HomeMy WebLinkAboutPA2023-0112_20230531_Social Pies applicationCommunity Development Department
Discretionary Application
Owner's Affidavit
1. Check Permits Requested:
D Approval-in-Concept -AIC # D Lot Merger
D Coastal Development Permit D Limited Term Permit -
D Waiver for De Minimis Development D Seasonal D < 90 day 0>90 days
D Coastal Residential Development D Modification Permit
D Condominium Conversion D Off-Site Parking Agreement
D Comprehensive Sign Program D Planned Community Development Plan
D Development Agreement D Planned Development Permit
□ D Site Development Review -Development Plan □ Major □ Minor
0 Lot Line Adjustment D Parcel Map
2. Project Address(es)/Assessor's Parcel No(s)
i 106 Main St., Newport Beach, CA 92661 APN -048-132-07
CITY OF NEWPORT BEACH
100 Civic Center Drive
Newport Beach, California 92660
949 644-3200
newportbeachca.gov/communitydevelopment
D Staff Approval
D Tract Map
D Traffic Study
D Use Permit -lilMinor □Conditional
Iii Amendment to existing Use Permit
D Variance
□ Amendment -□Code □PC □GP □LCP
D Zoning Clearance -□ADU D Use
D Other:
3. Project Description and Justification (Attach additional sheets if necessary):
Modification to an existing use permit for the construction of a bar top and the addition of permissieve
sale of a full line of alcoholic beverages.
4. Property Owner's Affidavit*: (I) (We) '-'I /_rJ_6_~_'i_ll,,___..>}._-J-.._l _l _C ____________ ___.
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): ~e-u, f-) & '4-/ZTitle: ~I _/Jll_lAl_~-~~~--~I Date: I !>-(~I )... :? ~ 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 Parcelffract 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"
\\cnb.lcl\data\Users\CDD\Shared\Admin\Plannino Division\Aoolications\Aoolication Guidelines\Plannino Permit Ownefs Affadavit 2022.docx Rev: 01/24/23