HomeMy WebLinkAbout15121 Graham St - CofO (27)APPLICATION ERTIFICATE OF 0 AN
CITY OF HUNTINGTON BEACH
ENT OF COMMUNITY DEVEL P NT &bt
DEPARTMENT NT Zf(,
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HILINFINGTON KACH (PRINT OR TYPE ONLY) DATE
Address -<&F District
Business Name Av Ito Gcek, _'SA(� &r0Y_F Tel,
Business Type.ManuiFC cftwers' tide
Occ. Group
BUILDING OWNER BUSINESS OWNE
Name 0,6jj�ed421,-A:fi),1 Name VQ110yl M-Ma �1
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Address jAddress —
City AiAarrba- 'ATel. City T CA 92ZON Home Tel.
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THIS USE WOULD BE DESCRIBED AS:
❑ NEWLY CONSTRUCTED BLDG. ❑ CHANGE OF OWNER K 7 CHANGE OF OCCUPANT
EXISTING BUILDING ❑ CHANGE OF USE ❑ ADDITIONAL OCCUPANT
Indicate former use, it any —Occupancy Gr. Div.
E OCCUPIED 1131-4ow OTVV-4-4
SQUARE FT. OF BUILDING TO B
SUPPLEMENTAL. INFORMATION `
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1.
BUSINESS ADDRESS
2.
Person to contact in case of emergency
Telephone number:
3.
Does the building in question have electricity?
es
❑ No
(a) If No, are you requesting that the electricity be
❑ Yes
turned on?
No �
es
4.
'The building is sprinklered?
❑ No
i
.
5.
Operations will produce dust/wood shavings or similar
r
❑Yes
material?
❑ No
6.
Operations will involve the repair or replacement of
❑ Y s
UO
automobile parts?
_
If Yes:
(a) Describe the components repaired ,or replaced.
(b) Does the operation involve the use of an open
flame? I Yves
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7.
The business is drinking, dining or assembly use that
will
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result in an occupant load of more than 50 persons.
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3.
The foll win describes my operation;
Offic Onl
Retail Sales
Warehouse
Manufacturing / Distribution (describe process and end product)
Restaurant / Take Out Food
Medical / Dental 5 �O
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Other (describe)
SUPPLEMENTAL INFORMATION
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SUPPLEMENTAL INFORMATION Co
( ntinued)
Does
the operation involve a �y of the following
materials? ❑ Y s
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If
Yes, indicate -quantities:
Material Quantity
1.
Flammable liquids
Class I -A
Class I-B
1
Class I-C
2.
Combustible liquids
Class Il
;
Class III -A
3.
Combination flammable liquids
4.
Flammable gases
5.
Liquefied flammable gases
C.
Flammable fibers - loose
7.
Flammable fibers - baled
t
8.
Flammable solids
9.
Unstable materials
10.
Corrosive liquids
11.
Oxidizing material - gases
12.
Oxidizing material _ _liquids
13.
Oxidizing material,- solids_
14.
Organic peroxides
15.
Nitromethane (unstable materials)
I - 16.
Ammonium nitrate
17.
Ammonium nitrate compound mixtures
containing more than 50% nitrate
by weight
18.
Highly toxic material and
poisonous gas
19.
Smokeless powder
20.
Black sporting powder
I hereby certify that the above information
is true and correct to
'
the best of my knowledge.
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Date
7,
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SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT
(Nonresidential Buildings Only)
Location of Subject Property:- In
Property Owner Name: Phone#:
Name of the person preparing this form in print and signature,
Name: kerli I Signature:
The person preparing this lorm must be the same person applying for building permits. Please answer the
following questions regarding your proposed occupancy of the subject building. IF' YOU DO NOT KNOW
THE ANSWER TO A QUESTION, MARK IN THE "YES" COLUMN:
AQMD PERMITTING CHECKLIST
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 wig dusts or smoke?
4. Does your facility refine any liquids or solids or reclaim any metals?
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5. Does your facility plate or coat anythmg?
6. Does your facility have any combustion equipment (i.e. boiler, furnaces,
broiler, baking ovens, etc.) rating greater than 2,000,000 BTU/HR?
7. Does your facftity handle or store solvents or motor fuel?
8. Do you use or store any acids?
9. Do you use any chemical process?
10. Doo-you use any sotvatina for. clean-up?
11. Are you a dry cleaner, restaurant with a charbroiler, body shop, gasoline
station, printer, br 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 91765-4182
Please call: Plan Check (909) 3%-2000
Type of constructuon:
Stories 3 Height(it)
Sprinkling used?
OStoryincrease
I
Ordinance
�OOne hour construction
❑Unlimited area
OAtria
ClArea Increase
11Cha ter 9
i Arsa allowed:
Basic:
Yard:. Area separation: Sprinkling:
For multistoried and mixed us attach a separate work sheet or include in sketch area
Attach work sheets b Planning or Fire if rovided
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