HomeMy WebLinkAbout15301 Graham St - CofO (4)�;
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�a d APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH ' 9
DEPARTMENT OF COMMUNITY DEVELOPMENT DALE
wNDNGTON 9FACT1 (PRINT OR TYPE ONLY)
153 1 Cocnl��Cr4 s►.• �}p+.�titaI� �Ci4 ��4y District
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us/iness NameL UG{'1kJ.SS Tel 7/y 37 f' S y g
B sinessType, flSSi'�N_�ldi �P �� `jC Sou)iCiM'�at%S Occ Group
} BUILDIf2 DINNER BUSINESS OWNER/MANAGER
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I C cPgTfAtz 1-TD . Name
/e � tZ,�o P,g-e-ars t
�A Mess �06Sif 1' SM }��f}C� ` ��11 Address NI'c C1 • 1OL°� ne T 1. a �q6- 9Y7`J
city
HIS USE WOULD BE DESCRIBED AS:
ElCHANGE OF OWNERA CHANGE OF OCCUPANT
NEWLY CONSTRUCTED BLDG.
1 EXISTING BUILDING ❑ CHANGE OF USE El ADDITION;L OCCUPAN
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Indicate former use, if any -- Occupancy Gt.—Div. 1'
SQUARE 1`7. OF BUILDING TO BE OCCUPIED14,INo—x— r
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(FOR OFFICE USE ONLY)
ZONING —
SUPPLEMENTAL INFORMATION
OCCUPANCY GROUPS
PLAN CHECK NO.
NO PARKING SPACES
I
OCCUPANT LOAD
PERMIT NO
HEALTH DEPT-APPROVAL
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NO, OF
ADMIN. ACTIONI
UTILITIES RECAS�D(
PRIES
/ 2-
CERTIFICATE OF OCCUPANCY FEE
SOV
ATE
CHANGE OF USE OR OCCUPANCY FEE
$
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TOTAL
75-039 Rev.11/90
COMMUNITY DEVELOPMENT
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SUPPLEMENTAL INFORMATION
1.
BUSINESS ADDRESS 15,:301 GfAh► ,s—F. W671► Mo 'be_4"
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2.
Person to contact in case of emergency for r
Telephone number: .310) -624 - 9y7Z
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3.
Does the buildingin question have electricity?
.Yes
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(a) If No, are you requesting that the electricity be
CT No
❑ Yes
turned on?
❑ No
I
4.
The building is sprinklered?
ArYes
G 5.
Operations will +
p produce dust / wood shavings or similar
No
material ?
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Yes
6.
Operations will involve the repair or replacement of
No
❑ Yes
;
automobile parts?
o
If Yes:
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(a) Describe the components repaired or replaced.
'
1
(b)Does the operation involve the use of an open flame? ❑ Yes
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1'No
7.
The, business is drinking, dining or assembly use that will
result in an occupant load of more than 50 persons.
❑Yes
;
8.
The following best describes my operation;
-No
Office Only
Retail Sales
x Warehouse
XManufacturing / Distribution (describe process and end product)
N
Restaurant / Take Out Food
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Medical / Dental'
Other (describe)"
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SUPPLEMENTAL INFORMATION (Continued)
Does tl'ie -operation involve any ` of • -thefollowing materials? ❑Yes
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If Yes, indicate . -quantities:
Quantity'
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Material.-
1. Flammable liquids
Class i-A
------------
Class 1-B
i Class I-C
2. Combustible liquids
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Class It
Class 111-A
3. Combination flammable liquids
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4. Flammable gases
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5. Liquefied flammable gases
6. Flammable fibers - loose
7. Flammable fibers - baled
8. Flammable solids
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9.` Unstable materials
10. Corrosive liquids
;.
11. Oxidizing material - gases
12. - ,Oxidizing material - liquids
13. Oxidizing material - solids
14, `Organic peroxides
k 15, Nitromethane (unstable materials)
16. _ Ammonium- nitrate
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4 17. 'Ammonium nitrate compound mixtures
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containing more than 60°l° nitrate
If,
by weight
i 18. Highly toxic material and } .
poisonous gas
k. 19. Smokeless ,powder
.
20. Black sporting powder
I hereby certify that the above information is true and correct to
the best of my knowledge.
-- Date
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RETURN TO THE PLANNING DIVISION, CITY
HUNTINGTON BEACH, P-O• Box r
2000 Main Street, Huntington Beach, CA
SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT
(Nonresidential Buildings Only)
3
Location of Subject Property: -'
` Phone #'
Property Owner name:
k
Name of the Person Preparing this ford in printandsignature
Signature {
[dame
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 DO NOT KNOW THE ANSWER
To A QUESTION MARK IN THE "YES" COLUMN:
SCAQMD PERMITTING CHECKLIST
YES NO
1. Does your facility use any internal combustion L_J
`r engines greater than 50-HP> blending,or
2. Does your facility involve mixing,ants
processing any solvents, adhesives, p
or coatings? El
3. Does your facility create any dusts or smoke?
4. Does your facility refine any liquids or solids?
F Reclaim any metals? -J a
. Does your facility plate or coat anyth�r>g? tr-_
5. Does your facility have any combustion equipment
I i.e. boiler, furnaces, broiler, baking ovens, `etc.)
rated greater than 2,000,000 BTUre e
7. Does your facility handle or store solvents or motor
fuel?
8. Do you use or store any acids? t y
` 9. Do you use any chemical process? {
1 10. Do you use any solvents for clean-up?iler
11_. Are you a dry cleaner, restaurant with a cartbcoater?
body shop, gasoline station, printer, or p r�
L. 12. is the subject building located within one thousand
(1,000) feet of any school?
PROPERTY LINE TO PROPERTY LINE. GRADES K-12
„ „ you do not need an Air Quality }L:
If you have marked NO in all columns,
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
�t.
--0 FLAIR DRZVE, EL MONTE, CA 91731
i,lcose call these offices: Plan Check (818) 572-6111,,(818)- 572-6406 572-6261
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I)' AL00603
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South Coast
AIR QUALITY MANAGEMENT DISTRICT
9150 FLAIR DRIVE, EL MONTE, CA 91731 (818) 572-6200
Assembly Bill 3205 requires the Building Departments not to
issue the final certificate of occupancy unless the
i
applicant has met or is meeting the requirements of the
;
P District. The Building Department must obtain a written
release from the District to show the applicant has complied
f-
with this law. The attached check list is designed to help_
the applicant and the buildng•departments to meet these
requirements,
`
I- The applicant ( the same person applies permits from the
Building Department) must fill the check list which can
be
obtained either at the Building Department or at the
.District.
2. If all boxes in the list are checked "no", the Building
�>
Department can accept the check list as the release.
3. If there are any "yes" answers in the List, the
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applicant must contact a District engineer by calling
(818-572 6406, ;818-572 6111, 818-5726261 ) to find out
whether air permits are required for the proposed
construction project.
1>.'
4. If air permits are not required, the applicant will
i cbtain a written release from the District engineer.
5. If air permits are required, the applicant must ust submit
I the necessary permit applications before the release can
be issued A sample copy of the release is attached.
Because of the tame it may take for :,the District engineer to
go through above
�
procedures, the applicant is advised to
contact the District immediately after applying for
Building
permits.4v
myl/al AB3205ID
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