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HomeMy WebLinkAboutPA2023-0048_20230221_Planning Permit Owners AffCommunity Development Department Discretionary Application Owner's Affidavit 1. Check Permits Requested: D Approval-in-Concept -AIC # D Coastal Development Permit D Waiver for De Minimis Development D Coastal Residential Development D ·condominium Conversion D Comprehensive Sign Program D Development Agreement D Development Plan D Lot Merger D Limited Term Permit - D Seasonal D < 90 day 0>90 days D Modification Permit D Off-Site Parking Agreement D Planned Community Development Plan D Planned Development Permit D Site Development Review - D Major D Minor D Lot Line Adjustment D Parcel Map 2. Project Address(es)/Assessor's Parcel No(s) 1458-301-08 100 Civic Center Drive Newport Beach, California 92660 949 644-3200 newportbeachca.gov/communitydevelopment D Staff Approval D Tract Map D Traffic Study Ii] Use Permit -li!Minor □Conditional D Amendment to existing Use Permit D Variance 0 Amendment -□Code □PC □GP □LCP D Zoning Clearance -□ADU D Use D Other: 3. Project Description and Justification (Attach additional sheets if necessary): Request for approval to allow a Type 20 Off-Sale Beer & Wine license and Type 86 Instructional Tasting license for to be added to the existing retail operations of Roger's Gardens and finding of Public Convenience or Necessity ("PCN") 4. Property Owner's Affidavit*: (I) (We) I RG Realty, LLC, Gavin Herbert, Jr., President =1 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): L~✓-&----~ Ch ' Title: I President . I Date: f_;J_ ' Gt , ~'3 I f I MM/DD/YEAR Signature(s): _______________ Title: '----------------'i Date: '------I J .,.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"