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Home My WebLink AboutPIP 04-05; VENTANA REAL LOT 3; Planned Industrial Permit (PIP)• • CITY OF CARLSBAD LAND USE REVIEW APPLICATION 1) APPLICATIONS APPLIED FOR: (CHECK BOXES) (FOR DEPARTMENT (FOR DEPARTMENT D USE ONLY) rzf RrPOqaJ> Administrative Permit Planned Industrial Permit D D Administrative Variance Planning Commission Determination D Coastal Development Permit D Precise Development Plan D Conditional Use Permit D Redevelopment Permit D 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 +eRt:at:ive PaFeel Ma13 Obtain from Engineering Department D Local Coastal Program D Tentative Tract Map Amendment D Master Plan D Variance D Non-Residential Planned D Zone Change Development D Planned Development Permit D List other applications not specified 2) 3) 4) ASSESSOR PARCEL NO{S).: f.,/2 -OZ() -Z77 PROJECT NAME: BRIEF DESCRIPTION OF PROJECT: 5) OWNER NAME (Print or Type) I CERTIFY THAT I AM THE LEGAL OWNER AND THAT ALL THE ABOVE INFORMJ.:\TION IS TRUE AND CORRECT TO THE BEST OF MY KNO E. 7" 1.r-,1 DATE 7) BRIEF LEGAL DESCRIPTION 6) APPLICANT NAME (Print or Type) MAILING 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. 04/04 I· I ! PAGE 1 OF 6 1' I • • 8) LOCATION OF PROJECT: STREET ADDRESS SIDE OF I ~k CAt1l~? OF~ ON THE (NORTH, SOUTH, EAST, WEST) (NAME OF STREET) AND .._I _fi.......,~~c..,/OA.,.,,,~---==-==-----1 (NAME OF STREET) BETWEEN 9) LOCAL FACILITIES MANAGEMENT ZONE ? 10) PROPOSED NUMBER OF LOTS ~( 11) NUMBER OF EXISTING '-112) PROPOSED NUMBER OF '-I ~ RESIDENTIAL UNITS LQ_j RESIDENTIAL UNITS LQ__j 13) TYPE OF SUBDIVISION ~14) PROPOSED IND OFFICE/~15) PROPOSED COMM ~ SQUARE FOOTAGE SQUARE FOOTAGE 16) PERCENT AGE OF PROPOSED ~17) PROPOSED INCREASE IN D 18) PROPOSED SEWER D PROJECT IN OPEN SPACE ADT USAGE IN EDU 19) GROSS SITE ACREAGE j4,q1120) EXISTING GENERAL ~ 21) PROPOSED GENERAL ~ PLAN PLAN DESIGNATION 22) EXISTING ZONING ~23) PROPOSED ZONING ~ 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 INSP. CT AND ENTER THE PROPERTY THAT IS THE SUBJECT OF THIS APPLICATION. I/WE CONSENT TO E FO THI PURPOSE FOR CITY USE ONL V FEE COMPUTATION APPLICATION TYPE FEE REQUIRED t I TOTAL FEE REQUIRED Farm 14 Rev, 04/04 D JUL 2 8 2004 CITY OF CARLSBAD Dftl1f)JJ~f\A.GtJwS?:,N RECEIVED PAGE 2 OF 6 • PROJECT DESCRIPTION/EXPLANATION PROJECT NAME: V~AM, ~ APPLICANT NAME: \/~f..AAa E7ea Q J:ltM:k?A , LLL 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: ~ ft--ort~ pYo}A:-f t~ .fur-~ (I) ·fwo 4vl l)fh~ biirttf~. '11At? a.er' ( lAhU\"l f '7 betfA] %1:; l1,t f t-f.ed (M f .~ f~ f'e fJ" I ~t\ ~ ~u'_ UJ 11e, ~ pr O reLI-( 0 c-c..h VY1 Project Description 10/96 Page 1 of 1 • City1 of Carlsbad IQ@i,1,11 ,i·l•J§.g;u;,t§,ii 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 definc1d as "Any individual, firm, co-partnership, joint venture, association, social club, fraternal organization, corporation, estate, trust, receiver, syndicate, in this ahd 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 sigh 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.) Person'Ve:t,,baie,, f.<ecQ 1Uta4J&i ,-UL,, Corp/Part __________ _ Title 0tJJAL6f!. Title ____________ _ Address #!;% fzlaa~ &,.e 4 too 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 necessary.) Person ~ aJzovt: Corp/Part __________ _ Title ___________ _ Title _____________ _ Address _________ _ Address ____________ _ 1635 Faraday Avenue• Carlsbad, CA 92008-7314 • (760) 602-4600 • FAX (760) 602-8559 • www.ci.carlsbad.ca.us @ • 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 $250 worth of business transacted with any member of City staff, Boards, Commissions, Committees and/or Council within the past twelve (12) months? D Yes IS] No If yes, please indicate person(s): ___________ _ NOTE: Attach additional sheets if necessary. I certify that all the above information is true and correct to the best of my knowledge. Sig H:ADMIN\COUNTER\DISCLOSURE STATEMENT 5/98 Page 2 of 2 Cit}' of Carlsbad I :.1 EID O hf· I •l4 •tau; ,id ,ii HAZARDOUS WASTE AND SUBSTANCES STATEMENT Consultation Of Lists of Sites Related To Hazardous Wastes (Certification of Compliance with Government Code Section 65962.5) Pursuant to State of California Government Code Section 65962.5, I have consulted the Hazardous Wastes and Substances Sites List compiled by the California Environmental Protection Agency and hereby certify that (check one): ~ The development project and any alternatives proposed in this application are not contained on the lists compiled pursuant to Section 65962.5 of the State Government Code. D The development project and any alternatives proposed in this application ~ contained on the lists compiled pursuant to Section 65962.5 of the State Government Code. APPLICANT Name: VdihaAAa. ~ J11MfeA, UL Address: fS::Vi ~' Ave <Sle, I DO Ca.I$~ , CA · 12008::> Phone Number: (7(;p(J7 <a,7-4ZBZ ~ (O 7 Address of Site: NVf" :(ef: M'51bAJEl2 PROPERTY OWNER Name: ____________ _ Address:. ___________ _ Phone Number: _________ _ Local Agency (City and County):_C.,,___~...u='--"--"-'fz~· _,_f?A:J~c..r:12'------------------ Assessor's book, page, and parcel number: lOf F fif .{Z&Ad,6 Ha;{ fCSiqtfa, btc.p 82'3, ,Zl''l..,..020--2:;, Specify list(s): _____________________________ _ Regulatory Identification Number: ______________________ _ Date of List: _____________________________ _ Property Owner Signature/Date 1635 Faraday Avenue• Carlsbad, CA 92008-7314 • (760) 602-4600 • FAX (760) 602-8559 • www.ci.carlsbad.ca.us @ City of Carlsbad 1635 Faraday Avenue Carlsbad CA 92008 Applicant: VENTANA REAL MASTER LLC Description Amount PIP04005 3,060.00 Receipt Number: R0044028 Transaction Date: 07/28/2004 Pay Type Method Description Amount Payment Check 52075 3,060.00 Transaction Amount: 3,060.00 7580 07/28 .. lOir 0002 O.l c::Gr:u C 0 t/t:IIJHI/A /Z.Mt. 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