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Home My WebLink About127 Main St - CofO (9)k APPLICATION FOR CERTIFICATE OF OCCUPANCY CITY OF HUTTING T ON BE ' CH - DEP--RTy�1 N T OF BurLDING 6-57 S<� u E'3 `7 - (3"f Floor- llfustApplyIn-Fersor2) U? Business Lie — A� � j! Ade.-t-s usiness leleplone �tusLn,-s-s Type 3 Pronerly Owner Information $IiSilles5 ORaler �� Name Name C�6'1 } — Z ',home address City dress '� /1 0 pity Tel. Tel. 1 WOULD BE DESCRIBED �S: THIS'USE a QNewl- Constructed Building or QExistincr Building CHECK A T73AT APPLY: Change of Owner QCiange of Occupant QChange of Use. ❑Additional Occupant Indicate former use, if any Does the building have electricity? Yes NoQ it that the electricity be turned ? Yes No rha u re uestln tY If No, are e b Y �l The building is sprinklered? Yes ❑ No �/' ood shavings or.similar. material? Yes No Operaticns will product dust/wood g olve thereP air car replacement of automobile parts Yes Q Operations will i v N j .be the components repaired ed or replaced. es. Descr _ CI Does the operation involY.. the use `of welding or open. flame? Yes F1 No The business is drildrha, dining or assembly use that will result in an occupant load of more than 50 persons. Yes i The following'best 4ibes my operation: �i Office Only Retail Sales Q1VledicaUDental QRestaurant/Take Out Food DWarehouse K Q1Vlauufacturing/Distribution (describe process- and end product)- E ------------ Y t Q Other (describe) ; p.. 10 ffoe Usa oily>� Ld:r- �% Occ Load:%C3 i Zo1:n- ScPt Oceup Occ Group: j --�--- sl 1 TI,r Review: Y/ 1 A.i2i� PaidS: t' �' S tones : Par1r�112g Spaces: Paid BEFIo I inai la --Vl an i' Y I` Building Permit - 1✓ntitleir_ei?t: B1darPlan Checker Initials:Co�O m o121 ya n2 `is: _.__ Planner 1 x Y South Coast Air Quality Management District 21365 E. Copley Drive Diamond Bar, CA 91765-4182 (909) 396-3529 htpp://vrw--w.agmd.gov Air Quality Permit Cheddis California Government Code 65850.2 prohibits cities from issuing a Certificate of Occupancy to a business without clearance from the local air quality agency. This checklist will determine if you need to obtain clearance from the South Coast Air Quality Management District (AQiY1D). j Company dame: I Property Address: City: —Zip Code: Contact Person: Title: — Type of Business: Telephone: O Applicant: (print name) Signature: Will the facility have any of the following equipment? lies ❑ No Charbroiler Dry cleaning machine Spray Booth Printing Press (screen/lithographic/flexographic) Internal combustion engine (greater'than 50HP) (excluding motor vehicles) Boiler/combustion equipment (greater than 2 million BTU/hrmaximum input) Abrasive blasting cabinet/room Baghouse/cartridge'type dust filteriscrubber -Motor fuel storage and dispensing equipment • Will any of the following operations be performed? Yes ❑ No 0 Application of paints or adhesives Etching, plating,, casting, or melting of metals Molding and blending of liquids and/or powders Storage of nts, organic liquids or fuels Productio; events, organic liquids, or fuels Production dust, smoke or strong odors F If you answered' No" to both questions, this checklist is your clearance uom AQNID. • If you answered "Yes" to either question, you must contact AQNID to determine if air qualibj permits are will assist you in submitting �oerrait application(s) and then provide you required. If permits are needed, AQMD with a clearance letter. You can call AQ-TVID at their Small Business Assistance office at (800) 38$iLl N _ ..._ _: __. _ ... m........ . - m P 4�. A CATION FOR CERTIFICATE OF OCCUPANCY CITY OF FIMITINGTON BEACH - DEPARTMENT OF BUILDING & SAFETY (3"' F1001' - lWasl Apply In Pelson) (� k Business Licenser Date Address Mam % A Business Name BeA01 0.Y)G1 Telephone 3di{'� Business Type p.{A( — G�'t�TLiSt,U{P(1"S Prooerty Owner Information Business Owner Name d Vi CKL i- W-, Name Q l� Address Home Address _�j 1Y2K City �fiiwhVl Tel. t) ity IYUlY1C1 ' Tel.�?l 2 2�J THIS USE'WOULD BE DESCRIBED AS: ❑Newly Constructed Building or Existing Building CHECK Lip THAT APPLY: Change of Owner DChange of Occupant ❑Change of Use ❑Additional Occupant Indicate former use, if a.ny'1I��`� t� Does the building have electricity? Yes NoU If No, are you requesting that the electricity be turned pn? Yes ❑ No The building is sprinklered? Yes ❑ No4 a Operations will product dust/wood shavings or similar material? Yes' ❑ No of automobile parts Yes oOperations -will involve he repair or replacement If yes: Describe the components repaired or replaced. Does the operation involvethe use of welding or open flame? Yes ❑ No �+ The business is drinking, dining or assembly u e that. will result in an occupant load of more than 50 persons. Yes 0 No The following bes scribes my operation: ❑ Office Only etail Sales ❑Medical/Dental ❑Restatuant/Take Out Food ❑ Warehouse ❑Mairufacturing/Distribunon (describe process and end product) .�.� Other (describe) t Office Use Ottly: C? _ Occ Load l Zor inQ: �p�— - Sq Ft Dccupied; 3 l a Occ Group; , ? Stories: Parking Spaces: TIF Review: YIN' Amt PaidS: a, _—-- Paid BEFQE.Final Inspections j Building Permit Entitlement T: f I Comments: Bldg,/Plan Ch cker,Initials: CofO r Plaiulei°Initials: California Health and Safety Code requires the Fire Department to regulate businesses that handle hazardous materials. Motor oil, hydraulic fluids, gasoline, dry cleaning fluid, etc., are considered hazardous materials and ouuse, handle or store hazardous materials or waste materials equal to or in must be disclosed. If y excess of the following basic quantities, your are required to disclo5. . 0 55.gallons of liquid • 500 pounds of solid 0 200 cubic feet of compressed gas • Any amount of radioactive materials • Any amount of Class A. explosive Any amount of chemicals known to cause cancer Any amo unt t of comm eicial pestic ides • Reportable quantity of any chemical on EPA Extremely Hazardous Materials Substance List 4, Disclosure is not required for the following: Q cosmetic or tobacco products. cs 0 food, drug, ed in f u stanc es contain,� 1. Hazardous substances 2. Upon approval of the Fire Chief, hazardous, materials contained sol .ly in consumer products packaged for use by and distributed to the general public. However, pesticides, herbicides, and ammonium • m disclosure. from are not x over there. required disclosure amounts P nitrate fertilizers q O a ers prepared in accordance with 3. The transportation of hazardous materials accompanied by shipping papers p p the provisions of 49 rode of Federal Regulations. 4. Infectious waste generated by health care facilities that are regulated under Title 22 of the California Administrative Code., follo wing' Check one. of theowin g• No chemicals are used, handled or stored at this business. Chemicals are used, handled or stored at this business, but do not meet the .requirements for disclosure Chemicals are`used, handled or stored at this business. Disclosure fortis will be sent to yarn. Amounts will be verified by the Fire Department during annual inspections. It is unlawful for any person to knowingly violate any provision of this ordinance. I certify, under the penalty of perjury, that the above information is true and correct to the best of my knowledge. Signature Date Home Phone Please ca11714.536-5 67 6 )vUh questions regarding he Hazardous JVaterials Program. r A South Coast Air Quality Management District 21865 E. Copley Drive Diamond Bar, CA 91765-4182 (909) 396-3529 htpp:/hvww,agmd:gov Air Quality Permit Checklist California Government Code 65850.2 prohibits, cities from issuing a Certificate of Occupancy to abusiness without clearance from the local air quality agency. This checklist will determine if you need to obtain clearance from the South Coast Air Quality Management District (AQMD), Company Name - Property Address: h — city: d + G161 c c \ Zip Code: Q2L4` Contac Person: c �71Jt 0V, Title: -" (/�j, �L elephone: Type of Business: _.�.�_ Applicant: (print name) Tane-Ash k�_Signature: 4 6j • Will the facility have any L the fallowing equipment. Yes NO Charbroiler Dry cleaning machine Spray Booth Printing Press (screen/lithographic/fle:cographic) Internal combustion, engine (greater than 50H11) (excluding motor vehicles) Boiler/combustion equipment (greater than 2 million BTU/hr. maximum input) Abrasive blasting cabinet/room Baghouse/cartridge type dust filter/scrubber Motor. fuel storage and dispensing equipment • Will anv of the following' operations be performed? Yes Ci NO Application of paints or adhesives Etching, plating, casting, or melting of metals Molding and blending of liquids and/or powders Storage of acids, solvents, organic liquids or fuels Production of acids, solvents, organic liquids, or fuels Production of fumes; dust, smoke or strong odors j 4, If you answered "No" to both questions, this checklist is your clearance from AQNID. • If you answered "Yes" to either question, you must contact AQ1YM to determine if air quality permits are required. If permits are needed, AQ1y1D will assist you in submitting permit application(s) %-id then provide you with a clearance letter. You can call AQKD at their Small Business assistance Offlee apt (800) 388-2121. i {6 7-8 (oc-c, '4-ey�