HomeMy WebLinkAbout15021 GOLDEN WEST - CofO (6)SUPPLEMENTAL INFORMATION
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BUSINESS ADDRESS 150,2/ �OFJ Vqz- ST �/�'/tJA6-7Dd1
&AQy 9d?(Oi
2.
Person to contact in case- of emergency. 1.LC
Telephone number:
3.
Does the building in question have electricity?
lid Yes
❑ No
(a) If No, are you requesting that the electricity be
O Yes
a
turned :on? _
❑ No -
4.
The building is sprinklered? _
❑ Yes
No
5.
Operations will produce dust / v:ood shavings. or similar
material?
❑ Yes
s.
No
6
-Operations - will involve- the repair- or replacement of
❑ Yes
;
automobile parts?
No
If Yes:
(a) Describe the components repaired or replaced'.
(b) Does the operation involve the Use of ..an open flame? . 0 Yes
No
1-,
The business is drinking, dining or assembly use that
will
`
result in an occupant load ,of more than 50 persons.
: " ❑. Yes
8.
The following best" describes my operation;-
Office Only
etail
Warehouse
Manufacturing? Distribution (describe process and end
product)
Restaurant / Take Out Food
Medical / Dental
Other. (describe)
.
SUPPLEMENTAL iNFORMATiON
�., South Coast
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AIR QUALITY MANAGEMENT DISTRICT
21865 E. Copley Drive, Diamond Bar, CA 91765-4182 (909) 396-2000
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AIR QUALITY PERMIT CHECKLIST
for nonresidential buildings only
Company Name: 95kjlig, l 5 _S�{'AQ?l tUf, C 3?SD
:.
Location of Property: 15221 CmeDFx/ lrt��3?�
city�t► J6-72 J �'i H . 9-201
: Zip Code. _
Contact Person: ';A a [�L Title: 1f ® 2kaiD,ce fflhX1s#�_
Telephone Number: 93#- 833 Fax Number:
Type of IndustryBusiness;
To apply fora nonresidential building permit, you must complete this checklist. If you have any
questions about completing this checklist, please call (800) 388-2121. ,
YES
NO
I. Will the facility have a charbroiler?
- 2. Will any internal combustion engine with greater titan 50 horsepower
}
operate, at the facility (excluding motor vehicles)? [ ]
3. Will operations at the facilityinvolve mixing, blending, orproceasing of
solvents, adhesives, paints or coatings?
4. Will dust or smoke be generated at the facility?
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?
7. Will any combustion equipment rated greater than,2,000,000 ET[i/hr be
'
operated at the facility? [ ]
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8. Will any acids, solvents, or motor fuel be used or stored at the facility? [ j
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? [ ]
(5C
,,
11. Will any CFC (Freon) recycling machines operate at the facility?
Applicant. cant: _ fober•1 t3. 'DY1e_ _Signature.
(Print name clearly)
If you have ;narked "NO" in all the boxes, an air quality permit is nQj 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 Distract (AQMD). Please read the requirements on the beck of the checkhs`i.
t.
(800) 388-2121
,.ADDITIONAL, SUPPLEMENTAL. INFORMATION,
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