HomeMy WebLinkAbout15317 Pipeline Ln - CofOI
g
�
I
LA
� �` APPLICATION FOR CERTIFICATE OF OCCUPANCY
;{
CITY OF HUNTINGTON BEACH
j
HUNnNclon eras+ DEPARTMENT OF COMMUNITY DEVELOPMENT
OR- /(j _ p t
(PRINT OR TYPE ONLY)
DATE
C
k
' 1631 � l�1 rt11V1=
Address
ii
(I
;
business Name J G /YI—Z5/�i�l Pr
District
Business Type �
Tel
Occ. Group
I BUILDING OWNER BUSINESS OWNERWANAGER
Name lam/. 'G C P4QPL- 7W /V&ri/1G
Name Q/1/7`�
- M/yl
Address_`17ZQ VL,-W /�-�/r/St)p,t/ /SUE Home
Address 707 412-i�
;
PT
Tel �$_ 7n /al�� City l=CZ4%
��`S— &r'/��me Tel.
I THIS USE WOULD BE DESCRIBED AS:
' ❑ NEWLY CONSTRUCTED BLDG ❑ CHANGE OF OWNER
CHANGE OF OCCUPANT
EXISTING BUILDING ❑ CHANGE OF USE
❑ ADDITIONAL OCCUPANT
Indicate former use, if any - Occupancy Gr
Div hh
SQUARE FT. OF BUILDING TO BE OCCUPIED
4
s
p�
'i
9
I
SUPPLEMENTAL INFORMATION
(FOR OFFICE USE ONLY)
ZONING M f - Q�
OCCUPANCY GROUP—
PLAN CHECK NO,
PC —
NO PARKING SPACES
OCCUPANT LOAD p�
9--
NO. OF STOGIES
PERMIT NO.
HEALTH DEPT APPROVAL
ADM(N, ACTION
UTILITIES RELEASED
y
CERTIFICATE OF OCCUPANCY FEE
$f
APPROVED BY D TE
CHANGE OF USE OR OCCUPANCY FEE
-
$
TOTAL
_/—n
$ Z -� )'
' 75-039 Rev, 11/90
COMMUNITY DEVELOPMENT
r.
r
#
_
j
SUPPLEMENTAL INFORMATION
1.
BUSINESS ADDRESS /��17 P//���1✓.t/� �.�/U /�/iir�ilTO/ rtC�/
�� -Z r/
2.
Person to contact in case of emergency.:20za,/0'»�"�/1
Telepho^%� number:
i
3.
Does the building in question have electricity?
❑ Yes
No
l
(a) If No, are you requesting that the electricity be
�' Yes
turned on?
El No
4.
The building is sprinklered?
Yes
No
5.
Operations will produce dust/wood shavings or similar
material?
❑ Yes
No j
6.
Operations will involve the repair or replacement of
❑ Yes_
15 No }
automobile parts?
F.
If Yes:
4
(a) Describe the components repaired or replaced.
E
(b) Does the operation involve the use of an open flame?
I
❑ Yes`
No
7.
The business ' is drinking, dining or assembly use that will
s
result in an occupant load of more than 50 persons.
❑ Yes
,' No
8.
The following best describes my operation;
Office Only
r
Retail Sales
Warehouse
i
Manufacturing/ Distribution '(describe process and end product)
i
/�Cr rr�/�QC'lej ! gyyq A-1YP
-
Restaurant/Take Out Food
Medical/ Dental
Other (describe)
SUPPLIMENTAL INFORMATION
f
i
SUPPLEMENTAL INFORMATION (Continued)
Goes the operation involve any of the following materials? d Yes
No
If Yes, indicate quantities.
Material _ _ Quantity _ __._,___--
1. Flammable liquids
Class I -A _
Class I-B
Class I-C
2. Combustible liquids
Class 11
Class Ill -A
3. Combination flammable liquids
4. _ Flammable gases
5 L'iquefied flammable gases
6. Flammable fibers - loose
T Flammable fibers - baled
8. Flammable solids
9. Unstable materials
i0. Corrosive liquids
11. Oxidizing material - gases
12. Oxidizing material --liquids -
13. Oxidizing material - solids
14. Organic peroxides
15. Nitromethane (unstable materials)
16. Ammonium nitrate
17. Ammonium nitrate compound. -mixtures
containing more than 60% nitrate
by weight
18. Highly toxic material and
poisonous gas
19. Smokeless powder
20. Black sporting powder
h,
a
a
l
i
e
i
f
s
i
' I
Government Code Section 65850.2(b) requires that the City of Huntington Beach not issue the final
the l rements of the South
certificate of occupancy unless the applicant has metor
Department of mmunis meeting
District (AQMD). The p ty Development must
Coast Air Quality Management
building division omlied f to meet these checks law. The
obtain a written release from AQMD to show the applicant
list on the reverse side is designed to help the applicant and the
requirements.
�
1. The applicant (the same person who applies for permits from the
must complete the check fist 1
Department of Community Development)
which can be obtained either from the Department of Community
Development or at AQMD. 1=
r.
2. If all boxes in the list are checked "no", the Building Division can accept the
check list as the release. f
3. If there are eny "yes" answers in the list, the applicant must contact an
AQMD engineer by calling (?i 4) 396 -2000 to find out whether air permits are
I
required for the proposed construction project.
l
4. If air permits are not required, the applicant will obtain a written release from
AQMD: F
5. If air permits are required, the applicant must submit the necessary permit
applications before the release can be issued. };
Because of the time it may take for AQMD to go through the above procedures, the applicant !s
advised to contact AQMD immediately after applying for building permits.
n
I
(130D)
ADDITIONAL SUPPLIMENTAL INFORMATION
L
i
i
W9
I
F
1
,`�V T �1� r�3J ^Q AST Aid - (� f»' •� t•
,Nonresidentf�il
l
Property t vjner l'lanne: �,
Nance of the person preparing this form in print and signature:
Name: ANT/��vV k
.�. _ Signature:_�Y?'`z�o='----
---
The person preparing this form must be the same person applying for building
following questions regarding g permits. Please answer the
9 g Your proposed occupancy
of the subject building:: IF YOU DO NOT KNOW
THE ANSWER TO A QUESTION, MARK IN THE "YES„ COLUMN:
AQMD PERMITTING CHECKLIST
YES NO
1. Does your facility use any internal combustion engines greater than 50HP?
2. Does Your facility
t inn g, x
volve mixing, blending, or processing any solvents,
adhesives, paints or coatings?
=. 3. Does your facility create any dusts or smoke?' ,
4. Does your facility refine any liquids or solids or reclaim any metals?
Does your facility plate ar coal anything?
6. Does our facility
y have any combustion equipment (i.e. boiler, furnaces,
I broiler, baking ovens, etc.) rating than
JI
greater 2,000,000 BTU/HR? X t
7. ,Does your facility, handle or stare solVents or motor fuel?
t1
8. Do you use or store any acids?
9. Do you ui6 any chemical process?
10. Do you use any solvents for clean-up? ;
11. Are you a dry cleaner, restaurant with a charbroiler, body shop, gasoline s
station, printer, or part coater?
12. Is the subject building located within ane th^usand (t,000) feet of any
school? PROPERTY LINE TO PROPERTY LINE. GRADES K-12. X_
_ _
If you have marled "NO" in ail columns, you do not need an Air Ouality permit at ti 3 time. If you have marked
any questions in the "YES" column you must contact the ,South Coast Air Qlality Mana<gament i
District lccated at:
21865 E. Copley Lri;re
' Diamond bar, CA 91765-4182
,
Please call: Plan Check (009) 396-2000
A
cas,:vu-2j
i�
i
CITY OF HUNTINGTON BEACH
4°
'J, Phone 536-5241 iy
DEPARTMENT OF L
1
COMMUNITY DEVELOPMENT
❑ Correction Notice =_
❑ Inspection Report
❑ Structural ❑ Electrical ❑ Plumbing ❑ Mechanical ❑ Other
�r
Job Address Lot Permit(s) No.
Et
;r
s
{
3
p
t
f
{