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HomeMy WebLinkAboutPA2023-0125_20230725_Notarized Parcel Map ApplicationCommunity Development Department Discretionary Application Owner's Affidavit 1. Check Permits Requested: D Approval-in-Concept -AIC # ii Coastal Development Permit D Waiver for De Mlnimis 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 ii Parcel Map 2. Project Address(es)/Assessor's Parcel No(s) 2596 Crestview Dr (049-183-27) and 2592 Arbor Dr (049-183-28) 1 OD Civic Center Drive Newport Beach, California 92660 949 644-3200 newporlbeachca.gov/communitydevelopment D Staff Approval D Tract Map D Traffic Study D Use Permit -□Minor □Conditional D 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): Adjust single lot line for lot deviation. 2 existing lots and 2 proposed lots 4. Property Owner's Affidavit*: (I) (We) LI B_r_ia_n_&_R_o_c_io_G_ril_e_y _______________ ___J 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 I respects true and correct to the best of (my) (our) knowledge and belief. Signature(s): "'"'-"'-,L!...J"""'+---------Title: I ()ccki\<? (( I Date: LiJ I 2-/ 2-> MM/DD/YEAR Signature(s): .::::::-:±_~~~'_'G~:._. -=-==£~~~"--Title: I {) cJ"'-0/_ "May be signed by the ssee or by an authorized agent i ritten authorization from the owner of the record is filed concurrently with the application. Please note, the owner(s)' signature for Paree 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 doffars ($250) made within the preceding 12 months by the party or the party's agent to any elected or appointed officer of the City. ff you have made a qualifying contribution, please ensure to make this disclosure on the record. Please review Senate Biff 1439 -Statues 2022 for further information" \lcnb./cl\dala\Users\CDD\Shared\Admin\Planning_Division\Appllcations\ApplicaUon_Guidelines\Planning Permit Owner's Affadavit 2022.docx Rev: 01124123 INDIVIDUAL ACKNOWLEDGMENT lllillill@lli!l!ll,§l!OO}fl!lllll@E--'8--8'll!OOl ___ _ State/Commonwealth of --::[_1).j'.\ t\; 0 County of ___ t\-'--','"""O=o"'-\t<~c'.=Xl~O,.,,~\~· ----- On this the 'd\ day of _ __:31""· ,_:Vv~A-"Vi+------~ _ _;,,[2:_,:,o"-'a-"'-'3""'---~• before me, Nlonth Year Day ----'M'-'-,\'OJ=Y_,OJ"""'Q__,""--'\ __ ------',,--''n'-'"'o~m-'-'""°'"""-L_,<c·--------~· the undersigned Notary Public. \ Name of Notary Public personally appeared _!:J_+"O'"-'C,,"-\,_()=------=~='\J'('-\,_\,_~'==+--'00'.)""'--"c\=---J:)~'f,_,_\ ~=-'--g--'---r--'1--'\-~_'"'l--1---~ 'Name(s) of Signer(s) \ - Mardel Thomas COMM.# 55323 NOTARY PUBLIC STATE OF IDAHO MY COMM. EXP. 11104/2027 Place Notary Seal/Stamp Above □ personally known to me -OR -~ 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 for the purposes therein stated. WITNESS my hand and official seal. ._/Y\r\ ~ ~Yv\ 9-vCl \ Signature of Notary Pubik" Any Other Required Information (Printed Name of Notary. Expiration Date. etc.) ---------------OPTIONAL--------------- This section is required for notarizations performed in Arizona but is optional in other states. Completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document (»)'(\~·~d '-\- Title or Type of Document: V \ S C.,Y e:\-1 c5V\CL '\q fs;\\)l I c:__a3 \ ~Y"\ Q.\j 1 Document Date: :::::TGv\u \?-, d-O;;;L=:i Number of Pages: __ __c\ ___ _ I Slgner(s) Other Than Named Above: ______________________ _ >l-g'8!ll®llill$ilill$8'1llll®mll~. -------------------llll>m ©2020 National Notary Association