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Home My WebLink About101 Main St - CofO (19)r �kPPLICATION FOR CERTIFICATE OF OCCUPANCY CITE' OF HUNTINGTOPT BEACH DEPARTMENT OF I31UILDING & SAFETY T cr. (3rd Floot' llfllsz,, .9 y lli-person) Date pS.� l3-oy Business License �S�f Address Business Name -Tr;.SW 4:a —dM�r r v n ��yNG� Spec art-LSr Telephone Business Type /.i 01/lv✓L 7`i�ST�/� r C c�iy S v cTT.y� — Property Owner Information Business Owner Name A13VLe.Mj./r1- 11 r_,vr-�d/'r�vt �,- Name �1 J r r�71'.vnrMP2 1 Address ^f U ( fiv i Home Address �t � I A! ellty� L., <- �1 City I-E- A - � Tel. 6'GJ G 7 _ City �� _�6,Tel. 3 � t� THIS USE WOULD BE DESCRIED AS: �,[ ❑1\Tewly Constiucted Building or Existing Building CHECK ALL THAT APPLY: I ❑ Change of Owner Change of Occupant ❑Change of Use ❑Additional Indicate former use, if any - Does the building have electricity? Yes NO If No, are you regl letting that the elec 'city be turned on? Yes ® No The building.is sprinklered? Yes ❑ No ❑ Operations' -will product dust/wood shavings or similar material? Yes ❑ NO Operations will involve the repair or replacement of automobile parts Yes ❑ No If yes: Describe the components repaired or replaced. Does the operation involve the use of welding or open flame? Yes ® No The business is drinking, dining or assembly use that will result in an occupant load E of more than 50 persons. Yes ❑ NO The following best describes my operation: ❑Office Only ❑Retail Sales ❑Medical/Dental ❑Restaurant/Take Out Food ❑ Warehouse ❑Manufacturing/Distribution (describe process and end product) F k Other (describe) T sLl D V �'�5��✓r �+ .F-,�rx�vc. tv,��U��A-mil .:�-- [111iBuilding fice Use Only. /o Occ Load: ning' 5i''S-' -'� " _ Sq Ft Occupied: Occ Group: 1 �' TIF Review: Y/N AmtPaid$:Stories: Parkuzg Spaces: Paid BEFORE Finai Inspection if PermitEntitlement: onunents: d <. -� CofO # i Pla)ume Initials e" . j _z? Bldg/PIan Checker Initials: — _ - _ _ - HAZARDOUS MY LTERIALS DISCLOSURE INFORMATION JFluntin;ton Beach Fire Department California Health and Safety Code requires the Fire Department to regulate businesses that handle hazardous -,, iaterials. Motor oil, hydraulic fluids, gasoline, dry cleaning fluid, etc., are cor Sider-tdhazardous materials and must be disclosed. If yc,a use, handle or store hazardous materials or waste materials equal to or in excess of the following basic quantities, your are required. to disclose: • 55 gallons of liquid • 500.pounds of solid • 200 cubic feet of compressed gas • Any amomit of radioactive materials •- Any amount of Class A explosive • Any amount ofchemicals known to cause cancer • Any arnount of commercial pesticides • Reportaoie quantity of any chemical on EPA Extremely Hazardous Materials Substance List Disclosure is not required for -the following. 1. hazardous substances contained in food, drug, cosmetic or tobacco products. 2. Upon approval of the Fire Chief, hazardous materials contained sol ay in consumer products packaged for use by and distributed to the general public. I owever, pesticides, herbicides, and ammonium nitrate fertilizers over the required disclosure amounts are not exempt from disclosure. 3. The transportation of hazardous materials accompanied by shipping papers prepared in accordance with the provisions of 49 Code of Federal Regulations. 4. Infectious waste generated by health care facilities that are regulated under Title 22 of the California Administrative Code. Cheek one of the following: 1-4o chemicals are used, handled or stored at this business. _jJ Pc. Chemicals are used, handled or stored at this business, butdo, not meet tb.t. rpq irements for disclosure Chemicals are used, handled or stored at this business.. Disclosure_/btyns will be se"t to you. 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 p enalty'of perjury, that the above information is true and correct to the best of my knowledge. Signature Date __ Home Phone Please call 714-536-5676 with questions regarding the Hazardous lVaterials Program. Y: South Coast Air Quality Management District 21865 E. Copley Drive Diamond Bar, CA 91.765-4182 (.909) 396-3529 htpp://w-ww.agmd.gov is Air Qua11ty Petra i CheekUst California Government Code 65850,2 prohibits cities from issuing a Certificate of Occupancy to a business witbnut clearance from the local air quality agency. This checklist will determine if you need to obtain clear :ice from the South Coast Air Quality Management District (AQAf D). Company ?ame: ciV C%:� _ EAG Aze 6%Aif r z7i TA)d S $T, ' Property Address: City: 4o QT-uyc 0A t_tt U Zip Grade: Contact Person: Title WA/e/Z PAv:t,-0 &7-WWX�', Type of Business: o C9 r: r s Cr,�SutT A?111 Telephone:6 U Applicant: (print name) �5 T`� Jyii� =' 11 Signatrire: LL, a Will the facility have any of the following equipment? Yes 0 No Charbroiler Dry cleaning machine Spray Booth Printing Press (screen/lithographic/flexographic) Internal combustion engine (greater than 5011P) (excluding motor vehicles) Boiler/combustion equipment (greater than 2 million BTU/11r. maximum input) Abrasive blasting cabinet/room baghouse/cartridge type dust filter/scrubber Motor fuel storage and dispensing equipment * Will any of the following operations be performed? Yes ❑ NO Application of paints or adhesives III Etching, plating,.casting, or melting of metals Molding and blending of liquids and/or powders Storage of acids, solvents. organic liquids or fuel-, Production of acids, solvents, organic liquids, or fuels Production of fu nes, dust, smoke or strong odors If you answered "No" to both questions, this checklist is your clearance from AQMD. . If you answered "Yes" to either que,,ton, you must contact AQMD to determine if air 9.Ualitypermits are required. If permits are needed, AQ1y1D will assist you in submitting permit application(s) and then provide you with a clearance letter. You can call AQ1MD at their Small Business Assistance Office at (800) 388-2121. *,-",--"*-,-,--,---,-"-----,--",,--*--*-,*-,"--" CERTIFICATE OF OCCUPANCY EVALUATION FORM GENERAL BUILDING INFORMATION } Owner narr.a; Address and/or suite i b(1 i T-p)ogAgq,( ( M4L4) 7-d 0 Err gency contact; Phone number; Occupancy Class primary use(s) & sq. ft.: r Occupant load. { F S I # i Occupancy Class - second use(s) & sq. ft» f Type of constructuon: Stories & Height(ft) Sprinkling used? ❑Story increase OCity Ordinance QUnumited area i t 00ne hour construction Atria i ❑Area increase OChapter 9 I Ara allowed; Basic: Yard: Area separation: Sprinkling For multi storied and mixed use attach a separate work sheet or include in sketch area I Attach wort: sheets b Planningor Fire if rovided YARD �'�yP,' STORAGE INI RM ^ RM Kn:kiEN YARD 3 Y RM° YARD 1 WAITING DINING RM Ito 0 o ENTRY PARKING P R IN SAMPLE - ASSEMBLYUSE � l 14KI G - - - - -- - ^ STREET NAME .. _ Q.-WILDINGTORMS\Cert of Occupancy\CofO Evalulation.DOC May 3, 2004