HomeMy WebLinkAboutCDP 04-10; DEYOUNG SECOND DWELLING UNIT; Coastal Development Permit (CDP)CITY OF CARLSBAD
LAND USE REVIEW APPLICATION
1 ) APPLICATIONS APPLIED FOR: {CHECK BOXES}
(FOR DEPARTMENT (FOR DEPARTMENT
USE ONLY} USE ONLY)
D Administrative Permit -2nd D Planned Industrial Permit
Dwelling Unit
D Administrative Variance D Planning Commission
Determination
D Coastal Development Permit 6)P r~-Io D Precise Development Plan
D Conditional Use Permit D Redevelopment Permit
0 Condominium Permit D Site Development Plan
D Environmental Impact D Special Use Permit
Assessment
D General Plan Amendment D Specific Plan
D Hillside Development Permit D =Fefltati't'e Pareel Map
Obtain from Engineermg Department
D Local Coastal Plan Amendment D Tentative Tract Map
D Master Plan D Variance
D Non-Residential Planned D Zone Change
Development
D Planned Development Permit D List other applications not
specified
ASSESSOR PARCEL NO{S).: ISS. ~"2..\. 0 4-2)
3)
4)
PROJECT NAME: DE:.'1o .... ~<;.;r::)£~OI ... )l) OlL-It:-J-J...t ~~I(~-t i, 1..-) (T
BRIEF DESCRIPTION OF PROJECT: ONE.' S~~ Si::c:.cY'\\=" Pu..I~ .... ~ \,.J~,,~ e. ~~"'-o~
5) OWNER NAME (Print or Type)
Jo/#J 2Yc ",,.It;,
MAILING ADDRESS
2.¥11 '8£J~H t/tSPl C,1'l .
t=-" p.o~""""r"J
6) APPLICANT NAME (Print or Type)
VOIfAl ~ ,,~4t
MAILING ADDRESS
Z 'III ~~-nM 1/157» C I If! •
CITY AND STATE ZIP TELEPHONE CITY AND STATE ZIP TELEPHONE
(}A.
I CERTIFY THAT I AM THE LEGAL OWNER AND THAT ALL THE ABOVE
INFORMATIO IS T E AND CORRECT TO THE BEST OF MY
KNOWLED .,'
I CERTIFY THAT I AM THE LEGAL REPRESENTATIVE OF THE
OWNER AND THAT ALL THE ABOVE INFORMATION IS TRUE AND
CORRECT TO HE BE OF MY KNOWLEOGE.
~~~~~~---~~;4Y
7) BRIEF LEGAL DESCRIPTION eo ~ t-fte "iO. 249"2..
O[ lie I..-I( 3i
NOTE: A PROPOSED PROJECT REQUIRING MULTIPLE APPUCATIONS BE RLED, MUST BE SUBMITTED PRlbR TO 3:30 P.M.
A PROPOSED PROJECT REQUIRING ONLY ONE APPUCAllON BE FILED, MUST BE SUBMITTED PRIOR TO 4:00 P.M.
Form 16 PAGE 1 OF 2
•
LOCATION OF PROJECT:
STREET ADDRESS
ON THE
BETWEEN
(NORTH, SOUTH, EAST, WEST)
\'-At.::r-' '" ... ...... \.
SIDE OF Il!.u~ ~ \J \ ~"t'tII. c.\I~.,"",""ii:...
(NAME OF STREET)
AND
(NAME OF STREET) (NAME OF STREET)
J1 LOCAL FACILITIES MANAGEMENT ZONE
'¢) PROPOSED NUMBER OF LOTS
1~ TYPE OF SUBDIVISION
~) PERCENTAGE OF PROPOSED
PROJECT IN OPEN SPACE
1/) GROSS SITE ACREAGE
,/-) EXISTING ZONING
NUMBER OF EXISTING
RESIDENTIAL UNITS
'111t) PROPOSED NUMBER OF
~ RESIDENTIAL UNITS
PROPOSED IND OFFICE! I ~'bI1;S} PROPOSED COMM
SQUARE FOOTAGE SQUARE FOOTAGE
PROPOSED INCREASE IN D ltB) PROPOSED SEWER
ADT USAGE IN EDU
\'/.11 .... ~2J!) EXISTING GENERAL
PLAN
PROPOSED ZONING
PROPOSED GENERAL
PLAN DESIGNATION
QJ
D
D
D
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 OR THI RP. SE
FOR CITY USE ONLY
FEE COMPUTATION
APPLICATION TYPE FEE REQUIRED
TOTAL FEE REQUIRED
DATE FEE PAID
Form 16
RECEIVED
MAR 1 7 2004
CITY OF CARLSBAD
PLANNING DEPT.
DATE STAMP APPLICATION RECEIVED
RECEIVED BY:
RECEIPT NO.
PAGE 2 OF 2
• SUPPLEMENTAL APPLICATION FORM FOR ALL COASTAL
DEVELOPMENT PERMITS
• APPLICATION CHECKLIST FOR SINGLE FAMILY
REGULAR & MINOR COASTAL DEVELOPMENT PERMITS
(Application checklistforNon-Single Family Regu/arCoasta/ DeveIopmentPetmits covered underseparate handout)
This supplemental application is to be filed for any development requiring a Coastal
Development Permit issued by the City of Carlsbad.
I. GENERAL BACKGROUND
A. Estimated Cost of Development:
B.
Form 15
Development costing $60,000 or more does not qualify as a Minor Coastal
Development Permit. The Planning Director shall make the final determination
regarding a proje~t's cost of development.
The primary basis for determining cost of development will be the application of
dollar costs per square foot for different types of residential construction. These
costs are set by the International Conference of Building Officials (leBO) and
are applied throughout San Diego County.
Please complete the following information to assist in the determination of this
project's cost of development (Contractor proposals may also be submitted for
consideration by the Planning Director).
New Residential Square Footage:
G:,. '3 & square feet x $78.00/sq. ft. = $ 4-.,. 7 (-4-.-
Residential Addition Square Footage:
______ square feet x $94.00/sq. ft. = $ ______ _
Any Garage Square Footage:
______ square feet x $22.00/sq. ft. = $ ______ _
Residential Conversion Square Footage:
______ square feet x $26.00/sq. ft. = $ ______ _
For Non-Residential Uses, use the following figures for calculations:
Retail/Store @ $38.00/sq. ft.; Restaurant @ $69.00/ sq. ft.; Office @
$55.00/ sq. ft.; ManufacturinglWarehouse @ $24.00/sq. ft.:
______ square feet x $ Isq. ft. = $ ______ _
COST OF DEVELOPMENT ESTIMATE: $ __________ _
Do you wish to apply for:
1. A Minor Coastal Development Permit (Under $60,000) V
2. A Regular Coastal Development Permit ($60,000 or more) __ _
10/03 Page 1 of8
C. Street address of proposed development
Z 4-\ \ 5\..J~A ~\ .... T~ c\.~"-....... €:..
D. Assessor's Parcel Number of proposed development
\SS'""""2...""2-(.o4-
E. Development Description:
Briefly describe project: ~. "STep=) "5e.c..=~ PLJv~\+4~ Uti' ~
F. Describe the present land uses (i.e. Vacant land, single famil)· homes,
apartments. offices, etc.) that surround the proposed development to the:
North: 'S. E. \2-i (of!!oo..;:r = h,', que:" .... 1 YAc...~-r
South: <;,~. p...
East: -? ·r· ~.
G. Is project located within a 1 ~O-year flood plain? es !)?J No
II. PRESENT USE OF PROPERTY
III.
A. Are there existing structures on the property?
If yes, please describe. e:..x \ <?o \I ~ c...;:r ~t... S \.a "'" c::;\""\ <-<'-'~
[:zJYes D No
B. Will any existing structure be removed/demolished? DYes )Zr No
If yes to either question, describe the extent of the demolition or removal,
including the relocation site, if applicable (also show on plans).
LOT COVERAGE
A. Existing and Proposed
Existing New Proposed Total
Building Coverage I S 'Z. c::::> sq. ft. ~3~ sq. ft. 'Z..\ C; b sq. ft.
Landscaped Area 2:>lo~ sq. ft. c:> sq. ft. B,os sq. ft.
Hardscape Area G::. tS 5"0 sq. ft. 0 sq. ft. '=:> 57 4: 0 sq. ft.
Unimproved Area
l \. (po';-sq. ft. c:;> \ \ ('oS sq. ft. (Left Natural) sq. ft.
Form 15 10/03 Page 2 of 8
8. Parking: Number of existing spaces
Number of new spaces proposed
Existing/Proposed TOTAL:
Number of total spaces required
Number of covered spaces
Number of uncovered spaces
Number of standard spaces
Number of compact spaces
Is tandem parking existing?
Is tandem parking proposed?
e
4-
0
4
3
3
4
0
.!R1Yes# __
DYes# __
C. Grade Alteration:
Is any grading proposed? DYes
If yes, please complete the following:
0 1. Amount of cut ______________ _
0 2. Amount of fill ______________ _
C;:) 3. Maximum height of fill slope _________ _
0 4. Maximum height of cut slope _________ _
0 5. Amount of import or export ________ ---..;;~_
DNo
)K]NO
jEfNO
cu. yds.
cu. yds.
feet
feet
cu. yds.
0 6. Location of borrow or disposal site ______ =-_____ _
Form 15 10/03 Page 30f8
IV. ENVIRONMENTAL REVIEW
Submit Environmental Impact Assessment (EIA) Part I with Regular Coastal
Development Permits; check with Planning Staff regarding Minor Coastal Development
Permits and SingJe Family Regular Coastal Development p~,rmits for any environmental
review requirements.
V. GENERAL APPLICATION REQUIREMENTS
(For Single Family Regular and Minor Coastal Development Permits; Regular
Coastal Development Permits covered under separate handout)
A. Site Plan: Four (4) copies for a Minor Coastal Development Permit, four (4)
copies for a Single Family Regular Coastal Development Permit prepared on a
24" x 36" sheet(s) folded to 9" x 12". The site plan shall include the following
information:
1. General
L
~. 7: ft h.
/
Name and address of applicant, engineer and/or architect, etc.
Location, size and use of all easements. ( L"-' Te ~ E i' : ( •• -~
Dimensions and locations of: access, both pedestrian and vehicular,
showing service areas and points on ingress and egress, off-street
parking and loading areas showing location, number and typical
dimension of spaces, and wheel stops.
Distance between building and/or structures.
Building setbacks (front, rear and sides).
Location, height and materials of walls and fences.
Dimensions/location of signs.
A summary table indicating the following information (if applicable to the
application):
jt) Site acreage
(2) Existing zone and land use
(3) Proposed land use
)A1 Total building coverage 9n Building square footage
j!f) Percent landscaping
(7) Number of parking spaces
~ Square footage of open/recreational space (if applicable)
~ Cubic footage of storage space (if applicable)
Show all applicable Fire Suppression Zones as required by the City's
Landscape Manual.
B. Building elevations (all sides of all buildings) and floor plans: Four (4) copies for
Form 15
a Minor Coastal Development Permit and four (4) copies for a Single
Family Regular Coastal Development Permit, prepared on 24" x 36"
sheets folded to 9" x 12" size. The building and floor plans shall include
the following:
1. Location and size of storage areas (if applicable)
2. All buildings, st'ructure, walls and/or fences, signs and exterior lights.
3. Existing and proposed construction.
4. Provide documentation demonstrating compliance with City Council Policy
44 -Neighborhood Architectural Design Guidelines.
10/03 Page 4 of 8
)
\
~ ---
C.
. (
Grading and Drainage: GrCiding and drainage plans must be included with this
application. In certain areas, an engineering geology report must also be
included. Please consult the City Planning and Engineering Department
representative for a determination on any grading plan geotechnical
requirements if the project is in an overlay zone. The following information shall
be submitted at a minimum:
.:1:'~ Approximate contours at l' intervals for slopes less than 5%; 2' intervals
for slopes between 5% and 10%; and 5' intervals for slopes over 10%
(both existing and proposed). Existing and proposed topographic
contours within 1 ~O' perimeter of the boundaries of the site. Existing
onsite trees; those to be removed and those to be saved.
,,2.. Earthwork volumes; cut, fill, import and export.
3:' Spot elevations at the comers of each pad.
4~ , Method of draining each lot. Include a typical cross section taken parallel
to the frontage for lots with less than standard frontage.
,6. Location, width and/or size of all watercourses and drainage facilities
within and adjacent to the proposed subdivision. Show location and
approximate size of any proposed detention/retention basins.
¢. Clearly show and label 100 year flood line for the before and after
conditions for any project which is within or adjacent to a FEMA flood
plain.
D. Colored Site Plan and Elevation Plan: (Not required with the first submittal) It is
the Applicant's responsibility to bring one (1) copy of a colored site plan and one
(1) copy of a colored elevation to the Planning Department by 12:00 noon, eight
(8) days prior to the Planning Commission meeting. Do not mount exhibits.
VI. REQUIRED DOCUMENTS
A. Land Use Review Application Form
B. Completed Coastal Development Supplemental Application Form
C. Disclosure Statement
D. Completed "Project Description/Explanation" Sheet
E. Title Report (required for sites in Coastal Commission Appeal Area and for
single family residential)
Form 15 10/03 Page 5 ot8
VII. OTHER REQUIREMENTS
A. Property Owners List and Address Labels
NOTE: When the application is tentatively scheduled to be heard by the
decision making body, the project planner will contact the applicant and advise
him to submit the radius map, two (2) sets of the property owners list and
labels. The applicant shall be required to sign a statement certifying that the
information provided represents the latest equalized assessment rolls from the
San Diego County Assessor's Office. The project will NOT go forward until this
information is received.
1. A typewritten list of the names and addresses of all property owners
within a 600' radius of subject property (including the applicant and/or
owner). The list shall include the San Diego County Assessor's parcel
number from the latest assessment rolls.
2. Two (2) separate sets of mailing labels of the property owners within a
600' radius of the subject property. The list must be typed in all
CAPITAL LETTERS, left justified, void of punctuation. For any address
other than single-family residence, an apartment, suite or building
number must be included on a separate line. DO NOT include it on the
street address line. DO NOT TYPE ASSESSOR'S PARCEL NUMBER
ON LABELS. DO NOT provide addressed envelopes -PROVIDE
LABELS ONLY. Acceptable fonts are: Arial 10, Enterprise TM or
Courier NEW (TT) no larger than 11 pt. Sample labels are as follows:
UNACCEPTABLE
Mrs. Jane Smith
123 Magnolia Ave., Apt #3
Carlsbad, CA 92008
UNACCEPTABLE
Mrs. Jane Smith
123 Magnolia Ave.
Apt. #3
Carisbad,CA 92008
ACCEPTABLE
MRS JANE SMITH
APT 3
123 MAGNOLIA AVE
CARLSBAD CA 92008
3. 600' Radius Map: A map to scale not less than 1"=200' showing each
lot within 600' of exterior boundaries of the subject property. Each of
these lots shall be consecutively numbered and correspond with the
property owners list. The scale of the map may be reduced to a scale
acceptable to the Planning Director if the required scale is impractical.
4. 100' Radius Occupants/Address List and Labels (for coastal
zone/COPs only): One (1) list of the occupants/addresses located within
a 100' radius of the project site; and two (2) sets of labels (as described
in "A" above) of the addresses within a 100' radius.
B. Fees and Deposit for Publication of Notices: See Fee Schedule for amount.
VIII. SPECIFIC APPLICATION REQUIREMENTS
(May apply to single family, regular and minor coastal development permits)
Coastal Overlay Zones require additional information to be submitted as follows: (refer
to the Municipal Code for a full description):
A. Coastal Agriculture Overlay Zone
Form 15 10103 Page 6 of 8
,.
8.
1. Refer to the Carlsbad Municipal Code Section 21.202.060 for specific
requirements.
Coastal Resource Protection Overlay Zone
1. Slope analysis/mapping for 25% and greater subject to Section
21.203.040 of the Carlsbad Municipal Code.
2. Topographic and vegetation mapping/analysis subject to Subsection
21.203.040(8)(1) of the Carlsbad Municipal Code, if project is located
along the first row of lots bordering 8uena Vista Lagoon including the
Lagoon mouth.
3. Topographic, drainage and wetland mapping subject to Subsections
21.203.040(8)(2)(a) and (b) of the Carlsbad Municipal Code if located
east of Interstate 5 in the 8atiquitos Lagoon watershed.
4. Drainage study subject to Subsection 21.203.040(8)(3) of the Carlsbad
Municipal Code if project is located west of existing Paseo del Norte,
west of Interstate 5 or along EI Camino Real immediately upstream of
existing storm drains.
5. Geologic report addressing landslides and slope stability subject to
Subsection 21.203.040(8)(4) of the Carlsbad Municipal Code.
6. Geologic report addressing land slides and seismic hazards subject to
Subsection 21.203.040(C) and (D) of the Carlsbad Municipal Code.
C. Coastal Shoreline Development Overlay Zone
1. Geotechnical report subject to 21.204.110 if project is located adjacent to
an existing seabluff edge between the sea and the first public road
parallel to the sea; also may be required by Planning Director if deemed
necessary consistent with Section 21.204.110 of the Carlsbad Municipal
Code.
2. Show all structures and decks on adjacent north and south properties to
perform "stringline" test subject to Subsection 21.204.050(8) of the
Carlsbad Municipal Code.
3. Unless otherwise submitted project in this zone must also be submitted
with plans showing:
a. 80undaries and topography
b. Existing and proposed structures
c. Circulation
d. Drainage
e. Finished topography
f. Landscaping
D. Coastal Resource Overlay Zone Mello I LCP Segment
Form 15
1. Erosion, sedimentation and drainage report subject to Section
21.205.060 of the Carlsbad Municipal Code if project is located in the
8atiquitos Lagoon watershed.
10/03 Page 7 of8
IX. REQUIRED COASTAL PERMIT FINDINGS
Approval of a regular or minor coastal development permit is based on the ability to
make three coastal related findings. These three findings are presented below for your
review and information.
1. That the proposed development is in conformance with the Certified Local
Coastal Program and all applicable policies.
2. That the development is in conformity with the public access and public
recreation policies of Chapter 3 of the Coastal Act.
3. That the development conforms with any applicable decision pertinent to this
proposal and/or site as set by the Coastal Commission on a previously related
appeals decision per Public Resources Code §30604(c).
Form 15 10/03 Page 8 of 8
CITY .CARLSBAD -AFFIDA YIT OF CO::\Ua,:\C£
FOR A SECO:\"D DWELLI:\G Cl\lT
Instructions to Property 0\\11er {Affiant):
Please type or print complete and accurate answers in an blank spaces in Section 1. Please read
carefully. particularly Section II. Please read. sign and date Section III indicatmg that you
understand and agree with the conditions of compliance.
SECTION I -INFORMATION
Property owner(s):
Name(s)
Property Address: Zetll C/~ .
Street Address
C/t4.t.5 (JA'O
City Slate
Assessor Parcel No. I 5"~ Z Z-I 0'"
Subdivision: ~d tit J'rA 6~67tIS I ~il(
Name Lot/Block
Project Number:
SECTION II -CONDITIONS FOR COMPLIANCE
PLEASE READ CAREFULLY
Zip Code
or _-=Z::....Jf'L-9!.-"l...=-,--_
Parcel No.
1. A second dwelling unit is an attached or detached dwelling unit which is located on the same lot as
an existing owner-occupied single-family detached dwelling unit and is:
3.
a. Suitable for use as a complete living facility with provisions within the facility for
cooking, eating, sanitation and sleeping:
b. Occupied by one or more persons: and
c. Subordinate to the main dwelling unit.
The Property O\\ner(s) listed above hereby 'certifies that he/she O\\ns the above referenced
property. as of the date of this affida\it, and to hislher belief and knowledge. there are no
condItions, covenants or restrictions on the property prohibiting a second dwelling umt apartment.
The Property O\,\ner(s) agrees to the follo\\ing terms and conditions:
FR.1\I0006 6/03 PAGE 1 OF2
a.
b.
c.
d.
The propert)"d residence referenced above must naontam a second resIdential
dwelling unit unless it is m comphance with the second dwelling unit provisIOns of the
Zoning Ordinance of the City of Carlsbad.
The Propert)' Owner(s) shall reside in either the main dwelling unit or second d\wllmg
unit described above. now. and for the life of this agreement. unless a lessee leases both
the main dwelling unit and the second dwelling unit.
The Second Dwelling Unit may only be rented and shall not be sold separately from the
main dwelling unit, unless the lot on which such units are located is subdivided.
The Propert)' Owner(s) agree to rent the Second Dwelling Unit at a monthly rental rate
which shall not exceed an amount equal to 30~·o of the gross monthly income of a 10\,\'-
income household, adjusted for household size, at SO% of the San Diego County median
mcome.
e. A copy of this agreement and Affida'it must be given by the Property Owner\s) to
prospective purchasers of the propert)' prior to entering into a sales contract for said
propert)'.
SECTIO~ III -AFFIR'tATIO~ AlXD AGREEMEl\'T
I HEREBY DECLARE fu,\'D AFFIRM, under penalty of perjury, that all maners and facts set forth in this
agreement are true and correct to the best of my knowledge, infonnatlon and belief. and that I (we)
understand, accept and will abide by the regulations. requirements, and standards governing the Second
Dwelling Unit.
Date ( I
BY:
Propert)' Owner Date
Owner's Telephone Number(s): (1M ) '/Jy,57'13 I( 76D ) "l07 -:57<fJ
Home Office
FRM0006 6/03 PAGE10Fl
,
PROJECT NAME:
• •
PROJECT DESCRIPTION/EXPLANATION
2;:;cXV/./4 l
APPLI~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 an addendum sheet if
necessary.
Description/Explanation:
Project Description 10196 Page 1 of 1
• City • of Carlsbad
IRFj,i,ii,i.i·'4·tUai"i4a'
DISCLOSURE STATEl\IENT
Applicant's statement or dIsclosure of certam ownership interests on all applicatIons which will reqUIre
discretIOnary action on the part of the City Councilor any appointed Board. CommIssion or Committee.
The following information l\lUST be disclosed at the tIme of application submittal. Your proJect cannot
be re\'ie\ved until this information is completed. Please prmt.
Note:
Person is defmed as "Any individual, f:inn, 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 combmation acting as a unit."
Agents may sign this document:; however, the legal name and entity of the applicant and property O\\'Iler must be
provided below.
1. APPLICM"'T (Not the applicant's agent)
2.
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 ovming 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-o\vned corporation. include the
names, titles, and addresses of the corporate officers. (A separate page may be attached if
necessary.)
Person LPIhJ :2e,M(/~6, CorplPart'--_--L.~~b'"'-'A'--_-_-_
Title ()t,f/pt:;1'l-Title ______________ _
Address Zo/II dr/avA 145m e,11'L 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 O\\'llership (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 owping more
than 10% of the shares. IF NO INDIVIDUALS OWN MORE mAN 10% OF THE SHARES,
PLEASE INDICATE NON-APPLICABLE (N/A) IN THE SPACE BELOW. If a publicly-
o"'lled corporation, include the names, titles. and addresses of the corporate officers. (A separate
page may be attached if necessary.)
Person LiIlN' a-(k",,vt:..
)
Title aWIf./l;?L-
corplPart. ____ ~~~~~~'__ __________ _
Title _______________ _
Address 2'111 BveR 1/1$171 CIA.. Address, ______________ _
RECEIVED
AI 1'--i ~ 'VVU. vJ £.W"1
1635 Faraday Avenue • Carlsbad. CA 92008-7314. (760) 602-4600 •
• • --..'
3. NON .. PROllT ORGAl\"IZAnON OR TR.UST
If any pe2'i0Zl iden.tifled ~t to (l) or (2) above is I npnmgfit wgpniHtipn or a l1US1. list ttte
names and addresaes of ~ person serving u an officer or director of the non-profit
organization or as ttuatcc or beneficiary of the
Non ProfitITna5t Non ProfitlTrust __________ _
Title ~-----------
Title, ___________________ _
Ad~, ____________ ..... ______ _ ~r~, ______________________ .....
4. Have you had more the S250 worth of blHmest tranucted wsth &ny member of City staff,
Boards, CiiS' Ccmul11ttees and/or Council within the past twelve (12) months'? Dyes . No Ifyes,pleaseindieateperson(s):, ____________ _
NOn:: At1achadditional sheets i!aeceuary.
SignaNtc of owner/appticlIlt's agent if appticabJeJdate
Print or type name of ownerJapplicant's atent
H:Aou..cOUNTlR\DISCLOSUM S'TATIUlNT 518& !'age 2 of 2
ORDER NO. 34351745
EXHIBIT "/t('
Lot 4 of Buena Vista Gardens, in the City of Carlsbad, County of San
Diego, State of California, according to Map thereof No. 2492, filed in
the office of the County Recorder of San Diego County August 4,
1948.
Assessors Parcel No.: 155-221-04
3
POOR
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PROOF OF PUBLIaTION
(2010 & 2011 C.C.P.)
STATE OF CALIFORNIA
County of San Diego
North County Times
Formerly knmvn as the Blade-Citizen and The
Times-Advocate and which newspapers have been
adjudicated newspapers of general circulation by
the Superior Court of the County of San Diego,
State of California, for the City of Oceanside and
the City of Escondido, Court Decree number
171349, for the County of San Diego, that the
notice of which the annexed is a printed copy (set
in type not smaller than nonpariel), has been
published in each regular and entire issue of said
newspaper and not in any supplement thereof on
the following dates, to-wit:
October 07t\ 2004
I certify ( or declare) under penalty of perjury that
the foregoing is true and correct.
Dated at SAN MARCOS California
This 07th Day of October, 2004
Signature
Jane Olson
NORTH COUNTY TIMES
Legal Advertising
This-space ie the County Clerk's Filing Stamp
Proof of Publication of
1 PI' Ii _ 4'
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24-11 E:iJ.G.NA ~lsTA
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RECEIVED
AUG 1 3 2004
CITY OF CARLSBAD
PLANN. G DEPT.