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HomeMy WebLinkAbout20190522_ApplicationCommunity Development Department Planning Permit Application 1. Check Permits Requested: D Approval-in-Concept -AIC # D Limited Term Permit - Ii] Coastal Residential Development D Seasonal D < 90 day 0>90 days Ii] Condominium Conversion D Modification Permit D Comprehensive Sign Program D Off-Site Parking Agreement D Development Agreement D Planned Community Development Plan D Development Plan D Planned Development Permit D Lot Line Adjustment D Site Development Review - 0 Major O Minor D Lot Merger D Parcel Map 2. Project Address(es)/Assessor's Parcel No(s) js1 s 36thStt APN 4?3-~a1 ~07 ... 100 C,v,c Cent~r Drive Newport Beach, Cailfom,a 92ti6il 949 644-3200 newportbeachca.gov/conimun,tydevelopmi>nt D Staff Approval □Tract Map D Traffic Study D Use Permit -□Minor □Conditional D Amendment to existing Use Permit D Variance 0 Amendment -□Code □PC □GP OLCP D Other: 3 . Project Description and Justification (Attach add itional sheets if necessary): I - !Convert duplex to condominium -----------------------~ 4 . Company\ Applicant ~ck Guo Mailing Address r SO W . Lemon Ave Suite/Unit 1#23 City ~o~rov ia ----------State CA _ _ -J Zip 191016 _ Phone f909 .319 .6888 ---Fax ,-_ I Email lnrj789@gmai l.com =-~----- 5 . Company\Contact ~----------- __ ---.=-=-=-..:::::--__ J __ S_u_i_te,/Unit ;===:==:==:::...._.::....: Mailin g Address . City -;:::==~=--S~t'.ate ~-;:======:::'._....:Z::i!:.p-=======: Phone ,.__ ________ _ I Fax Email '----------------- 6 . OwnerName jJac~Guo -~ ____ _ __ Mailing Address r-ls_o_w ___ L_e_m_o_n_A_v_e ___________ =i Suite/Unit 1#23 C ity !Monrovia _ State jcA --1 Zip ';:::I9=1=0=16=_=====. ~ --1 Phone 1909 .319 .6888 J Fax J Email lnrj789@gma il.com 7. Property Owner's Affidavit*: (I) (We) !Jack Guo 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 infomiation herewith submitted are in all respects true and correct to the best of (my) (our) knowledge and belief. s;gnatu,e(s), ~-Hie, [owne,--~ Date: 1.r-:?_"-=~~<r l . ~ Lrl-/ 7--A fe _____ DD/MO/YEAR , .· . s ~c ~tt-l:--2 C ~ ~L r---------··-· I I 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. F:\Users\CDD\Shared\Admin\Planning_Oivision\Applications\Application_Guidelines\Planning Permit Application -NEW .docx Rev : 02/05115 PA2019--096 F:\Users\PLN\Shared\Staff_Dir\Garciamay\Ruby\desktop\DESKTOP_\CUT_PASTE_DRAG_COPY\Office Use Only.docx Updated 08/15/17 FOR OFFICE USE ONLY\ Date Filed: _______________________ 2700-5000 Acct. APN No: __________________________ Deposit Acct. No. ________________________ Council District No.: _________________ For Deposit Account: General Plan Designation: ____________ Fee Pd: _______________________________________ Zoning District: _____________________ Receipt No: ____________________________ Coastal Zone: Yes No Check #: __________ Visa MC Amex # ____________ CDM Residents Association and Chamber Community Association(s): _______________________ Development No: __________________________ _____________________________________________ Project No: ________________________________ _____________________________________________ Activity No: _______________________________ Related Permits: ___________________________ APPLICATION Approved Denied Tabled: _________________________ ACTION DATE Planning Commission Meeting Zoning Administrator Hearing Community Development Director Remarks: __________________________________________________________________________________________ __________________________________________________________________________________________ APPLICATION WITHDRAWN: Withdrawal Received (Date): ________________________ APPLICATION CLOSED WITHOUT ACTION: Closeout Date: ________________________ Remarks: __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ □ □ □ □ □ □ □ □ □ □ □ □ □ □ PA2019--096 CIVIL CODE§ 1189 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT ~~~~~~~~0ffl~~~~~~~~~~~~~~~~~~~~ A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of Los On JY7 Ir'( :,..o , ?--<> I 1 Date before me, ·P/9-N NZ t'1 ~ ,Yv , Ne t.d/l 7 f? il8 h L- Here Insert Name and Title of the Officer personally appeared ___ J _.ft_c._k. __ 6_t-_t~o ____________________ _ Namef5j' of Signe~ who proved to me on the basis of satisfactory evidence to be the person(sf whose name(8)' is/aro suqscrjbed ..to the within instrument and acknowledged to me that he/s,l;l0t_be1 executed the same in his/tler/tbeir authorized capacity(i~ and that by his/~/t.Pef(signature.(sYon the instrument the person~ or the entity upon behalf of which the person(s)"acted, executed the instrument. Place Notary Seal Above I certify under PENAL TY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature ____ &-+--l ___ /44 __ · --~----- SignU::of Notary Public ---------------oPTIONAL--------------- Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document . 1 t, Ju11 f,i•AJ Title or Type of Document: f)AANN/Nfz pl-£M, rtf Document Date: .S -~ -11 Number of Pages: / 7signer(s) 0th; Than Named Above: ------~-- Capacity(ies) Claimed by Signer(s) Signer's Name: ___________ _ Signer's Name: ____________ _ □ Corporate Officer -Title(s): ______ _ D Corporate Officer -Title(s): ______ _ lJ Partner -□ Limited □ General D Partner -□ Limited □ General [J Individual □ Attorney in Fact □ Individual □ Attorney in Fact 0 Trustee □ Guardian or Conservator D Trustee D Guardian or Conservator D Other: _____________ _ □ Other: _____________ _ Signer Is Representing: ________ _ Signer Is Representing: ________ _ .~~--~~~~-. ~~ ~ ©2014 National Notary Association• www.NationalNotary.org • 1-800-US NOTARY (1-800-876-6827) Item #5907 PA2019--096