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HomeMy WebLinkAbout19051 Brookhurst St - CofO (6)JJ HliNTINr,TON BEACH Business License # Business Address Business Owners N Business Name _ Business Type CERTIFICATE OF OCCUPANCY `�.Y`�� a 020 F C:t `1 CITY OF III7N'TINGTON BEACH — DEPT. OF PLANNING & BUIIA)JNC. APPLICATION 714/536-5241 A(U (3" Floor- Must Apply In -Person) Date _66_0,15,1613 Zip L Code ' �`L` Iephone Na .4T/ g Bus. Phone %/#-VI-f9 77 PropcM Owner Information (require r�) , Tenant/Emergency Contact (req 41redi' Nance ae Nanne 6) Address ' ®" Home Address City Q /3 State/Zip C,4 qj'-)CitV i! •9 eQ 1�=State/Zip Telephone No. 90 -f4`60 612 2 Telephone No. 33 7- f 0 3 THIS USE WOULD BE DESCRIBED AS: ❑ Newly Constructed Building or Existing Building CHECK ALL THAT APPLY: ❑ Change of property Owner Change of Occupant ❑Change of Use 7Additional Occupant Indicate farmer type of business Are you requesting that the electricity be tinned on? Yes ❑ No. Is the building sprinldered? Yes X , Nu b ® Will operations produce dust/wood shavings or similar material? Yes❑ Nok ® Will operations involve the repair or replacement of automobile darts Yes NoX If yes: Describe the components repaired or replaced. Does the operation involve the use of welding or open flame? Yes 7 No Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons? Yes XNe ❑ Will there be storage racks, gondolas, or shelving exceeding 5feet 9 inches in height? Yes ONo X The following best describes my operation: 0 Office Only Retail Sales ❑ Medical/Dental Warehouse /Manufacturing/Distribution klestaurant/Take Out Food (describe process and end product) Other (describe) For Q&ial Use ( ?UN ti p 0cc Group:- S Are Zr*occ Load: Occ Group: _ Area: Zi3S.2— Occ Load Occ Group: Area: Oce Load: Total Sq Ft Occupied:t '�j No. of Stories: �TIF Review:nY/ N Bldg. Permit # 3�)Entitlenient #: Zoning: Plnr Initials: Date: - Plan Chkr Initials: Date:�� Insp Initials: Date: Conditions of Approval or Other Notes: R/T:@G d e"9eS9G0ET:0l aM-96bTZ e08:WOJA 99:OT 2T02-90-Nlf Ora - 3so� South Coast Air Quality Management District 21865 Copley Drive, Diamond Bar, CA 91765-4182 (909) 396-3529 o 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 duality agency. This checklist will determine if you need to obtain clearance from the South Coast Air Quality Management District (AQMD). //J Company Name: Yvt �''�''�'� "` Property Address: ©� �� j�t1 C!� � STf ,f City: '"j -9 I aN , A44 zip Code: � 2 � `f 4 Contact Person: C :k-lat-c'o Title: Type of Business: a4tP&V-V(-- Telephone: qD`k 9/a— 7 S ; Fax Number: e-mail acddnass. _ Applicant (print name):t� Signature: Date:, / �� 13 ® Will the facility have any of the following equipment? Yes ❑ No IPf Charbroiler Dry cleaning machine Spray booth Printing press (screen/lithographic/flexographic) Intemal combustion engine greater than 50 HP (excluding motor vehicles) Boiler/combustion equipment (greater than 1 milIion 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❑ NOX 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 flumes, 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). ..2- �ZrZ:a6Fd 6bt796S9606T:01 LLeSt796bTL 888:WOJA 9S:OT ET02-90-N f