HomeMy WebLinkAbout15039 GOLDEN WEST - CofO (4)r _
APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH - DEPARTMENT OF BUMDP G & SAFETY
(3"" Floor -Must Apply In Person)
Business Li.censs # AX3 116 ® Date 7,11 / % f
AddressS�
Business Name G oL9/z/%JW i Telephone '7/�4 ,1` P 0,006`
Business Typed
Y Oawse�.�
Arien . �'„ t information_ Business Owner
IrTame N OS r w &! S PA P! R'T t NamePL.RWck,J tS� i T
Address - r Ft7'Gif Home Address 19'0) 44 y eYk
Tel..-,' E I/Va� City A 4l� t 1. ( lr _ "Tel.
City �_,� „ter t� � �. G l�` tY—�--�--
j THIS USE W(5ULD BE DESCRIBED AS:
� fWQk 'V�A_
❑Newly Constructed Building or OExisting Building
CHECK ALL THAT APPLY: r� �
Q�hange of Owner Change of Occupant OrChange of Use ❑Additional Occupant
Indicate former use, if any ��� 1.
Does the building have electricity? Yes ❑ Non
If No, are; you requesting that the electricity be turned on? Yes ❑ No
The building is sprinklered? Yes Non
Operations will productaiust/wood shavings or similar material? Yes ❑ No
Operations will involve the repair or replacement of automobile parts Yes ❑ No 0'
' If yes: Describe the components repaired or replaced.
Does the operation involve the ust-1 of welding or open flame? Yes ❑ No i frr—
T he business is drinking, dining or assembly usethatwill result in anoccupant load
of more than 50 persons, Yes ❑ No
The following best describes my op,e�rratffnn:
❑Office Only ❑Retaa Sales l4M dicai/Dental ❑Restaurant/Take Out Food UWarehouse
❑Pvtanufacturing/Distribution (describe process and end product)
❑ Other (describe)
Office Use Only: l
Zoning: Sq Ft Occupied:_C:� I L' Occ Group: Oce Load: _3
urr Stories: g Spaces: TIF Review: YI N Amt Paid$:
_ Parkin -ces: Paid BEFORE Final Inspection
Building Permit d R 3LV5 Entitlement:
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Comments,
CofO #
ji runner .uUua:b:lLAI
California health and Safety Code requires the Fire Department to regulate businesses that handle hazardous
materials. Motor oil, hydraulic fluids, gasoline, dry cleaning fluid, etc., are considered hazardous materials and
must be disclosed. If you use, handle or store hazardous materials or waste materials equal to or in excess of
the following basic quantities, your are required to disclose:
• 55 gallons of liquid
• 500 pounds of solid
• 200 cubic feet of compressed gas
• Any amount of radioactive materials
• Any amount of Class A explosive
• Any amount of chemicals known to cause cancer
Any amount of commercial pesticides
• Reportable quantity of any chemical on EPA Extremely Hazardous Materials Substance List
Disclosure is not required for the following:;
1. Hazardous Substances contained in food, drug, cosmetic or tobacco products.
-7- Upon .pproval of the Fire Chief, hazardous materials contained solely in consumer products packaged
for use by and distributed to the general public. However, pesticides, herbicides, and ammonium
nitrate fertilizers over the required disclosure amounts are not exempt from disclosure.
3. The transportation of hazardous materials accompanied by shipping papers prepared in accordance with
the provisions of 49 Code of Federal Regulations.
4. Infectious waste generated, by healthcare facilities that are regulated under Title 22 of the California
Administrative Code.
Che k one of the following:
No chemicals are used, handled or stored at this business. ,
Chemicals are used, handled or stored at this business, but do not meet the requirements for disclosure
Chemicals are used, handled or stored at this business.. Disclosure forms wil' be sent to you.
Amounts will be verified by the Fire Department during annual inspections. It is unlar': ful for any person to
knowingly violate any provision of this ordinance.
I certify, under the penalty of perjury, that the above information is trueandcorrect to the best of my'
knowledge.
Signature v Date 72l / .
Dome Phone
Please call 714-536-5676 with questions regarding the Hazardous Materials Program.
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South Coast
Air Quality Management District
21865 E. Copley Drive
Diamond Bar, CA 91765-4182 "
f (909) 396-3529 htpp://www.agmd.gov
Air 'Quality Permit Checklist
California Government Code 65850.2 prohibits cities from issuing a Certificate of Occupancy to a business
without clearance froTM► the local air quality agency. This checklist will determine if you need to obtain
clearance from the South Coast Air Quality Mana ement District (AQMD).
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# Company Name: C
Property Address: 3 1 0 0 1-0/3-tVH E%r
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city..
►� 6P 0 I tj A fF c� U )V /0 ;P k, � ►� Zip Code: '1'44 %
oncactPerson: a42 U('�' FAs(4 %10� Title �'/�Stllrewr
Type of Business: o 1-rM- i ! F- i v 16 & t ! Telephone:
Applicant: (print name) UG9 I.1,rCZ! Ile Signature:
• Will the facility have any of the following equipment? Yes ❑ No
Charbroiler
Dry cleaning machine
Spray Bootle
Printing Press (screen/lithographic/tlexographic)
Internal combustion engine (greater than 50HP) (excluding motor vehicles)
Boiler/combustion equipment (greater than 2. million BTU/hr. m&-dnium input)
Abrasive blasting cabinet/room
Baghouse/cartridge type dust filter/scrubber
Motor fuel storage and dispensing equipment
• Will any of the following operations be performed? Yes Lal No
Application of paints or adhesives
Etching, plating, casting, or melt.ing of metals
Molding and blending of liu' aadlr powders
Storage of acids, solvenL<organic liquids or fuels
Production of acids, solvents, uias 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 mast contact AQMD to determine if air quality permits are
required. If permits are needed, AQMD 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.
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