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Home My WebLink AboutV 02-02; Serab Residence; Variance (V)1 * .* - CITY OF CARLSBAD LAND USE REVIEW APPLICATION APPLICATIONS APPLIED FOR: (CHECK BOXES) 1 Administrative Permit - 2nd Dwelling Unit Administrative Variance Coastal Development Permit Conditional Use Permit Condominium Permit Environmental Impact Assessment General Plan Amendment Hillside Development Permit Local Coastal Plan Amendment Master Plan 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 Obtain from Engineering Department Tentative Tract Map Variance Zone Change List other applications not specified (FOR DEPARTMENT 4 V OA-CQ --i I 2) ASSESSOR PARCEL NO(S).: al25-om-7a 3) PROJECT NAME: NCE 4) BRIEF DESCRIPTION OF PROJECT: 5) OWNER NAME (Print or Type) Em4 seem MAILING ADDRESS 3m 5DJ4kS D@sw ‘-WSRhD 43-53 Y*-W CITY AND STATE ZIP TELEPHONE I CERTIFY THAT I AM THE LEGAL OWNER AND THAT ALL THE ABOVE INFORMATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. 6) APPLICANT NAME (Print or Type) 54wG MAILING ADDRESS TELEPHONE CITY AND STATE ZIP I CERTIFY THAT I AM THE LEGAL REPRESENTATIVE OF THE OWNER AND THAT ALL THE ABOVE INFORMATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. S IG N AT U RE DATE 7) BRIEF LEGAL DESCRIPTION NOTE: A PROPOSED PROJECT REQUIRING ONLY ONE APPLICATION BE FILED, MUST BE SUBMITTED PRIOR TO 4:OO P.M. A PROPOSED PROJECT REQUIRING MULTIPLE APPLICATIONS BE FILED, MUST BE SUBMITTED PRIOR TO 3:30 P.M. Form 16 PAGE 1 OF 2 LOCATION OF PROJECT: STREET ADDRESS ON THE I WEST I SIDEOF I TPws DS (NORTH, SOUTH, EAST, WEST) (NAME OF STREET) BETWEEN 7 AND )I (NAME OF STREET) (NAME OF STREET) \JA=mLG sc: \moD .C\ro> -0a) LOCAL FACILITIES MANAGEMENT ZONE PROPOSED NUMBER OF LOTS TYPE OF SUBDIVISION PERCENTAGE OF PROPOSED PROJECT IN OPEN SPACE GROSS SITE ACREAGE rl20) EXISTING ZONING NUMBER OF EXISTING RESIDENTIAL UNITS PROPOSED IND OFFICE/ SQUARE FOOTAGE PROPOSED INCREASE IN ADT EXISTING GENERAL PLAN m PROPOSED ZONING W PROPOSED NUMBER OF RESIDENTIAL UNITS PROPOSED COMM SQUARE FOOTAGE l4 PROPOSED SEWER USAGE IN EDU PRO PO SED GENERAL PLAN DESIGNATION 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. INVE CONSENT TO ENTRY FOR THIS PURPOSE SIGNATURE K FOR CITY USE ONLY FEE COMPUTATION TOTAL FEE REQUIRED I fr \v&b I RECEIVED BY: -wb-bs Form 16 RECEIPT NO. ama r] PAGE 2 OF 2 4 - City of Carlsbad 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 persons having a financial interest in the application. If the applicant includes a corporation or Dartnership, include the names, title, addresses of all individuals owning more than 10% of the shares. IF NO APPLICABLE @/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 fl i /r, < 2 ~24 Corp/Part Title _I ‘4; /2 Title Address 3? C ? - 7PhC-I &a. Address INDIVIDUALS OWN MORE THAN 10% OF THE SHARES, PLEASE INDICATE NON- 2. OWNER (Not the owner’s agent) Provide the COMPLETE, LEGAL names and addresses of 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 comoration or uartnershiu, 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 publiclv- owned cornoration, include the names, titles, and addresses of the corporate officers. (A separate page may be attached if necessary.) Person L! i 1.2 c_ fZ c 4 L: CorpRart Title , L,. , 2) c; ,9 Title Address 3‘3 C: 7 J-6) PI !> 1 2 /? Address 1635 Faraday Avenue - Carlsbad, CA 92008-731 4 - (760) 602-4600 FAX (760) 602-8559 @ - - 3. NON-PROFIT 0. 4NIZATION OR TRUST If any person identified pursuant to (1) or (2) above IS a nonmofit 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 ProfitITrust Non Profit/Trust Title Title Address Address 4. 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? 0 Yes Po If yes, please indicate person(s): NOTE: Attach additional sheets if necessary. I certify that all the @m+mformation is true and correct to the best of my knowledge. _- - /-+ /=-- ?-A%% Signature of owner/date PCd - <@&An Q PA; <;5fzA Ti Print or type name of owner Print or type name of applicant Signature of owner/applicant’s agent if applicable/date ~~ Print or type name of owner/applicant’s agent H:ADMIN\COUNTER\DISCLOSURE STATEMENT 5/98 Page 2 of 2 9 JUSTIFICATION FOR VAR~ANCL P8gtSof5 PROJECT DESCRlPTION/EXPLANATION 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 - - City of Carlsbad 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, I have consulted the Hazardous Wastes and Substances Sites List compiled by the California Environmental Protection Agency and hereby certify that (check one): &e 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. 0 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. Address of Site: 5 /.q/J-) ,LY Local Agency (City and County): Assessor’s book, page, and parcel number: Specify list(s): Regulatory Identification Number: Date of List: - ---- _. - &5-- _-- yay Cd _- - / A- J 4,,p - -c _.- &=- r” 1’ c s4F-L- B“\ , Property Owner Signature/Date Applicant SlgnatureDate AdminlCounteriHazWaste 1635 Faraday Avenue Carlsbad, CA 92008-731 4 (760) 602-4600 - FAX (760) 602-8559 @ City of Carlsbad 1635 Faraday Avenue Carlsbad CA 92008 Applicant: RON SERAB Description v0200002 Amount &rib0 06/05/02 0002 Of 02 1,860.00 CGP 1860 m 00 Receipt Number: ROO27725 Transaction Date: 06/05/2002 Transaction Amount: 1,860.00