HomeMy WebLinkAboutPA2022-051_20220303_ApplicationPA2022-051
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 O C®f:1e } ss. I
On I /)1/102.1, , 20 M.-before me, D~K, 0cJ'IW f sp/lJdJq -.
Notary Public, personally appeared ,61 :e.s.s, o P:&"--l e, -, who
proved to me on the basis of satisfactory evidence to be the person(s) whose name(s)@ /are
subscribed to the within instrument and acknowledged to me thatdle/she/they executed the same in
(!)@/her/their authorized capacity(ies), and that by &/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. ► • ~
(I) DAIKI OCHOA ESPINOSAro
1-COMM ... 2360798 o U NOTARY PUBLIC-CALIFORNIA --J
ID ORANGE COUNTY W
My Term Exp. June 11, 2025J
WITNESS my hand and official seal.
~
Signature (seal)
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 ______________________ ,
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.
WITNESS my hand and official seal.
Signature (seal)
PA2022-051
I:\Users\CDD\Shared\Admin\Planning_Division\Current_Templates\Office Use Only Form Updated 01/27/2020
2700-5000 Acct.
Deposit Acct. No. ________________________
For Deposit Account:
Fee Pd: _______________________________________
Receipt No: ____________________________
FOR OFFICE USE ONLY
Date Filed: _______________________
APN No: __________________________
Council District No.: _________________
General Plan Designation: ____________
Zoning District: _____________________
Coastal Zone: Yes No Check #: __________
Visa MC Amex # ____________
CDM Residents Association and Chamber
Community Association(s): _______________________ Development No: __________________________
_____________________________________________ Project No: ________________________________
_____________________________________________ Activity No: _______________________________
Related Permits: ___________________________
Remarks:
________________________________________________________________________________________
PA2022-051