The URL can be used to link to this page

Home My WebLink About16872 Bolsa Chica St - CofO (44)Y • HUNTINGTON BEACH CERTIFICATE OF OCCUPANCY 020- ' CITY OF HUNTINGTON BEACH DEPARTMENT OF COMMUNITY DEVELOPMENT APPLICATION (3rd Floor — The Applicant Must Apply In -Person) Q ;.,_ AAA h o V 7.2 901 5 A r / ` 1 Clt. �� 20 1 Date ' I' a_-_'_ 1_E Business Owners/Name hl E + 3,5A Go me Z- Zip Code ge:ltg� Business Name Qr r, CGzYI l�t� G icier a�12a�,e�5 Telephone No. S&ZSq3 Business Type TR Ai G� Bus. Phone Jed �� 1 �% 5�� Property Owner Information (required) Tenant/Emergency Contact (required) Name Name M 91155A 60ry7 0 Z Addreffss f Home Address j_ )D �`�s" r` �'r'l Cit�t'�ll> iQ'� �3Cac�. State/Zip C,Ltl�,� City /�6�.�' - State/Zip C4 'JD_7V-o Telephone No. ( q S 4 (P Telephone No. SPwx THIS USE WOULD BE DESCRIBED AS: �� El Newly Constructed Building or / [D Existing Building IS THIS BUILDING FIRE SPRINKLERED? LJ Yes ❑ No CHECK ALL THAT APPLY: Change of Business Owner ❑Change of Occup o ❑ Change of Use ❑ Additional Occupant • Indicate former type of business G �G.�k is • Are you requesting that the electricity be turned on? ❑Yes VNo • Will operations produce dust/wood shavings or similar material? ❑ Yes MNo / • Will operations involve the repair or replacement of automobile parts? ❑Yes �4 If yes: Describe the components repaired or replaced. • Does the operation involve the use of welding or open flame? ❑ Yes No • Will the business be a drinking, dining or assembly use with an occupant load of more than 50 perso s? ❑ Yes Lio • Will there be storage racks, gondolas, or shelving exceeding 5 feet 9 inches in height? ❑Yes ❑INO • The following best describes my operation: IVOffice Only ❑ Retail Sales ❑ Medical/Dental ❑ Warehouse/Manufacturing/Distribution ❑ Restaurant/Take-Out Food ❑ Other • Will any meat products including beef, poultry, and/or fish be cooked or fried onsite? ❑ Yes ID o If you answered yes, please proceed to the next question. • Does your facility currently have a grease control device (i.e. grease trap or grease interceptor)? Check one: ❑ Yes VMo Grease Interceptor Verified For Official Use Only Occ Group: Occ Group: Occ Group: Total Sq Ft Occupied: Bldg. Permit # Inspected By Initials: Date: Planning Initials:-J�,L Date: ll 21( t) Area: Area: Area: No. of Stories: Entitlement #: Use Permitted: Y / N Occ Load: Occ Load: Occ Load: TIF Review- X Zoning: Parking Meets Code (for use): Y / N Building Reviewed By Initials: Date: Conditions of Approval or Other Notes: l - L u �h2 — No C ` fl , 0 r South Coast ;�L Air Quality Management District 21865 Copley Drive, Diamond Bar, CA 91765-4182 10NOW , _dt_� Phone Number (909) 396-3529 http://www.agmd.gov Air Quality Permit Checklist California State Law Code 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 me"). 1(>6 B gok&_r.S Property Address: I LP)S I oL 0U( -'>A L4AA,6e, _NT _ 41" / City: 44(,t,*ytA 4n, &At� Zip Code: Contact Person: m E 1156A &M Title: I) IOI►.& Type of Business]?id ra 4&+C C-Rtu Telephone: SII J- `` S"115D� Fax Number: i jsyq- E-mail Address:if Applicant (print name): N) E 1 i % A 6y D P4 0 Z Signature: Date: 1. Will the facility release air pollutants, including but ngt limited to, dust fumes, gas, mist, odors, smoke, vapor, or a combination of these to the atmosphere? ❑Yes o 2. Will the facility resu -of fuel -burning equipment including, but not limited to, boilers, generators, and internal combustion engines? ❑Yes o 3. Will the facility result of hazardous materials cluding but not limited to, chemical, plastics, rubber, resins, solvents, paints, and other parts cleaners? ❑Yes LWO 4. Will the facility have use of above or underground storage tank? ❑Yes [j to 5. Will the facility consist of manufacturing, fabrications, finishing, or treatment of wood, metal or plastic products? ❑Yes [LNK 6. Will the facility result in the use of the equipment listed below? ❑Yes P<O- (Select all that apply) ❑Abrasive Blasting Cabinet/Room ❑Internal Combustion Engine (rated > 50 bhp; e.g. back-up generator) ❑Air Conditioning System (containing > 50 Ibs of refrigerant) ❑Application of Paints/Adhesive/Resins ❑Baghouse/Dust Collector ❑Bakery Oven (gas fired) ❑Boiler/Water Heater (max. heat input = or > 1 million BTU/hr) ❑Charbroiler/Smoker ❑Coffee Roaster/Afterbunner ❑Mixing/Blending of Liquids and/or Powders ❑Molding /Extruding/Curing of Plastic ❑ Pharm ace utical/Nutraceutical ❑Plasma/Laser Cutter ❑ Printing/Coating/Drying ❑ Production of Fumes/Dust/Smoke/Odors ❑Refrigeration Systems (containing > 50 Ibs of refrigeration ❑Deep Fryer (excluding equipment located at eating establishment) ❑Soldering Oven ❑Dry Cleaning Equipment ❑Spray Booth ❑Electrostatic Precipitator ❑Storage of Acids/Solvents/Organics Liquids/Fuels ❑Fermentation ❑Gasoline Storage & Dispensing Equipment ❑Storage Silos (sugar, flour, etc.) If you answered "No" to any of the above questions and your facility will not have the following equipment listed, 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). Business License # Business Address_ Business Owners l` Business Name Business Type. Certificate of Occupancy No. 020io APPLICATION FOR CERTIFICATE OF OCCUPANCY CITY OF HUNTINGTON BEACH - DEPT. OF BUILDING & SAFETY --� (3" Floor — Must Apply In -Person) Nam Hom City Tele Date e12 Z (6'9' Zip Code Telephone No. � _ 66 Bus. Phone THIS USE WOULD BE DESCRIBED AS: ❑ Newly Constructed Building or 4 ''Existing Building CHECK ALL THAT APPLY: ❑ Change of Property Owner -fflChange of Occupant ❑ Change of Use ❑ Additional Occupant ■ Indicate former type of business ,y,� ■ Are you requesting that the electric be to ed on? YesON9K 1 Is the building sprinklered? Yes QN ■ Will operations produce dust/wood shavings or similar material? Yes4Ngs` ■ Will operations involve the repair or replacement of automobile parts Yes ON%- If yes: Describe the components repaired or replaced. ■ Does the operation involve the use of welding or open flame? Yes DNo ee ■ Will the bus* ess be a drinking, dining or assembly use with an occupant load of more than 50 persons? Yes ON p- ■ The following best describes my operation: Office Only ❑ Retail Sales -,S*edical/Dental ❑ Restaurant/Take Out Food ❑ Wareho�se /Manufacturing/Distribution (describe process and end product) ❑ Other (describe) For Official Use Only Occ Group: Occ Group: Occ Group: Total Sq Ft Occupied: Bldg. Permit # Area: Area: Area: No. of Stories: Entitlement M Occ Load: Occ Load Occ Load: TIF Review: Y/ Zoning: C-Gc- Plnr Initials: &6rt' Date: 0 Z2 0cl Plan Chkr Initials: Date: Insp Initials: Date: Conditions of Approval or Other Notes: (�fftcc —'Co— of -VI Cie ` n!D G. vy 0. qt�&�V Inspection Date: (G:Building/Forms/document id goes here)