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HomeMy WebLinkAbout120 5th St - CofO (9)J� HUNTINGTON BEACH Business Addrf Business Owne Business Name Business Type CERTIFICATE OF OCCUPANCY b20 2- i233 CITY OF HUNTINGTON BEACH DEPARTMENT OF COMMUNITY DEVELOPMENT APPLICATION (3'd Floor - The Applicant Must Apply In -Person) Date /-A t7 Zip Code z-c-q 8 Telephone No. 3073- %7 Bus. Phone Property Owner Information (required) Ten t/Em r enc Contact (required) Name 1= A L L Name Addre s Loa Home Address S - V State/Zip :7K :75:7L z.!�— City State/Zip Telephone No.! y' - GtZ -1& 7 Telephone No. THIS USE WOULD BE DESCRIBED AS: O Newly Constructed Building or Ei"rxisting Building IS THIS BUILDING FIRE SPRINKLERED? ❑ Yes ONo CHECK ALL THAT APPLY: ❑ Change of Business Owner Change of Occupant ❑ Change of Use ❑ Additional Occupant ■ Indicate former type of business ■ Are you requesting that the electricity be turned on? ❑Yes Z No ■ Will operations produce dust/wood shavings or similar material? ❑ Yes ©No // ■ Will operations involve the repair or replacement of automobile parts? ❑Yes ©No If yes: Describe the components repaired or replaced. ■ Does the operation involve the use of welding or open flame? ❑ Yes Z No ■ Will the bus' ess be a drinking, dining or assembly use with an occupant load of more than 50 persons? ❑ Yes To ■ Will there be storage racks, gondolas, or shelving exceeding 5feet 9 inches in height? ❑Yes ❑No ■ The following best describes my operation: El Office Only ❑ Retail Sales ❑Medical/Dental OWarehouse /Man ufacturin g/Di stri buti on E�Restaurant/Take-Out Food ❑ Other ■ Will any meat products including beef, poultry, and/or fish bee cooked or fried onsite? Pf Yes If you answered yes, please proceed to the next question. • Does your facility currently have a grease control device (i.e. grease trap or grease interceptor)? Check one: ❑ Yes ❑ No For Official Use Only Occ Group: Occ Group: Occ Group: Total Sq Ft Occupied: �2 Bldg. Permit # J6 1% "723� Planning Initial�_;__�Date: 1 ?mil 16 Area: 16ZU Area: Area: No. of Stories: Entitlement #: Use Permitted: Y / N Occ Load: ❑ No Occ Load: Occ Load: TIF Review: Y/ N Zoning: ,P Parking Meets Code (for use): Y / N Building Reviewed By Initials:�_Date: l6 Conditions of Approval or Other Notes: k k Grease Interceptor Verified Inspected By Initials: Date: South Coast Air Quality Management District 21865 Copley Drive, Diamond Bar, CA 91765-4182 ED (909) 396-3529 • http:// www.aqmd.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). Company Name: Property Address: / 26 n F.1/1 s L City: / r Zip Code: g2-Z Contact Person: Title: Type of Business: Telephone: Fax Number: e-mail address: Applicant (print name): Signature: Date: • 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 HP (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 • Will any of the following operations be performed? Yes❑ NoD� 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). -2-