HomeMy WebLinkAbout10118 Adams Ave - CofO (2)J�
CERTIFICATE OF OCCUPANCY
CITY OF H"JNTINGTON BEACH
DEPARTMENT OF DEVELOPMENT SERVICES Date
HUNTINGTON BEACH
Address _ _ District_
Business Name—_ Tel.
Business Type Occ. Group
BUILDING VWNER OWNFR(MANAGER
i
N-me � � � � ___ � _ - Name
Address
Address
-City _ _... Tel. City — _ Tel.
!1
1!Construction,..__ No, of Stories ___...Occupant Load---. Sprinklereri
DEPARTMENT OF DEVELOPMENT SERVICES
ax This Certificate of Occupancy
''.LL BE posted in a conspicuous place on
remises and shall not be removed except
by
sae i3uitding Official,
J
M
4.4
WNTiNGTON BEACH
APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HU►iTINGTON BEACH
DEPARTMENT OF DEVELOPMENT SERVICES
(PRiN7" 4R TYPE ONLY)
1 a
BATE
1
Address f t'/ lQ'-''' °C''
64
Business Name �r `�%:�,.s'.i L •
Tel.
9 0-
Business Type
Occ. Group
aUl!.USNG OWNER ..- �
O{MPJERjMANAGER
NameC . a ca`i.r.9lr",'-•^ic--- _ f Name
y
Address t"�}'"�4' _ Address ��'_�.':_�'`.`''�
€:ity�, ?c`�c Tet. ~' �� City
°'x9i
Y"v?� __`fct _
_. Teri. - Via:✓
THIS USE WOULD BE DESCRIBED AS:
Q NEWLY CONSTRUCTED BLDG. CHANGE OF OWNER i CHANGE OF OCCUPANT
EXISTING BUILDING
CHANGE OF USE ADDITIONAL OCCUPANT
Indicate former use, if any _ Occupancy Gr. Div.
NOTICE: 1.
Occupancy of any building is prohibited and a'bi.i iiness 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 existin - building until the service has been inspected
and certified safe. All applicants for occupancy in ,n existing building are recTuired to schedule at!
electrical 'fuse ilp' inspection in the Department of Development Services at the time th?s applica-
tion is fcled.
3.
Change of occupancy or use inspection fee. Whenever it is necessary to make inspection of a build-
ing or premises in order to determine if a change may be made in the character of occupancy or use
V
of the building or premises which would place the bui'.ling in a different division of the :;rime group
of occupancy or in a different group of occupancy, a ;,hange of occupancy inspection fee of $30.00
shall be paid to the city.
4.
Huntington Beach Fire Coda erection 10.208 requires that building numbers must be a minimum
of four (4) inches in height with one half ('fz) inch stroke, and of a contrasting color from the back-
ground. These numbers must be posted an your Building in a location that is visible from the street.
5.
Huntington Beach Fire Code Section 10.301 requires fire extinguisr selection nd distribution
Association 10 (see reverse id
r r —
per the National Fire Protection pamphlet .
SUPPLEMENTAL INFORMATION
SQUARE FT. OF BUILDING
OCCUPANCY GROUP
OCCUPANT LOAD —
NO. OF STORIES
-
APPR VED By- _ ATE
Ili y1K
75-039 REV.
(FOH OFFICE USE ONLY)
PLAN CHECK NO.
PERMIT NO.
ADNNN. ACTION
NO. PARKING SPACES — -
HEALTH DEPT. APPROVAL
UTILITIES RcLEASED
r
CERTIFICATE OF OCCUPANCY FEE $
CHANGE OF OCCUPANCY FEE $
TOTAL $
'D-E EL0 N1 NEfCACE
�J CERTIFICATE 9F OCCUPANCY
CITY OF HUNTINGTON BEACH _
DEPARTMENT OF DEVELOPMENT SERVICES Date
HUNTINGTON BEACH
Address._,.��,�._-..�_,
Business Tel. _
Business Type _ _. __ ,....., _ _.. ___ Occ. Group
BUILDING OWNER OWNER/MANAGER
Name . Name -
Address - ,_ Address,.,.n,, ,..
City, Tel. _ee City _ - - — Tel. -
Constiuction No. of Stories Occupant Load._. ._Sprrnklered_
Notice:
„Cis-artificete of Occup-ncy DEPARTMENT OF DEVELOPMENT SERVICES
SHALL BE posted in a conspicuous place on
the premises and shall not be removed except
by the Building Official by___
"TINGTON BEACI4
Add ress
APPLICATION FOR CCR TI FICAT E OF 0CWPANC
CITY OF HUNTiNOTON I -ACH
DEPARTMENT OF DI~ylirLOlyPM»NT SERV.CES
(PRINT OR TYPe ONLY)
District
Badness Name Tel. ;ry_`t�
Business Typo ,t _ C�.C� c„ - , r�~n'�G`� _.� Occ. Group
BUILDING OWNER n �' UWN1LR MANAGEjR r
AI- Y_�/'�1..a.s.s .I�i.H /< •'"i.:.,.si%r'i.'L...f..�...... S i�lnrv�n �:r::d ."'`..�'F.....�..r <✓Zl".F'.. t:. tY�"ACT.�'C> i'4rL.-o
FiV
& e
Address .,;,31 Address''aP "`_. `'�; , 4 '
ri ,se° t J _ r Tel., 3 r}_. i`�'r� tvi"i ���laG-�n�y+l-'�s—av 1/G�� To!2�%!✓ C
THIS USE WOULD BE DESf GIBED AS:
NEVI'LY COWS T RUC T ED BLDG
:'XISTING BUILDING
Indicate former use, if any
UCHANGE Or OWNER
n CHANGE OF OCCUPANT
CHANGE OF USE ADDITIONAL. OCCUPANT
- Occupancy 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 issuer!.
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 Development Services at the time this applica-
tion is filed. i
3. Change of occupancy or use inspection fee, Yl,'henever it is necessary to make inspection of a build-
ing or premises in order to determine sf 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 occupaoc,.- • in a different group of occupancy, a change of occupancy inspection fee of $30.00
shall be paid to the city.
4. Huntiny�on Beach Fire Code Section 10.208 requires that building nur�bers must be a minimum
of four (4) inches in height with one half (1/2) inch stroke, and of a contrasting color from the bac..-
ground. These number,must be poeted on your building in a location that is visible from the street.
5. Huntington Beach Fire Code Section 10.301 r,)quires fire exth,.guis4er Fi1ection .nd distribution
�-" per the National Fire Protection Association pamphlet 10 (see reverse i F „m
E
SUPPLEMENTAL, INFi.?RMA4ION
SQUARE FT. OF BUILDING_-
OCCUPANCY GROUP 1, %
OCCUPANT LOAD
NO. OF S OR;ES
APPROVED BY IATr
l
(FOR OFFICE U:iE ONLY)
PLAN CHECK NO. NO. PARKING SPACES
PERMIT NO. —__ HEALTH DEPT. APPROVAL
ADMIN. ACTION UTILITIES RELEASED L14 a�
CERTiFIC ATE OF OCCUPANCY FEE $
CHANGE OF OCCUPANCY FEE $
TOTAL_ $
75•Qi3 r�Ev. DEVELOPMENT SERViCES
CERTIFICATE OF OCCUPANCY 5130/9£�
CITY OF HUNTIN.iON BEACH
bate
10 1 '18 ADA133
Address District
R4 CLEANERS 713,-96P —900
i Business Name tS Tel,
7
t Business Type Occ. Group,
EUiLDING OWNER BUSINESS OWNER/MANAGER
j r usINESS P SEQG
i Name Name _
17631 PITCH Home 2337 CONEJO LAME
Address Address
IFVINE, CA 9271 714-474-8900 FULLERTON, pgme 879, 527. -
City Tel. City 10 Tel.
Construction No. of Stories Occupant Load Sprinklers
A
CONDITIONS OF -APPROVAL
it
" DEPARTMENT OF COMMUNITY DEVnLOPMENT
j This Certificate of Occupancy
SHALL BE posted in a conspicuous place on the
premises and shall not be removed except by the y ,
sl +
Building Official.
i�
COMMUNITY DCVFL OPfdlESJT }
I
APPLICKI tON FOR tIFICATE OF OCCUPA,P!
CITY OF HUNTINGTON F3EACF^'�
%� DEPARTMENT OF COMMUNITY JEVELOPME '� _ J
HUH�GroN Kw� `•�% • {PRINT OR TYPE ONLY) ATE g
r
Address _�— .�iYf/�� District
Business Name Telw lq1_�---���-y
"asiness Type Occ. Group ij..
BUILDING OWNER BUSINESS OWNERRIMANAGER
Na lh lh Name.
Home
e
Addr ss 1t` •trJA Address.-�1334 Obh4aYa Lin FEE
city=its° GA+ Q1�fIT—Te1. ' 0Phty_ _ +' —Home Tel.
f
THIS USE WOULD BE DESCRIBED AS
❑ iVEWLY CONSTRUCTED SLOG. LXJ CHANGE F OWNER
L�J CHANGE CF'�CCUPRN7
�j� r
L"J EXISTING BUILDING -� ❑ CHANG OF USE ❑ ADDITIONAL OCCUPANT
Indicate former use, if any J/%r C �''`^��' Occupancy Gr. Div. )
SQUARE FT. OF BUILDING TO BE OCCUPIED O
NOTICE: 1. Occupancy of any building is p hibited and a business license will not be issued until the buildirg has been
inspected and a certificate o occupancy is issued.
2. No electrical service./
ervice will b ro�eased for any existing building until the service has been inspected and
certified safe. All applican for occupancy in an existing building are rewired to schedule an electrical
'fuse up' inspection in th Department of Community Development at the time this application is filed.
3. Change of occupancy use Inspection fee. Whenever if is necessary to make inspection of a building or x
premises in order to d ermine i -a change maybe made in the character of occupancy or use of the building
or premises which w, u!d place the building in a different division of the same group of occupancy or in a
different group of o cupancy, a change of occupancy inspection fee of $ shall
tZr� be paid to the city
�J 4. Huntington Raac Fire Code Section 10.201P, requires that building numbers must bE a minimum of four(4)
inches it Neigh with one half (Yz) inch stroke, and of a contrasting Dolor from the background. These
numbers must a posted on your building in a location that is visible from the street.
5. Huntington B ch Fire Code Section -i0.301 requires fire extinguisher selection and distribution per the
National mire rot
ection Association pamp:-'rt 10 (cec raverse side). �c
/toil. 16.!*
TRAFFIC IMPACT FEE
DATE PAID < t 21cli
d..'AOUNT R CJ11F�.13
IVAtJIE
fFOR OFFICE USE ONLY)
SUPPLEMENTAL INFORM ION ZONING
OCCUPANCY GROUP PLAN CHECK NO. NO. PARKING SPACES _
OCCUPANT LOAD PERMIT NO. __ _ HEA�_TH DEPT- APPROVAL
NO. OF STORIES ADMIN. ACTION — UTILITIES RELEASED
CERTIFICATE OF OCCUPANCY FEE $
j:�k/PPROVECL45Y DATE CHANGE OF USE OR OCCUPANCY FEE g� -
TOTAL g
7"39 Rev. 11190 COMMUNITY DEVELOPMENT
t
r
,' l
r�
y
SUPPLEMENTAL INFORMATION
If ill
1.
BUSINESS ADDRESS Lod Ajo,.4111je`_�#
2.
Person to contact n case of emergency OfT�
Tetaphone number:
3.
Roes the building in question have electricity?
Yes l ;
0 No
(a) If No, are you requesting that the electricity be
❑ Yes
turned on?
ED No
4.
The building sprinklered`?
❑ Yes
C 'No
5,
Operations will produce dust/wood shavings or similar
material?
ff—yes
❑ No
6.
Operation:., will involve the repair or replacement of
❑ Yes
%t
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
viill
result in an occupant load of more than 50 persons.
❑ Yes
V No
8.
The following best describes my operation;
II
Office Only
I,
`etail Sales
Warehouse
Manufacturing / Distribution (describe- process and end
product)
Restaurant / Take Out Food
Medical / Dental
Other (descr;be) �c�-�► 5 t-V
.
`�
i
1
SUPPLEMENTAL INFORMATION (Continued) �
j
Does the operatiun , involve any of the following materials? ❑,Yes
If Yes, indicate quantities:
Material
1. Flammable liquids
Class I -A
Class I-B
Class I-C
2. Combustible liquids
Class 1
3.
Crass ill -A
Combination flammable liquids
Ouara
4. Flammable gases
5. Liquefied flammable gases
6. Flammable fibers - loose
7. Flammable fibers - baled
8. Flammable solids
0.
10
11
12
Unstable materials
Corrosive liquids
Oxidizing material - rases
Oxidizing material - liquids
13. Oxidizing material - solids
14. Organic peroxides
-
15. Nitromethene (unstable materials)
16, Ammonium nitrate
17. Ammonium nitrate compound mixtures
- containing more than 60% nitrate
by weight
18. Highly toxic material and � � = '
poisonous gas j
19. Smokeless povider
20. Black sporting powder - r;
hereby certify that the above information is true and correct to J
the best of my knowledge.
;r
4 10'
/" -
Signature
iF
SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT
(Nonresidential Buildings Only)
Location of Subs';ct Property:-�i_$._- f�,�C,, --_ t, -- `-� • t3 •�_ fi`t-�J
Property Owner NamEr I Phone # —zi _--�- fZ f
Name of the person preparing t"iis form in print and signature: r
Name: Signature:
The person preparing this form must be the same person applying:'r)r building permits. Please answer the
following questions regarding your proposed occupancy of the subjoct building. IF YOU DO NOT KNOW
THE ANSWER TO A QUESTION, MARK IN THE "YES" COLU: 1N:
AGIVID PERMITTING CHECKLIST
YES NO
1. DoPs your facility use any internal combustion engines greater than 50HP?
2. Does your facility involve mixing, b1Ei,,;ing, or processing any solvents,
adhesives, paints or coatings?
3._ Does your facility create arry dusts or smoke? 4. Does your facility reline any liquids or solids or reclaim any metals? ,
5. Does your facility plate or scat anything?
r
6. Does your facility have :any combustion equipment (i.e. boiler, furnaces,
broiler, baking ovens, etc.) rat;ng greater than 2,000,000 BTUIHR? _ 1/
7. Does your facnity handle or store solvents or motor fuel?
8_ Do you use or store any acids? _
9. Do you use any chemical process? j
10. Do you use any solvents for clean-up?
11, Are you a dry cleaner, restaurant with a c.harbroiler, body shop, gasoline
station, printer, br part coater? _ —
12. Is the subject building locates; within one thousand (1,000) feet of any .
schoo(? PROPERTY LINE TO PROPERTY LINE, GRADES K-12.yyy
If you have marked "NO" in all columns, you do not need an Air Quality parnit at this time. If you have marked
any questions in the "VES" column you must contact the South Coast Air Quality Management District io%;ated at:
1,
21865 E. Copley Drive
Diamond Bar, CA 91765-4182
Please call: Plan Check (909) 396-2000
�t
1
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ri
1�
SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT Permit No.
21865 East Copley Drive, Diamond Bar, i ;A 91765 D97875
PERAUT TO OPERATE fvN 313982
Page 1 .. i�
This initial permit shall be renewed ANNUALLY unlec� the equipment is moved or than ownership. If the
P� g P
�iEiinaVfne•,Annnal ranPutal_faP ![rt4P '3f11 F1 is not rpraiv ±rl hT fhp Pmiratinn dntPwrnnfar} fh r •Tle�nc} -
71
Legal Owner ID 108279
Or Operator: R CLEANERS, SEOG H CHOI, DBA
ATTN: SEOG H CHOI (OWNER)
10118 ADAMS AVE.
r'
HUNTINGTON BEACH, CA 92646
Equipment
located at: ,AME AS ABOVE
Equipment uzscription:
SYNTHETIC SOLVENT DRY CLEANING UNIT, MULTIMATIC, MODEL SHOP STAR 300 CS, WITH s
A BUILT-IN REFRIGERATED VAPOR CONDENSER.
Conditions:
1. OPERATION OF THIS EQUIPMENT SHALL BE CONDUCTED IN COMPLIANCE WITH LL
DATA AND SPEC'FICATIONS SUPMITTED WITH THE APPLICATION UNDER. Wfl,!,H
THIS PERMT IS ISSI;ED UNLESS OTHERWISE NOTED BELOW.
2. THIS EQUIPMENT SHALL BE PROPERLY MAINTAINED AND KEPT IN GOOD �E
OPERATING CONDITION AT ALL TIMES.
:i. THE TOTAL QUANTITY OF SOLVENT THAT IS REPLENISHED IN 'THIS EQUIPMENT
SHALL NOT EXCEED 10 GALLONS PER MONTH.
4. THE TO'. AL AMOUNT OF REACTIVE ORGKI IC COMPOUNDS (JROG) EMITTED FROM
THIS EQUIPMENT SHALL NOT EXCEED 150 POUND(S) PER MONTH WHICH
C('=tRES DNDS TO A 5 POUND(S) PER DAY 30-LAY AVERAGE.
5, A TEMPERATURE GAUGE WITH A MINIMUM RANGE FROM 0 DEGREES FAH.RENHEIT
TO 150 DEGREES FAHRENHEIT SHALL BE INSTALLED IN THE OUTLET DUCT OF THE
CONDENSER.
i
I. 6. THE REFRIGERATION CONDENSER ON THE RECLAIM TUMBLER UNIT SHALL: BE
OPERATED DURING THE CLOSED LOOP COOL DOWN PERIOD UNTIL THE AIR
TEMPERATURE FROM THE CONDENSER OUTLET IS 45 DEGREES FAHRENHEIT t1
LOWER. E
j
?. COMPLETE RECORDS OF MONTHLY REPLENISHED SOLVENT SHALL BE MAINTAINED
AND KEPT FOR AT LEAST TWO YEARS. THE RECORDS SHALL BE IN A FORMAT
ACCEPTABLE TO THE EXECUTIVE OFFICER AND SHALL BE MADE AVAILABLE TO
( THE DISTRICT UPON REQUEST.
f
OR F INAL CO2Y
t
V, P
x
SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT Permit No.
l 21865 East Copley Drive, Diamcnd Bar, CA 91765 D97875
A/N 313982
t— PERMYT TO OVERATE �aBR
CONTINUATION OF PERMIT TO OPERATE
NOTICE
IN ACCORDANCE WITH RULE 206, THIS PERMIT TO OPERATE OR COPY SHALL BE r./STED
ON OR WITHIN 8 METERS OF THE EQUIPMENT.
THIS PERMIT DOES NOT AUTHORIZE TIM EMISSION OF AIR CONTAMINANTS IN EXCESS OF
rT.TnQP AT T OWFT) RV I)IVTSTnN 26 OF TffF. HF,AT.TH ANT) SAFF,TV CODF OF THE STATF, OF
PPG iNDUSTRIES, INC.
* * * PERCHLOROETHYLENE
ONE PPG PLACE
MSDS NUMBER: 0041
DATE: 11/16/93
EDITION: 015
TRADE NAME: PERCHLOROETHYLENE
CHEMICAL NAME/SYNONYMS: TETRACHLOROETHYLENE., DERCHLORETHYLENE, PERCHLOR
CHEMICAL FAMILY: HALOGENATED HYDROCA 20N
FORMULA: CCL2=CCL2 CAS NUMBER: 000127 18 4
U.S. DOT SHIPPING NAME: TETRACHLOROETHYLEN$
f U.S. DOT HAZARD CLASS: 6.1 (HARMFUL - STOW AWAY FROM FOODSTUFFS)
SUBSID,ARY RISK: N/A
I.D. NUMBER: UN1897
PACKING GROUP: III
�. REPORTABLE QUANTITY: 100 LBS/45.4 KG
MARINE POLLUTANT
------ -- -- --------------------- -------- - f
' SECTION i * PHYSICAL DATA
BO%LING POINT C 760 MM HG: 121 C
VAPOR DENSITY (`,IR=1): 5.83
SPECIFIC GRAVITY (H2O=1) 1.6 @ 20/20 C
PH OF SOLUTIONS: 6.8 TO 8.4
FREEZING/MELTING POINT: -22.3 G
SOLUBILITY (WEIGHT % IN WATER): 0.015% @ 25 C
BULK DENSITY: 13.6 LBS/GAL @ 20 C
VOLUME % VOLATILE: 100
VAPOR PRESSURE: 14.2 MM HG @ 20 C -
EVAPORATION RATE: (ETHYL ETHER=1): 0.09
HEAT OF SOLUTION: N!A
APPEARANCE AND ODOR:
CLEAR, COLORLESS LIQUID WITH ETMER-LIKE ODOR. j
-- --------------------- -- ------------------ -- ---- -
SECTION 2 * INGREDIENTS
MATERIAL PERCENT
PERCHLOROETHYLENE (STABILIZED) > 99
I
* k 24-HOUR EMERGENCY ASSISTANCE: (304) 843-1300 it rk ,F
ateria Safet Data Sheet
FORM 6372 Rev. 3.96
�y 1
i
PPG INI)USTRIES, INC. ONE PPG PLACE
** PERCHLOROETHYLENE
11/16/93
------------------------------------------- '------ ---------------------------------------
SECTION 3 * FIRE/EXPLOSION HAZARD DATA
FLASH POINT (METHOD USED);
NONE (BY DOT TEST METHOD)
FLAMMABLE LIMITS IN AIR (% BY VOLUME)
LEL: NONE
UEL: NONE
EXTINGUISHING MEDIA:
WATER, DRY CHEMICALS, OR CARBON DIOXIDE
SPECIAL FIRE FIGHTING PROCEDURES:
FIRE FIGHTERS SHOULD WEAR NIOSH/MSHA -.-ROVED PRESSURE DEMAND SELF-CONTAINED '
BREATHING APPARATUS FOR POSSIBLE EXPOSURE TO HYDROGEN CHLORIDE AND POSSIBLE
TRACES OF PHOSGENE.
UNUSUAL FIRE AND EXPI `SION HAZARDS:
PERCHL•OR INVOLVED IN FIRES CAN DECOMPOSE TO HYDROGEN CHLORIDE AND POSSIBLE
TRACES OF PHOSGENE.
--------•------ ---- --
SECTION 4 * HEALTH HAZARD DATA
TOXICITY DATA:
LC50 INHALATION: (RAT) 4000 PPM (4 HOURS)
LD50 DERMAL: NOT DETERMINED
SKIN/EYE IRRITATION: SEE SECTION 5
LD59 INGESTION: (RABBIT) 5000 MG'/KG `
FISH,LC50 (LETHAL CONCENTRATION): 9E HR TLM: 100-10 PPM
CLASSIFICATION
INHALATION: MODERATELY TOXIC
SKIN: NOT DETERMINED
SKIN/EYE: MILDLY IRrIT:ATING / IRRITANT 4
INGESTION: SLIGHTLY TOXIC
AQUATIC: TOXIC
SECTION 5 * EFFECTS OF OVEREXPOSURE
24-HOUR EMERGENCY ASSISTANCE: (304) 843-1300
FORM 6372 Rev, 3-88 Material Safety Data Sheet
iF
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O
12
PF = INDUSTRIES, INC. ONE PPG PLACE PITTSBURGH, PA15272
* * PERCHLORGETHYLENE _
11/16/93 PAGE 3
IS CHEMICAL LISTED AS A CARCINOGEN OR POTENTIAL CARCINOGEN?
NTP - YES IARC - YES OSHA - YES
MEWCAL CONDITIONS GENERALLY AGGRAVATED BY EXPOSURE:
PROLONGED EXPOSURE ABOVE THE OSHA PERMISSIBLE EXPOSURE LIMIT MAY COMPLICATE
EXISTING :LIVER AND KIDNEY DISEASES.
PERMISSIBLE EXPOSURE LIMITS:
OSHA: 25 PPM, 8-HOUR TWA (TIME WEIGHTED AVERAGE); 29 CFR 1910.1000,
TABLE Z-2,, REV. 3/1/89. NOTE: THE 1971 LIMIT TS 100 PPM, S-HOUR TWA.-
ACGIH: 25 PPM, 8-HOUR TWA; 100 PPM, 15-MINUTE STEL (SHORT-TERM EXPOSURE
LIMIT).
PPG INTERNAL PERMISSIBLE EXPOSURE LIMIT: 25 PPM, 8-HOUR TWA; 100 PPM, STEL.
ACUTE:
INHALATION: PERCHLOROETHYLENE IS PRIMARILY A CENTRAL NERVOUS SYSTEM
DEPRESSANT AND CAN CAUSE POSSIBLE CENTRAL NERVOUS SYSTEM DAMAGE WITH
OVEREXPOSURE INHALATION CAN CAUSE IRRITATION OF THE RESPIRATORY TRACT,
DIZZINESS, NAUSEA, HEADACHE, LOSS OF COORDINATION AND EQUILIBRIUM,
UNCONSCIOUSNESS AND EVEN DEATH IN CONFINED OR POORLY VENTILATED AREA.
FATALITIES FOLLOWING SEVERE ACUTE EXPOSURE TO VARIOUS CHLORINATED
SOLVENTS HAVE BEEN ATTRIBUTED TO VENTRICULAR FIBRILLATION.
EYE/SKIN: LIQUID SPLASHED IN THE EYE. CAN RESULT IN DISCOMFORT, RAIN AND
IRRITATION. PROLONGED OR REPEATED CONTACT WITH LIQUID ON THE SKIN CAN
CAUSE IRRITATION AND DERMATITIS. THE PROBLEM MAY BE ACCENTUATED BY
LIQUID BECOMING TRAPPED AGAINST THE SKIN BY CONTAMINATED CLOTHING AND
SHOES, AND SKIN ABSORPTION CAN OCCUR.
INGESTION: SWALLOWING OF THIS MATERIAL MAI RESULT IN IRRITATION OF
THE MOUTH AND GI TRACT ALONG WITH OTHER EFFECTS AS LISTED ABOVE FOR
I INHALATION. VOMITING AND SUBSEQUENT ASPIRATICA INTO THE LUNGS MAY
LEAD TO CHEMICAL PNEUMONIA AND PULMONARY EDEMA WHICH IS A POTENTIALLY
FATAL CONDITION.
CHRONIC:
PROLONGED EXPOSURE ABOVE THE OSHA PERMISSIBLE EXPOSURE LIMITS MAY RESULT
IN LIVER AND KIDNEY DAMAGE. PERCHLORO'ETHYL•ENE HAS BEEN EXTENSIVELY
STUDIED FOR ITS CANCER POTENTIAL. A RECENT NTP STUDY HAS DETERMINED
THAT THERE IS CLEAR EVIDENCE OF CARCINOGENICITY (LIVER) IN BOTH MALE AND
FEMALE MICE, CLEAR EVIDENCE OF 1-YUKEMIA IN MALE AND FEMALE RATS AND SOME
EVIDENCE OF ANIMAL CARCINOGENICITY (KIDNEY TUMORS) IN MALE RATS. THE
NTP STUDY EXPOSED RATS TO 200 AND 400 PPM AND MICE TO 100 AND 200 PPM
IN A LIFETIME STUDY. PRUDENT HANDLING PRACTICES SHOULD BE FOLLOWED TO
* The 1989 limits have been invalidated by court action. The
enforceable limit is i00 ppm. we recommend compliance with the
ACHIH limit.
* * * 74-HOUR EMERGENCY ASSISTANCE: (304) 843-1300
'.. FORM 6372 Rev. a'-88 Material Safety Da t o Sheet
L
I'Ki INUUS T Rlii5, INC. ONE PPG PLACE PITTSBURGH, PA 15272
* * P�;iRCHLUROETHYLENE ��
11/16/93 PAGE 4
MINIAIZE HUMAN EXPOSURE.
PERCHLOROETHILENE IS LISTED i-NDER !ARC AS A 2B.
------------------------------------------------- I -----------------------------
EMERGENCY AND FIRST AID PROCEDURES
INHALATION:
REMOVE TO FRESH AIR, IF NOT BREATHING, GIVE ARTIFICIAL RESPIRATION,
PREFERABLY MOUTH-TO-MOUTH. IF BREATHING IS DIFFICULT, GI'✓E OXYGEN.
CALL A PHYSICIAN.
EYE OR SKIN CONTACT:
FLUSH EYES AND SKPi' WITH PLENTY OF WATER (SOAP AND WATER FOR SKIN) FOR
AT LEAST 15 HINUTES, W!13'LE RE14OVING CONTAMINATED CLOTHING AND SHOES. IF
IRRITATTON OCCURS, CONSULT A PHYSICIAN, THOROUGHLY CLEAN CONTAMINATED
CLOTHING AND SHOES BEFORE REUSE OR DISCARD.
!NGESTION :
IF CONSCIOUS, DRINK LARGE QUANTITIES OF WATER. DO NOT INDUCE VOMITING:
TAKE IMMEDIATELY TO A HOSPITAL OR PHYSICIAN. IF UNCONSCIOUS, OR IN
CONVULSIONS, TAKE IV112bIATELY TO A HOSPITAL. DO NOT ATTEMPT TO GIVE
A'NYTHI"'G BY MOUTH TO AN UNCONSCIOUS PERSON.
NOTES TO PHYSICIAN (INCLUDING ANTIDOTES):
ONLY ADMINISTER ADRENALINE AFTER CAREFUL„ CONSIDERATION FOLLOWING PERCHLORO-
ETHYLENE OVEREXPOSURE. INCREASED SENSITIVITY OF THE HEART TO ADRENALINE
MAY BE CAUSED BY OVEREXPOSURE TO PERCHLOROETHYLENE.
.'iECTION 6 * REACTIVITY DATA
STABILITY: STABLE
CONDITIONS TO AVOID: OPEN FLAMES, HOT GLOWING SURFACES OR ELECTRIC ARCS
HAZARDOUS POLYMERIZATION* WILL NOT OCCUR
CONDITIONS TO AVOID: NONE
INCOMPATIBILITY (MATERIALS TO AVOID):
NONE
HAZARDOUS DECOMPOSITION PRODUCTS:
:HYDROGEN CHLORIDE AND PO.'SIBLE TRACES CY PHOSGENE
}
±, * i 24-HOUR EMERGENCY ASSISTANCE: a04) 843-1300 it it
FORM 502 Rev. ;I.6d
Ma�teral Safety Data
Sheet
r
o
PPG INDUSTRIES, INC.
.t PERCH LOROETHYLENE
11/16/93
AM �1
ONE PPG PLACE
PITTSBURGH, PA '16272
PAGE 5
SECTION 7 * SPILL OR LEAK PROCEDURES
STEPS TO BE TAKEN IF MATERIAL IS SPELLED OR RELEASED:
IMMEDIATELY EVACUATE THE AREA AND PROVIDE NAXIMUM VENTILATION. UNPROTECTED
PERSONNEL SHOULD MOVE UPWIND OF SPILL. ONLY PERSONNEL EQUIPPED WITH PROPER,
RESPIRATORY AND SKIN/EYE PROTECTION (SEE SSCTION 8) SHOULD BE PERMITTED IN"
AREA. DIKE AREA TO CONTAIN SPILL. TAKE PRF.CAu'TIONS A3 NECESSARY TO PREVENT
CONTAMINATION OF GROUND AND SURFACE WATE::S. RECOVER SPILLED MATERIAL ON
ADSORBENTS, SUCH AS SAWDUST OR VERMICULITE, AND SWEEP INTO CLOSED CONTAINERS
FOR DISPOSAL. AFTER ALL VISIBLE TRACES, INCLUDING IGNITABLI: VAPORS, HAVE
BEEN REMOVED, THOROUGHLY WET VACUUM THE AREA. DO NOT FLUSH TO SEWER. IF
AREA OF SPILL IS POROUS, REMOVE AS MUCH EARTH AND GRAVEL, ETC. AS NECESSARY
AND PLACE IN CLOSED CONTAINERS FOR DISPOSAL.
WASTE DISPOSAL METHOD:
CONTAMINATED SAWDUST,VERMICULITE,SOIL OR PORGUS SURFACE MUST BE DISPOSED OF
IN A PERMITTED HAZARDOUS WASTE MANAGEMENT FACILITY. RECOVERED LIQUIDS MAY BE
REPROCESSED OR INCINERATED OR MUST BE TREATED IN A PERMITTED HAZARDOUS WASTE
MANAGEMENT FACILITY. CARE MUST BE TAK.6N WHEN USING OR DISPOSING OF CHEMICAL
11ATERIALS AND/OR THEIR CONTAINERS TO PREVENT ENVIRONMENTAL CONTAMINATION.
IT IS YOUR DUTY TO DISPOSE OF THE CHEMICAL MATERIALS AND/OR THEIR CONTAINERS
IN ACCORDANCE WITH THE CLEAN AIR ACT, THE CLEAN WATER ACT, THE RESOURCE
CONSERVATION AND RECOV>RY ACT, AS WELD AS ANY OTHER RELEVANT FEDERAL, STATE,
OR LOCAL LAWS/REGULATIONS REGARDING DISPOSAL.
------------------------------------------------------------------------------------------
SECTION 8 * SPECIAL PROTECTION INFORMATION
RESPIRATORY PROTECTION:
USE A HALF OR FULL FACEPIECE ORGANIC VAPOR CHEMICAL CARTRIDGE OR CANISTER
RESPIRATOR WHEN CONCENTRATIONS EXCEED PERMISSIBLE L'IM.7TS. USE SELF-
CONTAINED BREATHING APPARATUS (8CBA) OR FULL FACEPIEL;E AIRLINE RESPIRATOR
WITH AUXILIARY SCBA OPERATED IN THE PRESSURE DEMAND MOD! FOR EMERGENCIES
AND FOR ALL WORK PERFORMED IN STORAGE VESSELS, POORLY VENTILATED ROOMS, AND
OTHER CONFINED AREAS. RESPIRATORS MUST BE APPROVED BY NTOSH OR MSHA. THE
RESPIRATOR USE LIMITATIONS MADE BY NIOSH/MSHA AND BY THE MANUFACTURER MUST
BE OBSERVED. RESPIRATORY PROTECTION PROGRAMS MIDST BE IN ACCORDANCE WITH
29 CFR 1910.134.
VENTILATION(TYPE) :
USE LOCAL EXHAUST OR DILUTION VENTILATION AS APPROPRIATE TO CONTFOL
EXPOSURES TO BELOW PERMISSIBLE LIMITS.
rt * * 24-HOUR EMERGENCY ASSI447ANGE: (304) 843-1,300
FORM 6372 Rec 3-83 Material
Safety
Data
Sheet
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FPG INDUSTRIES, INC. ONE PPG PLACE PITTSBURGH, PA 15272
* PERCHLOROETHYLENE
11/16/93 PAGE 6 j
EYE PRO'"LCTION:
SPLASHPRUOF GOGGLES
GLOVES:
VITON(R), SILVER SHIJ.LD(R).
FOR L1.13ITED SERVICE ONLY: NITRILE AND
POLYVINYL ALCOHOL (DEGRADES IN ;-]ATER).
OTHER PROTECTIVE EQUIPMENT:
BUTS, APRONS, OR CHEMICAL SNITS SHOULD BE UCED WHEN NECESSARY TO PREVENT
SKIN CONTACT. PERSONAL PROTECTIVE CLOTHING AND USE OF EQUIPMENT MUST BE
IN ACCORDANCE WITH 29 CFR 1910.132 AND 29 CPR 1910.133.
SECTION 9 * SPECIAL PRECAUTIONS
PRECAUTIONS TO .- F TAKEN DURING HANDLING AND STORING:
• CANCER 11"FORMATION: HAS CAUSED CANCER IN CERTAIN LABORATORY ANIMALS,
OF QUESTIONABLE RELEV�`NCE TO HUMANS. ,
• DO HOT USE IN POORLY VENTILATED OR CONFINED SPACES WITHOUT PROPER
RESPIRATORY PROTECTION (SEE SECTION 8)
• PERCHLOROFTHYLENE VAPORS ARE HEAVIER THAN .IR AND WILL COLLECT IN LOW
AREAS.
• KEEP CONTAINER CLOSED WHEN NOT IN USE.
• STORE ONLY IN CLOSED, PROPERLY LABELED CONTAINERS.
• THIS MATERIAL OR ITS VAPORS WHEN IN CONTACT WITH FLAMES, HOT GLOWING
SURFACES Ob. ELECTRIC ARCS CAN DECOI4POSE TO FORM HYDROGEN CHLORIDE GAS
:AND TRACES OF PHOSGENE.
a, AVOID CONTAMINATION OF WATER SUPPLIES. HANDLING, STORAGE AND USE
PROCEDURES MUST BE CAREFULLY NOWTORED TO AVOID SPILLS OR LEAKS. ANY
SPILL OR LEAK HAS THE POTENTIinL ;0 CAUSE UNDERGROUND WATER CONTAMINATION
VHIGH MAY, IF SUFFICIENTLY SEVERE, RENDER _'f DRINKING WATER SOURCE UNFIT
FOR HUMAN CONSUMPTION. CONTAMINATION THAT POES OCCUR CANNOT BE 'EASILY
CORRECTED.
* A CHLORINATED SOLVENT USED AS A FLASHPOINT SUPPRESSANT MUST BE ADDED IN
SUFFICIENT QG NTITY OR THE RESULTANT MIXTURE MAY HAVE A FLASHPOINT LOWER
THAN THE FLAMMABLE COMPONENT.
*'DO NOT USE CUTTING OR WVLDING TORCHES ON DRUMS THAT CONTAINED,iERCHLORO—
ETHYT!Eiu UNLESS PROPERLY PURGED AND CLEANED. J
OTHER PRECAUTIONS:
• DO ,NOT BREATHE VAPORS. HIGH VAPOR CONCENTRATIONS CAN CAUSE DIZZINESS,
UNCONSCIOUSNESS, POSSIBLE CENTRAL NERVOUS SYSTEM DAMAGE OR DEATi. LONG—
TERM OVEREXPOSURE MAY CAUSE LIVER/KI'DNEY INJURY.
* USE ONLY WITH ADEQUATE VENTILATION, VENTILATION MUST BE SUFFICIENT TO a
LIMIT EMPLOYEE EXPOSURE TO PERCHLOROETHYLENE BELOW PERMISSIBLE EXT'OSUR$ j
t * 24-HOUR EMERGENCY ASSISTANCE: (304) 843-1300 �t it 7t
FORM 63n Rev. 3-88 Material Sa$ety Data Sheet
Inc
PPG INDUSTRIES, INC. ONE PPG PLACE PITTSBURGH, PA 16272
* * PERCHLGROETHYLENE -�-�
11/16/93 PACE 7 r�
LIMITS. OBSERVANCE OF LOWER LIMITS (OUTLINED IN SECTION 5) IS ADVISABLE.
AVOID CONTACT WITH EYES. WILL CAUSE IRRITATION AND PAIN.
,VOID PROLONGED OR REPEATED CONTAV"T WITH SKIN. MAY 'CAUSE IRRITATION OR
DERMATITIS.
Lr DO NOT SWALLOW. SWALLOWING MAY CAUSE INJURY OR DEATH.
DO NOT EAT, DRINK, OR SMOKE IN WORK AREA.
COMMENTS:
TSCA - PERCHLOROETHYLENE IS LISTED ON THE TSCA INVENTORY UNDER CAS
NO. 127-18-4.
SARA TITLE III - A) 311/312 CAIZOORIES - ACJ76,. CHRONIC, B) LISTED IN
SECTION 313 UNDER TETRACHLOROETHYLENE, C) NOT "L•ISTED AS AN "EXTREMELY
HAZARDOUS SUBSTANCE" IR; SECTION 302.
CERCLA - .LISTED IN TABLE 302.4 OF 40 CFP, PART 302 AS A HAZARDOUS SUBSTANCE
WITH A REPORTABLE QUAK:7ITY OF 100 POUNDS. RELEASES TO AIR, LAND OR WATER j
WHICH ENCEr,D THE RQ MUST BE REPORTED TO THE NATIONAL RESPONSE CENTER, ¢_
$:)0-424-3802.
f
RCRA - WASTE PERCHLOROETHYLENE AND CONTAMINATLD SOILS/MATERIALS FROM
SPILL CLEAN-UP ARE U210 HAZARDOUS WASTE AS PEI 40 CFR 261.33 AND MUST BE
DISPOSED OF ACCORDINGLY UNDER RCRA. SEE 40 CFh 261.33(C) AND 261.7(B)(3)
OR TRIPLE RINSING REQUIREMENTS FOR EMPTY DRUMS.
�a
CALIFORNIA PROP. 65 - THIS PRODUCT IS A CHEMICAL KNOWN TO THE STATR OF
CALIFORNIA TO CAUSE CANCER.
i'
l
NEW JERSEY is uHT-TO-KNOW - GREATER THAN 99% PURE, NO COMPONENT INFORMATION
REQUIRED.'
CANADA WHMIS - SENSITIZATION TO PRODUCT: NONE KNOWN, B) REPRODUCTIVE
TOXICITY: NONt KNOWN; C) ODOR THRESHOLD: APPROXIMATE'Y'50 PPM; D)
PRODUCT USE: DRY CLEANING SOLVENT; E) REQUIRES POISON SYMBOL (CLASS
D.1),
REVISIONS MADE TO 7/12/93, 14TH EDITION - DATE, EDITION, ADDED 1971 OSHA
LIMIT AND UPDATED ACGIH LIMIT (SECTION 5)
R. KEN►vT_H LEE
MANAGER, PRODUCT SAFETY
24-HOUR EMERGENCY ASSISTANCE: (304; 843-1300
FARM 6372 R.,,, 3-88
Material Ssat¢V,ty Data Sheet
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BWT #7166 Pg.
CARCINOGENS
This product container no known carcirogens.
'
Section V Spill, Leak and Disposal Procedures
SPILT. CONTROL
Small Spill: Flush area with water to an industrial sewer dine.
f%
--4,rge Spill: Contain spill with dikes of aosorbant materials such as clay,
I sand or verminculate. This material is not considered hazardous aid
;>J
may be disposed of as non -hazardous refuse.
i
WASTE DISPCSAL
All hazardous materials ;must be solidified and disposed of in an EPA approved
'
class one facility. When disposing of chemicals, contact local, stag and federal
"!
environmental agencies to fully understand the necessary regulations guverning the
disposal of chemical wastes.
Section VI Fire and Explosion Hazards
Flash Point: None Method: Average
J
Flammable Limits in Air: P/A Lower: N/A
Fire Extinguishing Materials: Sand, Dry Chemical, Dry Foam, Halon & Water.
Special Fire Fighting Procedures: This product will not burn or support combustion.
Unusual Fire and Explosion Hazards: None
1
Under normal conditions, hazardous polymerication will not occur.
Section VII Special Protection Information
Respiratory Protection: None
Protective ulo.es: Rubber
Eye Protection : Safety glasses or goggles are recommended to prevent accident'l
splashing of eyes.
Other Equipment: None
Section VIII Special Precautions
r *Chemicals can be hazardous if not respected. The use of proper equipment and
procedures Gf handling chemicals are not only a benefit for their obvious uses,
but can reduce the possiblit.y of serio•is injury and time loss accidents.
*Keep this material away from high heat and observe proper housekeeping procedures.
**DO NOT MIX CHEMICALS UNLESS INSTRUCTED BY QUALIFIED PERSONNEL**
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M^1rM1R1 AL SAFETY 1C>^'Y'^ SX-3EET
Section 1
EMS BOILER WATER TREATMENT #766 - Issue Date: 5/1/89
Mfg: E. W. Smith Chemical Company Hazard Range: 0 = Minimal
15020 E. Proctor Avenue 4 = Severe
Industry, CA 9174E Health l
Fire l
Reactivity 1
Special None
Section II Hazardous Ingredients/Identity Information
Chemical CAS NO. % WT..
Sodium Hydroxide 1310-73-2 2%
The balance of the components comprises proprietary information.
Section III Physical Data
Boiling Point greater than 2120 Specific Gravity (water=l) 1.06
Vapor Pressure N/A pH (solution) 8-9
Vapor Density N/A Solubility: 100% in water
pH Concentrate greater than 12 `y
Appearance and Color Yellow with bland color
Section IV Health hazard Data
Effect of Overexposure
Skin: Contact of this product upon the skin can cause slight irritation.
Eyes: Contact of this product upon the eyes can cause slight irritation of
the eyes and eyelids.
Inhilation: Fumes from this product are generally considered non -toxic, but
can cause slight irritation of the nose, nasal passages and lungs.
Ingestion: When concentrated solutions of this product are swallowed, it can
cause .lig;it irritation to the mouth, esophagus and stomach.
FIRST AID PROCEDURES
Skin: Flush exposed area with lukewarm water. If irritation persists, consult
physician immediately.
Eyes: Flush eyes for 30 minutes with cool water. If irritation persists, consult
physician immediately.
Inhilation: Remove patient to clean atmosphere and administer oxygen if necessary.
consult physician immediately.
Ingestion: Do not induce vomitting. have patient drink large amounts of water
or milk. Consult a physician immediately.
r,-
Oq�APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH
DEPARTMENT OF COMMUNITY DEVELOPMENT
HUNTINGTON KAOi
(PRINT OR TYPE ONLY) DATE
Address
Business
Business
District
Tel 71. ,� ` ��� 3744
Occ. Group _
BUILDING OWNER BUSINESS OWNERIMANAGER
Name 8Uzi dfNSA Id 6-' (Name oGk Hyu,V ki M _
Address /Old d phmS 11( C— Home ed
T
Address
City �f ,13; Tel. City_I0 Y l"a,,yl -'e Home Tel. i� _
THIS USE WOULD BE DESCRIBED AS:
❑ NEWLY CONSTRUCTED BLDG. LJ CHANGE OF OWNER ❑ CHANGE OF OCCUPANT
❑ EXISTING BUILDING RANGE OF USE ❑ ADDITIONAL OCCUPANT
Indicate former use, if any i✓ Occupancy Gr. Div._
SQUARE FT. OF BUILDING TO BE OCCUPIED
NOTICE: 1
2.
3.
A.
J.
Occupancy of any build'n5 is prohibited and a business license will not be issued until the building has been
inspected and a certAcate of occupancy is issued.
No electrical service v,ill be released for any existing building until the service has been inspected and
certified sa''e. 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.
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 ci,- - may be made in the characterof 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 occupy .cy inspection fee of $ shall
be paid to the city.
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 visibie from the street.
Huntington Beach Fire Code Section 10.301 requires fire extinguisher selection and distribution per the
National Fir e Protection Associa ion pampiaet 10 Oee reverse side).
-• eC G /�� r, n
TRAFFIC IMPACT FEE _I� / / _.�
DATE PAID
AMOUNT R CEIVE �/ /_ _ (FOR OFFICE USE ONLY)
NAME _ ( — ZONING
OCCUPANCY OROUP_ PLAN CHECK NO.. NO PARKING SPACES
OCCUPANT LOAD ' —r PERMIT NO. — HEALTH DEPT APPROVAL
NO. OF STORIES ADMIN. ACTION_ _ UTILITIES RELEASED
CERTIFICATE OF OCCUPANCY FEE
OVED ATE _ CHANGE OF USE OR OCCUPANCY FEE
TOTAL
75-M9 Rev. 1/91 r.'INVAI IMITV 17,Pki::f nPhAFAIT
$ Omer
$—
$ --
3/�,3�-�
South Coast
Air Quality Management District
21865 E . Cooley Drive, Diamond Bar, CA 91765-4182
(909) 396-3529 • http://www.acrnd.gov
Air Quality Permit Checklist
California State Law Code 65850.2 prohibits cities from issuing an occupancy permit without
clearance from the local air quality agency. This checklist will determine if you need to obtain
clearance: from the South Coast Air Quality Management District (AQMD).
Company Name: 9 G lCiiwel--S
Property Address: / d /% 11dan9 f 4 U
City: 1?e/a cy Zip Code:
Contact Person: Ock H4/i,fA) k /4 Title: �iGtiYlGYS
Type of Business: J /P�i�tei--_( Telephone: (�/O_ 1 d -7
Applicant (print name) 0 CK 41V L; M Signature:
• Will the facility have any of the following equipment? YES[ ] NO [ ]
CharL,roiler
Dry Cleaning Machine
Spray Booth
Printing Press (screen/lithographic/flexographic)
Internal Combustion Engine (greater :ban 50 HP (excluding motor vehicles)
Boiler/Combustion Equipment (greater than 2MM BTU/hr. maximum input)
Abrasive Blasting Cabinets/Rooms
Baghouse/Cartridge-Type Dust Filter/Scrubber
Motor Fuel Storage & Dispensing Equipment
• Will any of the following operations be performed? YES[ ] 1401 ]
Application of Paints and Adhesives
Etching, Plating, Casting or Melting of Metals
Plastic Molding, Extruding or Curing
Mixing and Blending of Liquids and/or Powders
Storage of Acids, Solvents, Organic Liquids or Fuels
Production of Fumes, Dust, Smoke or Strong Odors
If you answered "NO" .o both questions, this checklist is your clearance from AQMD. If you
answered "YES" to either question, you must contact the AQMD to determine if air quality
permits are required. If permits are needed, AQMD will assist you in submitting permit
application(s) and then provide you with a clearance letter. If you have any questions, please call
AQMD's Small Business Assistance office at (800)-CUT .A 10 G, and press 41.
SUPPLEMENTAL INFORMATION
1.
BUSINESS ADDRESS riJQ4,MS
2.
Person to contact in case of emergency- r�ti��
CMS
Telephone number: �j14-63�—L9o�
3.
Does the building in question have electricity?
❑ Yes
d No
(a) If No, are you requesting that the electricity be
❑ Yes
turned on?
❑ No
4.
The building is sprinklered?
Li Yes
❑ No
5.
Operations will produce dust/wood shavings or similar
material?
❑ Ye3
d 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 o't more than 50 persons. ❑ Yes
L�1 No
8. The following best describes my operation;
Office Only
etail Sa
Warehouse
Manufacturing / Distribution (describe process and end product)
Restaurant /'rake Out Food
Medical / Dental
Other (describe)
SUPPLEMENTAL INFORMATION
A
SUPPLEMENTAL INFORMATION (Continued)
Does the operation involve any of the following materials? ❑ Yes
FI No
indicate quantities:
Material Quantity
1. Flammable liquids
Class I -A
Class 1-B
Class I-C
2. Combustible liquids
Class 11
Class Ill -A
3. Combination flammable liquids
4. Flammable gases
5. Liquefied flammable gases
G. Flammable fibers - loose
7. Flammable fibers - baled
8. Flammable solids
S. 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 pnwder
I hereby certify that the above information is true and correct to
the best of my knowledge.
Signature Data
tt
'130'" bZA
TfSs 2!
/OPLICA.TION FOR CER IFJCATE OF OCi..- TPANCY .
CITY OF RUINITINGTON BEACH - DEPARTIM, NT OF BUILDING & SAFETY
(T"fFloor —j1dustApply Ttt Person)
Business License ���-3 6 Date
Address 4LIM� � 77 �Q c y�d�d
Business Naive G Mn-AeV Telephone _✓l�Sr- q °`�'
Business Type 1? }�/ �/�c� e►- ^
r
Property Owner Information Business Owner
Name I�GfSLi?['s5 pYopz^T_ Name _ i } h'yrle C.,k-o�
Address HonnAddress{)e
CityR V 1 r Tel. 9s��� �Z _eo City T-,'�,70rk-- , CA- zd W—Tel. 174-) 1)30,ra
THIS USE WOULD BE DESCRIBED AS:
❑Ne-4y Corstructed Building or �Ex 's4kng Building
CHECK ALL THAT APPLY:
Change of Owner ❑Change of Occupant ❑Change of Use ❑Additional Occupant
Indicate former use, if anyc
Does the building have electricity? Yes ►� No❑
If No, are you requesting that the electricity be turned on? Yes ® No ❑
The building is sprinklered? Yes ❑ No'`'
Operations will product dust/wcod shavings or ,:irnilar material? Yes ❑ No
Operations will involve the repair or replacement of automobile parts Yes F1 No
If yes: Describe the components repaired rr replaced.
Does the operation involve the use of welding or open flame`? Yes ❑ No Er
The business is drinking; dining or assembly use that will result in an occupant load
of more than 50 persons. Yes ❑ No U
The foliowing best.,ducribes my operation:
❑Office Only Retail S.sles 13Medical(Dental ❑Restaurant/Take Out Food
❑lviaiiufacturi.ng/Distribtttion (describe process and end product)
❑ Other (describe)
Warehouse
- j
0 f Dice Use 0IZt•}r"
? i3ning: "" q Ft Occupied: Occ Group: IF I Occ Load:
m Stories: _ Parking Spaces: TIF Review: Y/ N Aunt Paid$-
3i Paid BEFORE.Final Inspection
3� Building Permit < Entitlement 4:
i comments: � P--?rM 1, -
t Planner Initials:__ - _ Bldg/Phm,! ire p
CofO
a �•
South Coast
Air Quality Management District
21865 E. Copley Drive
Diamond Bar, CA 91765-4182
(909) 396-3529 htpp://www.aqmd.cov
Air Quality Permit Checklist
California Government Code 65850.2 prohibits cities from issuing a Certificate of Occupancy to a b ,dness
without clearance from the local air quality agency. This checklist will determine if you need to obtain
clearance f-orn the South Coast Air Quality Management Districf'AQYID).
Company N;ame: C If &K C r,
Property Address: /]C/6 ?'!
City: i3�c_A Zip Code: GA 5
s
Contact Person: A h Y11 e- r_kl c) Title: ObJ17 eyi",
Type of Business: b 9,/ G1-e-f t e ✓'S- Telephone: d�7
Applicant: (print name) /_q L o Signature:
• Will the facility have any of the following equipment? Yes No
Charbroiler
Dry cleaning machine
spray Booth
Printing Press (screen/lithographic/flexographic)
Internal combustion engine (greater than 50HP) (excluding motor vehicles)
Boiler/combustion equipment (greater than 2 million BTU/hr. maximum input)
Abrasive bla_stin e cabinet/room
Baghouse/cartridge type dust filter/scrubber
Motor fuel storage and dispensing equipment
• Will any of the following operations be performed? Yes No Q
Application ofpaints or adhesives
Etching, plating,.casting, or melting of metals
Molding anj blending of liquids and/or powders
Storage of acids, solvents, organic liquids or fuels
Production of acids, solvents, organic liquids, or fuels
Production of fumes, arts;, smoke or strong odors
• If you answered "No" 'to both questions, this checklist is you, clearance from. AQMD.
• If you answered "Yes" to either question, you must contact AQMD to eiptermine if air quality permits are
required. If permits are needed, AQMD will assist you in submitting permit application(s) and then provide you
with a clearance letter. You can call AQ1'VID at their Small Business Assistance Office at (800) 388-2121.
CERTIFICA T E OP OCCUPANCY EVALUAT;CN FORM
GENERAL BUILDING INFORMATION
Owner name: Address and/or suite #:
Eme. gency contact: Phone n+"mber.
Occupancy Class - primary use(s) & sq. ft.: Occupant load:
f
I
Occupancy Class - second use(s) & sq. ft.: #
Type of constructuon: Stories & tielght(ft)
Sprinkling used?
Ostory increase '
OCity Ordinance
❑Unlimited area
i!
COne hour constructicn
MAtela
i
oArsa Increase
❑Cha ter9
Area allowed:
Basic:
Yard:
77T�
sep aration:
Sprinkling: }
t
I
For multistoried and mixed use attach a separate work sheet or include In sketch area l
Attach work sheets b Pltinnin or Fire if provided
YARD
_ STORAGE'
DINE G 9M RM
YARD 3 � �' �'
RMO KrrCHEN
wArtwG YARD 1
EN1R DINING RM 1� � ,sa, I
PARKING
P R IN
SAMPLE -ASSEMBLY USE
l }
JP+J 'Gj I
F. _..—
STREET NAME
G:\BUILDING\FORMS\Cent of Occuoancv\CofO Evalulation.DOC
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