HomeMy WebLinkAboutPA2023-0063_20230315_Discretionary Owner's ApplicationCommunity 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: 01/24/23
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 herewithsubmitted 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 the 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.
“Under the Levine Act, Section 84308 of the Government Code, a party to a proceeding before the City involving a license,
permit, or other entitlement for use is required to disclose on the record of the proceeding any contribution in an amount of more than two hundred fifty dollars ($250) made within the preceding 12 months by the party or the party’s agent to any
elected or appointed officer of the City. If you have made a qualifying contribution, please ensure to make this disclosure on the record. Please review Senate Bill 1439 - Statues 2022 for further information”