HomeMy WebLinkAbout120 5th St - CofOCERTIFICATE OF OCCUPANCY OB®®� 1
9;
CITY OF HUNTINGTON BEACH —
DEPT. OF BUILDING & SAFETY APPLICATION
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Business License # 1'7 r% G-r u
Business Address
Business Owners Name GR1 s-f CP
Business Name. M K) n5 y Rj
Business Type
(P Boor - Must APPiy I
Date
Zip Code
Telephone N
12S Bus. Phone
- 23
Property Owner Information (required) Tenant/Emer enc v Contact (required)
Name 0 0 Name o a..)
Address EL 4� a Home Address 'z°13 �H z/4-5
City State/Zip C� �4�':Piy City �os " `- ES State/Zip' CA °100 �-
Telephone'No. Q1{3 - Oro -03 �0 " Telephone No. ' �145 �q 5 0!' 4 (527
THIS USE WOULD BE DESCRIBED AS: .
❑ ;Newly Constructed Building or .0� Existing Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner ❑Change of Occupant ;ffChange.of Use ❑Additional Occupant
• Indicate former type of business
• Are you requesting that the electricity be turned on? Yest4 No❑
■ Is the building sprinklered? Yes No❑
■ Will operations produce dust/wood shavings or similar material? Yes Now
■ Will operations involve the repair or replacement of automobile parts Yes EJ Nod If yes: Describe the
components repaired or replaced.
• Does the operation involve the use of welding or open flame? Yes El Nod
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes Flo ❑
• The following best describes my operation: ❑ Office Only ❑ Retail Sales ❑ Medical/Dental
❑ Warehouse /Manufacturing/Distribution %Restaurant/Take Out Food
(describe process and end product)
❑ Other (describe)
For Official Use Onl / Occ Group:_ Area: _ 13 Occ Load: _ - 60
Occ Group: Area: ?,3 Z Occ Load: /
Occ Group: _ �_�._`. Area: -75- 3 Occ Load:
Total Sq Ft Occupied: A.No. of Stories: z T1F Review: Y/ N
Bldg. Permit # O ..y'� _ '1� Entitlement #: Zoning:
Plnr Initials: —bate P-lan Ch1Q Initials: Date: Insp Initials: 73.�:_ Date: -7 • L4 • U9
Conditions of Approval or Other Notes:
Inspection Date:
(G:BuildingAdmin/WebDocuments/CertificateofOccupancy)
w
South Coast
Air Quality Management District
21865 Copley Drive, Diamond Bar, CA 91765-4182
(909) 396-3529 o http:// www.agmd.gov
Air QuaUtty 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: Lrz, S.TcrrT . &(Zt7o P I 0moru Y �oG4LG�S
Property Address: - 120 rfc3 16�,
City:-, . �Av'N-ttn2�-ro,.3 79"CP1 Zip Code: C �1 1SZ 0S. 9659"A10
Contact Person: �Z� c H � ' I� e- a n•� Prr�� Title: R�51 tDEPi T - /1Qvi i sr----rS
Type of Business: 2,&Fs-m u (Rrr- Telephone: 32-37 C46�;_- --O 66
Fax Number: $06 6 e-mailaddress: Y�rs�;�arc�, • �►�
Applicant (print name): LNA2 s7 Signature:
Date: �2�z
® Will the facility have any of the following equipment? Yes ❑ No
Charbroiler
Dry cleaning machine
Spray booth
Printing press (screen/lithographic/flexographic)
Internal combustion engine greater than 50 BP (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's
o Will any of the following operations be performed? Yes❑ NoR
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-CUB'-SMOG (1-800-288-7664).
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Revised June 2005