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Home My WebLink AboutCP 99-02A; Head Deck Addition; Condo Permit (CP) (3)CITY OF CARLSBAD LAND USE REVIEW APPLICATION 1) APPLICATIONS APPLIED FOR: (CHECK BOXES) (FOR DEPARTMENT USE ONLY) (FOR DEPARTMENT USE ONLY) n D n Administrative Permit - 2nd Dwelling Unit Administrative Variance Coastal Development Permit Conditional Use Permit Condominium Permit Environmental Impact Assessment General Plan Amendment Hillside Development Permit Local Coastal Plan Amendment Master Plan Non-Residential Planned Development Planned Development Permit Planned Industrial Permit Planning Commission Determination D n I I Precise Development Plan I | Redevelopment Permit Site Development Plan Special Use Permit Specific Plan Tentative Parcel Mop Obtain from Engineering Department nn n n I I Tentative Tract Map | I Variance I I Zone Change I I List other applications not specified 2) 3) 4} ASSESSOR PARCEL NO(S).: PROJECT NAME: BRIEF DESCRIPTION OF PROJECT:I*-/'T/3// 5) OWNER NAME (Print or Type) MAILING ADDRESS CITY AND STATE ZIP TELEPHONE 5#fiJ /fl#&S05 Cfr ^72.07^ 7£07M'3t>£7 1 CERTIFY THAT 1 AM THE LEGAL OWNER AND THAT ALL THE ABOVE INFORMATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. SIGNATURE f DATE 6) APPLICANT NAME (Print or Type) jT&wiS MAILING ADDRESS CITY AND STATE ZIP TELEPHONE 1 CERTIFY THAT 1 AM THE LEGAL REPRESENTATIVE OF THE OWNER AND THAT ALL THE ABOVE INFORMATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. SIGNATURE DATE 7) BRIEF LEGAL DESCRIPTION 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 16 PAGE 1 OF 2 8) LOCATION OF PROJECT: (NORTH, SOUTH, EAST, WEST) e> (NAME OF STREET) ON THE BETWEEN 9} LOCAL FACILITIES MANAGEMENT ZONE 10) PROPOSED NUMBER OF LOTS STREET ADDRESS SIDE OF AND 13) TYPE OF SUBDIVISION 16) PERCENTAGE OF PROPOSED PROJECT IN OPEN SPACE 1 9) GROSS SITE ACREAGE 22) EXISTING ZONING 11) NUMBER OF EXISTING RESIDENTIAL UNITS 14) PROPOSED IND OFFICE/ SQUARE FOOTAGE 1 7) PROPOSED INCREASE IN ADT 20) EXISTING GENERAL PLAN 23) PROPOSED ZONING /V9A/3£ (NAME OF STREET) (NAME OF STREET) 1 2) PROPOSED NUMBER OF RESIDENTIAL UNITS 15) PROPOSED COMM SQUARE FOOTAGE 1 8) PROPOSED SEWER USAGE IN EDU 21) PROPOSED GENERAL PLAN DESIGNATION 24) 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 PURPOSErunrvoc /] ST-&&^?( SIGNATURE FOR CITY USE ONLY FEE COMPUTATION APPLICATION TYPE TOTAL FEE REQUIRED FEE REQUIRED DATE STAMP APPLICATION RECEIVED RECEIVED BY: DATE FEE PAID RECEIPT NO. Form 16 PAGE 2 OF 2 City of Carlsbad Planning 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 . 2. 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 publiclv-owned corporation, include the names, titles, and addresses of the corporate officers. (A separate page may be attached if necessary.) Person. Title Corp/Part_ Title Address *t ~7 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 publiclv- owned corporation, include the names, titles, and addresses of the corporate officers. (A separate page may be attached if necessary.) Person Corp/Part_ Title Address Pt 0.Address 1635 Faraday Avenue • Carlsbad, CA 92OO8-7314 • (760) 6O2-4600 • FAX (760) 602-8559 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 Address Address 4. 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 X JSFo If yes, please indicate person(s):. NOTE: Attach additional sheets if necessary. I certify that all the above information is true and correct to the best of my knowledge. Signature of owner/date 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 5/98 Page 2 of 2 PROJECT DESCRIPTION/EXPLANATION PROJECT NAME: &£S I f&M? £ - feu / LD* y/4-fO 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: Project Description 10/96 Page 1 of 1