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Home My WebLink About10184 Adams Ave - CofO (4)APPLICATION FOR CERTIFICATE OF OCCUPANC-Y t CITY Or HUNT Mi TGTON BEACH - DEPARTMENT OF BUILDING &; SAFETY Cr< (3rd door-tllust Apply 17'-Persoli) Business License 4 + % � Date !0 /j p r '� U Address_ j o ! (� % Lt t; Business Name A GiocpL Z,,.jTuri^ n�.�,c,_ ST�;��u Telephone Business Type Property Owner Information Business Owner i`I,srrie L'` �t�- L• SM ( Name -'NiC*H P-Aeklk ¢ ti:=M—j AQ�s�f� Address 1 -k Home Address 24 Z &1 1 i w k (, City 'z 9-v11") < Tei.fh�y) 4_ City Cc\k4 ,-o� 5; Tel.'c, uq) s(a -'�; `t THIS USE WOULD BE DESCRIBED AS: (0 v ❑Newly Constructed Building or ),A�Existirg Building CHECK ALL THAT APPLY: ❑ Change of Owner '-Z'Change of Occupant ❑Change of Use ❑Additional Occupant Indicate former use, if any ""tJ(L'(- i>, U Does the building have electricity? Yes �- NC,❑ If No, are you requesting that the electricity be turned on' Yes ® No ❑ The building is-prinklered? Yes ❑ No ❑ Operations will product dust/wood shavings or similar material? Yes ❑ Operations will involve the repair or replacement of automobile parts Yes ❑ N If yes: Describe the components repaired or replaced. Does the operation involve the �zse of welding or opein flame? Yes ❑ No�~— The business is drinking, dining or assembly use that will result in an occupant load of more than 50 persons. Yes ❑ No L7 "1 he following best describes my operation: ❑ Grtice Only ❑Retail Sales ❑Medical/Dental ❑Flestauurant/Take Out Food ❑Warehouse ❑Manufacturing/Distribution (describe process and end product) CU` Other (describe) C, 'f._ v C� t�t t- i 1 , if 14 sJ n A- '�7A 4% Office Use Only: Zoning: Sq Ft Occupied: �I D� n Stories: Building Permit #. Comments \- Planner Initials: Parking Spaces: Oq Bldg/Ph Checker it Occ Group:; Oce Load:_ TIF Review: Y/ N Amt PaidS: Paid BEFORE Final Inspection En-�Itlement z CofO K,, ZARB OUS iyIATERIALS DIS CLO5,31 RE ENF ORPYLAMON Huutingtnn Beach Fire Department California Health and Safety Code requires the Fire Department to regulate businesses that handle hazardous materials. Motor o:l, hydraulic fluids, gasoline, dry cleaning fluid, etc., are considered hazardous materials and must be disclosed. If you use, handle or store hazardous materials or waste materials equal to or in excess of the following basic quantities, your are required to disclose: • 55 gallons of liquid • 500 pounds of solid • 200 cubic feet of compressed gas • Any amount of radi6active materials • Any amount of Class :', explosive • Any amount of chemicals known to cause cancer 14 Any amount of commercial pesticides • Reportable quantity of any chemical on EPA Extremely Hazardous Materials Substance List Disclosure is not required for the foltowir_g: 1. Hazardous substances contained in food, drug, cosmetic or tobacco prcd;icts. 2. Upon approval of the Fire Chief, hazardous materials containers sol :ly in consumer products packaged for --e by and distributed to the general public. However, pesticides, herbicides, and ammoniunk 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 vast. generated by health care facilities that are regulated under Title 22 of the California Administrative Code. Check one of the following: `�-" 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 busines_. Disclosure forms will be sent to you. Amounts will be venfned by the Fire Department during annual inspections. It is unlawful for any person to knowingly violate ,,.ny provision of this ordinance. ,. f � I certify, under the penalty of perjury, that the above information is true and correct to the best of my knowledge ✓` l Signatu Date d / �i! I 0 {1 Home Phone Please call7I4-536-5676 with questio!is regarding the HazardDus �Vaterials Program. 1 South Coast Air Quality Management District 21865 E. Copley Drive Diamond Bar, CA 91765-4182 (909) 396-3529 htpp:/hvww.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 need to oL Lain clearance from the South Coast Air Quality Management District (AQMD). Company Name: CZ l? M 1) j C;.`- Property Address: t M,-5 LJif- City: ,rzrkLjc, iot^..l Zip Code: 7 G, r� Contact Person: S` ,AJ4(2-A r^ ►�t�_v �- Title: 0,jr-JC(Z-- - Type of Business: ' Ar%CTAD(U_ _ Telephone. - Applicant: (print name)9(tl,^n P- S. Signatur • Will the facility have any of the following equipment? Yes 4� N Charbroiler Dry cleaning mac'iine Spray Booth Printing Press (screen/lithographic/flexographic) Internal combustion engine (greater than 50BT) (excluding motor vehicles) Boilericombustion equipment (greater than 2 million BTU/hr. maximum input) Abrasive blasting cabinet/room Bagho,ise/cartridge type dust filter/scrubber Motor furl sto:age and disrpeasing equipment • Will any of the following operations be performed? Yes r... Application of paints or adhesives Etching, plating, casting, or melting of metals Nfolding and blending of liquids and/or powders Storage of acids, solvents, organic liquids or fuels Production of acids, solvents, organic liquids, or fuels Prod»ctivn of fumes, dust, smoke or strong odors • If you answered "Xi o" to both questions, this checklist is your clearance from AQMI). If you answered "Yes" to either question, you must contact AQL\M to determine if air quality permits are required. If permits are ne,.ded, AQMD will assist you in submitting permit appli.cation(s) and then provide ,vu with a clearance letter. Yo-i can call AQTNM at their Small Business Assistance Office at (800) 3$5-2121. CERTIFICATE OF OCCUPANCY EVALUATION FORM GENERAL BUILDING INFORMATION Owner nanie: Fmergency - primary use(s) & sq. ft.: I Occupant load: r,y Class - second use(s) & sq. ft.: i rype of constructuon: Stories & HeigM(ft) Sprinkling used? ❑Story increase j ❑City Ordinance ❑Unlimited area i ❑One hour construction ❑Atria i ❑Area increase ❑Cha ter 9 Area allowed: Basic: Yard: Area separation: Sprinkling: t or muni-stoneo ano mixed use attacn a separate worK sneer or Inciuoe in sKetrn area i Attach work sheets by Plan nin or Fire if R.ro.vided I YARD sTGRAG ..91.P.M 2 RM �y CGMD KITCHEN YARD 000 0 IF — Cb YARD 1 WAITING DINING RM i� EN7113 PARKING 17.1 {11 1 �IN SAMPLE -ASSEMBLY USE 1 I IPAKI�Gl I ( I I I , A I STREET NAME \BUILDING\FORMS\Cent of OccuDancv\CofO Evalulation.DOC Mav 3 2004 SKETCIZ ARL