HomeMy WebLinkAboutPA2023-0007_20230109_Discretionary Application Owenrs Affidavit Community Development Department Discretionary Application
Owner’s Affidavit
CITY OF NEWPORT BEACH
100 Civic Center Drive Newport Beach, California 92660 949 644-3200 newportbeachca.gov/communitydevelopment
\\cnb.lcl\data\Users\CDD\Shared\Admin\Planning_Division\Applications\Application_Guidelines\Planning Permit Owner's Affadavit 2022.docx Rev: 07/05/22
1. Check Permits Requested:
Approval-in-Concept - AIC # Lot Merger Staff Approval
Coastal Development Permit Limited Term Permit - Tract Map
Waiver for De Minimis Development Seasonal < 90 day >90 days Traffic Study
Coastal Residential Development Modification Permit Use Permit -Minor Conditional
Condominium Conversion Off-Site Parking Agreement Amendment to existing Use Permit
Comprehensive Sign Program Planned Community Development Plan Variance
Development Agreement Planned Development Permit Amendment -Code PC GP LCP
Development Plan Site Development Review – Major Minor Zoning Clearance - ADU Use
Lot Line Adjustment Parcel Map Other:
2. Project Address(es)/Assessor’s Parcel No(s)
3. Project Description and Justification (Attach additional sheets if necessary):
4. Property Owner’s Affidavit*: (I) (We) depose and say that (I am) (we are) the owner(s) of the property (ies) involved in this application. (I) (We) 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.
Signature(s): ________________________________ Title: Date:
MM/DD/YEAR
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.
3800 E Coast Hwy, Corona Del Mar 92625
Application is for approval of use by tenant (Rainbow Inc.) for use of approximately 395 sq. ft. of
leased area within a multi-tenant commercial property having approximately 11,526 sq. ft. (per tax
assessors information)
Brad Kuish
DocuSign Envelope ID: 1B05862A-5B81-4F18-86A1-C646FD1DE29B
12/30/2022Owner
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:
________________________________________________________________________________________