HomeMy WebLinkAbout5075 Warner Ave - CofO (20)N
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HUNTINGTON BEACH
Business Address
Business Owners
CERTIFICATE OF OCCUPANCY 020 tS - 3
CITY OF HUNTINGTON BEACH
DEPARTMENT OF COMMUNITY DEVELOPMENT APPLICATION
Business Name Off. C y 1/U!//� s rI Cc..► 0 r-tJ
Business Type -v &-y-we-r -
(3rd Floor - The Applicant Must Apply In -Person)
Date //- /g - If
Zip Code rj 2C V-q
Telephone No.1/1f Mr
Bus. Phone 91-1
Property Owner Information (required) Tenant/Emergency Contact (required)
Name / rI e! L C Name 41,11"
Address S Home Address /(_ 3fs1 171.4ut ,- C4
City Cam" & C ZA State/Zip CA 6 2L7 5 City /-1-6 State/Zip C 0
Telephone No.:zty) G/ j - Telephone No. % /%3 i33
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or Existing Building
IS THIS BUILDING FIRE SPRINKLERED? ❑ Yes MN o
CHECK ALL THAT APPLY:
❑ Change of Business Owner p Change of Occupant ❑ Change of Use ❑ Additional Occupant
• Indicate former type of business 4 f/C_
• Are you requesting that the electricity be turned on? ❑Yes PiNo
• Will operations produce dust/wood shavings or similar material? ❑ Yes XNo
• Will operations involve the repair or replacement of automobile parts? ❑Yes P6o 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 persons? ❑ Yes j No
• Will there be storage racks, gondolas, or shelving exceeding 5 feet 9 inches in height? ❑Yes ❑ No
• The following best describes my operation: ,.Office 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 No
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 M1 o
Grease Interceptor Verified Inspected By Initials: Date:
For Official Use On/y
Occ Group:
Occ Group:
Occ Group:
Total Sq Ft Occupied:
Bldg. Permit #
Planning Initialsc_Date:iI$
Occ Load: 0'
Occ Load:
Occ Load:
TIF Revie Y N
Zoning:
Use Permitted: Y / N Parking Meets Cbde (for use): Y / N
Building Reviewed By Initials: ---'-'---Date: I f ) co 16
Area: Q
Area:
Area:
No. of Stories: )
Entitlement #:
Conditions of Approval or Other Notes: `)T" KT--A GY1&64 U—'MA UY I w,x
r
South Coast
Air Quality Management District
21865 Copley Drive, Diamond Bar, CA 91765-4182
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:
Property Address: S6 7 C- W l.Jar .4,
City: /-� Zip Code: 5 ?z qT
Contact Person: a_ 617 Title: ._
Type of Business: /01-tu/cTC_ .�iitJ,�1� yea � Telephone: we 1 9w �-ag
Fax Number: E-mail Address: u Lf7 anatr
Applicant (print name): %� Signatu Date://
1. Will the facility release air pollutants, including but not limited to, dust fumes, gas, mist,_016ors, smoke, vapor, or a
combination of these to the atmosphere? ❑Yes XjNo
2. Will the facility result of fuel -burning equipment including, but not limited to, boilers, generators, and internal combustion
engines? ❑Yes �41\10
3. Will the facility result of hazardous materials, including but not limited to, chemical, plastics, rubber, resins, solvents,
paints, and other parts cleaners? ❑Yes KNo
4. Will the facility have use of above or underground storage tank? ❑Yes KNo
5. Will the facility consist of manufacturing, fabrications, finishing, or treatment of wood, metal or plastic products? ❑Yes19No
6. Will the facility result in the use of the equipment listed below? ❑Yes e 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
❑Mixing/Blending of Liquids and/or Powders
❑Molding /Extruding/Curing of Plastic
❑ Pharmaceutical/Nutraceutical
❑Plasma/Laser Cutter
❑ Printing/Coating/Drying
❑ Production of Fumes/Dust/Smoke/Odors
❑Coffee Roaster/Afterbunner ❑Refrigeration Systems (containing > 50 Ibs of refrigeration
❑Deep Fryer (excluding equipment located at eating establishment) ❑Soldering Oven
❑Dry Cleaning Equipment
❑Electrostatic Precipitator
❑Fermentation
❑Gasoline Storage & Dispensing Equipment
❑Spray Booth
❑Storage of Acids/Solvents/Organics Liquids/Fuels
❑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).