HomeMy WebLinkAbout15039 GOLDEN WEST - CofO}
� y APPLICATION FAR CERTIFICATE OF OCCUP
ANCY
CITY OF HUNTYN�'Y' N BEACH DEPARTMENT OF BUILDING & SAFETY
TY
ert (3"' Floor— IVlustAPPY III-Pel sort)
Business Lice;.se Date.
Address 1 0`3�►— d !?�
Business Name �i� ►�� ��s"1'^ �� Telephone
i Busi.riess Type
Pro erty Owner Information Business Owner
Name Name
` Address Home Address 1i 2 M t1VN
i City RITel. City�re p.�. � o#e- Tel. IlL.`�34
THIS USE i�'OULD`BE DESCBED AS: ��,,��
f
❑Newly Constricted Building or LVExisting Building
1 CHECK. ALL THAT APPLY:
❑Change of Owner ❑Change of Occ;.ipant ❑Change of Use �AddztionaLOccupant
Indicate former use, if any ►� ��� t
Does the building have electricity? Yes El No
If No, are you requesting that the electTi itybe tuned on? Yes ❑ No
The building is sprinklered? Yes No
Operations will product dust/rvood'shavings or similar material? Yes ❑ No
1.
Operations ull 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
The business is drinking, dining or assembly us that will result in an occupant load
of more than 50 persons. Yes ❑ No
Fd
The following best describes my operation:
❑Office Only ❑Retail Sales �edical/Dental ❑Restaurant/Take Ot;t Food ❑Warehouse
❑Ivialiufacturing/Distribuiion (describe process and End product)
❑ Other (describe)
t Off ce Use Oily: ,. Occ Group:_Occ Load
. —
I Zoning-, S •
-
1' TIF Review: Y/ N Amt PaidS. !
1i Stories: i Parking Spaces: paid BEFORE Final Inspection
} Entitlement 4:
Building Permit
Comments: 1, > trs� C�-
B:ld /Ply CnfO� �?
t` Planner Irutr Q
-------------
I1AZARDOUS MATERIALS DISCLOSURE INFORMATION'
Huntington Beach Fire Department
7; 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'e ' losive
F• Any amount of chemicals known to cause cancer,
• Any amount of commercial pesticides
a • 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.
2. Upon approval of the Fire Chief, hazardous materials contained sol :ly in consumer products ,:ackaged
for use by and distributed to the general•public. However; pesticides, herbicides, and ammonmm
-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
Administrative Code.
Check one of the following:
r No chemicals are used, handled or stored at this business.
L..
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 will be sent to you.
Amounts will be verified by the Fire Department during annual inspections. It is unlaw.l for any person to
knowingly violate any provision of this ordnance.
Ice rtify, under the penalty of perjury, that the above information is true and correct to the hest of my
knowledge. _-r:,----7 1
Sim e_
Date
Home Phone
Please call 714-536-5676 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:/Iwww.agmd.co
Air Quality Permit Checklist
California Government Code 65850.2 prohibits cities from issuing a Certificate of Occu fancy 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 (AQMD).
Company Name;
Property Address 1505� (5ac(4v
City: +1-�'►` Zip Code: 514 4—
Contact Person: `1 _ Title:►'`
-----fit
Type of Business: W06 cc.L2ggMaare:
T ,
Applicant: (print name) 01rt1 7{
• Will the facility have any of the following equipment? Yes ❑ No
Charbroiler
Dry cleaning machine
Spray Booth
Printing Presa (screen/lithographic/ilexographic)
Internal combustion engine (greater than 50HF) (excluding motor vehicles)
Boiler/combusdon equipment (greater than 2 million BTU/hr. maximum 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 ❑ No
Application of paints or adhesives`
Etching, plating,:casting, or melting of metals
Molding and blending of liquids and/or powders
Storage of acids, solvents, organic liquids or fuels
Production 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. Upermits 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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Trancode:
[PERMIT] C O M M U N I T
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Function:
[HST] P E R MI
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[4411]
['unction:
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F O H 1 S T 0 R
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Address: (150391
[GOLDENWEST
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Business Name
Issue Date
Admin.Action
Detail?
[ADVANCE LASER INSTITUTE
]
[00/00/00001
[
]
[ ]
CC
& R'CLOTHIERS
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[11/15/1974]
[
[C
& R 'CLOTHIERS
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[10/16/19971
[
[COLDENWEST 5URIICENTER
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[03/04/20041
{
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& J BILLING.: SERVICE
]
[04/`28/2004]
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[CORRECTIVE CONCEPTS
]
[04/29/20041
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[ ++++
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RCV
jFORMf
1LTAII Col 13JRoW
1(FaHe 3'1WS14UC
x,
4 APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUVNTINGTON BEACH - DEPARTMENT OF BUILDING & SAFETY
q..� (3rd Floo1, — PIfirst Apply lic-Pea-soii,)
Business License 9 Date
-Address � �j P7
Business'Ta>ne Telephone
Business Type v
Pro erty Owner 'in ormation /�" Business Owner
r�.ame Name Ian � ` ty,
Ekddress -7 Home dress
1i{
Tel,, - �'`" City `?.Mel.
city THIS USE WOULD n DESCRIBED AS: 0
❑Newly Constructed Building or. _ xisting Building
CHECK ALL THAT APPLY:
❑Change of Owner ❑Change of Occupant ❑Chang -- of Use Additiona'_ Occupant
Indicate former use: if any�>rC1�
r,, °o the buildiz,� have el�ctricity? Yes R No❑
if No, are you requesting that the elecuicity, Burned on? Yes ❑ No Q
The building is sprinklered? Yes Ito ❑ /
Operations will product dust/wood shavings or similar material? Yes ❑ No
Operations will involve the repair or replacement of automobile parts, Yes ❑ IrTo
If yes: Describe the components repaired or replaced.
Does the operation involve tt c use of tiveldina cr open
P lame? Yes ❑ No
The business is drinking, dining or assembly use t will result in an occupart load
of more than 50 persons. Yes ❑ No
The lowingbest'describes my operation:
Office Only ❑Retail Sales ❑Medical/Dental ❑Restaurant/Take Out Food 0-Warehouse
❑1, mufacturing/Distribution (describe processand end product)
❑ Other (describe)
Office use Only,
Zoniu-: Sq Ft Occupied:--Occ Groups `�'`� Occ Load: +
1 Stories Parking Spaces: TIP Review: Y/ N Amt PaidS: i
i Paid BEF69 Final lnspecdcn
E
Building Pen-nit4Entitlement T: t}
!comments"
iglPlCofO
Planner Init ls: B.!dg/pl s �._.
'in iw
6 t-4
�a
OUS MATERIALS --DISCLOSURE--DISCLOSURE DTOWMATI�JiI�i
HAZARD
LHuntington Beach Fire Department
California Health and Safety Code requires the Fire Department to regulate businesses that handle hazardous
materials. Mo'sOr oil, hydraulic fluids, gasoline, dry cleaning fluid, etc., are considered hazardous materials and
must disclosed. If you use, handle or store hazardous materials or waste materials ;equal to or in excess of
the following bas;c 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
o Any amount of commercial pesticides
• Reportable quantity of any chemical on EPA Extremely Hazardous Materials Substance List
Disclosure is not required for the followi.11g:
1. Hazardous substances contained in food, drug, cosmetic or tobacco products.
2. Upon,Chief, hazardous materials contained'sol;lyin consumer products packaged
approval of the Fire
for use, by and 'distributed to the general public. However; pesticides, herbicides, and ammonium
•nitrate fertilizers over the required disclosure amounts arc, not exempt fronz'disared i ..
3. The transportation of hazardous materials accompanied by shipping, papers prepared m 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
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 disclosfare
_ Chemicals are used, handled or stored at this business. Disclosure forms will be sent to You.
Amounts will be verified by the Fire Department during annual inspections. it is unlawful for any person to
knowingly 'violate'anyprovision of this ordinance:
I certify. unde . the enalty of perjury, that the above,information is true and correct to the best of my
knowledge.
i Date____ Signature z
Home Phone_ _
Please call'14-536-S6i6 with questions regarding the Hazardous aterialsProgram.
fSouth Coast
Air Quality Managvment District
21865 E. Copley Drive_
'Bar, CA 91765-4182
(5,09) 396-3529 htpp:/lwww.agmd-goti
Air Quality Permit Checklist
California roverriment Code 65850 2 prohibits cities from issuing a Certificate of Occupancy 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
Company Name
�`--'
Property Address: ,
City: 10fZ Jip Code:
Contact Person:
v
Type of Business: Telephone:
_ _ P • (
Applicant: (print name) %i'l T %C SignaturZ'
e
• Will the facility have any of the following equipment? Yes 0 No
Charbroiler
Dry cleaning machine
Spray Booth
Printing Press (screen/lithograpWc/flexographic)
Internal combustion engine (greater than 50HP) (excluding motor vehicles)
Boiler/combustion equipment (greater. than 2 minion BTU/bx. maximum input)
Abrasive blasting cabinet/room
Baghouse/cartridge ;ype dust filter/scrubber
Motor fuel storage and dispei.sing equipment
• Will any of the following operations be performed? Yes ❑ NO
Application of paints or adhesives
Etching, plating„casting, or melting of meals
Molding and blending of liquids and/or powders
Storage of acids, solvents, organic liquids or fuels
Production of acids, solvents, organic liquids, or fuels
Production of flumes, dust, smoke or strong odors
If you answered `No" to both question s, this checklist is your clearance from AQMD,
If you answered "Yes" to wither' question, you must contact AQM D to determine if air quality permits are,
required. If permitsare needed, ACT wvill assist you in subraittine permit application(s) and then provide you
with a clearance letter. You can call AQMn at their 5ina11 Business Assistance Office at (8t7t!) 38$-2i21.
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