HomeMy WebLinkAbout15081 GOLDEN WEST - CofO (5)APPLICATION FOR CERTIFICATE OF OCCUPANCY;
CITY OF HUN7INGTOiN BEACH
DEPARTMENT OF DEVELOPMENT SERVICES - 7•* - S'
BATE
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THIS USE WOULD BE DESCRIBED AS:
NEWLY CONSTRUCTED EIL't`,t:i � CN "•!{_ E OF Ci`vl't�{�AI'v?
I E7{t; PNG 8 J&Lt1 NG E _ C HANG:- t.t I-] ADI-JiRONAI aXt:U"ANT
47dt..a:e #evraer u-;N. if an}���",`����
SOL"ARE FT fir R�i,i.71f is '; f) RE GICCUPIED
j# N ICE, 1, { �i cup-inc;y of any ��i71 i(1 t�rC ..1F.'' and � t..,. t .0 §P ,_ t};�k will lot LkIir_ 1':fl� �!dS
} t✓l tiFi n p - tt_'C' rlj a,[ wa t �. t t�C "I,�r -�ncy .. s,,d,
No electrical Service v.,Jt hw [i t a ff r : 1r trig I H d i t nt l r r itt , € as bef-.n ir- , -
p tited and
CtPrflft+.tT .:v3f<a All f3 li.a[ Ss rrr onupawy in an t..hx.r.y t :%jred f(, 4#, dry#C .a l !EClICiCtil
f{!Se =t1f r m the Der)=Wt d Ut.k Wof n Fit tnic, 7 tiict.
Change of occupancy or use inspection fee. `" r =r� ,vr o ,. r.iu�� r�r , toof a building
Cr >rrGnft n: r der M doximme * a amye nmy t e made in Via Char4t: k.[ if L.C>,UOanCy or use of the
} t' #31Ang Q i r (:?mASP„s whah w«iWd pia e TO 1 IE" `i A xsM{rF E M q4 ion of ?a same £g}"Gli,. p Ci IJC' mj'?ramy f
I Or 4 a k,{tff':ft'."r C rCup of wc^tif-i3n y, a change : "cc"pt3nc flspe'c.icin f.e at
P SAD be pat to Me ot'y
. Huntington Beach Fire Cade Section I 3.2:3 fe a rr a. : , - - rs f
n,1 fu�fdtn, nu.T�k�t mrast �� � rnintmtaz: c�, four
(41 inches w helhi Lail'' one AN f ., Kch ..tWS and of a,, cunfiasting color front the background. These
j nurrJn[ . rrius! be posfr".d Cn Yme building in a fcc(at,or, tha! is li3ibif °rQ.m the street.
5. Huntington .Beach Fire Code Section 1a3G1 rt cat,tr 5 hre extirutt skier selection and dist6bution pei
Me Nalkirm! RM Protk s on AS'.'tt(;IiAttm Rar''!phat "V (ee reve4` e SIdy,
SUPPLE(FOR OFFICE USE ONLY)
SUPPLEMENTAL INFOFSMATION rCfti4hdCi w
C.
OCCUPANCY CRO'JP :.' _.__. _.__W.— PLAN, .iEC;'r: NC, .____,__�.... NO PARKIPI,,.F'AC;ES
OCCUPANT" LOAD �� f'CHt,JI" NO _._ __ ._�. HEALTH f'sEPT-APPRO✓AL _
NO. OF STORIES _ —_ � W AF)'M1N. ACTION--.—____�_ _ PJ4trrfiFS RELEASED
APPROVED BY
DATE QHA U
r_iF ,. U OH OCCUt' NOY FETE
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SUPPLEMENTAL INFORMATION (Continued)
Does
the operation involve any of the following materials? ' [❑ Yes
%No
If
Yes indicate quantities:
Material Quantity
1.
Flammable liquids
Class I -A
—'
Class I-B
-
Class I-C
2.
Combustible Liquids
Class 1[
Class 111-A
3.
Combination flammable liquids
4.
Flammable gases
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5.
Liquefied flammable gases
}
6.
Flammable fibers - loose
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7.
Flammable fibers - balnd _
' 8.
Flammable solids
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9.
Unstable materials.
10.
Corrosive liquids
11.r
Oxidizing material - gases
3,
12,
Oxidizing material - liquids
13.
. Oxidizing material - solids
14.
Organic peroxides
15.,
Nitromethane (unstable materials)
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16.1.
;ammonium nitrate
17.
Ammonium nitrate compound mixtures
containing more than 60No nitrate
by weight
18.
Highly toxic material and
poisonous gas
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19.
Smokeless powder
20.
Black sporting powder
1 certify that the above information is true .and correct to
_rereoy
the of y knowledge.
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Signature Date
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Government Code Section 65850.2(b) requires that the City of Huntington Beach not issue the final
certificate of occupancy unless the applicant has met or is meeting the requirements of the South
6 Coast Air Quality Management District (AQMD). The Department of Community Development must
obtain a written release from AQMD io show the applicant has complied with this law. The check
list on the reverse side is designed to help the applicant and the building division to meet these
requirements.
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1. The applicant (the same person who applies for permits from the
Department of Community Development) must complete the check list
which can be obtained either from the Department of Community
Development or at AQMD.
2. If all boxes in the list are checked "no the Building Division can accept the
check list as the release.
3. If there are any "yes" answers in the list, the applicant must contact an
AQMD engineer by calling (714) 396-2000 to find out whether air permits are
required for the proposed construction project.
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4. If air permits are not required, the applicant will obtain a written release from
I' AQMD. &
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5. If air permits are required, the applicant must submit the necessary permit;
applications before the release can be issued.
1 Because of the time it may take for AQMD to go through the above procedures, the applicant is
advised to contact AQMD immediately after applying for building permits.
Y ADDITIONAL SUPPUMENTAL INFORMATION
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SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT
(Nonresidential Buildings Only)
Location of Subject Property:_ / 768 ( �bt,�i�_ YJC=`f-
Property Owner Name: Lt L_ E��_ Phone #:JT_r��)
` Name of the person preparing this form in print and signature:
l Name: ae � LY / 2 _. Signature:^_t_---_
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The person preparing this form must be the same person applying for building permits. Please answer the
followinguestions're ardin our proposed occupancy of the subject building. IF YOU DO NOT KNOW
Q 9 9Y R p p Y 1 9•
THE ANSWER TO A QUESTION, MARK IN THE "YES" COLUMN:
AQMD PERMITTING CHECKLIST
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YES NO ;
1. Does your facility use any internal combustion engines greater than 50Hp?
2 Does your facility involve mixing, blending, or processing any solvents,
adhesives, paints or coatings?
3. Does your facility create arV dusts or smoke? - �/ 1,
' 4. Does your facility refine any liquids or solids or reclaim any metals?--
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5. Does your facility plate or coat anything?
6. Does your facility have any combustion equipment (.e. boiler, Furnaces, 1` a
l broiler, baking ovens, etc.) rating greater than 2,000,000 I3TU/HR?
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i 7. Does your facflity handle or store solvents or motor fuel?
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8. Do you use or store any acids?
9. Do you use any chemical process? - �—
10. Co you use any solvents for clean-up? ------
11. Are you a dry cleaner, restaurant with a charbroiier, body shop, gasoline ;
station, printer, or part coater? -
12. Is the subject building located within one thousand (1,000) feet of any >�
school? PROPERTY LINE TO PROPERTY LINE. GRADES K-12.
If you have marked "NO" in all columns, you do not need an Air Quality permit at this time. If you have marked
any questions in the "YES" column you must contact the South Coast Air Quality Management District located at:
21865 E. Copley Drive
Diamond Bar, CA 91705-4182
Please call: Rlan Check (909) 396 2000
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