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Home My WebLink AboutX2011-1483 - Misc4f IIUle U "ft 4045 CITY OF NEWPORT BEACH COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 3300 Newport Boulevard I P.O. Box 1768 I Newport Beach, CA 92658 www.newportbeachca.gov I (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 1-(0 e1r pSp Mailing Addfess g h NOa f (3r Nte---' Site Address (MA- I C45 Dr:Ve YES NO ❑ n Will your business activity generate Hazardous Waste in any quantity, in any physical form (solid, liquid, gas)? State e1- (� Telephone trf Zip (2.6C0 J_ 2.6 C 0 Zip (b4g2(e60 Contact Person grit q,Vi rain City City t fri 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. Will your business store, use or handle Carcinogens or Human Reproductive Toxins in any amount? 4. ❑ Q/ Will your business use an existing or install an Underground Storage Tank for Hazardous Substances or Hazardous Wastes? 5. Will your business store, use or handle Acutely Hazardous Materials? 6. ❑ �� 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? ❑ ILK' ❑ Er Briefly describe the nature of the business activity: . Printed Name of Respondent: Circle one: owner lessee geri tenant architect engineer I declare under penalty of perjury that to the best of my knowledge and belief the responses made herein are true and correct. /1 Sign2ftur of Responde —1`( — 20(( Date For NBFD-Fire Prevention Use Only Business Plan Required YES NO Reviewed By. ❑ ❑ Date: Plan Check No: 05/12/11 - - - Forms\Hazquest 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). Company Name: //a et �i /fa ce Property Address: 014-C- ✓fl-egts be,vc_ City: tt` e.A/ Qe. e.:i... Zip Code: C 11 q Z, l_�i�e 0. Contact Person: 94 1t�/� "eq L i ✓u -- Title: 5-A'vfr Atli j �GT -inea r py`� Type of Business: YSe Telephone: g lI 1 76 E(- t I t t (O t{ Fax Number: y/// 7 Co(-(-63 3 e-mail address: 6, ►1 es iy>,,,,, 7 (4r a5 was? , on Applicant (print name): t 4w. Loj9 2- Signature: cl Date: %— ,ay—. 7-0 1( • Will the facility have any of the following equipment? Yes ❑ No L� 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 n 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 Please print 3 copies 5K-Ai Worksheet for Building Combo Permit Application De -AP City of Newport Beach - Building Department r,Building r' Grading IDrainage CElec r',Meth Plum 1. Project Address (Not mailing address) 'One Hoag Drive, Building 44 Tenant Name(If Applicable)I.i4'Otd-le » t) Q.re-co crberuct4 c 2. Description of Work 'Tenant Improvement Exist House SF 91.134 Exist Gar SF r', Add Floor Suite No 2nd _._.... 200 # Unit (if Residential) r— Tged-ur= s cUre °"9ds1Office Ado�c� Ab(\nVA. v�x i �h\49asF Demo House SF Add/Reconstruct House SF 11.883 Demo Garage SF Add/Reconstruct Garage SF Alter rDemo TOTAL HOUSE SF -Par TOTAL GARAGE SF I Valuation $-80989— bS9, o-eo # Stories �/ t II -A 50-- Cu Yd Cut' Cu Yd Fill' Check ADorooriate Box for ADDlicant RI 3. Owner's Name Last (Hoag Hospital REFCO i First Owner's Address Owner's E mail Address 1500 Superior Avenue, Suite 300 City'Newport Beach i State CA Zip 92663 J Telephone'949-764-4486 r14. Archltect/DesignerName Last (s Wood � First l Rick i Lit. No. C15130 I Architect/Designer's Address Architect/Designees E-mail Address 11800 Quail Street, Suite 120 rick.wood@wbsarch.com City (Irvine State CA Zip (92660 Telephone(949-552-2061 r 5. Engineer's Name Last' First' Lic. No. Engineer's Address Engineer's E-mail Address I_.__ --- City' -_. '. State r , Zip Telephone) r,6.ContractorsName Last Contractor's Address Gl1(U.�I�rv�5`31A I1—ngLJe$� i Fiirstt'— t KYrnosilt Cor _. Lc.No.F'o7U7 ctor's E-mail Address Class 0(/13 ' (11, l z (toSn hsr--'°✓I ('j.tp✓C.�/✓_Q � 'I�J (Z W. i fWz5'C ✓ c City l�"1(iYA enfCA1-(_._- ! State Zip J / air? C-d/ Tar}1 '�%c(��.•7Z r�/`f OFFICE USE ONLY ENERGY P/C FEE $ 5, j I'`'•�-DC)Ji' 1�11�N><U11 X 24S Lt I I — Iton 63 I�� GRADING P/C FEE $ 1 I �Q l `/ C o I �PFLANN�CpHEEpCTK gN�O.. ��{ Rev 1/18/07 ELEC/MECH/PLUM P/C 75.c .' b5.?4 ,,j Ore "PL{N'CHECKFEE3"' 54 j , �rint For Please print 3 copies Worksheet for Building Combo Permit Application City of Newport Beach - Building Department 1g Building r' Grading fDralnage r1Elec r:Mech 1. Project Address (Not mailing address) XPlum 'One Hoag Drive, Building 44 Tenant Name(if Applicable) t-Ev W C, t.) 4) 2. Description of Work 'Tenant Improvement n p cijw Exist House SF 91.134 Demo House SF Exist Gar SF S, Floor 2nd Suite No 210 # Unit (If Residential) I—. i ste. Qc �e ---1-e-446vAt Add/Reconstruct House SF 7,883—' Demo Garage SF j, Add/Reconstruct Garage SF I Add r! Alter r Demo TOTAL HOUSE SF TOTAL GARAGE SF I Use 'Office Valuation $ 180, dt� I o®o r #Stores F Cu Yd Cut Cu Yd Filll Check Appropriate Box for ADDlicant r; 3. Owner's Name Last HHoag Hospital REFCO First' Owner's Address Owner's E mail Address '500 Superior Avenue, Suite 300 City 'Newport Beach State CA Zip 92663 I Telephonel949-764-4486 r 4. Architect/Designer's Architect/Designer's Name Last Address ' Wood -----_ First Architect/Designer's 'Rick E-mail Address Lic. No. C15130 ' 11800 Quail Street, Suite 120 'rick.wood@wbsarch.com City 'Irvine State CA Zip 192660 : Telephonel949-552-2061 r 5. Engineer's Engineer's Name Last) Address j First Engineer's I E-mail Address Lic No.I City' State � Zip Telephone' r 6. Contractor's Name Last I . First I 1 Lic. No. Class Contractor's Address Contractor's E-mail Address I_ City I....,_..___...... State � Zip �f Telephon IAI® OFFICE USE ONLY ENERGY P/C FEE $ 53 . �,1PERI�I��JQ. °011XZC� O GRADING P/C FEE $ PLAN c� r . r ,0 I I �Q " LO t )V. t Rev 1/18/07 ELEC/MECH/PLUM P/C 3% b 33 ? 3 Z7 , bG CreAOleNEWf a,•: SEACF�i. F% ',