HomeMy WebLinkAbout15211 Springdale St - CofO (3)I
APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH
DEPARTMENT OF COMMUNITY DEVELOPMENT CY1iy�
RUNnN,GTON BFi\Qi (PRINT OR TYPE ONLYI DATE
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Address 1. �` e �'� LC �� Di5lrictt`tl,am
Business Name 0�11 C4C N \C �4�Y1TlC�iJAi CD Tel] 14_ 99 '
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Business Type � ]. &z is C� ETC — ��Cl S�.I G Occ Group —
BUILDING BUILDING OWNER BUSINESS OWNERIMANAGER
NameyAQ 9 NO-17ER ice.(U AIS c�
Name d
Home
Addryes�sAddress
City Tel City Home Tel.
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THIS USE WOULD BE DESCRIBED AS:
(❑NEWLY CONSTRUCTED BLDG ❑ CHANGE C F OWNER CHANGE OF OCCUPANT
EXISTING BUILDING ❑ CHANGE OF USE ❑ ADDITIONAL OCCUPANT
Indicate former use. it any Occupancy Gr.—Div
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SQUARE FT. OF BUILDING TO BE OCCUPIEC"t -
(FOR OFFICE USE ONLY)
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SUPPLEMENTAL INFORMATION
ZONING_
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OCCUPANCY GROUP
PLAN CHECK NO.
NO POPKING SPACES
OCCUPANT LOAD _ ,
PERMIT NO
HEALTH UEPT APPROVAL
NO. OF STORIES-
ADMIN. ACTION
UTILITIES RELEASED'
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CERTIFICATE OF OCCUPANCY FEE
PlPr VED Y ATE
CHANGE OF USE OR OCCUPANCY FEE
TOTAL
75.039Rev. 11/90
commuNITY DEVELOPMENT
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SUPPLEMENTAL INFORMATION
1. BUSINESS ,ADDRESS �
2. Person to contact in case of emergency Clk -��_��G
► Telephone number:
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Yes
3. Does the .:building.. in question have electricity?
No
k (a) if No, are you requesting that the electricity be -
Yes
(] No
turned on?
Yes
4. The building is spr'nklered?
❑ No
5. Operations will produce dust/ wood shavings or similar
❑ Yes
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material?
6, Operations will invclve the repair or replacement of,
C7 Yes
�NO
automobile parts? -
if Yes:
-(a) Describe the components repaired or replaced.
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the operation in the use of an open flame .
Yes
(b) Does
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is drinking, dining or assembly use that will
7, The business arsons.
' than 50 p
❑ Yes
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result in an occupant toad of more
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8. The following best describes my operation;
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Office Only ;
Sales
Warehouse f
r /Distribution (describe process and end l�,duct )
Manufacturing
Restaurant/Take Oi t Food
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Medical / Dental
Other (describe) -------
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SUPPLIMSNTA.L jjA'O'MATI0N
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City of Huntington ngton each
.; 208'11 MAIN STREET CALIFORNIA92648
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DEPARTMENT OF CONIMUN, iY DEVELOPMENT
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Building 536-5241
Planning 536-5271
Housing 536-5271
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Government Code Section 65850.2(b) requires the City of Huntington,
Beach Building Division not to issue the final certificate of
occupancy unless the applicant has met or is meeting the
requirements of the South Coast Air Quality Management District
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(AQMD). The Building Division must obtain a written release from
` AQMD to show the applicant has complied with this law. The check
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list on the reverse side is designed to help the ,applicant and the
building division to meet these requirements.
1. The applicant (the same person who applies for Permits from
the Building Division) must complete the check list which
can be obtained either at the Building Division or at AQMD.
2. If all boxes in the list are checked "no", the Building
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Division can accept the check list as the release.
3. I.f there are any "yes" answers in, the list, the applicant
F must contact an AQMD engineer by calling-(714)- 396-2000 to
find out whether air permits are required for the proposed
construction project,
` 4_. If air permits are not required, the applicant will Obtain
a written release from AQMD.
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5. If air permits are required, the applicant must submit the
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necessary permit applications before the release can be
issued.
Because of the time it may take for AQMD to go through the above
procedures, the applicant is advised to contact AQMD immediately
i after applying for Building permits.
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(1360D)
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SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT
(Nonresidential Buildings Only)
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Location of Subject Property:
Property Owner Name:�t N i Pone #
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Name of the Person Preparing this form in print an
signature'
�Z� �(Z Signature:
Name : � �! \n `�' �
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The person preparing this form must be the same person applying for
answer the following questions regarding
building permits. Please
proposed occupancy of the subject building. IF YOU DO NOT
KNOW
your
THE ANSWER TO A QUESTION MARK IN THE "YPS" COLUMN:
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AQMD PERMITTING CHECKLIST
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YES
NO
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1. Does your facility use any internal combustion
engines greater than 50-HP?
2. Does your facility involve mixing, blending, or
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processing any solvents, adhesives, paints
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or coatings?
3. Does your facility create any dusts or smoke?
4. Does your facility refine any liquids or solids
Or reclaim any metals?
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5. Does your facility plate or coat anything?
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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 you use or store any acids?
9. Do you use any chemical process?
10. Do you use any solvents for clean-up?
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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 (1,000) feet of any school?+
PROPERTY LINE TO PROPERTY LINE. GRADES K-12.
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If you have marked "NO" in all columns, you do not need an Air
Quality at this time. If you have marked any questions
in
�
,permit
the "YES" Column youmustcontact 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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