HomeMy WebLinkAbout150 5th St - CofO (5)I Certificate of Occunancv N4. ONO vvv ~ ' I
APPLICATION FOR CERTIFICATE OF OC
CITY OF HUNTINGTON BEACH - DEPT. OF BUILDING & SAFETY
Business License # R:::rl �0, t O 9
Business Address &o J*
Business Owners Name J41fcteL F.
Business Name ,.fig t; ol os C,-
Business Type GOrrelf- CA
(3''f Floor — Must Apply In -Person) ('�� �� 1 t `1C U%/�� V
Date O he A01-0
a 1J"4r i*-r io Atxe.t% CA Zip Code JZ(o Yd'
4LM x ct Np / Telephone No. (:kl4l ) & -Y P"
Bus. Phone A4Nr
Pro2erty Owner Information (required) Tenant/Emergency Contact (required)
Name CA M Name SARU-6rf- • r "$roc slA/
Address Home Address Y-5 r S Y C4.�it(F �A/ �
SOs City D" tate/Zip CA �(�Z6 City CYfP-e rs State/Zip C-.A, 1?063d
Telephone No�jZ�� �Co�} ' �' n/[�� Telephone No. �i'`t ) f Z a
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or a' Existing Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner /Change of Occupant ❑ Change of Use ❑ Additional Occupant
■ Indicate former type of business
Are. you requesting that the electricity be turned on? Yes?No❑
■ Is the building sprinklered? Yes QNoe
■ Will operations produce dust/wood shavings or similar material? YesONoitl'
■ Will operations involve the repair or replacement of automobile parts Yes ONo E •- If yes: Describe the
components repaired or replaced.
Does the operation involve the use of welding or open flame? Yes ONo F-
Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes ❑No a -
The following best describes my operation: ❑ Office Only 0 Retail Sales ❑ Medical/Dental
,Ef-Restaurant/Take Out Food ❑ Warehouse /Manufacturing/Distribution
(describe process and end product) _
❑ Other (describe)
For Official Use Only
Occ Group: 1�
Occ Group:
Occ Group:
Total Sq Ft Occupied:.
Bldg. Permit # ` g
(:
Area:
Area:
Area:
No. of Stories:
Entitlement #:
Occ Load: q 3-1- 3 4(,,
Occ Load:
Occ Load:
TIF Review: Y/
Zoning: NP5 - - ut
Plnr Initials:_ Date: JoXq. Plan Chkr Initials:��_Date: ' Ia Insp Initials: MO Date: Date: V !! J/0
Conditions of Approval or Other Notes:
USL 100M IT09 wJIYV (AS'fl (cV,M0. 12-SMTS ONLM WMT ilYytts !IDV WVl7)
Inspection Date:
(G:Building/Forms/document id goes here)
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: S "/�.T/ �t/ c7.S 60 rod' r CAr c
Property Address: /Sa r�4. �' S �t �'{�- /r0
City: �rct�t -lr",F 14 n jj�,� C4 . Zip Code: fa(� Y�
Contact Person: <,-4A1c-461(— (7. 04-74,44-mVD! Title:
Type of Business: Co er e&' CA Pe Telephone: (/) *I 9 — 3 Z- Z-- •i�l
Applicant: (print name)S'4Y44(4d 4-- P. /07At-44/1'OP'Signatu
Ei Will the facility have any of the following equipment? Yes DNo R
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
F1 Will any of the following operations be performed? Yes []No W
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
CiIf you answered "No" to both questions, this checklist is your clearance from AQMD.
Cl 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.