HomeMy WebLinkAbout10116 Adams Ave - CofO (3)APPLICATION FOR CERTIFICATE OF OCCUPANTCY
CITY OF HUNTING T ON BE zCH - DEPARTIVIE T OF BUTILD— 1MG SAII'ET Y
(3"'� Floor — r'4pply lft-c eisosrj
Busln6ss License —,—.'Date
Address L(q f 6 " A-LVYS ,�S p 2 tsh" 'i �f�t/.t/� rstir. �1`&V CX.
Business'Name Tele_ hone
Business Type ({l f S'&OA/
Pro-o— O�vr�er 7n orn_ation Bus,. --ass OvViler
Name 4AiV poklz�Zl_ Narse
Address i `7 6 :?Z •mil,7—ZYY Home address 726l M. � XO 8
City 4damle eCA Tel 17¢ City MINA _ �`f/V Tel.�i�
Tip JSE WO L'I-.E5CR3BEI�5, `�r%b — — 'u`6'3�j �l? �'`F? 7777
O\Tpwly Constructed Building or Existui,g Building
CHECK :ALL THAT APPLY:
Change of OwnerChange of Occupant L'�Change of Use UAdditional Oceupacit
indicate fori:-rer ase, if any
Does the building have electricity? Yes (z No®
If No, are you requesting that the electricity be turned on? Yes El No
The building is sprinklered? Yes n . No
Operations will product dust/wood shavings or similar material? Yes No
Operations will involve the repair or replacement of automobil� parts Yes E No Elf
If yes: Describe the components repaired or replaced.
Does the operation involve the use of welding or open flame? Yes � No
The business is drinking, dining or assembly use that will result in an = ;parlt load
of more than SO persons. Yes No
The followincr best describes my operation:
QOfFice Only QRetail Sales ❑Nledical/Dental ORestaurant/Take Out Food ❑Warehouse
C]Maliufactariug/Distributiorz (describe process and and product
® Other (describe)
Office Use 0711y•
Zoiing, f l✓!'l' Sq Ft Occupied: r/lV Occ Group;�_� Occ Lone:
r, Stories: Parking Spaces: TIr Review: Z'/ NN Anit t aide
Paid BEFORE Final lnspcaion
su
Ile „ Entitlement
Comments. g
Plaluzer Ini`aa
lan Checker Initials:
South Coast
Air Quality Management .District
21865 E. Copley Drive
Diamond Bar, CA 91765-4182
(909) 396-3529 htpp://YaTy-w.agmd.gov
Air Quality Permit Checklist
California Government Code 65850.2 prohibits cities from issuing a Certificate of Occupancy to a business
without clearance from the local air quality agency. This checklist will determine if you reed to obtain.
clearance from the South Coast Air Quality Management District (AQiMD).
Company Name: SaAf"P-C'G'r�
Property Address: I Q f g Afm-IY .
City: id v ! A16G iaN O'Ce"' C 7`i Zip Code: 92 C If6
Contact Person: Z40411 Title: C� A 11-X4 c7-0
Type of Business: Telephony:: () � 2 Z46 3 C? t a
Applicant: (print name) �CtW 0V Signature: x -_
• Will the facility have any of the following equipment? Yes Li No Ud
Charbroiler
Dry cleaning machine
Spray Booth
Printing Press (screen/lithographic/flexographic)
Internal combustion engine (greater than 50H13) (excluding motor vehicles)
Boiler/combustion equipment (greater than ? million BTUTALT. maximum input)
Abrasive blasting cabinet/room
Baghouse/oartridge type dust filter/scrubber
Motor fuel storage and dispensing equipment
C Wi11any of the following operations be performed? Yes ❑. No
Application of paints or adhesives
Etching, plating,. casting, or melting of metals
Molding and blending of liquids and/orpowders
Storage of acidR, ,solvents, organic liquids or fuels
Production of a z olvents, organic liquids, or fuels
Production of L- 4s, dust, smoke or strong odors
• If you answered "No" to both questions, this checklist is your clearance from. AQiViD.
• If you answered "Yes" to either question, you must contact AQNM to determine if air quality permits are
required. If permits are needed, AQMM will assist you in submitting permit application(s) and then provide you
with a clearance letter. You can call kQ11D at their Small Business Assistance Office at (800) 389-2121.
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