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HomeMy WebLinkAbout14896 Springdale St - CofO (4)F-7.7111 I i it l r SUPPLEMENTAL INFORMATION V; 1. BUSINESS ADDRESS (W( S�J ✓�G��� { s 2. Person to contact in case of emergency•�r' Telephone' , 3. Does the building in question have electricity? O' Yes j (a) If No, are you requesting ,that the electricity be ❑ No ❑ Yes turned on? ❑ No r, 4. The building is sprinklered? —✓� Yes 5. Operations will produce dust/wood shavings or similar ❑ No material? ❑ Yes , _❑-N.o t 6. Operations will involve the = repair or replacement of ❑Yes automobile parts? NoT I ` 1t Yes: t (a) Describe the components repaired or replaced. t R n (b) Dues the operation involve the use of an open flame? ❑Yes -No '' 4 7. The business is drinking, dining or assembly use that will result in an occupant load of more than 50 persons. ❑Yes rfi ;, 8: The following best describes my operation - Office Only Retail Sales 71, Warehouse J Manufacturing / Distribution (describe process and end product); n - Restaurant / Take Out Food Medical / Dental f Other (describe) x r} SUPPLEMENTAL INFORMA71ON F i F . C `T L ij<,. . rt,J`-, _ �� " t a" v ICI SUPPLEMENTAL IWORMATION (Continued) i ; C Does the operation involve any of the following materials? Yes V 0 No i If 1'e^,, indicate quantities: Material 1. Flammable liquids Quantity i Class I -A ttt Class I-'S3 'Ala _ Class 1-C ----_ , 2. Combustible liquids --- 11� ClassIV Class 111-A Comlaination flammable liquids n 4. Flammable ` gases F 5• Liquefied flammable gases 6 Flammable fibers -loose 7• Flammable fibers - baled 8• Flammable solids y # g• Unstable ;materials r — } 10. Corrosive liquids 11. Oxidizing material - gases 'material 'mod 12• Oxidizing liquids 13. Oxidizing ;material - solids 14. Organic peroxides l 5. Nitromethane (unstable materials) ;{ 10. Am-nor.ium nitrate 4/0 a l l 17• Ammonium nitrate compound mixtures_ containing more than 60°lo nitrate by weight 8 Highly toxic material and — f ,. 19. poisonous gas Smokeless powder------------ i 20. Slack sporting powder I hereby certify that the above information Ss true and correct to the best of my, knowledge. -- Signature. Date ;. t s i �I I . it ti r South Coast AIR QUALITY MANAGEMENT DISTRICT 21865 E. Copi*2y Drive, Diamond Bar, CA 91765-4182 (909) 396-2000 AER QUALITY PERMIT CIjfECKLIST k for nonresidential L dings only Company Name: �� Location of Property:11�� City: f�r/f /ji✓`�I /c'��/� Zip Code: _ Contact Person:/` —' Title.. l�i�i9.�l•�;//,�.����G,Jit�f�l r= � l Teepone Number: ,'� � c �2_. ^% h � `^ � / Fax Number:. - ' r ' Type of Industry/Business: To al ply for a nonresidential building permit, you must complete this checklist. If you have any questions about completing this checklist, please call (800) 388-2121. 4 1. Will the facility have a charbroiler? YES NO 2. Will any internal combustion with en :rie �"' greater than 50 horsepower Y operate at the facility (excluding motor vehicles)? 3. Will operations at the facility involve mixing, blending,. or processing of r solvents, adhesives, r :ts or coatings? �) 4. Will dust or smoke b• generated at the facility? • Will refining of -myliquids or solids be done at the facility? , 6. Will any plating or coating of materials be done at the facility? `gr 7. Will any equipment rated greater r than 2,000,000 BTU/hr be operated at the facility? 8. Will any acids, solvents, or motor fuel be used or stored at the facility? , 3 9. Will any organic liquids or gases be reacted or roduced? 10. Will any ovens be used to dry or care products at the facility? I L Will a,y CFC (Freon) recycling machines operate at the facility? Applicant: Signature: (Print name clearly) , If you have marked "NO" in all the boxes; an air quality permit is not needed at this time, and this checklist is your written release. If you marked "YES" in any of the boxes, you must contact the South Coast Air Quality Management District (AQMr3). Please read the requirements on the back of the checklist. (800) 388-2121 7 ADDMONAL SUPPLEMENTAL iNFORM1A710N t - f k i is i; " F w I DESCRIPil, TR FU ' ACCOUNT DEPT. 1 DIV. 1\ /AMOUNT BUSINESS Li-cf,�SE R �A 3-01-00 CD 1234 BUILDING PERMITS =AA 3-06-00. CD 234 PLAN CHECK FEES AA. -CD 234 ilUMBING PERMITS R AA 3-07-00 CD 234 ELECTRICAL PERMITS R I AA 3-08-00 CD 234 77 HEATING PERMITS R AA 3-09-00 CD 234 POOL PERMITS R-AX --3--1 5-00 CD 234 PARK & REC (UNIT LOT FEE) R I SK 3-55-00 CD 234 LIBRARY FEES (CELF) R AA 7-11-00 CD 234 GRADING PERMITS R_ AA 3-11-00 PW 411.. GRADING PLAN CHECK FEE R AA 7 PW 411 CERTIFICATE OF OCCUPANCY 'Fl, AA 7-19-00 'N 234 ZONING APPLI'IONS R AA--7<1-00 CD, 231 PARK & REC (SU13DIV. A 6R SK 3-14-00 CD SMIP A8 2-01-16 00 000 OTHER OTHER