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HomeMy WebLinkAboutRP 04-04A; Roosevelt Garden Condominiums; Redevelopment Permits (RP)CITY OF CARLSBAD LAND USE REVIEW APPLICATION 1) APPLICATIONS APPLIED FOR: (CHECK BOXES) (FOR DEPARTMENT USE ONLY) (FOR DEPARTMENT USE ONLY) • Administrative Permit - 2nd Dwelling Unit • Planned Industrial Permit • Administrative Variance • Planning Commission Determination • Coastal Development Permit • Precise Development Plan • Conditional Use Permit Redevelopment Permit • Condominium Permit • Site Development Plan • Environmental Impact Assessment • Special Use Permit • General Plan Amendment • Specific Plan • Hillside Development Permit • Tentative Parcel Map Obtain from Engineering Department • Local Coastal Plan Amendment E] Tentative Tract Map • Master Plan • Variance • Non-Residential Planned Development • Zone Change • Planned Development Permit • List other applications not specified 2) ASSESSOR PARCEL NO(S).: 3) PROJECT NAME: <l00 S«^V^S*UT Qf\{l\?(ShJS COA/Po/HlA//0'n/jS 5) OWNER NAME (Print or Type) MAILING ADDRESS MAILING ADDRESS /0'2'Z'Z S'/f/v/ pev£G<5 /WtSS»<JA/ /?OA?P CITY AND STATE ZIP TELEPHONE CITY AND STATE ZIP TELEPHONE 1 CERTIFY THAT 1 AM THE LEGAL OWNER AND THAT ALL THE ABOVE INFORMATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. 1 CERTIFY THAT 1 AM THE LEGAL REPRESENTATIVE OF THE ©WNEH AND THAT ALL THE ABOVE INFORMATION IS TRUE AND ytORRECT TO THE BEST QF MY KNOWLEDGE. SIGNATURE DATE SIGNATORE DATE 6) APPLICANT NAME (Print or Type) 7) BRIEF LEGAL DESCRIPTION To TH€ 'n\^MNl^sof= AJO./72.7. Ft^\^ /^J rH>S oFF«Ctr of TH^ COQA/TV g.ge^a:bi 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 Rev. 05/03 PAGE 1 OF 2 8) LOCATION OF PROJECT: ON THE BETWEEN STREET ADDRESS SIDE OF (NORTH, SOUTH, EAST, WEST) AND (NAME OF STREET) 9) LOCAL FACILITIES MANAGEMENT ZONE 10) PROPOSED NUMBER OF LOTS 13) TYPE OF SUBDIVISION 16) PERCENTAGE OF PROPOSED PROJECT IN OPEN SPACE 19) GROSS SITE ACREAGE 22) EXISTING ZONING JC.5S- Vd 11) NUMBER OF EXISTING RESIDENTIAL UNITS 14) PROPOSED IND OFFICE/ SQUARE FOOTAGE 17) PROPOSED INCREASE IN ADT 20) EXISTING GENERAL PLAN 23) PROPOSED ZONING v/L (NAME OF STREET) (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 n 0 Vi/L 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. l/WE CONSENT TO ENTRY FOR ™S PURPOSE SIGNATURE FOR CITY USE ONLY FEE COMPUTATION APPLICATION TYPE TOTAL FEE REQUIRED FEE REQUIRED 4 \^^S + 110x^(6 CCO y V % % 020 J DATE STAM AU3 2006 CITYOFCARLSBAD CEIVED RECEIVED BY: 0. Foonr\a\f\ DATE FEE PAID RECEIPT NO. PAf^F P OF P Citv of Carlsbad Housing & Redevelopment Department DISCLOSURE STATEMENT Applicant's statement or disclosure of certain ownership interests on aU appUcations 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 conpleted. Please print. Note: Person is defined as "Any individual, firm, co-partnership, joint venture, association, social club, fratemai organization, corporation, estate, trust, receiver, syndicate, in this and any other county, city and county, city municipality, district or other political subdivision or any oth^ group or combination acting as a unit." Agents may sign this document; however, the legal name and entity of the applicant and property ovmer must be provided below. 1. APPLICANT OSIot the applicant's agenO Provide the COMPLETE, LEGAL names and addresses of ALL persons having a financial interest in the application. If Uie applicant includes a corporation or partnership, include the names, tide, addresses of all individuals owning more than 10% of the shares. IF NO INDIVn^UALS 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 A Title Address Corp/Part SAtJ-p^^^g H^^^T^^ Po^ /iv/^^A/>n; iiOC. Title Address /Oi-ti. S^isj Puf /vt rs<>/f3A/ ^o/^-P 2. OWNER (Not the owner's agem) 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 INDrVK)UALS 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 Address Corp/Part C^^t3g>49 (ZseV(f\/i^o^/uf<sh)T /?GtSNXlV Title Address ^^65" rt^ostf •cgt.r STTtvfgr, S u«^ 2965 Roosevelt St., Ste. B • Carlsbad, CA 92008-2389 • (760) 434-2810/2811 • FAX (760) 720-2037 ^ NON-PROFrr 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 3/<io DUTOQ H4gtT>^ft>/T hOAiAiit^rr', tuc Title Tide Address Address/OZ'Z.'Z :5/f/v PUJ-GQ n«>3S/QAi r2o/?p ^f\t\i Vti£ao, df^ 91-108 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? n Yes [X] No If yes, please indicate person(s):. NOTE: Attach additional sheets if necessary. I certify that all the above information is tme 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 appUcant •S/l-rJ Pit?GO H^^iT'tr Fo/t HUiM/^hlxTi", /AJC Signature of owner/applicant's agent if appUcable/date Print or type name of owner/applicant's agent H:ADMIN\COUNTER\DISCLOSURE STATEMENT 5/98 Page 2 Of 2 Habitat for Humanity Finally, enclosed is a check (# 333249) made payable to the City of Carlsbad in the amount of $9,580.00 for fees as follows: Major Redevelopment Permit Amendment Fee $ 1,205.00 Notice Fee $ 345.00 CT Fee $8,030.00 Please call if there are any questions. Sincerely. Cheryl Keenan Executive Director Enclosures