HomeMy WebLinkAbout15011 GOLDEN WEST - CofO (2)i
CERTIFICATE OF OCCUPANCY 1 / 16 / 9 6
1
CITY OF HUNTINGTON BEACH
Date
Address 15011 GOLDENWEST
District
—
Business. Name ACE DONUTS
Tel. 7,14--89r 6887
DONUT SHOP
_ Occ. Group _
Business Type -
�
X
'x
BUILDING OWNER
BUSINESS_OWNER/MANAGER
1.
a
I°
LESTER C SMULL AS TRUSTS
Name ECHA PATTANA51NTH
Name
i
Ad&(ysg61 FITCH
Home
Address 25 AMATO
CTt?VINE CA 92714 Tel. 714-474-8900 C�TSSION VIED Tome 714;86-8557
Cf
vI
Construction No. of Stories
Occupant Load 1 8 — Sprinklers
CONDITIONS OF APPROVAL
1'
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DEPARTMENT OF COMMUNITY DEVELOPMENT -
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This Certificate of Occupancy
SHALL BE posted in a conspicuous place on theLA
I remises and shall not be removed except by the
P
b y
t Building Official.
t
COMMUNITY DEVELOPMENT
MOAO
APPLICATION FUR CERTIFICATE OF OCCU NC
CITY OF HUNTINGTON BEAICH
DEPARTMENT OF COMMUNITY DEVELOPMENT CA IqONff" (PRINT ORTYPE ONLY) ., DATE.
Address fJ0l CoLt7FN WZ*1" 5iP-E1T �()N INArO d>;ACfr cfj District
pgT7A NA ' PVC. DDA �E DONGQI L4) $94pr`�
BusinE,s Name /4i
Business Type _ Do INVT Occ. Group'
BUILDING OWNER BUSINESS OWNERIMANAGEiI
name LESTE K C - S M U 4-l. AS ! QGSTLG Name PR�CEFA- PR-TT,4 N-A Sit N'rH
a yb 3 '1 FIT"CH Home 0?5 ANATO
Address ' Address i
City ZRVI rVF CIF qq--7rIt Tehf/�J S a—g*B 'city 015$I6� _V rrl P CA' 9022 Home 4TORIIinS` I
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THIS USE WOULD BE DESCRIBED AS:
❑ NEWLY CONSTRUCTED BLDG, CHANGE OF C`AINER ❑ CHANGE OF OCCUPANT
EXISTING BUILDING ❑ CHANGE OF USE ❑ ADDI', IONAL OCCUPANT
Indicate former use, it any, Q.-r-- - 1 � Occupancy Gr. Div. _
SOUARF FT, OF BUILDING TO BE OCCUPIED 4134 19(R VAgE Fr'
TRAFFIC IMPACT FEE
DATE PAID
AMOUNT RECEIVED
NAME
(FOR OFFICE USE ONLY)
(.' 6r-
SUPPLEMENTAL INFORMATION
ZONING
OCCUPANCY GROUP /-?
PLAN CHECK NO.
NO. PARKING SPACES
OCCUPANT LOAD
PERMIT NO.
HEALTH DEPT APPROVAL
NO. OF STORIES
ADMIN. ACTION
UTILITIES RELEASED ._
CERTIFICATE OF OCCUPANCY FEE
g
APPRO EV D BY DATE
CHANGE OF USE OR OCCUPANCY FEE $
TOTAL
$
75-039 Rev. 11/90
COMMUNITY DEVELOPMENT
SUPPLEMENTAL INFORMATION
f5017 U-O�Df N WE5T HW4 04TON Ar_-ACV
(Zfl R2b¢9
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BUSINESS ADDRESS
3
SUclk trgt PA-T7%NP,5(NThl
2.
Person to contact case; of emergency*
C�rw) 5868551
Telephone number.
i
lYes
3.
Does the building in question hays electricity?
0 No
(a)- If No, are you requesting that the electricity be
❑ Yes
❑
turned on?
R'"
21-Yes
f
4.
The building is sprinklered?
❑ No
i
5.
c r
.. or similar
,. shavings
+� oduce dust /wood g
Operations will produce
L•7
± d
material?
Yes
a No
6.
Operations wiil involve the repair or replacement of
❑ Yes�
automobile parts?
If Yes;
(a) Describe the components repaired or replaced.
�No
(b) Does the operation involve the use of an open flame?
1
7.
The business is drinking, dining or assembly use that will
❑-Yes
result in 4 ' occupant load of more than 50 persons.
2r No
8.
m operation;
t describes p
The following best Y
z
:
Office Only
Retail Sales
Warehouse
Manufacturing / Distribution (describe process and end product)
,.(
ake Out Food'
restaur;Z"
Nle I aT JpN�1 r
Other (describe)
l
SUPPLEMENTAL INFORMATION
i
SUPPLEMENTAL INFORMATION (Continued)
Does
the operation involve any of the following
materials? ❑ Yes
No
0VI'L
4PH-ATtyAJ SSE COHMJ�-P-CtAL OAS
IDR C dVW(W "DCffVUj,`
If
Yes, indicate quantities:
Material Quantity
1.
Flammable liquids
Class I -A
Class I-S
Class I-G
2.
Combustible liquids
Class 11
Class III -A
3.
Combination flammable liquids
4.
Flammable gases
5,
Liquefied flammable gases
6.
Flammable fibers - loose
7.
Flammable fibers - baled
8.
Flammable solids
9.
Unsiable materials
10.
Corrosive liquids
11.
Oxidizing material - gases
12.
Oxidizing material - liquids
13.
Oxidizing material - solids
14.
Organic peroxides
15.
Nitromethane (?.instable materials)
16.
Ammonium nitrate
17.
Ammonium nitrate compound mixtures
containing more than 60% nitrate
by weight
18.
highly toxic material and
i
poisonous gas
19.
Smokeless powder
20.
Slack sporting powder
I hereby certify that the above information
is bue and correct to
the best of my knowledge.
Signature
Date
SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT
(`nonresidential Buildings Only)
Location of Subject Property:__IS0 i/ CQLDE1VW4Sr �_ Hfw o-11vamV BfWC7-r C4 9�26f�Y
Property Owner Narrte:A£' G. SM UL L i}s *R USTE Phone
Name of the person preparing this form in print and signature: n ,
Name: '' P� c�fA PA'" A1,4,9IfVTf{ Signature
applying for building permits. Please answer the
The. person preparing this form must be the. same person g p f
following questions regarding your proposed occupancy of the subject building. IF YOU DO NOT KNOW
'HE ANSWER TO A QUESTION, MARK IN THE "YES" COLUMN:
AQMD PERMITTING CHECKLIST
i
YES NO1
l
1. Does your facility use any internal combustion engines greater than 50HP? _
2. Does your facility involve mixing, blending, or processing any solvents,
adhesives, paints or coatings? -- --- — ,/
3. Does your facility create an;r dusts or smoke?
4. Dces your facility refine any liquids or solids or reclaim any metals?
5. Does your facility plate or coat anything? - I
j
6. Does your facility have any combustioni equipment (i.e. boiler, furnaces, ;V
broiler, baking ovens, etc.) !ating greater than 2,000,000 BTU/HR?
7. Does your facrlity handle or store solvents or motor fuel?
8. Do you use car store any acids?
9. Do you use any chemical process?
10. Do You use any solvents for clean-up?
11. Are you a dry cleaner, restaurant with a charbroiler, body shop, gasoline i
station, printer, br part coater? —
12. Is the subject building located within one thousand (1,000) feet of any i
school? PROPERTY LINE TO PROPERTY LINE. GRADES K-12.
If you have marked "NO" in all columns, you do not need an Air Quality permit at this time. If you have marked
any questions in the' `YES" column you must contact the South Coast Air Quality Management District located at:
21865 E. Copley Drive
Diamond Bar, CA 91765-4182
Please call: Plan Check (909) 396-2000