HomeMy WebLinkAbout15011 GOLDEN WEST - CofO (11)r
APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACHnN
WACH
r i0 DEPARTMENT OF COMMUNITY DEVELOPMENT
DATE
HUN
aON \` (PRINT OR TYPE ONLY)
Addre 15 01 t {i (L-D e�.. vj � District
Business • ame CJ t-� '-'� of ��^�1.1 1 / Tel, t
Business Type Crl��r��'�iP Occ. Group
1 / BUILDING TOW,,BUSINESS OWNERIMANNAGGEER
Name L O. , 'lir1 �"G�' Name �'��71�1'i�-*,JoeK_
Home A,.,� G. j
Address �f Ad_drvss �f�w�-`��ry
City �VT %7/Cit�yJJ�i,IVy7�/�' / HomeTe��l'�C�'
THIS USE WOULD BE DESCRIBED AS; Imo
❑ NEWLY CONSTRUCTED BLDG. 144, CHANGE OF OWNER i�- ❑ CHANGE OF OCCUPANT
r EXISTING BUILDING ❑ CHANGE OF USE ❑ ADDITIONAL OCCUPANT
,f
Indicate former use, if any _Occupancy Gr.--Div.
SQUARE FT. OF BUILDING TO BE OCCUPIED
TRAFFIC IMPACT FEE
..:. DATE PAID 7
AMOUNT RECEIVED
NAME f
(FOR OFFICE USE ONLY)
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SUPPLEMENTAL INFORMATION
ZONING
UP
OCCUPANCY GROUP
NO.
PLAN CHECK_
PARKING SPACES —
N0: PA G
OCCUPANT LOAD
PERMIT NO.
HEALTH DEPT. APPROVAL
NO. OF STORIES -- ADMIN. ACTION
r
UTILITIE", LEASED
f
( �j CERTIFICATE OF OCCUPANCY FEE
$
PROVED BY
DATE CHANGE OF USE OR OCCUPANCY FEE
$
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TOTAL
g ;
75-039 Rev.1/97
COMMUNITY DEVELOPMENT
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SUPPLEMENTAL INFORMATION
1.
BUSINESS ADDRESS��L%�GIICL%ST!'TdYl �cil
2.
Person to contact in case of emergenc jJ�e'&tpolee4
Telephone number: /
3.
Does the buildingin y? question have electricity? � es
❑ No
(a) If No, are you requesting that the electricity be C1 Yes
turned on? ❑ No
i
4.
The building is sprinklered7 ❑ Yes
G7�No
5.
Operations will produce dust/wood shavings or similar
material? Yes
0
'
6.
Operations will involve the repair or replacement of ❑y-
automobile parts? No
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If Yes:
(a) Describe the components repaired or replaced.
4 L4
4
a
(b) Does the operation involve the use of an _open flame? s
7.
The business is drinking, dining or assembly use that will
result in an occupant loadof more than 50 persons. ❑ Yes
^
9
8.
The following best describes my operation; -
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Office Only
Re • les
Warehouse
Manufacturing / Distribution (describe, process and end product)
Restaurant/Take Out Food
E
Medical / Dentil
Other (describe)
•
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.. az SUPPLEMENTAL 1NFORMAMON
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SUPPLEMENTAL INFORMATION (Continued)
. =Does ` t�� operation involve. ' any of the 'following' materials?
d Y
No
If "Yes, 'indioate quantities:
Material F Quantity
1. Flammable liquids
E
Class I -A
Class I-6
Class I-C
2. Combustible liquids
..
Crass 11
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Class 111-A
3. Combination flammable liquids
4. Flammable gases
'
5. Liquefied flammable gases
"
6. ,,,Flammable fibers - loose
7. Flammable fibers - baled
f
8. Flammable solids
9. Unstable materials
j 10. Corrosive liquids
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11. Oxidizing material - gases
12. Oxidizing material - liquids
13. Oxidizing material - solids
14. 'Organic peroxides
15. Nitromethane (unstable materials)
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16. _, Ammonium nitrate
17. " Ammonium nitrate compound mixtures
,
containing more than 60% nitrate
by weight
18. Highly toxic material and
poisonous gas
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19. Smokeless powder
.,
l 20. Black sporting powder
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f I hereby certify that the above information is true and correct
to
the best of my knowledge.
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Signature Cate
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South Coast
AIR QUALITY MANAGEMENT DISTRICT
Y
21865 E. Copley Drive, Diamond Bar, CA 91765-4182 (909) 396-2000
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AIR QUALITY PERMIT CHECKLIST
�b
Company Name: r nonresidential ildings only
L173
Location of Property: APW e��4r-KI FKZ- V-
City:6!1T1dY1 Zip Code: --9uV7
Contact Person A .�,e�l4--e-4t Title flJcc)7LP/�--
Tele hone Number 71 S16?4r2
� P Fax Number:
Type of Industry/Business: � . f 7":S
To apply for a nonresidential building permit, you must complete this chee'klist. If. you have any
questions about completing this checklist, please call (800) 388-2121.
YF,S NO
1. ''Will the facility have a charbroiler?
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`
A, Will dust or smoke be generated at the facility? ]
5. Will refining of any liquids or solids be done at the facility? ]
G. Will any plating or coating of materials be done at the facility?
° 7. Will any combustion equipment rated greater than 2,000,000 BTU/hr be
operated at the facility?
8. Wi1I 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?
t 11. Will an CFC (Freon) recycling mgcnines operate at the facility? -4 ]
Applicant:
�Signatur
(Print name clearly)
-7-77
If you have marked "NO" in all the boxes, an air quality permit is not 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
it Management YDistiiet (AQMID). Please read the requirements on the back of the checklist.
(800) 388-2121
,,. #DDIT10NAL SUPPLEfYENTAL 1NFORMATfON -N x _ w_...
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