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Home My WebLink AboutPUD 91-05E; Engeseth Addition; Planned Unit Development - Non-Residential (PUD) (5)CITY OF CARLSBAD LAND USE REVIEW APPLICATION1)APPLICATIONS APPLIED FOR: (CHECK BOXES) (FOR DEPT. USE ONLY) | I Administrative Permit C I — I — Administrative Variance Coastal Development Permit Conditional Use Permit Condominium Permit Environmental Impact Assessment General Plan Amendment Habitat Management Plan Permit Hillside Development Permit Local Coastal Program Amendment Master Plan Minor Conditional Use Permit Non-Residential Planned Development |£y Planned Development Permit Jto*fi6KY*4<h I I Planned Industrial Permit Planning Commission Determination | | Precise Development Plan I | Redevelopment Permit I | Site Development Plan | I Special Use Permit I I Specific Plan | I Tentative Parcel Map Obtain from Engineering Department I | Tentative Tract Map Variance I I Zone Change I | List other applications not specified (FOR DEPT. USE ONLY) f ttO fl-05® 2) 3) ASSESSOR PARCEL NO(S).: PROJECT NAME: BRIEF DESCRIPTION OF PROJECT: ^- ^6f ;x 5) OWNER NAME (Printpr Type)6) APPLICANT NAME (Print or Type) MAILINODDRESS MAILING ADDRESSP.O. CITY AND STATE ZIF TELEPHONE CITY AND STATE ZIP TELEPHONE EMAIL ADDRESS:EMAIL ADDRESS: 1 CERTIFY THAT 1 AM THE LEGAL OWNER AND THAT ALL THE ABOVE INFORMATION IS TRUE ANDORRECT TO THE BEST OF MY 1 CERTIFY THAT 1 AM THE LEGAL REPRESENTATIVE OF THE OWNER AND THAT ALL THE ABOVE INFORMATION IS TRUE AND CORBECT TOnHBfiEST OF MY KNOWLEDGE. SIGNATURE DATE DATE NOTE: A PROPOSED PROJECT REQUIRING MULfTIPLEiAPPLICATIONS BE FILED, MUST feEiUBMITTED PRIOR TO 3:30 P.M. A PROPOSED PROJECT REQUIRING ONLY ONE APPLICATION BE 'FILED, MUST BE^UBMRTWD 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 BETWEEN (NORTH, SOUTH, EAST, WEST) (NAME OF STREET) SIDE OF AND (NAME OF STRBET) AI^IE'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) NOTICE OF RESTRICTION: PROPERTY OWNER ACKNOWLEDGES AND CONSENTS TO A NOTICE OF RESTRICTION BEING RECORDED ON THE TITLE TO HIS PROPERTY IF CONDITIONED FOR THE APPLICANT. .NOTICE OE-RESTRICTIONS RUN WITH THE LAND AND BIND ANY SUCCESSORS IN INTEREST. FOR CITY USE ONLY RECEIVED AUG 0 6 ?^n CITY OF CARLSBAD PLANNING DEPT DATE STAMP APPLICATION RECEIVED RECEIVED BY: Form 14 Rev. 03/08 PAGE 2 OF 4 RECEIVED City of 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 "Anyr individual, Jrm, co-^artnership/joihtventure, association, social club, fraternal organization, corporation, estate, trust, receiver, syndicate, in (his and any other county, city and county, city municipality, district or other political subdivision or any other group or combination acting as' ajjnit." ' •. ' 'r J " , v *" " , i - '' * , 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 publicly-owned corporation^ include the names, titles, and addresses of the corporate officers. (A separate page may be attached if necessary.) Person Title_ Corp/Part R Title & Address Address p. 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 publiciv-owned corporation, include the names, titles, and addresses of the corporate officers. (A separate page may be attached if necessary.) , / ^~<7. f. *r -£^'^7 ^e. Corp/Part TitleTitle Address ^ 7 Address 1635 Faraday Avenue • Carlsbad, CA 92008-7314 • (760) 602-4600 • FAX (760) 602-8559 • wvww.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 AjslY 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 $500 worth of business transacted with any member of City staff, Boards, Commissions, Committees and/or Council within the past twelve (12) months? J Yes IXI No If yes, please indicate person(s):_ NOTE: Attach additional sheets if necessary. I certify that aJUtae above information is true and correct to the best of my knowledge Signature of owner/date ,.Sigature of applicanWJa Print or type name Print or type name of applica/ft Signaiure of owner/a/piicant's agent if applicable/date Print or type name of owner/applicant's agent H:ADMIN\COUNTER\D1SCLOSURE STATEMENT 12/06 Page 2 of 2 (ECE1VED A.UG 0 8 20Q8 CITY OF CARLSBAD PLANNING DEPT 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 65962.5,1 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. (~1 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: B- A. PROPERTY OWNER f Name: Address:_/>X Address: Phone Number:"725^Phone Number:.. Address of Site: Local Agency (City and County): Assessor's book, page, and parcel number: Specify Hst(s>: A/ ./I . "2- ~ "T / Regulatory Identification Number:, Date of List: Applicant Signature/Date Admin/Counler/HazWasicI \ Property Owner Signature/Dai City of Carlsbad 1635 Faraday Avenue Carlsbad CA 92008 Applicant: B.A. WORTHING INC Description PUD9105E 6747 BARBERRY PL CBAD Amount 346.72 Receipt Number: R0071290 Transaction Date: 08/06/2008 Transaction ID: R0071290 Pay Type Method Description Amount Payment Credit Crd VISA 346.72 Transaction Amount: 346.72 City of Carlsbad Faraday Center Faraday Cashiering 001 0821901-1 08/06/2008 75 Wed Aug06,2008 10:30 AM PERMITS - PERMITS $346.72 Tran Nbr: 082190101 0023 0024 Trans/Rcpt#: R0071290 SET #: PUD9105E 1 ITEM(S): TOTAL: $346.72 Credit Card (Auth# 037281) $346.72 Total Received: $346.72 Have a nice day! **************CUSTOMER COPY************* 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: Project Description 10/96 Page 1 of 1