HomeMy WebLinkAbout15237 Springdale St - CofO (6)r
A ICATION FOR CENTIFICATE OF O�Ot1 ANC
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CITY OF HUNTINGTON BEA� �1
\ D PARTMENT OF COMMUNITY DEVELOPMEN _ r
`n DATE
(PRINT OR TYPE ONLY) ,
S49ddre � " ) QG- �� District
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Business Name.yOJ'D C E� �1 Tel. /1
Business Type wj+DLQSA-Lo� — eEL Z1k1A-9Q-bu5IF Occ.
Group—f
BUILDING OWNER BUSINESS O�W+NEWNANAGER# j
Name Voiv LLAke , �` l'%NE/`� ` LC Name %U/ T. %E€� — f t -1
1� T f L O S'} b Home `� bb ��+t2F� L /M'A
Address Q � .Addre+ss' — +
City M f 5 lDAI �/ l 6y Tel l � 9h40 City Home Tel.
THIS USE WOULD BE DESCRIBED AS:
❑ NEWLY CONSTRUCTED BLDG. 0 CHANGE OF OWNER CHANGE OF OCCUPANT
XEXISTING BUILDING 1
El CHANGE OF USE ❑ ADDITIONAL OCCUPANT
■ Indicate former use, if any Wt!/u!1. 1 ,, A Pw _Occupancy Gr.—DM
en. 1noe cr rye Brill I-IInir_ m aF nrrn IPiFn
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f TRAFF!G IMPACT FEF _.
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t DATE PAID _
AMOUNT RECEIVED .
NAME
(FOR OFFICE USE ONLY)
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ZONING
a
OCCUPANCY GROUP • t --
PLAN CHECK NO.
NO PARKING SPACES
OCCUPANT LOAD
PERMIT NO:
HEALTH DEPT. APPROVAL—
NO. Or STORIES
ADMIN. ACTION
UTILITIES RELEASED
CERTIFICATE OF OCCUPANCY FEE
APPROVED43y DATE
CHANGE OF USE OR OCCUPANCY FEE $
TOTAL
$
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78-03e Rev. 1/92
COMMUNITY DEVELOPMENT
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SUPPLEMENTAL INFORMATION
1.
BUSINESS ADDRESS ��}4 I GPAL
2.
Person to -contact in case of emergency CAEf-tIL 6 EER
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Telephone number: S
3.
Does the building in question have electricity? Yes
❑ No
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(a) If No, are you requesting that the electricity be ❑ Ye
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turned on? ❑ No
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3
4.
The building is sprir.kiered?, OYes
El No
5.
Operations will produce dust/wood shavings or similar
E
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material? ❑ Yes
- No
6.
Operations will involve the repair or replacement of ❑ Yes
h
automobile parts? No
If Yes:
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(a) Describe the components repaired or replaced.
,
,
(b) Does. the operation ' involve the use of an open . flame? ❑ Yes
ONo
7,
The business is drinking, dining or assembly use that will
result in an: occupant load of more than 50 persons. IT Yes
XNo
8.
The following best describes my operation;{
Office Only
R ales
arehouse�
Manufacturing Distribution (describe process and end product)
Restaurant / Take Out food
Medical / Dental
Other (describe)
a
SUPPLEMENTAL INFORMATION
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SUPPLEMENTAL INFOBMAt OM (Continued)
Does the. -`operation involve any of the following 'materials?
❑' Yes
nlo>
If
,
Yes; indicate` quantities:
Material p
Quantity
1.
Flammable liquids
Class- 1-A
Class I-B
Class l-C
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2.
Combustible liquids
Class II
I.
.Class Ill -A
3.
Combination . flammable -liquids a
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4.
Flammable gases
`.
I.
5.
"Liquefied flammable gases
6.
'Flammable fibers - loose
`
7.
Flammable fibers - baled
i
8.
Flammable solids.
9.
Unstable materials-
10.
Corrosive liquids
Oxidizing material - gases
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Viz.
Oxidizing material- - liquids
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13.
' : Oxidizing material.- solids
14. "
Organic peroxides
I
15.
Nitromethane materials)
4
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16.
,(unstable
_
Ammonium 'nitrate
17
Ammonium nitrate compound mixture&
containing more than 60% nitrate
C
by, weight
i '18.
Highly toxic material and
'poisonous gas
19...
,...,.Smokeless powder
20.
Black- sporting powder
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L. hereby certify that the above ._.information JSL true , and :.corredt
to
the b st ;of my knowledge.
Signature date
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s South Coast
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Air Quality Management District
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,, ....: • 21865 E. Copley Drive, Diamond Bar, CA 91765-4182
(909) 396-3529 • bttp://wNvtv.agmd.gov
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Air Quality Permit Checklist
California State Law Code 65850.2 prohibits cities from issuing an occupancy permit without
clearance from the local air quality agency. This checklist will determine ifyou 'need to obtain
: '
clearance from the South Coast Air Quality Management District (AQMD).
Company Name:
Property Address:
1
City: '' �— pCode:
y' L�✓n�iac ��. elf Zip f
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Contact Person: ti FORDP 5 I^ P.LTSE Title: (OFF/ CE
Type of Business: 9nJ1 V LE S- - Telephone: 01 _ ;Y� 3 G 00
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Applicant (print name) ro(LREs1- gRz�SE Signature:
• Will the facility have any of the following equipment? YES[ ] NO
f
Charbroiler�
Dry Cleaning Machine
Spray Booth
Printing Press (screen/lithographic/flexographic)
Internal Combustion. Engine (greater than 50 BP (excluding motor vehicles)
Boiler/Combustion Equipment (greater than 2MM BTU/hr. maximum input)
w.
Abrasive Blasting Cabinets/Rooms
Baghouse/Cartridge-Type Dust Filter/Scrubber
Motor Fuel Storage & Dispensing Equipment
• Will any of the following operations be performed? YES[
Application of Paints and Adhesives
Etch!ng, Plating, Casting or Melting of Metals
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Plash Molding, Extruding or Curing
Mixing and Blending of Liquids and/or Powders
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Storage of Acids,Solvents, Org-anic Liquids or Fuels
Production of Fumes, Dust, Smoki- or St.ong Odors
t
If you answered "NO" to both questions, this checklist is your clearance from AQMD. If you
i
answered "YES" to either question, you must contact the AQMD to determine if air quality
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permits are required. If permits are needed, AQMD will 'assist you in submitting permit
application(s) and then provide you with a clearance letter. If you have any que:�tions, please call
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AQMD's Small Business Assistance office at (800)-CUT-SMOG, and press 41.
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