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HomeMy WebLinkAbout17011 Beach Blvd - CofO (275)IJ HUNTINGTON BEACH Business Addre: CERTIFICATE OF OCCUPANCY 020 44 a O CITY OF HUNTINGTON BEACH DEPARTMENT OF COMMUNITY DEVELOPMENT APPLICATION I1t)it Business Owners Name Business Name Business Type (3rd Floor - The Applicant Must Apply In -Person) Date 1� s- pl4 Zip Code L z(o Telephone No. 71q''?O((- Bus. Phone Property Owner Info mation required)�j� Te nt/Emer enc Contact (required) Name Name c� Address blvif. wud Home Address City State/Zip City State/Zip C46r q d�,S- Telephone N t n 1 3 6 O 6 Telephone No. '114 " 61D V -06 V THIS USE WOULD BE DESCRIBED AS: ❑ Newly Constructed Building or % Existing Building IS THIS BUILDING FIRE SPRINKLERED?] Yes ❑ No CHECK ALL THAT APPLY: ❑ Change of Business Owner [:]Change of Occupant ❑ Change of Use VAdditional Occupant • Indicate former type of business • Are you requesting that the electricity be turned on? ❑Yes 3No • Will operations produce dust/wood shavings or similar material? ❑ Yes Elf1 o • Will operations involve the repair or replacement of automobile parts? ❑Yes kNo If yes: Describe the components repaired or replaced. • Does the operation involve the use of welding or open flame? ❑ Yes EhNo • Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons? ❑ Yes N, No • Will there be storage racks, gondolas, or shelving exceeding 5 feet 9 inches in height? ❑Yes a 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 Flo 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 PNo Grease Interceptor Verified Inspected By Initials: Date: For Official Use On/y Occ Group: Area: Occ Load: Occ Group: Area: Occ Load: Occ Group: Area: Occ Load: Total Sq Ft Occupied: No. of Stories: TIF Rev w: Y/ N Bldg. Permit # Entitlement #: Zoning: Use Permitted: Y / N Parking ets Code (for use): Y / N Planning Initial V Date: Building Reviewed By Initials: Date: Conditions of Approval or Other Notes: 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 A dress City: Contact Person: Type of Business: �.vcl za t4 . (,6-,VK Zip Code: j 2 G Title: fJ Telephone: Fax Number: / / \E-mail Address: i Applicant (print name): 5�r ���-U Signature: W���-7I%1 En Date: 1. Will the facility release air pollutants, including but pot limited to, dust fumes, gas, mist, odors, smoke, vapor, or a combination of these to the atmosphere? ❑Yes VNo 2. Will the facility result of fuel -burning equipment including, but not limited to, boilers, generators, and internal combustion engines? ❑Yes [�No 3. Will the facility result of hazardous materi s, including but not limited to, chemical, plastics, rubber, resins, solvents, paints, and other parts cleaners? ❑Yes o 4. Will the facility have use of above or underground storage tank? ❑Yes NAo 5. Will the facility consist of manufacturing, fabrications, finishing, or treatment of wood, metal or plastic products? ❑Yes PNo 6. Will the facility result in the use of the equipment listed below? ❑Yes XNo (Select all that apply) ❑Abrasive Blasting Cabinet/Room ❑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 ❑Internal Combustion Engine (rated > 50 bhp; e.g. back-up generator) ❑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 ❑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). ©12 -"11? limo r j lt` a 5 ..5 a �v `� art. , P_. 0 APPLICATION FOR CERTIFICATE OF OC�CUPAYVCY CITY OF HUNTINGTON BEACH - DEPARTMENT OF 13UILDING & Sik ETY (3"' Floor — Must Av ? y In -Person) Business Licen A ddress`� Business Name Business Type Date Telephon(q ct.Inforniation Business Owner NamC Name Address UM Home Address alMA" 06 i City l� 4.4 TeA qhity Mib Tel.26 THIS USE WOliLD BE DESCRIBED AS:�� QNewly Constructed Building or " lJEsisting Buildtn, CHECK ALL THAT APPLY: y j QChange of Owner range of Occupant ❑Change of Use F-JA.dditional. Occupant Indicate former use, .if any Does the building have electricity? Ye"-� No0 If Na, are you requesting that the elect' it be ned on? Yes No The building is sprinl:lered.? Yes V No❑ Operations will product dust/wood shavings or similar material? Yes 0 No lJd� Operations will involve the repair or replacement of automobile parts Yes U : No.2 If yes: Describe the components repaired or replaced. Does the operation involve the use .of welding or open flange? Yes ❑ No The business is drinking, dining .or assembly use that that will result in an occupant load of more tliin 50 persons. Yes O No tfI The following best,describes my operation: L-Kffice Oizly ❑Retail.Sales plvledical/Dental ❑Restaurant/Take Out Food. UWarehouse ❑Ivlanuf eturing/Distribution (describe process and end product) 0 Other (describe) I. - ._ _ O fficeUse. o1,ly: Sd Ft Occupied:0� Occ Group: Occ Load:s: Parking Spaces: TIF Review: Y/ N Amt Paid . PdidrlCFORGFinal Inspection g Permit # + l Entitlement #r nts: p` ei 46, �-"� ! Initial: __-- Bldg/Plan Checker Initials:. CofO 4