HomeMy WebLinkAbout15323 Pipeline Ln - CofO�.
APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH
DEPARTMENT OF COMMUNITY DEVELOPMENT
(PRINT OR TYPE ONLY) DATE
Address k !�-'�a;� 'ac� L District -
Business Name �I? S % S TeCDT
Business Type ��Tt� FRR.,CA i fi7111
OcC. Group_
I"( �� ING OWNER V B� SS OWNER/MANAGER
Name _�f y� N 1"0 Name I C� fv —�i} I CI &} j A —
Address ` 2-1 1 pF I Pill— ( �\1 Address 1S:Z1�___ (PE LI f j (L�/J
City _T�f � }it' Tel Sn3_ 9Cily---�A-_— P1F 1` C--H_ Home Te . / kF
THIS USE WOULD BE DESCRIBED AS: �(
❑ NEWLY CONSTRUCTED BLDG. 1=1 CHANGE OF OWNER ❑ CHANGE OF OCCUPANT
EXISTING JUILDING CHANGE OF USE .�.{ El ADDITIONAL OCCUPANT
Indicate former use, if anYT-Y✓t yl��l 1 U�� ��ycGr
Pnc Y Div.
SQUARE FT. OF BUILDING TO BE OCCUPIED Ci(J 6r(C'
tilt;/Illhl( l:r_li A
DATE PAID
AMOUNT RECEIVED V-V
NAME /
(FOR OFFICE USE ONLY)
SUPPLEMENTAL INFORMATION ZONING
OCCUPANCY GROUP ^/ PLAN CHECK NO. —_ NO PARKING SPACES
OCCUPANT LOAD PERMIT NO HEALTH DEPT APPROVAL
NO. OF STORIES
ADMIN. ACTION UTILITIES RELEASED
CERTIFICATE OF OCCUPANCY FEE $ t J 1
APPROVED BY ATE CHANGE OF USE OR OCCUPANCY FEE $
TOTAL $
75-039 Rev. 1/97 COMMUNITY DEVELOPMENT'S E
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SUPPLEMENTAL INFORMATION
BUSINESS ADDRESS 1S`%a TI C LINE i_K1
2.
Person to contact in case of emergency- u�t---�j
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Telephone number: C�65-- S Ila
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3.
Does the building in question have electricity?
L'3�Yes
❑ No
(a) If No, are you requesting that the electricity be
❑ Yes
turned on?
❑ No
X
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4.
The building is sprinklered?
Yes
No
5.
Operations will produce dust / wood shavings or similar
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material?
QYes
I
❑ No
6.
Operations will involve the repair or replacement of
Epyes
ri
automobile parts?
❑ No
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If Yes:
(a) Describe the components repaired or replaced.
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(b) Does the operation invoive the use of an open flame?
❑ Yes
EYNO
7.
The business is drinking, dining or assembly use that will
result in an occupant load of more than 50 persons.
❑ Yes
"o
8.
The following best describes my operation;
Office Only
Retail Sales
1
Warehouse
\
and end product)
urin Distribution describe process p )
Manufacturing/ g / ( p
,
Restaurant/Take Out Food
dica[/ Dental
Othe (describe)
SUPPLEMENTAL INFORMATlO V
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SUPPLEMENTAL INFORMATION (Continued)
Does the operatics involve any of the following materials? Yes
❑ No
I If
Yes, indicate quantities:
Material Quantity
1.
Flammable liquids
Class I -A
Class I-B
Class I-C
2.
Combustible liquids
Class If
Class Ill -A
I
Combination flammable liquids
4.
flammable gases
5.
Liquefied flammable gases
6.
Flammable fibers - loose
t 7.
Flammable fibers - b;aled
f 8.
Flammable solids
y 9.
Unstable materials
10.
Corrosive liquids
11.
Oxidizing material - gases
12.
Oxidizing material --liquids
13
O .d. .,
xi izing material - solids
14. Organic peroxides
15. Nitro ;ethane (unstable materials)
i 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 — I
4
hereby certify that the .11• we information is true and correct to
the best of my knowledge.
Signature Date
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South Coast
Air Quality Management District
21865 E. Copley Drive, Diamond Bar, CA 91765-4182
®
(909) 396-3529 • http:/hvww.agmd.gov
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Air Quality Permit Checklist ,
California State Law Code 65850,2 prohibits cities from issuing an occupancy permit without
clearance from the local air quality agency. This checklist need
to obtain
clearance from the South Coast Air Quality Management District(AQMD).
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Company Name:
Property Address: 1-
/N)E
City:
f�— Zip Code: C
!
Contact Person: Title: C7L�S N�'12
Type of Business: t l T=i t s 1-1 � +�Qo,Cnp6rTele hone:
p p ►�{-) 61 i ���
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Applicant (print name) Signature:
• Will the facility have any of the following equipment? 11S [ ] NO �]
[
Charbroiler
4
Dry Cleaning Machine
Spray Booth
Printing Press (screen/lithographic/flexographic)
Internal Combustion Engine (greater than 50 HP (excluding motor vehicles)
Boiler/Combustion Equipment (greater than 2MM BTU/hr. maximum input)
Abrasive Blasting Cabinets/Rooms
Baghouse/Cartridge-Type Dust Filter/Scrubber
Motor Fuel Storage & Dispensing Equipment
i
• Will any of the following operations be performed? YES[ ] NO
Application of Paints and Adhesives
Etching, Plating, Casting or Melting of Metals
Plastic Molding, Extruding or Curing !
Mi,,dng and Blending of Liquids and/or Powders
Storage of Acids, Solvents, Organic Liquids or Fuels
Production of Fumes, Dust, Smoke or Strong Odors
If you answered "NO" to both questions, this checklist is your clearance from AQMD. If you I
answered "YES" to either
question, you must contact the AQMD to determine if air quality
permits are required. If permits are needed, AQMD will assist you in submitting permit
application(s) and then provide you with a clearance letter. If you have any y questions, please call
AQMD's Small Business Assistance office
at (800)-CUT-SMOG, and press 41.
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