HomeMy WebLinkAbout15302 Pipeline Ln - CofO (4)1
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CERTIFICATE OF OCCUPANCY 12 / 3 0/ 9 b l
CITY OF HUNTINGMN BEACH —
Date [
Address 15302 PIPELINE District E
COMMUNITY ACHIEVEMENT SERVICES INC Tel. 7i4..895-3966
Business Name B/51
EDUCATION SERVICE/DISTRIBUTION Occ. Group
f Business'rype
BUILDING OWNER BUSINESS OWNER/MANAGER
WILLIAM/TONI - t 'U Name W I L L I A F U G,
Name
496i LAS PATOS Home 4911 LOS PATOS
i Address Address
H.B.?1t+�846.8790 H.B. Home 71A-846r8�90 t
Tei. City Tel.
City 1 69
Construction No. of Stories Occupant Load Sprinklers ' f
1 CONDITIONS OF APPROVAL
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DEPARTM NT OF COMMUNITY DEVELOPMENT
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This Certiticste of Occupancy 1
i SHALL BE posted in a conspicuous pace on the
premises and shall not be removed except by the by
Building Official.
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i COMMUNITY DEVELOPMFNT
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APPLICATION FOR CERTIFICATE OF OCCUPANCY
�i CITY OF HUNTINGTON BEACH J C�
DEPARTMENT OF COMMUNITY DEVELOPMENT f
RUNTRCTON Brio+
(PRINT OR TYPE ONLY) DATE !
Address L4 District
Business Name
Business Type lR a_
BUILDING OWNER / BUSINESS O
WNER/MANAGER
Name ; e� Cy�s- Name —t
Home
Address yy77Address �(//�
City ' Tel2'"_7/CHomo l !
r THIS USE WOULD BE DESCRIBED AS:
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❑ NEWLY CONSTRUCTED BLDG. "L; t NGE OF OWNER LJ CHANGE OF OCCUPANT
1�kXISTING BUILDING ❑ CHANGE OF USE ❑ ADDITIONAL OCCUPANT
Indicate former use if any Occupancy Gr.
' SQUARE FT. OF BUILDING TO BE OCCUPIED
TRAFFIC IMPtCllkEE
DATE PAID
AMOUNT RECEIV
U
t
NAME
I
(FOR OFFICE USE ONLY)
SUPPLEMENTAL INFORMA ION
ZONING -
OCCUPANCY GROUP
PLAN CHECK NO.
NO. PARKING SPACES
OCCUPANT LOAD
PERMIT NO,
HEALTH DEPT APPROVAL
NO. OF STORIES
ADMIN. ACTION
UTILITIES RELEASED
o 72 -
- CERTIFICATE OF OCCUPANCY FEE
$ _� 1
PROVED .BY
DATE CHANGE OF USE OR OCCUPANCY FEE
$
TOTAL
$
75-039 Rev. 11/90
COMMUNITY DEVELOPMEN'.I
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SUPPLEMENTAL INFORMATIONol
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1. BUSINESS ADDRESS'
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2. Person to contactin case of emergency
Telephone number: ,<
3. Does the building in question have electricity? s
C) No .
(a) if No, are you requesting that the electricity be Yes
( turned on? ❑ No i
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4. The building is sprinklered? ❑ Yes
a
5. Operations will produce dust/wood shavings or similar
material? ❑ Yes
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6. Operations will involve the repair or replacement of CJ Yes
automobile parts? Go
a
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If Yes:
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(a) Describe the components repaired or replaced.
(b) Does the operation involve the use of an open flame? ❑ Yes
❑ No
7. The business is drinking, dining or assembly use that will
result in an occupant load of more than 50 persons. ❑ Yes
No #
8. The following best describes my operation;
Office Only
Retail Sales ik
Warehouse
Manufacture g / Distribution descri a process and end product)
Restaurant Take Out Food"
Medical /Dental ¢
Other '(describe)
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SUPPLEMENTAL INFORMATION
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SUPPLEMENTAL
INFORMATION (Continued)
Does the operation involve any of the
following materials? ❑ Yes
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If
Yes, indicate quantities:
Material
Quantity
1.
Flammable liquids
Class I -A
`
Class I-B
Class I-C
2.
Combustible liquids
Class 11
Class 111-A
3,
Combination flammable liquids
4.
Flammable gases
5.
Liquefied flammable gases
6.
Flammable fibers - loose
7.
Flammable fibers - baled
8.
Flammable solids
j 9.
UnstabiP materials
' 10.
Corrosive liquids
11.
Oxidizing material - gases
12.
Oxidizing material - liquids
k
13.
Oxidizingmaterial - solids`
�
14.
Organic peroxides
15.
Nitromethane (unstable materials)
16.
Ammonium nitrate
it 17.
Ammonium nitrate compound mixtures
containing more than 60% nitrate
(
by weight
18.
Highly toxic material and
poisonous gas
19.
Smokeless powder
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20.
Black sporting powder
I ,hereby certify that a above information is true and correct to
t e best of m edge.
Signature
Date
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SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT
(Nonresidential Buildings Only)
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Location of Subject Property: /z
Property Owner Name _lJ �_+!_ a`? Y hone #:
Name of the person preparing this form in print and signature:
Name: W_`? ' iV I L __.. Signature:
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:
AQMD PERMITTING CHECKLIS
YES NO
1. Does your facility use any internal combustion engines greater than 50HP?
2. Does your facility involve mixing, blending, or processing any solvents,
adhesives, paints or coatings?
I 3. Does your facility create any dusts or smoke? _
d. Does your facility refine any liquids or solids or reclaim any metals?
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5. Does your facility plate or coat anything?
6. Does your facility have any combustion equipment (i.e. boiler, furnaces,
broiler, baking ovens, etc.) rating greater than 2,000,000 BTU/HR?
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7, Does your facility handle or store solvents or motor fuel?
8. Do you use or store any acids?y
9. Do you use any chemical process?
10. Do you use any solvents for clean-up?
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11. Are you a dry cleaner, restaurant with a charbroiler, body shop, gasoline '
station, printer, br part coater?
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12. Is the subject building located within one thousand (1,000) feet of any
school? PROPERTY LINE TO PROPERTY LINE. GRADES K-12.
If you have marked "NO" in all columns, you do not need an Air Quality 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 at:
E:
21865 E. Copley Drive }.
Diamond Bar, CA 91765-4182
Please call: Plan Check (909) 396-2008
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