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Home My WebLink AboutCP 89A; Freeman Residential Remodel; Condo Permit (CP)CITY OF CARLSBAD LAND USE REVIEW APPLICATION 1) APPLICATIONS APPLIED FOR: (CH L_J Administrative Permit 1 ] Administrative Variance I | Coastal Development Permit LJ Conditional Use Permit b^l Condominium Permit ^ *»* LJ Environmental Impact Assessment 1 | General Plan Amendment 1 | Hillside Development Permit 1 1 Local Coastal Program Amendment 1 1 Master Plan I 1 Non-Residential Planned Development Ixl Planned Development Permit jT* ECK BOXES) (FOR DEPARTMENT USE ONLY) tip ooDWiC/ 1 1 Planned Industrial Permit 1 ] Planning Commission Determination 1 1 Precise Development Plan LJ Redevelopment Permit |i_J Site Development Plan LJ Special Use Permit LJ Specific Plan | 1 Tentative Parcel Map Obtain from Engineering Department LJ Tentative Tract Map 1 1 Variance LJ Zone Change Lj List other applications not specified . '(FOR DEPARTMENT . .USE ONLY) - 2) 3) 4) ASSESSOR PARCEL NO(S).: PROJECT NAME: Ql| - Q |Q - BRIEF DESCRIPTION OF PROJECT: Siog/r -Cam.'I y QUirk.d remrtde.1 3^ .<^r-^.—f^ -_; - - j Sc, . 5) OWNER NAME (Print or Type) D.GDuCjlas aod De/)'f5C 6) APPLICANT NAME (Print or Type) 13. O&ocjlas (Md Dcn'isc MAILING ADDRESS GameAVta flocc. MAILING ADDRESS CITY AND STATE ZIP TELEPHONE 81-30 CITY AND STATE ZIP TELEPHONE 5^1 «^r30 ":Ko T-^ Us 03 EMAIL ADDRESS:EMAIL ADDRESS: 1 CERTIFY T INFOR M THE LEGAL OWNER AND THAT ALL THE ABOVE TRUE AND CORRECT TO THE BEST OF MY 1 CERTIFY TH OWNER AND C DATE THE LEGAL REPRESENTATIVE OF THE THE ABOVE INFORMATION IS TRUE AND T OF MY KNOWLEDGE. DATE NOTE: A PROPOSED PROJECT REQUIRING MULTIPLE AP; PLICATIONS BE FILED, MUST BE SUBMITTED PRIOR TO 3:30 P.M. A PROPOSED PROJECT REQUIRINQ ONLY ONE APPLICATiQN BE FILED, MUST BE SUBMITTED PRIOR TO 4:00 P.M. c 1 nc c LOCATION OF PROJECT: #4 3, Camilla PiQOL . Gf STREET ADDRESS ON THE BETWEEN Nor fa (NORTH, SOUTH, EAST, WEST) & SIDE OF AND CjQroell i Q (NAME OF STREET) (NAME€»F STREET) 9) LOCAL FACILITIES MANAGEMENT ZONE 10) PROPOSED NUMBER OF LOTS Manolia 13) TYPE OF SUBDIVISION 16) PERCENTAGE OF PROPOSED PROJECT IN OPEN SPACE 19) GROSS SITE ACREAGE 22) EXISTING ZONING 25) 11) NUMBER OF EXISTING RESIDENTIAL UNITS 14) PROPOSED IND OFFICE/ SQUARE FOOTAGE 17) PROPOSED INCREASE INADT 20) EXISTING GENERAL PLAN 23) PROPOSED ZONING (NAME OF STREET) 12) PROPOSED NUMBER OF RESIDENTIAL UNITS 15) PROPOSED COMM SQUARE FOOTAGE 18) PROPOSED SEWER USAGE IN EDU 21) PROPOSED GENERAL PLAN DESIGNATION 24) HABITAT IMPACTS IF YES, ASSIGN HMP # IN THE PROCESS OF REVIEWING THIS APPLICATION IT MAY BE NECESSARY FOR MEMBERS OF CITY STAFF, PLANNpS-QOMMISSIONERS, DESIGN REVIEW BOARD MEMBERS OR CITY COUNCIL MEMBERS TO INSPECTD ENTER THE PROPERTY THAT IS THE SUBJECT OF THIS APPLICATION. I/WE CONSENT URPOSE Src,SI FOR CITY USE ONLY FEE COMPUTATION APPLICATION TYPE FEE REQUIRED RECEIVED AUG 0 3 2005 CITY OF CARLSBAD RECEIVED RECEIVED BY: TOTAL FEE REQUIRED Form 14 Rev. 12/04 PAGE 2 OF 5 r r >Lfru ^ City of Carlsbad 1635 Faraday Avenue Carlsbad CA 92008 Receipt •Illllllllll Applicant: FREEMAN D DOUGLAS & DENISE Description Amount CP00089A 300.73 Receipt Number: R0051773 Transaction ID: R0051773 Transaction Date: 08/03/2005 Pay Type Method Description Amount Payment Check 6464 300.73 Transaction Amount: 300.73 3923 08/03/05 0002 01 02 CGF" 300.73 PROJECT DESCRIPTION/EXPLANATION 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: 363 Sq, addition Project Description 10/96 Page 1 of 1 City of Carlsbad••••—- ••-• J VHHMHnHH>r>l'WB*MMH«*mPlanning Department 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 officers. (A separate page may be attached if necessary.) D.CbuqlciS Ond D&rttt.Kl.Fnbcr'ioi'i ^ ,„ . \Person -* . Corp/Part _ X _~ Title and OS Title Address?1^ Cow*VViQ O 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 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 necessary.) l^.CtouolQS and Cfey>\sc-Is^.:F*T6ejrno^ , Person . Corp/Part \ itle Title \ Address<£L& Comdlb Address. <760) 1602-4600 * FAX (7BO) GOZ-6SS9 NON-PROFIT ORGANIZATION OR TRUST If any person identified pursuant toc^or (2) above is a nonprofit organization or a trust, list the names and addresses of ANY pereon serving as an^office/ or director of the non-profit organization or as trustee or beneficiary otthe. Non Profit/Trust Nop Pr6fit/Trust_ Title Address Have you had more than $250 worth of business transacted with any member of City staff, Boards, Commissions, Committees and/or Council within the past twelve (12) months? Yes No If yes, please indicate person(s):. NOTE: Attach additional sheets if necessary. ertify that-aJI the above information is true and correctio the best ofjjjY_knowledge Signalrfre Sj^ner/date __ D. Do c/ 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 5/98 Page 2 of 2 City of Carlsbad Planning Department HAZARDOUS WASTE AND SUBSTANCES STATEMENT 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 Wastes 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. CD The development project and any alternatives proposed in this application are contained on the lists compiled pursuant to Section 65962.5 of the State Government Code. APPLICANT Name::-Q PROPERTY OWNER Name: O.Cbe/9/OS Qnd Address:Address:Camellia CA Phone Number:C,3o 3 0303 Phone Number:1- Address of Site:Co>oW/>? Q 'Pic*. Local Agency (City and County):C/f- Assessor's book, page, and parcel number: ,_-SpeciEy_list(s): * / £— yv- ^Rpgnlafnry Iripntificgtion Number: Date of List: Property Owner St§cuature/DateApplicant S/qifcature/Crate Admin/Counter>H5zWaste 1635 Faraday Avenue • Carlsbad, CA 92008-7314 • (760) 502-4600 • FAX (760) 602-8559 • www.ci.carlsbad.ca.us The Hazardous Waste and Substances Sites (Cortese List) is a planning document 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. Government Code section 65962.5 requires the California Environmental Protection Agency to develop at least annually an updated Cortese List. Below is a list of agencies that maintain information regarding Hazardous Waste and Substances Sites. Department of Toxic Substances Control www.dtsc.ca.gov/database/calsites Calsites Hotline (916) 323-3400 State Water Resources Control Board www.swrcb.ca.gov/cwphome/lustis County of San Diego Certified Unified Program Agency (CUPA) Mike Dorsey Chief, Hazardous Materials Division Department of Environmental Health Services Hazardous Materials Management Division Mailing address: P.O. Box 129261 San Diego, CA 92112-9261 (619)338-2395 Call Duty Specialist for General Questions at (619) 338-2231 fax: (619) 338-2315 www.co.san-diego.ca.us Integrated Waste Management Board www.ciwmb.ca.gov 916-255-4021 Environmental Protection Agency National Priorities Sites ("Superfund" or "CERCLIS") www.epa.gov/superfund/sites/cursites (800)424-9346 National Priorities List Sites in the United States www.epa.gov/superfund/sites/npl/npl.htm 5/19/03