HomeMy WebLinkAbout10038 Adams Ave - CofO (3)Certificate of Occupancy No. 0200 90ol G��'
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APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH — DEPT. OF BUILDING & SAFETY
714/536-5271 0 `1 Floor - Must Apply In -Person)
$kB„usiness License # ' \��
Business Address t 0o3`) P CY Q AA5
Business Owners Name ►RaAU4 � z
Business Name
Business Type
Date 1 6
Zip Code
Telephone No ' -6"
Bus. Phone I'1 14 I
Proverty Owner Information (required) Tenant/Emer enc Contact (required)
Name Name
Address tiAL Home Address (&a-.
City State/Zip Co, SC-0- City :SC,S� Kk.,c State/Zip
Telephone No. (t'�1 q C 2, a--\ 0 �-- Telephone No Qj ts� 1 [ X'3 - A-S C1
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or 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? YesQNo
■ Is the building sprinklered? Yes IlNo❑
■ Will operations produce dust/wood havings or similar material? YesQNoK
■ Will operations involve the repair or replacement of automobile parts Yes ONo q&
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? Yes KNo ❑
If yes: Describe the
■ WiIl the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes QNo 4'
■ The following best describes m):__p on_:__0_Office_0nLy__0__R.e_tail Sales f edical/Dental
rl Restaurant/Take (hut Fond V Warehouse /Mannfacturino,/Distrihut_ in7
(describe process and end product
❑ Other (describe)
Ct'VNn
For Off cial Use Only
Oce Group: Area: 10000 _ Occ Load: l0
Oce Group: Area: _ Occ Load
Oce Group: Area: Oce Load:
Total Sq Ft Occupied: \ moo �Q No. of Stories: 1 TIF Review: Y/
Bldg. Permit # Entitlement #: Zoning:
Plnr Initials:_M Date:oi_ Plan Chkr Initials: Date:'Abinsp Initials: _
Conditions of Approval or Other Notes: "%
Inspection Date:
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(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: .3— 0 0 0 cnQ.W�\CAS
Property Address: (00 M Q\) a 'l Acoe,
City: C S5C,X Zip Code:
Contact Person: %WOAI Title: Ow 4yK
Type of Business: � :e N: UAaaTcY-oN Telephone: (Q Iti)
Applicant: (print name) qJ1J p(�-,�� Signature:C7,ylU�� 1/
Q Wily 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 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
[]Will any of the following operations be performed? Yes KNo ❑
Application of paints or adhesives
Etching, plating, castm , 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
U If 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.