HomeMy WebLinkAbout19066 Magnolia St - CofO (13)2i .
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Hu BEACH
CERTIFICATE OF OCCUPANCY
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CITY OF HUNTINGTON BEACH
DEPARTMENT OF COMMUNITY DEVELOPMENT APPLICATION
(3`d Floor - The Applicant Most Apply In -Person)
Business Address 19066 Magnolia St. Date 05/31/17
Business Owners Name Davta Medical Management u.c. Zip Code 92w
Business Name Dayita Healthcare Partners Telephone No. 949-279-1230
Business Type Medical Once Building BUS. Phone 949.279-1230
Property Owner Information (required) Tenant/Emergency Contact (required)
Name 19M Magnolia LTD Name JEFF KRUEGER
Address tot Wilshire Blvd. end R. Home Address 201 Wilshire Blvd. 2nd Fl.
City jams Monica State/Zip 90401 City taM01lcaState/Zip 90401
Telephone No. 310.395.5200
THIS USE WOULD BE DESCRIBED AS:
Telephone No. 949.279-1230
O Newly Constructed Building or ❑ Existing Building
IS THIS BUILDING FIRE SPRINKLERED? ❑ Yes ENO
CHECK ALL THAT APPLY:
❑ Change of Business Owner ❑ Change of Occupant ❑ Change of Use 0 Additional Occupant
■ Indicate former type of business
■ Are you requesting that the electricity be turned on? ❑Yes ® No
■ Will operations produce dust/wood shavings or similar material? ❑ Yes ENO
■ Will operations involve the repair or replacement of automobile parts? []Yes ®No 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 ® No
■ Will there be storage racks, gondolas, or shelving exceeding 5feet 9 inches in height? ❑Yes ®No
■ The following best describes my operation: ❑ Office Only ❑ Retail Sales EMedical/Dental
❑Warehouse /Manufacturing/Distribution ❑ Restaurant/Take-Out Food ❑Other
■ Will any meat products including beef, poultry, and/or fish bee cooked or fried onsite? ❑ Yes m 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 N No
For Official Use Onl
Occ Group:
Occ Group:
Occ Group:
Total Sq Ft Occupied:
Bldg. Permit # .43 %mil I —
Planning Initials: Date:
Conditions of Approval or Other Notes:
Area: .2- 265 e
Area:
Area:
No. of Stories:
Entitlement #:
Use Permitted: Y / N
Occ Load: G d
Occ Load:
Occ Load:
TIF Review: Y/ N
Zoning:
Parking Meets Code (for use):
Building Reviewed By Initials: Date:
Y/N
Grease Interceptor Verified Inspected By Initials: Date:
South Coast
Air Quality Management District
21865 Copley Drive, Diamond Bar, CA 91765-4182
(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: DaVita Healthcare Partners
Property Address: 19066 Magnolia St.
City: Huntington Beach zip Code: 92646
Contact Person: Charles Doughan Title: Project Manager
Type of Business: Medical Office Telephone:
Fax Number: e-mail address: ' G t ko t)bv&r h
Applicant (print name): Charles Doughan Signature: Date:
• Will the facility have any of the following equipment? Yes ❑ No ❑■
Charbroiler
Dry cleaning machine
Spray booth
Printingpress (screen/lithographic/flexographic)
Internal combustion engine greater than 50 HP (excluding motor vehicles)
Boiler/combustion equipment (greater than 1 million 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[] Non
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 fumes, 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).
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