HomeMy WebLinkAbout15131 Triton Ln - CofO (99)> APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH
DEPARTMENT OF COMMUNITY DEVELOPMENT Al1
HUNTINGTON REACH (PRINT OR TYPE ONLY) DATE l
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Address l3l 'ICr� (t'E`�t LOB District
Business Name.— t �-- Tel
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�ll� Cpt�T�m Occ Group
Business Type BUSINESS OWNERIMANAGER
BUILDING OWNER'
Name R R�I✓F Name
q Home
Address It)jd S .�Ls S� - Address t iEr✓
E11 1 bF' .Home Tel. g�g`3>rt7
City A �� CA. 5Ri�tG Tel City -
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THIS USE WOULD BE DESCRIBED AS:
❑/NEWLY CONSTRUCTED BLDG ❑ CHANGE OF OWNER ❑ CHANGE OF OCCUPANT
l�l EXISTING BUILDING ❑ CHANGE OF USE ❑ ADDITIONAL OCCUPANT
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Indicate former use, if any —Or, upancy Gr._Div a
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805
SQUARE FT: OF BUILDING TO BE OCCUPIED 'I
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-(FOR OFFICE USE ONLY)
SUPPLEMENTAL WFORMATION
ZONING ;I
OCCUPANCY GROUP
—
PLAN CHECK. NO
PARKING SPACES !
OCCUPANT LOAD
-- PERMIT NO
HEALTH DEPT APPROVAL
NO. OF ST R S
ADMIN. ACTION
UTILITIES RELEASED —
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ti
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qq
t J CERTIFICATE OF OCCUPAN Y FEE
_
g_9- 5 f�
A PROVED Y
DA E CHANGE OF USE OR OCCU NCY FEE $
TOTAL
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75-039 Rev;1t/90
COMMUNITY DEVELOPMENT
SUPPLEMENTAL INFORMATION
I BUSINESS ADDRESS �� 131 �'121ZOi�i
2• Person to contact in case of emergency. `�`�� S
Telephone
number:
3• Does the building in question have electricity?
(a) If No, are you requestingQ
turned on? that the electricity tae
Yes
No
.Q Yes
Q No
4. The building is sprinklered?
5. Operations will produce gust/wood shavings or similar
material?
0 Yes ;
El No
Q Yes
6. Operations will involve the repair or
�No
automobile parts? replacement of
❑ Yes
M'No
If Yes:
(a) Describe the components repaired or replaced.
(b) Does the operation involve the use of
an open flame?
The business is drinking,El
dining
g
Yes
BNo
or assembly use that :will
result in an occupant load of more than 50
-
persons.
8.. The folio t describes my
El es
N0
CS ice O operation;
,,.
Retail Sales
rehoused
Manufacturing/ Distributions (describe
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p
process and end product)
Restaurant / Take Out Food
Medical / Dental
,
Other (describe)
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SUPPLIMENTAL INFORMATION
SUPPLEMENTAL. INFORMATION (Continued)
Does the operation involve any of -the following -
materials'?- 177 Yes
�'FJo
If Yes, indicate quantities:
Material. Quantity _
1.
Flammable liquids
Class i-
`Class I-B
Class I-C
2.
Cornbustible liquids
Class Il
Class ill -A
_ -
3.
Combination flammable liquids
4.
Flammable gases
5.
Liquefied Flammable gases
6.
Flammable fibers - loose
7.
r'lammable fibers - baled
}
8.
Flammable solids
9.
Unstable materials
10.-
Corrosive liquids
11.
Oxidizing material - gases
12,
Oxidizing material-- liquids
13.
Oxidizing material - solids
5
14,
Organic peroxides.
�
15.
Nitromethane (unstable materia!s)
16.
Ammonium nitrate
17.
Ammonium nitrate cc mound; mixtures
containing more than 0% nitrate
by weight
18.
Highly toxic material and
poisonous gas
x
19.
Smokeless Powder
20.
Black sporting powder
I
6
i hereby certify that the above information
is true and correct to
the best of my knowledge.
6
{
Signature
Date
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.i� City of Huntington each
2000 MAIN STREET CALIFORNIA 92648
' DEPARTMENT OF COMMUNITY DEVELOPMENT
Building 536-5241
Planning 536-5271
Housing 536-5271
i
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
j-
(AQMD). The Building Division must obtain a written release from
AQMD to show the applicant has complied with this law. The check
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
f`
the Building Division) must complete the check list which`
can be obtained either at the Building Division or at AQMD.
'
l
" 2. If all boxes in the list are checked "no", the Building
Y
Division can accept the check list as the release.
_ 3. If there are any "yes" answers in the list, the applicant
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
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
after applying for Building permits.
t
1 (1360D)
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Y
SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT
(Nonresidential Buildings Only)
Location of Subject Property:31 1i1%(`i�roS
PropeLty Owner Name:-firI� S Ph( ne # 14 6-CO
Name of the Person Preparing this farm in print and signature
.ems' i
Name: �NnL�i-- S:ignature:.
i
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 subjec} building. IE YOU DO NOT KNOW
THE ANSWER TO A QUESTION MARK IN THE -YES"' COLUMN:
AQMD PERMITTING CHECKLIST
YES NO
1. Does your facility use any internal combust..on
engines greater than 50-HP?
2. Does your facility involve mixing, bleiding, or
processing any solvents, adhesives, paints
or coatings? -- t
3. Does your facility create any dusts or smoke?
4. Does your facility refine any liquids or solids 1
or reclaim any metals? —
5. Does your facility platy or coat anything?
6. Does your facility have any combustion equipment V/
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?
E 8. Do you use or store any acids?
9. Do you use any chemical process? �- f
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 :he subject buildinglocated within one
thousand (1,000,) feet of any school?
PROPERTY LINE ,TO PROPERTY LINE. GRADES K-12
if you have marked "NO" in all columns, you do not need an Air
Quality permit at this time. If you have marked any questions in
the "YES Column you must contact the South Coast Air Quality
Management District located at:
21865 E. Copley drive
Diamond Bar, CA 91765-411.82
Please call: Plan Check (714) 396•-2000
(1360D-2)
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