HomeMy WebLinkAbout120 5th St - CofO (4)2a11-c7�2� .
• CERTIFICATE OF OCCUPANCY t020- -
%� CITY OF HUNTINGTON BEACH -
DEPT. OF PLANNING & BUILDING APPLICATION
HUNTINGTON BEACH 714/536-5241 (3rd Floor —Must Apply In -Person)
Business License # Date S-
Ag 11
Business Address ► 2 D S !J' ~ D zo Zip CodV 1 q Z-44 V
Business Owners Name a, ol v c ee r Telephone No.
Business Name v Bus. Phone
Business Type _ IS P, al I a a Ker-N FAAX 1 2 �
Property Owner Information (required) . Tenant/Emer bnc C ntact (required)
Name w Name f!,�.
Address Home Address
City V_Stake/Zip 0 D'Z $ City State/Zip Cif&-
Telephone No.. 37-3 - kS p !f is O Telephone No. �+ f _xS_(o ' s' 3 (/ J
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or XExisting 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 N
■ Is the building sprinklered? Yes)< No❑
■ Will operations produce dust/wood shavings or similar material? Yes❑ No'9
■ Will operations involve the repair or replacement of automobile parts YesQ Nc' < If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? Yeso NOX
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes qNo X
■ The following best describes my operation: ❑ Office Onl Sales ❑ Medical/Dental
❑ Warehouse /Manufacturing/Distribution ❑ Restaura lgake Out Fo
(describe process and end product)
Other (describe)
For Official Use Only
Occ Group:
Occ Group:
Occ Group:
Total Sq Ft Occupied:
Bldg. Permit #
Area:
Area:
Area:
No. of Stories:
Entitlement #:
Plnr Initials: Date: tl i Plan Chkr Initials: Date
Conditions of Approval or Other Notes:
J le---ro V-T-- I=-1 T=-� n VrT PCP: tf — b t N 1 N
Inspection Date:
Occ Load:
Occ Load
Occ Load:
TIF Review: Y/ N
Zoning:
Insp Initials: Date: /4
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).
CompanyName:
Property Address: 1-2-0 *hl-- /
City: V V41 "I 1?7ew�'l Zip Code:
Contact PersonTitle: OwNie✓`
Type of Business: 17>-aK4"'-�_ Telephone: '
Fax Number: e-mail address:
Applicant (print name):JP-Signature:
Date:
Will the facility have any of the following equipment? Yes ❑ No ja]
Charbroiler
Dry cleaning machine
Spray booth
Printing press (screen/lithographic/flexographic)
Internal combustion engine greater than 50 HP (excluding motor vehicles)
Boiler/combustion equipment (greater than I 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❑ No�
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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