HomeMy WebLinkAbout15122 Bolsa Chica St - CofO4
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�',1S OR CERTIFICATE OF OCCLICA�T L
f^ 'yt_.'�yir . � �1f ART17J•fi'4 N i OF 2:r 3:aJ S:'�SAFETY
71 Y ��`� r itDINC
�Tli' ,. _� Prd Flooi' - 1MIStAppt t in -person)
Business Licen e -
Address.
Busin:s. tii.m= ��r v ►�-.�,nrlm �t9 k( �Gs A� S tll C��i1� t; �
Bush_ _-s Type _
Bu lr ess O oYiiei'
?;rtF Owner 1 0_
t?'oia _
Name �rs, r�y,�/ ----= _ Ho address !//
Te
duress T �J7��•3�7.�1� �i.�l• 41—
City s"
TfrIS -u i -w Oi LD BE DESCIL�ED �E;dsting Building
C]Netivly Cor_siructed Building or
CFIEcx ALL TH4 T APPLY; OChar_ge of Use U hdditiorlal Occupant
tChange o1' 0�vnar '�Cl.ange of Occupant
Indicate former use. if any
Does the building l�av electricity? Yes Itio
D Yes N
If No, are you requesting that tee electneity be turned on?
q rin tiered? Yes TTo
The Uuildin- is sp
s tivill Product dustitivaod shavings or sirnilar material? Yes Q
Operation p
O erations Nvzil involve the repair or replacement of automobile parts Yes -�..
P
If yes: Describetile COn�Ql1e11`s repaired or replaced. _
en T No
Doe t le operation aule? Yes
involve the us j of ti�velding or lPa w 11 result an occupanL load
The business is drinking; dining or assembly use t
.of ,,lore than 50 persons. Yes No
The foilowing best describes my operation: .
al/Dental ORest
Office On ❑detail. Salts
❑�jedicauTantlTake Out Food �''�Na�'zhous�
�Ilal.lufaeturing/Distribution (describe process and end product)
Ir
Other (descriU ).
_ __ Occ Lo
1 4f tcc terse Orly: - --- _ - --, , d I`t%C1 ^Occ Group:--
Gf SgFi Occ�.p.e _ _------
Zoning; 'St_ �nitPaia
TjF ReviSvv: paid5ec GG' laspeccic
Parkin9z S-0acLs: ___:____—
4t Stories:�
w titlen e ant
,�.,{�fie �Ae-)n CofO
! Collnaents: 03 Eld�tl l lr Ghec' :r .. Q .--4--r-
1 a]111..T j111i.1...i5:�___� Y���� �,;, � _••'y.-K '
w .
South Coas
Air Quali�y Manage ens District
2186 E. Copley Dave
Diamcud Bar, CA 9176c —1 02
(909) 396-3529 htpp://w,v-, v.agmd.gov
Ai3 Qualiry Permit Checklist
o-fCalifornia Government Cade b585t7.2 prohibits cities from i c 1nQti�i1 amine ifCvou razed to obtain
without clearance from the local air quality agency. This ch.e k
clearance from the South Coast Air Quality Management District (_AQMD).
Company Name: 1
Address i `'-� (2�p
Prc per-ty _— -----
Zip Code:
City:
Contact Person:
Titie:
Type of Business: Act rz��i� !•1 L'p�i7��ephone; () i'� t�') �Pf 5 " ���
Signature:
Applicant: (print name)
o Yes 0 N a
Will the facility have any of the following equipment.
Charbroiler
Dry cleaning machine
Spray Booth
Printing Press (screen/lithographic/flexozraphic) (excluding motor vehicle)
Internal combustion engine (greater than 50F3P)
Boiler/combustion equipment (greater thano.nilhon BTU/hr. maximum input)
Abrasive blasting cabinetlroom
Baghouse/cartridge type dust fliter/scrubber
IvIctor fuel storage and dispensing equipment
• Will a_ny of he following operations be performed? Yes No
Application of paints or adhesives
Etching,plating,. casting, or melting of metals
Molding and blending of liquids and/or powders
Storage of acids, solvents, orgarzc liquids or fuels
Production of acids, solvents, organic liquids, or fuels
Production of fumes, dust, smoke or strong odors
• if you answered "No" to both questions, this checklisr, is your _jearance uaIn JkQ)L'iD,
Y
. you answered "Yes" to either question, you must contact AQN[D to determine if air q�sality permits are
Ir y Q pest applications) �;�o,then provide you
required. If permits -are needed, AQNI M will assist y ou in submitting
with a clearance letter. you can call _�.QN1 11) at their Small Business Assistance Offzee at (SOD) 338-21.1.
........ ......... .........
I CERTIFICATE OF OCCUPANCY EVALUATION FORM
I GENERAL BUILDING INFORMATION
O,�rner name: Address and/or suite #:
Emergency contact: ho}ne number. ^�
Occupancy Class - primary use(s) 8 sq. ft.: I Occupant load:
i ff,-Z op lCeh Np- si4io
Occupancy Class - second use(s) & sq. ft.:
Type of constructuon:
Stories & Height(Q
Sprinkling used?
❑Story increase
❑City Ordinance
❑Unlimited area
❑One hour construction
❑Atria
❑Area increase _
❑Cha ter 8
i Area allowed:
1
Basic:
Yard:
Area separation:
Sprinkling;
i
i For multistoried and mixed use aaacn a separate wurre
Attach work sheets b planningor Fire if provided
................................
YARD 2
STO
YARD 3 FFI
LYARD
1
11.
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1 RET&L
i PARKING b L I
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i ISO �
SA;VIPLE
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STRIP RETAIL USE
PARKIGj
- STREET NAME
+
SKL r c H AREA: