HomeMy WebLinkAbout15011 GOLDEN WEST - CofO (6)YLJ ? Jati ri I
Ji APPLICATION FOR CERTIRCATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH
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DEPARTMENT OF COMMUNITY DEVELOPMENT
HUNTVCTON Et" tPR(NT OR TYPE ONLY) DATE
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r Address -411
Z �2// f� '. `—'�'.c— 'F�" District
{ Business Name ��--�-='_ a'7/tr�,ticr/W T 1�
Business Type �r-!1�� Qcc. Group
BUILDING OWNER BUSINESS OWNEWMANAGEA
Name: �� P�� Name'11L�%°� C'??�ff_✓C
Home
Addsassl_%' S'd- �`/-�t�'tir °'i�:` f'r Address: —
City Z/ G3 lt''? fief `� t✓�tyi ✓t� linJ4 H m el, .
T141S USE WOULD RE DESCRIBED, AS
NEWLY CONSTRUCTED BLDG. RANGE OF OWNER CHANGE OF OCCUPANT
EXISTING BUILDING
0 CHANGE OF USE ❑ ADDITIONAL OCCUPANT
Indicate former use, if any Occupancy Gr" Div
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,
SQUARE FT. OF BUILDING TO BE OCCUPIED
T'RA 1MC, 011 RACT F0�
I(lp t • kk 96
NAME
(FOR OFFICE USE ONLY)
ZONING
OCCUPANCY GROUP
PLAN CHECK NO. - NO PARKING SPACES
OCCUPANTLC?AE+ - -
PERMIT NO HEALTH E]EPT APPROVAL
NO, OF STO S __ _ �
- ------
- ADMIN ACTION �....� — �-- UTILITIES RELEASED
E
CERTIFICATE OF t�CGUPANCY FEE $
w..
APt'ROVED BY
DATZ
CHANGE OF USE OR OCCUPANCY FEE $ _
f
TOTAL
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7�-p$9Rer,119 -.
",'t i4'ii4ilii IE'$'E. EVEE,.Or''f43ENT — -- - --- -
r SUPPLEMENTAL INFORMATION
1'.
BUSINESS ADDRESS .44?:a � i`� a�'� �- /CAP
q2.4° -
2.
Person to contact in case of emergency
Telephone number:
3.
Does the building in question have electricity?
Yes
CJ No
(e) If No, are you requesting that the electricity be
❑ Yes
turned on?
❑ No
4.
The building is sprinklered?
❑ Yes
i No
5.
Operations ` will produce dust/wood shavings or similar
material?
G7 Yes
No ,r
6x.
Operations will involve the repair or replacement of
❑ Yes
automobile parts?
0,No
It Yes:
(a) Describe the components repaired or replaced.
j
-
(b) Does the operation involve the use of an open ,flame.?
3
❑ Yes !'
Na
7.
The business is drinking, dining or assembly] use that
will
-
resultin an occupant load of more than 50 persons.
❑ 'Yes r
Q.�No
8.
The following best describes my operation;
Office Only
Ware ouse
Manufacturing d Distribution ,(describe process and end product) x
Restaurant ' Take Out Food
Medical t Dental
Other (describe)-
4
SUPPLEMENTAL NTAL INFORMATION
I
I,
SUPPLEMENTAL INFORMATION (Continued)
Does the operation involve any of the followingmaterials'?
0 Yes
No
'}
it
'Yes, indicate quantities:
Material Cuantliv
h
_
1 .
Flammable liquids
Glass ..A
'
Class #-1
Class I -G
2.
Combustible liquids
Class 11
Class M -A
3,
Combination flammable liq«idS
R. ,'
Flammable gases.
5.
Liquefied flammable gases
G.
Flammable fibers loose
7.
Flammable fibers �- baled
B.
Flammable solids
9.
Unstable materialsT�
10.
corrosive liquids
11-
oxidizing material gases
2.
Oxidizing material - liquids
13w
Oxidizing materialsolids m
14.
Organio peroxides
M
Nitromethane (unstable materials)
18,
Ammonium 'nitrate
17,
Ammonium nitrate compound 'mixture
containing reore than ' 60%o nitrate
by weight
18.
Highly toxic material and
Poisonous gas
19.Smokeless-
powder
20,
Black sporting powder
l hereby certify that the above information is true and correct-
the best of my knowledge.
Signature Date
to
South Coast
Air Quality Management District
• ® 21865 E. Copley Drive, Diamond Bar, CA 91765-4182
(909) 396-3529 • htip://Nvww,agmd.gov
3 sir Quality Permit Checklist
California State Law Code 65850.2 prohibits cities from issuing an occupancy permit to a
business without clearance from the local. air quality agency. This checklist will determine if you
need to obtain clearance from the South Coast Air Quality Management District (AQVID).
i
Company Name: C i. � S' f�f,�'/ .,%��
r—
Property Address:
City; ri��%;/ dip Code:Z %
Contact Person: Title:
Type of Business: 1- '�G Telephone: OR)—
Applicant (print name) 11���?'% Signature;
• Will the facility have any of the following equipment? Yes[ ] No
Charbroiler
Dry cleaning machine
Spray booth
Printing press (screen/lidh(igrcpnic/flexographic)
Internal combustion engine (greater than 50 IIP (excluding motor vehicles)
Boiler/combustion equipment (greater than 2 million BTU/hr. maximum input)
abrasive blasting cabinettroom
Baghouse/cartridge-type dust filter/scrubber
Motor fuel storage and dispensing equipment
• Will any of -the following operations be performed? Yes[ ] No [
Application of paints or adhesives
Etching, plating, casting, or melting of metals
Molding; extruding, or curing of plastics
Mixing and blending of liquids and/or powders
t;torage of acids, solvents, organic liquids, or. fuels
Production of fumes, dust, smoke, or strong odors
If you answered "No" to both questions, this checklist is your clearance from AQMD. If you
answered "Yes" to either question, you must contact AQMD to determine if air quality permits
are required. ' If permits are needed, AQNM Will assist you in submitting permit application(s) ,
and then provide you with a clearance letter. You can call AQMD at their Small Business
Assistance Office at (800) 388-2121.
Rrvised February 1999