HomeMy WebLinkAbout180 5th St - CofO (7)f ,
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HUNTINGTON BEACH
F319 - 1513
CERTIFICATE OF OCCUPANCY 0 -
CITY OF HUNTINGTON BEACH
DEPARTMENT OF COMMUNITY DEVELOPMENT APPLICATION
(3rd Floor - The Applicant Must Apply In -Person)
Business Address /80 5-* SST i! /ea Date 6 - f S - & ► 8
Business Owners Name 16,9A xtLOA) Zip Code 72-&K0�
Business Name F45- G/%NeSS Telephone No. '917- SvY- y779'
Business Type n-I FiTNncr Bus. Phone 9S'8- Z5P -/Bao
Property Owner Information (required) Tenant/Emergency Contact (required)
Name 4 J"Tz-�r PAt2ryE-,Ls A,4,PRcr srng Name /a, SGo.U;t
Address /rs' S-� Sm,"i— 10o Home Address J19S6/ Agn,p,��2
City �� 4. State/Zip C,, 92-6c/g CityAjd6u 4„ &-,-L State/Zip CA-
Telephone No. �� y 37 y - 3a/ Telephone No. 9/ 7- 36Y - -/77
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or T5Existing Building
IS THIS BUILDING FIRE SPRINKLERED? 59Yes ❑ No
CHECK ALL THAT APPLY:
❑ Change of Business Owner g!�Change of Occupant 0 Change of Use ❑ Additional Occupant
• Indicate former type of business -'6P -/-,.v 6 S772C
• Are you requesting that the electricity be turned on? ❑Yes ®No
• Will operations produce dust/wood shavings or similar material? ❑ Yes ® No
• Will operations involve the repair or replacement of automobile parts? ❑Yes Wo If yes: Describe the
components repaired or replaced.
• Does the operation involve the use of welding or open flame? ❑ Yes 64 No
• Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons? ❑ Yes 9 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 lig Other r/Y-Ay�A /Sz�-a
• 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 ®No
Grease Interceptor Verified
For Official Use On/y
Occ Group:
Occ Group:
Occ Group:
Total Sq Ft Occupied:
Bldg. Permit # ~ �) 3
Inspected By Initials: Date:
Planning Initials: Date:
Conditions of Approval or Other Notes:
Area: -.45-4�
Area:
Area:
No. of Stories:
Entitlement #:
Use Permitted: Y / N
Occ Load:
Occ Load:
Occ Load:
Zoning: Sm
Parking Meets Code (for use): Y / N
Building Reviewed By Initials.Date: X It/ I'&
:-1
South Coast
Air Quality Management District
21865 Copley Drive, Diamond Bar, CA 91765-4182
3x - 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:
F 415- fli/,JASS
Property Address: /90 57-4,k s Me-F-T tf /OD
City: d aA0A 81!!:aG� Cs;- Zip Code r! Z !� V 9
Contact Person: //,y,< Title: A-9V-A_
Type of Business: 015/ 1'nJFs57 ZacF Telephone: 9/7 - 316y- 'i 77 V
Fax Number: ��� E-mail Address: / or
Applicant (print name): %a or Signature: Date:
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 [FNo
2. Will the facility result of fuel -burning equipment including, but not limited to, boilers, generators, and internal combustion
engines? ❑Yes 6 No
3. Will the facility result of hazardous materials, including but not limited to, chemical, plastics, rubber, resins, solvents,
paints, and other parts cleaners? ❑Yes ZNo
4. Will the facility have use of above or underground storage tank? ❑Yes ®No
5. Will the facility consist of manufacturing, fabrications, finishing, or treatment of wood, metal or plastic products? ❑Yes,O.No
6. Will the facility result in the use of the equipment listed below? ❑Yes §SNo
(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 utrace utical
❑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).