HomeMy WebLinkAbout17421 Nichols Ln - CofO (34)J�
HUNTINGTON BEACH
Business
Business
Business
Business Type QYY
CERTIFICATE OF OCCUPANCY 020
CITY OF HUNTINGTON BEACH
DEPARTMENT OF COMMUNITY DEVELOPMENT APPLICATION
(3rd Floor — The Applicant Must Apply In -Person)
Date I t 11411b
Tr
Zip Code
Telephone No. "lt' r� U 5" W19I
�1 01n�F� Bus. Phone -U':A' �1^`:'�—1 l
Property Owner Information (required) Tenant/Emergency Contact (required)
Name_- Rol.�V��IES'TN. N"T5 Name(
Address kS\ A'We (1 1�K `� Hom''eII Address Ub7 U
CityNin5'A 14—sp, State/Zip CA q2LQ(o CityJQVI� CAState/Zip
Telephone No.�I L� • (DL �- ti3D Telephone No. oksA _` 1Ws- 47�
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or X Existing Building
IS THIS BUILDING FIRE SPRINKLERED? 'Yes ❑ No
CHECK ALL THAT APPLY:
❑ Change of Business Owner ❑ Change of Occupant 59 Change of Use ❑ Additional Occupant
• Indicate former type of business
• Are you requesting that the electricity be turned on? ❑Yes jtgNo
• Will operations produce dust/wood shavings or similar material? ❑ Yes *No
• Will operations involve the repair or replacement of automobile parts? ❑Yes -j2No 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 'L No
• Will there be storage racks, gondolas, or shelving exceeding 5 feet 9 inches in height? Yes 'N
• The following best describes my operation: ❑ Office Only El Retail Sales` ElMedica ental
';J4Warehouse/Manufacturing/Distribution ❑ Restaurant/Take-Out Food ❑ Other
• Will any meat products including beef, poultry, and/or fish be cooked or fried onsite? ❑ Yes N�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 'gNo
Grease Interceptor Verified
For Official Use Only ,�
Occ Group:
Occ Group:
Occ Group:
Total Sq Ft Occupied:
Bldg. Permit #
Planning Initials: Date:
Inspected By Initials:
Area: (11,900
Area: Gat)
Area:
No. of Stories:
Entitlement #:
Use Permitted: Y / N
Date:
Occ Load:
Occ Load: 2
Occ Load:
TIF Revie Y/ N
Zoning:
Parking Meetl Code (for use): Y / N
Building Reviewed By Initials: Date: � 16
Conditions of Approval or Other Notes: Vy ML*TTy Vim LlW_1 AIL `7
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: ` l �/ d1 T-
City: 1 ; A h `. Zip Code:
Contact Person:c+. V-\S a �. � ILI-- Title: 6A�'✓t
Type of Bus iness:('�M_� %NilTelephone:
Fax Number: E-mail Address:
Applicant (print name):( fk1 _ t1 o"\M�+.LSignature: Date: l
1. Will the facility release air pollutants, including but not limited to, dust fumes, gas, mist, odors, smoke, vapor, or a
combination of these to the atmosphere? ❑Yes $No
2. Will the facility result of fuel -burning equipment including, but not limited to, boilers, generators, and internal combustion
engines? ❑Yes ''[21No
3. Will the facility result of hazardous materials, including but not limited to, chemical, plastics, rubber, resins, solvents,
paints, and other parts cleaners? ❑Yes gNo
4. Will the facility have use of above or underground storage tank? ❑Yes O.No
5. Will the facility consist of manufacturing, fabrications, finishing, or treatment of wood, metal or plastic products? ❑Yes EjNo
6. Will the facility result in the use of the equipment listed below? ❑Yes tWNo
(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/N utraceutical
❑Plasma/Laser Cutter
❑ Printing/Coating/Drying
❑ Production of Fumes/Dust/Smoke/Odors
❑Coffee Roaster/Afterbunner ❑ Ref rigeration 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).
, Department of Planning & Building
2000 Main Street
Huntington Beach, CA 92648
Phone: (714) 536-5241 Fax: (714) 374-1647
CERTIFICATE OF OCCUPANCY
RANDALL E PALLESEN
PERSONAL OFFICE AND WAREHOUSE
STORAGE
17421 NICHOLS LN STE D
HUNTINGTON BEACH CA 92647
Cert. Number CO2016-005642
Date Printed 11/15/2018
Address:
17421 Nichols Ln D
Issue Date: 07/28/2016
Permit Number:
02016-005642
TCofO Issue Date:
Business Name:
TCofO Expiration:
Business Type:
Approved Sq Ft.: 1,200.00
Current Use:
OFFICE AND STORAGE
# of Stories: 1
Occupant Groups:
Description: Area:
I I Occupant Load:
B
600
6
S-1
600
6
nditions of Approval: 771
Contacts:
Contact Type:
Name:
RANDALL E PALLESEN
Phone:
(657) 289-8038
Business Owner
Address:
17421 NICHOLS LN STE D
Cell:
( ) -
City / State:
HUNTINGTON BEACH CA
Fax:
( )
Zip:
92647
Pager:
( )
Contact Type:
Name:
FROME DEV OMEGA LLC
Phone:
(000) 000-0000
Property Owner
Address:
151 KALMUS DRIVE STE F-2
Cell:
( ) -
City / State:
COSTA MESA CA
Fax:
( ) -
Zip:
92626
Pager:
( ) -