HomeMy WebLinkAbout120 5th St - CofO (7)6a.,�0S-- L90A 33
Certificate of Occupancy No -
APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH - DEPT. OF BUILDING & SAFETY
Business License #
Business Address I ,
Business Owners Name
Business Name
Business Type _ (�?
Name _
Address
City
Telephone
(3'd Floor — Must Apply In -Person)
Date
Zip Code q 2J.o y
Telephone No.1 j q Q (PD . Q y33
Bus. Phone q�y Q 'r • Lu 7 4
State/Zip U < q Z(y ,1 City k-A ?j State/Zip _P.. O%Z-UL4
a 4 q 491 - LD -1 43 Telephone No. � � � q (n 3 - to a
THIS USE WOULD BE DESCRIBED AS:
g Newly Constructed Building or ❑ Existing Building
CHECK ALL THAT APPLY:
`4 Change of Property Owner 0 Change of Occupant
■ Indicate former type of businessC7�(a r&je_
❑ Change of Use ❑ Additional Occupant
■ Are you requesting that the electricity be turned on? YesONoX Q V+Y64
■ Is the building sprinklered? Yes ON09
■ Will operations produce dust/wood shavings or similar material? YesONo'9
■ Will operations involve the repair or replacement of automobile parts Yes ONo 6 If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? Yes ONo
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes ONo%
■ The following best describes my operation: 0 Office Only `!6 Retail Sales ❑ Medical/Dental
❑ Restaurant/Take Out Food 0 Warehouse /Manufacturing/Distribution
(describe process and end product)
❑ Other (describe)
For Official Use Only M
Occ Group:
Occ Group:
Occ Group:
Total Sq Ft Occupied: +200
Bldg. Permit #-:S-'®!&
Area: 1110 0 4
Area:
Area:
No. of Stories: Z. W (If -
Entitlement #: ""
Plnr Initials: C:2—' Date: 1 . o Plan Chkr Initials: Date:
Conditions of Approval or Other Notes: /
mo t ioiz-y5� A LL.rD
Inspection Date:
Oce Load: 4NO
Occ Load
Occ Load:
TIF Review: Y/ N
Zoning: 5// :
Insp Initials: rYV Date: IS
3
(G:Building/Forms/document id goes here)
5
�'i South Coast
Air Quality Management District
21865 E. Copley Drive
Diamond Bar, CA 91765-4182
(909) 396-3529 htpp://www.agmd.gov
Air Quality Permit Checklist
California Government Code 65850.2 prohibits cities from issuing a Certificate of Occupancy 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:
City:
Contact Person:
Type of Business:
Applicant: (print nam
�ACC1-\' _ �S SA.21 MMW-
UD 5 S - C-IIn
Zip Code: R 2-Lo H
Title: 0Jac)
Telephone:() IN 91- R H3 j
Signature:
L! Will the facility have any of the tollowing equipment'! Yes "INO (J
Charbroiler
Dry cleaning machine
Spray Booth
Printing Press (screen/lithographic/flexographic)
Internal combustion engine (greater than 50HP) (excluding motor vehicles)
Boiler/combustion equipment (greater than 2 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 Q No
Application of paints or adhesives
Etching, plating, casting, or melting of metals
Molding and blending of liquids and/or powders
Storage of acids, solvents, organic liquids or fuels
Production of acids, solvents, organic liquids, or fuels
Production of fumes, dust, smoke or strong odors
QIf you answered "No" to both questions, this checklist is your clearance from AQMD.
Q 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 (800) 388-2121.