Management Practices (BMP's) into the project design per the City's Standard Urban Stormwater Management Plan (SUSMP ). To view the SUSMP, refer to the Engineering Standards (Volume 4, Chapter 2) at www.carlsbadca.gov/standards. Initially this questionnaire must be completed by the applicant in advance of submitting for a development application (subdivision, discretionary permits and/or construction permits). The results of the questionnaire determine the level of storm water standards that must be applied to a proposed development or redevelopment project. Depending on the outcome, your project will either be subject to 'Standard Stormwater Requirements' or be subject to additional criteria called 'Priority Development Project Requirements'. Many aspects of project site design are dependent upon the storm water standards applied to a project. Your responses to the questionnaire represent an initial assessment of the proposed project conditions and impacts. City staff has responsibility for making the final assessment after submission of the development application. If staff determines that the questionnaire was incorrectly filled out and is subject to more stringent storm water standards than initially assessed by you, this will result in the return of the development application as incomplete. In this case, please make the changes to the questionnaire and resubmit to the City. If you are unsure about the meaning of a question or need help in determining how to respond to one or more of the questions, please seek assistance from Land Development Engineering staff. A separate completed and signed questionnaire must be submitted for each new development application submission. Only one completed and signed questionnaire is required when multiple development applications for the same project are submitted concurrently. In addition to this questionnaire, you must also complete, sign and submit a Project Threat Assessment Form with construction permits for the project. Please start by completing Section 1 and follow the instructions. When completed, sign the form at the end and submit this with your application to the city. Does your project meet one or more of the following criteria: 1. Housing subdivisions of 10 or more dwelling units. Examples: single family homes, multi-family homes, condominium and a artments 2. Commercial-greater than 1-acre. Any development other than heavy industry or residential. Examples: hospitals; laboratories and other medical facilities; educational institutions; recreational facilities; municipal facilities; commercial nurseries; multi-apartment buildings; car wash facilities; mini-malls and other business complexes; shopping malls; hotels; office buildin s; ublic warehouses; automotive dealershi s; airfields; and other Ii ht industrial facilities. 3. Heavy Industrial I Industry-greater than 1 acre. Examples: manufacturing plants, food processing plants, metal working facilities, printing plants, and fleet storage areas (bus, truck, etc.). 4. Automotive repair shop. A facility categorized in any one of Standard Industrial Classification (SIC) codes 5013, 5014, 5541, 7532-7534, and 7536-7539 5. Restaurants. Any facility that sells prepared foods and drinks for consumption, including stationary lunch counters and refreshment stands selling prepared foods and drinks for immediate consumption (SIC code 5812), where the land area for development is greater than 5,000 square feet. Restaurants where land development is less than 5,000 square feet shall meet all SUSMP requirements except for structural treatment BMP and numeric sizing criteria r uirements and h dromodification r uirements. E-34 Page 1 of 3 REV 1/14/11 6. 7. 8. 9. STORM WATER STANDARDS QUESTIONNAIRE E-34 Development Services Land Development Engineering 1635 Faraday Avenue 760-602-2750 www.carlsbadca.gov Hillside development. Any development that creates more than 5,000 square feet of impervious surface and is ✓ located in an area with known erosive soil conditions, where the development will grade on any natural slope that is twentv-five percent (25%) or areater. Environmentally Sensitive Area {ESA>1. All development located within or directly adjacent2 to or discharging directly3 to an ESA (where discharges from the development or redevelopment will enter receiving waters within the ✓ ESA), which either creates 2,500 square feet or more of impervious surface on a proposed project site or increases the area of imoerviousness of a orooosed oroiect site 10% or more of its naturally occurrino condition. ., Parking lot. Area of 5,000 square feet or more, or with 15 or more parking spaces, and potentially exposed to urban ✓ runoff Streets, roads, highways, and freeways. Any paved surface that is 5,000 square feet or greater used for the ✓/ transportation of automobiles, trucks, motorcycles, and other vehicles 10. Retail Gasoline Outlets. Serving more than 100 vehicles per day and greater than 5,000 square feet ✓ 11. Coastal Development Zone. Any project located within 200 feet of the Pacific Ocean and (1) creates more than 2500 square feet of impervious surface or (2) increases impervious surface on property by more than 10%. 12. More than 1-acre of disturbance. Project results in the disturbance of 1-acre or more of land and is considered a Pollutant-generating Development Project4. .. .. 1 Environmentally Sensitive Areas include but are not ltm1ted to all Clean Water Act Section 303(d) 1mpaIred water bodies; areas designated as Areas of Special Biological Significance by the State Water Resources Control Board (Water Quality Control Plan for the San Diego Basin (1994) and amendments); water bodies designated with the RARE beneficial use by the State Water Resources Control Board (Water Quality Control Plan for the San Diego Basin (1994) and amendments); areas designated as preserves or their equivalent under the Multi Species Conservation Program within the Cities and County of San Diego; and any other equivalent environmentally sensitive areas which have been identified by the Copermittees. 2 "Directly adjacent· means situated within 200 feet of the Environmentally Sensitive Area. 3 "Discharging directly to· means outflow from a drainage conveyance system that is composed entirely of flows from the subject development or redevelopment site, and not commingled with flow from adjacent lands. 4 Pollutant-generating Development Projects are those projects that generate pollutants at levels greater than background levels. In general, these include all projects that contribute to an exceedance to an impaired water body or which create new impervious surfaces greater than 5000 square feet and/or introduce new landscaping areas that require routine use of fertilizers and pesticides. In most cases linear pathway projects that are for infrequent vehicle use, such as emergency or maintenance access, or for pedestrian or bicycle use, are not considered Pollutant-generating Development Projects if they are built with pervious surfaces or if they sheet flow to surrounding pervious surfaces. INSTRUCTIONS: Section 1 Results: If you answered YES to ANY of the questions above, your project is subject to Priority Development Project requirements. Skip Section 2 and please proceed to Section 3. Check the ·meets PRIORITY DEVELOPMENT PROJECT requirements· box in Section 3. Additional storm water requirements will apply per the SUSMP. If you answered NO to ALL of the questions above, then please proceed to Section 2 and follow the instructions. E-34 Page 2 of 3 REV 1/14/11 / <<t'~ .. < "'' ~ CITY OF CARLSBAD STORM WATER STANDARDS QUESTIONNAIRE E-34 Development Services Land Development Engineering 1635 Faraday Avenue 760-602-2750 www .carlsbadca.gov INSTRUCTIONS: Complete the questions below regarding your project 1. Project results in the disturbance of 1-acre or more of land and is considered a Pollutant-generating Development Pro·ect *? INSTRUCTIONS: If you answered NO, please proceed to question 2. YES If you answered YES, then you ARE a significant redevelopment and you ARE subject to PRIORITY DEVELOPMENT PROJECT re uirements. Please check the "meets PRIORITY DEVELOPMENT PROJECT re uirements" box in Section 3 below. 2. Is the project redeveloping an existing priority project type? (Priority projects are defined in Section 1) INSTRUCTIONS: If you answered YES, please proceed to question 3. If you answered NO, then you ARE NOT a significant redevelopment and your project is subject to STANDARD STORMWATER REQUIREMENTS. Please check the "does not meet PDP re uirements" box in Section 3 below. 3. Is the work limited to trenching and resurfacing associated with utility work; resurfacing and reconfiguring surface parking lots and existing roadways; new sidewalk; bike lane on existing road and/or routine maintenance of damaged pavement such as pothole repair? Resurfacing/reconfiguring parking lots is where the work does not expose underlying soil during construction. INSTRUCTIONS: If you answered NO, then proceed to question 4. If you answered YES, then you ARE NOT a significant redevelopment and your project is subject to STANDARD STORMWATER REQUIREMENTS. Please check the "does not meet PDP re uirements" box in Section 3 below. 4. Will your redevelopment project create, replace, or add at least 5,000 square feet of impervious surfaces on existing developed property or will your project be located within 200 feet of the Pacific Ocean and ( 1) create 2500 square feet or more of impervious surface or (2) increases impervious surface on the property by more than 10%? Replacement of existing impervious surfaces includes any activity that is not part of routine maintenance where impervious material(s) are removed, e osin underl in soil durin construction. INSTRUCTIONS: If you answered YES, you ARE a significant redevelopment, and you ARE subject to PRIORITY DEVELOPMENT PROJECT requirements. Please check the ·meets PRIORITY DEVELOPMENT PROJECT requirements" box in Section 3 below. Review SUSMP to find out if SUSMP requirements apply to your project envelope or the entire project site. If you answered NO, then you ARE NOT a significant redevelopment and your project is subject to STANDARD STORMWATER REQUIREMENTS. Please check the "does not meet PDP requirements" box in Section 3 below. □ *for definition see Footnote 4 on page 2 My project meets PRIORITY DEVELOPMENT PROJECT (PDP) requirements and must comply with additional stormwater criteria per the SUSMP and I understand I must prepare a Storm Water Management Plan for submittal at time of application. I understand flow control (hydromodification) requirements may apply to my project. Refer to SUSMP for details. My project does not meet PDP requirements and must only comply with STANDARD STORMWATER REQUIREMENTS per the SUSMP. As art of these re uirements, I will incor orate low im act develo ment strat ies throu hout m ro·ect. Applicant Information and Signature Box This Box for City Use Only Address: Assessor's Parcel Number(s): City Concurrence: I YES I NO 0w br-1\Jl-\!ti7:--L0 l -3S- Applicant Name: I i--~o • Applicant nt1e: Date: e:; I B '1,0 I 2__ I /I By: I ~(AA-~ Oate: G/ I 1/\v- Project ID: 'mCltP 01-0l/'f.t E-34 Page 3 of 3 REV 1/14/11 ENVIRONMENTAL INFORMATION FORM {To be Completed by Applicant) Date Filed: M ~ f . 'J{} /~ {To be completed by City} Application Numb~__,__/Y_. 1 ...... C"'--"'-uJ?""-f-___,Q"'"--'7'-----'-0=--4 ...... A......_.:.../ _________ _ General Information 1. Name of project: J:--tvl O t,~ le td-U\-\ IA-\Jerv\ \.h \ l S Y ~, \< 2. Name of developer or project sponsor: _:t....JL._M---=-o...,;\)_\_\_e _______ --,,-__ _ Address: \QS1) q, \hS'"trA :')Q),q-er\1-{) ~etr\<VJct'i! sul--\--e t:1'2--o I; City, State, Zip Code: ~ \) \~ 0 ,, cA\:: '1. '1, l 7--I Phone Number: ( e,;-9>) 3':;>L\-lo\ 00\ 3. Name of person to be contacted concerning this project: '?5? ~ \?c-e\?S Address: '-t0~3> "\2-oV\'.S°'uv\ C<our +, Sul-\--e N City, State, Zip Code: ?QA(\ ])~lf?00,1 CJ1: v\."2.-l\ \ Phone Number: (~5Ei) b5l0-3 \?0 4. Address of Project: 1,_q d\J ~ \t15:j Q\N \J \-\\.}e Assessor's Parcel Number: \ (o 7 -\ © l -;> S: 5. List and describe any other related permits and other public approvals required for this project, including those required by city, regional, state and federal agencies: J'!th/l:f 6. Existing General Plan Land Use Designation: ______________ _ 7. Existing zoning district: ____________________ _ 8. Existing land use(s): 00\AAw\ "'-v\.\'t'-l ~'(" \l_ ~'\-V\ W \ ,e,\e55 Co\MWl ~ ~ (i_, ,c: 7" , , ¾h-nt.., 9. Proposed use of site {Project for which this form is filed): ~::tr-e te.ss C..JulMIMUJ\. \ ~5 ' ~ \ ~ Ley ( ~ ~ \ ~ -s '\CW) ()~ CtA f Project Description 1 o. Site size: TI ~"7--\ci V:, '21-' X 8' ' §{. t<ivwJI: 'f1l O WI J s\ ""a \.e \\ ".} ~ f e \.€ 11. Proposed Building square footage: Vt O ~ -~( "5~ '('f:) 12: Number of floors of construction: U\.QW.., --0')(( '5' \-i V\j 13. Amount of off-street parking provided: _'v'\_() _ ____.Q'\ll,.,.__.:....:V\--1')...,;'"t-;__ ________ _ 14. Associated projects: _..:.\t--....;~:..:.Vl...;;....J{ .... , _________________ _ P-1(D) Page 2 of 4 Revised 07/10 15. If residential, include the number of units and schedule of unit sizes: VI,{}+ Q ~f \i ci1z k 16. 17. 18. 19. P-1(0) If commercial, indicate the type, whether r regionally oriented, square footage of sales area, and loading facilities: .....:..V..C.;..~~-~l'-4-....._.""""'-...-.------------ If industrial, indicate type, estimated employment per shift, and loading facilities: _____ _ '-" ct: a.fr\ la\o le If institutional, indicate the major function, estimated employment per shift, estimated occupancy, loading facilities, and community benefits to be derived from the project: ________ _ ~· Mi~J~4 If the project involves a variance, conditional us • • • e this and indicate clearly why the application is required: __;C~r..;....;:;=.>.....,,>..:.~~.,___..;;..;.;;;....._+=:...:....,.:.....~------- \)J\ re \.e~5 ~\M v0_~l ad-;£W1.s ~ \c\---'( Page 3 of 4 Revised 07/10 Are the following items applicable to the project or its effects? Discuss all items checked yes (attach additional sheets as necessary). Yes ~ 20. Change in existing features of any bays, tidelands, beaches, or hills, or substantial □ alteration of ground contours. ✓ 21. Change in scenic views or vistas from existing residential areas or public lands or □ roads. 22. Change in pattern, scale or character of general area of project. □ ✓ 23. Significant amounts of solid waste or litter. □ ~ 24. Change in dust, ash, smoke, fumes or odors in vicinity. □ 25. Change in ocean, bay, lake, stream or ground water quality or quantity, or □ ✓ alteration of existing drainage patterns. ✓ 26. Substantial change in existing noise or vibration levels in the vicinity. □ 27. Site on filled land or on slope of 10 percent or more. □ ~ 28. Use of disposal of potentially hazardous materials, such as toxic substances, □ flammables or explosives. ✓ 29. Substantial change in demand for municipal services (police, fire, water, sewage, □ etc.). ~ 30. Substantially increase fossil fuel consumption (electricity, oil, natural gas, etc.). □ 31. Relationship to a larger project or series of projects. □ Environmental Setting Attach sheets that include a response to the following questions: 32. Describe the project site as it exists before the project, including information on topography, soil stability, plants and animals, and any cultural, historical or scenic aspects. Describe any existing structures on the site, and the use of the structures. Attach photographs of the site. Snapshots or Polaroid photos will be accepted. 33. Describe the surrounding properties, including information on plants and animals and any cultural, historical or scenic aspects. Indicate the type of land use (residential, commercial, etc.), intensity of land use (one-family, apartment houses, shops, department stores, etc.), and scale of development (height, frontage, set-back, rear yard, etc.). Attach photographs of the vicinity. Snapshots or polaroid photos will be accepted. Certification I hereby certify that the statements furnished above and in the attached exhibits present the data and information required for this initial evaluation to the best of my ability, and that the f ts, statements, and information presented are true and correct to the best of my :l,.elief. Date: ) I~ ( <1.Al\ 'L Signature: -~_ .... r_ jl __ !/f_ • _______ _ ,-(\rvob\~e For: P-1(0) Page 4 of 4 Revised 07/10 ENVIRONMENTAL INFORMATION FORM T-Mobile S006378, Calavera Hills Community Park Environmental Setting (32) Description of Project Site This is an application to extend a conditional use permit for an existing T-Mobile wireless communications facility at Calavera Hills Community Park. There is a large gymnasium located on the subject property, along with ball fields, tennis courts, parking lots, and lighting. (33) Description of Surrounding Properties The subject property is surrounded by residential development to the east and west, and by undeveloped land to the north and south. Adjacent residential development primarily consists of multi- story, multi-family dwellings with small set-backs and rear yards. See attached photographic survey. ENVIRONMENTAL INFORMATION FORM -PHOTOGRAPHIC SURVEY T-Mobile S006378, Calavera Hills Community Park • View of the Subject Property ~ (1) View of the subject property looking north (2) View of the subject property looking west . ... -• (3) View of the subject property looking south (4) View of the subject property looking east (1) View from the subject property looking north (2) View from the subject property looking east (3) View from subject property looking south (4) View from subject property looking west