HomeMy WebLinkAbout120 5th St - CofO (5)CERTIFICATE OF OCCUPANCY 020 kk - �&Z-
CITY OF HUNTINGTON BEACH
DEPT. OF PLANNING & BUILDING APPLICATION
Ilk
(3'd Floor - Must Apply In Person)
Business L11
Business Addrt
Business Owne
Business Name
Business Type
Property Owner Information (required) Tenant/I
Name Name F-Y12I
Address O �! HomerQddress
City --,t)s GHQ .5 State/Zip CA q QW City twrll i�
Telephone No. 3Z3 O'1"7- 00Z?j Telephone No.
Date 1-- - 1
Zip Code
Telephone No. l - • t D
Bus. Phone
State/Zip
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or ZExisting Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner GY Change of Occupant ❑ Change of Use ❑ Addit'onal Occupant
■ Indicate former type of business W.e *&(A " r-xn tT o 14P„oc�- �OO
■ Are you requesting that the electricity be turned on'? YesONo❑
■ Is the building sprinklered? Yes X0
■ Will operations produce dust/wood shavings or similar material? YesONoF
■ Will operations involve the repair or replacement of automobile parts Yes 11No e If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? Yes QNo
■ Will the busi ess be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes ONo
■ The following my operation: ❑ Office Only ❑ Retail Sales ❑ Medical/Dental
VRestauran ake Out Food , ❑ Warehouse /Manufacturing/Distribution
(describe proces roduct)
❑ Other (describe)
For Q cial Use Only
Oce Group:
Occ Group:
Occ Group:
Total Sq Ft Occupied:
Bldg, Permit #.
Occ Load:
Occ Load:
Occ Load:
TIF Review: Y/ N
Zoning: tS 115 -- G--11L
Plnr Initials: Date: q Plan Chkr Initials: Date: Insp Initials: 'EJ-- Date:
Inspection Date:
No. of Stories:
Entitlement #:
'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: u.1 12-eA 15 C, CA.V--e-'
Property Address: l2 b 5+yx S+Q , I;L 10 Z
City: t4ym-6" 04-0y) aeGG nqb Zip Code: _ q?,W -1 g'
Contact Person: priek-Gk Pjme44eA Title: Oyty1.e,r^
Type of Business: (�,e.��7t tt YG�,I�L'i--1 'apt (tom `(-i- Telephone: () 1 3 1
T
Applicant: (print name) ri c(eu. (',m.ea- et Signature•
0 Will the facility have any of the following equipment? Yes , O
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
0 Will any of the following operations be performed? Yes 11 No V"
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
DIf you answered "No" to both questions, this checklist is your clearance from AQMD.
UIf 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.