HomeMy WebLinkAbout15121 Graham St - CofO (23)J
I f
APPLICATION FOR CERTIFICATE OF OCCUP}
i
% CITY OF HUNTINGTON BEACH j /3 p
. � DEPART'N.ENT OF COMMUNITY DEVELOPMENTcl(�T/"i' JC,
MJNfNr.TCN LFA[H
(PRINT OR TYPE ONLY) DATE
15121 69 AIIA t s T v/y17 /d f>C�9
Address Divtrict
Business Name i4Q1-F /� R% t/ Tel. 04 0 2
Business Type W DoQ wv,�Kl N
Occ. Group /,3-
BUILDING OWNER BUSINESS OWNER/MANAGER
Name6anF:ed-'rcu i�'c" I Glee- lost ryf Name_/ZUN AGPPCA
Address 2 6 TN �YY �iJ/e hUJ�/ �'l Home J �}n/dCA sTl
Address /}
City � l y rt �� G � /� Tel. City,4L/So (11'G; '"r) r' Home Tel.
3r,,2 ;has+)
THIS USE WOULD BE DESCRIBED AS:
❑ NEWLY CONSTRUCTED BLDG. ❑ CHANGE OF OWNER CHANGE OF OCCUPANT
EXISTING BUILDING ❑ CHANGE OF USE ADDI (ONAL OCCUPANT
I Indicate former use, if any V w L,vraw.L/ Occupancy Gr. Div.
SQUARE FT. OF BUILDING TO BE OCCUPIED O 8 d
TRAFFIC IMF -ACT FEE
DATE PAIR
V v L `a. LA _ci V
AMOUNT RECEIVED
NAME _ tr C
(FOR OFFICE USE ONLY)
Y
ZONINGh
LrASU.
PPLEMENTAL INFORMATION
,
OCCUPANCY GROUP
PLAN CHECK NO.-_,
NO: PARKING SPACES
OCCUPANT LOAD
PERMIT NO,
HEALTH DEPT. APPROVAL
INC, OF STORIES
ADMIN. ACTION
UTILITIES RELEASED
CERTIFICATE OF OCCUPANCY FEE
$
;'
APPROVED BY D TE
CHANGE OF USE OR OCCUPANCY FEE
$
I.
TOTAL
$j
7&039 Rev. t 1/90
COMMUNITY DEVELOPMENT
t
rf
J
�J
SUPPLEMENTAL INFORMATION
Z / 4IZ4/%At4 fT
1.
BUSINESS ADDRESS
I
2.
Person to contact in case of emergency '714-
Telephone number:
,,.
{ lI, r
Does the building in question have electricity?3.
�] Yes
❑ No
(a) If No, are you requesting that the electricity be
❑ Yes
❑ No
-
turned on?
;EKYes
_
4.
The building is sprinklered?
❑ No
5.
Operations will produce dust / wood shavings or similar'Ery
es
material?
❑ No
S.
Operations will involve the repair or replacement, of
❑ Yes
lb
automobile - parts?
If Yes:
(a) Describe the components repaired or replaced.
(b) Does the operation involve the use of an open flame?
❑Yes
❑ No
7.
The business is drinking, dining or assembly use that will
❑ Yes
'
result in an occupant load of more than 50 persons.
1
S.
The following best describes mar operation
Office Only
Retail Sales
Warehouse
7cManufacturing / Distribution (describe process and end product)
�j
—
Restaurant ! Take Out Food
Medical / Dental
1,
Other (describe)
SUPPLEMENTAL INFORM.A110N
t
SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT
�
(Nonresidential Buildings Only)
/ G
Locatiun of Subject Property:_ 5 / 2 ! I2A N.i l _
-on Fed
Property Owner Name:_ _ - Phone #:�4
Name of the person preparing this form in print and signature:
o �
Name: Signature:___
c
--- _ __..
The person preparing this form must be the same person applying for building permits. Please
answer the
following questions regarding your proposed occupancy of the subject building. IF YOU 00 NOT KNOW
4 THE ANSWER TO A QUESTION,_ MARK IN THE "YES" COLUMN:
AOMD PERMITTING CHECKLIST
YES _
NO
-_
1. Does your facility use any internal combustion engines greater than 50HP? .�
r
2. Does your facility involve mixing, blending, or processing any solvents,
adhesives, paints or coatings?
3" Does your facility create any dusts or smoke?
1
4. Does your facility refine any liquids or solids or reclaim any metals?
5. Does your facility plate or coat anything?
f
6. Does your facility have any combustion equipment (i.e. boiler, furnaces,
_
.' broiler, baking ovens, etc.) rating greater than 2,000,000 BTUIHR?
7. Does your facftity handle or store solvents or motor fuel?
8. Do you use or store any acids?
4�
9_ Do you use any chemical process?
—
1
10. Do, you use any solvents 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 TOPROPERTY DINE. GRADES K,-12.
If you haua marked "NO" in all columns, you do not need an Air Quality permit at this time. If you have marked
any qt estions 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: flan Check (909) 396-2000
,
,
,
n =:7
tt ;
South coast
Air Quality Management District
r 21865 E. Copley Drive, Diamond Bar, CA 91765-4182 (909) 396-2000
DATE: January 4, 1996
TO: city of Iiuntington Beach Building Department
�I
FROM: Hemang Desai, Air Quality Engineer
SUBJECT: BUILDING 'PERMITTING UNDER AB3205, WATERS BILL
Regarding PLAN CHECK I: �
LOCKTION Table For Five
15121 Graham St., Unit 108-109
Huntington Beach, CA 92649
This site has met or is meeting the requirements of Section
42303 of the Health and Safety Code and the requirements for 4
a permit to construct and operate for 'the South Coast Air
Quality Management District.