HomeMy WebLinkAbout14896 Springdale St - CofO (4)F-7.7111
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SUPPLEMENTAL INFORMATION
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1.
BUSINESS ADDRESS (W( S�J ✓�G���
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2.
Person to contact in case of emergency•�r'
Telephone' ,
3.
Does the building in question have electricity?
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Yes
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(a) If No, are you requesting ,that the electricity be
❑ No
❑ Yes
turned on?
❑ No
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4.
The building is sprinklered?
—✓� Yes
5.
Operations will produce dust/wood shavings or similar
❑ No
material?
❑ Yes
,
_❑-N.o
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6.
Operations will involve the = repair or replacement of
❑Yes
automobile parts?
NoT
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1t Yes:
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(a) Describe the components repaired or replaced.
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(b) Dues the operation involve the use of an open flame?
❑Yes
-No
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7.
The business is drinking, dining or assembly use that will
result in an occupant load of more than 50 persons.
❑Yes
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The following best describes my operation -
Office Only
Retail Sales
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Warehouse
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Manufacturing / Distribution (describe process and end product);
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Restaurant / Take Out Food
Medical / Dental
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Other (describe)
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SUPPLEMENTAL INFORMA71ON
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SUPPLEMENTAL
IWORMATION (Continued)
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Does
the operation involve any of the
following materials? Yes
V
0 No
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If
1'e^,, indicate quantities:
Material
1.
Flammable liquids
Quantity
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Class I -A
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Class I-'S3
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Class 1-C
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2.
Combustible liquids
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ClassIV
Class 111-A
Comlaination flammable liquids
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4.
Flammable ` gases
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5•
Liquefied flammable gases
6
Flammable fibers -loose
7•
Flammable fibers - baled
8•
Flammable solids
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Unstable ;materials
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10.
Corrosive liquids
11.
Oxidizing material - gases
'material
'mod
12•
Oxidizing liquids
13.
Oxidizing ;material - solids
14.
Organic peroxides
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5.
Nitromethane (unstable materials)
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10.
Am-nor.ium nitrate
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Ammonium nitrate compound mixtures_
containing more than 60°lo nitrate
by weight
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Highly toxic material and
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19.
poisonous gas
Smokeless powder------------
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20.
Slack sporting powder
I hereby certify that the above information Ss true and correct to
the best of my, knowledge.
--
Signature.
Date
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South Coast
AIR QUALITY MANAGEMENT DISTRICT
21865 E. Copi*2y Drive, Diamond Bar, CA 91765-4182 (909) 396-2000
AER QUALITY PERMIT CIjfECKLIST
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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
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l Teepone Number: ,'� � c �2_. ^%
h � `^ � / Fax Number:.
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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.
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1. Will the facility have a charbroiler? YES
NO
2. Will any internal combustion with en :rie
�"' greater than 50 horsepower
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operate at the facility (excluding motor vehicles)?
3. Will operations at the facility involve mixing, blending,. or processing of
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solvents, adhesives, r :ts or coatings? �)
4. Will dust or smoke b• generated at the facility?
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Will refining of -myliquids or solids be done at the facility?
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6. Will any plating or coating of materials be done at the facility?
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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?
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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
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ADDMONAL SUPPLEMENTAL iNFORM1A710N
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DESCRIPil,
TR
FU '
ACCOUNT
DEPT.
1 DIV.
1\ /AMOUNT
BUSINESS Li-cf,�SE
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�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