HomeMy WebLinkAbout20210204_ApplicationDocuSign Envelope ID: A4BD8C77-CD66-42B2-83FA-D9704D563553"'ommunny ueve1opment Department
Planning Permit Application
1. Check Permits Requested:
D Approval-in-Concept -AIC # D Lot Merger
D Coastal Development Permit D Limited Term Permit -
D Waiver for De Minim is 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 Development Plan D Site Development Review -D Major D Minor
D Lot Line Adjustment D Parcel Map
2. Project Address(es)/Assessor's Parcel No(s)
13211 1 /2 Broad st Newport Beach Ca 92663
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 -□Minor □Conditional
D Amendment to existing Use Permit
D Variance
□ Amendment -□Code □PC □GP □LCP
D Other:
3. Project Description and Justification (Attach additional sheets if necessary):
l rage oooveraioo to ADU
• IMohsen Abbasi [ 4. Apphcant/Compa~n~y_N_a_m_e_~ _-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_------~-------~~~~~..:::::---
Mailing Address ~12_51_2_5_E_x_m_o_or _____________ ~-_-_________ ----~ __ S_u_i_,te/Unit I
City !Mission Viejo State lea I Zip 192692 I
Phone 19492317610 Fax ~------~I Email lmohsen.abbasi@aol.com I
5. Contact/Company~N=a:::m'..:.:e::....:::==================.------;:======i'
Mailing Address Suite/Unit ";======:
City -'----;===========,-~=====:::::::'...~State ~I -----;=====:::::::_I _..:z::.i:..!:'.p'.....'.:::=====;
Phone ~-------~ Fax ~-----~I Email ~-------------~
0 N IBroadway 162 LLc, Maryam Rahbar
6. wner ame ~-----;::::=====================::;------------;::::======:
Mailing Address 13211 Broad st Suite/Unit ';:::::========
City !Newport Beach State lea I Zip 192663
Phone 17148638567 I Fax ~-----~I Email lmarahbar@yahoo.com
• • l~aryam Rahbar 7. Property Owner's Aff1dav1t*: (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
herewith submitted are in all respects true and correct to the best of (my) (our) knowledge and belief.
I T·itle·. Owner I Date: 1111412021 ti DocuSigned by: I
Signature(s): --+-,/f-/\-...~-~.......+--------:1A7FE4CA~;o9
1
Signature(s): Title:~--------~ Date:~----~
DD/MO/YEAR
----------------
*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_Division\Applications\Application_Guidelines\Planning Permit Application -CDP added.docx Rev: 01/24/17
PA2021-025
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RECORDING REQUESTED BY
AND WHEN RECORDED MAIL DOCUMENT TO:
NAME
STREET
ADDRESS
CITY, STATE&
ZIP CODE
Broadway 162, LLC
5 Whiteshore
Newport Coast, CA 92657
Recorded in Official Records, Orange County
Hugh Nguyen, Clerk-Recorder
111111111111111111111111111111111111111111111111111111111111111111111111111 18,00
*$R0010361689$*
201800034406110:23 am 09/20/18
63 406 G02 5 07
902.00 902.00 0.00 0.00 12.00 0.00 0.000.000.00 0.00
SPACE ABOVE FOR RECORDER'S USE ONLY
GRANT DEED
Title of Document
Pursuant to Senate Bill 2-Building Homes and Jobs Act (GC Code Section 27388.1), effective January 1, 2018, a fee of
seventy-five dollars ($76.00) shall be paid at the time of recording of every real estate instrument, paper, or notice required or
permitted by law to be recorded, except those expressly exempted from payment of recording fees, per each single
transaction per parcel of real property. The fee Imposed by this section shall not exceed two hundred twenty-five dollars
($225.00).
fJ-Exempt from the fee per GC 27388.1 (a) (2); This document Is subject to Documentary Transfer Tax
D Exempt from fee per GC 27388.1 (a) (2); recorded concurrently "In connection with" a transfer subject to the imposition of
documentary transfer tax (DTT).
D Exempt from fee per GC 27388.1 (a) (2); recorded concurrently "In connection with" a transfer of real property that is a
residential dwelling to an owner-occupier.
D Exempt from fee per GC 27388.1 (a) (1 ); fee cap of $225.00 reached.
D Exemptfrom the fee perGC 27388.1 (a) (1); not related to real property.
THIS COVER SHEET ADDED TO PROVIDE ADEQUATE SPACE FOR RECORDING INFORMATION
($3.00 Additional Recording Fee Applies)
PA2021-025
RECOROING REQUESTED BY:
Order No. 420-1966744-12
Escrow No. 5707-SA
Parcel No. 425-283-08
AND WHEN RECORDED MAIL TO:
BROADWAY 162, LLC
5 WHITESHORE
NEWPORT COAST, CA 92657
SPACE ABOVE THIS LINE FOR RECORDER'S USE
GRANT DEED
THE UNDERSIGNED GRANTOR(S) DECLARE(S) THAT DOCUMENTARY TRANSFER TAX IS $1,804.00
[gJ computed on full value of property conveyed, or
D computed on full value less liens or encumbrances remaining at the time of sale.
D unincorporated area: [gJ City of Newport Beach, and
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Walter Chen and Lydia Chen,
Husband and Wife as Joint Tenants
hereby GRANT(S) to Broadway 162, LLC, a California Limited Liability Company
the following described real property in the City of Newport Beach, County of Orange, State of California:
Lot 11 in Block 8 of Tract No. 27, in the City of Newport Beach, County of Orange, State of California,
Boulevard Addition to Newport Heights, as per Map recorded in Book 9, Page 26 of Miscellaneous Maps,
Records of said Orange County, California.
More commonly known as: 3211 Broad Street, Newport Beach, CA 92663
Page 1 of 2
Mail Tax Statement to: SAME AS ABOVE or Address Noted Below
PA2021-025
Walter Chen Lydia Chen
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, accurac , or valid it of that document.
STATE OF _____ _
COUNTY OF _____ _ }s.s.
On-----------~ before me, _______________________ ,
personally appeared Walter Chen and Lydia Chen, who 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 in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument
the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
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 ____________ _ (Seal)
Page 2 of2
PA2021-025
DS-1986
05-2006
VENUE
U.S. Department of State
INDIVIDUAL ACKNOWLEDGMENT CERTIFICATE
Hong Kong
(Country)
Hong Kong
(State, Province, etc.)
Consulate General of the
(City)
United States of America
(Name of consular post)
I certify that on this day the individual named below appeared before me and
acknowledged to me that the attached instrument was executed freely and voluntarily.
---Walter CHEN and Lydia CHEN ---
( Signature of Consular Officer)
Rachael Parrish ua eon.u1
(Typed Name of Consular Officer)
( Title of Consular Officer)
09-06-2018
Date (mm-dd-yyyy)
PA2021-025
Government code -2736.17
I CERTIFY UNDER PENALTY OF PERJURY THAT THE ILLEGIBLE PORTION OF
THIS DOCUMENT, TO WHICH THIS STATEMENT IS ATTACHED, READS AS
FOLLOWS:
Consulate General Of The United States Of America, Hong Kong
Signature of Consular Officer: Rachael Parrish
PLACE OF EXECUTION: Laguna Niguel
DATE OF EXECUTION: September 20, 2018
SIGNATURE: /J .·, . __
:/ ii. 1/ Z,L I' /LW/Ji /tt/t/&~
!I
Penalty of Perjury Doc,
PA2021-025