HomeMy WebLinkAboutItem 2 - Attachment 3 - Disclosure StatementType of Review Requested
Conditional Use Permit
❑ Variance
❑ Design Review
ED Misc.
Application Information
0
D e v e l o p rh e n t S e r v i c e s D e p a r t m e n t
Planning Division t Development Processing
APPLICATION Type A Part 1
STAFF USE ONLY
Case #: FC�� l�° ®r5 t
Filing pate: - l -t 6y 1 . (15G,
Project Manager: ZIP Jr l_
Project Account: ' [[ __ U w 3
Deposit Account: Y
Related Lases:
❑ Z.A Public Hearing
Applicant Name LA�+n.dO � � E
Applicant Address. +� —Mat rt~C
Contact Name Mooicc-A Co 64-V Phone . M C -7-1
Applicant's Interest in Property (if applicant is not the owner, the owner's authorization signature at the end of this form is required
to process this request.) , own GN Rent ❑ other
Arch itect /Agent f (x C ^ Address A01'I 4�;l t l' K-f—' St 0- h tt LA VtS41�
Contact Name c> (, Phone
Primary Contact is: ❑ Applicant U Architec Agen�) E -mail of primary contact ' �' ' Q
Hazardous Waste and Substances Statement
Hazardous Waste and Substances Statement - Section 65962.5f of the State of California Government Code requires that, before the
City of Chula Vista accepts as complete an application for any development project, the applicant submit a signed statement
indicating whether or not the project site is identified on the state of California Hazardous Waste and Substances Sites List.
This list identifies known sltes that have been subject to releases of hazardous chemicals, and is available at
: ji, -,4 w.c,tsc.c .g =vlSi_es = an up Pico etc s .'L!_mc¢Rn. The development project and any alternatives proposed in this application
( ) is ( ) is not contained on the lists compiled pursuant to Section 65962.5 of the Government Code.
if Yes, provide Regulatory Identification Number: Date of List:
Historical Resources
The year(s) all structures were constructed on the property
If property is designated historical, provide Site #
I certify that the information above is correct and accurate to-the best of my knowledge, I understand that the project will be
reviewed based on the information provided
Print Name "on (a, �vZ;6 i Signature Ulu' Ct _ Date
General Project Description (all types)
Project Name Lk i(AG1n re�SlEtur&Uvll Rreprose �lJse
Project Description e*(C -0- Q '�Y i�lG t ttt1 l
Has this project received pre - application review comments? ❑ Yes (Date)
Subject Property Information (all types)
`_"A.i -zA 21I'
Location Street Address 42A 0 1 to (i 1 � ILt VPS
Parcel # Total Acreage Redevelopment Area (if applicable)
General Plan Designation Zone Classification CA)
Planned Community (if aplicable) Current Land Use
Form 320
Rev oA.ta /
Pg 112
YJ
276 Fourth Avenue I Chula Vista
i California I 91910 I (619) 691.5101
Attachment
11
D e v e i o p rn e n t S e r v i c e s D e p a r t m e n t
Planning division Development Processing
APPLICATION Type A Fart 2
3
Type of use proposed ❑ Residential Jo Commercial ❑ Industrial ❑ Mixed Use
Landscape Coverage (% of lot) Building Coverage (% of lot)
Residential Project Summary
Type of dwelling unit(s) Number of lots
Dwelling knits PROP05ED EXISTING
1 Bedroom
2 Bedroom
3+ Bedroom
TOTAL
Density (DU /acre) Maximum building height Minimum lot size Average lot size
Parking Spaces
Required Provided
Type of parking (i.e. size; covered, etc.)
Open Space description (acres each private, common, and landscaping)
Non - Residential Project Summary
_ f
Gross Floor Area ,q 'l -0 Proposed Existing Building Height
Hours of operation (days & hours) ` Dr e, 1tf Y-le A 10 PLO
Anticipated number of employees Maximum number of employees at any one time
Number and ages of students /children (if applicable) Seating capacity
Parking Spaces
Required Provided 22
Type of parking (i.e. size; covered, etc.)
Authorization
Print applicant name
Applicant Signature
Print owner name*
ni (
A Osrr, � 3"G( 64
L'0"A rho) ?'� t o .— k ov
Date Y- If Y
726 -- 001 "T d
Owner Signature" Date
Note; Proof of ownership may be re uired. Letter o€ consent may be provided in lieu of signature.
From 320
Hev 04.70
276 Fourth Avenue I Chula Vista California 1 91910 (619) 691.5101 Pg2/2
D e v e i a p m e n t S e r v i c e s D e p a r t m e n t
Planning Division I Development Processing
APPLICATION APPENDIX A
Project Description & justification
Project Name dar�
Applicant Name i" oh 1C!'1 CDrG� o -
Please fully describe the proposed project, any and all construction that may be accomplished as a result of approval of
this project, and the project's benefits to yourself, the property, the neighborhood, and the City of Chula Vista. include
any details necessary to adequately explain the scope and /or operation of the proposed project. You may include any
background information and supporting statements regarding the reasons for, or appropriateness of, the application.
Use an addendum sheet if necessary.
For all Conditional Use Permits and Variances, please address the required "findings" as listed in the Application
Process applicable guides. q
\ e a r-,, I'f 1f' A 41 V i ��� Il nn 1` C-x l cAR-Y) �
bee - 2 1,} T�l�l a -i�. ey s '� @ pern l�rntr dream ose
Form
App. A
276 Fourth Avenue I Chula Vista California 1 91910 (619) 691.5101 He�03.16
Disclosure Statement
D e v e I o p m e n t S e r v i c e s D e p a r t m e n t
Planning Division I Development Processing
APPLICATION APPENDIX B
Pursuant to City Council Policy 101 -01, prior to any action on a matter that requires discretionary action by the City
Council, Planning Commission or other official legislative body of the City, a statement of disclosure of certain
ownerships, financial interest, payments, and campaign contributions must be filed. The following information must
be disclosed:
1. List the names of all persons having a financial interest in the project that is the subject of the
application, project or contract (e.g., owner, applicant, contractor, subcontractor, material supplier).
Axy)(AJ 11i") rcl
2. if any person* identified in section 1, above is a corporation or partnership, list the names of all
individuals with an investment of $2000 or more in the business (corporation /partnership) entity.
Ir! oo:(e
3. If any person* identified in section 1. above is a non- profit organization or trust, list the names of
any person who is the director of the non - profit organization or the names of the trustee, beneficiary
and trustor of the trust.
no 11)
4. Please identify every person, including any agents, employees, consultants, or independent
contractors, whom you have authorized to represent you before the City in this matter.
none—
S. Has any person *identified in 1., 2., 3., or 4., above, or otherwise associated with this contract, project
or application, had any financial dealings with an official ** of the City of Chula Vista as it relates to this
contract, project or application within the past 12 months? Yes No
If yes, briefly describe the nature of the financial interest the official ** may have In this contract_
276 f=ourth Avenue I Chula Vista I California 1 91910 I (619) 691.5101
roan
App. $
Rev 03.10 }
Pg 1/2
D e v e k o p rn e n t S e r v i c e s D e p a r t m e n t
Planning Division I Development Processing
APPLICATION APPENDIX 13
Disclosure Statement - Page 2
6. Has any person *identified in 1., 2., 3., or 4., above, or otherwise associated with this contract, project
or application, made a campaign contribution of more than $250 within the past (12) months a
current member of the City of Chula Vista Council ? Yes No
if yes which council member?
7. Has any person *identified in 1., 2., 3., or 4., above, or otherwise associated with this contract, project
or application, provided more than $420 (or an item of equivalent value) to an official** of the City of
Chula Vista in the past (12) months? (This includes any payment that confers a personal benefit on the
recipient, a rebate or discount in the price of I nything of value, money to retire a legal debt, gift, loan,
etc.) Yes No
If yes, which official ** and what was the nature of the item provided?
B. Has any person *identified in 1., 2., 3., or A., above, or otherwise associated with this contract, project
or application, been a source of income of $500 or more to an official ** of the City of Chula Vista in the
past (12) months? Yes No
If yes, which official ** and the nature of the item provided?
Date JJ" 14 —i V
ce
Signature of Contractor /Applicant
"(–A -e V1�
Print or type name of Contractor /Applicant
* Person is identified as: any individual, firm, co- partnership, joint venture, association, social club,
fraternal organization, corporation, estate, trust, receiver, syndicate, any other county, city, municipality,
district, or other political subdivision, or any other group or combination acting as a unit.
** official includes, but is not limited to: Mayor, Council member, Planning Commissioner, Member of a
board, commission or committee of the City, and City employee or staff members.
* This disclosure Statement must be completed at the time the project application, or contract, is submitted
to City staff for processing, and updated within one week prior to consideration by legislative body.
Last updated: March 16, 2010
[a]276 Fourth Avenue Chula Vista California I 91910 1 (619) 691.5101
D e v e l o p m e n t S e r v i c e s D e p a r t m e n t
Planning Division Development Processing
APPLICATION APPENDIX C
Development Permit Processing Agreement
Permit Application 1
Applicant Name sm& C— '��`) #� qlt
Type of Permit G- rd ,120, 4 pk�rb' & - -
Agreement Date
Deposit Amount
This Agreement ( "Agreement„ ) between the City of Chula Vista, a chartered municipal corporation ( "City ") and
the forenamed applicant for a development permit ( "Applicant "), effective as of the Agreement Date set forth above,
is made within reference to the following facts:
Whereas, Applicant has applied to the City for a permit of the type aforereferenced ( "Permit ") which the City has
required to be obtained as a condition to permitting Applicant to develop a parcel of property; and,
Whereas, the City will incur expenses in order to process said permit through the various departments and before
the various boards and commissions of the City ( "Processing Services "); and,
Whereas the purpose of this agreement is to reimburse the City for all expenses it will incur in connection with
providing the Processing Services;
Now, therefore, the parties do hereby agree, in exchange for the mutual promises herein contained, as follows:
1. Applicant's Duty to Pay.
Applicant shall pay all of City's expenses incurred in providing Processing Services related to.Applicant's Permit, including
all of City's direct and overhead costs related thereto. This duty of Applicant shall be referred to herein as "Applicant's
Duty to Pay."
1.1. Applicant's Deposit Duty.
As partial performance of Applicant's Duty to Pay, Applicant shall deposit the amount aforereferenced ( "Deposit ")
I.M. City shall charge its lawful expenses incurred in providing Processing Services against
Applicant's Deposit. If, after the conclusion of processing Applicant's Permit, any portion of the
Deposit remains, City shall return said balance to Applicant without interest thereon. If, during the
processing of Applicant's Permit, the amount of the Deposit becomes exhausted, or is imminently
likely to become exhausted in the opinion of the City, upon notice of same by City, Applicant
shall forthwith provide such additional deposit as City shall calculate as reasonably necessary to
continue Processing Services. The duty of Applicant to initially deposit and to supplement said
deposit as herein required shall be known as "Applicant's Deposit Duty ",
2. City's Duty.
City shall, upon the condition that Applicant is no, in breach of Applicant's Duty to Pay or Applicant's Deposit Dutyr
use good faith to provide processing services in relation to Applicant's Permit application.
2.1. City shall have no liability hereunder to Applicant for the failure to process Applicant's Permit application, or
for failure to process Applicant's Permit within the time frame requested by Applicant or estimated by City.
Farm
App. C
Rev 03.10
276 Fourth Avenue Chula Vista California I 91910 I (619) 691 .5 101 P�'�
D e v e l o p m e n t S e r v i c e s D e p a r t m e n t
Planning Division Development Processing
APPLICATION APPENDIX C -Page 3
Development Permit Processing Agreement
Applicant. At its sole discretion, the City may participate at its own expense in the defense of any such action, but such
participation shall not relieve the applicant of any obligation imposed by this condition.
4.6 Administrative Claims Requirements and Procedures.
No suit or arbitration shall be brought arising out of this agreement against the City unless a claim has first been
presented in writing and filed with the City of Chula Vista and acted upon by the City of Chula Vista in accordance with the
procedures set forth in Chapter 1.34 of the Chula Vista Municipal Code, as same may from time to time be amended, the
provisions of which are incorporated by this reference as if fully set forth herein, and such policies and procedures used
by the City in the implementation of same. Upon request by City, Consultant shall meet and confer in good faith with City
for the purpose of resolving any dispute over the terms of this Agreement.
Now therefore, the parties hereto, having read and understood the terms and conditions of this agreement, do
hereby express their consent to the terms hereof by setting their hand hereto on the date set forth adjacent thereto.
Dated:
By:
Dated: f I-q � By:
(Staff)
City of Chula Vista
276 Fourth Avenue
Chula Vista, CA 91910
(Applicant)
IV 276 Fourth Avenue l Chula Vista California I 91914 1 (619) 691.5101
ryFa.ai�-' i�"1,'i'i� L "_�j= C;it1•�•,'s'1' —:3; IA: 's !.rz
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(19-227-20"14 _
00715000452063
CITY OF CHULA VISTA
STATEMENT OF AMOUNT DUE
PLANNING DIVISION
P f ®j eCt Type: CONDITIONAL USE PERMIT
Sub -Type: HEARING
PI anni ng Case #: PCC -14 -057
Receipt #: R1404299
Project Title: ASADA RESTAURANT
Location: 4340 MAIN ST
Applicant: ASADA RESTAURANT
Project ACCt #: BB -2043
Deposit Acct #; 1
C! (2,z � I
----------------------------------------------------------------------------
Transaction Date: 09/22/2014
Total payment: $ 11,000°00
Transaction List:
Type Method check # Amount
Payment check 11,000.00
Account Item List:
Fee Description Trans code Pmt Amt
Public Hearing 9501 11,000.00
Account Number: 00$92-- 2721/9109.FF-- $00000
17c; t,;
Initials: AC
User Id: ALEONSOC
Entered Date: 09/22/2014
Time: 02 :57 PM