HomeMy WebLinkAbout15261 Connector Ln - CofO (4)ApP_II jCATI0N .FOR CERTIFYCA E OF OCCUPANCI
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Bturl ASS Type':: f14MM_(Y-�7\I�'`Li
Prooe Owner Info— _at' or sc�tour B i i_±ess Du_,e
Name F�Y,t�. G� I u,�. ws IV, Pur4u,.s•�i IN"=e FvMY,k. t? ddress I (� ( i Gh ar(�cw. Lew e Homer ress i G S/ Salk 4-
City N,)..O C. . Tel, 7/4 356"-;sg City ij�hkrY,<�o fir_ Tel, �� sSs- s'If
THIS USE Yip ULD BED SCRIBED AS; ����,�`�i 35'S-;,;,7 y
EhNewly Constructed Building or existing Building
CHECK ALL THAT APPLY;
OChaage of Owner ❑Chw-ge of Occupant UChange of Use ❑additional Occupant
Indicate former use, if any _ �
Does the building have electricity? Yeses NoC
If No, are you requesting that the electricity be turn on? Yes ® No
The building is sprinidered? Ye No
Opezat ' :, s will product dust/wood shavings or similar material? Yes Now
Operations will involve the repair or replacement of automobile parts Yes Cl Nei
If yes; Describe the compoi1ents repaired or replced.
Does the operation involve the use ofwelding or open flame? Yes N
� o
The business 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 operation;
*flac_-QRetail Sales ❑NIedical/Dental FIRestatirant/Take Out Food `Warehouse
C]Manufacturing/Distribution (describe process and end product)
^
M Other (describe)
� Office Use Ou�nl� ; flee Load..--[ � O.
'l'Zoaune; r± Sq t Occup±ed;2 ,U F occ Group; --�
l t
f; Pa;ldz�g spaces; r �_ Tr Review': Yi i� ant t aids; 5t
t r S 4ories; pad BE.F
-: Fin2l tRspec.,tart
Building Per. -nit = Ertitlerrer:t �:
i1 Comn . enrs; ,tt:als — Co
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Brdr�P i :� Chacker
1, iarx_er Initials:
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South Coast
it Quality Manaorement District
21863 E. Copley Drive
Diamond Bar, CA 91765-4182
(909) 396-3529 htpp.//ti wv-i.agmd.,zov
.sir Quality Permit Checklist
California Government Code 65850.2 prohibits citi.s 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 roast Air Quality Management District (AQyiID).
Company Name, CQ `,5A-''' `' u
Property Address:
City: 1 c��k� t �r t Zip Coder
Contact Person' _w� (hea Ckp.-� <� Title
Type of Business: C�a"sAvu —6 w,, Telephone; ( )
F ro.-.lt G LI.(k— s u Signature: " "�-- -----'
Applicant; (print name)_.
Will the facility have �riy 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 blasting cabinethoorn
Baghouse/cartridge type dust filter/scrubber
Motor fuel storage anti dispensing equipment
• V►Till any of the following operations be performed` Yes ❑ NO
Applicatia.a of paints or adhesives
Itch ing, plating,, casting, or melting of metals
Moldiog anal blending of liquids and/or powders
Storage of acids, solvents, organic liquids or fuels
Production of acids, solvents, organic liquids, or fuels
Production of fiunes, dust, smoke or strong odors
.If you answered "Ivo"to both questions, this checklist is your clearance from AQN0.
• if you answered "Yes" to either question, you must contact AQ)L O to d t rmine if q and thenuality isare
provide you
required. If pe='ts are needed, AQIvID will assist you in �ubma#tus� perm P.
with a clearaeime letter, You can call �.QivlD at their Small Business Assistance office at ($00) 388=2121.
CERTIFICATE OF OCCUPANCY EVALUATION FORM
GENERAL BUILDING INFORMATION
Owner name; # Address andlorsuite It.,
Fr4w1x- �i�(k-�1�ts wi5 t� I cohnoc ,r 1a�,�
Emergency conl^ct: Phone number_
Occupancy Class - primary use(s) & sq. IC Occupant load:
Occupancy Class -se nd use(s) & sq. It:
Typo of construcluotr.
I Stories & }foighl(K)
Sprmk6ng usod?
0storyincrease
�r
{5ig11y Ordinance
❑l)nlimiled area
OAtria
Go�,wt s,
t]Ono hourconstruction
OAtea Increase
Ocha ter 9
c Area allowed: l]asic:
Yard:.
Area separation:
Sprinkrolg:
For multi sioned and mixed use attach a separate work sheet or Include in sKelcn area
Attach work sheets bv Alanniinctor Fire if r� ovided
YARD 2
d YARD 3
PARKING
YARD 1 I
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STRIP RETAIL USE �
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STREET NAME
FIRST FLOOR
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PIPELINE LANE
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