HomeMy WebLinkAbout10081 Adams Ave - CofO (2)HUNTINGTON BEACH
CERTIFICATE OF OCCUPANCY CY 0200'!�_W_�
CITY OF }H UNTINGTONI BEACH -
DIEPT. OF BUILDING & SAFETY APPLICATION
714/536-5241
(3rd Floor - Must Apply In -Person)
Business License # A Z 7 3,'/ 2 Date ZZZp 9
Business Address /00 ®/ AM V S Zip Code 9 ,Z 64 6
Business Owners Name US 8,+tVK %yAwpHA-t- ,I-s Telephone No. 7/4 - %4 - Z14
Business Name Ll$ Mtyle_ Bus. Phone
Business Type BAM9
Property Owner Information. (required) Tenant/Emergency Contact (required)
Name FA B. tW S G"Cex 69 S70fLE Name K69 nlW*VS ON CP02 PfX7 9
Address /0001 +M"S Home Address 350! /a® WST00
City ka,-4YAI iN ®QW,69State/Zip '�2946 City NR-VPfA1' RSO" State/Zip CA V?_660
Telephone No. ? M - 3 713 ^ 6 98 / Telephone No. 545 -5-0 9 v 4 2 2
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 9F wle-
• Are you requesting that the electricity be turned on? Yes No[]
• Is the building sprinklered? YesX • No
• Will operations produce dust/wood shavings or similar material? Yes❑ No
• Will operations involve the repair or replacement of automobile parts Yes[.] NoX If yes: Describe the
components repaired or replaced.
• Does the operation involve the use of welding or open flame? Yes[] Noy-
• Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes []No�
• The following best describes my operation: Office Only ❑ Retail Sales ❑ Medical/Dental
❑ Warehouse /Manufacturing/Distribution ❑ Restaurant/Take Out Food
(describe process and end product)
❑ Other (describe)
For Official Use Only
Occ Group: V!,
Occ Group:
Occ Group:
Total Sq Ft Occupied: 12,c�
Bldg. Permit #
Area: Occ Load:
Area:
Area:
Occ Load:
Occ Load:
No. of Stories: TIF Review: Y/ N
Entitlement #: Zoning: a%
Plnr Initials: Dater lan Chkr Initi Date d O d lisp Initials:T__ it�ate, l3
Conditions of Approval or Other Notes:
Inspection Date:
South Coast
Air Quality Management District
21865 Copley Drive, Diamond Bar, CA 91765-4182
(909) 396-3529 ® http:// www.aqmd.gov
Asir Quality Permit Cheel Ilist
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: U S I&A-P-MC
Property Address: 10O Z3! S
City: Zip Code: 97-646
Contact Person: TWP430P,1 Title: 1Pxota ' (IV60-
Type of Business: B A-NAf- Telephone: 941®51®� a 422 T
Fax Number: ?4? P a O �' f e-mail address: NNW Y JWXJ10X -7
Applicant (print name): Signature:
JWH50H Date: ?/T2
Will the facility have any of the following equipment? Yes ❑ No
Charbroi ler
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❑ Nop�
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 AQMII). 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).