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HomeMy WebLinkAbout15121 Graham St - CofO (36)/A APPLICATION FOR CERTIFICATE OF OCCUPANCY C� CITY OF HUNTINGTON BEACH (/`,J /v^t/ EAARTMENT OF COMMUNITY DEVELOPMENT wpercloN MACH T6 `'' ` (PRINT OR TYPE ONLY) kl, DATE Address } I �` 1-f %) Nil t C I c/ District Business Name `T�-S Tel. Business Type Ct7�^'�U rt✓ �c'P` 'aJA�-�c 1 ^'c€I o df�-i t^� t" Occ. Group BUILDING OWNER BUSINESS OWNERIMANAGER Name �s✓t✓ 1-+' 7 Name 4,Home Address Address 174 �u�nyi S r City vr�`� A 1 N V � V �-d 4 Tel �7 - City�C-_—NA- NGLjt,1, �-f'�''. Home Tel THIS USE WOULD BE DESCRIBED AS; [%©S ❑ NEWLY CONSTRUCTED BLDG. ❑ CHANGE OF OWNER K_CHANGE OF OCCUPANT / EXISTING BUILDING ,,CHANGE OF USE ❑ ADDITIONAL OCCUPANT L Indicate former use, if any f f�OT, )�1r&Alki/ (U�O�g�hOccupancy Gr. _ Div, SQUARE FT. OF BUILDING TO BE OCCUPIED t TRAF C IMPACT FEE _ DATE PAI ��''J_ AMOUNT R �__n (FOR OFFICE USE ONLY) _ — ZONING. OCCUPANCY GROUP PLAN CHECK NO NO, PARKING SPACES OCCUPANT LOAD PERMIT NO. HEALTH DEPT. APPROVAL NO. OF STORIES ADMIN, ACTION UTILITIES RELEASED y f�� _ CERTIFICATE OF OCCUPANCY FEE APPROVED DATE CHANGE OF USE OR OCCUPANCY FEE $ _ TOTAL g 75-039Rev. vs7 COMMUNITY DEVELOPMENT SUPPLEMENTAL INFORMATION 1. BUSINESS ADDRESS I o�-i �i2f%F-4 (�i'MVt S <` S- 2. Person to contact in case of emergency, Telephone number: 3. Does the building in question have electricity? Yes ❑ No (a) If No, are you requesting that the electricity be ❑ Yes f turned on? ❑ No s 4. The building is sprinkle red? 1 Yes ❑ No 5. Operations will produce dust/wood shavings or similar material? Yes �13 No 6. Operations will involve the repair or replacement of ❑ Yes automobile parts? No If Yes: z (a) Describe the components repaired or replaced. r (b)- Does the operation involve the use of an open flame? ❑ Yes No 7. The . business is drinking, dining or assembly use that will result in an occupant load of more than _50 persons. ❑ Yes f 'Z,No f 8. The foll win-9_b_est describes my operation; ffice : n�Ty'� � ,� Retail Sales Warehouse Manufacturing / Distribution (describe process and end product) i Restaurant/Take Out Food Medical / Dental Other (describe). } SUPPLEMENTAL INFORMATION SUPPLEMENTAL INFORMATION (Continued Does the operation involve any of the following materials? ❑ Yes R N o If Yes, indicate 'quantities: Material Quantity 1. _ Fiamr-iable liquids Class 1-A Class I-B Class I-C 2. Combustible liquids C Class II Class 111-A 4 3. Combination flammable .liquids 4. ' Flammable gases 5. Liquefied flammable gases 6. Flammable fibers - loose 7. Flammable fibers - baled a. Flammable solids 9. Unstable materials,.-, 10. Corrosive liquids 11. Oxidizing material - gases 12. Oxidizing material = liquids _ l 13. Oxidizing material - solids I 14. Organic peroxides 15_ Nitromethane {unstable materials} i 1.6. Ammonium nitrate it li 17. Ammonium nitrate compound mixtures containing more than 60% nitrate l` by weight 1 18. Highly toxic material and !' poisonous gas x 19. -Smokeless powder 20. , . Black sporting powder l hereby certify that. the above- -information is true and correct to the best of my knowledge. �J Signature bate South Coast AIR QUALITY MANAGEMENT DISTRICT 21865 E. Copley Drive, Diamond Bar, CA 91765-4182 (909) 396-2000 AIR QUALITY PERrMT CHECKLIST for nonresidential buildings only Company Name:G S j Location of Property: si 2 City: Af G Zip Code: T 6 Contact Person , , Title: C �. Telephone Number: &Y4©3 Fax Number.�l{"'--�1n3�'� Type. of Industry/i�3usiness:. To apply for a nonresidential building permit, you must complete this checklist. If you have any questions about completing this checklist, please call (800) 388-2121. Yf S 2VO 1. Will the facility have a charbroiler? 2. Will any internal combustion engine with greater than 50 horsepower operate at the facility (excluding motor vehicles)? [ 3. Will operations at the facility involve mixing, blending, or processing of solvents, adhesives, paints or coatings? 4. Will dust or smoke be generated at the facility? 5. Will refining of any liquids or solids be done at the facility? [ ] [ 6. Will any plating or coating of materials be done at the facility? 7. Will any combustion equipment rated greater than 2,000,000 BTU/hr be operated at the facility? [ J [ 8. Will any acids, solvents, or motor fuel be used or stored at the facility? [ ] 9. Will any organic liquids or gases be reacted or produced? [ ] 10. Will any ovens be used to dry or cure products at the facility? [ ] 11. Will any C//FC (Freon) recycling machines operate at the f ill '? [ J fA Applicant: '� ,ff,i /LC"u/t--/ Signature: -' (Print name clearly) If you have marked "NO" in alb, the boxes, an air quality permit is np—t needed at this time, and this checklist is your written release. ` If you marked "YES" in any of the boxes, you must contact the South Coast Air Quality 1Af11kr11 hack of the checklist. ADDITIONAL SUPPLEMENTAL 1NFOAMATION