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Home My WebLink AboutPUD 92-01G; Shaffer Residence; Planned Unit Development - Non-Residential (PUD) (4)CITY OF CARLSBAD LAND USE REVIEW APPLICATION 1) APPLICATIONS APPLIED FOR: (CHECKBOXES) 12' Administrative Permit Administrative Variance Coastal Development Permit Conditional Use Permit Condominium Permit Environmental Impact Assessment General Plan Amendment Hillside Development Permit Local Coastal Program Amendment Master Plan Minor Conditional Use Permit Non-Residential Planned Development Planned Development Permit (FOR DEPARTMENT USE ONLY) Planned Industrial Permit Planning Commission Determination Precise Development Plan Redevelopment Permit Site Development Plan Special Use Permit Specific Plan Tentative Parcel Map Obtain from Engineering Department Tentative Tract Map Variance Zone Change List other applications not specified (FOR DEPARTMENT USE ONLY) 2) ASSESSOR PARCEL NO(S).: 3) PROJECT NAME: £MM -^o 63 '0 O fe&_ 4) BRIEF DESCRIPTION OF PROJECT: 5) OWNER NAME (Print or Type)6) APPLICANT NAME (Print or Type) MAILING ADDRESS MAILINT3 ADDRESS CITY AND STATE ZIP TELEPHONE CITY AND STATE ZIP TELEPHONE EMAIL ADDRESS:EMAIL ADDRESS: I CERTIFY THAT I AM THE LEGAL RH3«£SENTATIVE OF THE OWNER AND THAT/ALL THE ABOVE INFORMATION IS TRUE AND CORRECT TO TH£T0eWOF MY KNOWLEDGE. I CERTIFY JHAT I A INFORMATION E LEGAL OWNER AND THAT ALL THE ABOVE CORRECT TO THE BEST OF MY DATE DATE 7) BRIEF LEGAufeeSCRIPTION 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. 01/07 PAGE 1 OF 5 I '8) LOCATION OF PROJECT:5X ON THE BETWEEN (NORTH, SOUTH, EAST, WEST) STREET ADDRESS SIDE OF AND (NAME OF STREET) (NAME OF STREET) 9) LOCAL FACILITIES MANAGEMENT ZONE 10) PROPOSED NUMBER OF LOTS 13) TYPE OF SUBDIVISION 11) NUMBER OF EXISTING RESIDENTIAL UNITS 16) PERCENTAGE OF PROPOSED PROJECT IN OPEN SPACE 19) GROSS SITE ACREAGE 22) EXISTING ZONING 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 # 25) 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. 26) PROPERTY OWNER ACKNOWLEDGES AND CONSENTS TO A NOTICE OF RESTRICTION FILED ON THE PROPERTY TITLE IF CONDITIONED FOR THE APPLICANT. CERTAIN APPROVALS (SUCH AS A CONDITIONAL USE PERMIT) RUNUVmlfTB$ LAND AJ^ BIND ANY SUCCESSORS IN INTEREST. FOR CITY USE ONLY FEE COMPUTATION APPLICATION TYPE FHvTOjp OF :CEIVED RECEIVED BY: TOTAL FEE REQUIRED Form 14 Rev. 01/07 PAGE 2 OF I City of Carlsbad Farada1/ Center Faraaay Cashiering 001 071-1501-3 1.^/25/200; 11 Fr-, May25,20u7 02:Ob PM PERMITS - PERMITS $321.64 Iran Mbr; 071450103 0008 0011 Trans/Rcpt#: R006461b SET /?: DUD9201G 1 HEM(S): TOTAL: $321.64 Chew (Chk# 0000003690; $321.64 Total Received. $321.64 Have a nine day! * ^CUSTOMER COPY************* City of Carlsbad 1635 Faraday Avenue Carlsbad CA 92008 Ckr/ s S, Applicant: SHAFFER WILLIAM Description PUD9201G 6712 WHITESAIL ST CBAD Amount 321.64 Receipt Number: R0064615 Transaction Date: 05/25/2007 Transaction ID: R0064615 Pay Type Method Description Amount Payment Check 9690 321.64 Transaction Amount: 321.64 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. 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.) Corp/PartPerson_ Title Title Address 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.) 1635 Faraday Avenue • Carlsbad, CA 92008-7314 • (760) 602-4600 • FAX (760) 602-8559 • www.ci.carlsbad.ca.us J-'l 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, Title Non Profit/Trust, 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? Yes o If yes, please indicate person(s):_ NOTE: Attach additional sheets if necessary. certify that all the above information is true and correct to the best of my knowledge Signature ofapplicgn^aate Print or type name of owner Print or type name of applicant Sigfiatureof owner/aopflidant's agemif applicable/date Print or type name of owner/applicant's agent H:ADMIN\COUNTER\DISCLOSURE STATEMENT 12/06 Page 2 of 2 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: RECEIVED CITY OF CARLSBAD PLANNING DEPT Project Description 10/96 Page 1 of 1