Disclosure Pursuant to the
City of Pasadena Taxpayer Protection Act
Pasadena City Charter, Article XVII
Does the value of this application/project have the potential to exceed $25,000? X Yes •No (Applicant must mark one) I. Is the application being made on behalf of a government entity? U Yes ANo III. Is the application being made on behalf of a non-profit 501(c) organization? • Yes Xio If yes, please indicate the type of 501(c) organization: L 501(c)(3) L 501(c)(4) LI 501(c)(6) 9/8/2022
Applicant's name: Larry Sue Date of Application:
Park Center, Le (626) 572-0883
Owner's name: Contact phone number:
(for questions regarding this form)
Project Address: 221 E. Walmut st., Pasadena, CA 91101
Project Description: office Space Rental
IV. Applicant and Property Owner must disclose all joint owners, trustees, directors, partners, officers and those with more than a 10% equity, participation or revenue interest in owner and/or project. If any of these are an organization/entity, include the name of the organization/entity and the first and last names of all parties of interest of that organization/entity. (List all parties below and use additional sheets as necessary, or provide all parties on an attachment) Please print legibly.
Have any additional sheets or an attachment been provided? C Yes C No Names of Owners), Trustees, Directors, Partners, Names of Owner(s), Trustees, Directors, Partners, Those with more than a 10% equity, participation Officers of Owner/Project (continued) or revenue interest in Owner and/or project California Forefront, LIC California Foremont, LLC
CFI AY, LLC CFI AY, LIC
John wong John Wong
1 hereby certify that L am the owner or designated agent and that the statements and answers contained hcrein, and the infonation attached, are in all respects une, accurate and complete to the best of my knowledge and belief. 918/2022
Signature of Owner or Designated Agent: Date:
For Office Use Only
Type of Application: | Variance (all types) | Adjustment Permit Sign Exception Temporary Use Permit Expressive Use Permit M Conditional Use Permit (excluding Master Plan) Master Plan Amendment M Planned Development Other Assigned Planner: PLN#:
Attached Address: L No Attached Address
Appealed: | Yes |I No Appeal PLN# I1 Application Withdrawn Final Decision: 7 Approved - Denied Decision Date: Decision Maker:
(Name and Title, or Name of Commission/Committee)
Votes in favor (please print):
Revised July 2007