HomeMy WebLinkAbout15052 Springdale St - CofOCOMMUNITY DEVELOPMENT
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/• 1�1E''� APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH
DEPARTMENT OF COMMUNITY DEVELOPMENT`'
HUNM400N BEACH (PRINT OR TYPE ONLY) DAT
District
Address �(e�+�J E2- �1'ytC<y._OclgR; Cve Fz Tel. %/ _'Crl a
Business Name_ t�
Business Type U�le7U'0_ -J C�° Ouc.Group
BUILDI
NG OWNER BUSINESS OWNERWANAGER
'—
Name ITh/Ylt1j.Home
l -p' ir/IL Address-
Address / �t�Ua- � y'
City
�jt/niftiyE cN & _6V _rel y Cityr R Home iel. O/��
THIS USE WOULD BE DESCRIBED AS:
' ❑ NEWLY CONSTRUCTED BLDG, ElCHANGE OF OWNER 1.- CHANGE OF OCCUPANT
EXISTING BUILDING ❑ CHANGE OF USE ❑ ADDITIONAL OCCUPANT
Indicate former use, if any Occupancy Gr --Div
SQUARE FT, OF BUILDING TO BE OCCUPIEDBQ
I(FOR
OFFICE USE ONLY)
1
ZONING{_�� ' _"'z'
SUPPLEMENTAL INFORMATION
OCCUPANCY GROUP
PLAN CHECK NO.
f40 PARKING SPACES ~
O
OCCUPANT LOAD
+ — PFRMIT NO
HEALTH DEPT. APPROVAL
NO OF STORIES
..�— ADMIN ACTION
UTILITIES RELEASED -- — -
I CERTIFICATE OF OCCUPANCY FEE.
$
PPOV
DATE CHANGE OF USE OR OCCUPANCY FEE $
r
TOTAL
$
COMMUNITY DEVELP.
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SUPPLEMENTAL INFORMATION
pvn's�� -fffvt'JC 01)-1 C
1.
BUSINESS ADDRESS
141C-YA1-T244
2.
,Person to contact in case of emergency. -M&
Telephone number:
3.
Does the building in question have electricity?
les
ONO
a. If No, are you requesting that the electricity be
Oyes
turned on?
ONO
4.
The building- is sprinklered?
ayes
C�Jo
5.
Operations will produce dust/wood shavings or similar
material?
OYes
6'3�0
6.
operationswill involve the repair or replacement of
OYes,
automobile parts? _
0*0
If yes:
(a) Describe the components repaired or replaced.
(b) Does the operation involve th(- use of an oWn flame?
OYes
QW0
7.
The business is drinking, dining or assembly use that will
result in an occupant Load of more than •50 persons.
OYes
{
�o
8.
The fol ow t describes my operation:
fice Onl
etafl Sales
warehouse
Manufacturing/Distribution (describe process and end
product)
estauranc e e OuE Fooao
Q
Medical/Dental
Other (describe)
-(0562D) (12/8/86j
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SUFPLEM9NTAL INFORMATION (,Continued)
,
Does the operation involve any of the fozlowing
materials? Oyes
nuantity
T es, in ica a quant ties:
Material
1.'Flammable liquids
Class I' -A
Class I - 8
--------
Class I-C-
2. Combustible liquids
Class II'
Class III -A
3 Combination flammable liquids
4. Flammable gases
5 Liquefied flammable gases
6. Flammable fibers _loose
7. Flammable fibers - baled
8. Flammable solids
i
9. Unstable materials
10. Corrosive liquids
11 oxidizing material --gases
12 Oxidizing material - lic(uids
1
13 Oxidizing material - solids _--
14 Organic 'peroxides
1
15. Nitromethane (unstable materials)
16. Ammonium nitrate
-.�-
17. Ammonium nitrate compound mixtures
containi. , more than. 60% nitrate
by weir
18. Highly taxic material and
poisonous gas
19. Smokeless powder
20. Black sEarting powder
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I hereby certify that the above information is
true and correct to the
best of my knowledge.
Signature
Date
(05�2D)
3
I
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SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT
(Nonresidential Buildings Only)
Location of Subject Property: 1 ,-JC,0Atk
`T`y
Property Owner name: C/��(�C=��'/� Phone #�-33YY
Name of the Person Preparing this form in print and signature
Name _:7 i l f/` S its (V,9ffZ—& Signature
The person preparing this form must be the/l�,'ame person applying for
building permits. Please answer the follo'w'ing questions regarding your
proposed occupancy of the subject building. IF YOU DO NOT KNOW THE ANSWER
TO A QUESTION MARK IN THE "YES" COLUbti:
SCAQMD PERMITTING CHECKLIST
YES NO
1
1. Does your facility use any internal combustion 0
engines greater than 50-HP?
2. Does your facility involve mixing, blending, or
processing any solvents, adhesives, paints
Y
or coatings?
3. Does your facility create any dusts or smoke?
4. Does yoar facility refine any liquids or solids?
Reclaim any metals?
5. Does your facility plate or coat anything?
,
Does your facility have any ,combustion equipment
F broiler, baking ovens etc.
furnaces, b r
i.e. boiler.,. _ g � )
rated greater than 2,000,000 BTU/HR?
7. Does your facility handle or store solvents or motor
I k
fuel?
8. Do you use or store any acids?
9. Do you use any chemical process?
10. Do you use an solvents for clean-up?
Y Y
11 Are you a dry cleaner, restaurant with a charbroiler,
body shop, gasoline station, printer, or part coater?
12. Is the subject building located within one thousand
(,000) feet of any school?
PROPERTY LINE TO PROPERTY 'LINE. ;GRADES K-12•
If you have marked "N'J" in all columns, you do not need an Air Quality
permit at this time. If you have marked any question:; in the "YES" Column
you must 'contact theSouthCoast Air Quality Management District located
at:
9150 FLAIR DRIVE, EL MONTE,CA 91731
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Please call these offices: Plan Check (818) 572-6406
(818) 572-6111, (818)` 572-6261
D:AL00603
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