The URL can be used to link to this page

Home My WebLink AboutRP 15-20; Glass and Mirror Shoppe A Frame Sign; Redevelopment Permits (RP). .?/"' ' (_City of Carlsbad LAND USE REVIEW APPLICATION P-1 Development Services Planning Division 1635 Faraday Avenue (760) 602-4610 www.carlsbadca.gov APPLICATIONS APPLIED FOR: (CHECK BOXES) Development Permits D Coastal Development Permit (*) 0 Minor D Conditional Use Permit (*) 0 Minor 0 Extension 0 Day Care (Large) 0 Environmental Impact Assessment 0 Habitat Management Permit 0 Minor 0 Hillside Development Permit (*) 0 Minor 0 Nonconforming Construction Permit D Planned Development Permit 0 Minor D Residential 0 Non-Residential 0 Planning Commission Determination 0 Site Development Plan 0 Special Use Permit 0 Minor D Tentative Parcel Map (Minor Subdivision) 0 Tentative Tract Map (Major Subdivision) D Variance 0 Minor (FOR DEPT. USE ONLY) Legislative Permits (FOR DEPT. USE ONLY) 1--------i 0 General Plan Amendment 0 Local Coastal Program Amendment (*) 0 Master Plan 0 Amendment 0 Specific Plan 0 Amendment 0 Zone Change (*) 0 Zone Code Amendment South Carlsbad Coastal Review Area Permits 0 Review Permit 0 Administrative 0 Minor 0 Major Village Review Area Permits W Review Permit 0 Administrative 0 Minor 0 Major A -~t?VVVUZ- (*) = eligible for 25% discount ~ftL?ZO NOTE: A PROPOSED PROJECT REQUIRING MULTIPLE APPLICATIONS MUST BE SUBMITTED PRIOR TO 3:30P.M. A PROPOSED PROJECT REQUIRING ONLY ONE APPLICA Tl ON MUST BE SUBMITTED PRIOR TO 4:00 P.M. ASSESSOR PARCEL NO(S).: ~V'3-1-?1 b .. t~0 ·-00 PROJECT NAME: ~ LASs ~ \'-'1 l\~Ro.~ S!±p e e£ A-'FR-A'rh~ "S' lf;t--) BRIEF DEscRIPTION oF PROJEcT: A>£~ArYt~-/;'1661\1 BRIEF LEGAL DESCRIPTION: LOCATION OF PROJECT: ON THE: SIDE OF (NORTH, SOUTH, EAST, WEST) (NAME OF STREET) BETWEEN AND (NAME OF STREET) (NAME OF STREET) P-1 Paoe 1 of6 Revised 04f 1 5 APPLICANT NAME (Print): MAILING ADDRESS: CITY, STATE, ZIP: ( 1, Q 0... TELEPHONE: EMAIL ADDRESS: TELEPHONE: ~ fR Q 7 ~tj ) 0 U ~ )cJ<)P.{Q fPCpiYlFfifJr1 ,(c ~AILADDREssgi5~S"~Yld m)([Or&.ic{oucJ,(oJrl I CERTIFY THAT I AM THE LEGAL OWNER AND THAT ALL THE ABOVE I CERTIFY THAT I AM THE LEGAL REPRESENTATIVE OF THE OWNER INFORMATION IS TRUE AND CORRECT TO THE BEST OF MY AND THAT ALL THE ABOVE INFORMATION IS TRUE AND CORRECT TO KNOWLEDGE. I CERTIFY AS LEGAL OWNER THAT THE APPLICANT AS THE BEST OF MY KNO~WEDG . PU0/ S OF THIS APPLICATION. Y\;\ l { SE~p6~TH HERE.IN IS MY AUTHORIZED REPRESENTATIVE FOR ~ \ ~0 /'cL b/Y =7::::-f:--"'-..,z.....<.--=----t l o ~ I S SIGNATURE S GNATURE ' DATE APPLICANT'S REPRESENTATIVE (Print): MAILING ADDRESS: CITY, STATE, ZIP: TELEPHONE: EMAIL ADDRESS: I CERTIFY THAT I AM THE REPRESENTATIVE OF THE APPLICANT FOR PURPOSES OF THIS APPLICATION AND THAT ALL THE ABOVE INFORMATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. SIGNATURE DATE 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. 1/WE CONSENT TO ENTRY FOR THIS PURPOSE. NOTICE OF RESTRICTION: PROPERTY OWNER ACKNOWLEDGES AND CONSENTS TO A NOTICE OF RESTRICTION BEING RECO~DED . N THE TITLE TO HIS PROPERTY IF CONDITIONED FOR THE APPLICANT. NOTICE OF RESTRICTIONS RUN WITH THE LAND D BIND ANY SUCCESSORS IN INTEREST. £ /fi / /;I .. •<' '-/ C·~L<t~· ~~# t,;/9.. FOR CITY USE ONLY OCT ~ 2 2015 DATE STAMP APPLICATION RECEIVED RECEIVED BY: P-1 Page 2 of6 Revised 04/15 Indemnification and Insurance Requirement for Village Area Administrative Permit Certification Statement: I Certify that I am the Legal Business Owner of the subject business and that all of the above information is true and correct to the best of my knowledge. I agree to accept and abide by any conditions placed on the subject project as a result of approval of this application. I agree to indemnify, hold harmless, and defend the City of Carlsbad and its officers and employees from all claims, damage or liability to persons or property arising from or caused directly or indirectly by the installation or placement of the subject property on the public sidewalk and/or the operation of the subject business on the public sidewalk pursuant to this permit unless the damage or liability was caused by the sole active negligence of the City' of Carlsbad or its officers or employees. I have submitted a Certificate of Insurance to the City of Carlsbad in the amount of one million dollars issued by a company which has a rating in the latest "Best's Rating Guide" of "A-" or better and a financial size of $50-$100 (currently class VII) or better which lists the City of Carlsbad as "additional insured" and provides primary coverage to the City. I also agree to notify the City of Carlsbad thirty days prior to any cancellation or expiration of the policy. The notice shall be delivered to: City Planner City of Carlsbad 1635 Faraday Avenue Carlsbad The insurance shall remain in effect for as long as the property is placed on the public sidewalk or the business is operated on the public sidewalk. This agreement is a condition of the issuance of this administrative permit for the subject of this permit on the public sidewalk. I understand that an approved administrative permit shall remain in effect for as long as outdoor d. p ys are permitted within the Village Review Area and the permittee remains i c mpliance with t~e Sf!bject a pr ved permit. {_ Signature I{}J~ Date: } 0? '(_, /5 Certification Statement: I Certify that I am the Legal Property Owner for the subject business location and that all of the above information is true and correct to the best of my knowledge. I support the applicant's request for a permit to place the subject property on the public sidewalk. I understand that an approved administrative permit shall remain in effect for as long as outdoor displays are permitted within the Village Review Area and the permittee remains in co~~ce with the subject approved permit. Signature ;;0 e_£ r 4/ Date:_..:...../_·c;, ..... ·y;::...:~:.....·· <!..:/....:"-':....'" _____ _ P-1 Page 3 of6 Revised 04/15 C"cityof 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.~"Anyindividual; firm, co-partnership, joint venture, association; social club; fraterna~ organization, corporation, estate, trust, receiver, syndicate, inthisandariy other c;ounty, city and county~ city municipality, district or other political subdivision or any other group or combination acting as a unit" • Af;lents •. may'sign this document;. hbwever, the legal n~me and:entity bfthe applicaht and propertY ownet 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 1 0% 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 e atta ed if 'g:cessary.) Person V{?Y\Y\ tA U { Corp/Part. _________ _ Title() OJ~i? Title. ___________ _ Addres~~~~J~~'f ij~DOB Address ______ _ 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 address2f'~he co;porate officers. (A separate page may be attached if necessary.) Person~~"'t~.i/ /.1~? Corp/Part. ___________ _ Title .4ac :)' /Zt~uf~u-· Title ____________ _ Addressefb:.t"/ L:."':JJhe2/L~ .lA Address a ----------------- 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, Boards, Commissions, 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 corre J . Print or type name of wner Print or type n Signature of 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 Ccicyof Carlsbad PROJECT DESCRIPTION P-1 (B) Development Services Planning Division 1635 Faraday Avenue (760) 602-4610 www.carlsbadca.gov PROJECTNAME: --~~--~~~~~--~~~~~~~~~~~~~ APPU~m~ME:~~~~--~~~~~----------------------~~~ 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 ~n addendum sheet if necessary. Description/Explanation: P-1 (E3) Page 1 of 1 Revised 07/10 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): 0 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. 0 The development project and any alternatives proposed in this application m contained on the lists compiled pursuant to Section 65962.5 of the State Government Code. APPLICANT I PROPERTY OWNER Name: Re Yl Y\ \..[ kill. [k\ V dh-: Name: V / dCJ' f {" qjQ J <\f. Address:~b<t cJ fu-i--c st-Address:-2Ct>'S~ R6D5cvel I D Caf l s L?0v d q £o o 8 ( ~-rl~b,~Av~ 0 2-oo 'Q Phone Number:70D 7 7..-q --/ o(oJ Phone Number:7(p0 -{f 3\f-:737 3 itlLL Addressofsite: 309S <S+~~ ~~ Ca(/<S~rAcl qzoo6 Local Agency (City and County):----"C~Vi"'-L..L.{__,{.......,G~(o_V\-"-d-=-' __ S-=-g__.__._V)-"----".j)<=--l).__" _E~~-+--0 __ Assessor's book, page, and parcel number:. ___________________ _ Specify list(s): _____ ·------------------------- Regulatory Identification Number: ______________________ _ 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 of 2 Revised 02/13 Pr-F r~ t'Y' -e ~;6n g&;~l/5 VJ t+ e-,dl CERTIFICATE OF LIABILITY /INSURANCE , ~~:~~~~DIYYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONF~~~S NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR LTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTR T BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. 1 . IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(ies) mu,_t be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. P{ statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(&). ' PRooucER ~z~r,cT L~nce Hale rftg.~.~u, 9$1-461-3536 _ . L&eK.J'~lg§1 ~§ 1_~~§-~~~-. ---~ Allstate Insurance Company 23771 Washington Ave #101 Murrieta Ca 92562 INSURED Penny Kachuck (DBA Glass and Mirror Shoppe) 3095 State St Unit G Carlsbad Ca 92008 ~t't~h?: lanpe.h_c:lle@alls!ate.s;om __ .. _ ·-, . __ _ I IN~~_}l§~(!;ti\ff91t~ii'I(3 __ C_{?_\':S~G.E_ .. .... ... .. . . .. .. ... .N.~I<;:#_ •.. I@J~~A: . ~ .. .AII~t§t~ -..... ·+ 1.~_51SL :::~::::' ·1·-·- _II'J!;I}I~.~,,~_I:l_:_ .. •••••••• '1 !_ IN_~lJ.I!\':1'{_~: INSURER F: I t···· COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUE D TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWIT~STANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONT ACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE PO ICIES DESCRIBED HEREIN IS SUBJECT TO All THE TERMS. ~X~~~~~~s~;~~~:~~;;~:--~~-~~C~~~;!~~IMJ!~~fl;:-:~~:::;;VE_~~~N tl~]~~:~~~ihl~j~f ...... -... ··-· ... -~IMITS ..... -····-···· -···· - GENERAL UI\61U1Y I ! i 27 d!)1 '0 /27/ 5 ! EACH OCCURRENCE -1 $ 2,000,000 i 648138017 :011 ,, 4 I 1 201 :DA1W\Ci'EI6REHIED.. i .. ---~1~]:::~:-~:~:Et.~]~:~~~: i . II : I:~~~~;~:::=::· f~i§:o~~-~-: _-·-·:: i PERSONAL & IIDV INJURY · $ 1,~F1 wi 7r :,~ 1 ; ! [:;~:;,~:.;~~.., i:I~~~r~ ... ::~~T:~~i:BIU1Yr ~-~I ~5~6~ULED 1 1 1.1 1 1 ! ~~~~ZE.tt · · · - I·· . NON.OWIIED 1 i PROPE[{fY DAMAGE······ • s . ... . r·--HIREDAuros j·--····i AuTos , 1 f.<l"~.r..~w~~JtmL. . ...... ·f s .-............ . I I I ' i I i i i i OESCRIP110N OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Permit outdoor signage for retail shop CERTIFICATE HOLDER City of Carlsbad 1635 Faraday Ave Carlsbad Ca 92008 ACORD 25 (2010/05) CANCELLAITION. SHOULD A lilY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. All rights reserved. The ACORD name and logo are registered marks of ACORD i Policy Number f THIS ENDORSEMENT CHANGES fE POUC~1lBOH PLEASE READ IT CAREF LLY. COMMON POUCY CHANGE EN ORSEMENT Allstate Insurance cqmpany Endorsement No. 001 Named Insured PENNY KACHUCK Effective Date: 03-06-14 12:01 A.M., Standard Time Agent Name LANCE HALE This endorsement will not be used to decrease coverages, increrse rates or deductibles or alter any terms or conditions of coverage unless at the sole request of the insured. i COVERAGE PART INFORMATION -Cowrage parts affected by this ~ange as indicated by !XI below. D Commeq::ial Property ; 0 9ommercial General liability 0 Commercial Crime . 0 Commercial Inland Marine ~ BUSINESSOWNERS NO CHARGE D I i The following item(s): 0 Insured's Name 0 ln~ured's Mailing Address 0 Policy Number D C~mpany 0 Effective/ Expiration Date D ln$ured's Legal Status/ Business of Insured D Payment Plan 0 Premium Determination 0 Additional Interested Parties 0 Cpverage Forms and Endorsements 0 Limits/ Exposures 0 Deductibles 0 Covered Property/Location Description 0 classification/Class Codes ORates 0 Underlying Exposure/Insurance is (are) changed to read {See Additional Page( s)} SEE NEXT PAGE . The above amendments result in a change in the premium as folio~: This premium does not include taXes and surch~. ~No Changes D To be Adjusted at Audit Additional NO CHARGE I Return NO CHARGE Tax and Surcharge Changes Additional Return Countersigned By: LANCE HALE AUTHORIZED AGENT DM CW300110 Allstate Insurance Company Insured Full coPy j j j j j j j j j j j j j j J j j j j j j j j j j j j j j j j j COMMON POLICY CHANGE EN~ORSEMENT I Allstate. Insurance Cqmpany Named Insured PENNY KACHUCK I Agent Name LANCE HALE i Policy Number 648138017 Endorsement No. 0 0 1 Effective Date: 0 3-0 6-14 12:01 A.M., Standard Time POLICY CHANGES ENDORSEMENT DE"fCRJPTION (CONT'D) THE POLICY IS AMENDED AS FOLLOWS: ADD INSURED THE FOLLOWING ADDITIONAL TO THE POLICY: CITY OF CARLSBAD INTEREST (ADDITI01AL INSURED) HAS BEEN ADDED 1~35 FARADAY AVE CARLSBAD CA 92008-7314 THE FOLLOWING FORM(S) HAS BEEN ADDED: 1 BP 04 52 01-06 ADDL INSD-STATE pR POLITICAL SUBDIVISION ALL OTHER TERMS AND CONDITIONS REMAIN THE ~AME REMOVAL PERMIT If this policy includes the Commercial Property Coverage Part, the following applies with respect to the Coverage Part: If Covered Property is removed to a new location that is described on this Policy Change, you may extend this insurance to include that Covered Property at each location during the removal. Coverage at each location will apply in the proportion that the value at each location bears to the value of all Covered Property being removed. This permit applies up to 10 days after the effective. date of this Policy Change; after that, this insurance does not apply at the previous location. DM CW 300110 Allstate Insurance Company Insured Full Copy j j j j j j j j j j j j j j j j j j j j j j j j j j j j City of Car·lsbad Faraday Center Faraday Cashiering 001 1527501-2 10/02/2015 149 Fri, Oct 02, 2015 04:21PM Receipt Ref Nbr: R1527501-2/0051 PERMITS -PERMITS Tran Ref Nbr: 152750102 0051 0053 Trans/Rcpt#: R0112053 SET #: RP150020 Amount: Item Subtota 1 : Item Total: PERMITS -PERMITS 1 @ $62.00 $62.00 $62.00 Tran Ref Nbr: 152750102 0051 0054 Trans/Rcpt#: R0112052 SET #: PS150103 Amount: Item Subtotal: Item Tot a 1: 1 @ $62.00 $62.00 $62.00 $124.00 j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j I j j City of Carlsbad 1635 Faraday Avenue Carlsbad CA 92008 11111111111111 ~1111111111111111111111111111111111111111111111111 Applicant: KACHUCK PENNY Description Amount RP150020 62.00 3095 STATE ST CBAD Receipt Number: R0112053 Transaction ID: R0112053 Transaction Date: 10/02/2015 Pay Type Method Description Amount Payment Check 62.00 Transaction Amount: 62.00