PASADENA PERMIT CENTER
www.cityofpasadena.net/permitcenter
PLANNING DIVISION MASTER APPLICATION FORM
Master Application (without supplementals)5/27/20
PLANNING DEPARTMENT // 175 NORTH GARFIELD AVENUE T 626-744-4009 PLANNING DIVISION PASADENA, CA 91101 F 626-744-4785 Project Address:
Project Name:
Project Description: (Please describe demolitions, alterations and any new construction) ____________________________________________ Zoning Designation: _______________________________ General Plan Designation: _________________________ Estimated Valuation (Cost of Project): _________________________
APPLICANT / OWNER INFORMATION
APPLICANT NAME: Telephone: [ ]
Address: Fax: [ ]
City State: Zip: Email:
CONTACT PERSON: Telephone: [ ]
Address: Fax: [ ]
City State: Zip: Email:
PROPERTY OWNER NAME: Telephone: [ ]
Address: Fax: [ ]
City State: Zip: Email:
TYPE OF PLANNING REVIEW AND APPROVALS REQUIRED (Mark clearly the type of approval(s) required):
ADJUSTMENT PERMIT HEIGHT AVERAGING PREDEVELOPMENT PLAN REVIEW
AFFORDABLE HOUSING
CONCESSION OR WAIVER HILLSIDE DEVELOPMENT PERMIT
RELIEF FROM THE REPLACEMENT
BUILDING PERMIT REQUIREMENT
CERTIFICATE OF
APPROPRIATENESS
HISTORIC DESIGNATION
(MONUMENT, LANDMARK, TREE OR
SIGN) SIGN EXCEPTION
CERTIFICATE OF EXCEPTION HISTORICAL RESEARCH/EVALUATION TENTATIVE PARCEL/TRACT MAP
CHANGES TO APPROVED
PROJECT LANDMARK TREE PRUNING TEMP. CONDITIONAL USE PERMIT
CONDITIONAL USE PERMIT MASTER DEVELOPMENT PLAN TREE PROTECTION PLAN REVIEW
DESIGN REVIEW MASTER SIGN PLAN TREE REMOVAL
DEVELOPMENT AGREMENT MINOR CONDITIONAL USE PERMIT VARIANCE
EXPRESSIVE USE PERMIT MINOR VARIANCE
VARIANCE FOR HISTORIC
RESOURCES
FLOOR AREA RATIO (FAR)
INCREASE PLANNED DEVELOPMENT ZONE ZONE CHANGE (MAP AMENDMENT) _________ GENERAL PLAN AMENDMENT _________ PRELIMINARY PLAN CHECK OTHER: _____________________ Note: Space for signature is on reverse side
656 S. Oak Knoll Ave. ~ Pasadena, Ca 91106
Application for Historic Designation and Mills Act Application Submittal of an application for
historic designation and mills act application
RS6
Ignacio Borensztejn and Mira Judith Simon
310
926-0186
656 S. Oak Knoll Ave.
Pasadena
Ca
91106
Mira Judith Simon
310
926-0186
656 S. Oak Knoll Ave.
Pasadena
Ca
91106
Ignacio Borensztejn and Mira Judith Simon
310
926-0186
656 S. Oak Knoll Ave.
Pasadena
Ca
91106
✔
Attachment B - Application & Historical Documentation
PLANNING DIVISION MASTER APPLICATION FORM
- 2 -
INDEMNIFICATION
Applicant agrees to defend, indemnify, and hold harmless the City and its officers, contractors, consultants, employees, and commission members (collectively, “City”) from any and all liab ility, loss, suits, claims, damages, costs, judgments and expenses (including attorney’s fees and costs of litigation), including any appeals thereto (collectively, “proceeding”) brought against the City with regard to any approvals issued in connection wi th the application(s) by the City, including any action taken pursuant to the California Environmental Quality Act. If Applicant is required to defend the City in connection with such proceeding, the City shall have and retain the right to approve counsel to so defend the City; and all significant decisions concerning the manner in which the defense is conducted; and any and all settlements, which approval shall not be unreasonably withheld. The City shall also have and retain the right to not participate in the defense, except that the City agrees to reasonably cooperate with Applicant in the defense of the proceeding. If the City’s Attorney’s Office participates in the defense, all City Attorney fees and costs shall be paid by Applicant. Further, Applic ant agrees to defend, indemnify and hold harmless the City from and for all costs and fees incurred in additional investigation or study of, or for supplementing, revising, or amending, any document if made necessary by said proceeding.
CERTIFICATION:
I hereby certify that I am the applicant or designated agent named herein and that I am familiar with the rules and regulations with respect to preparing and filing this petition for discretionary action, and that the statements and answers contained herei n and the information attached are in all respects true and accurate to the best of my knowledge and belief.
SIGNATURE OF APPLICANT OR AGENT: __________________________________________ Date: _______________
For Office Use Only
PLAN # ___________________________
CASE #__________________________
PRJ # ___________________________
DATE ACCEPTED:___________________________
DATE SUBMITTALS RECEIVED: ______________ _
RECEIVED BY (INITIALS): _____________________
FEES:
BASE FEE:: $ ___________________
3% RECORDS FEE: $____________________
TOTAL: $____________________
HISTORIC ARCH. RESEARCH REQUIRED? YES NO
PUBLIC ART REVIEW REQUIRED? YES NO
TRANSPORTATION REVIEW REQUIRED? YES NO
INCLUSIONARY HOUSING REQUIRED? YES NO
REVIEW AUTHORITY:
□ STAFF
□ HEARING OFFICER
□ PLANNING COMMISSION/BZA
□ DESIGN COMMISSION
□ HISTORIC PRESERVATION
COMMISSION
□ CITY COUNCIL
TAXPAYER PROTECTION
□ DISCLOSURE REQUIRED
□ NOT REQUIRED
CEQA REVIEW:
□ EXEMPTION
□ INITIAL STUDY
□ EIR
CEQA REVIEW STATUS:
□ PENDING
□ COMPLETED
Design & Historic Preservation:
TYPE OF HISTORIC PRESERVATION
REVIEW:
□ CATEGORY 1 (DESIGNATED)
□ CATEGORY 2 (ELIGIBLE)
LANDMARK/HISTORIC DISTRICT NAME:
___________________________
TYPE OF DESIGN REVIEW:
□ CONCEPT
□ FINAL
□ CONSOLIDATED
□ PRELIMINARY CONSULTATION
DocuSign Envelope ID: 2BACC8DA-A581-4EB4-ADC6-991518AC53D7 5/30/2023
PASADENA PERMIT CENTER
www.cityofpasadena.net/permitcenter
Supplemental Application for
HISTORIC DESIGNATION
Revised 10/2022
W:\Design-hp\Permit Center Applications & Handouts 1 Note: In addition to this application, a completed Planning Division Master Application Form is also required. Submit all materials via email or file transfer to [email protected].
PROPERTY PROPOSED FOR DESIGNATION
1. Name of Property:
2. Property Address:
3. Date of Original Construction:
4. Original Owner:
5. Original Architect / Builder:
DESIGNATION CATEGORY
(CHECK APPROPRIATE BOX—SEE CRITERIA ON PAGES 2 & 3 FOR MORE INFORMATION):
HISTORIC MONUMENT
LANDMARK
HISTORIC SIGN
LANDMARK TREE
BRIEF DESCRIPTION OF PROPERTY & HISTORICAL PHOTOGRAPHS
Briefly describe the property proposed for designation, indicating whether the entire site or a portion of the site is the subject of the nomination (e.g., how many buildings or objects on the site are included in the nomination) or if the nomination is for an object, sign or tree. If applying for historic monument designation, specify whether any interior public or semi-public spaces are included in the nomination. A site plan and/or floor plan may be used to supplement the narrative description.
Please also submit recent and, if available, historical photographs.
SUPPLEMENTAL INFORMATION ON SIGNIFICANCE OF PROPERTY
With this application, please attach information that will assist staff with the preparation of a designation report. Books, photographs, articles, and other archival information will all be useful to document the significance of the nominated resource. If applying for historic monument designation, an evaluation by a qualified architectural historian may be required to demonstrate exceptional or regional, statewide or national significance. Refer to bibliography, historical photographs, chronology, and other supporting information.
PASADENA PERMIT CENTER
www.cityofpasadena.net/permitcenter
Supplemental Application for
HISTORIC DESIGNATION
Revised 10/2022
W:\Design-hp\Permit Center Applications & Handouts 2
LEGAL DESCRIPTION
Attach a copy of the most recently recorded legal description for the property (usually in the deed for the property or other documents when the property was purchased—also available from a title company).
CRITERIA FOR DESIGNATION
Check the box under the category checked on first page that corresponds to the criterion/criteria under which you are nominating the property, object, sign or tree for designation. Multiple boxes may be checked if applicable. Submitted description and supplemental information should provide an explanation of how the property meets the specified criterion/criteria.
CRITERIA FOR DESIGNATING AN HISTORIC MONUMENT
(May include significant public or semi-public interior spaces and features) A. It is associated with events that have made a significant contribution to the broad patterns of the history of the region, state or nation.
B. It is associated with the lives of persons who are significant in the history of the region, state or nation.
C. It is exceptional in the embodiment of the distinctive characteristics of a historic resource property type, period, architectural style or method of construction, or is an exceptional representation of the work of an architect, designer, engineer, or builder whose work is significant to the region, state or nation, or that possesses high artistic values that are of regional, state-wide or national significance.
D. It has yielded, or may be likely to yield, information important in prehistory or history of the region, state or nation.
CRITERIA FOR DESIGNATING A LANDMARK
A. It is associated with events that have made a significant contribution to the broad patterns of the history of the City.
B. It is associated with the lives of persons who are significant in the history of the City.
C. It embodies the distinctive characteristics of a type, architectural style, period, or method of construction, or represents the work of an architect, designer, engineer, or builder whose work is of significance to the City or possesses artistic values of significance to the City.
D. It has yielded, or may be likely to yield, information important locally in prehistory or history.