HomeMy WebLinkAbout10078 Adams Ave - CofOCERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH
Address 1007�; HDAit;S
Business Name EGG ROLL K' t'G Tel.
Date
District
1�I^�i1i-4�I
TAKE --OUT
:3 i
Business Type
Occ. Group _
BUILDING OWNER BUSINESS OWNER/MANAGER
BUSIP.E;3S
PROPERTTL;�
FART THANH f.41
LAN
Name
Name
Address 1'i 631
FITCH
Address ;217 S.
CLINTER _
igVIOL
714-474-•8900 SANTA AAA
Home 14--545-2"91 1
City
Tel.
City
Tel. _
1 11
Construction
No. of Stories
Occupant Load _ Sprinklers _
i
CONDITIONS OF APPROVAL
Comments:
TAKE~ (, 'I UNLY
DEPARTMENT OF COMMUNITY DEVELOPMENT
This Certificate of Occupancy
`I SHALL BE posted in a conspicuous place nn the
premises and shall not be, emoved except by the by
Building Official. 1
COMMUNITY DEVELOPMENT
PPLICATION FOR CE$TIF,CATC OF OCCUPANCY
a CITY OF HUNTANGTON BEACH
Nurrrn+croa
DEPARTMENT OF COMMUNITY DEVELOPMENT
DATE
(PRINT OR TYPE ONLY)
Address O % /7 r% � ! f �� IoAPveq ct
Business Name -to l r�_ Te
Business Type �G 9 _ _ — —, Occ. Grcip P
BUILDING OWNER
Name
Address
City _Tel _
PJSINESS OWNER/MANAGER
Name `7 Ih Alg Z.
Home
dress 3 2- 7• s` cgk?`_/a_
city Sc^ "` fir _ ��l Z1' Hb6me Tel. N
't
THIS USE WOULD BE DESCRIBED A5:
L� NEWLY CONSTRUCTED BLCG. CHANGE OF OWNER r� CHANGE OF OCCUPANT
�EXI'•TING BUILDING L 1 CHANCE OF USE LI ADDITIONAL OCCUPANT
(Irdicate former use, if any 2!6__Occupancy Gr.�$��Div.
OU^:RE FT. OF BUILDING TO BE OCCUf.ED_�—
NOTICE: 1 Occupancy of any building is -prohibited and a business license will not be issuer) until the building has been
inspected and a certificate of occupancy is issued
2. No electrical service will be re!eased for any existing building until the service ha: been inspected and
certified safe. All applicants fir cccupancy in an existing building are required to schedule an electrical
'fuse Jp' inspection in the Deoertment of Communitv Oeve!opmant at the time this application is filed.
3. Change of occupancy or use inspertion fee. Whenever it is necessary to make inspection of a building or
premises in order to determine if a change may be made it,, the character of occupancy or use of the building
or premises H;,ich would place the bu!!ding 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 papa to the city.
4. Huntington Beach Fire Coda Secth;n 10.208 requires that building numbers must be a minimum of four (4)
inches in height with one half (%) inch stroke, and of a contrasting color from the background. These
numbs:>s must be posted on y, -•r building In a location that is visible from the street.
5. Huntington Beach Fire Cade Section. 10 301 requires fire extinguisher selection and distribution per the
National Fire Protection Association pamphlet 10 (see reverse side).
TRAFFIC IMPACT
DATE PAID
AM0LiNT RECe
NAME _
SUPPLEMENTAL INFOR rlA1 ION
OCCUPANCY GROUP
OCCUPANTLOAD
NO. OF STORIES --
APIA-)V' BY/ DATE`
75.039 Rev, 11/90
(r0 ; OFFICE USE. ONLY)
ZONING (-'�—F?92--
PLAN CHECK NO __ NO. PARKING SPACES —
PERMIT N0. _ — HEALTH DEPT. APPROVAL
ADMIN. ACTION UTiI_IT!ES RELEASED —
CERTIFICATE_ OF Or UPAN17Y FEE
CHANGE OF USE OR O CUPANCY FEE
TOTAL
}!,1 Vier
COKIMU UtMI�PMENT
CERTIFICATE OF OCCUPANCY 9 / 1 2 / 9'5
CITY OF HUNTINGTON BEACH
Dater
Address 10078 ADAMS
District
Business Name EGG ROLL KING Tel. 964-h429
Business Type RESTAURNT Occ. Group B2
BUILDING OWNER BUSINESS OWNER/MANAGER
EDWARD CHUNG EDIJARD CHUNG
Name Name
Add,&ss34 MARIGOLD Home
SADIE _
ty Tel. _ 775-8 (90 Home
City Tel.
20
Construction No. of Stories Occupant Load Sprinklers
CONDITIONS OF APPROVAL
DEPARTMENT OF COMMUNITY DEVELOPMENT
This Certificate of Occupancy F
SHALL BE posted in a conspicuous place on the k ,
premises and shall not be removed except by the by
Building Official.
COMMUNITY DEVELOPMENT
41AM
LOL-9
HUNnNGTON BEACH
U0
APPLICATION FOR CERTIFICATE OF OCCUPA Y �14(�
CITY OF HUNTINGTON BEACH
DEPARTMENT OF COMMUNITY DEVELOPMENT
(PRINT OR TYPE ONLY)
DATE
F ddress D` r" Jl /a I t J 0E DIS!nct )
/Business
�usiness Name L �� I J - �' il�lA` L\ i _ Tel c11 4) -q64-44Type _ \--Occ. Group
BUILDING OWNEn BUSINESS OWNER/MANAGER
Name L \yM Ci lk , ame F_ w 2Q l'.r l C1,tJC-7
�Acdess �-Z1 ddress qBq M8L\4dD i,liz
N y t,� t.i" t ►�1 V`/ 1 t( `�� fly?�-(,i 0 Ity� uN i n3 U ' LL' Home Tel. 7
USE WOULD BE DESCRIBED AS:
NEWLY CONSTRUCTED BLDG CHANGE OF OWNER CHANGE OF OCCUPANT
EXISTING BUILDING ❑ CHANGE OF USE ❑ ADDITIONA . OCCUPANT
to former use, if any .IS IQ td U Occupancy Gr.—Div.
RE FT. OF BUILDING TO BE OCCU46 1 d '�'C .
NOTICE: 1. Occupancy of any building is prohibited and a busines > license will not be issued until the building,"xas 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
1 'fuse up' inspection in the Department of Community Development at the time this application is filed.
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 ur 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.
untington Beach Fiore Code Section 10.208 requires that building numbers must he a minimum of four (4)
hches in height with one half (�/2) inch stroke, and of a contrasting color from .le background. These
numbers must be posted on your building in a location that is visible from the street.
Huntington Beach Fire Code Section 10.301 requires fire extinguisher selection and distribution, per the
National Fire Protection Association pamphle! 10 (see reverse side).
TRAFFIC IMPACT FE`
DATE P A,,D _.,,
AMOUNT RECEIVED
NAME
SUPPLEMENTAL INFORMATIO
OCCUPANCY GROUP
OCCUPANT LOAD
"10. OF STORIES
F VED BY v DATE
4
75-030, Rev. 11/90
(FOR OFFICE USE ONLY)
PLAN CHECK NO.
PERMIT NO. —
ADMIN. ACTION_
CERTIFICATE OF OCCUPANCY FEE
CHANGE OF USE OR OCCUPANCY FEE
TOTAL
COMMUNITY DEVELOPMENT
ZONINGr�
NO PARKING SPACES
HEALTH DEPT. APPROVAL
UTILITIES RELEASED
U
$
$
SUPPLEMENTAL INFORMATION
1. BUSINESS ADDRESS
2. Person to contact in case emergency -
Telephone number: '>i4-R-4 r- L66
3. Does the building in questicn have Electricity?
(a) If No, are you requesting that the electricity be
turned on?
4. The building is sprinklered?
5. Operations will produce dust/wood shavings or similar
material?
6. Operations will involve the repair or replacerr^nt of
automobile parts?
If Yes.
(a) Describe the components repaired or replaced.
Yes
❑ No
❑ Yes
❑ No
❑ Yes
a No
❑ Yes
No
❑ Yes
.0-No
(b) Does the operation involve the use of an open flame? ❑ Yes
9-No
7. The business is drinking, dining or assembly use that will
result in an occupant load of i�iore than 50 persons. ❑ Yes
8-No
S. The following best describes my operation;
Office Only
Retail Sales
Wareham -1se
Manufacturing / Distribution (describe process and end product)
Restaurant/Take Out Food
Medical / Dental
Other (describe)
SUPPLEMENTAL INFORMAITON
11,
SUPPLEMENTAL INFORMATION (Continued)
Does the operation involve any of the following materials? ❑ Yes
No
If Yes, indicate quantities:
Material Quantity
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
5. Liquefied 'flammable gases
6. Flammable fibers - loose
7. Flammable fibers - baled
8. Flammable solids
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 i
- i
18. Highly toxic material and
poisonous gas
19. Smoke,less powder
20. Black sporting powder
i
i
I hereby certify that the above information is true and correct to !'
the best of my knowledge.
Signature Date
I
Government Code Section 65850.2(b) requires that the City of Huntington Beach not issue the final
certificate of occupancy unless the applicant has met or is meeting the requirements of the South
Coast Air Quality Management District (AQMD). The Department of Community Development must
obtain a written release 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 person who applies for permits from the
Department of Commu►tity Development) must complete the check list
which can be obtained either from the Department of Community
Development or at AQMD.
2. If 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 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 applying for building permits.
ADDITIONAL SUPPLEMENTAL INFORMAWN
1/ 6W-A
/ ,
t'
0
SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT
(Nonresidential Buildings Only) n
location of Subject Property:_ �_�_� �_g___F1� �.7`� _- _ �1~�_ :--_ _) �_,j- _� C ?.}_ 646.
Praperty Owner Name:. .�_l,yl�tZ1_.---.�I-1 ��� _ _ __ __-- Phene
Name of the person preparing this form in print and signature.
-Signature.
r
The person preparing this form must be the same person 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:
AQMD PERMITTING CHECKLIST
YES
NO
1.
Does your facility use any internal combustion engines greater than 50HP?
2.
Does your facility involve mixing, blending, or processing any solvents,
adhesives, paints or coatings?
3.
Does your facility create anq dusts or smoke?
4.
Does your facility refine any liqu;ds 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,oaking ovens, etc.) rating greater than 2,000,000 BTU/HR?
7.
Does your fac8ity handle or store solvents or motor fuel?
8.
Do you use or store any acids?
9.
Do you use any chemiu i 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, br part coater?
12.
Is the subject building located within one thousand (1,000) feet of any
v/
t�—
school? PROPERTY LINE TO PROPERTY LINE. GRADES K-12.
If you have marked "NO" in all columns, you do 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 Drive
Diamond Bar, CA 91765-4182
Please call: Plan Check (909) 396-2000
SUPPLEMENTAL INFORMATION
1. BUSINESS ADDRESS 1 U67? A-12411,1f Avg /�u�, j �/ j��� Cc C1,57
2. Person to contact in case of emergency,_frf-��
Telephone number:
3. Does the building in question have electricity?
(a) If No, are you requesting that the electricity be
turned on?
4. The building is sprinklered?
E. Operations will produce dust/wood shavings or similar
material?
6. Operations will involve the repair or replacement of
automobile parts?
If Yes:
(a) Describe the components repaired or replaced.
�4- Yes
❑ No
Yes
❑ No
❑ Yes
❑ No
❑ Yes
® No
❑ Yes
a No
(b) Does the operation involve the use of an open flame? ❑ Yes
❑ No
7. The husiness is drinking, dining or assembly use that will
result in an occupant load of more than 50 persons. ❑ Yes
EL No
8. The following best describes my operation;
Office Only
Retail Sales
Warehouse
Manufacturing / Distribution (describe process and end product)
Restaurant/Take Out Food
Medical / Dental
A,
Other (describe)
SUPPLEMENTAL INFORMATION
SUPPLEMENTAL INFORMATION (Continued)
Does the operation involve any of the following materials? ❑ Yes
® No
If Yes, indicate quantities:
Material Quantity
1. Flammable liquids
Class I A
Class I-B
Class I-C
2. Combustible liquids
Class 11
Class Ill -A
3. Combination flammable liquids
4. Flammable gases
5. Liquefied flammable gases
6. Flammable fibers - loose
7. Flammable fibers - baled
B. Flammable solids
9. Unstable materials
10. Corrosive liquids
11. Oxidizing mate 'ial - gases
12. Oxidizing material - liquids
13. Oxidizing material - solids
14. Organic peroxides
15. Nitromethane (unstable materials)
1i6. 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 a ove information is true and correct to
the best of my kno edg
�0—
g�ature Date
i
I
i
i
.ompany Name:
South Coast
AIR QUALITY MANAGEMENT DISTRICT
2 , 865 E. Copley Drive. Diamond Bar. CA 91765-4182 (909) 396.2000
AIR (QUALITY lERII UT CHECKLIST
for none:identiiaJJ—�ll buildings only
i- C,P A o �iC Ait_.
- U
Location of ProperrV: % ° 6 ?>? 6ZIJ _f xye _
City: % / U &U "!hit 4A44- Zip Code:
Contact Person: 72-64,o a 2712-/ �'/`��`' Title: D / /I -Pit --
Telephone Number. /_y2I L�-42- Fax Number:
Type of Industry/Business: �Lo 0,-�- 7-a e
To apply for a nonresidential building permit, you nus complete this checklist. If you have any
questions about complee,.ng this the^klist, 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 vQcles)?
3.
Will operations at the facility involve =i)dzg, blending, or processing of
solvents, adhesives, paints or coatings? [ ]
[
4.
Will dust or smoke be generated at the facility?
S.
Will refining of any liquids or solids be done at the !aci::.y?
6.
Will any plating or coating of material be done at the facility? [ ]
[
7.
Will any combustion equipment rated greater thorn 2,000,000 BTU/hr be
operated at the facility? [ ]
[
8.
Will any acids, solvents, or motor fuel be used or stored at the facility? [ ]
[
9.
Will any organic liquids or gases be reacted or produced?
10.
Will any ovens be used to dry or cure products at -the facility? [ ]
M
11.
Will any CFC (Freon) recycling machines operate at the facility?
Applicant: 71Mr1f 01,i, signature:
(Print name cl ly) --_77
If you have marked "NO" in L the boxes, an air quality permit is nz needed at this time,
and this checklist i. your written release.
If you marked "YES" in any of the boxes, you raust contact the South Coast Air Quality
Management District (AQMD). Please read � ,_juirements on the back of the checklir-
(800) 386-`_ n
CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH
9t211t't998
Date
Address a f1.1 ;, fi n n a m.: District
Business Name rGGROT,T. ;'! wG Tel. 1!1 7R. f f 17
Business Type CHINESP FOOD TO GO Occ. Group H
BUILDING OWNER BUSINESS OWNER/MANAGER
Name
BUSINESS PRO.PERT!ES DEV Name Elfsti CHING CI -I N
Home
Addressl 7 F g l P T T C' H _ Address 1 7 1 A 5 C Il ri M A T E O Y.
city7 R V .t i4 E; Tel. 7 1 b 7 4 —i++ c3 G CY Home
City FC:TThTkTN �;I;j Tel. 711�-.r;�'�;�q�i7
Construction No. of Stories 1 Occupant Load , T Sprinklers
CONDITIONS OF APPROVAL
D PARTMENT OF OOMMUNITY DEVELOPMENT
This Cer*i'dicate of Occupancy
SHALL BE posted in a conspicuous place on the
premises and shall not be removed except by the by ..
Building Official.
COMMUNITY DEVELOPMENT v
al
.HUN IN TON ffAQ1
Address 1 00
Business Name L-6C
Business Type
,vd -qoc�
APPLICATION FOR CERTIr`CATE OF OCCUPANCY
CITY OF HUN' ' JN BEACH
DEPARTMENT OF CC V,Y DE4,iLOPMENT
(PRINT Or ONLY)
APAHs Avt
ZC1-1-K zip
>� DOD T 0
RI III r)lhlr-' ntA MiCQ
�-j.g; c,41..)-6(�-(
3USINE:
DATE
District
Tol 3zB-FNbtz
Occ.
�3UeT),r�S� PRO c-- d zy��o mblf Q '
Name �//, � � � j/1 13ame c g t �,,
Address 17 b � 1 F— I TC'ij .� IZVTN� C4 2 7 ���1 Add ess Home/� 7 � 1E San f°'�11 co
City 1_RVINT- Tel i 6l�f��i'y— Ayn ill .�Hi
THIS a1Sf WOULD BE DESCRIBED AS: ^�
❑ EWLY CONSTRUCTED BLDG. CHANGE OF OWNER ❑ CHANGE OF OCCUPANT
L�LI EXISTINr 11LDING ❑ CHANGE OF USE ❑ ADDITIONAL OCCUPANT
Indicate forme. , i, if any _4_:AP` 17 P?_ $ l "tqr Occupancy Gr. —Div.
SQUARE FT. OF BUILDING TO BE OCCUPIED I { t)1 2— 547
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.
2. No electrical service wili be released fo, 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 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 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 mphlet 10 (see reverse side).
TRAP1;G-1.t11r,PAGT FEE �1 tl qQ,
DATE PAID "=_._
AMOUNT RECEIVED
NAME (FOR OFFICE USE ONLY)
SUPPLEMENTAL INFOFIMATION
�L
ZONING
OCCUPANCY GROUP PLAN CHECK NO.
NO. PARKING SPACES
OCCUPANT LOAD PERMIT NO.
HEALTH DEPT APPROVAL
NO. Of STP ADMIN. ACTION
UTILITIES RELEASED
L�R:ERTIFICATE OF OCCUPANCY FEE
$ �Se� 0o
APPROVED DATE CHANGE OF USE OR OCCUPANCY FEE
R
T 7TAL
,00
75-039 Rev.1/97 COMMUNITY DEVELOPMENT
�$1 Q
`�'✓ 3✓��8
SUPPLEMENTAL INFORMATION
1.
BUSINESS P0
ADDRESS
2.
Person to contact in case of emergency
Telephone number:_-
s7
3.
Does the building in question have electricity?
8/yes
❑ No
(a) If No, are you requesting that the electricity be
❑ Yes
turned on?
❑ No
4.
The building is sprinklered?
❑ Yes
U/N o
5.
Operations will produce dust/wood shavings or : imilar
material?
❑ Yes
U/No
6.
Operations will involve the repair or replacement of
❑ �'es
automobile parts?
No
If Yes:
(a) Describe the compc.`O)nts repaired or replaced.
(b) Does the operation involve the use of ara open flame? ❑ Xes
No
7. The business is drinking, dining or assembly use that will
result in an occupant load of more than 50 persons. ❑ Xes
No
8. The following best describes my operation;
Office Only
r
Retail Sales
Warehouse
Manufacturing / Distribution (describe process and end product)
Restaurant Take Out Food
Medical / Den
Other (describe) _
SUPPLEMENTAL INFORMATION (Continued)
Does the operation involve any of the following materials?
If Yes, indicate quantities:
Material Quantity
1. Flammable liquids
Class I -A
Class I-B
Class I-C
2. Combustible liquids
Class 11
Class 111-A
3. Combination flammable liquids
4. Flammable gases
5. Liquefied flammable gases
6. Flammable fibers loose
7. Flammable fibers - baled
8. Flammable solias
9. Unstable materials
10. Corrosive liquids
11. Oxidizing material - gases
12. Oxidizing material - liquids
13. Oxidizing material - solids
14. Organic peroxides
15. Nitrornethane (unstable materials)
16. Ammonium nitrate
17. Ammonium nitrate con,00und mixtures
containing more than 0,110 nitrate
by weight
18. Highly toxic material and
poisonous gas
19. Smokeless powder _
20. Black sporting powder
❑ Yes
�No
I hereby certify that the above information is true aid correct to
the best of my knowledge. w r
Signature Date
South Coast
AIR QUALITY MANAGEMENT a!!STRICT
21865 E. Copley Drive, Diamond Bar, CA 91765-4182 (909) 396-2000
,AIR. QUA)L,ITY PERMIT C F ECKI.,IST
for nonresidenti -" buildings only
Company Name: C `'ICI p` 01-pL r �j T
Location of Property: 10 0 7 Q A u
City: t4LtN 12 lei T-° t\,j C (' r Zip Code: r 9
Contact Person: WA NJ (2117t' _ Title:
Telephone Number: 711 '-3 71- Fax Number:
Type of Industr}Business: (2�z2 i z'Sc
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 NOff
1.
Will the facility have a charbroiler?
[ ] fA
2.
Will any internal combustion engine with greater than 50 horsel ower
operate at the facility (excluding motor vehicles)?
3.
Will operations at the facility involve mixing, blending, or processing of
solvents, adhesives, paints or coatings?
4.
Will dust or smoke be generated at the facility?
5.
Will refining of any liquids or solids be done at the facility?
5.
Will any Eating or coating of materia!� be done at the facility?
[ J [ U'
7.
Will any combustion equipment rated greater than 2,000,0001BTU/hr be
facility?
operated at the
8.
Will any acids, solvents, or motor fuel be used or stored at the facility?
9.
Will any organic liquids or gases be reacted or produced?
[ ] [l
10.
Will any ovens be used to dry m_ curs products at the facility?
11.
Will C,FIC (Freon) recycling macHines olicLate at the facility?
iany
Applicant: 'vik �1�► �"U Cf1 �' Signature:
(Print name clearly)
If you have marked "NO" in all the boxes, an air quality permit i5 .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 Sotith Coast Air (quality
Management District (AQMD). Please read the requirements on the back Hof the checklist.
(800) 388-2121
ADDITIONAL SUPPLEMENTAL INFORMAT10ht