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Home My WebLink AboutPUD 91-05D; Kathman Addition; Planned Unit Development - Non-Residential (PUD) (4)CITY OF CARLSBAD LAND USE REVIEW APPLICATION 1) c I — D I — I — 2) 3) 4) APPLICATIONS APPLIED FOR: (CHE Administrative Permit Administrative Variance Coastal Development Permit Conditional Use Permit Condominium Permit Environmental Impact Assessment General Plan Amendment Habitat Management Plan Permit Hillside Development Permit Local Coastal Program Amendment Master Plan Minor Conditional Use Permit Non-Residential Planned Development ECK BOXES) (FOR DEPT. USE ONLY) | 1 1 1 Planned Development Permit ' Planned Industrial Permit Planning Commission Determination Precise Development Plan Redevelopment Permit Site Development Plan Special Use Permit Specific Plan Tentative Parcel Map Obtain from Engineering Department Tentative Tract Map Variance Zone Change List other applications not specified (FOR DEPT. USE ONLY) PUD<?/-CS( ASSESSOR PARCEL NO(S).: •£//£-- ^ (^ O - ^ £> PROJECTNAME: j^ ^ /-^ ^^^ ^ ^ sd d 1+ 1*& fl BRIEF DESCRIPTION OF PROJECT: /LsJ sj /? €^~S / L// '^L<3 ^sitfC^?* T* / /9 7^ /"/ 5) OWNER NAME (Print or Type)6) APPLICANT NAME (Print or Type) B. 4 MAILING ADDRESS MAILING ADDRESS Ro. fex CITY AND STATE ZIP TELEPHONE CITY AND STATE ZIP TELEPHONE f C4- racLtSrcjuri e s.EMAIL ADDRESS:EMAIL ADDRESS:,c 0fi<) \ CERTIFY THAT 1 AM THE LEGAL OWNER AND THAT ALL THE ABOVE INFORMATIOJL IS TRUE AND ODRRECT TO THE BEST OF MY SIGNA/lJRE / 'DATE 1 CERTIFY THAT 1 AM THE LEGAL REPRESENTATIVE OF THE OWNER AND THAT ALL THE ABOVE INFORMATION IS TRUE AND COSECT TZ> THE BESTDF MY KNOWLEDGE. SIGNATURE DATE NOTE: A PROPOSED PROJECT REQUIRING MULTIPLE APPLICATIONS BE FILED, MUST BE SVBMIjTED PRIOR TO 3:30 P.M. A PROPOSED PROJECT REQUIRING ONLY ONE APPLICATION BE FILED, MUST BE SUBMITTED PRIOR TO 4:00 P.M. Form 14 Rev. 06/07 PAGE 1 OF 4 7) BRIEF LEGAL DESCRIPTION 8) LOCATION OF PROJECT: ON THE BETWEEN (NORTH, SOUTH, EAST, WEST) (NAME OF STREET) STREET ADDRESS SIDE OF (NAME OF STREET) AND (NAME OF STREET) 9) IN THE PROCESS OF REVIEWING THIS APPLICATION IT MAY BE NECESSARY FOR MEMBERS OF CITY STAFF, PLANNING COMMISSIONERS, DESIGN REVIEW BOARD MEMBERS 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. 10) PROPERTY OWNER ACKNOWLEDGES AND CONSENTS TO A NOTICE OF RESTRICTION FILED ON THE PROPERTY TITLE IF CONDITIONED FOR THE APPLICANT. CERTAIN APPROVALS (SUCH AS A CONDITIONAL USE PERMIT) RUN WITH THE LAND AND BIND ANY SUCCESSORS IN INTEREST. OPERT? OWNER SIGNATURE FOR CITY USE ONLY C\TV DAT APPLICATION RECEIVED RECEIVED BY: Form 14 Rev. 06/07 PAGE 2 OF 4 City of Carlsbad 1635 Faraday Avenue Carlsbad CA 92008 Applicant: WORTHING B A Description PUD9105D Amount 320.00 Receipt Number: R0065732 Transaction Date: 07/27/2007 Transaction ID: R0065732 Pay Type Method Description Amount Payment Credit Crd VISA 320.00 Transaction Amount: 320.00 City of Carlsbad 1635 Faraday Avenue Carlsbad CA 92008 Applicant: WORTHING B A Description PUD9105D 1225 GOLD FLOWER RD CBAD Amount 25.83 Receipt Number: ROD65782 Transaction Date.- 08/01/2007 Transaction ID: R0065782 Pay Type Method Description Amount Payment Credit Crd VISA ' 25.83 Transaction Amount: 25.83 City of Car tsbaa Farsday Cent" Faraday Cat:!'-<:' ing Oi 0721301- '• 08/01/2007 32 Wed Augi : 2007 07:bt <w PERMITS - rtRMl!: $25.83 fran Nbr: 072130101 i )2 0002 rrans/Rcpt#; R0065782 SET 3; PUD9105D redit Card (AuthK ^'^c]j $^5,83rotal Received: $25.83 Have 3 nice day: Dripncdte: 08/06/2007 05 54.-04PH PROJECT DESCRIPTION/EXPLANATION PROJECT NAME: f< <* ^1^ ^ <?^ /jd,sj/ •// " APPLICANT NAME: ?, '/.: A/&^ , 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. Description/Explanation: «re Project Description 10/96 Page 1 of 1 City of Carlsbad Planning Department DISCLOSURE STATEMENT 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 . 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, title, 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. Title / Corp/Part Title Vrtl Address/^Address ir I t-"-** r ^^ ixr t| «-^y V 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, title, 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.) Title KtTm/lMi>i Corp/Part Title Address / 2-^.5 Address, 1635 Faraday Avenue • Carlsbad, CA 92008-7314 • (760) 602-4600 • FAX (760) 602-8559 • www.ci.carlsbad.ca.us 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 A/</l~, Non Profit/Trust Title Title Address Address 4. Have you had more than $500 worth of business transacted with any member of City staff, Boards, Commissions, Committees and/or Council within the past twelve (12) months? • Yes [Vj 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. Signatyre'of owner/datl Signature of applicant/datej Print o/type name of owner Print or type name of applicant 7^ Signature of owner/applicant's agent if applicable/date Print or type name of owner/applicant's agent H:ADMIN\COUNTER\DISCLOSURE STATEMENT 12/06 Page 2 Of 2 HAZARDOUS WASTE AND SUBSTANCES STATEMENT 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 65962.5,1 have consulted the Hazardous Wastes and Substances Sites List compiled by the California Environmental Protection Agency and hereby certify that (check one): The 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. I I The development project and any alternatives proposed in this application are contained on the lists compiled pursuant to Section 65962.5 of the State Government Code. APPLICANT Name: Address: /? Phone Number: X /O 4 / — 3 PROPERTY OWNER <r. Name: Address: Phone Number: . &>7 B^ Address of Site: Local Agency (City and County): Assessor's book, page, and parcel number: *2-/ Specify list(s): A/< 4\ Regulatory Identification Number: Date of List: " 3 Applicant Signature/Dare \ Admin/Counter/HazWaste \^^7 PropertyDwner Signature/Date The Hazardous Waste and Substances Sites (Cortese List) is a planning document 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. Government Code section 65962.5 requires the California Environmental Protection Agency to develop at least annually an updated Cortese List. Below is a list of agencies that maintain information regarding Hazardous Waste and Substances Sites. Department of Toxic Substances Control www.dtsc.ca.qov/database/calsites Calsites Hotline (916) 323-3400 State Water Resources Control Board www.swrcb.ca.qov/cwDhome/lustis County of San Diego Certified Unified Program Agency (CUPA) Mike Dorsey Chief, Hazardous Materials Division Department of Environmental Health Services Hazardous Materials Management Division Mailing address: P.O. Box 129261 San Diego, CA 92112-9261 (619)338-2395 Call Duty Specialist for General Questions at (619) 338-2231 fax: (619) 338-2315 www.co.san-dieqo.ca.us Integrated Waste Management Board www.ciwmb.ca.gov 916-255-4021 Environmental Protection Agency National Priorities Sites ("Superfund" or "CERCLIS") www.epa.gov/superfund/sites/cursites (800) 424-9346 National Priorities List Sites in the United States www.epa.gov/superfund/sites/npl/npl.htm 5/19/03