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HomeMy WebLinkAbout10056 Adams Ave - CofO (5)r CERTIFICATE OF OCCUPANCY 1C.l�h� c,a CITY OF HUNTINGTON BEACH _ Date Address i -'✓1 �' District Business Name rl 8,C1 1 rX.Ui,T�9 1 C. eba, UL' FT,' D0Pti' E Tel. 7`11'-05774 1G Business Type DUC: T 7 CO FEL•' SF Ca ' Oce. Group " BUILDING OWNER BUSINESS OWNER/MANAGER L'L`*'NX., 1LINUIi'. DC`a7 INC. REEAD AIE, Name _ Name r Address Home Address c j' t FAEB(iri ELVE ter City Ter. City CGSTA i• La ' A T el 71 4-95 (—� i 12 Construction No. of Occupant Load " 1-Stories Sprinklers CONDITIONS OF APPROVAL DEPARTMENT OF COMMUNITY DEVELOPMENT This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and shall not be removed except by the by, Building Official. t Ji APPLICATION FOR CERTIFICATE OF OCCUPANCY CITY OF HUNTINGTON BEACH / DEPARTMENT OF COMMUNITY DE'►ELOPMENT�` DATE HUNTINGTON REACH, (PRINT OR TYPE ONLY; (PRINT ess AQAa-1� 3i" Rtua,tjG o� 3 -AcAt, CA 4d16a6 District usii ess Name 11�or3ui� �l�.c �, .�1 t�u�.,sC� �3<-�J" Tel gs7_87td-- IX�usiness Type (�) O tat' It Cc*�ra-c� Si�r,;� Occ. Group BUILDING OWNER BUSINESS OWNERIMANAGER . 7VAAd e �� LAy- u4: -' w� � e �� rws� a t`'.� i�iC 1 re 3MI $ F-C /ate ��: OL Ql-y C) ess ✓Address�1 ft Tel._ ,ty �� 36- K�SA Home Tel. S - 7f d- 'HIS USE WOULD BE DESCRIBED AS: ❑ NEWLY CONSTRUCTED BLDG. EA CHANGE OF OWNER CHANGE OF OCCUPANT 12 EXISTING BUILDING ❑ CHANGE OF USE ❑ ADDITIONAL OCCUPANT / Indicate former use, i' any �Occupancy Gr. Div \ SQUARE FT. OF BUILDING TO BE OCCUPIEDl NOTICE: 1. Occupancyof anv building is prohibited and a business license will not be issued until the building has been inspected and a certificate of occupancy is issued. 2. No electrical service will be released for any existing building until the service has been inspected and certified safe. All applicants for occupancy in an existing building are required to schedule an electrical 'fuse up' inspection in the Department of Community Development at the time this application is filed. 3. Change of occupancy or use inspection fee. Whenever it is necessary to make inspection of a build ng or premises in order to determine if a change may be made in the character of occupancy or use of the building or premises which would place the building in a different division of the same group of occupancy or in a different group of occupancy, a change of occupancy inspection fee of $ shall be paid to the city. 4. Huntington Beach Fire Code Section 10.208 requires that building numbers must be a minimum of four (4) inches in height with o,ie half (1/2) inch stroke, and of a contrasting color from the background. These numbers must be posted on your building in a location that is visible from the street. 5. Huntington Beach Fire Code Section 10.301 requires fire extinguisher selection and distribution per the National Fire Protection Association pamphlet 10 (see reverse side). (FOR OFFICE USE ONLY) SUPPLEMENTAL INFORMATION r,` � ZONIN i� _ OCCUPANCY GROUP PLAN CHECK NO. NO. PARKING SPACES OCCUPANT LOAD PERMIT NO. HEALTH DEPT APPROVAL NO. OF ST RIES _ ADMIN. ACTION UTILITIES RELEASED \ RTIFICATE OF OCCUPANCY FEE �"' 4ATZANGE A 0 ED OF USE OR OCCUPANCY FEE $ TOTAL $ Lw�� 75-039 Rev. 11/90 CO pEVE OPMENT SUPPLEMENTAL INFORMATION 1.. BUSINESS ADDRESS �00U, 4.2aU 9a�a� 2. Person to contact in case of emergency- �'�'� ,r1 WAti-G Telephone number: 0 t!_q 3. Does the building in question have electricity? ❑ Yes No (a) If No, are you requesting that the electricity be Yes turned on? ❑ No 4. The building is sprinklered? ❑ Yes ® No 5. Operations will produce dust/wood shavings or similar material? ❑ Yes ® No 6. Operations will involve the repair or replacement of ❑ Yes automobile parts? No If Yes: (a) Describe the components .repaired or replaced. (b) Does the operation involve the use of an open flame? ❑ Yes No 7. The business is drinking, dining or assembly use that will result in an occupant load of more than 50 persons. ❑ Yes ® No 8. The following best describes my operation; Office Only Retail Sales Warehouse Manufacturing / Dist; ibution (describe process and end product) kA'r..Cry Restaurant / Take Out Food Medical / Dental Other (desci 'be) C-6 F rE L SUPPLEMENTAL INFORMATION (Continued) Coes`, the operation � iInvoive.,. =ai--ry .. of.. the- following ifiater4tlsl 0 Yes ® No if Yes, indicate gbantfties: Material Quantity 1. Flammable liquids Class l-A Class 1-13 Class I-C 2. Combustible liquids Class 11 Class Ili -A 3. Combination flammab.e liquids 4. Flammable gases 5. Liquefied flammable gases 6. : Flammable fibers loose 7. Flammable fibers - baled 8. Flammable solids ^M 9, Unstable materials 10. Corrosive liquids 11. Oxidizing material - gases 12. Oxidizing material - liquids 13. Oxidizing ; material -, solids 14, Organic peroxides - 15. Nitromethane (unstable materials) 16. Ammonium nitrate 17. Ammonium nitrate compound_ mixtures containing more than 60% nitrate by weight 18. Highly toxic material and poisonous gas 19, Smokeless . powder. 20. Black sporting powder _ I hereby certify . that . ,the above : information is true -and., correct to the best of my knowledge. 41 1i I Y 'S Signalur Date c"A Railding Planning Housing City of Huntington Beach e 2000 MAIN STR;ET CALIFORNIA92646 1J d ; DEPARTMENT OF COMMWN1TV DEVELOPMENT 536-5241 536-52a1 536-5271 Government Code Section 65850.2(b) ;requires the City of Huntingto,i Beach Building Division not to issue the final certificate of occupancy unless the applicant has met or is meeting the requirements of the South C:oas" Air Quality Management District (AQMD). The Build,.na Division must obtain a written release from AQMD to show the applicant has complied with this law. The Check list on the reverse sale is designed to help the applicant and the building division to meet these requirements. 1. The applicant (the same person who applies for peLmits from the B,gilf"-ig Division) must complete the check list which can be obtained either at the Building Division or at AQMD. 2. I' all boxes in the list are checked "no", the Building Division can accept the check list as the release. 3. If there are any "yes" answers in the list, the applicant must contact an AQMD engineer by calling (714', 396-2000 to find out whether air permits are required for the proposed construction project. 4. If air permits are not required, the applicant will obtain a written release from AQMD. 5. If air permits are required, the applicant must submit the necessary hermit applications before the release can be issued. Because of the time it may take for AQMD to go through the above procedures, the applicant; is ;advised to contact AQMD imm6diately SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT (Nonresidential Buildings Only) Ci�bab Location of Subject Property: ! otS & A (-,Am s roperty Owner Name: Phone # Name of the Person Preparing this form iA__prin-t ar.d signature Name: �tr�Al�'rSignature• �'L _ The person preparing this form mu�-be-IL-e- same erson applying for building permits. Please answer the following questions regarding your proposed occupancy of the subject building. IF YOU DO NOT KNOW THE ANSWER TO A QUESTION MARK IN THE: "YES" COLUMN: AQND PERMITTING CHECKLIST YES NO 1. Does your facility use any internal combustion / engines greater than 50-HP? 2. Does your facility involve mixing, blenO°'ng, or processing any solvents, adhesives, paints or coatings? 3. Does your facility create any dusts or smoke? 4. Does your fac '.lity refine any liquids or solids or reclaim any metals? �--- 5. Does your facility plate or coat anything? _ 6. Does your facility have any combustion equipment i.e. boiler, furnaces, broiler, baking ovens, etc.) rated greater than 2,000,000 BTU/HR?- 7. Does your facility handle or store solvents or motor fuel? rs 8. Do you use or store any acids? ti 9. Do you use any chemical process? 10. Do you use any solvents for clean-up?- 11. Are you a dry cleaner, restaurant with a charbroiler, body shop, gasoline station, printer, or part coater? c/ 12. Is the subject building located within one thousand (1,000) feet of any school? PROPERTY LINE TO PROPERTY LINE. GRADES K-12. If you have marked "NO" in all columns, you do not need an Ai?: Quality permit at this time. If you have marked any questions in the "YES" Column you must contact the South Coast Air Quality Management District located at: 21865 E. Copley Drive Diamond Bar, CA 91765-4182 Please call: Plan Check (714) 396-2000 (1360D-2) CERTIFICATE OF OCCUPANCY CITY OF HUNTINGTON 6EACH Address Date District I It f, Business Name L Z i Tel Business Type Occ. Group BUILDING O1,tJNER BUSINESS OWNER/MANAGER Name Name Home Address Address F�,KLh A , Hom'7 City Tel. city , I I..,`Tel.e 7 Construction No. of Stories Occupant Load Sprinklers CONDITIONS OF APPROVAL DEPARTMENT OF COMMUNITY DEVELOPMENT This Certificate of Occupancy SHALL PE posted in a conspicuous place on the premis,.is and shall not be removed except by the by Building Official. COMMUNITY DEVELOPMENT APPLICATION FOR CERTIFICATE OF OCCUPANCY CITY OF HUNTINGTON BEACH }� DEPARTMENT OF COMMUNITY DEVELOPMENT i 9 HUNTINGTON OFAOi (PnINT OR TYPE ONLY) DATE 7V d ess 1o)a rr)0A#-iS 3t kAILU;rl;r.Cl00 �cAC_ IOA Q4�� District_ ul ess Name i� 1�nNu� i i 1c i�_� .� t�u>J!� 'ti 13..c< _ Tel �� q57_ d 71 uJ-- siness Type n U +�'� '� Lc` "r�� S��a� _ _ Occ. Group BUILDING OWNER BUS' IESS OWNERWANAGER V7Addess— (Addnress ��__S 4 L\_P- 3a e- �v t� - I a Tel ty .�'h KeSP� Home Te��SZJ-L7 d- THIS USE `NOG LD BE DESCRIBED AS: ❑ NEWLY CONSTRUCTED BLDG © CHANGE OF OWNER r u EXISTING BUILDING ❑ CHANGE OF USE Indicate former use. if any SQUARE FT. OF BUILDING TO BE OCCLIPIED a 0"0 ® CHANGE OF OCCUPANT ❑ ADDITIONAL OCCUPANT paricy Gr_ —Div NOTICE: 1. Occupancy of any building is prohibited and a business license will not be issued until the building has been inspected and a certificate of occupancy is issued. k. No electrical service will be released for any existing building until the service has been inspected and certified safe. All applicants for occupancy in an existing building are required to schedule an electrical 'fuse up' inspection in the Department of Community Development at the time this application is filed. 3. Change of occupancy or use inspection fee. Whenever it is necessary to make inspection of a building or premises in order to determine if a change maybe made in the character of occupancy or use of the building or premises which would place the building in a different division of the same group of occupancy or in a different group of occupancy, a change of occupancy inspection fee of $ shall be paid to the city. 4. Huntington Beach Fire Code Sec"ion 10.208 requires that building numbers must be a minimum of four (4) inches in height with one half (1/2) inch stroke, and of a contrasting color from the background. These numbers must be posted on your building in a location that is visible from the street. 5. Huntington Beach Fire Code Section 10.301 requires fire extinguisher selection and distribution per the National Fire Protection Association pamphlet 10 (see reverse side). O-� H-L- (FOR OFFICE USE ONLY) SUPPLEMENTAL INFORMATION OCCUPANCY GROUP — PLAN CHECK NO OCCUPANT LOAD PERMIT NO. NO. OF STQRIES _— ADMIN ACTION l \ /CERTIFICATE OF OCCUPANCY FEE A O ED bAT CHANGE 01 USE OR OCCUPANCY FEE TOTAL 75-039 Rev. 11/90 CO nUNITY DEVELOPMENT ZONIN�— NO PARKING SPACES HFALTH DEPT APPROVAL UTILITIES RELEASED a S r P SUPPLEMENTAL INFORMATION 1. BUSINESS ADDRESS kDOS 2. Person to contact in case of emergency* r Telephone number: <'I t�� 9 S -7- R 2 f }- 3. Does the building in question have electricity? Cl Yes E N f,, (a) If No, are you requesting that the electricity be 0 Yes turned on? ❑ No 4. The building is sprinklered? ❑ Yes No 5. Operations will produce dust/wood shavings or similar material? ❑ Yes ® No 6. Operations will involve the repair or replacement of ❑ Yes automobile parts? 1 No If Yes: (a) Describe the components repaired or replaced. (b) Does the operation involve the use of an open flame? ❑ Yes ® No 7. The business is drinking, dining or assembly usp that will result in an occupant load of more than 50 persons. ❑ Yes l�l No 3. The following best describes my operation; Office Only Retail Sales Warehouse Manufacturing / Distribution (describe process and end product) Restaurant/Take Out Food Medical / Dental Other (describe) COFFEE Shop SUPPLIMENTAL INFORMATION SUPPLEMENTAL INFORMATION(Continued) Does the operation involve any of the following materials'? 1-1 YYs ® No If Yes, indicate quantities:- __ Material G�uantity 1. Flammable -_liquids Class I -A °Class I-B Class I-C 2. Combustible liquids Class It Class 111-A 3. Combination flammable liquids 4. Flammable gases 5. Liquefied flamrn,abie gases 6. Flammable fibers - loose 7. Fiammable fibers - baled 6. Flammable solids 9. Unstable materials 10._.-___Corrosive liquids 11. Oxidizing material - gases 12. Oxidizing rnate,iai - liquids 13. Oxidizing material - solids 14. Organic peroxido� 15. Nitromethane (unstable materials) 16. Ammonium nitrate 17. Ammonium nitrate compound mixtures containing more than 60% nitrate by weight j6. Highly toxic material anti poisonous gas 19. Smokeless powder 20. Black sporting powder I hereby certify that the above information is true and correct to the k Est of my knowledge. A�, 5ignafure,) Date r1d • .�J City of Huntington Beach 2000MAIN STREET CALIFO;NIA92640 DEPAWMENT OF COMMUNITY DEVELOPMENT Building 536-5241 Planning 536-5271 Hou$Ing 536-5271 Government Code Section 65850.2(b) requires the City of Huntington Beach Building Division not to issue the final certificate cf occupancy unless the applicant has met or is meeting th,e requirements of the South Coast Air Quality Managament District (AQk4D). The Building Division must obtain a written Tease from AQMD to show the applicant has complied with this law. The check list on the reverse side is designed to help the applicant and the building division to meet these requirements. 1. ThE applicant (the same Pgr.son who applies for permits from i the Building Division) must complete the check list which can be obtained either at the Building Division or at AQMD. 2. If all boxes in the I'-st are checked "no", the Building Division can accept the check list as the release. 3. If there are any 'yes" answers in the list, the applicant must contact an AQMD engineer by calling (714) 396-2000 to find out whether air permits are required for the proposed construction project. 4. If air permits are not required, the applicant will obtain a ..written release from AQMD. 5, If air permits are required, the applicant must submit the necessary permit applications before the release can be issued. Because of the time it may take for AQMD to go through the above procedures, the applicant is advised to contact AQMD immediately after applyir for Building permits. (1360D) SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT (Nonresidential Buildinas Only) Cta6aC Lor,a'tion of Subject Property: IozS6 Property Owner N'amerp[:�, ��Y� �. �..t�.. z�� Phone # Name of the Person Preparing this form in__rinnt and signature Name: +"KN&Mc� AwA,�,E Signature:,/ AL. The person preparing this form muses—b�:—tle same �erson applyingfor .building permits. Please answer the following questions regarding your proposed occupancy of the subje7t building. IF YOU DO NOT KNOW THE ANSWER TO A QUESTION MARK IN THE "YES" COLUMN: AQMD PERMITTING CHECKLIST YES NO 1. Does your facility use any internal combustion engines greater than 50-HP? _ ✓�� 2. Does your facility involve mixing, blending, or processing any solvents, adhesives, paints or coatings? 3. Does your facility create any crusts ,,or smoke? 4. Does your facI111-1 refine any liquids or solids r reclaim any metals? 5. :',- , your facility plate or coat anything? 6. homes your facility have any combustion equipment i.e. boiler, furnaces, broiler, baking ovens, etc.) rated greater than 2,000,000 BTU/HR? 7. Does your facility handle or store solvents or motor fuel? 8. Do you use or store any acids? c� 9. Do you usa any chemical. process? 10. Do you use any solvents for clean-up? .�- 11. Are you a dry cleaner, restaurant with a charbroiler, body shop, gasoline station, printer, or part coater? 12. Imo' the su.�ject building located within one thousand (1,000) feet of any school? r� PROPERTY LINT; TO PROPERTY LINE. GRADES K-12. If you have marked "NO" in all columns, you Go not need an Air Quality permit at this time. If you have marked any questions in the "YES" Column you must contact the South Coast Air Quality Management 'District located at: 21865 E. Copley Drl_�;�e Diamond Bar, CA 91765-4 82 Please call: plan Check (714) 396-2000 1360D-,2) CERTIFICATE OF OCCUPANCY 7 / 0 ; / 9 6 CITY OF HUNTINGTON BEACH Date Address 10056 ADi 1S District (' ROYAL D60UTS & BAKERY 714-378-0980 I, Business Name Tel, FOGD/BAKERY SERVICE B I' Business Type _ Occ. Group BUILDING OWNER BUSINESS OWNER/MANAGER bUSINESS PRO i a 1-IFIGNT LANG YT: LIEE Name Address 1 (531 EITCH ST, City IRVINE Tel. 714-474 -8900 Construction No, of Stories _ Occupant Load CONDITIONS OF APPROVAL Fhis Certificat^ of Occupancy SHALL BE posted in a conspicuous place on the premises and shall not be removed except by the Building Official. Name Home 26521 SRIDLE;,IOOD DR Address LAGUNA HILLSHome 714-582-8712 City Tel, 31 _ Fprinklers DEPARTMENT OF COMMUNITY DEVELOPMENT by _ H -' COMMUNITY DEVELOPMENT . rr f• ,a'� I 01 HUWFINMON Address --le— ' Business Name 9usiness Type LIGATION FOR CERTIFICATE OF OCq CITY OF HUNTINGTON BEACH DEPARTMENT OF COMMUNITY DEVELOPME (PRINT OR TYPIE ONLY) District Te�%�i7 Occ. Group OR BUILDING OWNER BUSINESS OWNER/MANAGER i Name l/S//VG—SS I%)2oi° i2?'i£ lYl /Home Address 12�T7' ST _ Addressf,2�� f�j I City `�12✓/%y��' Te�.4_� City /%Nf} ! !'% —Home Te_'��`y �a• is THIS USE WOULD BE DESCRIBED AS: ❑ NEWLY CONSTRUCTED BLDG V-N CHANGE OF OWNER�r CHANGE OF OCCUPANT EXISTING BUILDING ❑ CHANGE OF USE ❑ ADDITIONAL OCCUPANT l Late former use, if any Occupancy Gr Div. SQUARE FT. OF BUILDING TO BE OCCUPIED ( � f NOTICE: 1. Occupancyof any building is pr, oibited and a business license will not be issued until the building has been inspected and a certificate of occupancy is issued. 2. No electrical service will be released for any existing building until the service has been inspected and certified safe. P!l applicants for occupancy in an existing building are required to schedule an electrical 'fuse up' inspection in the Department of Community Development at the time this application is filed. 3. Change of occupancy or use inspection fee. Whenever it is necessary to make inspection of a building or premises in order to determine if a change may be made in the character of occupancy or use of the building or premises which would place the building in a different division of the same group of occupanry or in a different group of occupancy, a change of occupancy inspection fee of $ — shall be paid to the city. 4. Huntington Beach Fire Code Section 10,208 requires that building numbers must be a minimum of four (4) inches in height with one half (112) inch stroke, and o. a contrasting color from the background. These r numbers must be posted on your building in a location that is visible from the street. 5. Huntington Beach Fire Code Section 10.301 requires fire extinguisher selection and distribution per the National Fire Protection Association pamphlet 10 (see reverse side). t ,01 UP SUPPLEMENTAL INFORMATION TIQ OCCUPANCY GROUP C/ OCCUPANT LOAD NO. OF STORIES A RO Eq DATE (FOR OFFICE USE ONLY) PLAN CHECK NO. PERMIT NO. — ADMIN. ACTION_ CERTIFICATE OF OCCUPANCY FEE CHANGE OF USE OR OCCUPANCY FEE TOTAL 75-039 Rev, 11/90 COMMUNITY DFVELOPMENT ZONING C CQ_ NO PARKING SPACES HEALTH DEPT APPROVAL UTILITIES RELEASED SUPPLEMENTAL INFORMATION 1. BUSINESS ADDRESS %f�/r/l_� �T% . Zly��,/f�/rJiV%�-ri`' 2. Person to contact in case of emergency* f 'y Telephone number: 3. Does the building in question have electricity? Yes ❑ No (a) If No, are you requesting that the electricity be ❑ Yes turned on? ❑ No 4. The building is sprinklered? Yes No5. Operations will produce dust / wood shavings or similar material? Ca Yes ,E4 No 6. Operations will involve the repair or replacement of ❑ Yes automobile parts? No If Yes: (a) Describe the components repaired or replaced. (b) Does the operation involve the use of an open flame? ❑ Yes No 7. The business is drinking, dining or assembly use that will result in an occupant load of more than 50 persons. ❑ Yes No 8. The following best describes my operation; Office_ Only Manufacturing / Distribution (describe process and end product) estaurant / Take Out Food Medical / Dental ,Ake 0)5 Other (describe) SUPPLIMENTAL INFORMATION SUPPLEEMENTAL INFORMATION (Continued) Does the operation involve any of the ollowing materials? L3 Yes No `t Yes, indicate quantities: MaterialQuantity ! 1. Flammable liquids Class I -A Class I-B Class I-C 2. Combustible liquids Class II Class III -A 3. Combination flammable liquids' 4. Flammable gases 6. Liquefied flammable gases 6. _ Flammable fibers - loose _ 7. Flammable fibers - baled 8. Flammable solids �- 9. Unstable materials I 10. Corrosives liquids 1 11. Oxidizing material - gases 12, Oxidizing material - Liquids 13. Oxidizing material - solids 14. Organic peroxides 15. Nitromethane (unstable materials) 16. Ammonium nitrate 17. Ammonium nitrate compound mixtures i containing more thar, 60% nitrate by weight 18. Highly toxic material and poisonous gas 19. Smokeless powder 20. Black sporting powder 1 I hereby certify that the above information Is true ctnd correct to\J the best of my knowledge. / Signature Date i ( South Coast AIR QUALITY MANAGEMENT 9ISTR"CT 21865 E. Copley Drive, Diamond Bar, CA 91765-4182 (9G1) 396-2000 AIR QUALITY PERMIT CHECKLIST for nonresidential buildings only Company I Tame: a Nv7:Y r y Location of Property: _ /eQISS2� mewls A-Vr= . City: ,' rn1T//V /�� A�h� Zip Code: '2�4��/tn Contact Person: �/�� 1--r:-:5 Title: C- ; Telephone Number: 7/ Fax Number: Type of IndustryBusiness: )b D� C'rP To apply for a nonresidential building permit, ,you must complete this checklist. If you have any questions about completing this checklist, please call (800) 388-2121. YES NO 1. Will the facility have a charbroiler? [ ]] 2. Will any internal combustion engine with greater than 50 horsepower operate at the facility (excluding motor vehicles)? [ j 3. Will operations at the facility involve mixing, blending, or processing of solvents, adhesives, paints or coatings? [ ] pfJ 4. 5. Will dust or smoke be generated at the facility? Will refining of any liquids or solids be done at the facility? [ ] 6. Will any plating or coating of materials be done at the facility? [ ] 7. Will any combustion equipment rated greater than 2,000,000 BTU/hr be operated at the facility? [ ] 8. Will any a :ids, solvents, or motor fuel be used or stored at the facility? [ ] ] 9. Will any organic liquids or gases be reacted or produced? [ ] 10. Will an [ ] y ovens be used to dry or cure products at the facility? 11. Will any CFC (Freon) recycling machines operate at the facility? Applicant: LA-i,,!t - LCz—: Signature: name clearly) If you have marked "NO" in all the boxes, an air quality permit is not needed at this time, and this checklist is your written release. If you marked "YES" in any of the boxes, you must contact the South Coast Air Quality Management District (AQMD). Please read the requirements on the back of the checklist. (800) 388-2.121 n