HomeMy WebLinkAbout20190410_ApplicationCommunity,,_Qevelopment Department
PlanninQ ~ermit Application
1. Check Permits Requested:
D Approval-in-Concept -AIC # D Lot Merger
Iii Coastal Development Permit D Limited Term Permit-
□ Waiver for De Minim is Development D Seasonal D < 90 day 0>90 days
D Coastal Residential Development D Modification Permit
D Condominium Conversion D Off-Site Parking Agreement
D Comprehensive Sign Program D Planned Community Development Plan
D Development Agreement D Planned Development Permit
cifftfll{t)~IJ l.?M
· AJ 100 Civic Center Drive flv, ,, Newport Beach, California 92660
949 644-3200
newportbeachca.gov/communitydevelopment
D Staff Approval
D Tract Map
D Traffic Study
D Use Permit-OMinor □Conditional
D Amendment to existing Use Permit
D Variance
D Development Plan D Site Development Review -D Major D Minor
0 Amendment -□Code □PC □GP □LCP
D Other:
D Lot Line Adjustment Iii Parcel Map
2. Project Address(es)/Assessor's Parcel No(s)
3. Project Description and Justification (Attach additional sheets if necessary):
New single family residence to be 2734 s.f. Living and 464 Garage.
4. Applicant/Company Name Jsrand0 ~ .A.~?hitects Jj
Mail h1g ~cidrE:ls~ -l
1
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5
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~K~~l~r11~~s~·· ·~~v~e~· · ~~~~~~~~~~~~=======::---__ S_u_i ...... te/Unit .... 1 . .,...G-:::::..~
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City jcosta ~esa State j CA !zip ~lg~2e_.2_e~~~~'
Phone 171~.754A040 Fax ],... ........... _ ......... _____ I ~mail l1nf?@brandonarchitects.com I
5. ContacVCompany Name jca1tlin Smi th j
Mailing ~dcirE:lSS =b_5
_
1
~K~al_m_u~s~~v_e~·. ~~~~~~~~~~~~========-'"'--S_u_i_te/Unit ....... I_G:::.~
1-:::::..:::.-::.-::.-:::::.::::::::::::.=~I
City jcosta Mesa State lcA I Zlp'--lg_2e_2~e-----~'
Phone 171~-!5~.40~0 Fax -1-----.............. , Email kaitlin~~r~~~~~ar~~it~~ts.cor11 I
6. Owner Name !south B~yfront \f\/~terpoint~, ~~~-I
Mailing Address 1
61 O Newport Center dr. Suite/Unit '---1_
8-9_0_._. ::.-:::..======:::I
City !Newport Beach State ..... ,C_A _______ I Zip 1~2660 I
Phone 19~9·644·89?? Fax J_ ........................................................... , Email I
7. Property Owner's Affidavit*: (I) r,Ne) ~~~-~~~~-~~~~~~~-~~~~-~
depose and say that (I am) (we are) the owner(s) of the property (ies) involved in this application. (I) r,Ne) further
certify, under penalty of perjury, that the foregoing statements and answers herein contained and the information
herewith submitted are in all respects true and correct to the best of (my) ( our) knowledge and belief.
Signatu~s::::::.~======----Title: l~ .. I Date: 11/~JJolR .• ~
Signature(s): ______________ Title:=' ~~~~=~~~~I Date: =j ~~~~~~'
*May be signed by the lessee or by an authorized agent if written authorization from the owner of record is filed concurrently with the
application. Please note, the owner(s)' signature for Parcel/Tract Map and Lot Line Adjustment Application must be notarized.
ACKNOWLEDGMENT
A notary public or other officer completing this
certificate verifies only the identity of the individual who
signed the document to which this certificate is
attached, and not the truthfulness, accuracy, or validity
of that document.
State of California
County of _________ ~ ss.
On ___________ 20 __ before me, _____________ ,
Notary Public, personally appeared _____________________ , who
proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are
subscribed to the within instrument and acknowledged to me that he/she/they executed the same in
his/her/their aut~orized capacity(ies), and that by his/her/their signatures(s) on the instrument the
person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
I certify under PENAL TY OF PERJURY under the laws of the State of California that the foregoing
paragraph is true and correct.
WITNESS my hand and official seal.
Signature
ACKNOWLEDGMENT
A notary public or other officer completing this
certificate verifies only the identity of the individual who
signed the document to which this certificate is
attached, and not the truthfulness, accuracy, or validity
of that document.
State of C~rnia / / ,,,-;----• co~ o>y;'J. e:-t } ss. ( 1 ~ebrPra.lJ .!).es .:J ~01 S' On r, 0/ , 20 before e, ,
Notary Public, personally appeared (54-.rr'IC/~ 3la.cc e • '.
proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are
subscribed to the within instrument and acknowledged to me that he/she/they executed the same in
his/her/their authorized capacity(ies), and that by his/her/their signatures(s) on the instrument the
person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
I certify under PENAL TY OF PERJURY under the laws of the State of California that the foregoing
paragraph is true and correct.
(seal)
F:\Users\PLN\Shared\Staff_Dir\Garciamay\Ruby\desktop\DESKTOP_\CUT_PASTE_DRAG_COPY\Office Use Only.docx
Updated 08/15/17
FOR OFFICE USE ONLY\
Date Filed: _______________________ 2700-5000 Acct.
APN No: __________________________ Deposit Acct. No. ________________________
Council District No.: _________________ For Deposit Account:
General Plan Designation: ____________ Fee Pd: _______________________________________
Zoning District: _____________________ Receipt No: ____________________________
Coastal Zone: Yes No Check #: __________
Visa MC Amex # ____________
CDM Residents Association and Chamber
Community Association(s): _______________________ Development No: __________________________
_____________________________________________ Project No: ________________________________
_____________________________________________ Activity No: _______________________________
Related Permits: ___________________________
APPLICATION Approved Denied Tabled: _________________________
ACTION DATE
Planning Commission Meeting
Zoning Administrator Hearing
Community Development Director
Remarks:
__________________________________________________________________________________________
__________________________________________________________________________________________
APPLICATION WITHDRAWN: Withdrawal Received (Date): ________________________
APPLICATION CLOSED WITHOUT ACTION: Closeout Date: ________________________
Remarks:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________