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HomeMy WebLinkAbout10120 Adams Ave - CofO (6).A -PLICATIO1N FOR CERTIFICATE OF OCCUPANCY CITY OF HUNTING'S ON BEACH DEPARTMENT OF BUII. DENTU & SAFETY P", Floor — Must Apply 17e-persona) Business License,#A'?;'2 Date Address Tele;�hone74/ Business Type Prooerry Owner Information / Business Owzier Name Name Address / 7G 3> ,c—1 ii Home Address City Tel, 9*-9"?8'voCity Tel.9-9 29Z�y� TINS USE )h'OULD BE DESCRIBED AS: ❑Newly Constructed Building or UExisting Building CHECK :ALL THAT APPLY.—, 2fChange of Owner ,Change of Occupant Change of Use QAdditional Occupant Indicate former 3!se, if any 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 ND❑ Operations will product dust/wood shavings or similar material? Yes 0 No,J Operations will involve the repair or replacement of automobi,a parts Yes No;� If yes: Describe the components repaired or replaced. Does the operation involve th? use of welding or open flaine? Yes CJ No Q The buo-iness is drinking, dining or assembly use that will result in an occupant load of more than 50 persons. Yes' No The following best describes my �peration: Office Only ❑Rstail Sales ❑Medical/Dental ❑RestatLant/Ta'.re Out Food ❑lVarehouse D vlainnfacturinz'Distribution (describe process and end product) 0 Other (describe) Office Lse O;:tly: Zoning: Sq F: Occupied 7-rf t''c� S'r— Occ Group:, , Occ Load:_� 1 r Stories: ( Parking Spaces TIF Review: Y!N Amt PaidS: 0 {f�� PaidSEFGRE Final nspc4on Buildiag Pen t P Entitlement T Com!.n .nts: Planner• Initials:_Bldg%Plan Checker inirials: .a South Coast Air Quality Management District 21865 E. Copley Drive Diamond Bar, CA 91765-4182 (909) 396-3529 htpp://Txw�v.agmd.gov Air Quality Permit Checklist California Government Code 65850.2 prohibits cities from issuing a Certificate of Occupancy to a business without clearance fT,,.n the local air quality agency. This checklist will c,etermine is you need to obtain clearance from the South Coast Air Quality Management District (AQNM). Company Name: /'/G2 �`"c ��/� y_�✓� �iy� Property Address: City: � n � , s : Zj _ Zip Code: _ `7 2_Zo,4-Z Contact Person: Title: sire :j> Type of Business:Telephone: () 7/c'_ (v 3_ 3 Applicant: (print name) Signature: GEC'-�-- • .dill 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 50I1P) (excluding motor vehicles) Boiler/combustion equipment (greater than 2 miIlion BTU/hr. maximum input) Abrasive blasting cabinetiroom Baghouse/cartridge type dust filter/scrubber Motor fuel storage and dispensing equipment • Will any of the following operatio3 s be performed? Yes F-1 NG Application of paints or adhesiN"es Etching, plating, casting, or melting of metals Nloldilig and blending of liquids and/or powders Storage of acids, solvents, org?.dc liquids or fuels Production of acids, solvents, organic liquids, or fuels Production of fumes, Bust, -smoke or strong odors If you answered "No" to both questions, this checklist is your clear-ance from AQN1D. • If you answered "Yes" to either question, you roust contact AQNiD to exte,rmine if air quality permits are required. Ifpe .snits are deeded, AQN1D will assist you in submitting perniit application(s) and then provide you with a clearance letter. You can call AQN1D at their Swr,ll Business Assistance Office at (800) 388-2121. .r CITY OF r U-.N-=NGT•MI BE'=zC33 - �: EPAR`TiL EN A' 01' B�1�.I,I EINTG & S 4 �FE;1 (3"� �laar -)dust dpply IIt-Person) �� -Business License-' A111T°�k !�c�T2 /G' 2 •3 -�P Address la f 2 e,:; �� s' � �s e �' ��� . �� . `/2Zg6 Business Tele-phone %!f ylr 3 y' `>_3 Business TypeV- 1..,Os�'n��_ %s� �.P��r A/677- ProAerry Owner information Business Owner Name G 41S1,V Ls s l-.F'o152 ---s Natne Address _ Nome Address "z� City y1W6- 99 e,,( /Tel '1497- A City Lam: urn ✓ ' d el. �1- zz - -7 4-z THIS USE WOULD BE DESCRIBED AS: v ©Newly Constructed Building or Axisting Building CHECX ALL THAT APPLY: Change of Owner Chan_e of Occupant )ZCharige of Use C A.dditionai Oce.r. ar:t .Indicate former use, if any Does the building have electricity? Yes Z] NaZ] If No, are you requesting that the electricity be turned on? Yes No The building is sprinklered? Yes,© N00 Operations will product dust/wood shavings or similar material? Yes ® No Operations will involve :he repair or replacement of automobile parts Yes Q No; If yes: Describe the components repaired or replaced. Does the operation involve the use of welding or open flame? Yes C� I`•� o Tae business is drinking, dining or assembly use that will result in an occupant load of more than 50 persons- Yes Q No The following best describes my operation: 0 Gflice Only U.1 etail Sales QMedical/Dental ORestaurant/Take Out Food U IVc.ehouse ❑ Manufac;turing/Distribution (describe pro-.ess aad end product') S�/J��''/l�% � .S�.,e� �' t/!C t`' S G'r'�r=/! c� �a .�=:2L'J G E.S , if /f' "7✓�,/.LY /",i'r.+�•Y� �� y' Other (describe) Office (•,'se 111, Gonino: 4: Stories: Buddii T Permit 1,:yg le, 5,t= ot.rr- or- Sq rt Occupies:: '+t Ocz Group: Oce Load:_ Parking Spaces: T I F Revie,v: Yr N Arne P aid.S: raid BEFORE Find inspectiot; Entitlement -: Comm-,nts _ Plannerhikiais: - W1 24 * Bldg PLn Cliecker Lnirials. ��• � �-t CofO m ILAZARDO S MATERIALS DISCLOSURE EXFOPENLAMON Huntington Beach Fire Department California Health and Safety Code requires the Fire Department to regulate businesses that handle hazardous naterials. Motor oil, hydraulic fluids, gasoline, dry cleaning fluid, etc., are considered hazardous materials and nust be disclosed. if you use, handle or store hazardous materials or waste materials equal to or in excess of he following basic quantities, your are required to disclose: i 55 gallons of liquid • 500 pounds of solid • 200 cubic feet of compressed gas • Any amount of radioactive materials • Any amount of lass �y explosive • Any amount of chemicals known to cause cancer • Any amount of commercial pesticides Reportable quantity of any Chen. cal on EPA Extremely Hazardous Materials Substance List .isclosure is not required for the following: 1. Hazardous substances contained i.r food, drug, cosmetic or tobacco products. 2. Upon approval of the Fire Chief, hazardous materials contained sol :ly in consumer products packaged for use by and distributed to the general public. However, pesticides, herbicides, and ammonium nitrate fertilizers over the required disclosure amounts are not exempt from disclosure. 3. The transportation of hazardous materials accompanied by shipping papers prepared in accordance with the provisions of 49 Code of Federal Regulations. 4. Infectious waste generated by health care facilities that are regulated under Title 22 of the California Administrative Code. Check one of the following: i/ No chemicals are used, handled or stored at this business. Chemicals are used, handled or stored. at this business, but do not meet the requirements for disclosure Chemicals are used, handled or stored at this business. Disclosure forms will he sent to you. Amounts will be verified by the Fire Department during annual inspections. It is unlawful for any person to knowingly violate any provision of this ordinance. I certify, under the penalty of perjury, that the above information is true and correct to the best of my knowledge. Signature , rl�� t�U ,,tir,� -r!f ` Date fir Home Phone %>``'' Please call 714-536-5676 with .questions regarding the Hazardous materials Program. ri'a South Coast Air Quality Management District 21865 E. Copley Drive Diamond 'Bar, CA 91765-4182 (909) 396-3529 htpp:// vvrw.agmd.gov .Air Quality Permit C:heelrlist 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 need to obtain clearance from the South Coast Air Quality (Management District (AQNID). Company Name: —,/' /�X-'1X Ile - Property Address: City: Zip Code: el Contact Person: _56Title; Type of Business: ��r �, ��� Telephone: 56 g 9 3 8 2 Applicant; (print name) Signature: ,r - • Will the facility have any of the following equipment? Yes ❑ No Charbroiler Dry cleaning machine Spray Booth Printing Press('creen/lithographic/flexographic) Internal combustion engine `greater than 50HP) (excluding motor vehicles) Boiler/combustion equipment (greater ;har12 miIIion BTU/hr. maximum input) Abrasive blasting cabinet/room Baghouse/cartridge type dust filter/sc• iabber Motor fuel storage and dispensing :quipznent • Will any of the following operations be performed? Yes ❑ Noed Application o'Lpaints or adhesives Etching, plating.casting, or melting of metals Molding and 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, dust, smoke or strong odors it If yogi answered `No" to both questions, this checklist is your clearance frorr, AQID. • If you answered "Yas" to either questioryou must contact AQMD to determine if air quality permits are required. If permits are needed, AQN0 will assist you in submitting permit application(s) and then provide you with a clearance letter, You can call AQI1ID at their Small Business Assistance office at (800) 383-1121,