HomeMy WebLinkAboutX2011-0730 - MiscGRADING P/C FEE $
wilding FT
42:q-ii-12,Dis
for Building Combo Permit pplication
of Newport Beach - Building Departm nt
el
Grading I —Drainage
1. Project Address (Not mailing address)
X Elec
Mech
cAJ- Da--- 6-0(z> • 117
I?g
Tenant Name(if Applicable) j
„. in I
"De_ liarvior-r"5t0 sP. ofeto
2. Description of Work
Extg Building SF
Extg Gar sf
Demo Building SF I
Demo Garage sf
fl New r— Add Alter r Demo
Check Appropriate Box for Applicant
Add/Reconstruct Bldg SF
Add/Reconstruct Garage sf
TOTAL BLDG SF
TOTAL GARAGE SF
b.%
Floor
I LI
# Units (if Residential)
15(oorsR
Suite No
ZITS
Valuation $ 14-9-e-crtrert.,
ta4 ce+o
stc. # Stories
Cu Yd Cut
Cu Yd Fill
I 3
3. Owner's Name
Owner's Address
Last
City
State
Zi
First I
Owner's E-mail Address
Telephone'
41 5.44 kr Ack-ut Lic. No.'
. Architect/Designer's Name Last First CI Ce)c. ef..3
Architect/Designer's Address Architect/Designer's E mail Address
e
ficene c-LA-,R 0<-- 2 1c.) Or.SC-ac&_)A-
CyJjt State Zip tikoka_ Telephonel ft:51 Co 1
fl 5. Engineer's Name Last I
Engineer's Address
City
State Zip
First
Engineer's E-mail Address
Lic. No.
Telephone'
r- 6. Contractor's Name Last
Contractor's Address
Obt\--6- tin c, •
I to 1 961\tateA "A
Cityj N. 6.
*AID CA
-2.0 MAR 2 5 ap
OFFiCE USE ONLY ENERGY P/C FEE $
Tv OF NE
Rev 4/16/09 ELEC/MECH/PLUM P/C FEE $
First
Lic. No.
Contractor's E-mail Address
63701
Class' 131
DP I 12-66 3
Telephone
`). 173 .047
PERMIT NO
PLAN CHECK NO.
PLAN CHECK FEE $
0--r3v
ft-L(1/44 .-761 t
(5E- 3-2 7
CITY OF NEWPORT BEACH
BUILDING DEPARTMENT
3300 NEWPORT BLVD.
P.O.BOX 1768, NEWPORT BEACH, CA 92658
(949) 644-3275
HAZARDOUS MATERIALS QUESTIONNAIRE
If the answer to any of the questions below is yes, applicant must contact the Fire Prevention Office, 3300
Newport Boulevard, P.O. Box 1768, Newport Beach, CA 92658-8915. Telephone: (949) 644-3106.
Business Name Contact Per o a Telep ne
Ore U0 j (Air ► mot' V151-(0 L
Mailing Address City State Zip
O V61 \ --i-, ter.... EL06 ` ± 'aCT: C'P-CA--\ Qx--
Site Address City Zip
t--Ob A- #1% h)"12C06 0
YES NO
1. ❑lig Will your business activity generate Hazardous Waste in any quantity, in any physical
form (solid, liquid, gas)?
2, 0 Will your business at any one time store, use or handle Hazardous Substances in
quantities
equal to or greater than 55 gallons, 500 pounds or 200 cubic feet of compressed gas?
3. 0 tZ1 Will your business store, use or handle Carcinogens or Human Reproductive Toxins in
any amount?
4. ❑ 4 Will your business use an existing or install an Underground Storage Tank for
Hazardous Substances or Hazardous Wastes?
5. ❑ {4 Will your business store, use or handle Acutely Hazardous Materials?
6. ❑ [A If your business will be handling Acutely Hazardous Materials, will your business be
located within 1,000 feet from the outer boundary of a school?
Briefly describe the nature of the business activity: meta
Printe Name of Respondent:
owner lessee agent
tit -QE'"--- tenant architect engineer
I declare under p
and correct.
Signature of Responden
to the best of my knowledge and belief the responses made herein are true
Date
South Coast
Air Quality Management District
21865 Copley Drive, Diamond Bar, CA 91765-4182
(909) 396-3529 • http:// www.aqmd.gov
Air Quality Permit Checklist
California Government Code Section 65850.2 prohibits cities from issuing an occupancy permit
to a business without clearance from the local air quality agency. This Checklist will determine
if you need to obtain clearance from the South Coast Air Quality Management District (AQMD).
`Le
Company Name: t— ,
Property Address: �— L4DPti , Q " f1.JC^ / (z D LJ
City: elS:liS6-'1} Zip Code: (1)2- Ca Ci
_ $C Contact Person: C�� ��,.�-..J Title: p n
Type of Business: .C' a\1 Telephone: 1� c\ a Wi L � � C1
Fax Number e-mail address:051E!(
Applicant (print name): Ski iA ;t) Signature: oT 2t3R.. b
Date: 3I 0 41
• Will the facility have any of the following equipment? Yes ❑ No
Charbroiler
Dry cleaning machine
Spray booth
Printing press (screen/lithographic/flexographic)
Internal combustion engine greater than 50 HP (excluding motor vehicles)
Boiler/combustion equipment (greater than I million BTU/hr. maximum input)
Abrasive blasting cabinet/room
Baghouse/cartridge-type dust filter/scrubber
Motor fuel storage and dispensing equipment
• Will any of the following operations be performed? Yes ❑ No
Application of paints or adhesives ' \
Etching, plating, casting, or melting of metals
Molding, extruding, or curing of plastics
Mixing and blending of liquids and/or powders
Storage of acids, solvents, organic liquids, or fuels
Production of fumes, dust, smoke, or strong odors
If you answered "No" to both questions, this checklist is your clearance from AQMD. If
you answered "Yes" to either question, you must contact AQMD to determine if air quality
permits are required. If permits are needed, AQMD will assist you in submitting permit
application(s) and then provide you with a clearance letter. You can call AQMD at their Small
Business Assistance Office at 1-800-CUT-SMOG (1-800-288-7664).
Revised November 2006