HomeMy WebLinkAbout15215 Springdale St - CofO (4)7
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SUPPLEMENTAL INFORMATION
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1.
ESS ADDRESS 5- t C-,f• C
BUSINESS
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2.
Person to contact in case of emergenc
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Telephone number; `�--
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E Yes
3.
Does the building in question have electricity?
!] No
(a) If No, are you requesting that the electricity he
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turned on?
No
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Er Yes
4.
The building is sprinklered?
0 No
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5.
Operations will produce dust / wood shavings or similar
❑Yes
material?
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6.
Operations will involve the repair or replacement of
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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?
❑ Y s
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7.
The business is drinking, dining or assembly use that
will
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result in an occupant load of more than 50 persons.
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8.
The following bes, describes my ` operation;
Office Only
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Re Sales
Warehouse
Manufacturing / Distribution (describe process and end product)
x
Restaurant / Take Out Food
Medical / Dental
Other` (describe)
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SUPPLEMENTAL INFORMAnON
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South Coast,
I AIR QUALITY MANAGEMENT DISTRICT'
21865 E. Copley Drive, Diamond Bar, CA 91765-4182 (909) 396-2000
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.4 R QUALM PEW2 HT CHECKLIST
for nonresidential buildings only
Company Name: - e — C !
I Location of Property:
C L Zip Code:? (° 9
city:-
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Contact Person: Title:
(('
Telephone Number: i i'�O') `i �! �' �� ° Fax Number: [#
Type of IndustryBusiness: r' �—av\
1 To apply for a nonresidential building permit, you must complete this checklist. If you have any
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4 questions about completing this checklist, please call (00 ) 388-2121. YES NO
1. Will the facility have a charbroiler? )
2. Will any internal combustion engine with greater than 50 horsepower
operate at the facility (excluding motor vehicles)? L
Will operations at the facility involve mixing, blending, or processing of
solvents, adhesives, paints or coatings.
4. Will dust or smoke be generated at the facility? _ 1
} 5. Will refining of any liquids ar solids be done ac the facility?
6. Will any plating or coating of materials be done at the facility?
7. Will any combustion equipment rated grater than 2,000,000 B'I'U/hr be
operated at the facility?
or motor fuel be used or stored at the facility?
8. Will any acids, solvents,
9. Will any organic liquids or gases be reacted or produced?
10. Will any ovens be used to dry or cure products at the facility?
11. Will any CFC (Freon) recycling machines operate at the facility?
Signature:
Applicant:k� -
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(Print name clearly)
4 If you have marked "NO" in all the boxes, an air quality pernut is not needed at this time,,
and this checklist is your written release.
If you marked "YES" in any of the boxes, Yo
u must contact the South Coast Asir Quality
Management District (AQMD). Please read the requirements on the back of the checklist.
(800) 388-2121
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ADDITIONAL SUPPLEMENT6,1L
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NOTICE OF REQUIREMENTS I
GOVERNMENT CODE SECTION 65850.2 (AB3205)
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California State Law (Government Code 65350.2) prohibits the Building Departments from
issuing a final certificate of occupancy unless all requirements of the local air quality agency are
met, All applicants are required to complete the air quality permit checklist. The checklist is
designed to aid the applicant for a nonresidential building permit only. If the answer to any of
the questions is "YES," the Building Department must obtain a written release from the local air
quality agency verifying that. the applicant is in compliance.
1. All nonresidential building permit applicants must complete this checklist.
2. If the answers to all questions are "NO," the Building Department can accept the checklist
as the written release.
3. If any questions are answered "YES," the applicant must contact the AQMD by calling
(900) 388-212I to determine whether air quality permits are required for any equipment
which may be operated at the site. If the AQMD determines that air quality permits are -
not required or that all requirements have been met, a written release will be issued.
4. If air quality permits are required and applications have not been submitted, the applicant
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must submit the necessary permit application(s) and appropriate fees' before a written
{ release will be issued.
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AQI%M is committed to expediting all clearance letter requests. However, it may take several
weeks to verify compliance with ail requirements. Therefore, you are advised to contact AQivID
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immediately after, applying for building permits.
(800) 388-2121
revised 9/95
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