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HomeMy WebLinkAboutMCUP 09-04; SD06915 POINSETTIA VILLAGE - 1ST EXTENSION; Minor Conditional Use Permit (MCUP)( 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: (CH CK BOXES) Develop{11!nt Permit§ 0 Coastal Development Permit [gJ Conditional Use Permit Ii] Minor O Extension 0 Day Care (Large) 0 Minor D Environmental Impact Assessment D Habitat Management Permit O Minor 0 Hillside Development Permit 0 Minor 0 Nonconforming Construction Permit 0 Planned Development Permit O Minor 0 Residential O Non-Residential D Planning Commission Determination 0 Reasonable Accommodation D Site Development Plan D Special Use Permit 0Minor 0 Tentative Parcel Map (Minor Subdivision) 0 Tentative Tract Map (Major Subdivision) 0 Variance 0 Minor (FOR DEPT usr; ONL VJ L,el•la'liye PermiJf i-------,i 0 General Plan Amendment 0 Local Coastal Program Amendment 0 Specific Plan 0 Zone Change 0Amendment □Amendment 0 Zone Code Amendment §,mth Carl§bad {;ont,I Review Srea ~ D Review Pel'ff'lit 0 Admlnistratiw D Minor O Mliljor VIiiage Review Am, Pt,rmtt, D Review Permit 0 Administrative D Minor D Major (FOR DEPT. USF; ONLY) B NOTE: A PROPOSED PROJECT IUiQUIFUNG APPLICATION SUBMITTAL MUST IUIUBMITTED SY APPOINTMENT'. PLEASE CONTACT THE APPOINTMl!NT SPECIALIST AT (760) 602•2723 TO SCHEDULE AN APPOINTMENT. •SAME !)AV APPOIN'l'MliNTS ARI! NOT AVAIi.ABLE ASSESSOR PARCEL NO(S): 214-430-14-00 ---------------------------------LO CAT l ON OF PROJECT 7040 Avenida Encinas, Carlsbad, CA 92009 NAME OF PROJECT: BRIEF DESCRIPTION OF PROJECT: PROJECT VALUE (SITE IMPROVEMENTS) FOR CITY USE ONL V 0 (STREET ADDRESS) T-Mobile CUP Renewal Renew Minor CUP. No physical work to be done. ESTIMATED COMPLETION DATE Development Na.}f ~0 3 Q {QI Lead Case No. Hcu.P 09::::0 ~ x ( P-1 Page 1 of 6 Revised 03/17 OWNER NAME (PLEASE PRINT) APPLICANT NAME (PLEASE PRINT) INDIVIDUAL NAME INDIVIDUAL NAME (if applicable)· (If applicable): JoseQh Rose COMPANY NAME ~ "-"'>,.~vo. S..1,U !.m ... ...._ ~d! /~ '• COMPANY NAME (if applicable): pt applicable): T-Mobile MAILING ADDRESS: z~ C:3/fo1 t:A,t'#).--; 5Tl:;r Jc,<1 MAILING ADDRESS: 1 osos Vista Sorrento Pkwy #206 ' CITY, STATE, ZIP: C'.crST-Y\ A/412.SA " G..fl'r ~&,:~ CITY, STATE, ZIP: San DieQO, CA 92121 TELEPHONE: -r l lf. 'J_fa.C, . ~ '{Z'{ TELEPHONE: 858-334-6112 EMAIL ADDRESS: 1 Sc.. t ~ e \ 'I) ~ft. :;;i '= a "i)S €4,,0, ..... EMA.IL ADDRESS: josegb ccse.t4j@i-mcbile com I CERTIFY THAT I AM THE LEGAL OWNER ANO 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 KNOWLEDGE. SET FORTH HEREIN IS MY AUTHORIZED REPRESENTATIVE FOR ;,~:;~ Dr;/4 SIG~h,--u,. 4/4/19 ...-sTGNATURE DATE APPLICANT'S REPRESENTATIVE (Print): J§rrod Ploof/§martlink MAILING ADDRESS: 2277 Boundary Street CITY, STATE, ZIP: San Diego, CA 92104 TELEPHONE: 858-344-4444 EMAIL ADDRESS: j~[[QC,l:2IQQf@Str1at11iols.LLC,ccro 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. Jerrod Ploof ,Sc•.:-:,'· 4/~L20l9 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/INE 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 • T~:-~:2:"~S ~INTEREST. / PROPERTY OWNER SIGN URE FOR CITY USE ONLY P-1 Page 2 of 6 APR O 5 2019 l-i I y ur= L 1.:..i,LS8H1.• Pl /\t\l!\.i "-1(:'. n!\/IS!O\. DATE STAMP APPLICATION RECEIVED Revised 03/17 { City of 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. APPLICANT (Not the applicant's agent) Provide the COMPLETE, LEGAL names and addresses of & 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 (NIA) 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 T-Mobile West LLC Title -----------Title -------------Address. _________ _ Address 10509 Vista Sorrento Pkwy, #206, San Diego, CA 9~121 2. OWNER (Not the owner's agent) P-1(A) 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 gorporation 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 pupljs;ly-owned corpgration, include the names, titles, and addresses of the corporate officers. (A separate page may be attached if necessary.) Person__________ Corp/Part ~~k,.._ ~i4.,•!>'Nk: U.,sl~ '"~~1-.f. Title__________ Title '?e-<?fo,:Jt1y tt-i,,,.,.,.,C7L-_ Address_________ Address 2-ro <::6§:,--lb,. Itel? ST. s...>, f1l IQJ e.csm iY!aA, vft 1'2/4();5 Page 1 of2 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 Profitn"rust________ Non Profitn"rust _________ _ 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 0 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£1/4(~ Signature of owner/date ~Ml&:S: C.. ~~ '-f /':</11 Print or type name of owner Jerrod Ploof Joseph Rose Oi!lltally signed by Joseph Ros& Date: 20111:04.04 12:28:21 -07'00' Signature of applicant/date T-Mobile/Joseph Rose Print or type name of applicant Signature of owner/applicant's agent i.f applicable/date Jerrod Ploof/Smartlink Print or type name of owner/applicant's agent P-1(A) Revised07110 ("city of Carlsbad PROJECT DESCRIPTION P-1{B) Development Services Planning Division 1635 Faraday Avenue {760) 602-4610 www.carlsbadca.gov PROJECT NAME: T-Mobile CUP renewal APPLICANT NAME: T-Mobile ------------------------ 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: The project submittal is to renew Minor CUP No. MCUP 09-04 for the continued operation of a T •Mobile wireless eommunieations faeility at 7040 Avenida Encinas. No physical work is proposed as a part of this submittal. P-1(B) Page 1 of 1 Revi11ed 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 l,.ists of Sites Related to H•zardous Waates (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): [ii The development project and any alternatives proposed In this application gr, not contained on the lists compiled pursuant to Section 65862. 5 of the State Govemment Code. D The development proje.et and any alternatives proposed in this application m contained on the lists compiled pursuant to Section 65982.5 ofth~ State Government Code. APPLICANT Name: T ~Mobile :as , --nn x -a.:m, _;s:;::,e:www. ,.., Address: 10509 Vista Sorrento Pkwy, #206 San Diego, CA 92121 Phone Number: 858-334-6112 Address of Site: 7040 Avenida Encinas PROPERTY OWNER Name:B.-tt:~d Ss:t.,,, lat,tJ, (tr,/~ t:,Ulf t.f, Address: 24!(;, I.S d:"''F b\ ~ o:~ , "> Th ... pa C&:i-sn1: W\.y,d. CA, q~~~ f ' Phone Number: 7 I'-{_· 'Jl,t, .. k ¥2 £ Local Agency (City and County}: City of Carlsbad, County of San Diego Assessor's book, page. and parcel number:_A_P_N_2_14_. _-4_3_· o_-_1_4_-_o_o _________ _ Specify list(s):~~~~-~-· -... =··=-·""""""'"'"«--.=,----------------- 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 02/13 smartlink Applicant: T~Mobile Address: 7040 Avenida Encinas, Carlsbad, CA 92009 RE: Request for CUP extension Date: 4/4/2019 T •Mebile requests aR extensieA ef the Miner eUP fer the eell site at 7040 Avenida Encinas, MCUP 09-04. Please eerntaet me if veu have any questions or require additional information. Thank you, Jerrod ~loef Ag~nt for 'f ~Mebile 858.344,4444 Jerrod'.Ploof@Smartlinklb~,f~tt:11 1997 Annapolis Exchange Parkway . Suite 200 . Annapolis, MD 21401 p 888.828.5465 f 410.263.5470 smartlinklk.com