HomeMy WebLinkAboutPA2022-0200_20220909_ApplicationCommunity Development Department
Planning Permit Application
1. Check Permits Requested:
0 Approval-in-Concept -AIC # 0 Lot Merger
0 Coastal Development Permit O Limited Term Permit -
0 Waiver for De Minimis Development D Seasonal D < 90 day D >90 days
0 Coastal Residential Development O Modification Permit
0 Condominium Conversion O Off-Site Parking Agreement
0 Comprehensive Sign Program O Planned Community Development Plan
0 Development Agreement O Planned Development Permit
0 Development Plan O Site Development Review -O Major D Minor
0 Lot Line Adjustment lil Parcel Map
2. Project Address(es)/Assessor's Parcel No(s)
717 Poinsettia Ave., Corona Del Mar, CA 92625 / 459-073-18
2CfdkF'le<, wk zff!<$2L#
100 Civic Center Drive
Newport Beach, California 92660
949 644-3200
newportbeachca.gov/comm unitydevelopment
0 Staff Approval
□Tract Map
0 Traffic Study
0 Use Permit -□Minor []Conditional
D Amendment to existing Use Permit
D Variance
0 Amendment -jcode I PC I GP I LC
D Other:
3. Project Description and Justification (Attach additional sheets if necessary):
Create a parcel map for condominium purposes.
I 4_ Applicant/Company Name IForkert Engineering & Surveying, Inc.
Suite/Unit ';:I==========::::.'
State ,...._lc_A----;::::=====::__I .....:Z::.:i:!:.P ..:::::1
9=26=46===='.I
M .1. Add 122311 Brookhurst St. Ste. 203 a1 mg ress .
City !Huntington Beach
Phone 1114 963-6793 Fax ~I ----~I Email '-----------~j
5 C t tic N
'
Thomas E. Decker I
. on ac ompanyf.-.!..:!a~m=..:.::.e.=· ==================================::;--------;::===========i"'·
Mailing Address j22311 Brookhurst St. Ste. 203 Suite/Unit ';:12=03=======~'
City jHuntington Beach State lcA J Zip 192646 I
Phone ]114 963-6793 Ext. 244 I Fax ,_ _____ --JI Email ltomd@forkertengineering.com I
6. owner Name .,___LA--;:=2=1=G=, =L=LC==, a=C=a=lii=o=m=ia==L::::im=it=e=d=L=ia=b=il=ity=C=o=rp:::::o=ra=t=io=n====.------;::==:;:::;::;::====t
I I 100 I M .1• Add 26880 Aliso Viejo Pkwy S ·t /U ·t a, mg ress u1 e m ';::============i·
City !Aliso Viejo I . 192656 I
Ph 1949 894-8034 mrosene@ ·husa com ______ J one Fax ~------Email -·
7. Property .6wner'$ Affidavit*:.-'·(I) r,Ne) I Mark Rosene/ Authorized Signer I
depose and· say that (I am) (we are) the owner(s) of the property (ies) involved in this application. (I) (YVe) further
certify, under penalty of perjury, that the foregoing statements and answers herein contained and the infonnation
herewith submitted are in an respec~ true and correct to the best of (my) (our) knowledge and belief.
Title: lOl«...~ ~ · I Date:1.--S--. ,-~-.. -~-z..--1! I •'•it,:
Signature(s): .,_l\,'l,. __..
DD/MONEAR
Signature(s): ______________ Title:~' ---------~'Date:~' ------
*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.
F:\UserslCDD\Shared\Admin\Planning_Di\lisionlApplications\Application_GLidelines\Aanning Pe,mij Application -CDP added.docx Rev: 01/24117
PA2022-0200
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 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
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
(seal)
County of ~a a~e } ss. --i . t-1 ..
On As , ~I t ff' , 20 2'"2..--before me, husabk::}q,<..) >1::1enw "vr¢S
Notary Pu lie, personally appeared Mar K p, ()_--X, (I. I
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 foregoin
paragraph is true and correct.
WITNESS my hand and official seal.
~-A1--, kuv f4<L--si natur~
KA:-HRYN FRANCO KRACS
" ;. l'lotary Public -Ca1ifornia 11_
~: Onnte County s ~ commission:/ 2385493 · ·
• My Comm. ExpirM Dec 6, 2025
(seal)
PA2022-0200
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:
________________________________________________________________________________________