Loading...
HomeMy WebLinkAbout15131 Triton Ln - CofO (75)1 1 SUPPLEMENTAL INFORMATION 1. BUSINESS ADDRESS /3! �i7 0,,r t �. a Person to contact in case of emergency - Telephone number: iy 6 3. Does the building in question have electricity? Yes Q No (a) If No, are you requesting that the electricity be ❑ Yes, l turned on? No 4. The building is sprinklered? Yes 41 El No 5. Operationswill produce dust/wood shavings or similar _ { material? El Yes No 6. Operations will involve the repair or replacement of ❑Yes ; automobile' parts?o 1 r If Yes: l; (a) Describe the components repaired or replaced. (b) Does the operation involve the use of an open flame? ❑ Yes , No 7. The business is drinking, dining or assembly use that will a result in an occupant load of more than 50 persons. ❑Yes No r 8. The following best describes my operation; Office Only Retail Sales Warehouse Manufacturing ! Distribution (describe, process and end product) ('AODUC- D0610 uk'��rl � Sell r, n, t- n hu 1Id�Ig `. s , Restau. ant / Take Out Food' Medical / Dental Other (describe) `I SUPPUMENTALINFORMATION.,,_,....,,... : 1 a k i, t. SUPPLEMENTAL INFORMATION (Continued) Does the operation involve any of the following materials? Yes No If Yes, indicate quantities; _ Material Quantity 1. Flammable liquids Class I -A Class I-B Class I-C i 2. Combustible liquids r 1 Class II Class 111-A 3. Combination flammable liquids ► 4. Flammable gases 5. Liquefied flammable gases 6. Flammable fibers - loose 7. Flammable fibers - baled ��. Flammable solids 9. Unstable materials 10. Corrosive liquids 11. Oxidizing material - gases 12. Oxidizing material: - liquids 13. Oxidizing material - solids 14. Organic peroxides ti 15. _Nitromethane (unstable materials) i 16. Ammonium nitrate" 17. Ammonium nitrate compound- mixtures containing more than 60% nitrate by weight 18. Highly toxic material and - poisonous gas 3 19. Smokeless powder 20. Black sporting powder r ;, tI hereby certify that the above information is true the best of my knowledge. and correct to S 'ture Date r i h r t: T South Coast I. . Alit QUALITY MANAGEMENT DISTRICT 9150 FLAIR DRIVE. EL MONTE, CA 91731 (818) 572-6200 Assembly Bill 3205 requires the Building Departments not to the � issue the final certificate of occupancy unless is meeting the requirements of the ► applicant has met or District. The Building Department must obtain a written has release from the District to show the applicant complied attached check list is designed to help with this law. The the buildng'departme:nts to meet these 5 the applicant and requirements. 1. The applicant ( the same person applies permits from the fill the check list which can Buildin De artment) must either at the Building Department or at the be obtained District. 2. If all boxes in the list are checked"no", the ease. g list as the release. Department can accept the check 3. If there are any "yes" answers in the list, the engineer by calling applicant must contact a District (818-572 6406, 818-572 6111, 818-572 6261 ) to find out whether air permits are required for the proposed construction project. 4. If air permits are not required, the applicant will the District engineer. obtain a written release from It k, '. 5. If air permits are required, the applicant must 'submit the necessary permit applications before the release can is be issued. A sample copy of the release attached. Because of the time it may take for the District engineer to is to go through above procedures, the applicant advised immediately after applying for Building contact the District p `. permits. 4 my,l/al AB3205Ib T f i d ,i 1 `' i —..r—�.,7•--.�-�--.—. — � — — — art w--T —:.-m'�. � - q yy _., 1 Z (Y p I' f a: RETURN TO Tyu• HUN TINGTON BEACH, P.O. Box 190, HE PLANNING DIVISION, CITY O' 2000 Main Street, Huntington Beach, CA 92648 a SOUTH COAST AIR QUALIT: MANAGEMENT. DISTRICT (Nonresidential Buildings Only) t Location of Subject property: 51 77z1rP Phone #_7�/ Property Owner name: ,��✓©s 35� �i�6Y Name of the Person Preparingthis form in print and signature Name Signatur ; The person preparing this form must be the same persona plying for $ building permits. Please answer the followincg questions regarding your Y proposedoccupancyof the subject building. IF YOU Do IJOT KNOW THE ANSWER TO A QUESTION MARK IN THE "YES" COLUMN: SCAQMD PERMITTING CHECKLIST YES NO 1. Does your facility use any internal combustion FIZI engines greater than 50-FIP? 2: Does your facility involve mixing, blending, or processing any solvents, adhesives, paints or coatings? 3. Does your facility create any dusts or smoke? 4. Does your facility refine any liquids or solids? i Reclaim any metals?� 5. Does your facility plate or coat anything? 6. Does your facility have any combustion equipment i.e. boiler, furnaces, broiler, baking ovens, etc.), T� j rated greater than 2,000,000 BTU/HFt? 7. Does your facility handle or store solvents5 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? f 11. Are you a ry cleaner, restaurant with a charbroiler, a 1 body shop, gasoline station, printer, or part water? d M 12. Isth i '=� subject building located within one thousand I (1,000) feet of any school? PROPERTY LINE TO PROPERTY LINE. GRADES' K-12. It you have marked "NO" in all columns, you do not need an Air Quality permit at this time. If you have marked any questans'n the "YES" Column YOU must contact the South Coast Air Quality Management District located �t: 9150 FLAIR DRIVE, EL MONTE, CA 91731 818 572-6406 F�lease call these offices: Plan Check ( ) (818) 572.-6111, ,(818) 572-6261 ; s 1):AL00603 7 i