Loading...
HomeMy WebLinkAboutAD 09-02; THE COUNTER CUSTOM BUILT BURGERS; Administrative Permits (ADMIN)I _r CITY OF £tAR LSBAD LAND USE REVIEW APPLICATION P-I Development Services Planning Department 1635 Faraday Avenue (760) 602-4610 www.carlsbadca.gov APPLICATIONS APPLIED FOR: (CHECK BOXES) Development Permits (FOR DEPT. USE ONLY) Legislative Permits Administrative Permit El Coastal Development Permit (*) 0 Minor 0 Conditional Use Permit (*) 0 Minor 0 Extension (rnP flFPT I I.;: (I'JI '/\ El General Plan Amendment El Local Coastal Program Amendment (*) El Master Plan El Amendment 0 Environmental Impact Assessment El Habitat Management Permit 0 Minor O Hillside Development Permit (*) El Planned Development Permit 0 Residential 0 Non-Residential O Planned Industrial Permit El Planning Commission Determination El Site Development Plan O Special Use Permit O Tentative Tract Map El Variance El Administrative El Specific Plan El Amendment El Zone Change(*) El Zone Code Amendment List other applications not specified El El El (*) = eligible for 25% discount NOTE: A PROPOSED PROJECT REQUIRING MULTIPLE APPLICATIONS BE FILED, MUST BE SUBMITTED PRIOR TO 3:30 P.M. A PROPOSED PROJECT REQUIRING ONLY ONE APPLICATION BE FILED, MUST BE SUBMITTED PRIOR 104:00 P.M. ASSESSOR PARCEL NO(S).: PROJECT NAME: BRIEF DESCRIPTION OF PROJ IL__ - lIAiiAfl( OWNER NAME (Print): ''y *JL LU, APPLICANT NAME (Print): o ) '10 o MAILING ADDRESS: !, oc (L MAILING ADDRESS: çj ( CITY, STATE, ZIP: f3nt CITY, STATE, ZIP: C 4A TELEPHONE: TOO-.{q TELEPHONE: 3D -1O EMAIL ADDRESS: co' EMAIL ADDRESS: .4 ( 11~gwt. 60 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 KNQyEGE. /J i2)o THE BTOF'MYKNQJLLPGE. ( SIGNAT .,' / 0 DATE NAT E DAITE 0— 0 1 nf nA/AG \ WE . . BRIEF LEGAL DESCRIPTION:L0f 1 LM ot fl 4 13j C4iI6d Tiac+ No q-og LOCATION OF PROJECT: aq Igg o c_al 3TREET ADDRESS k j?rce/o,'( (NAME OF _euc'i (NAME OF ON THE: çoj --11 (NORTH, SOUTH, EAST, WEST) BETWEEN (NAME OF STREET) SIDE OF AND 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. 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 AND SUCCESSORS IN INTEREST. PIROITATY WNER SIGNATURE FOR CITY USE ONLY RECEIVED NOV 16 2009 CITY OF CARLSBAD PLANNING DEPT DATE STAMP APPLICATION RECEIVED RECEIVED BY: 6 1 n 4 DISCLOSURE STATEMENT P-1(A) CITY OF CARLSBAD Development Services Planning Department 1635 Faraday Avenue (760) 602-4610 www.carlsbadca.gov 2. Applicants 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. APPLICANT (Not the applicant's agent) Provide the COMPLETE, LEGAL names and addresses ofJ 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 I Li C' fl4S 'fcc Corp/Part_______________________ Title P1rc,def Title________________________ Address 1 II Abcwfv 5td Address__________________________ CcuSsbQ,Cn ¶ooq 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.) °tr&&. ttePtr,e. LLc_ Person iS. .4RAEs L*.er Corp/Part 1-&RT4 4ieL &cQ. Title ten.Ckê,tthcM5 Title O?r- Address IC\Oc Cu-C tX$tcLo", Address______ Ct'O14q0CA 9.3O P.1(A) Page 1 of Revised 04/09 3. NONPROFIT 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? 1-1 Yes No If yes, please indicate person(s):___________________________ NOTE: Attach additional sheets if necessary. I cerffy that all the aboxe information is true and correct to the best of my knowledge. " VQHK,L oq nat re of owner/date ( Signature cffappjieánt/date ' Print or type name of owner —I LI I LiO(fl145 /00 Print or type name of applicant Signature of owner/applicant's agent if applicable/date Print or type name of owner/applicants agent P-1(A) Page 2ot2 Revised W09 PROJECT Development Services S I DESCRIPTION Planning Department CITY 0 F P-I (B) 1635 Faraday Avenue (760) 602-4610 CARLSBAD PROJECT NAME: APPLICANT NAME: 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: S-cc k1 9cint t -{-ci fu' ei-{-iv y'.e ~+A U ul 11 if I Lot tt4fldcTh 'Pr') Ct2nt-ti. P-1(B) Page 1 of I Revsed 04/09 HAZARDOUS WASTE Development Services AND SUBSTANCES Planning Department CITY 0 F STATEMENT 1635 Faraday Avenue (760) 602-4610 CARLSBAD 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): 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. fl The development project and any alternatives proposed in this application are contained on the lists compiled pursuant to Section 65962.6 of the State Government Code. APPLICANT Name: (IitiMccs '100 Address: 711 4hgmt 1..s Giii.co4,CA- OZ DL) PhoneNurnber___________________ Address of Site: Vii 3 (' Local Agency (City and County): L Li Assessor's book, page, and parcel number: e Specify list(s):______________________________ Regulatory Identification Number:_____________ PROPERTY P\WNER Name: NZ tTH tfl "4-t tic.- Address: ri 06 CA t.jf j\(ZE/ozJ tj crc?c CP9Afl 1r4 12co7 Phone Number:I'lb-0 - c' C4 qzo C Date of List: A 76HXXLCL Appänt sign2tT }Iopit9er Signature/Date 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 04109