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Home My WebLink AboutCDP 02-05X2; KIRGIS SUBDIVISION; Coastal Development Permit (CDP)A CITY OF CARLSBAD YANo USE REVIEW APPLICATION 1) APPLICATIONS APPLIED FOR: (CHECK BOXES) (FOR DEPT. USE ONLY) D Administrative Permit D Planned Development Permit D Administrative Variance D Planned Industrial Permit ~oastal Development Permit ~9n~•O! • ~ Planning Commission tX. Determination D Conditional Use Permit D Precise Development Plan D Condominium Permit D Redevelopment Permit D Environmental Impact Assessment D Site Development Plan D General Plan Amendment D Special Use Permit D Habitat Management Plan Permit D Specific Plan D Hillside Development Permit D +eAtative Parnel Ma13 Obtain from Engineering Department D Local Coastal Program Amendment D Tentative Tract Map D Master Plan D Variance D Minor Conditional Use Permit D Zone Change D Non-Residential Planned Development D List other applications not specified (FOR DEPT. USE ONLY) 2) 3) 4) ASSESSORPARCELNO(S).: ~~,-~~-~~~'~~--~-~~~~~~~~~~~~~~~~~ PRoJEcTNAME: K•YJ\tS Tentd11Ae VVl4:f BRIEF DESCRIPTION OF PROJECTO 5) OWNER NAME (Print or Type) 6) APPLICANT NAME (Print or Type) MAILING ADDRESS MAILING ADDRESS oLJl~ D<lM_Y)M ~ CITY AND STATE TELEPHONE CITY AND STATE EMAIL ADDRESS: OWNER AND THAT ALL THE ABOVE CORRECT TO THE BEST OF MY t{-/-0% DATE EMAIL ADDRESS: ZIP TELEPHONE 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 TO 4:00 P.M. Form 14 Rev. 03/08 PAGE 1 OF 4 7) BRIEF LEGAL DESCRIPTION 8) LOCATION OF PROJECT: STREET ADDRESS ON THE SIDE OF (NORTH, SOUTH, EAST, WEST) (NAME OF STREET) BETWEEN AND (NAME OF STREET) (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) E TRICTION: PROPERTY OWNER ACKNOWLEDGES AND CONSENTS TO A NOTICE OF IN CORDED ON THE TITLE TO HIS PROPERTY IF CONDITIONED FOR THE I ESTRICTIONS RUN WITH THE LAND AND BIND ANY SUCCESSORS IN INTEREST. ;J::::/:.~1':-1/1'---JJ- FOR CITY USE ONLY DATE STAMP APPLICATION RECEIVED RECEIVED BY: Form 14 Rev. 03/08 PAGE 2 OF 4 City of Carlsbad I @Fi•• el• Ii· I •J§ •E•ii • ,k§,JI 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 office_rs. ,epar!lfi. pa~e f11~Y be attached if necessa! J 1 . \ l . Person lo~tlo~ Corp/~~rt~ ~ 0 cJY\. Title ""' ~ @..! Title ~ fV};;;J;;-e_r Address Address ~~~~~~~~~~~~- 2. 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 necess~ 1 ~ ) l . PersonJ,s::'fJ~ ~-l ~ 6&V'- Title fY}frlA.#jl~~~er ~ Address 'f 31JbJe-~t!f-W:£ :okQ_ 1635 Faraday Avenue• Carlsbad, CA 92008-7314 • (760) 602-4600 • FAX (760) 602-8559 • www.ci.carlsbad.ca.us @ e 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 ~~~~~~~~~~~~~- 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· D No If yes, please indicate person(s): __________ _ NOTE: Attach additional sheets if necessary. II the jJ/ve info;~ation is true and correct to the best of my knowledge. !f..,...../-;;..lfl-tr~ I -or' Signature of applicant/date Print or type name of owner Print or type name of applicant 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