HomeMy WebLinkAbout15079 GOLDEN WEST - CofO (6)M �rt
MITLICATION FAR CERTIFICATE OF OCCUPANCY � �
C11TY OF IR TNTLNGTON BEACH - DE�'�.ART� MINT OF BUMDUKG a SAFETY-?
Y
(s`4Floor -MustAprply In -Person)
Business Licenser Date -# — N -cj
Address- 0. o` �a C-6t _"-. S-1. 13� _ ? f .
Business ;ia_me ►� t I &P-i A C � � c, K. €mac. n or.. Telephone qt f iS `t
Business Type
aormation Business Owner
Na,-re _ M4�� ���1 �arsae
.address t-ass
..
C ; ry r, r ► c-G. 'r ::� (14-'5eIC- ,'SYlCity Tel.
TMS USE WOULD BE DESCRIBED AS.
]tiewly Constructed Building or �kxisti q Buil UDC
CHECK ALL TRAT APPLY.
:Change of Owner QLhange of Occupant CIChange of Use —, Additional Occupant
lndica'e former use, if any
Dees the building ;nave electricity? Yes, . N0
If ti o, are you requesting that the electricity be turner on? Yes Q. No n
The building is sprutklered? Yes 0 No X
Operations wall product dust/wuod shavings or similar material? Yes a 3NTO
operarons will ins o!ve the repair or replacement of au0mobile parts Yes U No
If %'es: Desr .be the components repaired arripplaced.
oes the operation involve the use of welding or opera flame? Yes n No
The business is drinking, dining or assembly c9e that will result in an occupant load
ci more than 50 persons. Yes U NO
ZI
Tha following best describes my operation:
� Offce Only QRetail Sales Zedical/DAntal URestau*antlTake �?ut,Fc od � Pare ause
:1 .manufacturing/'Distribution (describe -process and end Ixoduct)
Other (describe)
Office Cse Only:
Zoning. C._ �7 Sq Ft Occuptedt Aocc Group. Ocr Load:. _,______
Stories. / Purring Spaces: TII= Revie� . Y Aptl?aii S: _o i
>,rb�.�,
paid BEFORE 1Wp=ion
Eutitiement rr
BuildingPernut r f f
Pl u-;fir Initials Bld, gli'l�dn Ghecli �ntti CofO
South Coast
Au Quality Management District
21865 E. Copley Drive
Diamond Bar, CA91765-4182
(909) 396.;3529 htrip://www.aqmdgov
Air Quality PenWt Cheddtstf
California Government Cade 65850.2 prohibits cities from issuing a Certificate of Occupancy to abusiness k
«rithout clearance froin, the local air quality agency. This checklist will determine if you need` to obtain
clearance from the South Coast Air Quality Management District (A.QMD)
Companyivame: bv. a'' AQA
Property Address: two--J i S i
City: tin -,. Zip Code: q Z. �;,4
Contact Person: t` r A - 'Title:. A>_
Type of Business: � � �-�,�, � �--� i � Telephone;
Applicant: (pr%nt name) M �,e o Signature:
Will the facility have any of the :followmig equipmcnt? Yes Q No UK ;
Chaforoiler
Dry cleaning machine
Spray Booth
Printing Mess (screen/Uthographic/flexographic)
Internal combustion engine (greater than SOB?) (excluding motor vehicles)
Boiler/combustion equipment (greater tf a 2 million BTU/hr. maxis num input)
Abrasive blagang cabinettroon
Baghouse/cartridge type dust, filter/scntbber
Motor fuel storage and dispensing equipment }
• WiD. any of the following opuratic-as be performed? gyres i�i v
Application of paints or adi:esives
Etching, plating, casting, or melting of metals
Molding and blending, ofliquids and/or powders
Storage of acids, solvents, organic liquids or fuels
Production of acids, solvents, organic liquids, or, €uel
Production of fumes, dust; smoke or strong odors
® If you answered ``llio" to both questions, this checkl sties your clearance from AQ M-
* If you answered "Yes" to either question, }Vu must contact AQIvII� to det�rrrttne if air quality pmiits :are
requut.d, ifperoaits are needed, AQMD will assist you. in submitting permit application(ts j and.then provide you
with a clearance letter, You can call AQTvID af their Small Busijncss Assistance {7fce at (800) 38L-2121. s
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