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HomeMy WebLinkAbout101 Main St - CofO (73)f A y -- O C —TT A ' 1 O 7 J.s T-J i. 1: 4 B.... Lam.. .rJElm.'L .i. - ._..___ J.L/vj/�/.•ff t/1W/ �6 0� er ltia Ra.y vP��b- r-ATT A (Zorj A6DO FrA i City �4 e? 536 -6S!,2 Cit ,14 6 THISTiSL WOULD BE ESCI�I3ED AL, �'vetiYly Cor:s i'Eic ed o.I�g or U ,,r 'iic 3�ila_ CHECK ALL I-L-�T AFIPLY�� ��-,, CICIa g of w ne? 1C Chang 0f 0CCCi;���� Cl?&_i�4 O Use � _ is z Ci;a: Q%c —Man, ill dicaLa forill -,r vse, if ail; T(At Does the buildin.7 b.eve 5lec ric'.y? Yes S o{ _ If N are yb-Lregi estin, mat ,he zfeci-lci Y be tir ed on? Yes o i g s prik'erLeLdi? i�yes No The build nL;GiSG31>lar�; ielial? Y e5 m? Q Pu .54vill prod irOde ?Ii7 Operations wu IiZYQlVe '-IIe rePair Or reP aG '"Kill: Oi aU%2n 00U1 � 2ic5 ti es !Li0 If yes; Describe th COliZ_irOilei2%S ce airea or teplGce . a-10I1 I ;VoIV� e f ti e of epee ;a A� yes Does the, Ope. ! e th- Lts o r - a g v t g 'l"'t yi'I:1 t- lzt IP. a OGCt> ant j�rit ;,tic d ,c ur a. sa='01 .i e The ot��tsii�zpnss1 is �alli�:�_C�, i:*IiY:.� (..—may{' {\\1/ j� - •©? 111,�1.V ihni: 50 I'. -1:sons, .4 ei .L \ �+ The f ollo-wh g best descri -es Ir j oa,'� z iol.' - . CAR=���tLw��Ta� 0�� Leo` I i f1%.� e�otsv L?Or=lce Ol,l ORe-Imil Sales ❑'vi aical`Dental • - F i eSC. e - recess �-.L ii�l�.. I.i�• �_ C C�rallll_ac�;i .z'D s. { _ iot3�»Gs scribe J Yam' ' �Oi t 1 C• 'l �r � �C, _ : CCU,.._ �'.� �� ,._.,�� O+L,, t,'� v t.� _i1� S. e Ln. f Calrror�:ia Gcuen- e... Code fJJa�Q. 9 =0h=01 � Cl ?c5 o ....L.n ' Ce=ti Cain C= L^1 C"Nci C c -- �:a Without Clearance _:OS`i the local air QLality a9'r1Cy. T nis c_I"eclr?1St i; 11 dete=ni ' _ ^ 'Cu %ec tJ obtal- Clearance fi or,- the South Coast Ai Qualit-Y Mana`ement District (A Q-N1D). Cornpany ,INane: A 1PGI�� 6i fZLs Propery Address: _..LL �)�T- City: -u - ---- zi-O Code: 926 8 Contact Person: iZd CC FA rt A q Title: 01- Type ofBusmess: iZET1,iL. SAIL- 5 Teleahore: {} 5 36 - 65 6'7 Applicant; (print name) coTC ►'hpS�r' SiFlature:d m Will the facility have ariy of the following egeipment? yes 0 � Charbroile; Dry cleaning nriaehine Spray Booffi Panting Press (screev'lithographic/i1e�di aphiG) Internal cmnbustion engine (greater than (evclsdir g inotor vehicles) Boiler,combustion equip .ent (greater than _' ;n.ill?oh BTUh . niaximur input) Abrasive bl::sting cabinet/roorn Baghouse/cartridge type dust filter/scrubber Motor fuel storage and dispensing equipment No • Vyill any of the foll©tiuiag operations be pel:sorlLed? Yes .kpplicadors of paints or adhesives Btc sizig platL� ..�astil`lg, or MI-Itinis: Ofetala q, Molding and blendi g of liquids and Cyr powders x, ,_ y: ��,' li zips or fuel S' Sa,e 01 kids, sole ;- t , ors do . traductio,? of ac.ds scl� �s, io IiCIaids, a r f4.l. P Cj 'iriaVii0 Q1 �=1= IS YOU�rr:'vG . v i �0 bG � Gi e5t v'r 5 sy_ c:1 C'e.. Z., A ' S : . n , =1-: COn1 C vL J l C 'ie_ Cis • s ��e7.. a1,=,sere^ tic_ qiiec 1 _. `� Y �f `.. � �? x� i.-t��1: t i�1� vG� Y..L v a•..��l.at �.itJJl u.lo a(.��(.�cu r p�Qt}S witi` = c e� t=1d��:r. You ca-i call_-Q: It Lueir Small Business z'Sisiance O;itce i.._...... _................ _............__............ .... ._......... ....... ......._.......... ......... ..._. CLIP'!"!(-IC/ATE 01:OCCUPANCCY EVALUATION FORM GENERAL BUILDING INFORMATION Uwncr a 1u1�: Address and(or 1:11le.1i wyctnllacl: Pbonenumber. Ucr.ursnry (r rst•-p flmly a e( ) A s q, l! Occupant load: Uccupant y Gl r s - rxuntl tt rO u sq. II __._ l Typo or Lin .uurlwm. Stuuus Ill Iluigld(11)� sprinkling usod7 GSlory Incraaso ! LICIly Ordlnanco , DUnllmiled area i]uacflour construction I I'^.Jria �. _ _ _ UPvca me raso _ J u�!tapter 9 Aw r arluwcrJ (IJ a Yard: htca separali�n: Sprrnlding; f of ucnlli-sturi�^�t :mcl rtrllrcd re:c :dtar.lr a srlTara[e wurlr sweet or Jncrucle rrt skelc(t araa Arr,rct�work sheetu�Uy Plarmmzil�c arPire if provided �.. _ _..._. .. c .G. mm.... .............__. YARD 2 —�—tl Rd YAR. s YARD tzc PARKING i L rL, l i SAMPLE '-"'T[-')IID RETAIL_ USE JPAIJ 21;1 IG 1 111110 STREET NAME SKE CI i ARTHA,