HomeMy WebLinkAbout15121 Graham St - CofO (12)'
r
::.::.
.. ...,..:.:.. ., _' ... .:,.:. ..... -.. _: .. . .'. .. _...
... ..__,_. ......._,..ter. � t+,3.
...
SUPPLEMENTAL INFORMATION
1.
BUSINESS ADDRESS
S U
I
2.
Person to contact in case of emergency
5162L ' 2=-
3
j
Telephone
a
lr f
f
3.
Does the building in question have electricity?
Ha
Yes.
#
�'
❑ No
f ,
(a) If No, are you requesting that the electricity be
,.❑ Yes
{,
turned on?<
a i4o.
9
t
IS Yes
4.
The building is sprinklered?
❑ No
5.
O erations will produce dust / wood shavings or similar
p,,
material?
VNeS
o
6.
Operations will -involve the repair or ` replacement of
❑ Yes
Flo
y �y
automobile parts?
r
If Yes:
(a) Describe the components repaired or replaced.
d`
(b) Does the operation involve' the use of an open
fiame� ❑Yes
`-
fi
.
Uf4
x
7.
The business is drinking, dining or assembly use that
will
result in an occupant load of , more tha,,- -50 persons.
❑Yes
WNo
8.
The st describes my operation;
Office O
Sales
Warehouse
i
Ma ufacturing / bistribution (describe process and end
product)
k n
- Restaurant / Take Out Food
'
�e rA`
Medical / Dental
Other (describe)'
l 4j
F °4
i
/
SUPPLEMENTAL INFORMATION
�
r
/1
$i .i QS}f R
fA kt�'t 1i�r
'M� z
i .. A!;
RR
e
l
tt
t
z,
South Coast ��-
AIR.. QUALITY MANAGEMENT DISTRICT
21865 E. Copley Drive, Diamond Bar, CA 917654192 (909) 396-2000
fA.$
i
,
a4;
P
AIR QUALI LT Y PERMIT CHECKLIST
for nonresidential buildings only
t`
—��
Company Name:
� �e
Location of Property:
�
l
City._ ` tsC-1 1,
Zip Code: �l24d
x #i
Contact Person: L 6KCS --
Title:
Telephone Number \ ,
p i) l �� 4� Fax Number:
Afi '
Type of Industry/l3usiness: _\TCO I tSI ��41.3Qj�011�1 S
g .�,
�`t
c
'
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.
}i
YES
I. Will the facility have a charbroiler?
NO
s '
2. Will any internal combustion engine with greater t1m 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? ]
t,
4. Will dust or smoke be generated at the facility?
g �
,&
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? [ ]
[�/
t>
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.
x
Will any ovens be used to dry or cure products at the facility?
�9
11. ` Will any CFC (.Freon) recycling machines operate a facility?
Applicant: ��5 _ Signature`
(Print. name clearly)
ty8
If you have marked "NO" i n � the boxes, an air quality permit is = needed at this time,
j
1
and this checklist is your m7 tten release.
�4
,
Y�
q•V �S .,p E
.i
If you marked "YES" in any of the boxes you must contact the South Coast Air Quality
'+
Management District (AQMD). Please read the requirements on the back of the checklist.
t
(800) 388�-2121
t k
' k:`w t \f
t
iit
i,
a p i
AD11TI0NAL SUPPLEMENTAL INFORMATION
h ,4
a x-
ht
"�Qi
t sr�'p7
•
,