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Home My WebLink AboutPA2022-0187_20220830_Discretionary Application Owner's AffidavitCommunity Development Department Discretionary Application Owner's Affidavit 1. Check Permits Requested: D Approval-in-Concept -AIC # Ill 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) 0472211 1 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 0 Amendment -□Code □PC □GP OLCP D Zoning Clearance -□ADU D Use D Other: 3. Project Description and Justification (Attach additional sheets if necessary): Coastal Development Permit for demo of existing SFR and construction for a new SFR of 3906 sf with 501 sf garage. The client also proposes reconstruction of the sea wall per the coastal hazard report. 4. Property Owner's Affidavit*: (I) (We) ,_I E_d_d_ie_a_nd_D_e_s_ire_e_H_ed_g_e _______________ __, 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 ~II r peels true and correct to the best of (my) (our) knowledge and belief. _ Signature(s): ~fl_ Title: ,__ _______ __, Date: ~~[ '3tr1 1</l..'2-J .---___;M ___ M ..... iD ..... D_IY ___ E ..... AR___;_ 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. \\cnb .lcl\data\Users\COD\Shared\Admin\Planning_ Oivision\Applicatlons\Application _ Guidelines\Planning Permit Owner's Affadavit 2022 .docx Rev: 07 IOS/22 PA2022-0187 I:\Users\CDD\Shared\Admin\Planning_Division\Current_Templates\Office Use Only Form Updated 01/27/2020 2700-5000 Acct. Deposit Acct. No. ________________________ For Deposit Account: Fee Pd: _______________________________________ Receipt No: ____________________________ FOR OFFICE USE ONLY Date Filed: _______________________ APN No: __________________________ Council District No.: _________________ General Plan Designation: ____________ Zoning District: _____________________ Coastal Zone: Yes No Check #: __________ Visa MC Amex # ____________ CDM Residents Association and Chamber Community Association(s): _______________________ Development No: __________________________ _____________________________________________ Project No: ________________________________ _____________________________________________ Activity No: _______________________________ Related Permits: ___________________________ Remarks: ________________________________________________________________________________________