HomeMy WebLinkAbout15052 Springdale St - CofO (10)SUPPLEMENTAL INFORMATION
1.
BUSINESS ADDRESS l S'052 S7(P! M' � daCP.
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2.
Person to contact in case of 'emergency >P�feEnyd
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Telephone number: S la ( (96 - Y�33
3.
Does the building in question have electricity?
I� yes
❑ No
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(a) If No, are you requesting that the electricity be
❑ Yes
turned on?
❑ No
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4.
The ` building is sprinklered?
❑ es
1. .
5.
Operations will produce dust/wood shavings or similar
iN o
material?
El Yes
L N0
6.
Ooerations will involve the repair or replacement of
❑ Yes
automobile parts?
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If Yes:
(a) Describe the components repaired or replaced.
;
(b) Does the operation involve` the use of an open flame?
❑❑/Yes
i No
7.
The business is drii,king, dining or assembly use that will
result in an occupant load of more than 50 persons.
❑Yes
g.
The following best describes my operation`
p' No
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Retain Sales
Warehouse
Manufacturing / Distribution (describe process and end product)
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Restaurant / Take Out Food
-` Medioal / Dental
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Other (describe)
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SUPPLIMENTAL INFORMATION,
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SUPPLEMENTAL INFORMAMU' j_ (Continued)
" toes the operation;, involve -"any of the following
materials? D 'Yes
No
If
Yes, i dicate quantities:
_
Material Quantity
17
_
Flammable liquids
3
Class I -A
Class I-B
Class i-C
2.
Combustible liquids
Class
Class III -A
3.
Con bination flammable liquids
4.
flammable -gases
5.
Liquefied flammable 'gases
6.
Flammable fibers - loose
7.
Flammable fibers - baled
8.
Flammable solids
9.
Unstable materials
}
10.
Corrosive liquids
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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 weigh
18.
Highly toxic materialand
poisonous gas
19.�
Smokeless powder
20.
Black sporting ` powder
1 hereby certify that the above information is
the best of my knowledge.
truz and correct to
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P
ton Beach
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` CALIFORNIA92648
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2000 MAIN STREET
DEVELOPMENT
DEPARTMENT OFCOMMUNITY
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Building 536-5241
e,
Pimining 536-5271
Housing 536-5271`
Go-iernment Code Section 65850,2(b) requires the City of Huntington;
final certificate of
Beach Building Division not to issue the
the applicant has met or is meeting the
occupancy- unless
the South Coast Air Quality Management District
requirements of
The Building Division must Obtain a written release from
(AQMD)• law. the check
AQMD to show the applicant has complied with this
is designed to help the applicant and the
list on the reverse ride
building division: t6 wa nt these requirements.
1. The applicant (?� same nPrson who -applies for-r�Prmits from
the check list which
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the Building D vi*ion) must complete
either at the wilding Division or at AQMD.
can be obtained
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2. If a11' boxes in the list are checked "no", the Building
the release.
Division can accept the check list as
3. If there are any "yes" answers in the list, the applicant'
by (714) 396-2000 to
must- contact an AQMD engineer calling
permits are required for the proposed
find out whether air
construction project.
4, if air permits are not required, the applicant will"obtain
a written release from AQMD.
5. If air permits are required, the applicant must submit the
the release can be
neces ons before
ary permit applicati
issued.
Because of the time it may take for AQMD to go through the above
is advised to contact AQMD immediately
procedures, the applicant
for Build ng_permits.
after applying
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(1360D)
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SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT
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(Nonresidential Buildings only)
Location of Subject. PropertyISD_ Z SP�►'t '%E!, jam , CA gz6�'9
Property Owner Name:_ hone # 7�-3ay
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Name of the Person Preparing this form in print ,and signature
Name: J. ?-Pkd4efer Signature: '/' J'
The person preparing this form must be the same ,person applying for
building permits. Please answer the following questions regarding
your proposedoccupancyof the subject building. IF YOU DO NOT KNOW
THE ANSWER TO'.A QUESTION MARK IN THE "YES" COLUMN:
AQND PERMITTING CHECKLIST
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YES NO
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1.Does your facility use any internal combustion j
engines greater than 50-HP?
_✓
2.Does your facility involve mixing, blending, or
processing any solvents, adhesives, paints -
or coatings?
3. Does your facility create any dusts or smoke? t/
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4e_ Does your facility refine any liquids or solids
or reclaim any metals?
5. Does your facility plate or coat anything?
6,, Does your facility have any combustion equipment
i.e. boiler, furnaces, broiler, baking ,ovens,
etc.) rated greater than 2,000,000 BTU/HR?
7'. Does your facility; handle or store solvents or
motor fuel?
8. Do yuu use or, store any acids?
9. Do you use 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 station, j
¢
printer, or part cpater?
12. Is the subject building,: located within one
thoueand,(1,000)
feet of any, school?
PROPERTY LINE TO PROPERTY LINE. GRADES K-12.
=If you have marked "NO" in all columns, you do not need an Air
Quality permit at this time. If you have marked any questions in
the "YES" Column you must contact the South Coast Air Quality
Management District located at;
21865 E. Copley Drive
Diamond Bar, CA 91765-4182
Please call: Plan Check (714) 396-2000 -
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(1360d-2)
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