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
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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