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HomeMy WebLinkAbout15001 GOLDEN WEST - CofOAPPLICATION FOR CER �ICAT(E OF OCCUPANCY \ � CITY OF HUNTINGTON BEACH DEPARTMENT OF COMMUNITY DEVELOPMENT DATE f3 FiUNr7N[.lON KA@1 (PRINT OR TYPE ONLY) _ Address l �i no Ii (.sty L1)iI :,I I' } I` District _ I>1 n1 �' S i.Ao i Tel. -tI LIri3- Business Name 4 .0�.�s PN:�"db A•. i Occ. Group Business Type I BUILDING OWNER BUSINESS OWNERIMANAGER N lamef, cl L _—� Name Home � � r. � Address _ c, SO, 4 Xn Address , , s• _�411=52 Jo �Si _ LAk �• a �� ; rig t. 3.n Home Tekl4491 laity. I > /' `� t Tel. City I THIS USE WORLD BE DESCRIBED AS: ; l (,< j n e S NEWLY CONSTRUCTED BLDG, A SE�WNER © CHANGE OF OCCUPANT LB,I EXISTING BUILDING CHANGE ADDITIONAL OCCUPANT Indicate former use, if any Occupancy Gr. _Div. SQUARE FT. OF BUILDING TO BE OCCUPIED-: 5 r>O TRAFFI?!VN !CT PEE _ DATE PAID RECEIVED AMOUNT T (FOR OFFICE USE ONLY) NAME � ZONING— CHECK NO __ PLAN'— NO PARKING SPACES ' OCCUPANCY GROUPHEAL PERMIT NO. H DEPT.APPROVAL I OCCUPANT LOAD ADMIN. P.CTION UTILITIES RELEASED NO. OF STORIES 3 CERTIFi'ATE OF OCCUPANCY FEE $ Y DATE CHANGE OF USE OR OCCUPANCY FEE $ APPROVED TOTAL $ COMMUNITY DEUELG ". Z:NT J is-oae Rev, vez i r SUPPLEMENTAL INFORMATION 1. BUSINESS ADDRESS IS L~)FrJ„Jif- 1T t; 2. Person to contact in case of emergency: — Telephone number: _'�ef40 Lti- iG J # j - 3. Does the building in question have electricity? fZ Yes i C No ' (a) If No, are you requesting that the electricity be ❑ Yes turned on? ❑ No 4. The 'building is sprinkiered? L� Yey ❑ No 5. Operations will ;produce dust/wood shavings or similar material? ❑Yes _ ® No 8: Operations will involve the repair or -replacement of ❑ Yes automobile parts? No r If Yes: ` (a) Describe the components repaired or replaced. r, b) Does the operation involve the use of an open >flarrl-? (P p ❑ Yes No 7. The buE.ineSs is drinking, dining or assembly use, that will result in an occupant load of more than 50 persons.- ❑ Yes # ® No 8. The following best describes my operation; Office Only Retail Sales Warehouse Manufacturing / Distribution (describe process and end product) 1 Restaurant/Take Out Fled Medical / Dental s . . ) _ _— Other devsncbe ��� .���� .: �...a.�eT-' 1 c SUPPLEMENTAL INFORMATION : i SUPPLEMENTAL INFORMATION, (Continued) Does _ the operation involve _ . any of the following materials? Cl Yes h i No u If, Yes, indicate quantities: Matena. _ Quantity � l 1. Flammable liq�.ids 'Class i-A `Class I-B z Class I-C . i 2. liquids Class 11 s Class lit -A 3. Combination flammable Iiggiris 3. _ �.. 4. Flammable gases 5. Liquefiedflammable gases 6. Flammable -fibers - lo65e 7. Flammable fibers - baled 8. Flammable solids 9. Unstable materials 10. Corrosive liquids r :. 11. Oxidizing ' material - gases _ s 12. - Oxidizing material - liquids 13. Oxidizing:, material - solids s, 14. Organic peroxides t 15. Nitromethane (unstable materials) _ s �� 1 16. , . Ammonium nitrate 17. Ammonium nitrate compound . mixtures containing more than 60% nitrate by weight 18. Highly toxic material and 1 poison -us, gas, '15. Smokeless powder 20. `' Black sporting powder 1 hereb certify that the above information is true and, correct to e. the best of my knowledge. Signature Date s r: a I r South Coast AIR QUALITY MANAGEMENT DISTRICT 21865 E. Copley Drive, Diamond Bar, CA 91765-4182 (909) 396-2000 � AIR QUALITY PERMIT CHECII-IST for nonresidential buildings only Company Name: Location of Property: aoa Lae ai City: Zip Code: Contact Person:. n --Title: r Telephone Number: H mti t q.ct 3Zti_<'., Fax Number: Type of Industry/Business: co ra a .- An -r. ; L n/l A 9 i I To apply for a nonresidential building permit, you must complete this checklist. If you have any ' questions about completing this checklist, please call (800) 388-2121. ; YES NO 1. - Will the facility have a charbroiler? [ ] [5Q f 2.:.Will any internal combustion engine with greater than 50 horsepower operate at the facility (excluding motor vehicles)? [ ] 3. Will operations at the facility involve mixing, blending, or processing of solvents, adhesives, paints .or coatings? [ : ] M i 4. Will :dust or smoke be generated at the facility? [ ] CX] 5. Will refining of any liquids or solids be done at the facility? [ ] [ 6. Will any plating or coating of materials be done at the facility? [ ] [xf 7. Will any combustion equipment rated greater than• 1,000,000 BTCUhr be operated at the facility? { [ 8. Will any acids, solvents, or motor fuel be used or stored at the facility?' 9. Will any organic liquids or gases be reacted or produced? 10. Will any ovens be used to dry or cure products at the facility? 11. Will any CFC (Freon) recycling machines operate at the facility? [ j fX1 ; , Applicant: Signature: (Print name clearly) If you have marked "NO" in ali the boxes, an air duality permit is n.Q-t needed at this time, and this checklist is your written release. If you marked "YES" in any of the boxes, you must contact the South Coast Air Quality Management Diistrict (AQMD). Please read the re uirements on. the back of the checklist. (800) 383-212/ ADDITIONALSUPPLEMENTAL INFORMATION