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HomeMy WebLinkAbout15132 Bolsa Chica St - CofOS 4 rMF, APPLICATION FOR CERTIFICATE OF 0r C rLJP.`CY CITY OF H UNTING T O BEACH - DEPARTMENT OF BUILDING & SAFETY (3`� Flo oi- - irlust Apply liz-PeFsoIi) Business License AID �`l' � Date Business Name I NJ-t T- Business Type G�i —;C4-_ t Telephone 71`1 l39Z'Zt% Property Owrikur Information Business Owner �6 � r0w� _ iyame _� � S f�.a✓r D ST t Name � --- ----- - t? Address S 3 Z OLS/� &P t(, A XJ2 Home Address yt �! Si City 1 � Tel. 7l`�- ¢- �n_i City l,�/n/n/5)��LJ'S TeL,iy-� THIS USE WOULD BE DESCRIBED AS: D tiewly Constructed Building or xisting Duilding CRECK ALL THAT APx)LY: DChange of 0 wner CIChange of Occupant ❑Cha.nge of Use � r dditional Occupant Indicate former use, if any __ �Si rca p� o Does the buildiag have electric,,ty? x es NO if No, are you requesting that the eiectricity be turned on? Yes 0 Nc The bwlaMg is sprinklered? Yes � NOD Operations will, product dust/wood shavings or similar material`s Yes d © o Operations will involve the repair or replacement of automobile parts Yes If yes: Describe the components repaired or replaced. Does the operation involve the use of welding or open flaine? Yes ❑ No ca The business is drinldng, dining or as err bly use that will result in an occupant load of more than 50 persons. Yes/LQ No The following Best describes my operation: Office Only ❑Retail Sales ❑IVledical/Dental DRestaurantlTake Out Food ClWarehouse Manufacturing!Distri'bu.tion (describe process and end product) d Other (describe) Office Use Only: Occ Load:_ 11 Zoning= _ _ q F- caupled• - — c Gro�tp; err„_ _ -- CrTIF Review: Y/ N Arr, Paid$: lit � Stories- P� n Paid Bfi?OREFinal lnspecrinn t Entitlement1-: Buil;,*ng Permit k #j Comments:-cCofo Bldg Plm Clacker Initials _._.... Platu� �r Initiais:� �1, _. .m __ ._ _ South Coast Air Quality Manacrernent District 2t865 E. Copley Drive Diamond Bar, CA 91765-4182 (909) 396-3529 htpp://www.agrnd-gov Air Quality Permit Chedd—lost California Government Code 65850.2 prohibits cities from issuing a Certt.Licate of Occupancy to a business without clearance from the local air quality agency. This checklist will de;`,eimine if you need to obtain, clearance from the South Coast Air Quality Management District (AQMD). Company Name: — Property Address: -r 32 2I�VSI�-� �1 c.AA- City : � ! � Zip Code: Contact Person: ___ Title,• t' Type of Business: 1 c, &C -do 'Telephone: () 1 tl -3 61 Applicant: (print nam% Signature: • Will the facility have any of the following equipment? Yes IJ No Charbroiler Dry cleaning machine Spray Booth printing Press (screen/lithographic/flexographic) Internal combustion engine (greater than 50112) (excluding motor vehicles) Boiler/combustion equipment (greaten than 2 million BTU/hr. maximum i.'iput) Abrasive blasting cabinet/room Baghouse/cartridge type dust fluter/scrubber Motor fuel storage and dispensing Equipment • Will any of the following operations be performed? "des ❑ No � .A,pplicati^n of paints or adhesives Etching, plating,, casting, or meltinc 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 Pro�?ection of fumes, dust, smoke or strong odors + if you answered. "No" to both g7,iestions, this checklist is your clearance from AQMD. + If you answered "Yes" to either questions you must contact AQbgD to determine if air quality permits are required. If permits are needed, AQMD will assist you in submit Jng permit application(s) and then provide you with a clearance letter. 'you can Gall AQivID at their Small Business .Assistance office at (800) 388-?.121. .i ti 1r HAZARDOUS MI ATEMALS DISCLOST RE lMIJEIVIAI"Jly Huntington Beach Fire Department California Health and Safety Code requires the Fire Department to regulate businesses that handle hazardous materials. Motor oil, 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 radioactive materials Any amount cf Cjac-s A explosive • Any amount of chemicals known to cause cancer Any amount of commercial pesticides Reportable quantity of any chemical on EPA E:<tremely Hazardous Materials Substance List Disclosure is not required for the following: l . Hazardous substances contained in food, drug, cosmetic or tobacco products. 2. Upon approval of tie Fire Chief, hazardous materials contained sol :ly in consumer products packaged for use by and dist huted to the general public. However, pesticides, herbicides, acid ammonium nitrate fertilizers over the required disclosure amounts are not exempt from ureu1 accordance with 3. The transportation of hazardous materials accompanied b shipping papers ap . prepared 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: 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 fornss will be sent to You. Amounts will be verified by the Fire Department during annual inspections, it is unlawful for any person to knQwingly violate any provision of this ordinance. I certify, under the penalty ofpe that the above information is true and correct to the best of my knowledge. jj✓ Y Signature. ------- —< Hume Phone/�___-��%�!% Please call 714-536-5676 with questions regarding j'Ice ffa ,rardouslVaterialsProgram.