HomeMy WebLinkAbout15039 GOLDEN WEST - CofO (3)t4 APPLIC.NTION FOR CERTIFICATE OF OCCUPANCY
" CI:TY ,OF -EETFUNTINGTONBEACH DEPARTMMNT OF BUILDINf, Viz. SAFETY
crl- (3`d Floor - Must Apply In -Person)
Business License # _ Date_—riCP `D
Address �7 �v-t�-f�E-s -�-�'I C
`s Business Name' Telephone -i l `f 9q 2-low
Business Type Yr or0, 0yVL+ cbin i crt.l rCE.
Pro erty Owner Information Business Owner
Name2iNameivt.e
Address/3EilrA Home Address &I q 9 Lake 14 ve-
Ciiy ln/ Tel. ( City "z4 j ge,4e, , Tel. jai "/ 0 b
THIS USE WOULD 11E DESCRIBED AS: �_,,��
❑Newly Consti acted ► Building or Existing Building
CHECK ALL THAT APPLY:
❑Change of Owner ❑Change of Occupant ❑Change of Use 21Additional Occupant
Indicate former use, if any ljer.'r c2�
Does the baildinghave electricity? Yes a- No❑
If No, are you requesting that die electricity be turned on? Yes ❑ No
The building is sprinklered? Yes U` ` No ❑
Operatioas will product dust/wood shavings or similar material? Yes ❑ No
Operations will involve the repair or replacement of automobile parts Yes ❑ No ®`
If yes: Describe the components repaired or replaced.
Does the operation involve the use of welding or open flame? Yes ❑ No 0''
The business is drinking, dining or assembly use that will result in an occupant load
of more than SO persons. Yes ❑ No
x
The following best describes my operation:
Office Only ❑Retail Sales C:ivledical/Dental ❑Restaurant/Take Out Food ❑ Warehouse
❑ N arufacturing/Distribution (describe process and f nd product)
• t
Other (describe)
�klhcare�'� f l S (t,5
f Office Use Only:
Zouing
S Ft Occupied: ; Occ Group: Occ Load �
: q P p' I
11 9 Stories: J Parking Spaces: TIF Review: Y/ N Anit Paid$: 1
i — PaidBEPokEFinafInspeaI.en ..
Building Permit 4 Entitlement #: -- �i
{ Co:nnients: _V-ePw,
Planner Initials Bldg/Plan Checker Initials; CofO 9-7-- ;
7/
- iri
HAZARDOUS MATERIALS PIS CLOSURE INFORTvIATION —�
Huntington Beach Fire ]Department
California health and Safety Lode requires 'the Fire Department to regulate businesses that handle hazardous
i;
materials. Motor oil, hydraulic fluids, gasoline, dry cleaning fluid, etc., are considered hazardous materials and
must be disclosed. If you use, h�:ndle or store hazardous materials or waste materials equal to or in excess of
the following basic quantities, YOU are required to disclose:
r
55 gallons of liquid
• 500 pounds of solid
• 200 cubic feet of compressed gas
• Anv 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 Extreme
Disclosure Materials Substance List
Disclosure is not required for the following:
1. Hazardous substances contained in food, drug, cosmetic or tobacco products.
2. Upon approval of the Fire Chief, hazardous materiels contained sol ;ly 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 health care facilities that are regulated under Title 22 of the California
f
,Administrative Code.
Check 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
• �t to You.
_ Chemicals are used, handled or stored at this business. Dcsclosui a forms will be see y
Amounts will be verified by Fire Department during annual inspections. It is unlawful for any person to
knowingly violate any provision of this ordinance.
I certify, under the penalty of perjury, that the above information is due and correct to the best o f my
knowledge.
0-1
Signature —
Date °2�
�5 Z) �3 — 8`4(o(�
HomePhone________�.
Please ca11714-536-56?b with questions regarding the Hazardous Materials Program. }
South Coast
Air Quality Management District
21865 E. Copley Drive
Diamond. Bar, CA 91765-4182
(909) 396-3529 htpp://www.agmd.gov
Air Quality Permit Checklist
California Government Code 65850.2 prohibits cities from issuing a Certificate of Occupanoy 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 Managem. en' DD istrict (AQMD).
Company Name. �
�(J l`-�E' ,� ! l�E'. (..
Property Address: _ / 6T 3 9 C-,?o l &VUA1 Ztil �1 �
City: %�UY1lJI Beo Ch Zip Code: �g17
Contact Person: a i 7� {�QSc�ta Title. _ f"% i
Type of Business: ��k 16 i c l rl! Telephone: () Vo� �e'U
Applicant: (print name)f a u� h �aS �(d a Signature:_
• Will the facility have any of the following equipment? ` Yes ❑ I'TO
Charbroiler
Dry cleaning machine
Spray Booth
Printing Press (screen/lithographic/flex,)graphic)
Intemal combustion engine (greater than 50HP) (exclu&,.ig motor vehicles)
Boiler/combustion equipment (greater than 2 million BTU/hr.-maximum input)
Abrasive blasting cabinet/room
Baghouse/cartridge type dust filfer/scrubber
Motor fuel storage and dispersing equipment
• Will any of the following operations be performed? Yes No
Application of paints or adhesives
Etching, plating„casting, or melting of metals
• liquids and/or powders
h
n blending of q
.and ble P
11IoldL. _ g ..
g
Storage of acids, solvents, organic liquids or fuels
Production of acids, solvents, organic liquids, or fuels
Production of furies, dust, smoke or strong odors
• If you answered "No" to both questions, this checklist is your clearance from AQ-NM, .
• if yo�z answered "Yes" to either question, you must contact AQMD to determine if air quality permits are
required. If permits are needed, AQMD will assist you, in suomitting perruit application(s) and then provide you
with a, clearance letter You can call A:QMD at their Small Business Assistance Office at (800) 388-2121.
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