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HomeMy WebLinkAbout15207 Springdale St - CofO (5)i t , /Q APPLICATION FOR CERTIFICATE OF OCCUPA CY CITY OF HUNTINGTON BEACH j g DEPARTMENT OF COMMUNITY DEVELOPMEN �Za IJUNDNG70N BEACH (PRINT OR TYPE ONLY) DATE fSZC? 7 CPa 1 .e1 NI A ,¢ L//� r; r :T�n/ / a CA 926 Qq District Address — Business Name S ZA`C' Tel. Business Type Yo /I � ��6 /'� 32 }� C / h � C _ /U %a O FGI Grz 9Cl %a UTAR F<i�7td fpCc. Group � BUSINESS OWNERIMANAGER BUILDING OWNER " 7 Name i/I�/kP PR(JPGfLT%rY' t LLC Name PH/`L��'P TANG Home Address _-2-7 US ! / OS _A /_ S 5 Ui 7'E z10 Address City%>/SS10N C///� i O 91 (D 9 l Tel City /-: (N T/ �U6 7rAl 6)5ACA( Home Tel. y4913 AK- 96 4O /Y /v THIS USE WOULD BE DESCRIBED AS: NEWLY CONSTRUCTED BLDG. ❑ HANGE OF OWNER dCHANGE OF OCCUPANT ❑ EXISTING BUILDING Lvf CHANGE OF USE ❑ ADDITIONAL OCCUPANT Indicate former use, if any w4 3 dIs*= t-e Occupancy Gr Div. SQUARE FT. OF BUILDING TO BE OCCUPIED 17/0 0 fr'14t� fhra huilrlinn has been J THAFFFV , { %PeACT FEE DATE PA°f.a Ai`:C UNT RECEIVEL . ___ NAIVE _ __ (FOR OFFICE USE ONLY) ZONING — OCCUPANCY P PLAN CHECK NO NO PARKING SPACES OCCUPAidC YG , DEPT APPROVAL A HEALTH OCCUPANT LOAD PERMIT NO _ NO. STO IES { ADMIN. ACTION— — UTILITIES RELEASED FEE .A E OF OCCUPANCY� � � CERTIFICATE AP OVI b BY DATE CHANGE OF USE OR OCCUPANCY FEE S TOTAL $ tag j r [•; (:tv�41t.4i`:I:l/ I1;.q:_S.'' t c,:I ST � 75-033 Rev. 1/97 . Ij J SUPPLEMENTAL INFORMATION L Me 1. r� SINESS ADDRESS 0N7-1616 d/y 9 -lCN 92-6U9 2. Person to contact in case of emergency - Telephone number; — 3. Does the building in question have electricity? C1 Yes ❑ No (a) if No, are you requesting that the electricity be Q Yes turned on? Cl No 4. The building is sprinklered? ® Yes' ❑ No n 5. Operations will produce dust/ wood shavings or similar material? ❑ Yes ® No 6. Operations will involve the repair or replacement of ❑ Yes i automobile parts? ®No If Yes: (a) Describe the components repaired or replaced. i � } r (b) Does the operation involve the use of an open flame? ❑ Yes R No , 7. The business is drinking, dining or assembly use that will result in an occupant load of ` more than 50 persons. ❑ Yes �{ © No 8. The, following best describes my operation; , v'Office Only � r1W Retail- Sales ✓Warehouse � Manufacturing / Distribution (describe process and end product) t 3f r U Restauraftt / Take Out Food Medical / Dental IN Other (describe) - x i SUPPLEMENTAL. NFORMATION SUPPLEMENTAL —INFORMATION RATION (Continued) Does the operation involve any of the following materials? 173 Yes' N� If Yes, indicate quantities; Material Quantity 1. Flammable liquids Class I -A Class I-I3 Class I-C .t r 2. Combustible liquids Class I! � Class UI-A 3. Combination flammable liquids l 4. Flammable gases 5. Liquefied flammable gases 6. Flammable fibers - loose, j 7. Flammable fibers - baled 8. Flammable solids w 9. Unstable materials 10. Corrosive liquids 11. Oxidizing material - gases 12. Oxidizing material - liquids 13. Oxidizing material - solids 14. Organic peroxides 15. Nitromethane (unstable materials) 16. Ammonium nitrate l 17. Ammonium nitrate compound mixtures 1 containing more than 60% rr:+--ate by weight is. Highly toxic material and poisonous gas " 19. Smokeless powder 20. Black sporting powder i hereby certify that the above information is true and correct to the best of my knowledge. 3'%Gl g �gnaturE Date 4 r S South Coast 1- Air Quality Management District 21865 E. Copley Drive, Diamond Dar, CA 91765-4182 ® (909) 396-3529 a http://vrww.agmd.gov i Air Quality Permit Checklist California State Law Code 65950.2 prohibits cities from issuing an occupancy permit to a a business without clearance from the local air quality agency. This checklist will determine if you need to obtain clearance from the South Coast Air Quality Management District (AQMD). k Company Name: L&C /A)G Property Address: /5 20 - SP/e/UGA/1 L� r. City: w oAJT1 /JGTcA/ 5 sA cat Zip Code: �/ k Contact Person: Pf/1.GL'� iA,UU Title: Type of Business: Ho R _ &CCOA 69- / 6A) Telephone: (7/y) 9-k3 7 ` Applicant (print name) ,e`I 7 Ny Signature: • Will the facility have any of the following equipment? Yes[ ] No [X] Cha -oiler Dry cleaning machine Spray booth i Printing press (screen/lithographic/flexographic)_ y Internal combustion engine (greater than 50 HP (excluding motor vehicles) $$€ Boiler/combustion equipment (greater than 2 million BTU/hr. maximum input) I Abrasive blasting cabinet/room Baghouse/cartridge-type dust filter/scrubber Motor fuel storage and dispensing equipment • Will any of the following operations be performed? Yes[ ) No [' .J, Application of paints or adhesives Etching, plating, casting, or melting of metals Molding; extruding, or curing of plastics F Mixing and blending of liquids and/or powders 1 Storage of acids, solvents, organic liquids, or fuels Production of fumes, dust, smoke, or strong odors ` questions, this checklist is our clearance from A MD. If you to both u ion answered `No Q If you any y q answered "Yes" to either question, you must contact AQMD to determine if air quality permits are required. If permits are needed, AQMD will assist you in submitting permit application(s) and then provide you with a clearance letter. You can call AQMD at their Small Business Assistance Office at (800) 388-2121, ! f h Revised. February 1999 l `�t