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Home My WebLink AboutPA2023-0092_20230602_Discretionary Application Owner's AffidavitCommunity Development Department Discretionary Application Owner's Affidavit 1. Check Permits Requested: D Approval-in-Concept -AIC # Ii] 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 Ii] Parcel Map 2. Project Address(es /Assessor's Parcel No(s) 513 Acacia Ave / 459-091-17 CITY OF NEWl'OllT 0EACfl 100 Civic Center Drive Newport Beach, California 92660 949 644-3200 newportbeachca.gov/communltydevelopment 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): Construct New Duplex . . I BIRE II LLC 4. Property Owner's Aff1dav1t*: (I) (We) L---' __________________ __, 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): Ctvwr,.;---)l{tt-,. ,--lcCl.,tA~~-Title: I tvl£ti,11?,.,YL-, I [)ate: I O b/o, /zov,, I MM/DD/YEAR Signature(s): ______________ _ Title:~---------~ Date: LI _____ _ *May be signed by the lessee or by an authorized agent if written authorization from the owner of lhe record Is filed concurrently with the application. Please note, the owner(s)' signature for Parcel/Traci Map and Loi 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.lct\data\Users\CDD\Shared\Admln\Plannlng_ DMslon'Appllcallons\Applf.catlon _ Guldelines\Plannlng Permit OWner's Affadavit 2022.docx Rev: 01(24123 ILLINOIS NOTARY ACKNOWLEDGMENT State of Illinois County of Cook This instrument was acknowledged before me, Ruth D. Doan, on 06/01/2023 (date) by Carmen Solano-De Carrier (name of person acknowledged). (Seal) ........................................... ___ 't OFFICIAi.SEAi. RUTHODOAN NOTARY Plllll.lC, STAT& 0V IUINOIS MY COMMISSION eJl!lfMS: 10/1l/2026 ILLINOIS NOTARY Page 1 of 1 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: ________________________________________________________________________________________