HomeMy WebLinkAboutRP 98-13; Carlsbad Family Medicine; Redevelopment Permits (RP)CARLSBAD REDEVELOPMENT AGENO^
ADMINISTRA1||p PERMIT APPLICATION & DISCLO(JRE STATEMENT
1. APPLICATION APPUED FOR: (CHECK BOXES) '
• New Construction of building(s) or addition(s) to the building footprint which have a building
permit valuation which is equal to or less than $60,000.
^ Interior or Exterior Improvements to existing structures which result in an intensity of use.
ST Provisional Land Uses, where a minor or major redevelopment permit is not required.
• Changes in permitted land uses which result in site changes, increased ADT, increased parking
requirements, or result in compatibility issues/problems.
S Signs for existing businesses or facilities.
• Repair or Maintenance Activities which are not exempt from obtaining a permit.
2. LOCATION OF PROJECT
Address: 3Q5Q Madison Avenue—Carlsbad, CA 92008
Bordering Streets:
North: carlsbad Village Drive
South: Oak Avenue
East: Jefferson Avenue
West: -Rnn.spvplt Avmie
Assessor Parcel No.: 203-351-03
Legal Description: Mctfejal FdulllL?
^^ccov^lr>c^ -Vo -yw^LoC rsos. ^sg^^ ar^A ^^{nk \W
Within Coastal Zone:
Within Appealable Area of Coastal Zone:
Land Use District within Village:
•
Yes
Yes
^ 1
• 4
• 7
•
•
•
• No
No
• 3
• 6
• 9
ADMINISTRA
CARLSBAD REDEVELOPMENT AGENCY
1^ PERMIT APPLICATION & DISCLO^p E STATEMENT
3. DESCRIPTION OF PROJECT
Project Name: Carlsbad Family Medicine
Please provide a complete description of the project proposed for approval under this application. Provide
any details necessary to adequately explain the scope and/or operation of the proposed project. You may
attach additional pages to this application if necessary to explain the project:
The proposed project will provide medical care to include family
practice, pediatrics, geriatrics and gynecoly. The projected number
of visits per year is 8,000 approximately 666 per month, 30 per day
The Staffing will comprise of one pediatrician and one family practice
physician who will work seperate shifts of 6hours each. Sam to 2pm and
2pm to Spm. Each shift will provide ^wo support staff for each
physician (a register nurse/ medical assistant and receptionist)
The 8,000 yearly visits are projected to be reached in a year or
year and a half.
I TVS
4 AUTHORIZATION TO INSPECT PROPERTY
In the process of reviewing this application it may be necessary for members of City Staff, Design Review
Board Members, or City Council members to inspect and enter the property that is the subject of this
application. 1/we consent to entry onto the subject property for this purpose.
Name: Irma Cota Date: 12/08/98
Signature: Applicant @ or Owner •
MENTAL HEAITH SERVICES FAX NO. biS b^2 bbb4 .^{OV-15-98 SUN 12:5? AM
APMINISTRATI^EffMlf APPUCATION 4 PiSCLOSjy STATIEMENT
r. 0
5. PROPERTY OWNER INFORMATION/CERTIFICATION
Mailing AHrirA«»i- 9/>
Daytimt Telephona No.: fAI<f) rr/ - g//r
List tha Namea and Addresses of all parsons having an ownership Interest In the property Involved:
-i^jg*^ _—
11 any person identified above is a oorporation or partnership, list the names and addresses of ali
Individuals owning more than 10% of the shares In the oorporation or owning any partnership Interest in
the partnership:
if any person identified above is a non-profit organization or a trust, list the names and addresses of any
person sen/ing as an officer or director of the non-profit organization or as tnjstee or beneficiary of the
I trust:
m ^ —
Have you had more than $260 worth of business transacted wHh any member of City Slaff, Boj^f •
Comrrtssions. Committees, and/or Council within the past twelve (12) months? • Yes BT^o
Ifyes, please indicate person(s):
|Cftrtif|(aatl9n $tatfnrwnt:
I Certify that I am the Legal Owner of the subject property for this application and JJ^^I^j'.^^^^^^^
Z^r^\^\9. true and correct to the best of my knowiedge. This application Is submitted with my consent
aTdTfgree t^^^^^^^^^ P^a^eS on the subiect property, including use of
buildings, as a result of approval of this application.
Signature.
"/
CARLSBAD REDEVELOPMENT AGEUgY
ADMINISTRA'lll^ PERMIT APPLICATION & DISCLdJ^RE STATEMENT
6. APPLICANT INFORMATION/CERTIFICATION (y\\ ccrrefeponAtrict Vo'.
IANVCVO.
Name: North County Health Service Otgo>tvs«k / Cc^y\^b<^j^ V^<^UV^ Cowley
Mailing Address: valpreda Fd Oceo^&.cb^ CiK ^lOS^^
San Marcos, CA 92069
Daytime Telephone No.: 760-736-6700
List the Names and Addresses of all persons having a financial interest in the application:
NONE
If any person identified above is a corporation or partnership, list the names and addresses of all
individuals owning more than 10% of the shares in the corporation or owning any partnership interest in
the partnership:
NQNE
If any person identified above is a non-profit 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
trust: j3-j^a Cota, Executive Director 150 Valpreda Rd San Marcos, CA 92069
Vince Andrade Chairman 8S7Quail HillAve. San Marcos, Ca 92069
Rebecca Pollastrini Treasurer 8849 Stargaze Ave. San Diego 92129
Mary Summers Vice Chaii-man 26738 Morro Hill Rd Fallbrook, CA 92082
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? "1 Yes C^No
If yes, please indicate person(s): .
Certification Statement:
Certify that I am the Legal Owner's representative and that all of the above information is true and
correct to the best of my knowledge. I have been authorized by the legal owner of the subject property to
submit this application and I agree to accept and abide by any conditions placed on the subject property,
including use of buildings, as a result of approvai of this application.
Siqnature .==^^-1^:^^^^^^^^^ (Zf^f^^:^ Date: l2/nR/Q«
•
RP 98-13/CDP 98-83 - Carlsbao|||^mily Medicine - Land Use Change to^ al Treatment Office
complete*by&«f«^^^^^^?^^^^
7. RECEIPT OF APPLICATION
Date Application Received: 12/9/98
Application Received bv: Lori Rosenstein. Redevelopment
Permit No. Assigned; RP 98-13/CDP 98-83
8. FEES FOR APPLICATION PROCESSING
The following fees shall apply to this application; list type of fee and amount:
$260.00 - Administrative Redevelopment Permit
$500.00 - Noticing Fee
Total Fee(s) required for this application: $760.00
Date Fee(s) collected by City Staff: 12/9/98
Receipt No.: 58957
9. ACTION ON THE APPLICATION
The following action has been taken by the Housing and Redevelopment Director on this application:
Approved subject to conformance with plans submitted as part of application, dated l/l^h^.
\Z Approved, with conditions. See conditions noted below.
• Denied. Reason
Housing and Redevelopment Director Signature: CD Director Initials: Date:
10. FINDINGS AND CONDITIONS OF APPROVAL (IF APPLICABLE) Page 1 of 2
The following findings have been made in order to approve the Administrative Redevelopment
Permit for a change in land use to medical treatment office:
1. The use is compatible with the land use district and adjacent development.
2. The use will not adversely affect retail intensity or retail continuity in the Village.
3. Adequate parking exists to serve the needs of this use.
4. The project is exempt from the requirements of the California Environmental Quality Act (CEQA)
per Section 15061 b.3 of the State CEQA Guidelines and will not have an adverse significant
impact on the environment.
Page 2 of 2
The following conditions haye been approved for the subject project:
1. This approved permit serves as the required redevelopment permit and coastal development
permit for the subject project approving a change in land use to a medical treatment office.
2. The project shall be completed according to, and be consistent with, the plans approved by the
Housing and Redevelopment Director on the date noted above. The approved plans have been
stamped by the Housing and Redevelopment Director and indicate the approval date of 1/12/99.
3. No construction shall take place until required building permits are issued. Compliance with
Uniform Building Code standards shall be reviewed by the Building Department during plan
check.
4. As part of the building permit process, the disabled parking space shall be properly striped and
required signage shall be installed to the satisfaction of the Building Department.
5. The access ramp adjacent to the disabled parking space shall meet current American Disabilities
Act (ADA) requirements for accessibility.
6. The use shall be operated in a manner that is consistent with the project description provided by
the applicant and contained within this approved permit. Any changes to the operations of the
subject facility or provision of intended services shall require prior written approval by the
Housing and Redevelopment Director. Certain changes to the proposed use may require an
amendment to the approved permit.
7. The applicant shall ensure that all clients waiting for services are accommodated within the
interior of the building.
8. The applicant shall pay any additionai fees as may be required through the building permit
process.
1^00 CARLSBAD VILLAGE DR.
CARLSBAD. CA 92008
(619) 434-2882
CITY OF CARLSBADf^
APPLICATION FOR BUSINESS LICENSE
MINIMUIVI LICENSE
IS $30.00
(fee schedule on reverse)
PLEASE CHECK THIS BOX IF, .
BUSINESS ADDRESS 3050 MADISON STREET
(No. P.O. Boxes) (Number) (Street) (Suite No.)
f^ART..qRAn r.A Q9nnR
(City) (State) (Zip Code)
MAILING ADDRESS 150 VALPREDA ROAD
(if different) (Number) (Street) (Suite No.)
SAN MARCOS CA 92069
(City) (State) (Zip Code)
EMERGENCY PHONE ( 7^n) BUSINESS PHONE
TYPE OF ORGANIZATION: (Check one) DATE BUSINESS STARTED IN CARLSBAD
SOLE PROPRIETORSHIP PARTNERSHIP CORPORATION K
APPLICANT NAME/ADDRESS (OWNER: IF PARTNERSHIP/CORP. GIVE NAMES OF PARTNERS OR CORP. OFFICERS)
(TITLE)
BOARD CHAIR
(TITLE)
VICE CHAIR
(TITLE)
TREASURER
(NAME)
Vincent Andrade
(NAME)
Mary Summers
(NAME)
Rebecca Pollastrini
(ADDRESS)
150 Valpreda Rd.
(ADDRESS)
150 Valpreda Rd.
(ADDRESS)
150 Valpreda Rd.
(CITY/STATE) (ZIP)
San Marcos CA 92069
(CITY/STATE) (ZIP)
San Marcos CA 92069
(CITY/STATE) (ZIP)
San Marcos CA 92069
(PHONE)
(760) 736-6700
(PHONE)
(760)736-6700
(PHONE)
(760) 736-6700
TYPE OF BUSINESS DOCTOR"S OFFICE
(PLEASE BE SPECIFIC)
PROVIDE THE FOLLOWING WHERE APPLICABLE:
95-7R47102
CA DRIVERS LICENSE
STATE SALES TAX NUMBER
STATE CONTRACTOR
LICENSE NUMBER
CLASS
FEDERAL TAX I.D. NUMBER
D-0676146
STATE EMPLOYER
IDENTIFICATION NUMBER
SOCIAL SECURITY NUMBER
NUMBER
GROSS RECEIPJS LICENSE
GROSS RECEIPTS y<Z
TAX RATE (per eacX$fo6o)
SUB TOTAL
BASE FEE / +
SUBTOTAL
PENALTY (25% -i^'^Vo per
day not to exceed'^oVo)
TOTAL
FLAT FEE LICENSE
AMOUNT
ADDITIONAL TRUCKS @ 3/5 EA
PENALTY (25% + 1% per
day not to exceed 50%)
TOTAL:
MAKE CHECKS PAYABL&^t<5i. CITY OF CARL66AD AND RETURN WITH APPLICATION
$'io. on
$50.00
EXECUTED THIS__2_2_ DAY OF Orfribpr , 19 98 • I. Tr-^a Tnte
(Day) (Month) (Year) (Print full name)
DECURE UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.
Executive Director
SIGNATURE TITLE
OFFICE USE ONLY
License # SIC#
Date Issued Ordinance
Expiration Date Restrictions
R.-.cinp,.- N^mP ^UNTY HEALTH PROJEDT.INC,
Business Addres.*; 3050 MADISON STREET • CARLSBAD CA 92008
APPLICATION FOR BUSINESS LICENSE
SUPPLEMENTAL FORM
This Business License Application does not authorize you to conduct business. You will be notified by the Finance
Department when your application is approved and you will be furnished a Business License Number at that time.
1. If this is a Home-Based Business, please complete a Home-Based Busines Form, which can be acquired
from the Business License Clerk.
2. Check the Redevelopment Map on the wall. If you intend to operate a business within this area, you may
need a Redeveiopment Permit. Please see a Planner at the Development Processing Counter or call Redevelop-
ment at 434-2811.
3. If you are planning to change or install a sign for your business, Contact Development Processing Services
at 438-1161.
4. ' What is the total square footage that your business occupies? 1»250
5. Will this business involve any of the following?
NO NO Wood Working? fLr Hazardous Processes?
Warehouse? NO Flammable Liquids? NO
Painting? HD
6. Type of Business: Wholesale Retail Consignment . . Service
7. Previous Use of site (Please be specific) Profeasloaal Faycholbglcal Services
8. Number of Employees (Include Self)
9. Will there be sale of alcoholic beverages
If Yes: On Sale Off Sale
Beer/Wine '. Liquor
10. Landlord/Property Owner: NORTH COUNTY HEALTH PROJECT, INC.
(Commercial Locations Only)
Address 1'iO VAT.PRRDA ROAD - SAN MARCOS CA ^2069
OFFICE USE ONLY
X Denied Date \ • ZS -^^ By V^A^^. Approved
Comments PILV^\ v\i).s<) ^WA\ W ofig-Yo^ecy \vr> cvccorc\(irNce Vx:^i\W
\
WHITE: Finance GREEN: Plannmg CANARY: Redevelopment PINK: Building GOLD: Fire (