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Home My WebLink AboutSDP 15-23; NORTH COAST MEDICAL PLAZA - 1ST EXTENSION; Site Development Plan (SDP)Ccityof Carlsbad LAND USE REVIEW APPLICATION P-1 Development Services Planning Division 1635 Faraday Avenue (760) 602-4610 www.carlsbadca.gov APPLICATIONS APPLIED FOR: (CHECK BOXES) Development Permits ~ Coa'lt_;tl.J;)evelopmenl Permit I.,,--6 )(7~ ~IO;-/ D Conditional Use Permit D Minor ~: D Minor D Extension D Day Care (Large) D Environmental Impact Assessment D Habitat Management Permit D Hillside Development Permit D Minor D Minor D Nonconforming Construction Permit 0 Planned Development Permit D Minor D Residential D Non-Residential D Planning Commission Determination D Reasonable Accommodation 4-site ~elopment Plan D Minor /51 ~J<76/VSION FOlf-'. D Special Use Permit D Tentative Parcel Map (Minor Subdivision) D Tentative Tract Map (Major Subdivision) D Variance D Minor (FOR DEPT. USE ONLY) Legislative Permits (fif ti,4-3 $Vt' 1~2-~ D General Plan Amendment D Local Coastal Program Amendment D Master Plan D Specific Plan D Zone Change OAmendment OAmendmenl D Zone Code Amendment South Carlsbad Coastal Review Area Permits D Review Permit D Administrative D Minor D Major Village Review Area Permits D Review Permit D Administrative D Minor D Major (FOR DEPT. USE ONLY) EJ NOTE: A PROPOSED PROJECT REQUIRING APPLICATION SUBMITTAL MUST BE SUBMITTED BY APPOINTMENT*. PLEASE CONTACT THE APPOINTMENT SPECIALIST AT (760) 602-2723 TO SCHEDULE AN APPOINTMENT. *SAME DAY APPOINTMENTS ARE NOT AVAILABLE ASSESSOR PARCEL NO(S): LOCATION OF PROJECT: NAME OF PROJECT: BRIEF DESCRIPTION OF PROJECT: PROJECT VALUE (SITE IMPROVEMENTS) FOR CITY USE ONLY £~ 5·+ 0£ /.Jrdb/ //..2 //'{2 '&ocl<d ;5°.A,{ ..,.j" fA@,, (STREET AD RESS) Nor"{A o,2s+ Medrca I r l..2~.J ESTIMATED COMPLETION DATE Development No. ~\/ lC;O\'J Lead Case No. Cr.AM ~.::oe,.cJ...,~is P-1 Page 1 of 6 ~~( !o,t' ':iifo f~) Revised 03117 OWNER NAME INDIVIDUAL NAME (if applicable): COMPANY NAME C (PLEASE PRINT) .-.,j . ..,...._ n,..,,"' " ,· LL" (if applicable): l • r::>1 ~ , ;, '- MAILING ADDRESS:~$ q3 l,_lj//ow/l"lq.re. L~ CITY, STATE, ZIP: s 2./'J \) ,e,o, C-,A 92-13,t:> TELEPHONE Ssfi.~t,B. rs>3. EMAIL ADDRESS -f-,-,._,,42 :6;;.zho-i_, _ MT APPLICANT NAME INDIVIDUAL NAME (if applicable): COMPANY NAME (if applicable): (PLEASE PRINT) MAILINGADDRESS: 5S~$ {,(Jt/)tJU/~rll 4:iti(:. CITY.STATE.ZIP $2.AI D,eeo,o,q.A 9V3o TELEPHONE: e, 5 ~-~ 6 ~, 13 J3 EMAILADDRESS: -t;;/1-?@ fv.zt,g:1.J ,/\,!,+ I CERTIFY THAT I AM THE LEGAL REPRESENTATIVE OF THE OWNER AND THAT ALL THE ABOVE INFORMATION IS TRUE AND CORRECT TO THE~LED SIGNATURE APPLICANT'S REPRESENTATIVE (Print): --~E=-Lr_,f__:C"'---'-M__,...,v"",v"'-'-"o'-'-i>5-______________ _ MAILINGADDRESS: ~/ S'2.. L,cns6ead Ave CITY.STATE.ZIP: C.1~lsba.d, '-1l,.D/0 TELEPHONE: 3:<eO, ~92. EMAIL ADDRESS: I CERTIFY THAT I AM THE REPRESENTATIVE OF THE APPLICANT FOR PURPOSES OF THIS APPLICATION AND THAT ALL THE ABOVE INFORMATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. E-M-< M~~ SIGNATURE : 1-. '5vl'1 '201!3 DATE IN THE PROCESS OF REVIEWING THIS APPLICATION IT MAY BE NECESSARY FOR MEMBERS OF CITY STAFF, PLANNING COMMISSIONERS OR CITY COUNCIL MEMBERS TO INSPECT AND ENTER THE PROPERTY THAT IS THE SUBJECT OF THIS APPLICATION. I/WE CONSENT TO ENTRY FOR THIS PURPOSE. NOTICE OF RESTRICTION: PROPERTY OWNER ACKNOWLEDGES AND CONSENTS TO A NOTICE OF RESTRICTION BEING RECORDED ON THE TITLE TO HIS PROPERTY IF CONDITIONED FOR THE APPLICANT. NOTICE OF RESTRICTIONS RUN WITH THE LAND AND BIND ANY SUCCESSORS IN INTEREST. PROPERTY OWNER SIGNATURE FOR CITY USE ONLY JUL O 2 2018 CITY c Cn: . '.'.D Plc·.;_,\i 1-.,, ~ DiV\·~_,.C:,N , ., "' "'. "~--- DATE STAMP APPLICATION RECEIVED RECEIVED BY: P-1 Page 2 of 6 Revised 03/17 {"city of Carlsbad PROJECT DESCRIPTION P-1(B) Development Services Planning Division 1635 Faraday Avenue (760) 602-4610 www.carlsbadca.gov PROJECT NAME: £.r.-f<1,,i"f,-Q1 2>+ SvP 15,2.3/c.,~p, s,t13 N "l""f /i a, .:l$' +- /Vl<L...J1 ca.-/ P I 2 5'~\ APPLICANT NAME: /r/1-'1 f-/o,J;} 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: £. x+<01 s-,1>11 r~, wst cf" s1> P ts.;~~ I c_ l>f rs. 'f3 iµA,c/2. A:JS Q,,>(71re+'On cl~-+~ ~ :Jvl( 41 2-Vt'b P-1(8) Page 1 of 1 Revised 07/10 {"city of Carlsbad DISCLOSURE STATEMENT P-1(A) Development Services Planning Division 1635 Faraday Avenue (760) 602-4610 www.carlsbadca.gov 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, titles, 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___________ Corp/Part ___________ _ Title ___________ _ Title _____________ _ Address __________ _ Address ____________ _ 2. OWNER (Not the owner's agent) P-1(A) 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, titles, 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~ Corp/Part,>S;;.cJ7..I ,t.. ,!..c_ Title ,~~ Titlet?~ ,t,?..4#~/,1/C., /l'j;,_,q..8~,e_ Address,5563 111(£-J e,pµ/11 ,t/14 L.M(ddress __________ _ ,<£!,./ J2LV..Q c:7A--"[217:/2 Page 1 of 2 Revised 07/10 C 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 $500 worth of business transacted with any member of City staff, Boards, Commissions, Committees and/or Council within the past twelve (12) months? D Yes ~o If yes, please indicate person(s): ___________ _ NOTE: Attach additional sheets if necessary. I certify that all zove information is true and correct to the best of my knowledge. ~ ~ s;go,to,e of appU~oUdate ~rd,,,,~ Print or type namefof owner Print or type name of applicant ~;vi~ Signature of owner/applic Print or type name of owner/applicant's agent P-1(A) Page 2 of 2 Revised 07/10 {"city of Carlsbad HAZARDOUS WASTE AND SUBSTANCES STATEMENT P-1(C) Development Services Planning Division 1635 Faraday Avenue (760) 602-4610 www.carlsbadca.gov 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 Waste 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 l!!!! contained on the lists compiled pursuant to Section 65962.5 of the State Government Code. APPLICANT PROPERTY OWNER Name: Ti-M /.Joa':) Name: _________ _ Address: '? '7 53, lu,'( /°'-<.1/Yl<t!~ Laa, Address: ________ _ S.:w Ui'e:1), CA 9.}..13,0 Phone Number: B 5 'B, ~ 8 <£>, ( 3 3 3 Phone Number: _________ _ Address of Site: ____________________________ _ Local Agency (City and County): G-:b, v£ C&-ls ful c....., 11 J' s~ °'':To Assessor's book, page, and parcel number: 2.f2 · DyD-~7-; '2.f'2,.' D yO,<t:>'[ Specify list(s): __ ____,tf-=-"-(A.,.:_ ___ ~------------------- A/ ( .A Regulatory Identification Number: _ _:_/_---------------------- Date of List: N (A. Ap Property 0 The Hazardous Waste and Substances Sites List (Cortese List) is used by the State, local agencies and developers to comply with the California Environmental Quality Act requirements in providing information about the location of hazardous materials release sites. P-1(C) Page 1 of 2 Revised 02/13