HomeMy WebLinkAbout15061 Springdale St - CofO (8)e
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DEB # 4 199 �
APPLICATION' FOR CERTIFICATE OE OCCUPANCY ticens� t
I; ITY OF HUNTINGTON BEACH
DEP?RTMENT OF COMMUNITY DEVELOPMENT
WO
-- DATE
HUNTINGTON BEACH (PRINT OR TYPE ONLY)
1.
1 District
AddressTel
-�piLT' r �_rO0 t j
'Business Name k
Ccr. Group
�BUsiness Type BJSINESS OWNERIMANAGER
BUI ING OWNER
/Name '<'me
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Li� n �, Address ( 7
�Addres /� �3 '
I I -/City 51 dtJ ,� _ Home Te —
ty --�
,/fHIS USE WOULD BE DESCRIBED AS -
NEWLY CONSTRUCTED BLDG. ❑ CHANGE OF OWNER Ll. CHANGE OF Or
E ITINGBIIILDING
El CHANGE OF USE l❑ ADDITIONAL C ANT
S
Indicate former use. It any i
Occupancy Gr _Div.__
SUUARE FT. OF BUILDING TO BE OCCUPIED
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SJPPL,EMENTAL INFORMATION(
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' ( S ftJ tr'L
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BUSINESS ADDRESS
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2.
Person 'to contact in case of emergency
Te,lephonri number:
3.
Does the building in question have electricity?
a —Ye
❑ No
(a) if No, are you requesting that the electricity be
❑ Yes
❑ No
turned on?
ads
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4.
The building is sprinklered?
❑ ho
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5.
Operations will produce dust /wood shavings or similar
❑ Yes
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material?
a -No
6.
Operations will involve the repair or replacement of
❑ Yes
0--NO
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automobile parts?
if Yes:
(a) Describe the _ components repaired or replaced.
(b) Does the operation involve the use of an open flame?
YNa
7.
The business is drinking, dining or assembly use that
will
❑ Yes
E
result in an occupant load of more tl,an 50 persons.
0-140
8.
The folio g best describes my operation;
fice Only
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Warehousew
Manufacturing / Distribution (describe process and end
product)
Restaurant/Take Out Food
Medical / Dental-
.
Other (describe)
E-..
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SUPPUMENTAL INFORMATION
SUPPLEMENTAL INFORMATION (Continued)
Does
the operation involve any of the following materials?11 L7 es
If Yes„ indicate quantities: Quantity
_Material
1. Flammable liquids
Class I -A
Class I-B
Class I-C ;
2.
Combustible liquids
Class 11
Class Ili -A
3.
Combination flammable liquids__
4.
Flammable gases
5.
'Liquefied flammable gases
6,
Flammable fibers - loose
7,
Flammable fibers -baled i.
8.
Flammable solids
9.
Unstable materials
10.
Corrosive liquids
11
Oxidizing material - gases
12,
Oxidizing material - liquids
` 13.
Oxidizing material - solids ---
14.
Organic peroxides j
15.
Nitromethane (unstable materials) _ ---
16.
Ammonium nitrate
17.
Ammonium ni*ratecompound mixtures i
containing more than 60% nitrate
by weight ---------
_18.
Highly toxic material and
poisonous gas -
19.
Smokeless powder,
-20.
Black sporting powder
I her" b # ce i€y
at th 'j above information is true and correct to
the es
of my k
owlet e.
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Sigrfature Date
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F
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RETURN TO THE PLANNING DIVISION, CITY OF HUNTINGTON BEACH, P.O. Box 190,
2000 brain Street, Huntington Beach, CA 92648
SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT
(Nonresidential Buildings Only)
Location of Subject Property: IJw E C(
/r 4
Property Owner name: �• Phone ,(
Name of the Person Preparing this form in pri tl 3n s` " nature
Name %i(%Signature #.
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The person preparing this form must be the same person applying for
building permits. Please answer the following questions regarding your
proposed occupancy of the subject building. IF YOU DO NOT KNOW THE ANSWER
TO A QUESTION MARK IN THE "YES" COLUMN:
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SCAQMD PERMITTING' CHECKLIST
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YES NO
I. Does your `acility-use any internal combustion
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?
4 Does your facility refine any liquids or solids:
Reclaim any metals?
S. Does your facility plate or cost anything?
6. Does your facility have any combustion equipment ;
i.e. boiler, furnaces, broiler, baking _ovens, etc.)
rated greater than 2,000,0or BTU/HR? f,
7. Does your facility handle or store solvents or motor B i• fuel? 6
8. Do you 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, printer, or part coater?
12. Is the subjectbuilding located within one thousand
(1,000) feet of any school?
PROPERTY LINETOPROPERTY LINE. GRADES K-12. b
If you have marked "NO" in all columns, you do not need an Air Quality
permit at this time. If you have markedanyquestions in the "YES" column L
You must contact the South Coast Air
Quality Management District located`
nt:
9150 FLAIR DRIVE, EL MONTE, CA 91731
' F°icase call these offices: Plan Check T
(8,18) 572-6406
1):AL00603 (818) 572--6111, (818) 572-6261
c' i
,.4 South Coast
AIR QUALITY MANAGEMENT DISTRICT
9150 FLAIR DRIVE, EL MONTE, CA 91731 (818) 572-6200
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Assembly Bill 3205 requires the Building Departments not to
issue the final certificate of occupancy unless the
applicant has met or is meeting the requirements of the
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District. The Building Department must obtain a written
release from the District to show the applicant has complied
with this law. The attached check list is designed to help
the applicant and the building departments to meet these
• requirements.
1. The applicant ( the same person applies permits from the
i
Building Department) must fill the check list which can
be obtained either at the Building Department or at the
District.
2. If all, boxes in the list are checked "no", the Building
Department can accept the check list as the release.
3.If there are any "yes" answers in the list, the
applicant must contact a District engineer by calling
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(818-572 6406, 818-572 6111, 818=572 6261 ) to find out
whether air permits are required for the proposed
f
construction project
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4. If air permits are not required, the applicant will
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obtain a written release from the District engineer.
�.
5. If air parnits are required, the applicant must submit
the necessary permit applications before the release can
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be issued. A sample copy of the release is attached.
s
Because of the time it may take for the District Engineer to
go through above procedures, the applicant is advised to
contact the District immediately after ,applying for Building
`-
permits.
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myl/al AB3205ID
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